Mean Preoperative Visual Acuity Research Articles

Comparison of Complications and Visual Outcomes of Combined Phacovitrectomy versus Standalone Phacoemulsification: A Multicenter Database Study.

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) to those with standalone phacoemulsification. A multicenter database study across 8 ophthalmology departments in the United Kingdom. Retrospective, nonrandomized, multicenter comparative study. We extracted data for patients who underwent Phaco-PPV and standalone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME after surgery. The study included 2222 eyes in the combined Phaco-PPV group and 112689 in the standalone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs. 1.7%), dropped lens fragments (0.5% vs. 0.2%), suprachoroidal hemorrhage (0.4% vs. 0.1%), and cystoid macular edema (3.6 vs. 1.1%) (P<0.001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs. 20/100) in the standalone phacoemulsification group (P<0.001). Visual acuity at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs. 0.22 logMAR (Snellen ∼20/100 vs. 20/32), P<0.001). Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative visual acuity when compared to standalone phacoemulsification surgery.

Title - Long term outcomes of vitrectomy and ERM peel: Can pre-operative metamorphopsia measured using the D-Chart help improve surgical candidate selection?

To assess the predictive value of pre-operative metamorphopsia, measured using the D-Chart, in patients undergoing epiretinal membrane (ERM) surgery and how this relates to improvement in quality of life after surgery. 17 patients from vitreo-retinal surgery clinics at a tertiary ophthalmology centre were recruited when listed for pars plana vitrectomy (PPV) with ERM peel between September 2019 - February 2020. Pre-operatively patients underwent visual acuity (VA), Visual-Function Index 14 (VF-14) and metamorphopsia (D-Chart-Thomson Software Solutions) assessment and answered a questionnaire regarding cardinal ERM symptoms. Post-operatively patients were re-assessed in the same domains. 13 patients completed the protocol (inclusion rate 76%) with a mean follow-up of 32.1 (± 3.1) months. Mean pre-operative VA of the affected eye was 0.42 logMAR (± 0.25). Mean pre-operative VF-14 score was 81.51 (± 12.8) and mean M-Score of the affected eye was 14.6 (± 12.7). Post-operatively, mean VA of the operated eye was 0.11 logMAR (± 0.11), mean VF-14 score was 97.4 (± 3.8) and mean M-Score was 1.31 (± 2.8). Mean improvement in VA was 0.31 logMAR (p < 0.001), in VF-14 15.9 (p = 0.002), and M-Score -13.3 (p = 0.003). There was a significant association between pre-operative D-Chart score and improvement in VA (r = -0.570, p = 0.042), visual functioning (r = 0.606 p = 0.028) and metamorphopsia (r = 0.916 p < 0.001), with those demonstrating poorer D-Chart scores showing greater improvements. Pre- and post-operative visual distortion measured using the D-Chart, correlates with vision related quality of life in patients undergoing epiretinal membrane surgery. Patients with worse pre-operative distortion scores noticed the greatest improvements in distortion and vision related quality of life following surgery. With a mean follow-up time of 32.1 months, this long-term follow-up data further reinforces the efficacy of vitrectomy and ERM peel by demonstrating significant and sustained improvement in visual acuity, metamorphopsia and visual functioning. The authors suggest there is a role for D-Chart assessment pre-operatively to improve selection of patients in ERM surgery.

Femtosecond-Assisted Mushroom Deep Anterior Lamellar Keratoplasty.

