Favorable Visual Outcome Research Articles

Descemet-stripping automated endothelial keratoplasty: a successful alternative to repeat penetrating keratoplasty

Although Descemet-stripping automated endothelial keratoplasty has replaced penetrating keratoplasty for primary treatment of endothelial disorders, many patients have already undergone penetrating keratoplasty. It is unclear when repeat penetrating keratoplasty is necessary or when endothelial keratoplasty may restore clarity to a failed graft. Retrospective case series of patients undergoing Descemet-stripping automated endothelial keratoplasty after penetrating keratoplasty by three surgeons at an academic tertiary care centre. Eight patients with Descemet-stripping automated endothelial keratoplasty after penetrating keratoplasty from 2006 to 2009. Microkeratome-prepared Descemet-stripping automated endothelial keratoplasty donor tissue was used. In seven cases, the penetrating keratoplasty bed was neither stripped nor scraped, and in one, scraping only was performed. Preoperative and 6-month postoperative best-corrected visual acuities in logMAR (logarithm of the minimum angle of resolution). The average pre-Descemet-stripping automated endothelial keratoplasty best-corrected visual acuity was 1.375, and the average best-corrected visual acuity 6months postoperatively was logMAR 1.0, a 2.5-fold improvement in the minimum angle of resolution (P=0.22). Seven of the eight patients showed an improvement in best-corrected visual acuity, and one patient had failure of Descemet-stripping automated endothelial keratoplasty and required penetrating keratoplasty. Five had a postoperative event: one had a gap that resolved spontaneously, three required rebubblings (injections of air only without otherwise repositioning the graft), and one experienced graft failure. Descemet-stripping automated endothelial keratoplasty can successfully rescue a prior penetrating keratoplasty, even with a fairly high detachment rate. Given these favourable visual outcomes, further study of this promising strategy is justified.

Regression of Serous Macular Detachment Due to Peripheral Exudative Hemorrhagic Chorioretinopathy following Intravitreal Bevacizumab

To describe a case of exudative macular detachment secondary to peripheral exudative chorioretinopathy with a favorable anatomic and visual outcome following treatment with intravitreal bevacizumab. The medical records of a patient with peripheral exudative chorioretinopathy were reviewed. Macular reattachment was achieved with a corresponding visual acuity improvement that was maintained over an uncomplicated 17-month clinical course. Bevacizumab may be an effective treatment option for exudative macular detachment secondary to peripheral exudative hemorrhagic chorioretinopathy.

Scleral fixation intraocular lens as a barrier for silicone oil in traumatic aphakia, aniridia, and recurrent retinal detachment:case report.

We report a patient with recurrent retinal detachment complicated with traumatic aniridia and aphakia, which was successfully managed by scleral fixation polymethyl methacrylate posterior chamber intraocular lens (PMMA PCIOL) and vitrectomy with silicon oil tamponade. Interventional case report. A 35-year-old man with traumatic aniridia, aphakia, and recurrent retinal detachment who received the combined surgery of scleral fixation PMMA PCIOL and vitrectomy with silicon oil tamponade. The patient had favorable visual outcome. The retina was reattached and the cornea remained clear without silicon oil in the anterior chamber after 1 year. The scleral fixation PMMA PCIOL can retain the silicone oil in the vitreous cavity for reattaching the retina and can also protect the corneal endothelium from contact with the silicone oil in the case of aniridia, aphakia, and retinal detachment.

New Look at Ocular Inflammation Control – Powerful and Fast-acting Twice-daily Bromfenac for a Novel Standard in the Treatment of Inflammation

