Average Postoperative Visual Acuity Research Articles

Liberty® by Medicontur, a Complex in Structure, Hydrophilic Intraocular Lens in the Correction of Eyes with Preoperative Myopia

A retrospective analysis of visual function in patients with preoperatively diagnosed myopia, after implantation of Liberty® intraocular lens, including the influence of some factors like a kind of surgery, values of angle alpha and kappa, pupil size, values of higher order aberrations generated by the lens on visual acuity to far and near distances was done. Lens removal and Liberty® implantation was done 47 eyes, including in 13 patients in both eyes. In 7 eyes, it was a toric lens. A mean preoperative value of myopia was -6.72 Dsph. Cataract removal accounted for 55% of all procedures performed, the rest being Refractive Lens Exchange. Preoperative pupil size was between 3.6 and 6,4 mm. The average postoperative visual acuity to far distances was 0.13 (logMar), and to near distances was 0.51 (Snellen). Rare cases of insufficient quality of vision to intermediate distances, when the postoperative pupil size was greater than 4 mm, resolved after increasing light intensity in the room. A bigger values of higher order aberrations corresponded with lower values of preoperative visual acuity to far distances. A bigger values of angle alpha corresponded with lower values of postoperative visual acuity to far distances, which were significantly higher in cataract group. Visual acuity to far distances was also better in eye with bigger pupil size. A specific structure of the lens allows patients to see good to the near distances, even if the light intensity not perfect.

Anterior vitrectomy, phacoemulsification cataract extraction and irido-zonulo-hyaloid-vitrectomy in protracted acute angle closure crisis.

PurposeTo describe a modified surgical approach with anterior vitrectomy, phacoemulsification (phaco) cataract extraction and irido-zonulo-hyaloid-vitrectomy (IZHV) in protracted acute angle closure crisis (AACC).Patients and methodsNon-comparative, retrospective case series including 21 eyes in 19 consecutive cases of protracted AACC, which persists for at least 7 days despite maximal medical and laser therapies, were included in this study. All patients underwent a modified surgical procedure with anterior vitrectomy, phaco cataract extraction, IOL implantation, goniosynechialysis (GSL) and IZHV, using modest phaco dynamic parameters with intraocular pressure (IOP) set at 30 mmHg through the procedure using Centurion® Vision System equipped with active fluidics while the anterior vitrectomy was set at 4000 or 5000 rpm. IOP and anterior chamber space were maintained through the procedure using ophthalmic viscosurgical device (OVD) injected through paracentesis whenever the Phaco or I/A probe was withdrawn from within the anterior chamber. Medical history, visual acuity (VA), IOP and anterior and posterior segment findings were recorded and compared before and after surgical treatment.ResultsThe average age of all patients was 60.05 years old, while the average period of persistent AACC was 20.05 days. Preoperatively, the average IOP of all included eyes was 44.40 ± 8.42 mmHg despite maximal topical and systemic anti-glaucoma medications and/or laser surgeries, while the average VA was 1.46 ± 0.88 (log MAR). Postoperatively, IOP was well controlled in all patients with an average IOP at 12.06 ± 3.07 mmHg without any anti-glaucoma medications at follow-ups, which was decreased significantly from that in preoperative measurements (P < 0.001). Visual acuity was improved significantly at final follow-up with an average postoperative VA at 0.74 ± 0.77 (log MAR, P < 0.001). Anterior segment inflammation was surprisingly mild with no or minimal inflammatory cells or exudates. Anterior segment configuration was resolved in all the cases. There was no recurrent IOP spike, anterior chamber shallowing or severe complications during an average follow-up of 5.38 months (ranging from 3 to 6 months).ConclusionsProtracted AACC is a complex situation while a modified surgical strategy of anterior vitrectomy, phaco cataract extraction and IZHV provides a safe and efficient solution.

Surgical Outcomes of Epiretinal Membrane Removal Due to Combined Hamartoma of the Retina and RPE.

