Mean Preoperative BCVA Research Articles

Refractive outcomes using Barrett formulas and patient characteristics of cataract surgery patients with and without prior LASIK/PRK.

The goal of this study is to describe characteristics of cataract surgery patients who previously underwent laser in situ keratomileusis/photorefractive keratectomy (LASIK/PRK) in comparison to non-LASIK/PRK cataract surgery patients including psychiatric comorbidities, as well as describe refractive prediction error after cataract surgery while accounting for axial length (AL) using the Barrett True-K and Barrett Universal II formulas. This was a retrospective study of patients from the University of Colorado Cataract Outcomes Registry. The primary outcomes were refraction prediction error (RPE), mean absolute RPE, and median absolute RPE. Outcomes were stratified by five axial length groups. Univariate and multivariate models for RPE were stratified by the AL group. Two hundred eighty-one eyes with prior LASIK/PRK and 3101 eyes without are included in the study. Patients with prior LASIK/PRK were significantly younger: 67.0 vs 69.9years, p < 0.0001. The LASIK/PRK group had significantly better mean pre-operative BCVA in comparison to the non-LASIK group, logMAR 0.204 vs logMAR 0.288, p = 0.003. The LASIK/PRK group had significantly lower rates of cardiovascular disease (18.5% vs 29.3%, p < 0.001), hypertension (49.1% vs 59.3%, p < 0.012), and type 2 diabetes (10.7% vs 26.0%, p < 0.001), and no significant difference in psychiatric disease. The absolute RPE was higher for the LASIK group for all ALs, but only significantly higher for eyes with AL less than 25mm. Patient eyes with prior LASIK/PRK surgery undergoing cataract surgery were significantly younger, had significantly less comorbidities, and a significantly better pre-operative BCVA. Using the Barrett formulas, absolute prediction error for eyes with longer ALs was not significantly worse for LASIK/PRK eyes than those without and the difference was smaller for eyes with longer AL.

INTRAVITREAL CHOPPING OF DROPPED NUCLEUS WITH A NITINOL INTRAOCULAR FOREIGN BODY FORCEPS: AN ALTERNATIVE TECHNIQUE FOR THE MANAGEMENT OF RETAINED NUCLEUS FRAGMENTS.

To evaluate the efficiency and safety of using an intraocular foreign body forceps with two nitinol loops at its tip to capture and chop dropped nucleus (DN) during vitrectomy as an alternative method and to evaluate the outcomes and complications of this surgical technique. The eyes that underwent 23-gauge vitrectomy with removal of DN using nitinol forceps with a minimum follow-up time of 1 year are included in this study. The efficiency of surgical technique and anatomical and functional results with complications is recorded. Nine patients with a mean age of 73.11 ± 2.15 years were included in this study. The mean time between DN and vitrectomy was 7.67 ± 3.74 (5-14) days. In all eyes, DN was easily chopped and removed with aspiration. Argon laser photocoagulation was performed in 4 eyes (44.44%) during surgery. All eyes were followed up for a mean time of 21.11 ± 12.36 (12-48) months. The mean preoperative best-corrected visual acuity increased significantly during the postoperative follow-up ( P < 0.001). No complications related to the cataract surgery or DN removal were observed. Surgical removal of DN with the help of these forceps with nitinol loops is found to be safe and effective in this study. This method avoids ultrasonographic energy and enables 23-gauge vitrectomy without a fragmatome.

Anatomical and functional outcomes of idiopathic macular hole surgery with fovea-sparing versus conventional internal limiting membrane peeling

