Anatomical Success Research Articles

Long-term follow-up after lens-sparing vitrectomy for complications of retinopathy of prematurity.

To report the long-term anatomical and functional results of lens-sparing vitrectomy (LSV) for stage 4 retinopathy of prematurity (ROP). Retrospective study. This is a study of 23 eyes of 16 patients with stage 4 ROP who underwent lens-sparing vitrectomy at a tertiary care center and had a minimum of 2 years of follow-up. The main outcome measures are the retinal status and visual outcome at the final follow-up. After a mean follow-up of 7.36 years, the lenses remained clear in 69.57%; anatomical success in terms of the attached retina was achieved in 19/23 eyes (82.61%) and vision of ≥6/24 was achieved in 8/23 eyes (34.78%), whereas navigational vision (≥1/60) was achieved in 16/23 (69.56%). The mean spherical equivalent was -8.50 + 6.39 diopters. High myopia (≥7 dsph) was noted in 43.47% of patients. The severity of myopia was not related to previous lasers and was less severe in eyes with posterior pole residual folds compared to normalized fundus or eyes with macular drag but no fold. At the final follow-up, 3/16 (18.75%) patients had bilateral blindness due to total retinal detachments and 11/16 (68.75%) had recorded functional vision in one or both eyes, whereas two others could potentially be having vision but could not be evaluated. The long-term results of lens-sparing vitrectomy for stage 4 ROP are favorable with a majority retaining clear lenses and attached retina and two-thirds having functional vision.

Effectiveness and Factors Influencing Success of Transcanalicular Laser-Assisted Endoscopic Dacryocystorhinostomy: Cohort Study.

Laser dacryocystorhinostomy (LDCR) is a surgical procedure designed to treat obstructions in the lacrimal duct system, which can cause excessive tearing, infections, and discomfort. This technique involves creating a new passage for tear drainage, thereby restoring normal tear flow and alleviating symptoms associated with duct obstruction. A retrospective study was conducted on 48 patients who underwent the LDCR procedure, amounting to 56 eyes. The primary outcome measured was the anatomical success rate, defined as the restoration of duct patency. Patients were examined postoperatively from 6 months to 3.5 years. The LDCR method demonstrated a 95% success rate, encompassing both anatomical and functional outcomes. The procedure's effectiveness was determined by achieving a patent osteotomy and resolving symptoms. Anatomical success was measured by the creation of a viable drainage pathway, while functional success pertained to the resolution of symptoms such as epiphora. The efficacy of the procedure was found to be independent of both age and gender. Among patients with successful anatomical outcomes, there was a statistically significant improvement in their Munk scores. The LDCR method is highly effective in treating lacrimal duct obstruction. These findings highlight the importance of the Munk score as a predictive indicator of procedural success in LDCR.

Clinical Presentations and Outcomes of Pediatric Rhegmatogenous Retinal Detachment: 11 Years' Experience at a Tertiary Eye Center.

Background and Objectives: Pediatric rhegmatogenous retinal detachment (RRD) represents a challenge for ophthalmologists and vitreoretinal surgeons. In this study, we aim to review the clinical features, and surgical and visual outcomes of pediatric RRD in a tertiary referral center. Materials and Methods: This is a retrospective study using the review of charts for all patients who presented to King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, from 2005 to 2016. This study included patients 18 years old or younger, had undergone surgical repairs for RRD, and were followed up for 1 year or more. Results: Eighty-nine eyes of 70 children who underwent surgical repair for RRD were included in the current retrospective study. A previous history of intraocular surgeries was present in 31.5%. The majority of cases had known ocular disease or syndromes (n = 58, 65.2%). The majority of eyes which had a primary surgical intervention achieved anatomical success (n = 88). Corneal complications accounted for the majority of complications following primary and secondary surgical interventions. Forty-two percent of the eyes had vision better than 20/200, while thirty-five percent had vision of hand motion or worse. Conclusions: In conclusion, despite the variability in causes of RRD in children, successful anatomical outcomes can be achieved with the proper surgical approach. Visual outcomes are less predictable due to other ocular complications.

