Mean Final Best-corrected Visual Acuity Research Articles

LONGITUDINAL QUANTITATIVE EVALUATION OF PHOTORECEPTOR VOLUME FOLLOWING REPAIR OF MACULA-OFF RETINAL DETACHMENT.

To quantify photoreceptor volume changes after successful surgical repair of macula-off retinal detachment and to correlate these volumetric changes to postoperative best-corrected visual acuity (BCVA). Retrospective study of 15 eyes of 15 patients with macula-off retinal detachment who underwent successful surgical repair. A minimum of 4 optical coherence tomography scans that straddled the foveal center was used to quantify the central photoreceptor volume (central 1 mm). Mean photoreceptor volume at the first postoperative visit was 0.451 mm, increasing to 0.523 mm at the final postoperative visit (P = 0.004). Mean BCVA improved from 1.13 ± 0.59 logarithm of the minimum angle of resolution units (∼20/270) preoperatively to 0.52 ± 0.42 logarithm of the minimum angle of resolution units (∼20/66) at the final postoperative visit (P = 0.001). Mean photoreceptor volume at either the initial or final visit demonstrated significant correlations with final postoperative BCVA (r = -0.670, P = 0.017 and r = -0.753, P = 0.005, respectively). Shorter time interval from diagnosis to surgery was significantly associated with greater mean final postoperative photoreceptor volume (r = -0.588, P = 0.021) and better mean final postoperative BCVA (r = 0.709, P = 0.003). We observed a significant increase in photoreceptor volume after successful retinal detachment repair; photoreceptor volume was positively associated with BCVA and time to surgery. Our series emphasizes the importance of prompt surgical repair and shows that photoreceptor recovery and volumetric improvement correlate significantly with BCVA.

Visual management of aphakia with concomitant severe corneal irregularity by mini-scleral design contact lenses

PurposeTo evaluate visual results, comfort of use, safety, and efficacy of mini scleral contact lenses in optical management in patients with traumatic aphakia and severe concomitant irido-corneal injury. MethodsIn a case series, eight eyes with post traumatic aphakia and severe concomitant irido-corneal injury that were evaluated at the Contact Lens Clinic of Farabi Eye Hospital, Tehran, Iran for contact lens fitting and could not be corrected with conventional corneal RGP contact lenses were fitted with miniscleral contact lenses. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and BCVA (Best corrected visual acuity) with miniscleral lens were recorded. Slit lamp examination, comfortable daily wearing time, and any contact lens-related complication were documented in each follow-up visit. ResultsThe mean UCVA and BSCVA of the cases was >2.7 and 0.41 LogMAR, respectively (BSCVA could not be assessed in one case due to severe corneal irregularity). The mean final BCVA with the miniscleral lens was 0.05 LogMAR (range from 0.4 to −0.04 LogMAR). The mean follow-up period was 14.6 months. The mean comfortable daily wearing time (CDWT) was 11.6 h, ranging from 8 to 16 h. The only contact lens-related complication was mild redness and irritation that was observed in 2 patients during the follow-up visits. All patients were comfortable with handling these lenses. ConclusionMiniscleral contact lenses can be considered a safe and effective option in aphakia patients with concurrent corneal scarring secondary to ocular injury for whom surgical intervention would be complicated.

Intravitreal bevacizumab plus macular laser photocoagulation for treatment of diabetic macular edema