The aim of this study was to describe our technique for performing femtosecond laser (FSL)-assisted mushroom configuration in deep anterior lamellar keratoplasty (DALK). We describe our surgical technique for a mushroom-configuration DALK using a femtosecond laser (FSL) both to prepare the graft and to perform a precut of the recipient cornea, as well as the steps for the dissection of the recipient cornea and for donor cornea implantation. Moreover, we show the parameters of energy and spot separation and the external and internal diameters as well as the thickness of the external and internal keratotomy. We performed a retrospective case series study of 20 patients with a mean follow-up of 4.36 ± 2.54 years. The indication for surgery was leukoma in 15 cases (75%), keratoconus in 4 cases (20%), and stromal corneal dystrophy in 1 case (5%). Four cases had to be converted to penetrating keratoplasty. The overall results were as follows: The mean preoperative corrected distance visual acuity increased from 0.11 ± 0.09 (0.01-0.30) to 0.78 ± 0.22 (0.30-1.0) with spectacles and to 0.92 ± 0.13 (0.5-1.0) with a gas permeable contact lens. The mean final cylinder was 3.90 ± 1.86 (1.25-7.0). The mean endothelial cell count at 6 months was 2033.83 ± 570.53 cells/mm2 (930-3207), and the mean final spherical equivalent was -4.67 ± 2.91 (-0.25 to -9.00). FSL-assisted technology is useful to achieve a predictable and safe procedure when using mushroom configuration to perform DALK. Our conversion rate from DALK to penetrating keratoplasty was similar to or even lower than that reported in the literature. In the successful DALK cases, the visual and refractive results were similar to those reported in other studies using FSL-assisted DALK (with a standard or mushroom configuration).

Trimanual vitrectomy versus bimanual vitrectomy in tractional proliferative diabetic retinopathy

ABSTRACT Objective To evaluate the impact as well as safety of trimanual vitrectomy versus bimanual vitrectomy in cases with complicated proliferative diabetic retinopathy (PDR) necessitating surgical intervention. Methods We designed a randomized, interventional, prospective study on 40 pseudophakic eyes suffering from tractional retinal detachment (TRD). 20 eyes of 16 cases with trimanual 23-gauge Parsplana vitrectomy (PPV) were categorized as Group A ”trimanual group.” Twenty eyes of 18 cases with bimanual 23-gauge PPV were categorized as Group B” bimanual group” in the duration between May 2021 and December 2022. All cases were under continual observation for ≥ 6 months postoperatively. Results A total of 40 eyes out of 34 cases with the mean age of cases 50.5 years (ranged between 29–69 y) in group A and 47.9 (ranged between 33–60 y) old in group B were assessed. Retinal attachment, total elimination of the pre-retinal proliferation attained in all cases of the two groups. Surgical time was statistically significant shorter in the trimanual group compared to bimanual group (p value < 0.05). Both groups gained statistically significant better vision. The mean pre-operative VA (Visual acuity) in group A was 1.75 (Log MAR) and 1.59 in group B, whereas the mean final visual outcome 6 months following operation was 0.73 in the 1st group & 0.82 in the 2nd one (p value < 0.001*). Conclusion Trimanual PPV is a safe as well as efficient approach that may ameliorate the result of vitrectomy in tractional PDR.

Fusion-Flanged Intrascleral Intraocular Lens Fixation Technique: Simple, Safe, Efficient.

To develop a new, sutureless intrascleral intraocular lens (IOL) fixation technique based on the Yamane double-needle and Canabrava 4-flanged techniques. The Fusion-Flanged technique involves using a 7-0 polypropylene suture loop threaded through the eyelets of the IOL. Afterward, both ends of the suture are passed outside the eye through a 27-gauge needle. This technique creates a single flange by joining the 2 suture ends through handheld cautery, and this flange is then embedded into the scleral tunnel to securely fix the IOL in place. This technique was performed on a total of 7 aphakic patients. Four of them had encountered complications following manual small incision cataract surgery, while the remaining 3 experienced complications after phacoemulsification. The results indicated a significant improvement in visual acuity, with mean preoperative and postoperative corrected distance visual acuities of 0.77 ± 0.11 and 0.27 ± 0.08 (logarithm of the minimum angle of resolution [logMAR] units), respectively. The Fusion-Flanged intrascleral IOL fixation technique offers improvements in simplicity, safety, and the overall efficiency when compared to existing sutureless intrascleral fixation techniques. Notably, this technique is versatile and can be applied to both non-foldable and foldable IOLs.

Microsurgical Vitrectomy with Pars Plana Incision for the Removal of Posterior Segment Intraocular Foreign Bodies.

