Final BCVA Research Articles

Five-Year Follow-up Results of Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To evaluate the 5-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). Retrospective study. Forty-two eyes of 36 patients with PCV followed up for at least 60 months after PDT were reviewed. All eyes were primarily treated with PDT. Main outcome measure was best-corrected visual acuity (BCVA; logMAR [logarithm of minimal angle of resolution]) at baseline and at each follow-up visit. We also classified the eyes into 3 groups: improved (improvement ≥0.3 logMAR), decreased (deterioration ≥0.3 logMAR), and stable. During the mean follow-up duration, 73.64 ± 13.47 months, the mean number of PDT was 2.21 ± 1.62 treatments. Recurrence was noted in 33 eyes (78.6%) during follow-up. The mean baseline BCVA was 0.78 ± 0.48 logMAR (20/120 Snellen equivalent), and the final BCVA at 60 months was 0.67 ± 0.52 logMAR (20/93 Snellen equivalent) (P = .050, paired t test). On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%), stable in 23 eyes (54.8%), and decreased in 5 eyes (11.9%). At 60 months after initial PDT, 88.1% of PCV patients showed stable or improved BCVA after PDT. Despite a high recurrence rate, PDT remained effective for 5 years, and represents a good therapeutic approach to PCV.

Cirugía de las membranas epirretinianas: resultados anatómicos y funcionales

ObjectiveTo study the influence of anatomic preoperative characteristics (based on the parameter, foveal central thickness, measured by optical coherence tomography) and functional characteristics (based on the parameter, best corrected visual acuity, [BCVA]) on functional recovery after epiretinal membrane (ERM) surgery. MethodsA total of 88 eyes (of 86 patients), on whom a vitrectomy due to ERM was performed during a 3 years period were reviewed in this longitudinal, prospective study.An analysis was made of, ERM aetiology, BCVA, presence or absence of metamorphopsia, lens status, and central foveal thickness. Data relating to surgery and local complications, changes in BCVA, and changes in foveal central thickness were collected during the follow-up period. ResultsAn improvement was in observed in BCVA in 82%, as well as a decrease in foveal thickness in 79% of the eyes which underwent surgery, both of these being statistically significant (P<.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. A significant correlation was found between preoperative and postoperative BCVA (P=.001), and also between preoperative and postoperative central foveal thickness (P=.004), but not between BCVA and foveal thickness. ConclusionsThere is functional recovery in terms of BCVA in more than 80% of the patients after ERM surgery. Most of the eyes showed persistent macular thickening, but this did not seem to have influenced the final BCVA. The best determinant of postoperative functional recovery (postoperative visual acuity) is, in our experience, the preoperative BCVA, and not the macular thickness.

Five‐year follow‐up results of photodynamic therapy for polypoidal choroidal vasculopathy

AbstractPurpose To evaluate the 5‐year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).Methods Forty‐two eyes of 36 patients with PCV followed up for at least 60 months after PDT were retrospectively reviewed. The diagnosis of PCV was based on indocyanine green angiography (ICGA), showing branching vascular network with polypoidal components. All eyes were primarily treated with PDT, and retreated with PDT and anti‐vascular endothelial growth factor (VEGF) injection or with only anti‐VEGF injection. The recurrence of PCV was defined as the emergence of active polypoidal lesions observed with fluorescein angiography (FA) and ICGA. Retreatment was performed when leakage of fluorescein or subretinal fluid/intraretinal cyst on optical coherence tomography was noted during follow‐up examiinations.Results During the mean follow‐up duration, 73.64±13.47 months, the mean number of PDT was 2.21±1.62 times, and the mean number of anti‐VEGF injection was 5.05±5.55 times. Recurrence was noted in 33 eyes (78.6%) during follow‐up. The mean baseline BCVA was 0.78±0.48 logarithm of the minimum angle of resolution (logMAR), and the final BCVA at 60‐month follow‐up was 0.68±0.54 logMAR. On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%) by at least 0.3 logMAR, stable (mean BCVA change within 0.2 logMAR from baseline) in 23 eyes (54.7%), and decreased in 5 eyes (11.9%) by at least 0.3 logMAR.Conclusion After 5 years, 88.1% of patients showed stable or improved BCVA after PDT. Despite of high recurrence rate up to 78.6%, PDT was effective for 5 years, and seems to be a good option of treatment in PCV patients.

