Median Postoperative Visual Acuity Research Articles

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design

To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. Single-center retrospective study. This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was≤6̊ (1 month) and≤10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

Preoperative Peripapillary Retinal Nerve Fiber Layer Thickness as the Prognostic Factor of Postoperative Visual Functions After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma.

To evaluate the prognostic ability of preoperative peripapillary retinal nerve fiber layer thickness (pRNFLT) for predicting postoperative visual functions, including the visual field index (VFI) and visual acuity (VA), of subjects with pituitary adenoma (PA) who were treated with endoscopic transsphenoidal surgery for pituitary adenoma (ETSS-PA) exclusively. This 11-year retrospective study was performed at a single institution in Thailand. Sixty-six eyes of 33 subjects who had a PA compressing the anterior visual pathway and were treated with ETSS-PA alone were included. The pRNFLT was measured globally and in the four quadrants preoperatively, using optical coherence tomography. Multivariable analysis and area under the curve (AUC) were used to demonstrate the prognostic ability of preoperative pRNFLT for postoperative visual functions (> 1 month but < 6 months after ETSS-PA). The mean postoperative VFI and median postoperative VA were 79.45% ± 24.24% and 0.14 [interquartile range: 0.02, 0.40] logarithm of the minimum angle of resolution. Among the 56 eyes with a reliable postoperative VFI, thicker preoperative temporal (odds ratio, 1.18; p = 0.024) and inferior (odds ratio, 1.07; p = 0.013) pRNFLT values were associated with a postoperative VFI > 90%. The strongest association occurred with the preoperative temporal pRNFLT (AUC = 0.821, 95% CI: 0.720-0.923) with a cut-off value of 60 µm. Multivariable analysis for all 66 eyes showed that thicker preoperative inferior-quadrant pRNFLT (odds ratio, 1.05; p = 0.001) was associated with a postoperative VA of at least 20/25. The strongest performance was found with the preoperative inferior pRNFLT (AUC = 0.732, 95% CI: 0.615-0.849) with a cut-off value of 105 µm. Preoperative pRNFLT offers clinical utility for predicting visual functions after ETSS-PA. Temporal pRNFLT ≥ 60 µm and inferior pRNFLT ≥105 µm predicted postoperative VFI > 90% and postoperative VA better than or equal to 20/25, respectively.

UNEXPLAINED VISUAL LOSS AFTER GAS TAMPONADE FOR MACULA-ON RETINAL DETACHMENT: Incidence and Clinical Characterization.

To identify the incidence rate and the clinical characteristics of unexplained visual loss after gas tamponade for primary macula-sparing rhegmatogenous retinal detachment. Retrospective longitudinal analysis of all subjects undergoing vitrectomy with gas for primary macula-on rhegmatogenous retinal detachment from 2010 to 2019. Outcome was the unexplained visual loss evaluated after gas absorption, defined as a loss of vision to less than 20/200 without evident causes. The diagnostic workup was reviewed. Nine eyes with unexplained visual loss of 357 surgeries were found. The incidence proportion was 2.52 new cases every 1,000 eyes affected by macula-on rhegmatogenous retinal detachment treated with gas per year. All subjects had an absolute central scotoma, with a median postoperative visual acuity of 20/1,600 (counting fingers). Structural findings were consistent with an axonal damage; all eyes had microcystoid macular edema and reduced thickness of both macular ganglion cell and retinal nerve fiber layers. No photoreceptor structural damages were noted. The incidence of unexplained visual loss after gas tamponade for primary macula-on rhegmatogenous retinal detachment is 2.52 new cases every 1,000 eyes per year. This rare complication, which findings are suggestive of an axonal damage within retinal ganglion cells, remains a serious and unexplained concern for vitreoretinal surgeons.

Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India.

Purpose:To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome.Methods:A prospective interview-based analytical cohort study was conducted on 156 children aged 0–16 years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome.Results:The mean age of presentation was 7.78 ± 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1–6 months, 11 (7%) had delay of 6–12 months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes.Conclusion:Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.