This study describes a pars plana incision surgical technique combined with 23 or 25-gauge vitrectomy in the management of intraocular foreign bodies (IOFBs) and to assess its anatomical and functional results. Sixteen patients with ocular trauma complicated with IOFB were enrolled in our study. The mean preoperative visual acuity was 2.01 ± 0.55 LogMAR, and the mean postoperative visual acuity at the final visit was improved to 0.91 ± 0.58 LogMAR (p < 0.001). Until the last follow-up, all IOFBs were successfully removed and anatomic success was obtained. Complications, such as endophthalmitis, silicone oil-dependent, and ocular hypotonia, were not observed. Microsurgical vitrectomy with modified pars plana incision is a safe and effective procedure in the treatment of retained IOFB, especially associated with transparent lens and posterior segment injury.

Outcomes of rhegmatogenous retinal detachment surgery in patients with Stickler syndrome.

Despite recent developments in vitrectomy technology and instrumentation, rhegmatogenous retinal detachment in Stickler syndrome (RDS) remains a challenge for surgeons. RDSs are associated with a higher rate of complications and surgical failures than those not associated with Stickler syndrome. This study is a report about anatomic and visual outcomes of RDS surgery and describes the surgical techniques associated with the treatment of this specific condition. This is a retrospective, interventional, consecutive case series of patients with RDS undergoing retinal reattachment surgery from 1990 to 2020 at the Institute of Ocular Microsurgery (IMO) in Barcelona, Spain. Twenty-four eyes of 18 patients with genetically confirmed Stickler syndrome were included in the study. Ten eyes (41.6%) presented a giant retinal tear. Retinal reattachment was achieved in all cases after an average of 1.21 (range 1-6) surgical interventions. Nineteen eyes (79%) required only one operation to achieve complete retinal reattachment. The most common first surgical procedure was a 4-mm scleral buckle with posterior pars plana vitrectomy and silicone oil endotamponade, performed on 16 (66.6%) of the eyes. The mean follow-up period was 10.2years. Mean preoperative visual acuity LogMar was 1.10 (Snellen equivalent 20/252), which improved to 0.50 (Snellen equivalent 20/63) at final follow-up (p < 0.05). In most RDS cases, anatomic success and visual acuity improvement can be achieved with the first surgical procedure, using a combination of silicone oil tamponade and a 4-mm scleral encircling band. In some early cases of RDS, other less invasive surgical techniques can be used.

Sociodemographic Disparities in Preoperative Visual Acuity and Cataract Surgery Utilization in the San Francisco Bay Area.

We examined whether cataract surgery utilization and preoperative visual acuity were associated with patient-specific factors, including ocular findings and comorbidities, general biomedical factors, and/or sociodemographic factors. Retrospective, cross-sectional study. We reviewed the electronic health records of patients from 2012 to 2022 who were examined and followed for at least 2years by an eye care provider at University of California San Francisco Health (UCSF Health)and who had cataract in at least one eye associated with best-corrected visual acuity of 20/25 or worse. Data include ocular factors (e.g., best-corrected visual acuity, lens opacity grade, diagnoses of glaucoma, and/or age-related macular degeneration), biomedical comorbidities, and sociodemographic factors including race/ethnicity, health insurance coverage, primary language spoken, and social vulnerability index. Logistic and multivariate regression analyses. We examined cataract surgery utilization and preoperative best-corrected visual acuity. Compared to White and Asian patients, Black patients had the lowest rates of cataract surgery utilization and the poorest mean preoperative visual acuities, with Hispanic patients following in second place in both categories. However, when the analysis controlled for sociodemographic and biomedical factors, Medicaid insurance and speaking Chinese as a primary language emerged as significant associations. In addition, higher cataract surgery utilization rates were associated with worse preoperative best-corrected visual acuity, a concurrent diagnosis of glaucoma, and a concurrent diagnosis of macular degeneration. Worse preoperative visual acuity was associated with Spanish or Chinese language preference, Medicaid status, and glaucoma diagnosis; poorer preoperative visual acuity was only weakly correlated withincreased social vulnerability. After adjusting for other biomedicalandsociodemographic variables, havingMedicaid insurance and being a non-English speaker were the factorsmost notably associated with reduced cataract surgery utilization and poorer preoperative visual acuity. Health insurance and language barriers, as well as other biomedical and sociodemographic factors, may explain a large proportion of the racial disparities inboth cataract surgery utilization and preoperative visual acuity observed among Black and Hispanic patients. Chinese-speaking patients with limited English proficiency are a vulnerable subgroup that exhibits lower rates of cataract surgery utilization and higher degrees of visual loss prior to undergoingcataract surgery compared to other Asian patients.