Implication of functional and anatomical preoperative characteristics in the outcomes of epiretinal membrane (ERM) surgery

AbstractPurpose To study the implication and meaning of preoperative functional and anatomical characteristics (based on the parameters Best Corrected Visual Acuity, BCVA, and foveal central thickness, measured by Optical Coherence Tomography, OCT) in the evolution after ERM surgery.Methods In this longitudinal, prospective study we reviewed 88 eyes (of 86 patients), on whom we had performed vitrectomy or faco‐vitrectomy due to ERM, with a follow‐up period of three years. We analyzed: ERM etiology, BCVA, metamorphopsia, lens status, and central foveal thickness measured by OCT. We collected the following data during the follow‐up: type of surgery (isolated vitrectomy or combined surgery), local complications, changes in BCVA, and changes in foveal central thickness.Results We observed an improvement in BCVA, and also a decreasement in foveal thickness, being both statistically significant (p&lt;0.01). However, most of the patients showed different grades of oedema and/or macular thickening in the postoperative period. We found significant correlation between preoperative and postoperative BCVA (p=0,001), and also between preoperative and postoperative central foveal thickness (p=0,004), but not between BCVA and foveal thickness.Conclusion A functional recuperation occurs (based on BCVA) in more of 80% of the patients, after ERM surgery. Most of the eyes show persistent macular thickening, but this does not seem to have influence on the final BCVA. The best determinant of postoperative functional recuperation is, in our experience, the preoperative BCVA, and not the macular thickness.

A prospective study on different methods for the treatment of choroidal neovascularization. The efficacy of verteporfin photodynamic therapy, intravitreal bevacizumab and transpupillary thermotherapy in patients with neovascular age-related macular degeneration

SummaryBackgroundThe aim of this study was to compare the efficacy of verteporfin photodynamic therapy (PDT), intravitreal injections of bevacizumab (IVB) and transpupillary thermotherapy (TTT) in patients with neovascular age-related macular degeneration (AMD).Material/MethodsThe study design was a prospective, interventional, comparative case series. Between December 2006 and March 2009, 426 eyes of 426 consecutive patients presenting with neovascular AMD were included into the study. Patients presented with subfoveal CNV predominantly classic, minimally classic, and occult with no classic component; lesion size less than 5000 μm in the greatest linear dimension, and the area of hemorrhages ≤1/3 were randomized to receive either PDT (group I) or IVB (group II) in a 1:1 ratio. Other patients with CNV were included into the group III and received TTT.ResultsOne hundred eyes were treated with PDT. Mean baseline logMAR BCVA was 0.62 and final visual acuity decreased to 0.74 (p<0.05, Wilcoxon test); 104 eyes were treated with IVB. Mean baseline BCVA was 0.82 and final visual acuity increased to 0.79 (p>0.05, Wilcoxon test); 222 patients were treated with TTT. Mean baseline BCVA was 1.10 and final visual acuity decreased to 1.15 (p>0.05, Wilcoxon test). Among all eyes the average number of treatment sessions was 2.34 (SD 1.17).ConclusionsOur study shows that IVB injections had the best efficacy in the improvement of final BCVA. However, both IVB and TTT demonstrated good stabilization of vision. Although after PDT final BCVA was significantly worse from baseline, it may also be beneficial for some patients with neovascular age-related macular degeneration.

Sulcus Suture Fixation of a Foldable IOL over Preserved Capsule for Managing Lens Subluxation in Marfan’s syndrom

Aim: To study the feasibility and efficacy of removal of the subluxated lens and sclera fixation of a foldable intraocular lens on top of the decentered preserved capsular bag. Patients and methods. Seventeen eyes of 10 patients (9 - 15 years) were done by phacoaspiration followed by trans-scleral fixation of foldable IOL in the sulcus on top of the decentered capsular bag of the subluxated lens. Results: Postoperative refraction spherical equivalent amplitude ranged from 0.25 to 1.38 diopters with a mean of 1.35 ± 1.13 diopters. The final postoperative BCVA ranged from 6/18 to 6/6 with a mean of 6/9 (0.67 ± 0.25 decimal). Intraoperative complications were hyphema in one case and accidental small zonular injury without vitreous prolapsed during needle passage in two cases. Postoperative complications were transient iridocyclitis in one case. Posterior capsular opacification (PCO) occurred in all cases but in thirteen cases the bag gets contracted and the opacity was away from the visual axis and only four cases needed YAG posterior capsulotomy. Conclusion: Combined sulcus and scleral fixation of foldable intraocular is a safe and effective method. This technique of keeping the decentered bag attached to the stretched zonules will prevent IOL tilt and avoid working on the vitreous with its known complications. Scleral fixation of the foldable IOL guarantees the long term stability and gets the benefits of small incision surgery.