Sumbawanga eye camp follow-up study 2019

In 2019 the German Commission for the Prevention of Blindness (DKVB) held an eye camp in the Tanzanian town of Sumbawanga. For patients with mature cataracts and the ability to see light cateracts were treated by manual small incision cataract surgery (MSICS). For the first time in this camp the quality of the results of the cataract operations was measured. The quality of the cataract operations is presented and the results were assessed in the context of the guidelines of the World Health Organization (WHO). Those patients who had acataract operation in the first week were examined during the second week with respect to the parameters vision, refraction, split lamp microscopic findings, results and complications after surgery. The results were retrospectively evaluated and compared with the guidelines of the WHO. A total of 42postoperative patients from the eye camp could be examined within 5-9days after cataract sugery. The following parameters were found: median postoperative visual acuity 0.26, spherical equivalent -2.82 dpt, astigmatism -2.2 dpt, axis 113°. Visual acuity >0.3 in 14.2% (WHO 80%), vision 0.1-0.3 in 62% (WHO 15%), vision <0.1 in 23.8% (WHO 5%). Prolonged healing time and intraocular irritation in 29% of the cases. Although the vision improved, the results are sobering when taken in the context of the WHO guidelines. The postoperative refraction showed amyopic shift and an high level of astigmatism. The reasons are manifold: ocular comorbidities, limited diagnostic and therapeutic possibilities in anonclinical setting. Other factors are the kind of training of the staff in the camp, the difficult circumstances and advanced findings. Consideration of the results of this study is imperative to be able to measure the quality of the work and to create the potential to make future improvements.

Surgical Outcomes Of Rhegmatogenous Retinal Detachment In Young Adults Ages 18-30 Years.

PurposeThe purpose of this study is to investigate associations with and surgical outcomes of rhegmatogenous retinal detachment (RRD) in young adults.MethodsThis is a retrospective consecutive case series of patients aged 18–30 years who underwent surgical repair for RRD between January 1, 2014 and December 1, 2016 at a university referral center.ResultsThe current study includes 38 eyes with RRD. Documented high or moderate myopia was present in 28 (74%) eyes. Connective tissue disease was present in 3 (8%) eyes. Median pre-operative visual acuity (VA) was 20/70. Surgery was performed via scleral buckle (SB) alone in 27/38 (71%) and via combined SB and pars plana vitrectomy (SB/PPV) in 11/38 (29%) eyes. Single surgery anatomical success (SSAS) rate was 20/27 (74%) for SB and 7/11 (64%) for SB/PPV. The retina was reattached at last follow-up in 25/27 (93%) for SB and 11/11 (100%) for SB/PPV. The median postoperative VA was 20/40.ConclusionIn the current study of young adults with RRD, the most common association was high or moderate myopia. Visual and anatomic outcomes at last follow-up were generally favorable.

New perspectives on macular hole surgery at three years of follow-up.

The aim of this study was to determine the functional and anatomical success rates as well as the safety of sutureless combined surgery involving vitreous base removal and internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining for the management of idiopathic macular holes after three years. Forty-six eyes of 46 patients with an idiopathic macular hole were enrolled in this retrospective study. The inclusion criteria were macular holes with a minimum linear diameter below 1,500 mm, 0.05 or better decimal best-corrected visual acuity and duration of symptoms less than two years. The exclusion criteria included pregnancy, optic nerve atrophy, advanced glaucoma, and other chronic ocular diseases. The surgical procedure included internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining, along with C3F8 tamponade and face-down positioning for three days postoperatively. Ophthalmologic examinations and optical coherence tomography were performed at 1 and 7 days and 1, 6, 12, 24, and 36 months postoperatively. If no anatomic closure of the macular holes occurred within the first month, the area of the internal limiting membrane peeling was enlarged in a second procedure. Multiple logistic regression and chi-squared tests were used for data analyses, and p-values of <0.05 were considered significant. Out of 46 eyes with a preoperative idiopathic macular hole, anatomic closure was achieved in 42 (91.3%) after one procedure and in 45 (97.8%) after an additional surgery. The median postoperative best-corrected visual acuity improvement was 0.378 (range: 0.050-0.900) decimal. None of the patients experienced macular hole reopening, surgery-related complications, or ocular complications related to the dye. Combined surgery including vitreous base removal and internal limiting membrane peeling after staining with Brilliant Blue G (0.5 mg/mL) for the management of idiopathic macular holes resulted in adequate staining, best-corrected visual acuity improvement, and macular hole closure with no signs of ocular toxicity at the three-year follow-up examination.

Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole.

PurposeTo compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice.MethodsIn this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy.ResultsThe MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\\126 (20 gauge), 20\\100 (23 gauge), and 20\\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\\60 (20 gauge), 20\\69 (23 gauge), and 20\\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053).ConclusionBased on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.

Macular Hole Closure With Internal Limiting Membrane Abrasion Technique.

Internal limiting membrane (ILM) abrasion is an alternative surgical technique for successful full-thickness macular hole (MH) repair. To study the effects of ILM abrasion as an alternative method of MH repair. Retrospective consecutive case series from January 2006 to December 2008. Demographic data and preoperative, intraoperative, and postoperative examination records of all patients were reviewed for patients who underwent ILM abrasion with a diamond-dusted membrane scraper during vitrectomy for MH repair. A total of 100 eyes underwent ILM abrasion as an alternative to traditional ILM peeling. Rate of MH closure and visual acuity (VA) outcomes at 3 months after surgery. Macular hole closure was achieved with a single surgical procedure in 94 of 100 eyes (94.0%; 95% CI, 87.4%-97.8%). Among all patients, the median preoperative VA was 20/100 (range, 20/30 to hand motions; 25th quartile, 20/60; and 75th quartile, 20/160), and the median postoperative VA at 3 months after surgery was 20/60 (range, 20/20 to hand motions; 25th quartile, 20/40; and 75th quartile, 20/100). Among all patients with stage 2 MHs, 30 of 38 patients (78.9%) had at least 2 lines of VA gain: 15 of 23 (65.2%) were phakic, and 15 of 15 (100%) were pseudophakic. Four of 38 patients (10.5%) with stage 2 MHs had at least 2 lines of VA loss, and all were phakic. Among all patients with stage 3 or 4 MHs, 42 of 62 (67.7%) had at least 2 lines of VA gain, of which 30 of 38 (78.9%) were phakic and 22 of 24 (91.7%) were pseudophakic. Six of 62 patients (9.7%) with stage 3 or 4 MHs had at least 2 lines of VA loss: 4 were phakic, and 2 were pseudophakic. In total, 35.0% (95% CI, 25.7%-44.3%) of patients achieved 20/40 vision or better, and 52.0% (95% CI, 42.2%-61.8%) of patients achieved 20/50 vision or better. Abrasion of the ILM with a diamond-dusted membrane scraper at the time of vitrectomy achieves high rates of MH closure. This technique avoids complete removal of the retinal ILM basement membrane and subjacent tissues and appears to provide MH closure rates similar to those of traditional ILM peeling.

Prospective, Randomized Intervention Study Comparing Retinal Pigment Epithelium-Choroid Graft Surgery and Anti-VEGF Therapy in Patients with Exudative Age-Related Macular Degeneration

Purpose: To investigate whether patients with exudative age-related macular degeneration and a submacular hemorrhage, retinal pigment epithelium (RPE) tear or nonresponders to anti-vascular endothelial growth factor (VEGF) benefit more from a free RPE-choroid graft transplantation surgery than from (continuation of) anti-VEGF treatment. Procedures: A total of 20 patients were included in this prospective, international, multicenter, randomized intervention study. Results: The change in the mean number of Early Treatment of Diabetic Retinopathy Study (ETDRS) letters in the graft group 1 year postoperatively was -15 (range -54 to +26), whilst 2 patients experienced a gain of >10 letters. The median preoperative visual acuity (VA) was 0.75 logMAR (range 0.46-2.8), and the mean postoperative VA was 1.48 logMAR (range 0.14-2.8). The change in the mean number of ETDRS letters in the anti-VEGF group was -8 (range -26 to +6); no patients experienced a >10 letter gain. The median preoperative VA was 1.36 logMAR (range 0.58-1.6), and the median postoperative VA was 1.42 logMAR (range 0.44-1.66). Conclusions: The included patient group is far too small to draw conclusions. However, both gain and loss of VA may be experienced by patients undergoing either treatment method; more gain might be possible for patients with a graft in the absence of complications.