Purpose The aim of the study was to evaluate the visual outcome and central macular thickness (CMT) after intravitreal injection of bevacizumab in conjunction with macular laser photocoagulation (MLP) for the treatment of diabetic macular edema (DME). Patients and methods This is a prospective, interventional, case study. A total of 32 eyes were included in this study. The following data were recorded at baseline and during the follow-up periods (≤6 months): best-corrected visual acuity (BCVA), CMT, fluorescein angiography, slit-lamp biomicroscopy, and intraocular pressure measurement by applanation tonometry. All eyes received intravitreal bevacizumab at a dose of 1.25 mg in 0.05 ml 2 weeks before MLP, which was applied in a focal or grid pattern according to the treatment map. Results This study included 32 eyes of 27 patients, 16 of whom were men and 11 were women. The mean baseline BCVA was 0.29 ± 0.11 decimal Snellen’s equivalent, and the final mean BCVA was 0.38 ± 0.13. Analysis of the final BCVA revealed that 15 (47%) eyes improved by two or more lines of BCVA, 16 (50%) eyes remained stable, and one (3%) eye lost one line of BCVA. Mean CMT at baseline was 625.18 ± 82.88 μm, which decreased to a mean of 283.46 ± 22.47 μm at the end of the follow-up period covering 6 months. Conclusion Primary treatment for DME with intravitreal bevacizumab in conjunction with MLP results in improvement or stabilization of BCVA and reduces CMT. Combined therapy seems to be an effective modality for treatment of DME.

Long-Term Results of the Boston Keratoprosthesis for Unilateral Corneal Disease.

To report the results of unilateral implantation of a Boston keratoprosthesis (BKPro) in patients with good visual acuity in the fellow eye. A retrospective analysis of 37 eyes of 37 patients who underwent an optical BKPro and had a preoperative best-corrected visual acuity (BCVA) of 20/40 or better in the fellow eye at Wills Eye Hospital from September 2005 to November 2013 was performed. Patients were excluded if they had less than 1 year of postoperative follow-up. The mean follow-up after BKPro implantation was 31.7 months (range, 12-78 months; SD, 21). Twenty-eight patients underwent a BKPro for failed penetrating keratoplasty, and 9 patients underwent a primary BKPro. The most common complications were elevated intraocular pressure and retroprosthetic membrane formation in 16 eyes (43%) each. The mean final BCVA (1.0 ± 0.8 logMAR; median, 1.0 logMAR) was statistically better than the mean preoperative BCVA (1.8 ± 0.2 logMAR; median, 1.8 logMAR) (P < 0.001). The probability of postoperative BCVA of 20/200 or better was 54.1% with an average 45.1 ± 4.7 (confidence interval: 35.9-54.3) months of follow-up. The probability of postoperative BCVA of 20/40 or better was 37.8% with an average 51.8 ± 4.9 (confidence interval: 42.0-61.5) months of follow-up. Half of the patients in our study achieved the minimum visual acuity required for binocular functioning, whereas one-third of the patients achieved a BCVA somewhat similar to that of the contralateral eye. The complications were similar to those reported previously with good retention of the device. BKPro implantation is a reasonable option for patients with good vision in the fellow eye.

Therapeutic Corneal Transplant for Fungal Keratitis Refractory to Medical Therapy.

To report the outcomes of therapeutic corneal transplant for managing fungal keratitis that is refractory to medical treatment. Retrospective data analyses of the medical records was performed on 17 patients who underwent a therapeutic corneal transplant for severe culture-proven fungal keratitis between October 2006 and August 2013. We evaluated demographics, fungal organism type, surgical data, recurrence presentation, disease course, follow-up, and graft status. Mean patient age was 53.2 years (range, 33-81 y). The male/female ratio was 12/5. All patients had positive microscopic evaluation and positive culture results for fungal infection. The most common fungal agent was Fusarium sp. (35%). Nine patients reported a history of injury to the cornea and/or contact with plant material or soil. The mean best-corrected visual acuity at the initial visit was 2.45 logMAR unit (range, 0.52-3.10 logMAR unit). The mean follow-up was 14 months (range, 6-76 mo). Four patients underwent evisceration surgery because of graft lysis or uncontrolled recurrent disease. Recurrence of the fungal infection after corneal transplant was seen in 8 patients (47.05%). The graft rejection rate was 18.18%. At the final visit, 5 grafts were clear, 4 were translucent, and 2 were opaque. There were 2 phthisis bulbi owing to catastrophic disease. The mean final best-corrected visual acuity was 1.64 logMAR unit (range, 0.22-3.10 logMAR unit). Although therapeutic corneal transplant has a higher incidence of infection recurrence and graft failure, it continues to be an effective treatment for uncontrolled, refractory fungal keratitis cases to save the affected eye.