Purpose: To compare fovea-sparing and conventional internal limiting membrane (ILM) peeling in idiopathic macular hole (IMH) surgery in terms of IMH closure type, hole closure incidence and visual outcome. Material and Methods: The ILM was peeled around the IMH in the conventional ILM peeling group. In the fovea-sparing ILM peeling group, an ILM flap was created temporally to the IMH (with an ILM remnant left attached to the margins of the IMH), folded over the hole and stabilized with viscoelastic. Gas tamponade with 20% SF6 or 15% С3F8 was used. In the postoperative period, IMH closure pattern was assessed. Thicknesses of the outer retinal layers, inner retinal layers and retinal nerve fiber layer in the macular region were measured at 1 and 3 months. Results: Totally, 70 patients (15 males and 55 females) had an IMH surgery in 71 eyes. The mean age (SD) was 65.7 (6.8) years. The median IMH duration (interquartile range (IQR)) was 3.0 (1.0-6.0) months, and the mean preoperative BCVA (standard deviation (SD)), 0.19 (0.16). Thirty-four eyes had an IMH surgery with conventional ILM peeling, and 37 eyes, an IMH surgery with fovea-sparing ILM peeling. The two groups were matched in terms of preoperative visual acuity and macular hole duration. IMH closure was achieved in 30/34 eyes (88.2%) in the conventional ILM peeling group and 33/37 eyes (89.2%) in the fovea-sparing ILM peeling group. Particularly, IMH closure was achieved in 13/17 eyes that received gas tamponade with 20% SF6 and 20/20 eyes that received that with 15% С3F8 in the latter group. The rate of correct IMH closure pattern was substantially higher (64% versus 47%) and median postoperative BCVA (IQR), significantly better (0.55 (0.35-0.7) versus 0.43 (0.35-0.6), р = 0.039) in the fovea-sparing ILM peeling group than in the conventional ILM peeling group. An analysis of variance found a significant effect of the type of IMH surgery and IMH closure pattern on the postoperative BCVA (F1 = 5.06, p = 0.027; F2 = 7.9, p = 0.0001). In both groups, we found a significant thinning of the total retinal thickness in the central 1-mm foveal zone at 3 months compared to 1 month after surgery. There was a significant thinning of the outer and inner retinal layers in the conventional ILM peeling group, and no significant thickness changes in the retinal layers in the fovea-sparing group. Conclusion: Our fovea-sparing ILM peeling technique is an effective treatment option for IMHs, and when used with gas tamponade with 15% С3F8, enabled a primary surgery IMH closure rate of 100%.

Change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital.

To determine the change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital. This study was conducted at Department of Ophthalmology Jinnah Postgraduate Medical Centre Karachi, for 6 months from 10th Dec 2019 to 10th June 2020. Sample size calculation of 52 eyes was done by using open epi software. Patients who fulfilled the inclusion criteria that is age ranging from 50 to 75 years, either gender with senile cataract having no preexisting ocular or systemic disease and those giving consent were included in this study. Patients with any comorbidity ocular trauma, having pre-existing ocular diseases such as active ocular infection, glaucoma, maculopathy or retinopathy were excluded from study. Patients with secondary cataract also excluded from study. After complete history, all patients underwent detailed ophthalmologic examination and Pre-surgery macular thickness recorded by using swept source OCT (DRI-OCT-2 Triton; Topcon). Surgery was performed and intraocular lens was implanted in all cases. Post procedure Macular thickness was measured using swept source OCT at 1st postoperative day, 1st month and 6th month after surgery. The mean age of patients was 62.06 ± 5.1 years. Total of 52 eyes diagnosed with senile cataract were included in this study. There were 30 (57.7%) males and 22(42.3%) females. The mean preoperative central foveal thickness was 201.3±24.8μm. The postoperative central foveal thickness was 200.3±25.2μm (153-265μm) at day 1st of surgery, 224.1 ± 53.8 μm (151-458 μm) at 1st month and 212.4±28.3μm (167-255μm) 6th month after surgery. The mean preoperative BCVA was 0.70 ± 0.43 (0.1-1.7) logMAR. The postoperative mean BCVA was 0.26 ± 0.42 (0.00-3.10) logMAR at 1st day, 0.07± 0.10 (0.000.7) logMAR at 1st month and 0.05 ± 0.10 (0.00-0.3) logMAR at 6th month. In our study we found an increase in macular thickness but there was no loss of BCVA from changes of macular thickness after surgery and the mean BCVA increased progressively in postoperative period.

The influence of corneal tunnel length on surgically induced astigmatism after various types of microincision phacoemulsification.

To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques. Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA. Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method. Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.

Complete manuscript title: role of sub-silicone oil application of triamcinolone acetonide (TA) drops on outcomes after 360° relaxing retinectomy: a pilot study.

