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Visual Outcome (visual + outcome)
Kinds of Visual Outcome Selected AbstractsBoston type I in pediatric patientsACTA OPHTHALMOLOGICA, Issue 2009J AQUAVELLA Purpose To present a retrospective review of keratoprosthetic implantation and retention in patients with congenital corneal opacities. Methods Pediatric patients younger than seven years old, the average age of permanent visual loss from understimulation of the visual cortex, were selected from a single center Boston Type I keratoprosthesis database and categorized by 1) primary diagnosis, 2) short-term visual outcome, and 3) post-operative complications. Results Seventeen patients, with an age range of 41 days up to 6 years, were selected from a database of over one hundred and forty patients. Six had a primary diagnosis of sclerocornea and eleven had Peter's anomaly. Visual outcome after one year improved in fourteen of the patients, with patients who previously could not detect light to subsequently being able to fixate and follow or even read allen cards. The remaining three patients showed no improvement in visual acuity but also no worsening from their baseline condition. In terms of post-operative complications of the optic, two had retroprosthetic membrane formation, and another patient required replacement of the keratoprosthesis due to phthisis and optic melting. From a retinal standpoint, four patients had retinal detachments. There were no cases of choroidal hemorrhaging or hypotony in these patients. Conclusion Based on visual outcome, the Boston Type I keratoprosthesis is a safe and effective procedure for patients with congenital corneal opacities. With great retention, the artificial cornea is a viable option for prevention of amblyopia. Due to comorbidities such as congenital cataracts, congenital glaucoma, and retinal detachments, it is crucial to have glaucoma and vitreo-retinal surgeons on hand when managing and implanting keratoprosthesis in a pediatric population. [source] Inflammatory choroidal neovascular membrane in presumed ocular Lyme borreliosisACTA OPHTHALMOLOGICA, Issue 3 2009Radgonde Amer Abstract. Introduction:, Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. Methods:, Descriptive review of the clinical records of two patients. Results:, Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. Conclusion:, Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based , both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar. [source] Visual outcome and corneal aberrometry after implantation of intracorneal ring segments (INTACS) for keratoconusACTA OPHTHALMOLOGICA, Issue 2007J HERNANDEZ VERDEJO Purpose: To analyze corneal aberrometry and visual outcome after implantation of intracorneal ring segments (INTACS) in keratoconus patients. Methods: Corneal aberration was measured in 15 keratoconus eyes pre and post implantation of INTACS. Root Mean Square values (RMS), (Total, RMS for corneal astigmatism and RMS for coma) where recorded for 5, 6 and 7 pupil diameters, and where divided into two groups due to their previous levels of coma and total RMS. Comatic aberration was divided in vertical (Z3-1) an horizontal (Z3+1) Zernicke Coeficcients. All data was recorded pre-op and three months after surgery. Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), spherical equivalent and astigmatism where also analyzed. Results: We found statistically significant decrease in spherical equivalent (p<0,01) and increase of UCVA (p<0,01). Significant increase (p=0,04) in coma and total RMS in patients with lower previous values for 5 and 6mm and significant decrease in patients with higher previous values for 7mm (p=0,03) Conclusions: INTACS implantation for keratoconus reduces the mean spherical refractive error, increases UCVA and improves keratoconus aberrations for 7mm pupil diameter in patients with previous high levels of coma and total RMS. [source] Jesus and the eye: New Testament miracles of visionACTA OPHTHALMOLOGICA, Issue 6 2005Ahmad M. Mansour Abstract. Purpose:,To compile and appraise the accounts of the miracles of vision in the New Testament. Methods:,We carried out a critical analysis of the compilation of ocular miracles using past medical knowledge and historical reconstruction based on the accounts of the apostles and of various historians living in the first three centuries ad. Results:,Three blind adult male beggars residing on three different street locations were described. Two had previously had good vision that had declined over a long time and the third had been born blind. The manifestations of the ocular diseases in these cases were meagre, precluding any precise diagnosis. The healing