To evaluate the surgical outcomes of epiretinal membrane (ERM) associated with combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) after vitrectomy and membrane peel. A retrospective review of 15 patients who underwent pars plana vitrectomy with membrane peeling. No plasmin enzyme was used. The mean age at surgery was 10 years old, with an average follow-up of 5.7 years. The average preoperative visual acuity (VA) was 20/514. The average postoperative VA was 20/138 (P = .0251) at 1-year follow-up and 20/89 (P = .0025) on the latest exam on final follow-up. VA was improved in 14 patients (93%) and deteriorated in one patient (7%). All 15 patients (100%) had improvement of retinal/macular anatomy postoperatively. In the treatment of patients with ERM due to CHRRPE, vitrectomy with membrane peeling without plasmin injection can result in improved VA and retinal structure. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:546-554.].

Impact of contact versus non-contact wide-angle viewing systems on outcomes of primary retinal detachment repair (PRO study report number 5)

Background/aimsVitrectomy to repair retinal detachment is often performed with either non-contact wide-angle viewing systems or wide-angle contact viewing systems. The purpose of this study is to assess whether the viewing...

Surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy and cataract surgery.

Purpose:To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery.Methods:A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications.Results:The average preoperative visual acuity of the patients was logMAR 1.57 ± 1.2, and the average postoperative visual acuity was logMAR 0.39 ± 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 ± 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 ± 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 ± 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 ± 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 ± 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony.Conclusion:Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.

The efficacy of intravitreal injection of Ranibizumab before vitrectomy in the treatment of proliferative diabetic retinopathy

Objective To evaluate the efficacy of intravitreal Ranibizumab injection before vitrectomy in the treatment of proliferative diabetic retinopathy (PDR) . Methods The data of 128 eyes of 92 patients of PDR from Jan. 2016 to Dec. 2016 were enrolled and analyzed retrospectively. All patients were randomly divided into observation group, 66 eyes of 46 patients, and control group, 62 eyes of 46 patients. The control group was treated with vitrectomy only. The observation group received intravitreal Ranibizumab injection before vitrectomy. The efficacy of two groups were compared. Results The operation time and hospital stay time in observation group were shorter than those in control group (P=0.000). At 3 months after operation, the visual acuity improvement rate was 92.42% in the observation group and 80.65% in the control group (P=0.034). The average postoperative visual acuity in the observation group was higher than that in the control group (P=0.009) . The intraocular pressure in the observation group was lower than that in the control group (P=0.001), the central macular retinal thickness in the observation group was thinner than that of the control group (P=0.000). The complication rate in the observation group was 3.03%, which was lower than 14.25% in the control group (P=0.020). The postoperative vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) in the observation group were lower than those in the control group (P=0.001, 0.000). Conclusion Intravitreal injection of Ranibizumab before vitrectomy for the treatment of PDR can promote visual acuity and improve the high level of VEGF and PEDF after operation. Key words: Retinopathy, diabetic, proliferative; Ranibizumab, intravitreal injection; Vitrectomy; Efficacy

Long-term results of pars plana vitrectomy as an anti-inflammatory therapy of pediatric intermediate uveitis resistant to standard medical treatment.

To evaluate the efficacy of pars plana vitrectomy (PPV) as an anti-inflammatory therapy in pediatric recurrent intermediate uveitis. A retrospective study evaluated the long-term results of PPV indicated for intermediate uveitis with a mean observation period of 10.3 years (range 7-15.6 years) in 6 children (mean age 8 years, range 6-12 years). Pars plana vitrectomy was performed on 10 eyes in the standard manner and was initiated by vitreous sampling for laboratory examination. Data recorded were perioperative or postoperative vitrectomy complications, anatomic and functional results of PPV, and preoperative and postoperative best-corrected Snellen visual acuity. No perioperative or postoperative complications were observed. Bacteriologic, virologic, mycotic, and cytologic analysis of the vitreous was negative in all tested children. Five eyes were subsequently operated on for posterior subcapsular cataracts. An average preoperative visual acuity of 0.32 improved to an average postoperative visual acuity of 0.8. In the case of systemic immunosuppressive treatment failure in pediatric uveitis, particularly in eyes with cystoid macular edema, we recommend PPV relatively early.

Endoscopic Management of Paranasal Sinus Mucoceles: Meta-analysis of Visual Outcomes.