Long-term outcomes of mechanochemical ablation using the Clarivein device for the treatment of great saphenous vein incompetence

ObjectiveThe short-term anatomical success rates of mechanochemical ablation using the Clarivein device (Merit Medical) in the treatment of great saphenous vein (GSV) incompetence are high. However, the anatomical success rates seem to drop over time. The aim of this study was to determine the long-term outcomes of GSV treatment using the Clarivein and to assess whether specific anatomical features better correlate with clinical or quality of life (QoL)-related outcomes. MethodsThis is a single-center, prospective cohort study in follow-up of a multicenter, randomized controlled trial using Clarivein with liquid polidocanol for the treatment of GSV incompetence. The primary outcome was anatomical success (AS), defined as complete occlusion or a recanalized segment, irrespective of reflux, of <10 cm in length. In addition, reflux-free anatomical success (RF-AS) was determined, and defined as complete occlusion or a recanalized segment with <10 cm of reflux. Clinical success was assessed using the Venous Clinical Severity Score (VCSS), and QoL was assessed using the Dutch version of the Aberdeen Varicose Vein Questionnaire (DAVVQ) and the 36-Item Short Form Health Survey (SF-36). Subgroup analyses were performed based on whether AS or RF-AS was achieved or not. ResultsA total of 109 patients (115 limbs) were included. The mean follow-up time was 8.4 ± 0.9 years (range, 5.5-10.3 years). AS was seen in 60.5% of limbs, and RF-AS was seen in 72.8% of limbs. Compared with baseline, the overall mean VCSS improved from 5.3 ± 2.4 to 4.1 ± 2.4, and the overall median DAVVQ score from 13.5 (interquartile range [IQR], 8.7-20.0) to 10.5 (IQR, 5.3-16.2) (P < .001). Improvement in VCSS was only significant in patients with successful treatment: from 5.5 ± 2.7 to 3.7 ± 2.5 (P < .001) if AS was achieved and from 5.0 ± 1.7 to 4.5 ± 1.9 (P = .20) if AS was not achieved. The same results were found for DAVVQ scores: improvement from13.5 (IQR, 8.7-20.6) to 10.3 (IQR, 3.0-14.5) (P < .01) if AS was achieved and from 12.9 (IQR, 8.3-19.3) to 10.8 (IQR, 6.7-18.2) (P = .35) if AS was not achieved. Regarding the overall SF-36 scores, the domains of vitality, mental health, and general health worsened significantly. ConclusionsIn over 8 years of follow-up, the anatomical success rate after the treatment of GSV incompetence using the Clarivein device decreased to 60.5%. However, clinical scores and disease-specific QoL still improved significantly compared with baseline. We found no convincing evidence that the absence of reflux correlates better with clinical and QoL-related outcomes compared with recanalization irrespective of reflux.

SURGICAL OUTCOMES OF RETINAL DETACHMENT ASSOCIATED WITH PROLIFERATIVE SICKLE CELL RETINOPATHY.