methodology did not rely on physical examination, detailed history, or the use of medicines. Jesus' tools consisted of spitting, touching, praying and the use of words. Visual outcome reported as a complete cure was realized in all three incidents. Conclusions:,The accounts of miracles in the Gospels appear to be historically reliable, yet subject to different interpretations: faith in the miracle (the Christian perspective); sorcery (the Jewish perspective); mythology (the atheist perspective), and scientifically possible human action by a charismatic, compassionate, knowledgeable man (the scientific perspective: psychotherapy or suggestion). [source] Visual outcome with macular hole surgeryCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2007Philip J Polkinghorne FRANZCO No abstract is available for this article. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] Triamcinolone-induced cataract in eyes with diabetic macular oedema: 3-year prospective data from a randomized clinical trialCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2010Mark C Gillies FRANZCO PhD Abstract Purpose:, To describe the 3-year risk of cataract after intravitreal triamcinolone (IVTA) injections for diabetic macular oedema and the outcomes of cataract surgery. Methods:, Prospective data from a randomized clinical trial were analysed. At baseline, 27 phakic eyes with diabetic macular oedema were randomized to receive IVTA and 25 to receive sham injection. After 2 years, initial sham-treated eyes were eligible to receive IVTA as the study became open label for the third year. The cumulative incidence of cataract surgery was the primary outcome of the study. Other outcomes assessed included progression of cataract, best-corrected logarithm of the minimal angle of resolution visual acuity before and after surgery and central macular thickness. Results:, Over the 3 years of the study, 15/27 (56%) phakic eyes in the IVTA treated group underwent cataract surgery as compared with 2/25 (8%) initial sham-treated eyes (P < 0.001). Mean visual acuity 6 months after cataract surgery was better than at entry into the trial. Two (15%) of the eyes in the IVTA-treated group undergoing cataract surgery had a loss of >15 letters. In the IVTA-treated group, 10/15 (67%) eyes that had three or more injections had progression of posterior subcapsular cataract by ,2 grades as compared with only 2/12 (17%) eyes that had fewer than three injections (P = 0.009). Conclusions:, Over half of the eyes receiving IVTA injections for diabetic macular oedema required cataract surgery within 3 years. In eyes with three or more IVTA injections, two-thirds had progression of posterior subcapsular cataract. Visual outcomes after cataract surgery were generally good, although a small proportion of eyes lost greater than 15 letters over the course of the study. [source] Visual outcomes following vitrectomy and peeling of epiretinal membraneCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2005James G Wong MMed Abstract Background:, Visual outcomes of patients following vitrectomy and peeling of visually significant epiretinal membranes were assessed to determine the influence of specific perioperative factors and surgical complications on final visual acuity and functional vision. Methods:, In an unmatched, consecutive surgical series, vitrectomy and membrane peeling were performed on 125 eyes of 123 patients with visually significant macular epiretinal membranes. Patients were followed for 6,36 months. Visual outcome measures included postoperative logMAR visual acuity, change in visual acuity and functional vision tasks evaluated by questionnaire. Perioperative factors including duration of symptoms, preoperative visual acuity, aetiology, membrane type and leakage on fundal fluorescein angiogram were correlated with final visual outcomes. Results:, Visual acuity improved by a mean of 0.31 ± 0.21 units (three lines of vision). In 104 cases (83%), visual acuity improved in patients by two lines or more, with 20 cases (16%) having unchanged acuity and one case (1%) having worse acuity. Ninety-three per cent of interviewed cases reported improvement in functional vision, especially reduction of distortion. Cataract was observed in 52 cases (52% of phakic eyes) postoperatively compared with 19 cases (19%) preoperatively. Postoperative visual acuity correlated with preoperative visual acuity. Patients with worse preoperative vision recorded greater visual improvement following surgery. No other perioperative factors were found to have a prognostic value in this study. Conclusion:, Epiretinal membrane peeling improves vision in the majority of patients with significant symptoms, even if preoperative