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa.

BackgroundOcular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual impairment. The purpose of this study was to characterize and analyze ocular involvement and visual outcome of HZO in patients from Tunisia, North Africa. This study is a retrospective chart review of 51 eyes of 45 patients with HZO.ResultsMean age was 44.5 years. Thirty patients (66.7%) were aged over 50 years. Twenty-four patients (53.3%) were male and 21 patients were female (46.7%). There was no statistically significant difference in gender distribution. Initial mean best corrected visual acuity (BCVA) was 20/50. Ocular manifestations included adnexal involvement (58.8%), keratitis (31.4%), keratouveitis (31.4%), isolated anterior uveitis (AU) (29.4%), intraocular pressure elevation (23.5%), oculomotor nerve palsy (5.8%), and optic neuritis (1.9%). Isolated AU (p < 0.001), isolated keratitis (p = 0.001), and intraocular pressure elevation (p = 0.013) were more likely to be concomitant to HZO active skin disease, while keratouveitis occurred more likely more than 1 month after HZO eruption (p < 0.001). AU and keratouveitis were more likely to be associated with age ≥ 50 years (p = 0.001 and p = 0.02, respectively). Ocular complications included neurotrophic keratopathy (1.9%), corneal opacity (5.9%), secondary glaucoma (7.8%), optic atrophy (1.9%), and postherpetic neuralgia (13.3%). Mean follow-up was 12 months. Mean final BCVA was 20/32; it was ≥ 20/40 in 78.4% of the eyes.ConclusionsOur study provided epidemiologic and clinical data of HZO in a Tunisian population. AU and keratitis were the most common ocular complications. Neurotrophic keratopathy was scarce. The overall visual outcome is good, with about three quarters of the treated patients maintaining VA of 20/40 or better.

Favorable anatomic and visual outcomes with 25-gauge vitrectomy for myopic foveoschisis.

PurposeTo report the surgical outcomes of 25-gauge vitrectomy in eyes with myopic foveoschisis (MF).MethodsThe medical records of 40 eyes of 36 patients that had undergone 25-gauge vitrectomy with internal limiting membrane peeling for MF were studied. The main outcome measures were the best-corrected visual acuity (BCVA) and the optical coherence tomography (OCT) findings. The eyes were divided into two groups: 1) those with a foveal detachment (FD; FD group); and 2) those without a FD (no-FD group).ResultsThe postoperative OCT images showed a resolution of the MF with a significant reduction in the central foveal thickness from the preoperative values in both the FD group (479±150 μm to 196±56 μm; P=0.002, mean ± standard deviation) and in the no-FD group (369±116 μm to 245±50 μm; P=0.001). The final mean BCVA significantly improved from the preoperative values in the FD group (0.96±0.53 logarithm of the minimum angle of resolution [logMAR] units to 0.70±0.56 logMAR units; P=0.009) and in the no-FD group (0.46±0.38 logMAR units to 0.34±0.36 logMAR units; P=0.007). The final BCVA in the FD group improved in 63%, remained unchanged in 31%, and worsened in 6%. In the no-FD group, the final BCVA improved in 21%, remained unchanged in 71%, and worsened in 8% of the eyes. A better final BCVA was significantly correlated with a better preoperative BCVA in both groups (P<0.001).ConclusionTwenty five-gauge vitrectomy results in favorable visual and anatomic outcomes for MF. We recommend that 25-gauge vitrectomy be used to treat eyes with MF.