To evaluate the long-term anatomic and visual outcomes in eyes with sickle cell retinopathy-related retinal detachments (RDs). Patients who underwent surgery for sickle cell retinopathy-related RDs at the Wilmer Eye Institute or Wills Eye Hospital between 2008 and 2020 and followed for at least 6 months postoperatively were retrospectively reviewed. The primary outcome was the rate of single-surgery anatomic success and final reattachment. This study included 30 eyes from 28 patients (16 women and 12 men) with tractional RD (n = 13), rhegmatogenous RD (n = 1), and combined tractional RD/rhegmatogenous RD (n = 16). Mean age was 42.1 ± 15.1 years. The mean follow-up duration was 47.8 ± 34.1 months. Twenty-five (83.3%) eyes underwent pars plana vitrectomy and five (16.7%) eyes underwent pars plana vitrectomy with scleral buckling. Single-surgery anatomic success was achieved in 21 (70.0%) eyes at 6 months. Final reattachment was achieved in 28 (93.3%) eyes (22 eyes [73.3%] without tamponade). Recurrence of RDs was significantly associated with male gender (P = 0.041), absence of previous laser (P = 0.032), iatrogenic breaks (P = 0.035), retinectomy (P = 0.034), and silicone oil tamponade (P = 0.024). Overall, the logarithm of the minimum angle of resolution visual acuity improved from 1.53 ± 0.57 (Snellen equivalent, 20/678) to 1.15 ± 1.01 (20/283) at the final visit (P = 0.03); however, eyes with recurrent RD did not achieve significant visual improvement. Pars plana vitrectomy to repair sickle cell retinopathy-related RDs was effective in achieving anatomic success and improving vision in most eyes. Single-surgery anatomic success is critical for optimizing visual outcomes.

Laparoscopic Sacrohysteropexy for the Management of Uterovaginal Prolapse: a Pilot, Single-Center Experience from Saudi Arabia.

Laparoscopic sacrohysteropexy is an emerging uterine-preserving strategy for management of uterovaginal prolapse (UVP). The literature on laparoscopic sacrohysteropexy for management of UVP is very scarce from Saudi Arabia. This research examined the feasibility, clinical utility, and safety of laparoscopic sacrohysteropexy in a Saudi setting. A retrospective study was conducted, including all patients who met the inclusion criteria. The laparoscopic sacrohysteropexy technique was adapted with modifications from the "Oxford hysteropexy". The primary endpoint was overall success, defined as anatomical success in all vaginal compartments (UVP grade 0 or 1 postoperatively). The secondary endpoint was the mean change in point C. Descriptive data were summarized with numbers and percentages, while numerical data used means ± standard deviations. Fisher's exact and Student's t tests were used for univariate analyses. Significant surgical outcome predictors were identified via logistic regression, with p <0.05 considered statistically significant. Overall, 21 patients met the inclusion criteria. The most frequent indication for laparoscopic sacrohysteropexy was UVP without anterior or posterior wall prolapse (n = 15, 71.4%), whereas the most frequent grade of UVP was grade III (n = 13, 61.9%). One patient (4.8%) required switch to laparotomy due to severe adhesions. No perioperative complications were recorded. The mean change in point C and hospital stay were 5.8 ± 2.1 (range: 0-8) and 1.4 ± 0.6 days (range: 1-3), respectively. Surgical success was achieved in 18 patients (85.7%). Only three patients experienced recurrences (one, two, and six months postoperatively). The mean change in point C was significantly higher in successful cases contrasted with the failed cases (6.5 versus 1.3). Laparoscopic sacrohysteropexy for management of uterovaginal prolapse revealed technical feasibility, safety, and beneficial utility of the procedure. Further large-sized and multicentric investigations are important to gather additional pertinent information on laparoscopic sacrohysteropexy.

SURGICAL OUTCOMES IN CONCURRENT SICKLE CELL AND DIABETIC RETINOPATHY.

To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy and diabetic retinopathy. Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent sickle cell retinopathy and diabetic retinopathy between January 01, 2014, and December 31, 2021. The study included 20 eyes of 14 patients. Indications for surgery included tractional retinal detachment in 12 eyes (60%), combined tractional retinal detachment/rhegmatogenous retinal detachment in 6 eyes (30%), and vitreous hemorrhage in 2 eyes (10%). Pars plana vitrectomy was performed in all eyes. One eye received a scleral buckle at the same time as pars plana vitrectomy. There was no change in mean best-corrected visual acuity at the last follow-up examination (1.5 [20/678]) when compared with mean preoperative best-corrected visual acuity (1.6 [20/762], P = 0.83). Preoperative best-corrected visual acuity correlated with postoperative best-corrected visual acuity at the last follow-up examination in eyes with retinal detachment (r = 0.49, P = 0.04). Single operation anatomic success was achieved in 11 of 17 eyes (65%) with retinal detachment. Functional and anatomic outcomes after surgery in eyes with concurrent sickle cell retinopathy and diabetic retinopathy are relatively poor.