visual acuity is not substantially reduced. Surgery improves functional vision including metamorphopsia not measurable by visual acuity, and thus assessment of functional vision should be included in surgical case planning. [source] Long-term outcome of children with cortical visual impairmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006Carey A Matsuba MDCM MHSc FRCP(C) Cortical visual impairment (CVI) is now the most common cause of visual impairment in children. Little is known about the long-term visual outcome. This study evaluates the outcome of children with congenital CVI. Using medical records, 423 children (225 males, 198 females) were identified with congenital CVI. Of these children, 259 had follow-up visual acuity assessments. The children's gestational age varied with 32 weeks or less representing 15.9%; 33 to 36 weeks representing 10.7%; 37 to 42 weeks representing 61.2%; and 43 weeks or greater representing 0.9% (11.3% of patients'gestational age was unrecorded). Clinical data were extracted and information regarding outcome was gathered. The majority of children showed improvement in their visual acuity levels after 2 or more years of follow-up. For the 194 children initially assessed before 3 years of age, 97 had improved, 75 were unchanged, 18 had deteriorated, and 4 had sub-optimal assessments. For the 74 children initially assessed at 3 or more years of age, 23 had improved, 44 remained unchanged, 3 had deteriorated, and 4 had sub-optimal testing. Children with better visual acuity levels at follow-up were more likely to have favourable cognitive outcomes (non-mental retardation)* in 12.2% versus 2.8% (p<0.01). Similarly, favourable motor outcomes (independent ambulation) were present in 20.1% for those with better visual acuities versus 7.9% for those with poorer visual acuities (p<0.01). Our study demonstrates that the majority of children with CVI underwent improvement in visual acuity. Additional disabilities were common, but those children with better visual acuity outcomes faired better. Given the frequency of comorbid conditions, appropriate diagnostic assessment services are needed. [source] Methylprednisolone exacerbates axonal loss following optic nerve trauma in ratsJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2002KD Steinsapir PURPOSE: This study investigates the clinical dogma that very high doses of methylprednisolone helpful in spinal cord injury are also helpful in optic nerve trauma. Methods: The right optic nerve of 29 male rats received a 5 second traumatic crush followed 30 minutes later by one of five intravenous treatments (methylprednisolone 30 mg/kg, 60 mg/kg, 90 mg/kg, 120 mg/kg, or saline). Treatment was continued for three additional administrations at 6 hour intervals. Untreated sham controls (n = 7) were also prepared. Six weeks after injury, animals were sacrificed, perfused and optic nerves systematically counted. RESULTS: Axon counts (means +/, s.e.m.) were as follows: Saline = 16,670 +/, 8,900 (n = 5); Methylprednisolone: 30 mg/kg = 8,098 +/, 4,741 (n = 5); 60 mg/kg = 6,925 +/, 6,517 (n = 4); 90 mg/kg = 2,663 +/, 2,653 (n = 4); 120 mg/kg = 6,149 +/, 3,487 (n = 6). Consequently, the data revealed that saline treated animals retained more axons than those that were administered methylprednisolone (p < 0.02). CONCLUSIONS: We conclude that methylprednisolone exacerbates axonal loss following crush injury in the rat optic nerve. Based on the results of this study, clinical studies of traumatic optic neuropathy in the future should also examine the possibility that corticosteroid treatment may have an adverse effect on visual outcome following optic nerve trauma. [source] Neuroplasticity predicts outcome of optic neuritis independent of tissue damageANNALS OF NEUROLOGY, Issue 1 2010Thomas M. Jenkins MRCP Objectives To determine whether lateral occipital complex (LOC) activation with functional magnetic resonance imaging (fMRI) predicts visual outcome after clinically isolated optic neuritis (ON). To investigate the reasons behind good recovery following ON, despite residual optic nerve demyelination and neuroaxonal damage. Methods Patients with acute ON and healthy volunteers were studied longitudinally over 12 months. Structural MRI, visual evoked potentials (VEPs), and optical coherence tomography (OCT) were used to quantify acute inflammation, demyelination, conduction block, and later to estimate remyelination and neuroaxonal loss over the entire visual pathway. The role of neuroplasticity was investigated using fMRI. Multivariable linear regression analysis was used to study associations between vision, structure, and function. Results Greater baseline fMRI responses in the