T-shaped pars plana scleral incision to remove large intraocular foreign body.

To investigate the efficacy and safety profile of T-shaped pars plana scleral incision technique in removing large intraocular foreign bodies, during 23-gauge pars plana vitrectomy. Retrospective interventional case series that included patients diagnosed with a large intraocular foreign body (IOFB). Possible postoperative complications were recorded 24 h, 1 month, 3 and 6 months postoperatively. Thirty eyes of 30 patients (48 ± 5 years old) were enrolled. All IOFBs were successfully removed: mean diameters of 7.8 ± 2.0 mm and 2.6 ± 0.3 mm. Silicone oil and sulfur hexafluoride were used in 27 and 3 eyes, respectively. Lensectomy was performed in 27 eyes. Intraocular lens was implanted at first attempt in 12 eyes; during a second operation in 12 eyes and 6 eyes remained aphakic. At any follow-up, no signs of postoperative complications were observed. Secondary retinal detachment occurred in 12 eyes. Mean preoperative corrected distance visual acuity was 0.04, on the Snellen scale; it increased to 0.07, at last follow-up. Mean intraocular pressure was 17.97 mmHg. All eyes were preserved. T-shaped scleral incision could be an effective, safe and easy-to-perform standard procedure to remove large IOFBs during pars plana vitrectomy, without increasing the risk of surgical complications and additional damage to the ocular tissues.

The Outcome of Surgeries Performed for Retinal Detachment Associated with Chorioretinal Coloboma

OBJECTIVES To study the outcome of surgeries performed for retinal detachments associated with chorioretinal colobomas. METHODOLOGY This retrospective study enrolled 16 eyes of 16 patients with retinal detachments associated with chorioretinal colobomas. Standard 3-ports 23-gauge Pars plana vitrectomy (PPV) with silicon oil tamponade and endo-laser was performed along the rim of colobomas in all cases. In 4 (25.0%) eyes, buckling was performed with 240 silicon bands and vitrectomy to support the vitreous base. In 12 eyes (75.0%), the natural lens was removed with phaco / lensectomy and intra-ocular lens implantation. RESULTSOut of 16 eyes, the retina was re-attached in 15 eyes (93.75%) after the first operation. One eye needed a second surgery, which was successful anatomically after the second surgery. Mean pre-operative best-corrected visual acuity (BCVA) was 3.36 (±0.52), while 2-weeks post-operative BCVA was 1.92 (±0.88), which was statistically significant (P&lt;.001) improvement. Increased intra-ocular pressure (IOP), silicone oil in the anterior chamber (AC), recurrent retinal detachment, and epiretinal membrane (ERM) formation were some of the complications observed post-operatively. CONCLUSION PPV with endo-laser photocoagulation along the rim of colobomas and silicon oil tamponade is an effective surgical procedure with a statistically significant retinal reattachment ratio and best corrected visual acuity improvement in cases of rhegmatogenous retinal detachment (RRD) associated with chorioretinal colobomas.

Outcomes of Pre-Descemet Endothelial Keratoplasty for Failed Therapeutic Penetrating Keratoplasty.