PEDICLE TRANSPOSITION FLAP, INVERTED FLAP, FREE FLAP, AND STANDARD PEEL FOR LARGE FULL-THICKNESS MACULAR HOLES: A Comparative Study.

To compare anatomical and functional outcomes of four different techniques for the treatment of large idiopathic full-thickness macular holes. This single-center retrospective study included 129 eyes of 126 patients with large (>500 µ m) full-thickness macular holes who presented between January 2018 and October 2022. All patients underwent 23/25 G vitrectomy and gas with standard internal limiting membrane (ILM) peel, pedicle transposition, inverted, or free flap technique. Postoperative optical coherence tomography images were assessed by two independent masked graders. Mean age was 73.2 years (SD 8.4) with a median F/U of 5 months (IQR 8). The overall anatomical success rate was 81%; it was significantly lower (59%) for the standard ILM peel ( P < 0.0001). The pedicle transposition flap showed superior visual recovery compared with the free flap (+27 vs. +12 ETDRS letters, P = 0.02). At 3 months, restoration of the external limiting membrane was significantly better for the pedicle transposition flap compared with free flap and standard ILM peel ( P = 0.008 and P = 0.03) and superior to all the other techniques at 6 months ( P = 0.02, P = 0.04, and P = 0.006). Standard ILM peel alone offers inferior outcomes for the management of large full-thickness macular holes. Of the alternative ILM techniques, despite similar closure rates, foveal microstructural recovery is most complete following the pedicle transposition flap and least complete following the free flap.

Two-year Follow-up on Surgical Outcomes of vNOTES High Uterosacral Ligament Suspension for the Prophylaxis and Treatment of Pelvic Organ Prolapse: A Multicenter Prospective Cohort Study

We aimed to evaluate the medium-term outcomes of high uterosacral ligament suspension (HUSLS) with vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients either suffering from pelvic organ prolapse (POP) or undergoing routine prophylaxis to prevent post-hysterectomy vaginal vault prolapse. Multicenter prospective cohort study SETTING: Three tertiary care hospitals PATIENTS: Patients who received vNOTES-HUSLS between January 1, 2021 and January 1, 2023, were included in the study. vNOTES-HUSLS MEASUREMENTS AND MAIN RESULTS: The data collected included surgery duration, intraoperative and postoperative complications, postoperative Visual Analog Scores (VAS), and Female Sexual Function Index (FSFI) pain subdomain scores. The changes in prolapse levels were measured using modified POP-Q scores, including the C, Ba, and Bp scores recorded prior to surgery and during the postoperative follow-up examination. Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire. The final analysis included 55 women. Of these, vNOTES-HUSLS was performed in 43 patients (78.2%) to treat apical prolapse, while the remaining 12 patients (21.8%) underwent prophylaxis following hysterectomy to prevent vaginal vault prolapse. The median follow-up period was 23.5 months, with a range of 12-37 months. Ba,C, and Bp points significantly improved in patients who underwent surgery for prolapse (p<0.001). There was no recurrence in the apical compartment following vNOTES-HUSLS for both performed prophylactic and treatment purposes after hysterectomy. Two (3.6%) patients were diagnosed with stage 3 anterior compartment prolapse. The overall vNOTES-HUSLS success rate was 96.4% at approximately two years follow-up. Bladder injury was detected as an intraoperative complication in one patient (1.8%). The overall satisfaction rate was 98.1% at the final follow-up. vNOTES-HUSLS was effective in the treatment and prophylaxis of apical prolapse, demonstrating high anatomical success rates. The procedure demonstrated a low complication rate, with intraoperative and postoperative complications each observed in 1.8%(n=1) of patients. The Medium-Term Outcomes of vNOTES High Uterosacral Ligament Suspension.

VNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. This study was aimed at comparing perioperative and short-term postoperative outcomes of vNOTES versus laparoscopic approaches to uterosacral ligament suspension (USLS) for apical pelvic organ prolapse. A retrospective cohort study included all women who underwent vNOTES versus laparoscopic USLS at two university-affiliated centers between 2017 and 2023. The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest. This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar. Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.

Surgical Outcomes of Rhegmatogenous Retinal Detachment Associated with Regressed Retinopathy of Prematurity.

To evaluate the characteristics and surgical outcomes of late-onset rhegmatogenous retinal detachment (RRD) associated with regressed retinopathy of prematurity (ROP) and the status of fellow eyes. Retrospective review of consecutive cases undergoing surgery for regressed ROP-related RRD and the fellow eyes between 2012-2022. Demographic data, fundus findings, retinal detachment characteristics, surgical procedures, and anatomic and functional outcomes were analyzed. Anatomic success was defined as retinal attachment after silicone oil removal at final follow-up. Fifteen eyes of 14 patients with a history of regressed ROP underwent surgical repair for RRD at a mean age of 12 (range, 3-26) years. Primary surgical intervention yielded a 53% failure rate overall. This rate was 33% for scleral buckling (SB), 100% for pars plana vitrectomy (PPV), and 40% for combined SB-PPV surgery. Eyes with posterior cicatricial changes and/or proliferative vitreoretinopathy (PVR) demonstrated a higher tendency for recurrence. The final anatomic success rate was 73% after a mean number of 2.3 (range, 1-5) surgeries. The chances of restoring useful vision diminished with repeated surgery despite the improvement in anatomic success. In the fellow eyes, peripheral retinal pathologies were universally observed, with posterior cicatricial changes noted in 33%. The study reveals a significant initial failure rate in surgical treatment of cases with late-onset RRD associated with regressed ROP, particularly in eyes with posterior cicatricial changes or PVR, suggesting the need for a combined surgical approach as an initial strategy in such high-risk cases. The consistent presence of retinal abnormalities in fellow eyes calls for proactive monitoring and potential prophylactic intervention.

Comparison of two laser power levels in the subthreshold micropulse yellow laser treatment of acute central serous chorioretinopathy

AimsTo compare the efficacy of two power levels in the 577 nm sub-threshold micro pulse laser (SML) treatment of acute central serous chorioretinopathy (aCSC). MethodsA retrospective comparative study was conducted. A total of 65 patients (65 eyes) with aCSC were enrolled. Of which, 32 patients received low power treatment and 33 patients received high power treatment of 577 nm SML. Best-corrected visual acuity (BCVA), central macular thickness (CMT), fundus-monitored microperimetry and height of subfoveal choroidal thickness (SFCT) as well as subretinal fluid (SRF) were evaluated at baseline and 3 months. ResultsThe height of SFCT and retinal sensitivity in the low power treatment group was significantly better than that in the high power treatment group at 4 weeks (all p < 0.001). Mean BCVA improved from baseline to 3 months after treatments but with no significant difference between the two groups after 3 months (p > 0.05). In the low power group, the CMT decreased from 379.76 ± 139.23 μm at baseline to 176.56 ± 37.78 μm at 3 months, and in the high power group, the CMT decreased from 364.97 ± 143.08 at baseline to 191.77 ± 38.26 μm at 3 months. There was no significant difference at 3 months between the two groups (p > 0.05). Similar results were also found in term of SRF. ConclusionsTimely intervention with 577 nm SML with low power treatment can improve visual acuity, and included anatomic success without adverse events.