Vitrectomy for idiopathic macular hole: outcomes and complications

Purpose The aim of this study was to determine the anatomical closure rate together with the rate of functional success of idiopathic macular holes following vitreous surgery in different optical coherence tomography (OCT) stages. Patients and methods This was a prospective, case series, interventional study. Twenty-two eyes were enrolled in this study conducted at Mansoura University Ophthalmic Center during the period between June 2012 and December 2014 with at least 3 months of follow-up. Eyes with stage 2, 3, and 4 idiopathic macular hole according to the Gass classification were included. All eyes were subjected to 23-G pars plana vitrectomy, inner limiting membrane peeling, fluid-gas exchange, and postoperative positioning. Results Idiopathic macular hole closure was achievable in 18 of 22 cases, with overall 81.4% anatomical success. Type 1 closure (U-shaped closure) was achieved in 13 cases (59.1%), type 2 closure (V-shaped closure) in three cases (13.6%), type 3 closure (irregular closure) in one case (4.5%), and type 4 closure was reported in one case (4.5%). The median postoperative log MAR visual acuity at 3 months was 1.0 (0.9445-1.2073). The overall postoperative visual acuity improvement was strongly statistically significant ( P = 0.000). The visual acuity improvement at 3 months compared with the preoperative visual acuity was statistically significant ( P = 0.000). The delta change in log MAR visual acuity at 3 months was 0.5 (−0.7782 to −0.4331), with greater improvement in log MAR visual acuity in group I (stage 2 OCT) compared with group III (stage 3 and 4 OCT at 3 months; P = 0.05). Retinal breaks were observed intraoperatively in three cases. Retinal detachment was reported in one case 4 months postoperatively. Conclusion Macular hole closure rate and visual acuity markedly improved following vitreous surgery for idiopathic macular holes.

Face-down positioning versus non-supine positioning in macular hole surgery

AimTo evaluate the full thickness macular hole (FTMH) closure rate in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP).MethodsWe retrospectively reviewed two FTMH case series—postoperative positioning was FDP...

Characteristics of rhegmatogenous retinal detachment and their relationship to visual outcome

To examine pre-operative characteristics of rhegmatogenous retinal detachment (RRD) and their relationship to visual acuity (VA) following surgery. Review of prospectively completed electronic database. Baseline characteristics, retinal drawings and outcomes were analysed. In all, 847 eyes from 847 patients with a mean age of 62.2 years, 60% males, and 56% right eyes were studied. Mean follow-up was 9.6 months. Preoperative VA correlated with final VA (r(2)=0.21, P<0.0001). Median postoperative VA was 6/9 (Logmar 0.18, quartiles=0.0-0.48) and was significantly related to anatomical success: 70.15% achieved 0.18 or better with fully attached retina and primary success, whereas only 8.33% achieved this when the retina was not fully attached at final follow-up (failure) (P<0.0001). Univariate analysis found multiple variables associated with achieving 0.18 postoperative vision, however, multivariate analysis revealed only primary anatomical success with surgery; absence of proliferative vitreo-retinopathy (PVR), better-presenting VA and fewer quadrants of detachment were associated with a better visual outcome (r(2)=0.26, P<0.0001). Patients with a clinically attached fovea achieved better vision than patients with a clinically detached fovea, independent of the visual loss duration. With foveal detachment however, postoperative VA was better in patients with 1-3 days of visual loss compared with 4-6 days (P=0.013). Failure of primary surgery, PVR, extensive RRD and poor-presenting VA are risk factors for poorer visual outcome following surgery for RRD. Fovea off RRD at presentation achieved poorer postoperative VA than fovea attached and visual outcome was poorer when there was a longer duration of visual symptoms.