The aim of this study was to analyze the outcomes of pre-Descemet endothelial keratoplasty (PDEK) for failed therapeutic penetrating keratoplasty. This was a retrospective, interventional study that involved 12 eyes of 12 patients with failed therapeutic penetrating keratoplasty that underwent PDEK. All cases had a minimum follow-up of 12 months. The main outcome measures were best-corrected visual acuity, graft clarity, endothelial cell density loss, and graft survival. Corneal clarity was graded on a scale from 0 to 4, where grade 4 denoted an absolutely clear cornea and grade 0 denoted a totally opaque cornea. Three cases underwent PDEK, 6 cases PDEK with phacoemulsification, and 3 cases underwent PDEK with pupilloplasty. The mean follow-up period for all cases was 18.5 ± 4.9 months. The mean preoperative and postoperative best-corrected visual acuity (in Snellen decimal equivalent) was 0.02 ± 0.01 and 0.54 ± 0.17, respectively, at the last follow-up. Postoperatively, corneal clarity grade 4 was present in 9 eyes, grade 3 in 2 eyes, and grade 2 in 1 eye. Mild subepithelial haze was noted in 2 eyes. The percentage of endothelial cell density loss was 28.2% ± 10.6%. No correlation was observed between the postoperative graft clarity and preoperative specular count (r = -0.021, P = 0.512). Rebubbling was performed for 1 eye that developed partial graft detachment in the first postoperative week. One patient had an episode of rejection that was managed with systemic and topical steroids. In patients with failed therapeutic penetrating keratoplasty, PDEK can be a useful alternative for visual rehabilitation as it demonstrates favorable visual outcomes with a good graft survival rate.

Early-Onset Myopia and Retinal Detachment without Typical Microcoria or Severe Proteinuria due to a Novel LAMB2 Variant

To describe the ocular and renal features, as well as outcomes of retinal detachment repair, in patients with a novel, homozygous laminin β-2 (LAMB2) pathogenic variant. Single-center retrospective chart review of patients with a homozygous variant, c.619T>C p.(Ser207Pro), in the LAMB2 gene. Eleven patients (22 eyes) from 4 families. Demographic data and ocular findings were recorded. Patients were recalled for a detailed renal evaluation. Ocular features, renal features, and outcomes of retinal detachment repair. The mean age at presentation was 6.0 (range, 1-26) years. None of the study eyes had microcoria, and none of the patients had nephrotic-range proteinuria. The mean refraction and axial length were-7.9 diopters (range,-4.0 to-12.0 diopters) and 25.3 (range, 22.7-27.7) mm, respectively. Eleven eyes (50%) had cataract at presentation. Fifteen eyes had a clear view to the fundus and all showed tessellated myopic fundus, avascular peripheral retina evident clinically or on fluorescein angiography, and rudimentary fovea. Optic disc pallor was observed in 10 eyes (66.7%). Straightened retinal vessels, abnormal vascular emanation (situs inversus) from the optic disc, supernumerary vascular branching at the optic disc, and vascular tortuosity were observed in 10 (66.7%), 2 (13.4%), 2 (13.4%), and 2 (13.4%) eyes, respectively. Discrete areas of punched-out chorioretinal atrophy were observed in 4 (26.7%) eyes. Spectral-domain OCT showed retinal and choroidal thinning in 13 eyes (86.7%), retinoschisis temporal to the fovea in 2 eyes (13.4%), and rudimentary fovea in 15 eyes (100%). Among the 22 eyes, 14 eyes (63.6%) developed rhegmatogenous retinal detachment (RRD), mostly during childhood, of which 5 patients had bilateral RRD. Eight eyes were operated on and 6 (75%) achieved retinal reattachment at the last follow-up. The mean preoperative visual acuity was 20/300 and the mean postoperative visual acuity at the last follow-up was 20/400. This study describes a distinct phenotype of LAMB2-related disease with a novel, homozygous LAMB2 variant, and further expands the spectrum of ophthalmic and renal features, and the molecular genetic basis, of LAMB2-related disease. Because the typical microcoria and nephrotic-range proteinuria might be absent, the retinal features can guide the diagnosis. The authors have no proprietary or commercial interest in any materials discussed in this article.

Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study.

To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery. Retrospective clinical database study. Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26). We analyzed visual acuity (VA) outcomes at 4weeks, 4-12weeks, and 12-24weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD). Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different. In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.

Clinical and Anatomic Outcomes of 3-Piece Poly(methyl methacrylate) Intraocular Lens Rescue and Needle-Assisted Transconjunctival Intrascleral Lens Fixation.