The outcome of congenital cataract surgery in Kuwait

Aim Congenital cataract is the most common cause of treatable blindness in children and the outcome of congenital cataract surgery has not been studied in Kuwait, so the purpose of this study is to evaluate the visual outcome and the postoperative complications. Methods Medical records of children who underwent congenital cataract surgery between September 2000 and December 2008 at Al-Bahar Eye Center, Ministry of Health of Kuwait were retrospectively reviewed. In 100 eyes that fill the inclusion criteria visual acuity and postoperative complications were recorded. The mean follow up was 3.9 ± 1.7 years with range from 3 to 6 years. Results The mean age of congenital/developmental cataract surgery is 8.9 ± 8.7 months for bilateral cases and it was 5.75 ± 4.61 months for unilateral cases. The mean final postoperative BCVA in unilateral cases was 1.0 (20/200) log MAR unit and it was 0.3 (20/40) log MAR unit for the bilateral cases. Four percent of the cases developed postoperative glaucoma and 2% of them developed significant opacification of the posterior capsule. Conclusion Our findings provide evidence of recent improvement over time in the visual prognosis in bilateral, and to a lesser degree, unilateral cataract, in children in Kuwait.

INFLUENCE OF SYSTEMIC STEROIDS ON SUBRETINAL FLUID AFTER SCLERAL BUCKLE SURGERY FOR MACULA-OFF RETINAL DETACHMENT

To investigate the effect of postoperative systemic steroid therapy on the incidence and duration of the subretinal fluid (SRF) and its correlation with the visual outcome after scleral buckle surgery for macula-off rhegmatogenous retinal detachment. Prospective interventional study of sixty patients with macula-off rhegmatogenous retinal detachment who undertook scleral buckle surgery. Those patients who had recurrent retinal detachment, proliferative preretinal membrane, or primary surgical failure were excluded. Patients were assigned to Group 1 (with prescription of oral prednisolone for 3 days postoperatively) and Group 2 (with no such prescription).Furthermore, patients in Group 1 were subdivided into Group 1A (0.5 mg prednisolone/kg)and Group 1B (1 mg prednisolone/kg) according to the dosage of prednisolone. Patients were followed-up initially 1 week and 2 weeks after surgery and then on a monthly basis for at least 1 year. After the operation, all patients had corrected visual acuity and also received examinations of indirect ophthalmoscopy and optical coherence tomography. We compared the incidence, duration of SRF, and the correlation with the visual outcome between the groups. Lower incidence of SRF was noted in Group 1 than in Group 2 (56.7% vs. 80%;P = 0.052), and the duration of SRF was significantly shorter in Group 1 than in Group 2 (218 days vs. 286 days; P = 0.039). There was no significant difference in the final BCVA between the two groups. However, patients in Group 1 had greater improvements of BCVA 1 year after operation (13 lines vs. 7 lines in Groups 1 and 2, respectively; P = 0.026). Statistically,there were no difference between Groups 1A and 1B, in terms of the incidence of SRF,duration of SRF, final BCVA, and improvement of BCVA. Postoperative systemic steroid treatment may decrease the incidence of SRF and facilitate the absorption of SRF. Patients treated with steroids had greater improvement of BCVA.

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 &lt;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 &gt;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.

Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion

BackgroundTo identify predictive factors for improvement of visual acuity and central retinal thickness by intravitreal bevacizumab for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO).MethodsTwo hundred and five eyes from 204 patients with ME secondary to BRVO were retrospectively included at six sites. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.05 ml). The mean follow-up was 36.8 ± 12.7 weeks (range, 18 to 54 weeks). Measurement of ETDRS best-corrected visual acuity (BCVA, in all eyes) and optical coherence tomography (OCT, in 87% of eyes) were performed at baseline and at follow-up examinations every 12 weeks. Using fluorescein angiography, the perfusion status of the macula at baseline could be assessed in 84% of the eyes. The main outcome measures were changes in BCVA and central retinal thickness (CRT). For analysis of predictive factors, the results at 24 weeks were used.ResultsThe median BCVA was 0.6 LogMAR at baseline and improved to 0.4 LogMAR at 24 and 48 weeks. This visual improvement was associated by a significant reduction in CRT, decreasing from a baseline of 454 μm to 267 μm and 248 μm after 24 and 48 weeks respectively. Eyes with ME and intact (perfused) or interrupted (ischemic) foveal capillary ring showed a 2-line increase of median BCVA [45 eyes (22%) and 128 eyes (62%) respectively]. However, the final median BCVA was significantly worse in eyes with ischemic ME (0.6 versus 0.3 logMAR in perfused ME). Other factors for visual improvement were absence of previous treatments of the ME, age younger than 60 years and low baseline BCVA (≥0.6 logMAR) (2, 3, and 2 median BCVA lines increase respectively). Furthermore, eyes with duration of the ME of less than 12 months responded with a 3-line increase of the median BCVA. Final CRT only showed minor differences between the subgroups. During the entire follow-up, retreatments were performed in 85% of the eyes, with a median number of injections of three (mean 3.2; range, 1 to 10) and a median time-interval between injections of 11.6 weeks (mean 14.6 weeks).ConclusionsIntravitreal injection of bevacizumab resulted in a significant improvement of BCVA and reduction of ME in BRVO. Baseline BCVA, patient’s age, and duration of BRVO were found to be of prognostic relevance for visual improvement. A less favorable outcome of the bevacizumab therapy in eyes with longstanding BRVO would advocate initiation of treatment within 12 months after onset.