LOCs were associated with better visual outcome at 12 months. This was evident on stimulation of either eye (p = 0.007 affected; p = 0.020 fellow eye), and was independent of measures of demyelination and neuroaxonal loss. A negative fMRI response in the LOCs at baseline was associated with a relatively worse visual outcome. No acute electrophysiological or structural measures, in the anterior or posterior visual pathways, were associated with visual outcome. Interpretation Early neuroplasticity in higher visual areas appears to be an important determinant of recovery from ON, independent of tissue damage in the anterior or posterior visual pathway, including neuroaxonal loss (as measured by MRI, VEP, and OCT) and demyelination (as measured by VEP). ANN NEUROL 2010;67:99,113 [source] 1362: Infectious posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010N MARKOMICHELAKIS Several infectious agents (parasites, bacteria, fungi, and viruses) can invade the eye and lead to ocular inflammation. Infectious causes should always be considered and ruled out in all patients with posterior uveitis. Toxoplasma gondii is by far the most common cause of infectious posterior uveitis in all ages, while Toxocara canis infects typically children. Onchocerciasis and other parasitic diseases may also cause posterior uveitis, more commonly in developing countries. Nowadays, old bacterial diseases, tuberculosis and syphilis, emerged as common causes of posterior uveitis. Bartonella henselae and Borrelia burgdorferi are other bacteria that can also cause posterior uveitis. Fungal posterior uveitis usually occurs in immunosuppressed patients or in intravenous drug users. Herpes viruses (HSV, VZV, CMV) are also associated with infectious retinitis, in immunocompromised as well as immunocompetent patients, with quite destructive clinical course. Recently, more viruses (such as West Nile virus, Rift valley fever, dengue fever, and chikungunya) have been recognized as etiologic factors of posterior infectious uveitis. A rapid and accurate diagnosis is of high importance for the successful treatment and visual outcome of infectious uveitis. Techniques and methods, such PCR and detection of specific antibodies in the intraocular fluids (Goldmann-Witmer coefficient), play a key role towards the detection of the pathogen of posterior infectious uveitis. [source] 3416: Surgical therapy of macular edemaACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Persistent macular oedema (ME) is the main cause of poor visual outcome during the evolution of retinal ischemic microangiopathies and traction related macular distortion. Among multiples treatment approaches, vitreoretinal surgery is applied with the goal to achieve the release of a traction related component of macular oedema . Methods Vitrectomy with peeling of the posterior hyaloid, epiretinal membranes, vitreoretinal tractions and/or internal limiting membrane removal, were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema with significant change in best corrected visual acuity, in epiretinal membranes, vitreoretinal traction syndrome and ischemic microangiopathies related macular thickening central, hemiretinal, branch retinal vein occlusion and diabetic macular edema). Evidence to date does not support any therapeutic benefit from radial optic neurotomy and arteriovenous crossing sheathotomy for BRVO and CRVO related macular oedema. Conclusion In the era of intravitreal injection of steroids and anti VEGF substances, vitrectomy seems to have a beneficial effect in traction related, selected pathologies associated to chronic macular edema. [source] 2166: Clinical applications of corneal Scheimpflug densitometry in DSAEK and cornea guttata patientsACTA OPHTHALMOLOGICA, Issue 2010M WEYNS Purpose The aim of this project is to study clinical applications of corneal Scheimpflug densitometry. In the first part of the study a correlation between corneal Scheimpflug densitometry and endothelial cell count in cornea guttata will be studied. The second part will investigate a possible correlation between the smoothness of the corneal graft and postoperative visual acuity in DSAEK patients. Methods Cross-sections of corneal Scheimpflug images will be analyzed by means of custom written software. Parameters such as average densitometry profile, position and intensity of the Bowman membrane and corneal endothelium peaks, as well as the position and intensity of the interface between an acceptor cornea and the DSAEK graft (if present) will be calculated. Results The method to analyze the corneal densitometry has already been developed and tested on corneas of contact lens wearers and post refractive surgery patients. A