Purpose: To report the clinical and anatomic outcomes of a single-stage rescue and sutureless 30-gauge needle-assisted transconjunctival intrascleral fixation of dislocated 3-piece rigid poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs). Methods: This retrospective noncomparative single-surgeon interventional study comprised eyes that had concurrent 23- or 25-gauge pars plana vitrectomy and IOL rescue with sutureless transconjunctival needle-assisted flanged haptic intrascleral fixation. Lamellar scleral dissection for haptic fixation was performed 3 mm posterior to the surgical limbus with 30-gauge needles. Primary endpoints included visual acuity (VA), IOL tilt measured with ultrasound biomicroscopy (UBM), and postoperative complications. Results: The study evaluated 25 eyes of 24 patients. The IOL was successfully refixated in 24 of the 25 eyes. The mean preoperative logMAR VA of 1.21 ± 0.79 SD (median 1.3; Snellen equivalent 20/400) improved to 0.28 ± 0.35 (median 0.14; Snellen equivalent 20/30) postoperatively (P < .0001). The mean IOL tilt measured by UBM (n = 7) was 3.79 ± 3.60 degrees. The mean postoperative follow-up was 348 ± 284 days (range, 7-979 days). Postoperative complications included self-clearing vitreous hemorrhage (n = 9), retinal detachment (RD) (n = 1), cystoid macular edema (n = 3), and corneal edema (n = 3). Three eyes (13%) required additional surgery, 1 for RD and 2 for delayed haptic slippage and secondary IOL tilt causing irregular astigmatism. Conclusions: Intrascleral needle-assisted fixation of dislocated or mobile 3-piece PMMA IOLs is an effective, safe method to restore VA.

Single Layered Free ILM Graft Technique in Large Macular Holes with Associated ERM

ABSTRACT Purpose We aimed to describe single layered free ILM graft technique (FIGT) and present results of this technique in the primary surgery of large macular holes (MHs). Methods In this retrospective study, we identified MHs with a minimum hole diameter >400 μm that underwent FIGT by a single surgeon. Nineteen eyes were found to have an associated epiretinal membrane (ERM) and four eyes demonstrated a patchy ILM staining intraoperatively. A single layered FIGT was performed first by peeling the ILM around the hole and then creating a free ILM flap and transplanting it to cover the hole. All cases were evaluated for anatomical closure and visual improvement. Results Twenty-three eyes of 22 patients (mean age 68.7 ± 7.4 years) were included in the study. The mean follow-up was 9.6 ± 4.9 months. Flap closure was observed in two eyes (8.6%) at week 1, while all eyes (100%) showed a complete closure at month 1. Mean preoperative visual acuity of 1.42 ± 0.66 LogMAR increased to 1.11 ± 0.51, 0.99 ± 0.34, 0.92 ± 0.38, 0.74 ± 0.37, 0.52 ± 0.28, 0.64 ± 0.39 respectively at week 1, month 1, month 3, month 6, year 1 and final follow-up postoperatively (p < .05 for all). In none of the eyes ERM recurred, nor flap contraction developed. Conclusion The study showed encouraging results using free ILM graft in the primary surgery of large MHs. This technique might be considered in large MHs that are associated with ERM or demonstrate patchy ILM staining. Further studies are needed to prove the effectiveness also in the long-term.

The Outcomes of Trabeculectomy Surgery among Patients at Makkah Specialist Eye Hospital Bauchi Nigeria