Characteristics and surgical outcomes of giant retinal tear associated rhegmatogenous retinal detachment

Giant retinal tear-associated rhegmatogenous retinal detachment (GRT–RRD) presents a significant surgical challenge. Trauma stands out as one of the risk factors. This retrospective case series aims to assess the outcomes of GRT–RRD patients treated with pars plana vitrectomy (PPV), distinguishing between non-trauma and blunt ocular trauma cases. The medical records and relevant retinal imaging of 60 GRT–RRD patients undergoing PPV and followed with a mean (SD) of 21.2 (13.4) months were reviewed (47 were non-trauma-related and 13 were trauma-related). Both the non-trauma and trauma groups exhibited comparable distribution of proliferative vitreoretinopathy grade (P = 0.067). Following the primary operation, there was no statistically significant difference in the proportion of patients achieving single surgery anatomical success between the non-trauma group (27/47 patients, 57.5%) and the trauma-related group (9/13 patients, 69.2%) (P = 0.534). At the final follow-up, 17 patients remained tamponade with silicone oil. Among the remaining 43 patients, 33/34 patients (97.1%) in the non-trauma group and 9/9 patients (100%) in the non-trauma group (P = 0.661) achieved comparable final surgical anatomical success. Additionally the final vision was comparable between the two trauma categories (Snellen equivalent of 20/125 for the non-trauma group and 20/200 for the trauma group, P = 0.331). In multivariable regression, no significant factors related to primary reattachment rate or final vision were identified. Non-penetrating ocular trauma did not emerge as a significant risk factor for recurrent detachment post-surgery. This study supports that PPV outcomes in GRT–RRD patients are unaffected by the ocular trauma association and reports the effectiveness of PPV in managing these patients.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12mm, group B ≥12mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1month, 12months and 24months postoperatively. 118 patients with GSV diameter <12mm (group A) and 87 with GSV diameter ≥12mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12mm, 1470nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470nm EVLA and RFA techniques performed similar outcomes.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

Predictive parameters for anatomical surgical success in full-thickness macular holes : Aretrospective evaluation of 391eyes

Full-thickness macular hole (FTMH) is arare disease. Not all FTMHs can be closed by primary surgical intervention. This work aims to characterize alarge patient population with FTMHs and to detect possible predictive factors for anatomical treatment success. The study comprises aretrospective analysis of all consecutive idiopathic macular holes between March 2008 and June 2019 at the University Eye Hospital Cologne. Epidemiologic data, preoperative parameters (size of the FTMH), and surgical technique were examined in relation to the closure rate following primary surgery. The anatomical closure rate for idiopathic FTMH after primary surgery was 83.6%. No association between age, gender, and lens status and closure rate could be shown. Regarding anatomical surgical success, the favorable prognostic factors identified were asmall FTMH size, short symptom duration, performance of transconjunctival 23-gauge vitrectomy, and application of the inverted flap technique of the internal limiting membrane (ILM). Surgical treatment represents avaluable treatment option for patients with macular holes due to good prospects of success. Prompt intervention after diagnosis using 23-gauge vitrectomy and an ILM flap with gas tamponade seems to result in the most favorable outcomes.

Comparing mechanochemical endovenous ablation using Flebogrif with endovenous laser ablation in the treatment of primary great saphenous vein incompetence: protocol for a multicentre, open-label, non-inferiority, observer-blinded, randomised controlled trial (REBORN trial)

IntroductionEndovenous laser ablation (EVLA) is associated with an excellent outcome in the treatment of great saphenous vein (GSV) incompetence. However, the use of thermal ablation requires tumescent anaesthesia and is...

Use of a dexamethasone implant to treat macular edema following pars plana vitrectomy and removal of the primary epiretinal membrane.