To perform a pilot study to evaluate the role of sub-silicone oil Triamcinolone Acetonide (TA) crystal drops in complex Retinal Detachment (RD) with extreme proliferative vitreoretinopathy (PVR) requiring 360-degree relaxing retinectomy (RR). It was a retrospective pilot study. It was a retrospective case-control pilot study. TA-assisted 23G or 25G vitrectomy was done in 24 complex RDs with extreme PVR where 360 degree RR had to be performed. Group A (n = 13) included cases where additional TA crystal drops were applied, after settling the detached retina, over the site of RR under silicone oil (SO 5000 CSt) tamponade. In the control arm, group B (n = 11), additional TA crystals were not applied. Mean pre- and post-operative BCVA, ultra-widefield fundus photograph by Optos 200Tx, macular OCT and the propensity to remove silicone oil were measured. Mean pre-operative and post-operative BCVA at final follow-up were Log MAR 2.69 ± 0.41 and Log MAR 1.51 ± 0.90 (Mann-Whitney U test, p < 0.05), respectively, in Group A and Log MAR 2.9 and Log MAR 2.37 ± 0.86 (Mann-Whitney U test, p < 0.05), respectively, in group B. Visual improvement in group A was significantly better than group B (Wilcoxon W test, p < 0.025) with significantly less recurrence of RD (Fisher's Exact Test, p = 0.002). Silicone oil removal was done significantly more in group A (Fisher's Exact Test, p = 0.0017). Sub-silicone oil crystals application over sites of RR after 360-degree relaxing retinectomy leads to improved postoperative visual recovery as well as improved anatomical outcomes with fewer complications.

Treatment of Massive Suprachoroidal Hemorrhage by Drainage Surgery with Vitrectomy: Experience of a Single Center

ABSTRACTPurposeThe present study assessed the treatment of and risk factors for suprachoroidal hemorrhage (SCH) and reported the outcomes of drainage surgery with vitrectomy in a consecutive series of patients.MethodsRetrospective case series were carried out to investigate the clinical data of 12 eyes from 12 patients who underwent suprachoroidal hemorrhage drainage with vitrectomy surgery over a 10-year period (from 2010 to 2020). The records of these patients were analyzed, including ophthalmologic examination, ophthalmologic ultrasonography, surgical procedures, and outcome measurements.ResultsTwelve consecutive patients with a mean age of 56.5 years were studied. Intraocular surgery, high myopia, glaucoma, hypertension and anticoagulant therapy were the most common risk factors for SCH. All patients underwent external drainage and pars plana vitrectomy surgery. All of the patients were followed up for 10.2 months. Overall, the mean preoperative BCVA improved from 2.3 LogMAR to 1.7 LogMAR at the last follow-up visit (P = .041).ConclusionsThe risk factors for SCH include high myopia, glaucoma, hypertension and anticoagulant therapy. Drainage of SCH with vitrectomy is a valuable approach in the management of SCH.

Visual Outcomes after Implantation of Lucidis EDOF IOL.

Purpose To evaluate the visual performance and clinical outcomes after implantation of Lucidis EDOF IOL following cataract surgery. Design In this retrospective study, medical records from all enrolled patients were analyzed, and the following information was extracted retrospectively over 3 months following surgery. Materials and Methods We reviewed retrospectively 181 eyes of 98 patients, who underwent cataract surgery with Lucidis extended depth of focus IOL. Results 44 patients were males (45%) and 54 were females (55%). The average age of the study population was 68 ± 11 years. The mean preoperative BCVA (logMAR) was 0.19 ± 0.18. The mean root mean square (RMS) high order aberration (HOA) was 0.18 ± 0.1. Monocular BCVA results were 0.02 ± 0.04 (logMAR) and 0.028 ± 0.04 (logMAR) 1 month and 3 months postoperatively, respectively. Between the baseline and 1-month measures, monocular distance BCVA improved by an average of 0.17 ± 0.14 logMAR (p = 0.0001). Between the baseline and 3-month postoperative measures, monocular distance BCVA improved by an average of 0.16 ± 0.13 logMAR (p = 0.0001). Monocular UDVA 1 and 3 months postoperatively was 0.08 ± 0.1 logMAR and 0.067 ± 0.08 logMAR, respectively. 1-Month postoperative binocular UDVA was 0.036 ± 0.05 logMAR, binocular UIVA was 0.1 ± 0.08 logMAR, and binocular UNVA was 0.12 ± 0.14 logMAR. 3-Month postoperative binocular UDVA was 0.038 ± 0.05 logMAR, binocular UIVA was 0.09 ± 0.1 logMAR, and binocular UNVA was 0.16 ± 0.14 logMAR. Conclusions Lucidis EDOF IOL achieves good visual performances in all distances.