OCULAR INJURIES WITH A METALLIC FOREIGN BODY IN THE POSTERIOR SEGMENT AS A RESULT OF HAMMERING

To evaluate the evolution of the best-corrected visual acuity (BCVA), to determine the prognostic factors, and to analyze the efficiency of the surgical procedures in the cases of ocular injuries caused by a metallic intraocular foreign body retained in the posterior segment as a result of hammering. A retrospective review of 64 consecutive patients was conducted at the Cantonal Hospital St Gallen over a 15-year period. The pre-, intra-, and postoperative clinical parameters were assessed. The statistics were performed using Fisher's exact test and a multiple correspondence analysis. The mean initial BCVA was 20/138 (standard deviation, 20/112). The mean ocular trauma score was 3.03 (standard deviation, 0.83). In all cases, the removal of the intraocular foreign body was performed within 24 hours after the injury. In 45 patients (70.3%), further operations were performed during the mean follow-up of 54.4 months (standard deviation, 22.7 months). The mean final BCVA was 20/39 (standard deviation, 20/55). In 53 patients (82.8%), the final BCVA was 20/40 or more. In 8 patients (12.5%), the final BCVA was 20/200 or less because of a direct macular lesion caused by the intraocular foreign body (P < 0.001). Thanks to the improvement in the surgical procedures, the ocular injuries with a metallic intraocular foreign body in the posterior segment as a result of hammering have a good visual outcome unless the macula is involved.

Outcomes of Double Frequency Nd:YAG Laser Membranotomy for Premacular Haemorrhage Secondary to Valsalva Retinopathy

Purpose: To determine the outcomes of double frequency Nd:YAG laser membranotomy for premacular hemorrhage secondary to Valsalva retinopathy. Methods: Retrospective case series of 24 consecutive patients with premacular hemorrhage of duration less than two months between Jan 2008 and Dec 2012 were included. Patients with any other vascular diseases such as diabetic retinopathy were excluded. The main outcome measure was the best-corrected visual acuity (BCVA) at final follow up. Results: Among 24 patients, majority 16 (67%) were men and all had unilateral Valsalva retinopathy. All patients underwent laser membranotomy using the double frequency Nd:YAG laser on the same day of presentation. The mean age of subjects was 44.03 ± 17.33 years (14-78 years) and the mean duration of symptoms was 10.29 ± 11.7days. The mean follow-up duration was 4.72 ± 2.54 months. All patients presented with blindness or severe vision loss with a mean baseline visual acuity of 1.72 ± 0.58 logMAR (Snellen’s equivalent 20/1050; range 0.17-2.3). Significant improvement of visual recovery was noted in 91.66% of patients at 1 month (mean final BCVA 0.20 ± 0.56 logMAR (Snellen’s equivalent 20/30; range 0-2.3 logMAR). Twenty-two (91.66%) patients were successfully treated with laser alone. No complications were noted. Two patients underwent vitrectomy and achieved 20/20 visual acuity. Conclusion: Prompt treatment using the frequency doubled Nd YAG laser appears to be safe and effective in achieving significant visual recovery in patients with premacular hemorrhage due to Valsalva retinopathy.

Degree, duration, and causes of visual impairment in eyes affected with ocular tuberculosis

BackgroundOcular tuberculosis (TB) can affect nearly every ocular tissue, leading to a variety of vision-threatening clinical manifestations. The goal of this study is to estimate the degree, duration, and causes of visual impairment in eyes affected by ocular TB.ResultsThis was a retrospective study of patients diagnosed as ocular TB based on polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex. We applied the World Health Organization definition of visual impairment (VI) to affected eye(s), instead of better-seeing eye. Best-corrected visual acuity (BCVA) of <6/18 and ≥6/60 in the affected eye was classified as moderate VI and <6/60 and ≥3/60 as severe VI. Data collected included presenting and final BCVA of affected eyes and the worst BCVA during the study period. Sixty-one eyes of 40 patients were analyzed. Twenty-five patients (52.1%) had bilateral disease. The mean worst BCVA and mean final BCVA (logMAR) were 1.26 ± 0.87 and 0.61 ± 0.85, respectively, and their difference was highly significant (p < 0.0001, Friedman test). The median worst and final BCVA results were 1.30 (range 0.0 to 3.0) and 0.20 (range 0.0 to 3.0), respectively. The mean duration of follow-up was 98.34 ± 81.81 weeks. Moderate and severe VIs were seen in 14 (22.9%) and 12 (19.7%) eyes, respectively, during the course of follow up. Twenty eyes (32.8%) had BCVA of <3/60. Moderate VI or worse was most commonly seen in eyes with multifocal serpiginoid choroiditis (n = 6; 100%), retinal vasculitis (n = 25; 80.6%), and panuveitis (n = 12; 80%). The mean duration of visual loss was 25.2 ± 42.37 weeks (median 6.43 weeks, range 0 to 206.42 weeks). Vitreous hemorrhage, complicated cataract, and macular scarring were the common causes of VI.ConclusionOcular TB can result in prolonged visual impairment, more commonly in patients with posterior uveitis or panuveitis.