Inflammation in the eye arising from various factors – including allergy, infection, injury and surgery – can have serious consequences, and can continue long after the cause is removed, resulting in permanently damaged vision. The treatment of ophthalmic inflammation after surgery has traditionally consisted of topical corticosteroids, but adverse events such as delayed healing, rise in intraocular pressure and increased susceptibility to microbial infections have driven the search for alternative treatments. Non-steroidal anti-inflammatory drugs (NSAIDs) have been used as alternatives to steroid treatments but also have limitations and cause adverse events. Bromfenac has emerged as a potent and safe treatment for inflammation after cataract surgery. Its unique chemical structure makes it a highly lipophilic molecule that penetrates all major ocular tissues in a rapid and sustained manner. It is also a potent inhibitor of the enzyme cyclo-oxygenase-2, which is believed to be the primary mediator of ocular inflammation. These properties permit less frequent dosing (twice-daily [BID]) and greater patient tolerability. A body of efficacy and safety data support use of bromfenac in this indication and it compares favourably with other NSAIDs and steroids in limiting post-operative inflammation. NSAIDs and corticosteroids have different, potentially synergistic effects. However, benefits specific to NSAIDs include lowering prostaglandin E-induced intraocular pressure elevation, no increased risk of secondary infections and stabilisation of the blood–aqueous barrier. With increasing demand for ophthalmic surgery, bromfenac and other treatments are likely to be important components in the treatment of inflammatory conditions after cataract surgery, decreasing pain and contributing to favourable visual outcomes.

Sphenoorbital meningioma: surgical technique and outcome

The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients [corrected], oculomotor palsy in 3 patients [corrected], and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months [corrected]. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively.Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

Neuro-retinitis asociada a enfermedad por arañazo de gato: Presentación de dos casos y revisión de la literatura

Cat scratch disease is the main clinical presentation of Bartonella henselae infection. However, ocular manifestations of bartonellosis occur in about 5 to 10% of the patients, mainly presenting as neuroretinitis, choroiditis or oculoglandular syndrome of Parinaud. We describe two patients with documented B. henselae infection and typical ocular compromise. Both patients were treated and had a favorable visual outcome.

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Cavernous malformations (CMs) of the optic pathway and hypothalamus (OPH) are extremely rare. Patients with these lesions typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retroorbital pain, and nausea. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature for reported cases of OPH CMs to analyze clinical and radiographic presentations as well as surgical approaches and neurological outcomes. A MEDLINE/PubMed search was performed, revealing 64 cases of OPH CMs. The authors report an additional case in the study, making a total of 65 cases. Each case was analyzed for clinical presentation, lesion location, radiographic features, treatment method, and visual outcome. In 65 patients with OPH CMs, the optic chiasm was affected in 54 cases, the optic nerve(s) in 35, the optic tract in 13, and the hypothalamus in 5. Loss of visual field and acuity was the most common presenting symptom (98%), followed by headache (60%). The onset of symptoms was acute in 58% of patients, subacute in 15%, and chronic progressive in 26%. Computed tomography scans revealed hyperdense suprasellar lesions, with calcification visible in 56% of cases. Magnetic resonance imaging typically demonstrated a heterogeneous lesion with mixed signal intensities suggestive of blood of different ages. The lesion was often surrounded by a peripheral rim of hypointensity on T2-weighted images in 60% of cases. Minimal or no enhancement occurred after the administration of gadolinium. Hemorrhage was reported in 82% of cases. Most patients were surgically treated (97%) using gross-total resection (60%), subtotal resection (6%), biopsy procedure alone (6%), biopsy procedure with decompression (23%), and biopsy procedure followed by radiation (2%). Those patients who underwent gross-total resection had the highest rate of visual improvement (85%). Two patients were treated conservatively, resulting in complete blindness in 1 patient and spontaneous recovery of vision in the other patient. Cavernous malformations of the OPH are rare and challenging lesions. Gross-total resection of these lesions is associated with favorable visual outcomes. Emergent surgery is warranted in patients presenting with chiasmal apoplexy to prevent permanent damage to the visual pathway.

Primary intraocular lens implantation for bilateral congenital cataracts in infants 0‐1 year old: long‐term anatomic and visual outcome