Objective Paranasal sinus mucoceles are benign cystic lesions originating from sinus mucosa that can impinge on adjacent orbital structures, causing ophthalmic sequelae such as decreased visual acuity. Definitive treatment requires surgery. We present the first meta-analysis quantifying the effect of preoperative visual function and time to surgery on postoperative visual acuity outcomes. Data Sources PubMed, Ovid, Embase, Web of Science, and the Cochrane Library. Methods Two independent authors systematically reviewed articles describing outcomes after endoscopic sinus surgery for paranasal sinus mucoceles presenting with visual loss. Available data from case reports and series were combined to analyze the associations among preoperative visual acuity, time to surgery, and postoperative outcomes. Results Eighty-five studies were included that provided data on 207 patients. The average presenting visual acuity was 1.57 logMAR (logarithm of the minimum angle of resolution), and the average postoperative visual acuity was 0.21 logMAR, with visual improvement in 71.5% of cases. Preoperative visual acuity ≥1.52 logMAR correlated with postoperative improvement >1 logMAR ( R = 0.4887, P < .0001). A correlation was found between a time to surgery <6 days and postoperative improvement ( R = 0.297, P < .0001). Receiver operator curve analysis of these thresholds demonstrated a moderately accurate prognostic ability (area under the curve: 75.1 for preoperative visual acuity and 73.1 for time to surgery). Conclusion Visual loss resulting from paranasal sinus mucoceles is potentially reversible in most cases, even those presenting with poor vision. When possible, surgery should be performed promptly after diagnosis, but emergency surgery does not appear to be necessary for vision restoration.

Visual outcome of cataract surgery with IOL implantation in traumatic cataract among 189 children: The Lahan experience

Trauma is an important cause of monocular blindness in the developing world. This study aims to determine the demo­graphic profile and visual outcome of cataract surgery among the children with traumatic cataract. It was a prospective and longitudinal study of 189 consecutive children below 16 years who underwent cataract surgery with intra ocular lens (IOL) implantation for traumatic cataract at Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from October 2012 to March 2014. Assessment included visual acuity measurement in the Snellen’s chart or the Cardiff card, anterior segment examina­tion with slit lamp, dilated fundus examination with the help of +20D lens in indirect ophthalmoscope, B-scan ultrasonogra­phy of posterior segment and objective and subjective refraction. Follow up was scheduled at first post-operative day, at dis­charge, one month and three months. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Among 189, majority of them were males (73%) and the average age was 8.8±3.6 years. The time of presentation ranged from 3 days to 8 years (median age two months). Wooden stick was the most common cause of injury (34.4%). The average preoperative visual acuity in logMAR scale was 1.6. The average postoperative visual acuity in logMAR scale was 0.8. Eye injuries with traumatic cataract are associated with significant visual impairment. Cataract surgery with intraocular lens implantation restores vision significantly.

Managing Cases of Dislocated Intraocular Lenses; a Retrospective Review of Cases over a 13 Year Period

Purpose: To report the incidence and outcomes over 13 years of managing cases of dislocated intraocular lens implants (PCIOL) Setting: St Thomas’s Hospital, London UK Design: Retrospective case series Methods: Clinical data of 40 patients on the VITREOR database were analyzed to determine pre-operative clinical findings, surgical methods and post operative outcomes. Results: The average age of the patients was 70 years and 60% were male. 24 cases were spontaneous late PCIOL dislocations, 13 were referred directly following complicated cataract surgery and 3 were post blunt trauma. The average post operative visual acuity for all patients was 0.65 LogMAR, 0.46 LogMAR in patients managed with an anterior chamber intraocular lens (ACIOL) and 0.25 LogMAR in the those manage with a posterior scleral fixated lens (PSFL). The number of patients with dislocated IOLs as a proportion of total operations performed by the Vitreoretinal service was significantly higher (0.8% of all surgical cases) in the last 6.5 years of data collection than the first 6.5 years (0.2% of all surgical cases) (p= 0.0036). Conclusion: There are several surgical options for correction of a dislocated PCIOL and none show obvious superiority. The incidence of dislocated PCIOLs appears to be increasing.