small number of DSAEK en cornea guttata eyes have been analyzed as well, demonstrating the potential of this technique in these patients. Conclusion Corneal Scheimpflug densitometry may be complementary to endothelial cell count in monitoring the disease progression in cornea guttata patients. Corneal Scheimpflug images may also be considered a predictor for visual outcome after DSAEK if the postoperative visual acuity variations in DSAEK patients can be linked to wrinkles in the posterior surface of the graft. [source] 4243: Capsular peeling in premium IOLs to improve visual outcomeACTA OPHTHALMOLOGICA, Issue 2010MJ TASSIGNON Purpose To demonstrate that capsular peeling may improve quality of vision of patients who experienced reduced vision in the short postoperative period after premium IOL implantation due to decentration of the IOL secondary to PCO. Methods Patients who were refered to our centre because of unsatisfactory quality of vision after premium IOL implantation (more specifically after multifocal IOLs) were scheduled for surgery aiming at peeling the capsular bag. The conditions which the patient needed to meet were: increased higher order aberrations, evidence of tilt or decentration of the IOL, important fibrotic proliferation in the capsular bag, no YAG laser capsulotomy performed. Results After capsular peeling, it was possible to demonstrate that the quality of vision of the patient improved, the higher order aberrations reduced and it was often unnecessary to explant the premium IOL. Although there was an obvious improvement of the quality of vision, this improvement still did not reached the high standard of vision as measured after monofcal IOLs. Conclusion This paper shows how important the role is of PCO on quality of vision. Because contrast sensitivity is already reduced after premium IOL implantation, patients will be very sensitive to an additional reduction as it appears after PCO. [source] 3334: Corneal dystrophies: the paediatric corneal specialist viewACTA OPHTHALMOLOGICA, Issue 2010KK NISCHAL Purpose To describe the range of corneal dystrophies presenting to a tertiary refferral paediatric ophthalmology centre and the treatment approach to these various dystrophies Methods Retrospective review of case notes between Jan 1999 and March 2010 Results The range of corneal dystrophies presenting varied from Meesmans, Map-Dot , Reis-Buckler, Posterior polymorphous corneal dystrophy, congenital hereditary endothelial dystrophy, Granular and Lattice -Granular and the newly described x linked endothelial corneal dystrophy. The youngest child to present with symptoms was 14 months old. Management approach depended on the ultimate goal of allowing normal visual developemnt until the age of 8 years. Amblyopia plays a great role in the eventual visual outcome in children with corneal transplant surgery also riddled with difficulties in young children. Conclusion The classical descriptions of corneal dystrophies are not how they present in children . Certain symptoms and signs may tip the clinician off to the possibility of a corneal dystrophy. Visual rehabilitation in children is time limited and must be the priority for the treating physician. [source] Longterm follow-up of children with traumatic optic nerve avulsionACTA OPHTHALMOLOGICA, Issue 4 2010Veit Sturm Abstract. Purpose:, We report the longterm follow-up of children with optic nerve avulsion (ONA) caused by traumatic events. The remarkable differences in courses and outcomes may elucidate the spectrum of ONA-associated symptoms and injuries. Methods:, During the last 15 years, three children with ONA were referred to our department. These cases are presented with special attention to their longterm follow-up. Results:, Two patients suffered from complete ONA after head injury. The third patient presented with partial ONA caused by a bicycle accident. Longterm follow-up varied between 7 and 15 years. In the first patient, a pale swollen retina without any visible retinal vasculature was observed early in the course of follow-up. The retina later completely detached. In the second patient, extended fibroglial scarring occurred and an extremely large epiretinal membrane formed and was finally released spontaneously into the vitreous. The third patient developed only mild fibroglial scarring and retinal pigment epithelium hyperplasia. The optic nerve head in this patient came to resemble a morning glory disc. Conclusions:, Optic nerve avulsion can adopt different courses and outcomes in different patients. Final visual outcome seems to depend on the degree of visual acuity immediately after injury. Substantial intraocular architecture changes can occur as a result of