Trabeculectomy remains the world’s gold standard and the main therapeutic intervention for controlling moderate to advanced glaucoma in Nigeria due to the expensive anti-glaucoma drugs as well as the unavailability of facilities to carry out minimal invasive glaucoma surgery (MIGS). There is still limited knowledge of the outcome of trabeculectomy surgery in northeastern, Nigeria. To determine the outcomes of trabeculectomy surgery regarding lowering post-operative Intra Ocular Pressure (IOP), preserved visual acuity (VA) as well as a preserved functional vision among glaucoma patients attending Makkah Specialist Eye Hospital Bauchi (MSEHB). A retrospective trabeculectomy surgery data search of operating theatre records was done to collect the outcomes from January 2021 to January 2023. Patients who have undergone trabeculectomy with a minimum follow-up of 6 months were included in the study. The criteria for a good outcome were post-operative IOP of less than 22mmHG or at least 30% reduction from pre-operative levels, and a preserved aided VA. A visiting consultant from the Ophthalmology Department of Federal Teaching Hospital Gombe performed the trabeculectomy surgeries. A total of fifty-two eyes of 50 patients having a postoperative follow-up of six months were included in the study. The mean age at presentation was 54.10(± 13.02) years. On the last day before surgery, the mean Snellen VA was 0.37(± 0.36) but became 0.40(± 0.36) post-operatively, p = 0.01, mean cup-to-disc ratio (CDR) was 0.86(± 0.12) but changed to 0.87(± 0.12) p = 0.79 at six months after surgery. Complete success, qualified success (with postoperative anti-glaucoma eyedrops), and failure of trabeculectomy (even with postoperative anti-glaucoma eyedrops) were 47(90.40%), 4(7.70%), and 1(1.90%), respectively. Based on the IOP, the complete success rate of trabeculectomy was 90.40%. The mean preoperative Snellen VA was improved by about half a line, six months after surgery and there was a significant reduction of IOP from its baseline. These outcomes will revolutionize our approach to the referral of suitable candidates for this surgical procedure as well as assure post-operative reserved vision.

Terson Syndrome in Patients with Aneurysmal Subarachnoid Hemorrhage: A 10-Year Single-Center Experience.

Terson syndrome (TS), an intraocular hemorrhage associated with aneurysmal subarachnoid hemorrhage (aSAH), occurs in up to 46% of all patients with subarachnoid hemorrhage. Despite its high incidence, TS is underrepresented in the literature, and patients with aSAH are sometimes not systematically evaluated for the presence of TS in clinical practice. This work aims to raise awareness of TS, reevaluate previous scientific findings, describe risk factors associated with the occurrence of TS, and present our local diagnostic and treatment concept. All patients with aSAH treated at our institution between October 2010 and May 2020 were included in this retrospective study. The frequency of ophthalmological screening by indirect funduscopy, as well as the results, was investigated. In addition, the collection and statistical analysis of epidemiological and clinical data was performed using χ2, Kruskal-Wallis, and analysis of variance testing; multivariate regression; and receiver operating characteristic analysis. The significance level was set at p < 0.05. A total of 617 patients were treated for aSAH in our institution. Of these, 367 patients (59.5%) were ophthalmologically examined for the presence of TS. The rate of TS in the examined patients was 21.3% (n = 78). Patients with TS had significantly higher Fisher and World Federation of Neurosurgical Societies (WFNS) scores (p < 0.0001). Regression analyses showed WFNS grade (p = 0.003) and the occurrence of seizures (p = 0.002) as independent predictors of TS, as did receiver operating characteristic analyses, which had a significant area under the curve of 0.66 for the combination of WFNS grade and seizures. For 12 (15.4%) patients, the TS had to be surgically treated by pars plana vitrectomy in a total of 14 eyes, which resulted in significant improvement of visual function in all patients: mean preoperative best-corrected visual acuity was 0.03 (± 0.08) versus 0.76 (± 0.21) postoperatively (p < 0.001). TS is a common complication in patients with aSAH, affecting approximately one in five patients. A higher WFNS grade and the occurrence of seizures are associated with TS; therefore, screening for TS should be performed in these patients.

Combined Cataract and Corneal Transplantation Surgery Without Viscosurgical Devices.