Novel Sutureless Scleral Fixated IOL for Inadequate or Absent Capsular Support

Purpose To evaluate the clinical outcome and safety profile of a new sutureless scleral fixation (SSF) technique using a single-piece foldable acrylic Carlevale intraocular lens. Methods In this case study, 27 eyes of 27 patients were implanted with an SSF single-piece IOL because of inadequate or absent capsular support. The hand-shake technique used during surgery was combined with the creation of scleral pockets in order to secure the IOL haptics. The BCVA was evaluated in the 1st and 6th month in every patient and in the 12th and 24th months, when possible. Also, we evaluated the improvement achieved in spherical equivalent values from baseline to the 6th month after the procedure. Intraoperative and postoperative complications were assessed. Results The mean age was 69.1 ± 14.9 years, and the mean follow-up was 13.6 ± 4.8 months. Indications of scleral-fixated IOL included dislocated posterior chamber IOL (40.7%), dislocated anterior chamber IOL (11.1%), subluxated traumatic cataract (18.5%), subluxated nontraumatic cataract (18.5%), and aphakia (11.1%). Concurrent PPV was performed on eight of the eyes (32%). The mean preoperative logMAR BCVA increased from 0.85 ± 0.59 baseline to 0.44 ± 0.30 one month after surgery (p < 0.01) and 0.36 ± 0.34 (p < 0.003) six months after surgery. The baseline refractive status expressed in SE was 4.3 ± 6.4 D, and the postoperative status was −0.5 ± 0.99 D. Postoperative complications included vitreous hemorrhage (7.4%), hypotony (7.4%), transient IOP elevation (3.7%), and postoperative cystoid macular oedema (3.7%). The IOL was very well centered and stable in every case during the follow-up period. Conclusion The use of the SSF technique with implantation of a single-piece foldable acrylic Carlevale IOL seems to be a safe and effective alternative method that provides good preliminary results in cases where capsular support is inadequate or absent. Long-term stability results would be required to evaluate the benefit of this novel surgical approach in order to compare it with other existing methods.

Outcomes of the flanged intrascleral haptic fixation with double-needle technique in patients with Marfan syndrome.

To investigate the clinical outcomes and complications associated with the flanged intrascleral haptic fixation with double-needle technique (a.k.a. the Yamane technique/FIHFT) in patients with Marfan syndrome (MFS) with subluxated or dislocated lenses. Eighteen eyes of 11 patients with MFS with subluxated or dislocated lenses who had undergone intraocular lens implantation using the FIHFT from March 2019 to October 2020 were evaluated. All patient data were retrospectively collected from medical records, including a complete ophthalmologic examination at baseline and follow-up examinations of uncorrected visual acuity (UCVA, logMAR), best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), and slit-lamp examination. The median follow-up period was 6 ± 3 (range, 3-12) months. The average patient age at the time of surgery was 13 ± 9 (range, 4-34) years. The mean preoperative BCVA was 0.49 ± 0.20 logMAR (Snellen equivalent visual acuity, 20/60), while the mean postoperative BCVA at the end of follow-up was 0.21 ± 0.14 logMAR (20/30), indicating an improvement of 0.28 ± 0.20 logMAR (20/40) postoperatively (p < 0.001). Postoperative iris capture occurred in six eyes (38.9%). No cases of hypotony, IOP elevation, or vitreous hemorrhage were noted, and no patients developed intraocular lens dislocation, retinal detachment, or endophthalmitis. To our knowledge, the present study is the first to report outcomes of the FIHFT in patients with MFS. Our findings suggested that scleral lens fixation is safe and effective for improving visual acuity in patients with MFS who have subluxated or dislocated lenses.