ONA. [source] Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgeryACTA OPHTHALMOLOGICA, Issue 4 2010Sambuddha Ghosh Abstract. Purpose:, To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non-foldable polymethyl methacrylate (PMMA) lens implantation. Methods:, Prospective study was carried out with one eye each of 224 patients with senile cataract randomized into two groups, phacoemulsification and MSICS, by simple 1:1 randomization. Following surgery by either of the two methods, macular thickness was measured by optical coherence tomography (OCT) on the 1st, 7th, 42nd and 180th postoperative day. Main outcome measure was postoperative macular thickness. Results:, On the first postoperative day, central subfield mean thickness (CSMT) in MSICS group was 192.8 ± 17.9 ,m and that in phacoemulsification group was 192.1 ± 27.4 ,m, with no significant difference (p = 0.12). On the 7th day, CSMT in MSICS group (198.9 ± 21.4 ,m) was significantly (p = 0.04) more than that in phacoemulsification group (193.1 ± 19.3 ,m). On the 42nd day, CSMT in MSICS group was 207.8 ± 26.3 ,m and that in phacoemulsification group was 198.3 ± 23 ,m, the difference being significant (p = 0.007). Clinically macular oedema was not diagnosed in any of the patients at any visit. The increase in macular thickness was sub-clinical and did not affect final visual outcome in any patient. Conclusion:, In spite of the greater theoretical risk of increased postoperative inflammation following MSICS, there was no evidence of cystoid macular oedema, either clinically or on OCT. However, chance of sub-clinical increase in CSMT was more following MSICS compared to phacoemulsification. [source] Long-term study of vascular perfusion effects following arteriovenous sheathotomy for branch retinal vein occlusionACTA OPHTHALMOLOGICA, Issue 3 2010Mahiul M. K. Muqit Abstract. Purpose:, To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO). Methods:, Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization. Results:, Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t -test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months. Conclusions:, PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery. [source] Macular appearance after diabetic vitrectomy for fibrovascular proliferation: an optical coherence tomography studyACTA OPHTHALMOLOGICA, Issue 2 2010Chung-May Yang Abstract. Purpose:, To investigate morphological variations in the macular area with optical coherence tomography (OCT) after vitrectomy for diabetic fibrovascular proliferation. Methods:, We reviewed 108 cases using OCT 7,15 months after vitrectomy. Of these, 32 received OCT within 3 months postoperatively. Morphological variations were categorized and correlated with visual outcome. Results:, Only 24 cases (21.4%) had no obvious abnormalities. The most frequent findings were epiretinal membrane (52.8%), macular thickening (37.0%) and macular cysts (28.7%). Multivariate regression showed that diffuse macular thickening, loss of foveal depression and diffuse retinal thinning were significantly associated with poor visual acuity. Sequential OCT (< 3 and , 7 months) revealed that epiretinal membrane and oedema outside of fovea changed significantly between two examinations. Conclusion:, OCT may identify diverse morphological changes in the macular area after diabetic vitrectomy for fibrovascular proliferation. Macular appearance may change over time, and certain types of morphological changes may be associated with poor visual function. [source] Incidence of redetachment 6 months after scleral buckling surgeryACTA OPHTHALMOLOGICA, Issue 2 2010Fleur Goezinne Abstract. Purpose:, The preoperative and intraoperative clinical variables associated with redetachment and/or a poor visual outcome following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) have mainly been studied after a short follow-up. This study aimed to analyse long-term effects by following patients for at least 6 months. Methods:, In a retrospective survey we evaluated the data of 436 eyes that underwent SB surgery. Postoperative data were collected at 3-month intervals. Results:, After a mean follow-up period of 51 months, anatomic reattachment was achieved in 76% after one SB procedure, with a final reattachment rate of 97% after additional vitreoretinal procedures. In total, 104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up, 32 eyes (7%) and 20 eyes (5%), respectively, developed redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. A cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent RRD. Conclusion:, Conventional SB surgery is a reliable procedure in a selected group of eyes with primary RRD. However, in eyes with a retinal