The most common complications after performing the triple Descemet's stripping automated endothelial keratoplasty (DSAEK), which combines the cataract phacoemulsification, intraocular lens implantation and DSAEK procedure, are detachment or decentration of the donor lamella and postoperative interface haze. One reason for this is the retained viscoelastic used during surgery. This study aimed to describe triple DSAEK procedure without the usage of viscoelastic and to discuss its potential benefits on surgical outcomes. The surgical procedures and outcomes of patients with Fuchs' dystrophy and lens opacification who underwent the triple DSAEK were retrospectively reviewed. The surgical procedure was described, and postoperative complications were studied. The study included 10 eyes of 10 patients. Capsulorhexis and IOL implantation performed in locally potentiated anesthesia compared to general anesthesia did not significantly differ (P > 0,05). The mean preoperative best-corrected visual acuity was 0.75 LogMar. The mean postoperative best-corrected visual acuity was 0.2 LogMar. The central graft thickness before surgery was 129.6 μm and 6 months after surgery was 114.2 μm. Successful attachment of the donor lamellae was observed in all 10 patients. None of the patients had postoperative interface haze or any other possible viscoelastic caused complication. Although viscoelastic can facilitate certain aspects of the triple DSAEK procedure, we conclude that this procedure can be performed completely without its use. If performed by a trained surgeon, the procedure can be feasible without the complications of donor lamella detachment, decentration, or interface haze.

23-Guage Vitrectomy with Internal Gas Tamponade for the Management of Rhegmatogenous Retinal Detachment

Purpose: To find out functional and anatomical outcomes of 23-G pars plana vitrectomy (PPV) with gas tamponade (C3F8/SF6) for Rhegmatogenous Retinal Detachment (RRD). Study Design: Quasi Experimental Study. Place and Duration of Study: Liaquat National Hospital Karachi Ophthalmology department, from October 2020 to April 2021. Methods: Fifty-five eyes of 55 patients with RRD were included in the study by convenient sampling. The patients underwent 23-G PPV with gas tamponade under general anesthesia. Anatomical and functional results were evaluated in the form of retinal attachment and change in the best corrected visual acuity (BCVA). Frequency of complications were also assessed. An average follow up period was 6 months. Results: Out of 55 patients, 32.7% were males and 67.3% were females. Mean age of the patients was 49.14 ± 17.11 years ranging from 17 years to 79 years. Four quadrants were involved in 36.4% of the patients. Among 55 eyes, 40% were phakic and 60% were pseudophakic. Only 4 (7.3%) patients needed redo procedure. Mean pre-operative and post-operative visual acuity was 2.52 ± 0.67 and 0.80 ± 0.66 with a significant mean difference of 1.71. Anatomical success was seen in 92.7% of patients. Conclusion: Anatomical success and improvement in the best corrected visual acuity (BCVA) is achievable with 23-G PPV with expansible gas used as internal tamponade in the treatment of RRD.

Femtosecond laser-assisted Bowman layer transplantation for advanced keratoconus.

To assess the technical feasibility and outcomes of femtosecond laser-assisted Bowman layer transplantation (FLABOLT) in stabilizing progressive, advanced keratoconus, which is ineligible for corneal crosslinking. This single-center retrospective study included 50 eyes of 49 patients with progressive advanced keratoconus, ineligible for corneal crosslinking, that underwent FLABOLT with both the donor graft and recipient mid-stromal pocket using a femtosecond laser. The mean follow-up was 13.2 ± 4.9 months (range 7-35 months). Donor graft preparation and accurate dissection of the recipient mid-stromal pocket were successful in 96% and 100% of cases, respectively. The mean maximum keratometry decreased by 1.93 D at 6 months after surgery and there was no change in the mean preoperative best contact lens-corrected visual acuity (BCLVA). Three eyes developed hydrops postoperatively and recovered after clinical treatment. One eye that achieved useful BCLVA postoperatively, worsened 2 years after the surgery due to progressive corneal scarring and required corneal transplantation for visual rehabilitation. Preoperative corneal scarring was a risk factor for BCLVA loss. All other eyes remained stable (92%), and no other procedure was required until the last follow-up. In this series, FLABOLT was successfully performed as an alternative to stabilize advanced progressive keratoconus. This technique is highly reproducible for graft preparation and recipient pocket dissection when assisted by femtosecond laser. Despite promising initial results, more studies with longer follow-up periods are needed to evaluate the effectiveness of FLABOLT in stabilizing advanced progressive keratoconus.