Analysis of the Maular Change in Optical Coherent Tomography after Internal Limiting Membrane Peeling

Purpose: To analyse the postoperative anatomical changes of maculae using optical coherent tomography after internal limiting membrane peeling during vitrectomy. Methods: A retrospective review of 22 patients (22 eyes) who underwent vitrectomy with internal limiting membrane peeling was performed. Age, sex, fundus findings, BCVA, operation methods, complications, and postoperative OCT findings were recorded. Results: Of 22 eyes, 12 eyes had epiretinal membranes, 5 eyes had macular holes, and 5 eyes had diffuse diabetic macular edemas. Eighteen of 22 eyes underwent internal limiting membrane peeling using ICG, with 1 eye treated with triamcinolone and 3 eyes treated with nothing. The postoperative improvement of BCVA was statistically significant in epiretinal membrane and diffuse macular edema patients (p0.05). Postoperative OCT findings of 17 eyes showed that they had returned to normal shape and thickness. However, among the 18 eyes that underwent ICG dye-assisted ILM, 3 eyes showed irregular macular thinning and 1 eye showed macular cystic changes. One eye treated with triamcinolone presented with a recurrent cytoid macular edema. No postoperative complications or recurrences were reported by epiretinal membrane patients. Conclusions: Changes to macular shape did not significantly affect the final BCVA after internal limiting membrane peeling, but they can cause changes to the microstructure of maculae. Therefore, caution during surgery and close follow-up are necessary.

PHOTODYNAMIC THERAPY AND HIGH-DOSE INTRAVITREAL TRIAMCINOLONE TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION

To evaluate the efficacy of photodynamic therapy (PDT) and high-dose intravitreal triamcinolone acetonide (TA) injection to treat choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD) at the 2-year follow-up. In this prospective, consecutive, comparative, nonrandomized, interventional case series, 30 eyes of 30 consecutive patients with subfoveal CNV associated with AMD were treated by PDT followed by intravitreal injection of 19.4 +/- 2.1 mg TA. Fifteen eyes were naive to treatment (group 1), and 15 had been treated previously by PDT alone (group 2). A group of 15 eyes of 15 patients treated by PDT alone served as controls. The number of Snellen lines gained or lost and PDT sessions were evaluated. Best-corrected visual acuity (BCVA) did not change significantly in group 1 from baseline (0.0 +/- 3.4 Snellen line; range, -5 to 9 Snellen lines; P = 0.81); group 2 lost an average -0.6 +/- 2.5 line (range, -7 to 3 Snellen lines) (P = 0.41), and the control group lost an average of -2.2 +/- 3.4 lines (range, -8 to 2 Snellen lines) (P = 0.03, Wilcoxon signed rank test). The average number of PDT sessions during the 24-month follow-up was 1.9, 1.2, and 3.9 for group 1, group 2, and the control group, respectively. Two years after combined PDT/high-dose intravitreal TA to treat AMD-associated CNV, final BCVA was stable, and the need for retreatment was reduced compared with historical controls.