tear with a cumulative size of more than three disc diameters, a primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 months, a longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after SB surgery. [source] Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of lifeACTA OPHTHALMOLOGICA, Issue 1 2010Caitriona Kirwan Abstract. Purpose:, To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life. Methods:, We conducted a review of all cataract surgery performed at our unit over a 23-year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract. Results:, Duration of follow-up was significantly longer (p < 0.001) in the aphakic (113 ± 69 months) compared to the pseudophakic group (56 ± 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged , 2.5 months. Analysis of all eyes that underwent surgery aged , 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases. Conclusion:, Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes. [source] Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Elisabeth Wittström Abstract. Purpose:, To evaluate patients with central retinal vein occlusion (CRVO) and neovascular glaucoma (NVG) using electrophysiology in order to gain better understanding of visual outcome and risk factors, such as previously diagnosed primary open-angle glaucoma (POAG). Methods:, Eighty-three patients (83 eyes) initially presenting with CRVO and examined with full-field electroretinography (ERG) within 3 months of the thrombotic event were analysed retrospectively regarding treatment, risk factors and visual outcome. In addition, 30 patients initially presenting with NVG caused by CRVO were also investigated regarding risk factors using electrophysiology in order to determine the cause of their visual impairment. Results:, Nineteen (23%) of the 83 patients initially presenting with CRVO had been diagnosed previously with POAG. Ninety-five per cent (18/19) of all the patients with previously diagnosed glaucoma developed ischaemic CRVO. Thirty-four per cent of the patients initially presenting with CRVO (28/83) developed NVG. Sixty-eight per cent (13/19) of the patients with previous glaucoma developed NVG, compared to 23% (15/64) of the patients without previous POAG. In the patients who initially presented with NVG, full-field ERG demonstrated a remaining retinal function of both cones and rods, indicating that the main cause of visual impairment is ischaemia of the ganglion cell layer. Conclusion:, Glaucoma is a significant risk factor for developing ischaemic CRVO and subsequent NVG. The presence of POAG in CRVO worsens visual outcome. NVG is associated with preserved photoreceptor function, thus indicating ischaemia of the ganglion cell layer as the primary cause of visual impairment. This emphasizes the importance of prompt treatment of ischaemia and elevated intraocular pressure in these patients. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] New perspectives of optical coherrence tomography in diagnosis and follow-up of macular holesACTA OPHTHALMOLOGICA, Issue 2009SA KABANAROU Purpose To compare Time Domain (TD) with Spectral Domain (SD) OCT for imaging macular holes, identify retinal pathology and correlate anatomical morphology after surgical intervention for hole closure with visual outcome. Methods 34 eyes of 34 patients with idiopathic macular holes stage II- IV were included in this study. Comparative studies were performed with both SD OCT (Heidelberg, Germany) and TD OCT (Stratus) using standard scanning protocols of 6 radial 6-mm scans through the fovea. All patients underwent a standard three port- pars plana vitrectomy. Postoperatively, all patients were evaluated using both OCTs. ETDRS visual acuities were recorded pre- and post-operatively. Results In general TD and SD OCTs showed comparable images of macular holes. However, the boundary line between the inner and outer segments of the photoreceptors was better imaged with the SD OCT preoperatively and postoperatively. Poor visual acuity postoperatively was measured mainly in cases with morphological disruption in this boundary line despite hole closure. Conclusion SD OCT imaging enhances the visualization of retinal anatomy in macular holes relative to TD OCT. [source] Macular hole surgery with and without internal limiting membrane peelingACTA OPHTHALMOLOGICA, Issue 2009C KOURENTIS Purpose To compare the results of surgery for idiopathic macular hole with or without the surgical removal of the internal limiting membrane (ILM) and the effect on anatomical and functional success rates. Methods 41 consecutive patients with idiopathic macular hole stage II (n=11), III (n=22) and IV (n=8) underwent pars plana vitrectomy and intraocular gas tamponade