Abstract Purpose To assess the long‐term anatomic and visual outcome of cataract extraction with primary intraocular lens(IOL) implantation in infants <1 year old Methods We retrospectively reviewed 86 eyes of 43 infants operated for bilateral congenital cataract from 1999 to 2006. The surgical procedure was anterior capsulorhexis, phacoaspiration, posterior capsulotomy and anterior vitrectomy, with implantation of a PMMA or hydrophobic acrylic IOL in the bag or the sulcus.The following data were analyzed: age at the time of surgery, type of cataract, associated abnormalities, complications, final anatomic and refractive status, final best‐corrected visual acuity Results The mean age at the time of surgery was 4.3±2.7 months. The morphology of cataract was total(45%), nuclear(42%), zonular(9%) and posterior subcapsular(6%).There was a family history of congenital cataract in 16 infants.Two infants suffered psychomotor delay. The most common postoperative complications were posterior proliferation, requiring anterior vitrectomy in 31% of the eyes, ocular hypertension (16%) and posterior synechia (14%). After a mean follow‐up of 3.7±1.5 years, the final spherical equivalent refraction was ‐2.2±4.1 diopters. 59% of eyes achieved final BCVA ≥ 20/70, 23% had BCVA ≥ 20/25,18% had BCVA ≤ 20/20. Visual outcome is significantly better in the group of infants older >6 months. Conclusion Primary IOL implantation appears effective and safe in the management of bilateral congenital cataract in infants. Favorable visual outcomes can be achieved in the majority of cases. Opacification of the visual axis is the most common complication and the risk of glaucoma requires a careful long‐term follow‐up.

Combination therapy in exudative age-related macular degeneration: visual outcomes following combined treatment with photodynamic therapy and intravitreal bevacizumab

Objective: To measure visual outcomes following combined treatment with photodynamic therapy (PDT) and intra-vitreal bevacizumab for exudative age-related macular degeneration (AMD). Design: Single-centre, retrospective cohort analysis. Participants: One hundred and seventy-four eyes in 174 patients, representing a consecutive series of all patients with at least 6 months’ follow-up after combined treatment with PDT and bevacizumab for exudative AMD. Methods: Each patient was treated with PDT, followed by intravitreal injection of bevacizumab approximately 30 minutes later. The patients were then followed at 8–12-week intervals. The primary outcome of the study was the mean change in visual acuity (VA) from baseline. Results: One hundred seventy-four eyes in 174 patients completed at least 6 months’ follow-up, with a mean duration of 10 months. The mean number of treatments was 3.0 for bevacizumab and 1.4 for PDT. After stabilization, the mean treatment-free interval was 193 days, and 52% of the patients did not require postinduction retreatment. Mean VA improved from baseline at 2,4, and 6 months of follow-up ( p < 0.05). In the subgroup analysis, treatment-naïve patients had more favorable visual outcomes ( p < 0.05). Conclusions: The combination of PDT and intravitreal bevacizumab is an effective therapy for preserving VA in patients with exudative AMD.

Pars plana lensectomy combined with pars plana vitrectomy for dislocated cataract

To assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for visual correction of complicated cataract. Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. This retrospective study reviewed the preoperative, intraoperative, and postoperative clinical features in eyes that had PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology (study group). The corrected distance visual acuity (CDVA), reoperations, retinal detachment (RD), and cystoid macular edema (CME) were ascertained. Results were compared with those in a control group of eyes having combined PPV and lensectomy for uncomplicated cataract. In the study group (40 patients), 23 eyes had traumatic lens dislocation, 12 had Marfan syndrome, 7 had idiopathic lens dislocation, and 4 had pseudoexfoliation syndrome. The median corrected distance visual acuity improved from 20/185 (range 20/20 to hand motions) preoperatively to 20/30 (range 20/20 to hand motions) 3 months postoperatively (P<.001). The postoperative CDVA was poorer in cases with an etiology of trauma (P = .018). Complications included RD (6.5%), transient vitreous hemorrhage (13.0%), choroidal detachment (4.3%) and CME (13.0%), which occurred more frequently in eyes with a history of trauma (P = .022). The control group (43 eyes; 42 patients) had 1 (2.3%) RD. Pars plana vitrectomy with lensectomy yielded favorable visual outcomes in eyes with complicated cataract in which standard anterior segment techniques were prohibitive or risky. However, preexisting conditions and postoperative complications may limit visual outcomes. Neither author has a financial or proprietary interest in any material or method mentioned.