PHOTODYNAMIC THERAPY AND HIGH-DOSE INTRAVITREAL TRIAMCINOLONE TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION

In Brief Purpose: To evaluate the efficacy of photodynamic therapy with verteporfin (PDT) and high-dose intravitreous triamcinolone acetonide to treat choroidal new vessels (CNVs) associated with age-related macular degeneration (AMD). Methods: In this prospective, consecutive, comparative, nonrandomized, interventional case series, 30 consecutive eyes of 30 patients with subfoveal CNVs associated with AMD were treated with PDT followed by the intravitreal injection of 19.4 ± 2.1 mg /0.1 mL triamcinolone 5 days later. Fifteen eyes had received no previous treatment (group 1), and 15 had been treated previously with PDT alone (group 2). A group of 15 eyes of 15 patients treated with PDT alone, matched for age and CNV composition and size, served as controls. Changes in best-corrected visual acuity (BCVA; logMAR), the number of Snellen lines improved or lost, and the number of PDT sessions were considered as primary outcome indicators. Results: Group 1 improved an average of 0.7 ± 3.7 Snellen lines (range, −5 to 10) (P = 0.62), group 2 lost an average of −0.7 ± 1.5 Snellen lines (range, −5 to 1) (P = 0.08), and the control group lost an average of −2.2 ± 0.4 Snellen lines (range, -9 to 4) (P = 0.06; Wilcoxon signed rank test). The average number of PDT treatments during the 12-month follow-up was 1.6, 1.2, and 2.8 for group 1, group 2, and the control group, respectively. Intraocular pressure rose in 8 (57%) of 14 eyes in group 1 and in 7 (50%) of 14 eyes in group 2. Cataracts developed in 4 eyes (31%) in group 1 and in 4 eyes (33%) in group 2. Conclusion: Combined PDT/intravitreal triamcinolone acetonide as treatment for AMD-associated CNVs was associated with improved final BCVA and reduced the need for retreatment compared with historical controls. Combined Photodynamic therapy followed by intravitreal triamcinolone acetonide injection at high dose (±20 mg) as treatment for AMD-associated CNVs in all lesion types was associated with improved final vision and reduced the need for retreatment rate compared to historical controls.

PHOTODYNAMIC THERAPY AND HIGH-DOSE INTRAVITREAL TRIAMCINOLONE TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION

To evaluate the efficacy of photodynamic therapy with verteporfin (PDT) and high-dose intravitreous triamcinolone acetonide to treat choroidal new vessels (CNVs) associated with age-related macular degeneration (AMD). In this prospective, consecutive, comparative, nonrandomized, interventional case series, 30 consecutive eyes of 30 patients with subfoveal CNVs associated with AMD were treated with PDT followed by the intravitreal injection of 19.4 +/- 2.1 mg /0.1 mL triamcinolone 5 days later. Fifteen eyes had received no previous treatment (group 1), and 15 had been treated previously with PDT alone (group 2). A group of 15 eyes of 15 patients treated with PDT alone, matched for age and CNV composition and size, served as controls. Changes in best-corrected visual acuity (BCVA; logMAR), the number of Snellen lines improved or lost, and the number of PDT sessions were considered as primary outcome indicators. Group 1 improved an average of 0.7 +/- 3.7 Snellen lines (range, -5 to 10) (P = 0.62), group 2 lost an average of -0.7 +/- 1.5 Snellen lines (range, -5 to 1) (P = 0.08), and the control group lost an average of -2.2 +/- 0.4 Snellen lines (range, -9 to 4) (P = 0.06; Wilcoxon signed rank test). The average number of PDT treatments during the 12-month follow-up was 1.6, 1.2, and 2.8 for group 1, group 2, and the control group, respectively. Intraocular pressure rose in 8 (57%) of 14 eyes in group 1 and in 7 (50%) of 14 eyes in group 2. Cataracts developed in 4 eyes (31%) in group 1 and in 4 eyes (33%) in group 2. Combined PDT/intravitreal triamcinolone acetonide as treatment for AMD-associated CNVs was associated with improved final BCVA and reduced the need for retreatment compared with historical controls.

Scleral-fixated posterior chamber intraocular lenses in nonvitrectomised eyes

To assess the long-term outcome of scleral-fixated sutured posterior chamber intraocular lens (SPCIOL) implantation in non pars plana vitrectomised eyes (1) to evaluate the long-term visual outcome, (2) to identify preoperative risk factors for poor visual outcomes, and (3) to identify the incidence of vitreoretinal complications. A retrospective review of 65 eyes, which had not undergone pars plana vitrectomy prior to scleral-fixated SPCIOL implantation. In all, 65 eyes of 61 patients were analysed. The median follow-up period was 16 months (range 1-68 months). At final follow-up, 43 (66%) eyes had unchanged or improved BCVA at final follow-up. A total of 20 (31%) eyes had at least a two line improvement and eight (12%) eyes had at least a two line deterioration in final BCVA. No significant preoperative risk factors for a poor visual outcome were identified. In all, 24 eyes (37%) had per- and postoperative adverse events. These eyes were significantly more likely to have a poor visual outcome. Three eyes (4.6%) had a retinal detachment in the postoperative period, all of which had no perception of light at final follow-up. This study confirmed that while scleral-fixated SPCIOL intraocular lens implantation might be beneficial, there is a significant risk of per- and postoperative complications leading to loss of best-corrected vision in some eyes.