Clinical Study of Scleral Fixated Intraocular Lens Implantation in Blunt Ocular Trauma

Aim: to assess visual outcome and complications associated with SFIOL implantation in traumatic lens subluxation/ dislocation cases.&#x0D; Methods: This is a retrospective study of 45 patients who were managed for traumatic dislocation/subluxation of clear or cataractous lenses from June 2019 to July 2020 in a Krishna hospital, Karad, Satara. All cases underwent anterior vitrectomy/3 port pars plana vitrectomy + removal of lens and ab externo 2 point scleral fixation with rigid or foldable sfiol. In posteriorly dislocated/subluxated lens, vitrectomy was done and the lens was removed using pick forceps and retrieved by hand shake technique. In anteriorly dislocated cataractous lens, the lens was removed through the tunnel incision.&#x0D; Results: Majority of the patients were between 55-65 years of age with male pre-ponderance (73.3%).Out of 45 cases, 21 cases (46.6%) were traumatic dislocated lens and 24 cases (53.3%) were traumatic subluxated lens. The mean preoperative BCVA was 0.13 ± 0.24 logMAR, which improved 0.39 ± 0.366 logMAR postoperatively (P &lt;0.0001 ).Preoperatively BCVA in logMAR in 39 cases (86.6%) was 0.3 or better, 6 cases (13.3%) was 0.3 to 1.0 . Postoperatively BCVA in logMAR in 21 cases (46.67%) was 0.3 or better, 24 cases (53.3%) was 0.3 to 1. P-value is 0.00057 which is significant. Early postoperative complications noted were raised intraocular pressure in 12 cases (26.6%), corneal edema in 9 cases (20%), vitreous hemorrhage in 8 cases (17.7%) and hypotony in 3 cases (6.67%).Late postoperative complications were persistent elevation of intraocular pressure in 10 cases (22.2%), cystoid macular edema in 3 cases (6.67%), epiretinal membrane in 3 cases (6.67%).&#x0D; Conclusion: In every horrendous case, long haul follow-up is needed to distinguish confusions and start treatment at the most punctual.

Long term predictive ability of preoperative retinal nerve fiber layer thickness in visual prognosis after chiasmal decompression surgery

ObjectiveTo investigate the relationship between preoperative retinal nerve fiber layer (RNFL) thickness and the recovery of visual field (VF) and visual acuity (VA) 1 year after surgery in chiasmal compression patients presenting with visual impairment. Patients and methodsTwenty-nine eyes of 16 patients with chiasmal compression and 14 eyes of 14 control subjects were enrolled. All patients undergoing chiasmal decompression surgery via a transsphenoidal approach were prospectively evaluated before and 1 year after surgery with best corrected visual acuity (BCVA, logMAR), mean deviation (MD) value with standard automated perimetry (SAP) and RNFL thickness with optical coherence tomography. Eyes with chiasmal compression were divided into two groups according to the mean preoperative RNFL thickness: ≥ 100 µm (Group 1) and < 100 µm (Group 2). The relationship between the mean preoperative RNFL thickness and visual prognosis parameters (VF, VA) was analyzed. ResultsThe mean preoperative RNFL thickness was 115.92 ± 8.97 µm, 84.0 ± 8.85 µm, and 114.21 ± 7.75 µm in Group 1 (n = 15 eyes), Group 2 (n = 14 eyes) and the control group (n = 14 eyes), respectively. The mean preoperative BCVA was 0.15 ± 0.3 in Group 1, and 0.41 ± 0.39 in Group 2. The mean BCVA increased to 0.03 ± 0.1 in Group 1 in the postoperative period but did not change in Group 2. MD value was − 6.10 ± 5.54 in the preoperative period and − 2.59 ± 2.23 in the postoperative period for Group 1 (p = 0.014), while it was − 18.97 ± 4.14 in the preoperative period and − 18.57 ± 4.51 in the postoperative period in Group 2 (p = 0.24). ConclusionsThis study suggests that lower mean preoperative RNFL thickness was associated with poorer long-term visual prognosis. Preoperative RNFL thickness measurements may be helpful in predicting the recovery of VF and VA after decompression surgery in patients with chiasmal lesion presenting with visual impairment.

Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction.

To describe a new technique to release the elevated symptomatic vitreofoveal traction. This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μ m, which significantly decreased postoperatively to 251 ± 79.13 μ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.