FACTORS CORRELATED WITH POSTOPERATIVE VISUAL ACUITY AFTER VITRECTOMY AND INTERNAL LIMITING MEMBRANE PEELING FOR MYOPIC FOVEOSCHISIS

The purpose of this study was to determine the factors that are correlated with the visual outcomes in patients who underwent pars plana vitrectomy with internal limiting membrane peeling for myopic foveoschisis (MF). In this retrospective, interventional consecutive case series, 39 eyes of 39 consecutive patients who had undergone pars plana vitrectomy with internal limiting membrane peeling for MF were studied. Preoperative optical coherence tomography showed that none of the eyes had a macular hole or vitreoretinal traction. Eyes were divided into those with MF and a foveal detachment (FD; FD group, n = 27) and those with MF without an FD (no-FD group, n = 12). The main outcome measures were best-corrected visual acuity (BCVA) and the optical coherence tomography findings. Optical coherence tomography showed a complete resolution of the MF with a reattachment of the fovea in all eyes, and the retina remained attached during the mean follow-up of 41 months. The final mean BCVA improved significantly in the FD group (P = 0.0003) but not in the no-FD group (P = 0.56). The final BCVA of the FD group and no-FD group improved in 70% and 42%, remained unchanged in 26% and 33%, and worsened in 4% and 25% of the eyes, respectively. A better final BCVA was significantly correlated with a better preoperative BCVA (P < 0.0001), a shorter axial length (P = 0.045), and the presence of an FD (P = 0.028). Pars plana vitrectomy with internal limiting membrane peeling results in long-term favorable anatomical and visual outcomes. Eyes with an FD may be good candidates for surgery.

Surgical Management of Vitreofoveal Traction Syndrome: Optical Coherence Tomographic Evaluation and Clinical Outcomes

To characterize vitreofoveal traction syndrome and to correlate clinical observations, optical coherence tomography features, and surgical results. A retrospective, consecutive, interventional case series of 36 patients. Clinical and optical coherence tomography features taken from patient charts were compared preoperatively and postoperatively and correlated with visual outcomes. Preoperatively, visual acuity ranged from 20/40 to 20/400 and improved more than 2 lines in 50% of eyes. A macular hole developed in 2 eyes. The optical coherence tomography appearance of traction resolved in all eyes; cystic change improved markedly or resolved in 86% of eyes. Preoperative optical coherence tomography features did not correlate with visual acuity. Patients with symptoms for less than a 6-month duration (P = .048) were more likely to obtain a visual acuity of 20/40 or better postoperatively. Presence or resolution of macular cystic changes and subretinal fluid did not correlate with visual acuity or change (P > .05). Patients with vitreofoveal traction syndrome usually achieve favorable visual optical coherence tomography outcomes after pars plana vitrectomy.

Epithelial Debridement for Epithelial Basement Membrane Abnormalities Associated with Endothelial Disorders

Epithelial basement membrane dystrophy (EBMD) is a corneal condition most commonly observed as a primary disease; less commonly it can also be seen as secondary to endothelial cell dysfunction. Epithelial debridement with or without polishing of the Bowman layer is a safe and effective way of removing the dystrophic basement membrane and promoting a smoother epithelial surface. Indications for debridement include symptoms of recurrent corneal erosions and vision loss attributable to epithelial irregularity. In this article we also present follow-up data on patients for whom we have previously performed epithelial debridement for EBMD in the setting of Fuchs endothelial dystrophy and iridocorneal endothelial syndrome, with favourable visual outcomes. We also present two new cases of EBMD that limited visual acuity after Descemet stripping automated endothelial keratoplasty, who responded successfully to epithelial debridement.

Incidence, Clinical Features, Causative Organisms, and Visual Outcomes of Delayed-Onset Pseudophakic Endophthalmitis