High-Power Handheld Blue Laser-Induced Maculopathy: The Results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group

To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. Consecutive case series. Fourteen eyes of 14 patients. Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. Analysis of the types of maculopathy and vitreoretinal pathologic features. All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300). Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

EFFECT OF SYMPTOM DURATION ON OUTCOMES FOLLOWING VITRECTOMY REPAIR OF PRIMARY MACULA-OFF RETINAL DETACHMENTS

To examine the effect of symptom duration on visual and anatomical outcomes following pars plana vitrectomy repair of primary macula-off rhegmatogenous retinal detachments. This is a retrospective, consecutive, interventional case series. All eyes underwent repair of macula-off rhegmatogenous retinal detachment with a 20-gauge, 23-gauge, or 25-gauge standard 3-port pars plana vitrectomy. Eyes with previous retinal surgery, giant retinal tear, Grade C or higher proliferative vitreoretinopathy, or less than 6 months of follow-up were excluded from the study. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the duration of macular detachment symptoms. The secondary outcomes studied were single surgery anatomical success and complication rates. Visual acuity analysis was performed on all eyes that were pseudophakic by the final follow-up visit. Overall, 81 eyes of 81 patients met inclusion criteria, with a mean follow-up length of 55 months (range, 6-171 months) and mean duration of macular detachment symptom of 12 days (range, 1-64 days). The mean final BCVA was 20/40 (range, 20/20 to hand motion), with 70% (n = 57) of all patients obtaining 20/40 or better final BCVA. Patients with symptom duration of 6 days or less achieved better final BCVA (mean 20/25, n = 34) than patients with longer symptom duration (mean 20/50, n = 47) (t-test, P = 0.0030; α = 0.005). After 7 days of macular detachment, no significant difference was seen in final BCVA (t-test, P > 0.05). The overall single surgery anatomical success rate was 88% (71 of 81 eyes). There was no correlation between the single surgery anatomical success rate and duration of macular detachment symptom (Fisher's exact test, P > 0.10). Primary pars plana vitrectomy repair results in good final visual outcome for patients with primary macula-off rhegmatogenous retinal detachments. Surgical repair within 6 days of the symptom onset yielded better visual outcomes. After 7 days, visual outcome was not affected by the timing of the surgical repair. Anatomical outcome following pars plana vitrectomy repair is not affected by symptom duration.