MACULAR EPIRETINAL MEMBRANE PEELING TREATMENT OUTCOMES IN YOUNG CHILDREN

The purpose of this study was to describe macular epiretinal membrane (ERM) peeling treatment outcomes in young children. The medical records of all vitrectomies from 1998 through 2010 were retrospectively reviewed. Patients who were selected were 16 years or younger and had primarily macular or posterior pole disease secondary to an ERM. Patients with retinopathy of prematurity, Coats disease, Norrie disease, and incontinentia pigmenti were excluded. Fourteen patients underwent vitrectomy with ERM peeling, and their preoperative and postoperative visual acuities were compared. The mean age at surgery was 8 years, with an average follow-up of 4.2 years (range, 6 months to 11 years). The average presenting visual acuity was 20/258. Average postoperative visual acuity was 20/100, with improvement in 12 patients (86%) and no change of visual acuity in 2 patients (14%). Pediatric ERMs respond well to vitrectomy and membrane peel with a low likelihood of recurrence. Other associated pathology, such as familial exudative retinopathy and combined hamartomas of the retina and retinal pigment epithelium, was associated with complications, such as delayed-onset rhegmatogenous retinal detachment from peripheral traction and recurrence of ERM in 7% of patients.

Extração da catarata pela técnica de facoemulsificação em pacientes com uveíte

To report outcomes of cataract extraction by phacoemulsification in patients with uveitis. We retrospectively reviewed the charts of 189 patients (242 eyes) with uveitis who underwent cataract extraction by phacoemulsification at the Uveitis and Ocular Immunology Unit of McGill University Health Centre, Montreal, Quebec, Canada. Average follow-up was 46 +/- 31.2 months. Average preoperative visual acuity was 20/100 and average postoperative visual acuity was 20/40. Hundred and forty-six eyes (59.9%) attained visual acuity better than 20/40. Visual loss occurred in 26 eyes. The most common peroperative complication was posterior capsule rupture with vitreous loss seen in 7 eyes (3%). Recurrence of uveitis was the most common postoperative complication seen in 73 eyes (30.16%). Other postoperative complications included iris atrophy (28.51%), ocular hypertension (28.09%), epiretinal membrane (26.44%), posterior capsule opacification (19%), cystoid macular edema (13.63%), ocular hypotony (12.80%), optic disc atrophy (8.67%) and posterior synechiae (6.61%). Cataract extraction by phacoemulsification is safe in patients with uveitis. Successful visual results are observed in long-term follow-up despite the prevalence of recurrence of uveitis, posterior capsule opacification and macular abnormalities. To the best of our knowledge this is the largest series presented to date.

Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement

AIMS/BACKGROUNDDeep lamellar keratoplasty (DLK) was performed to restore visual acuity in 120 eyes with corneal stromal opacification. DLK is believed to be an effective treatment in eyes in which endothelial...

Penetrating Keratoplasty for Pseudophakic Bullous Keratopathy Associated with Closed-loop Anterior Chamber Intraocular Lenses

Closed-loop anterior chamber intraocular lenses (AC IOLs) are associated with a high incidence of pseudophakic bullous keratopathy (PBK). The prognosis for recovery of vision with penetrating keratoplasty and the exchange of one type of AC IOL for another remains controversial. A total of 40 consecutive patients with closed-loop AC IOLs and varying degrees of PBK underwent penetrating keratoplasty, explantation of the closed-loop AC IOL, and implantation of a flexible tripod AC IOL—all done with a uniform technique. The average follow-up study was 24 months. Average preoperative visual acuity was 20/170 (range, 20/25-hand motions) and average postoperative visual acuity was 20/44 (range, 20/20-no light perception). A total of 23 eyes (57.5%) achieved a visual acuity of 20/40 or better. Eleven eyes (27.5%) had a visual acuity of 20/ 200 or worse. Persistent cystoid macular edema was the most frequent cause of poor vision postoperatively (4 eyes), followed by age-related macular degeneration (3 eyes) and graft rejection (2 eyes). This is the first series documenting a good visual outcome for at least 2 years after penetrating keratoplasty and exchange of a closed-loop AC IOL for a single type of flexible tripod AC IOL.

Control of intraocular pressure in glaucomatous eyes after extracapsular cataract extraction with intraocular lens implantation

Two hundred sixty eyes of 195 patients having extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens were studied retrospectively. Of these cases, 160 eyes had preexisting glaucoma while 100 had no ocular pathology except for cataract. Intraocularpressure decreased significantly after ECCE in both groups and slowly returned to baseline within two years. The average postoperative visual acuity was better in the control group than in the glaucoma group. Patients with glaucoma were controlled with less medication after surgery. We believe that ECCE with insertion of a posterior chamber intraocular lens can be safely performed in glaucoma patients and has a beneficial effect on the control of glaucoma.