To report the incidence, clinical features, causative organisms, and visual outcomes associated with delayed-onset pseudophakic endophthalmitis. We retrospectively reviewed the clinical records and microbiology files of all patients with culture-proven endophthalmitis that was present 6 weeks or more after cataract extraction and posterior chamber intraocular lens (IOL) implantation who were treated at King Khaled Eye Specialist Hospital (KKESH) during a 10-year period. From January 1997 through December 2006, 17 patients with culture-proven, delayed-onset pseudophakic endophthalmitis were treated at KKESH. Of the 17 cases, only 5 cases developed delayed-onset endophthalmitis, among 29,509 cataract surgeries performed at KKESH, indicating an incidence rate of 0.017% (5/29,509). The mean time between cataract surgery and diagnosis of endophthalmitis was 5+/-2.48 months. The culture isolates revealed Propionibacterium acnes in 7 (41.2%) eyes, polymicrobial (mixed) infections in 3 (17.6%) eyes, Staphylococcus species in 3 (17.6 %) eyes, fungal infections in 3 (17.6%) eyes, and Alcaligenes xylosoxidans in 1 (5.9%) eye. The mean follow-up period was 29.8 months. The final visual outcomes were as follows: 7 eyes (41.2%) achieved a final best-corrected visual acuity of >or=20/60; 6 eyes (35.3%) achieved a best-corrected visual acuity of <20/60 to >or= count fingers; 2 eyes (11.8%) had hand motion to light perception vision; and 2 eyes (11.8%) were enucleated. In this study, infection by P acnes was the most common cause of delayed-onset pseudophakic endophthalmitis and had the most favorable visual outcome, whereas fungal endophthalmitis had the worst visual prognosis.

Intravitreal Bevacizumab vs Sub-Tenon Triamcinolone Acetonide for Choroidal Neovascularization Attributable to Pathologic Myopia

To compare the visual outcomes of intravitreal bevacizumab (Avastin; Genentech Inc, South San Franciso, California, USA) and sub-Tenon triamcinolone acetonide (TA) for choroidal neovascularization attributable to pathologic myopia (mCNV). Retrospective, comparative, interventional case series. Fifty-four consecutive eyes of 53 patients with mCNV treated with either sub-Tenon TA or intravitreal bevacizumab in an institutional setting were included. Twenty eyes were treated with sub-Tenon TA and 34 eyes were treated with intravitreal bevacizumab. The main outcome measures included best-corrected visual acuity (BCVA) 12 months after the initial injection and logarithm of the minimum angle of resolution gain from baseline compared with analysis of covariance (ANCOVA). At 12 months, the BCVA improved by 1.9 lines in the intravitreal bevacizumab group and worsened by 0.3 lines in the sub-Tenon TA group. Thus, the intravitreal bevacizumab group had significantly greater visual improvement than the sub-Tenon TA group (P < .01). Statistical analysis (ANCOVA) revealed that age (P = .01), pretreatment BCVA (P < .01), and the treatment choice (intravitreal bevacizumab or sub-Tenon TA; P < .01) correlated significantly with the BCVA and the BCVA gain at 12 months. The refractive error was of borderline significance (P = .06). Although this study is limited because of its retrospective nature, intravitreal bevacizumab seems to result in a more favorable visual outcome than sub-Tenon TA in the treatment of mCNV. Patient age, the BCVA before treatment, and the refractive error must be considered to initiate the treatment.

Long-term visual outcomes of laser-treated threshold retinopathy of prematurity: a study of refractive status at 7 years

To assess the long-term visual outcomes and refractive status in patients with diode laser-treated threshold retinopathy of prematurity (ROP), and to investigate the causes of impaired visual function. A total of 60 eyes of 30 consecutive patients with diode laser-treated threshold ROP were recalled for assessment at the age of 7 years or more. There were 38 eyes (65.5%) achieving 6/12 or better vision, however, an unfavourable visual outcome (6/60 or worse) occurred in four eyes (6.9%). One eye (1.7%) had unfavourable structural outcome. Of these 60 laser-treated eyes, 46 eyes (77.0%) were myopic, the overall mean spherical equivalent was -3.87 D. Anisometropia (>or=1.5 D) was also noted in 14 patients (46.7%). Strabismus was present in nine patients (30.0%). Perinatal neurological events of intraventricular haemorrhage (IVH) were identified in eight children (26.7%), periventricular leucomalacia (PVL) in eight children (26.7%), and cerebral palsy (CP) in four children (13.3%). There was a statistically significant association of the presence of strabismus with PVL (P=0.002). The presence of anisometropia was a significant risk factor associated with poor visual outcome of 6/15 or worse in laser-treated ROP (P=0.002). The majority of patients with diode laser-treated threshold ROP had favourable anatomical and visual outcomes. However, anisometropia, advanced refractive error, strabismus, and perinatal neurological events remain important causes of impaired visual function. Long-term follow-up is very important for early detection and timely treatment of these ocular morbidities.