INTRAVITREAL RANIBIZUMAB VERSUS BEVACIZUMAB FOR TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION

To compare intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) in the treatment of subfoveal choroidal neovascularization associated with pathologic myopia. Fifty-five patients fulfilling inclusion and exclusion criteria were randomized either to IVB or to IVR. After the first injection, re-treatments were performed on a pro re nata basis in monthly examinations over an 18-month follow-up. Primary outcome measures were the change in mean best-corrected visual acuity and the proportion of eyes improving in best-corrected visual acuity by >1 and >3 lines at the 18-month examination. Forty-eight eyes received the treatment and were subsequently included in the analysis. At the 18-month examination, a significant improvement of 1.7 lines and 1.8 lines compared with baseline were noticed in the IVR and IVB subgroups, respectively. The difference in the final mean best-corrected visual acuity between the groups was not significant. A 3-line gain or higher was noted in 30% of eyes in the IVR subgroup and 44% of eyes in the IVB subgroup. Although both groups attained a significant improvement in central macular thickness, the IVR subgroup achieved a faster central macular thickness reduction. A significantly lower number of injections were administered in the IVR subgroup (2.5) compared with the IVB subgroup (4.7; P < 0.001). Intravitreal ranibizumab and IVB are effective in the treatment of subfoveal myopic choroidal neovascularization. Intravitreal ranibizumab achieved greater efficacy than IVB in terms of the mean number of injections administered.

Clinical Analysis of 50 Chinese Patients with Aqueous Misdirection Syndrome: A Retrospective Hospital-Based Study

To evaluate the efficacy of treatments for aqueous misdirection syndrome and explore possible risk factors influencing prognosis. Data including demographics, initial clinical characteristics and ocular outcomes at follow-up were collected for patients treated for aqueous misdirection syndrome. Main outcome measures were: best-corrected visual acuity (BCVA); intraocular pressure (IOP); number of antiglaucoma medications; recurrence; complications. Data were available for 50 patients (57 eyes). Final mean BCVA improved significantly and correlated with baseline BCVA (mean follow-up, 34.47±28.65 months). Final mean IOP and mean number of antiglaucoma medications were significantly reduced. Treatment failure rates were higher in patients with significantly higher IOP at baseline and/or shorter axial length. Following pars plana vitrectomy (PPV), recurrence occurred in two of 10 pseudophakic and one of 40 phakic eyes; complications were observed in 12/50 eyes (choroidal detachment, corneal decompensation, retinal detachment, vitreous haemorrhage, hyphaema). PPV and laser treatments, augmented by pharmacotherapy, were effective in treating aqueous misdirection syndrome. Surgical intervention should be undertaken early in eyes with higher baseline IOP and/or shorter axial length. Total vitrectomy-zonulectomy-iridectomy is a potential approach for recalcitrant cases.

Helicobacter pylori as a potential target for the treatment of central serous chorioretinopathy

OBJECTIVES:The objective of this study was to evaluate the relationship between the treatment of Helicobacter pylori gastric infection and changes in best-corrected visual acuity and macular detachment in patients with chronic central serous chorioretinopathy.METHODS:Seventeen patients diagnosed with central serous chorioretinopathy were examined for gastric infection with Helicobacter pylori using the urease test and gastric biopsy. Helicobacter pylori-positive patients were treated with the appropriate medication. The response to therapy was monitored by evaluating the best-corrected visual acuity and optical coherence tomography. The data were analyzed using Student's t-test before and after treatment.RESULTS:Fourteen patients (15 eyes) aged 30-56 years (mean 43.4±8.3 years) were positive for Helicobacter pylori. Most of the positive patients had gastric symptoms (78.5%); one had bilateral central serous chorioretinopathy. The mean baseline best-corrected visual acuity was 20/98 (logMAR = 0.53±0.28). Three months after starting treatment with antibiotics, the serous detachment had resolved in 14 of 15 eyes, but two cases required laser treatment. The follow-up period ranged from 6 to 27 months. The mean final best-corrected visual acuity differed significantly from baseline.CONCLUSION:Our findings suggest that Helicobacter pylori infection may be present in many chronic central serous chorioretinopathy patients and that treatment for the infection may have a favorable effect on the outcome of chronic central serous chorioretinopathy. Due to the possibility of the spontaneous regression of chronic central serous chorioretinopathy and the high prevalence of the infection in the general population, prospective and masked clinical trials are necessary to confirm that treatment for Helicobacter pylori infection may benefit patients with chronic central serous chorioretinopathy.

Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas

To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.