in this study. The surgery was performed either with ILM peeling,Group A (n=28), or without, Group B (n=13). Ocular coherence tomography and ETDRS visual acuity were measured pre- and postoperatively to assess macular hole size and anatomical hole closure as well as visual function. Results The postoperative macular hole closure rate was 100% (28/28) in Group A and 84,6% (11/13) in Group B. The 2 cases that failed to close with primary surgery had a hole size greater than 400µm. There was no significant difference between the two groups in the postoperative visual outcome once anatomical success was achieved. Conclusion The study suggests that more evidence based trials are necessary to investigate the benefit of ILM peeling especially in the treatment of larger macular holes. [source] Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?ACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non-ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed. Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity. Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A-V sheathotomy combined with intravenous t-PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease. [source] Progress in monitoring inflammation in JIAACTA OPHTHALMOLOGICA, Issue 2009B BODAGHI Purpose To analyze the most appropriate strategy to monitor ocular inflammation in children with juvenile idiopathic arthritis - associated uveitis. Methods Slit lamp biomicroscopy is widely used to evaluate the importance of anterior segment flare and cells in children with anterior uveitis. However, different studies have clearly shown that other tools such as laser flare photometry and OCT may improve the monitoring during the follow-up. Therefore, both tests are performed in all children referred to our Department for the management of JIA-associated uveitis. Results Laser flare photometry showed for the first time that active ocular inflammation may be associated with a significant level of flare even in the absence of detectable cells. This is a major finding to start a therapeutic approach or change it for a more aggressive strategy and monitor the decrease of flare. Moreover, the level of flare decrease under therapy may predict further serious complications such as secondary glaucoma or cataract. OCT features are important to identify macular alterations in nearly 85% of children with anterior uveitis associated with JIA. Conclusion Both laser flare photometry and OCT are non invasive and quantitative methods that may significantly improve the visual outcome of JIA-associated uveitis. [source] Boston type I in pediatric patientsACTA OPHTHALMOLOGICA, Issue 2009J AQUAVELLA Purpose To present a retrospective review of keratoprosthetic implantation and retention in patients with congenital corneal opacities. Methods Pediatric patients younger than seven years old, the average age of permanent visual loss from understimulation of the visual cortex, were selected from a single center Boston Type I keratoprosthesis database and categorized by 1) primary diagnosis, 2) short-term visual outcome, and 3) post-operative complications. Results Seventeen patients, with an age range of 41 days up to 6 years, were selected from a database of over one hundred and forty patients. Six had a primary diagnosis of sclerocornea and eleven had Peter's anomaly. Visual outcome after one year improved in fourteen of the patients, with patients who previously could not detect light to subsequently being able to fixate and follow or even read allen cards. The remaining three patients showed no improvement in visual acuity but also no worsening from their baseline condition. In terms of post-operative complications of the optic, two had retroprosthetic membrane formation, and another patient required replacement of the keratoprosthesis due to phthisis and optic melting. From a retinal standpoint, four patients had retinal detachments. There were no cases of choroidal hemorrhaging or hypotony in these patients. Conclusion Based on visual outcome, the Boston Type I keratoprosthesis is a safe and effective procedure for patients with congenital corneal opacities. With great retention, the artificial cornea is a viable option for prevention of amblyopia. Due to comorbidities such as congenital cataracts, congenital glaucoma, and retinal detachments, it is crucial to have glaucoma and vitreo-retinal surgeons on hand when managing and implanting keratoprosthesis in a pediatric population. [source] Predictive factors of visual outcome in acute post-cataract endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009A COMBEY-DE LAMBERT Purpose To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment. [source] | ||||||||||