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

PurposePostoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity.MethodsThe present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections.ResultsRetinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart.ConclusionsEarly extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.

Laser flare photometry in the therapeutic management of bacterial chronic pseudophakic endophthalmitis

To evaluate laser flare photometry in measuring aqueous humor inflammation in chronic pseudophakic endophthalmitis. Department of Ophthalmology, Pitié Salpétrière Hospital, Paris, France. This retrospective review comprised eyes with chronic pseudophakic endophthalmitis that were evaluated by slitlamp and laser flare photometry at admission and during follow-up. Nine eyes of 8 patients were reviewed. The laser flare photometry values were significantly reduced by antibiotic treatment in all eyes. The laser flare photometry values increased after antibiotic treatment was withdrawn in 7 eyes. Early detection of the relapse by laser flare photometry was confirmed at the slitlamp examination in the following days. Laser flare photometry, a noninvasive objective tool, was useful in monitoring the evolution of chronic pseudophakic endophthalmitis. Early detection of an increase in flare could lead to a close follow-up. The prompt modification of therapeutic intervention could help preserve a favorable visual outcome.

Sympathetic ophthalmia

Sympathetic ophthalmia (SO) is a rare, bilateral, non-necrotizing, granulomatous uveitis that occurs after ocular trauma or surgical procedures to one eye threatening sight in the fellow eye. The pathophysiology is not clearly understood, but it appears that the disrupted integrity of the inciting eye leads to an autoimmune hypersensitivity reaction against the exposed ocular antigens in the injured eye as well as in the sympathizing eye. More recently, vitreoretinal surgery has been noted to be a risk factor for the development of SO. Medline search for case reports of sympathetic ophthalmia with links to full text in English yielded articles for review of patient demographics, clinical presentation and examination, therapies and final visual acuity. Eighty-six patients with SO were included in this review. Sixty-two patients were male and 24 were female with an average age of 46 years. Injuries accounted for 47% of patients while ocular surgery was reported in 44% of patients with pars plana vitrectomy occurring in 21%. Most patients reported reduced vision and presented with uveitis. Ninety-five percent of them received systemic corticosteroid therapy and 75% of patients also received immunomodulators. About 70% of patients had improved visual acuity in their sympathizing eye at their last reported evaluation. Sympathetic ophthalmia warrants prompt evaluation and treatment to maintain a favorable visual outcome. Ocular surgeries including vitreoretinal surgery and cyclodestructive procedures have been noted to be risk factors for the development of sympathetic ophthalmia. With current medical management including corticosteroids and immunomodulators visual prognosis is relatively good.

Vitrectomy cryo gas for the treatment of pseudophakic retinal detachment

Abstract Purpose The management of pseudophakic rhegmatogenous retinal detachment (PsRD) has represented a challenge for vitreoretinal surgeons for many years. Different surgical techniques have been used to manage PsRD including pneumatic retinopexy, scleral buckling (SB) and primary pars plana vitrectomy (PPV) with or without SB. Recent advances in the vitrectomy technique and instrumentation have contributed to the expanding role of PPV as a first‐line surgical treatment in cases of PsRD. Methods A potential advantage of PPV is removal of posterior capsular and vitreous opacities for better visualisation of the peripheral retina and the use of wide‐angle viewing systems and microscopic inspection of the fundus periphery with internal illumination and scleral identation during PPV. This allows for an accurate diagnosis of retinal breaks, their prompt treatment and thus high initial anatomical success. Results A meta‐analysis of published studies suggested that PPV with or without SB is more likely to achieve favorable anatomical and visual outcomes than conventional scleral buckling alone in uncomplicated PsRD. Recently published prospective or randomized clinical trials also found that primary PPV alone is at least as effective as scleral buckling for the treatment of PsRD. The Scleral Buckling versus Primary Vitrectomy in Rhematogenous Retinal Detachment study, found no difference in visual acuity between PPV and SB alone in pseudophakic eyes, but anatomic outcomes were better in the PPV group. Conclusion Primary vitrectomy without scleral buckling provides a high anatomic success rate in eyes with PsRD and is associated with few complications.