Autologous platelets for macular hole surgery: the Sussex Eye Hospital experience

To evaluate the anatomical and visual outcomes of patients managed by macular hole surgery with adjunctive use of autologous platelets at Sussex Eye Hospital, UK. A retrospective non-comparative consecutive interventional case series was conducted. Standard macular hole vitrectomy surgery was combined with autologous platelets. No other adjuncts were used, nor internal limiting membrane peeling performed. The main outcome measure was anatomical closure of the macular hole. Secondary outcome measures included: visual outcome (best postoperative best corrected visual acuity [BCVA] and final BCVA), hole reopening and/or re-operation, complications, and time to and influence of cataract surgery. Seventy eyes of 65 patients underwent macular hole surgery with vitrectomy and autologous platelets. There were 14 stage 2 holes, 52 stage 3 holes and four stage 4 holes. Mean follow up was 29 months (range 1.5-78 months). Primary anatomical success (hole closure) was 95.7% (n = 67); however, six (8.5%) holes reopened at a mean of 12.7 months (range 3.6-36.3 months) after their initial surgery. Final surgical success was 98.5% (65/66) in those eyes of patients electing re-operation procedures. Seventy-seven per cent (n = 54) of patients obtained 2 or more lines of visual acuity improvement at final follow up with a mean improvement of 4 lines (range -3 to +12 lines). Forty per cent (n = 28) achieved final BCVA of 6/12 or better, which improved to 51% (n = 36) if best postoperative BCVA was considered. Adjunctive use of autologous platelets at the time of macular hole surgery yields good surgical and visual results, without significant complications, and should remain a considered option in the surgical management of macular holes. Improved macular hole closure with autologous platelets (compared with vitrectomy alone) has previously been demonstrated in a randomized controlled trial. Visual outcome benefit of platelets remains to be investigated by randomized controlled trial and any planned trials should include an autologous platelets intervention arm along with visual acuity as a primary outcome measure.

Epidemiology of ocular trauma hospital presentations in Sydney, Australia: insights for management and prevention

Aim: To facilitate care delivery and injury prevention by investigating the nature and outcomes of ocular trauma presentations to a tertiary care center serving an estimated 1.3 million people. Patients and methods: This is an observational case series, retrospectively analyzed, of all patients that presented to the tertiary care center for management of ocular trauma between 01/01/2006-31/12/2006. Data collected included: patient’s clinical findings, major diagnoses, initial and final visual acuity, whether the injury was work related, whether protective eyewear was worn, and whether the patient required surgery or admission to hospital. A final BCVA &lt; 6/12 was defined as significant visual deficit. Eligible patients were identified prospectively by researchers. Patients underwent standardized clinical assessment. De-identified clinical data was entered into a Microsoft Access database retrospectively and analyzed by separate, blinded researchers. Descriptive statistical analysis was then performed in Microsoft Excel. Analysis based on an ordinal regression model and risk factor analysis was performed in SAS.Results: There were 214 cases of ocular trauma in 197 individuals (17 bilateral injuries). Patients were mostly male (83%) with average age 35. The majority of cases were closed globe injuries (92.1%) with no significant final visual deficit (88.3%). Open globe injuries (7.9%) were more likely to have visual deficit (i.e., 47% with final BCVA &lt; 6/12) (p &lt; 0.01). In total, 13.1% required surgery and 12.1% required admission to hospital. Eye protection was worn in 7.9% of all cases, and 19.1% of work related cases. Nearly one quarter of cases (22.4%) were work related. Open globe injuries were more likely to occur at work. Open globe injuries at work were caused by a metal projectile in 85.7% of cases. Thirty percent of workers suffered a burn, with final BCVA &lt; 6/12 in 10% of burns.Conclusions: While the vast majority of ocular trauma is superficial with low morbidity, trauma persists as a significant cause of visual impairment. Most vision impairing injuries occur at work, where metal projectiles and burns are common, preventable causes of significant vision loss, which could be targeted in prevention efforts.