Intrascleral Reverse Pocket Approach of Transconjunctival Transscleral Sulcus Fixation of Intraocular Lens in Eyes With Ocular Trauma

To evaluate the efficacy of a novel technique of intrascleral reverse pocket approach of transconjunctival transscleral (TC-TS) sulcus fixation of intraocular lens (IOL) implants in posttraumatic eyes. A prospective case series of 12 patients who had ocular trauma underwent TC-TS fixation of intraocular implants (including posterior chamber IOLs, rigid or foldable and capsular tension ring) were examined for any intraoperative complications, postoperative best-corrected visual acuity (BCVA), status of conjunctiva, and other potential complications. Twelve eyes of 12 patients (8 men and 4 women) with a mean follow-up of 14.5±7.25 months were included in the analysis. In no case was any intraoperative deroofing of the tunnel or buttonholing of the conjunctiva performed. The mean final BCVA (in Snellen Equivalent [SE]) showed significant improvement from preoperative levels (0.48±0.29 SE vs. 0.65±0.19 SE, respectively; P=0.049). One case showed a single line drop in the BCVA at final follow-up. Another case had a dispersed vitreous hemorrhage in the immediate postoperative period that cleared in 3 weeks' time. One eye demonstrated a clinically detectable IOL tilt, which was corrected by astigmatic prescription in the spectacle glass. None of the cases exhibited postoperative suture knot erosion or breakage of polypropylene sutures until the last follow-up. The technique of intrascleral reverse pocket approach of TC-TS fixation is a successful method of sulcus fixation, which can obviate the need for conjunctival peritomy, thus helping in salvaging the conjunctiva for any future trabeculectomy in posttraumatic eyes predisposed to developing glaucoma.

Comparing deep anterior lamellar keratoplasty and automated lamellar therapeutic keratoplasty in patients with keratoconus

We compared outcomes of deep anterior lamellar keratoplasty (DALK) and automated lamellar therapeutic keratoplasty (ALTK) in patients with keratoconus. Seventy eyes with keratoconus that underwent corneal transplantation using either DALK (n = 40) or ALTK (n = 30) were included in this retrospective study. DALK was performed with Anwar's big-bubble technique and ALTK using an ALTK system. Best-corrected visual acuity (BCVA), refractive results, and complications were analyzed. Mean follow-up in the DALK (16.68 ± 3.36 months) and ALTK (15.27 ± 2.50 months) groups were similar (p = 0.058). Mean final BCVA of patients in the DALK group was 0.31 ± 0.14 logarithm of the minimum angle of resolution (logMAR) and in the ALTK group 0.34 ± 0.15 logMAR, (p = 0.492). Corresponding figures for final postoperative spherical equivalents were -3.45 ± 0.77 D and -4.19 ± 0.99 D, respectively (p = 0.001). Final postoperative degree of astigmatism was similar in the two groups: DALK -4.28 ± 0.66 D; ALTK -4.50 ± 1.05 D (p = 0.307). Final visual acuity outcomes were comparable for the DALK and ALTK groups. Thus, ALTK seem to be as efficacious as DALK for surgical treatment of keratoconus.

Anatomic and functional outcome after surgical removal of idiopathic macular epiretinal membrane