The purpose of this study was to evaluate the effectiveness and safety of an intravitreal dexamethasone (DEX) implant for the treatment of macular edema (ME) following pars plana vitrectomy (PPV) and removal of the primary epiretinal membrane (ERM) and to assess the impact of the integrity of the ellipsoid zone (EZ) and disorganization of the retinal inner layer (DRIL) grade on visual and anatomical outcomes. Forty-two pseudophakic patients who developed ME following PPV and removal of the primary stage 2-3 ERM were included. Patients were divided into two groups when ME was diagnosed via spectral domain optic coherence tomography (SD-OCT). In the DEX group (n = 22), DEX was implanted for the treatment of ME. In the control group (n = 20), only observation was conducted, without any treatment. The best-corrected visual acuity (BCVA) and macular thickness (MT) of the two groups were compared at baseline and 1, 6, and 12months after DEX implantation. The effects of OCT parameters such as EZ integrity and DRIL grade were also evaluated in terms of decreases in MT and increases in VA in the treatment of ME with DEX implantation. Intraocular pressure (IOP), number of DEX implantations and adverse effects were also recorded. While a statistically significant increase in the mean BCVA was observed in the DEX group (p < 0.001 at months 1, 6, and 12, respectively), no such increase was detected in the control group (p = 0.169, p = 0.065, and p = 0.058 at months 1, 6 and 12, respectively) compared with the baseline. A statistically significant decrease in the mean MT was observed in the DEX group (p < 0.001 at months 1, 6, and 12); however, no significant difference was observed in the control group (p = 0.081, p = 0.065, and p = 0.054 at months 1, 6 and 12, respectively) compared with the baseline. Significant differences were found between the two groups in terms of the increase in BCVA (p < 0.01) and decrease in MT (p < 0.01) at all visits, with the outcomes being more favorable in the DEX group. A statistically significant relationship was found between the increase in VA and EZ integrity and DRIL grade in both groups. Ten patients (45.4%) received two injections of DEX during the follow-up. An increase in IOP was observed in five patients (22.7%) who were treated with topical antiglaucomatous drops. No significant side effects were observed. DEX implantation was found to be effective and safe for the treatment of ME following PPV and primary ERM removal, although some eyes may require repeated injections to achieve visual and anatomical success. Additionally, a relationship was found between EZ integrity, DRIL grade and visual-anatomical outcomes.

Management and Clinical Outcomes of Eyes With Posterior Segment Intraocular Foreign Bodies Seen at a Tertiary Referral Center.

This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB). The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed. The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA (P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success (P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA (r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal (P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis (P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome. The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].

Comparative study between endovenous laser ablation (EVLA) with 1940 nm versus EVLA with 1470 nm for treatment of incompetent great saphenous vein and short saphenous vein: a randomized controlled trial

BackgroundTo date, the most commonly used endothermal ablation method is endovenous laser ablation (EVLA). The objective of this work is to assess the initial and short-term outcomes of a 1940 nm diode laser compared with 1470 nm diode laser utilization for the treatment of lower limb varicose veins. MethodsThis is a randomized controlled prospective study that included patients with varicose veins. The allocated patients were randomized according to the technique used: group I, which was treated using EVLA with a 1940 nm diode laser, and group II, which was treated using EVLA with a 1470 nm diode laser. ResultsThis study initially included 216 patients. After the exclusion of patients lost during follow-up, group I consisted of 105 patients, and group II consisted of 101 patients. There were high rates of anatomical success in the two groups with obliteration of the treated vessels at the 1-month follow-up (100% and 99%, respectively) and the 6-month follow-up (100% and 99%, respectively). A very low rate of adverse events was encountered (1%). Group II showed obviously longer median days to return for usual activities (11.5 compared with 7 days). They showed significantly higher pain scores, which was evident at the 7-day and 1-month follow-ups (P < .001). ConclusionsBoth lasers provided excellent outcomes in terms of anatomical success and low rates of adverse events. The 1940 nm diode laser was associated with lower median days to return for usual activities and significantly lower pain scores. Evidently, lower power and linear endovenous energy density were required for this laser.