Visual outcome in patients undergoing minimally invasive vitrectomy surgery in rhegmatogenous retinal detachment

Background: Micro-incision vitrectomy surgery otherwise called minimally invasive vitrectomy surgery (MIVS) is undoubtedly one of the most impressive evolutions in the surgical retina field of the past decade. This self-healing suture less procedure is safe and reliable with rapid visual recovery. The present study enlightens the visual outcome following MIVS for rhegmatogenous retinal detachment.Methods: This prospective study was done in 68 patients who underwent MIVS for rhegmatogenous retinal detachment. A detailed ocular examination of the patients undergoing MIVS was done. Outcome of the surgery was assessed in terms of functional and anatomical success after one week, 6 weeks and third month.Results: Of the 68 patients, maximum number of patients was in the age group of 51-60 years. Risk factors were previous cataract surgery in 28%, lattice degeneration in 26%, trauma in 22%, myopia in 18% and no specific risk factors in 6%. Mean preoperative BCVA was log MAR 2.16±0.37 and mean post-operative BCVA was log MAR 1.22±0.35 with p value of &lt;0.001 on paired t test indicating the difference was statistically significant. Functional success was achieved in 58% and anatomical success in 94% patients.Conclusions: Visual outcome following MIVS was good for rhegmatogenous retinal detachment. Secondary glaucoma and development or progression of cataract was found to be the major complication following MIVS. MIVS is a suture less safe surgery facilitating early visual recovery and associated with minimal complications.

Outcomes of suprachoroidal haemorrhage drainage with and without vitrectomy: a 10-year study.

The management of suprachoroidal haemorrhage (SCH) remains a challenge. We aimed to analyse and discuss the safety and efficacy outcomes of SCH drainage surgery over a 10-year period in one of the largest tertiary centres in the UK. Retrospective observational study of consecutive patients who underwent SCH drainage in Manchester Royal Eye Hospital over a 10-year period (from 2008 to 2018). Safety and efficacy were assessed by analysing surgery-related complications and functional and anatomical success. Outcomes of those who underwent external drainage alone versus combined drainage and vitrectomy were compared. Twenty consecutive patients with a mean age of 70 ± 19 years were studied. Age over 70 years, hypertension, cardiovascular disease, and glaucoma were the most common risk factors for SCH. Eleven patients underwent external drainage alone and nine patients had combined vitrectomy and drainage. Overall, mean pre-operative BCVA improved from 2.22 ± 0.26 logMAR (20/3319 Snellen) to 1.42 ± 1.02 LogMAR (20/526 Snellen) at last follow-up visit (p = 0.002). Severe hypotony occurred in 4 patients. Overall anatomical and functional success rates were both 75%. Drainage of SCH with or without vitrectomy is a valuable approach in the management of extensive SCH, a condition generally associated with poor prognosis.

Human Amniotic Membrane Plug for Macular Holes Coexisting with Rhegmatogenous Retinal Detachment.

PurposeTo evaluate the efficacy of human amniotic membrane in promoting closure of macular holes coexisting with rhegmatogenous retinal detachment.MethodsThis is a retrospective case series of 14 eyes (14 patients) with macula off retinal detachment. These patients had a macular hole coexistent with peripheral retinal breaks. A human amniotic membrane plug was used to close the macular hole during vitrectomy without ILM peeling.ResultsThe mean preoperative BCVA (logMAR value) was 1.87 ± 0.31. At the 6-month follow-up visit, the mean LogMAR best-corrected visual acuity was 0.67 ± 0.17. At the 6-month follow-up, all patients showed complete retinal reattachment with macular hole closure.ConclusionThe use of human amniotic membrane is a valid option in surgery for macular holes coexisting with rhegmatogenous retinal detachment.

Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study.

Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. The mean duration of the MH prior to SR-fluid application was 17months (6-96months). The mean age of the patients at the time of surgery was 72years (54-88). The mean preoperative aperture diameter of the opening was 1212μm (239-4344μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

Trans-scleral plugs fixated IOL: a new paradigm for sutureless scleral fixation.