The purpose of this study is to investigate the functional and structural outcomes of surgical treatment of eyes with idiopathic macular epiretinal membrane (ERM). Clinical records of 21 patients (22 eyes) who underwent macular ERM removal with at least 6 months of postoperative follow-up period were reviewed retrospectively. All patients were treated with pars plana vitrectomy and ERM peeling surgery. Fourteen patients also underwent cataract surgery at the same time. Pre- and postoperative visual acuity (VA), intraocular pressure (IOP), and macular thickness along with postoperative adverse events were all recorded. The mean follow-up was 8.5 ± 3.2 months. Three eyes were pseudophakic and 19 eyes were phakic preoperatively. Five phakic eyes undergoing simple ERM peeling surgery had worsened cataracts, and vision was recovered after subsequent cataract extraction surgery. Mean preoperative IOP was 13.1 ± 4.2 mmHg, which did not differ significantly postoperatively ( p = 0.228). One patient had increased IOP postoperatively and needed topical antiglaucoma treatment. Thirteen eyes showed visual improvement, and six eyes became worse during the follow-up. Mean preoperative best-corrected VA was 0.36 decimal equivalent, which was then converted to logarithm of the minimum angle of resolution (logMAR 0.502 ± 0.259) for statistical analysis; this had improved to a mean of 0.536 decimal equivalent (logMAR 0.38 ± 0.35) at the final follow-up. Mean central macular thickness (CMT) also significantly declined ( p < 0.0001). From an analysis of dividing patients into two subgroups according to clinical severity [macular pucker (MP) and cellophane maculopathy (CM)], measured mean CMT of both groups demonstrated significant reduction at final follow-up (MP, p < 0.0001; CM, p = 0.005). Mean final best-corrected VA also reached significant improvement in MP group ( p = 0.008). However, in the CM group, no significant change in VA was observed ( p = 0.52). Besides, VA measurements in the MP group had improved significantly to that of CM ( p = 0.037). The measured CMTs of the MP group had also reduced significantly ( p = 0.046) compared with those of the CM group. In conclusion, membrane peeling surgery can lead to a significant reduction of macular edema in patients with idiopathic macular ERM. The advantages of combined peeling and cataract surgery will achieve maximum positive visual outcome.

TWENTY-THREE–GAUGE PARS PLANA VITRECTOMY, DENSIRON-68, AND 360° ENDOLASER VERSUS COMBINED 20-GAUGE PARS PLANA VITRECTOMY, SCLERAL BUCKLE, AND SF6 FOR PSEUDOPHAKIC RETINAL DETACHMENT WITH INFERIOR RETINAL BREAKS

To compare the anatomical and functional outcomes of 23-gauge pars plana vitrectomy (PPV) with Densiron-68 tamponade and 360° endolaser versus 20-gauge PPV with encircling scleral buckling (ESB) and an SF6 gas tamponade for the repair of primary pseudophakic retinal detachment with inferior retinal breaks. Prospective, randomized, comparative, interventional study. Eighty-two eyes of 82 consecutive patients were randomly assigned to 1 of the 2 treatment groups: 23-gauge PPV/Densiron-68 (44 eyes, 54%) or 20-gauge PPV/ESB/SF6 (20%) (38 eyes, 46%). The inclusion criterion was the presence of primary pseudophakic retinal detachment with at least 1 retinal break between the 4- and 8-o'clock positions. The study protocol involved a minimum of 7 visits: baseline, day of surgery, 1 week, and 1, 3, 6, and 9 months postoperation. Densiron-68 removal was performed within 12 weeks of the initial surgery. Two surgical procedures were required in the Densiron group to remove the oil. After the primary procedure, the retina was reattached in 90% (40 of 44) of cases in the 23-gauge PPV/Densiron group and in 92% (35 of 38) of cases in the 20-gauge PPV/ESB/SF6 group (P = 0.2, Fisher's exact test). After resolution of redetachments, final anatomical success rate rose to 97% (43 of 44) in the 23-gauge PPV/Densiron group and 94% (36 of 38) in the 20-gauge PPV/SB/SF6 group (P = 0.32, Fisher's exact test). Mean final best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.40 in the 23-gauge PPV/Densiron group and 0.48 in the 20-gauge PPV/ESB/SF6 group (P = 0.31, t-test). Operative time was significantly less in the 23-gauge PPV/Densiron group (P = 0.002, t-test). No statistically significant difference in the complication rate between the two groups was recorded. Twenty-three-gauge PPV combined with Densiron-68 and 360° endolaser and 20-gauge PPV combined with ESB/SF6 seemed to have similar efficacy in the repair of primary pseudophakic retinal detachment. Supplementary scleral buckling can be avoided using a Densiron-68 tamponade for retinal detachment with inferior retinal breaks.