To assess the surgical and refractive outcomes of a new technique of sutureless scleral fixation (SSF) using a single-piece foldable acrylic intraocular lens (IOL) (Carlevale). Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Careggi, Florence, Italy. Prospective observational case series. Thirty-two eyes of 32 patients with aphakia, dislocated IOL, or subluxated lens who underwent SSF with a novel single-piece hydrophilic acrylic IOL were studied. Preoperative and postoperative refractive status and complications during and after surgery were recorded. The IOL tilt was evaluated using anterior segment optical coherence tomography (AS-OCT). Twenty-two eyes were IOL/bag luxations, 9 were aphakia, and 3 were subluxated crystalline lens. Mean preoperative corrected distance visual acuity was 0.46 ± 0.29 logarithm of the minimum angle of resolution (logMAR) and improved to 0.13 ± 0.12 logMAR (P < .05) at the 8-month follow-up, with a predictive error spherical equivalent of -0.24 ± 0.81 diopters (D); the IOL tilt was 2.08 ± 1.19 degrees. One patient (3.1%) experienced transient cystoid macular edema, and 1 (3.1%) experienced vitreous hemorrhage; pigment dispersion with AS-OCT findings of reverse pupillary block was found in 2 (6.2%) eyes. IOL dislocation, conjunctival erosion, and plug externalization were not observed in any eye during the follow-up. SSF using the novel IOL could be a viable option for the management of aphakia, lens subluxation, and IOL-bag complex dislocation with unique characteristics of stability. The advantages of this technique were the absence of haptic manipulation, self-centration, and firm fixation of the IOL.

Flattened flanged intrascleral intraocular lens fixation technique

To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated IOL implantation operation in which a new modified Yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. Forty-two eyes of 42 patients who had undergone scleral IOL fixation operation with Yamane technique comprised Group 1. The mean age of this group was 60.24 ± 14.3 (20-77) years. Out of 42 patients, 25 of them (60%) were males and 17 of them (40%) were females. Forty-three eyes of 43 patients who had undergone scleral IOL fixation operation with flattened flange technique comprised Group 2. The mean age of this group was 55.35 ± 15.77 (18-79) years. Out of 43 patients, 23 (53.4%) of them were males and 20 (46.6%) were females. There were no significant differences between two groups in respect to mean preoperative UCVA, postoperative UCVA, preoperative BCVA, and postoperative BCVA (p values 0.35, 0.11, 0.28, and 0.16, respectively). The mean postoperative UCVA and preoperative BCVA were significantly higher than those of preoperative values in both groups (p < 0.05). Intraoperative haptic sliding occurred in three eyes (7%) in the first group, and there was no intraoperative haptic sliding in the second group (0%) (p = 0.05). Postoperative IOL dislocation occurred in one eye (2.5%) in the first group, and there was no postoperative IOL dislocation in the second group (0%) (p = 0.32). In conclusion, this technique does not require sutures, decreases intraoperative haptic sliding, may provide more IOL stability and less tilt, and facilitates the implantation of the second haptic. For long-term results, further studies should be conducted.

Femtosecond laser-assisted anterior lamellar keratoplasty for treatment of herpetic corneal scars

Purpose The aim of this study was to report the results of femtosecond laser-assisted anterior lamellar keratoplasty (FS-ALK) for treatment of herpetic corneal scars in a small group of cases. Patients and methods A noncomparative case series of eight eyes with postherpetic stromal corneal scars underwent FS-ALK using the Alcon WaveLight FS-200. The donor and recipient corneas were cut using the same parameters at 70% depth from the thinnest location of the recipient cornea. The donor cornea was sutured using eight interrupted sutures. The main outcome measures included preoperative and postoperative uncorrected visual acuity and best-corrected visual acuity (BCVA, LogMar). Anterior segment optical coherence tomography was done preoperatively and 1 month after suture removal. Complications were documented. Results The procedure was uneventful in all eyes with easy separation of the precut lenticule with no intraoperative complications. The BCVA improved significantly in 7/8 (87.5%) eyes. The mean preoperative BCVA was 0.88±0.15 LogMar and improved 1 month after suture removal to 0.36±0.15 LogMar (P=0.00001). Conclusion The FS-ALK is a safe, easy, and effective procedure for the treatment of herpetic corneal scars.