Comparison of outcomes of penetrating keratoplasty versus Descemet’s stripping automated endothelial keratoplasty for penetrating keratoplasty graft failure due to corneal edema

To evaluate the outcomes of repeat corneal transplantation, either penetrating keratoplasty (PKP) or Descemet's stripping automated endothelial keratoplasty (DSAEK), for penetrating keratoplasty grafts which failed due to corneal edema. The charts of 24 eyes with failed PKP grafts, due to corneal edema, which underwent a repeat corneal transplant (PKP in 17 eyes [Group 1] and DSAEK in seven eyes [Group 2]) between 2003 and 2007 were retrospectively reviewed. There was no statistically significant difference in the median postoperative visual acuity between the two groups at 1, 2, or 3 years. In Group 1, two (18%) eyes had a final visual acuity ≥ 20/40, in contrast to four (80%) eyes in Group 2, which was statistically significant (P = 0.038). Seven (41%) of the Group 1 eyes developed postoperative complications compared to only one (14%) eye in Group 2. Eleven (65%) of the Group 1 eyes and five (71%) of Group 2 eyes had clear grafts on the last examination. There was no statistically significant difference in the graft survival rate for Group 1 versus Group 2 at 3 years (57.9% vs 68.6%, P = 0.507). There was a trend towards better postoperative visual acuity, a lower postoperative complication rate, and a higher graft survival rate in eyes that underwent DSAEK rather than repeat PKP for graft failure secondary to corneal edema. Given this small, retrospective study, future studies comparing repeat PKP with DSAEK are warranted to determine which procedure allows for improved outcomes.

Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment secondary to Eales’ disease

To report the occurrence of secondary rhegmatogenous retinal detachment (RRD) after intravitreal bevacizumab injection in patients with Eales' disease. This is a retrospective, non-controlled, comparative case series. We reviewed 14 eyes of 14 patients with Eales' disease who had received pretreatment with intravitreal bevacizumab (1.25mg/0.05ml) and subsequently undergone a pars plana vitrectomy for non-resolving vitreous hemorrhage and/or tractional retinal detachment. Clinical records were reviewed. The primary outcome measure was the occurrence of secondary RRD after intravitreal bevacizumab injection. Four patients had developed secondary RRD, with retinal breaks that were localized to the base of tractional retinal bands, within 1week of receiving intravitreal bevacizumab. On comparative analysis, median age of patients who had developed secondary RRD was 26.5years, significantly less than the median age of 33.5years in the rest (P = 0.022). Median post-operative best-corrected visual acuity (BCVA) in patients who developed secondary RRD was logMAR 0.7 (0.3-0.8), significantly worse than the BCVA of logMAR 0.3 (0.0-0.5) in the rest (P = 0.015). None of the patients who developed secondary RRD had a complete posterior vitreous detachment (PVD) at presentation. Intravitreal bevacizumab injections may be associated with the serious complication of secondary RRD in patients of Eales' disease within 7days of injection.

Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers

To investigate the incidence and cause of severe visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (RRD). Consecutive case series of 216 patients operated with vitrectomy for primary RRD in 2004-2005. In 162 eyes, SiO (5500 centiStoke) had been used as intravitreal tamponade and in 54 eyes gas (perflouropropane, C(3) F(8) ) had been used. Following chart review, we identified 16 eyes in 16 patients (nine SiO eyes, seven gas eyes) with macula-on and documented visual acuity ≥6/12 before surgery, where SiO had been removed, cataract surgery performed and no re-detachment had occurred. Examinations included best-corrected visual acuity (BCVA) and high-definition optical coherence tomography (OCT) of the macular area. Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes (>6/24) compared to gas eyes (>6/7.5), p = 0.005. Three of 9 (33%) SiO eyes had final BCVA ≤6/60 and 67% had final BCVA ≤6/12. No gas eyes had final BCVA <6/9. Macular OCT revealed thinning of inner retinal layers in SiO-operated eyes (5148 pixels) compared to gas-operated eyes (6897 pixels), p < 0.002. No other visually significant structural differences were found. Severe visual loss after SiO use was observed in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation.

New Viscodissection Instrument for Use With Microincisional Vitrectomy in the Treatment of Diabetic Tractional Retinal Detachments

To report on the results of the surgical management of diabetic tractional retinal detachments using 25-gauge vitrectomy and a newly developed viscodissection instrument. Single-surgeon, noncomparative, consecutive case series of 30 eyes with severe diabetic tractional retinal detachment in patients who underwent viscodissection-assisted 25-gauge vitrectomy using the viscodissection instrument. Median preoperative visual acuity was 20/400. Median follow-up was 170 days. All retinas were attached at last follow-up. Median postoperative visual acuity was 20/70. Visual acuity improved by 2 or more lines in 17 eyes and remained stable in 11 eyes, without worsening of vision in any eyes. The newly developed viscodissection instrument facilitates microincisional vitrectomy for complex diabetic tractional retinal detachment.

Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Large macular holes usually have an increased risk of surgical failure. Up to 44% of large macular holes remain open after 1 surgery. Another 19% to 39% of macular holes are flat-open after surgery. Flat-open macular holes are associated with limited visual acuity. This article presents a modification of the standard macular hole surgery to improve functional and anatomic outcomes in patients with large macular holes. A prospective, randomized clinical trial. Patients with macular holes larger than 400 μm were included. In group 1, 51 eyes of 40 patients underwent standard 3-port pars plana vitrectomy with air. In group 2, 50 eyes of 46 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique. In the inverted ILM flap technique, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. This ILM remnant was then inverted upside-down to cover the macular hole. Fluid-air exchange was then performed. Spectral optical coherence tomography and clinical examination were performed before surgery and postoperatively at 1 week and 1, 3, 6, and 12 months. Visual acuity and postoperative macular hole closure. Preoperative mean visual acuity was 0.12 in group 1 and 0.078 in group 2. Macular hole closure was observed in 88% of patients in group 1 and in 98% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 19% of patients in group 1 and 2% of patients in group 2. Mean (or median) postoperative visual acuity 12 months after surgery was 0.17 (range, 0.1-0.6) in group 1 and 0.28 (range, 0.02-0.8) in group 2 (P = 0.001). The inverted ILM flap technique prevents the postoperative flat-open appearance of a macular hole and improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400 μm. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery.

COMPLICATIONS ASSOCIATED WITH CLEAR CORNEAL CATARACT WOUNDS DURING VITRECTOMY

The purpose of this study was to report the intraoperative surgical complications that occurred during vitrectomy surgery associated with clear corneal incisions from previous cataract surgery. Retrospective, multicenter, case series, and chart review of five patients. Five patients, 3 men and 2 women, with a median age of 75 years (range, 59-78 years), were followed up for a median of 7.5 months (range, 6 months to 5 years). In each eye, the patient had previously undergone cataract surgery and intraocular lens implantation through a clear corneal wound. Each patient developed a surgical complication during the subsequent vitrectomy related to leakage through the clear corneal wound. Vitrectomy was performed for retained lens fragments (three), macular hole (one), and repair of combined rhegmatogenous/tractional diabetic retinal detachment (one). Twenty-gauge vitrectomy was performed in 3 cases; 23-gauge in 1 case; and a combined 25- and 20-gauge vitrectomy was used in 1 case. Median time between cataract surgery and vitrectomy was 8 days (range, 0-14 days). Median preoperative visual acuity was 20/200 (20/50 to hand motions), and median postoperative visual acuity was hand motions (20/40 to light perception). In all five eyes, the clear corneal wound was found to leak extensively with minimal manipulation of the sclera at the pars plana. Leakage through clear corneal wounds occurred during marking of the sclerotomy site (Case 1), during placement of a 23-gauge infusion cannula (Case 2), during lens fragmentation (Case 3), during retinotomy and retinectomy (Case 4), and during scleral depression (Case 4). Four eyes developed choroidal detachment associated with hypotony caused by leakage through the clear corneal wound. Three of these eyes developed hemorrhagic choroidal detachment with subretinal and/or vitreous hemorrhage. One eye developed iris incarceration and anterior subluxation of a sulcus-placed intraocular lens associated with leakage through the clear corneal wound. In all five cases, extra sutures were placed to secure the clear corneal incision, and the cases were able to be completed. Two eyes underwent repeat vitrectomy to address complications associated with hemorrhagic choroidal detachments. Median final visual acuity was 20/400 (range, 20/40 to hand motions). The retina remained attached in all cases at the latest follow-up visit. Intraoperative complications related to clear corneal incisions can occur during pars plana vitrectomy. We recommend that cataract surgeons encountering complications during surgery should secure clear corneal wounds in anticipation of eventual vitrectomy surgery. It is incumbent on the retinal surgeon to carefully inspect the corneal wound at the start of the vitrectomy procedure and to close it with sutures if it appears to leak with minimal manipulation. This should help to minimize additional intraoperative and/or long-term complications.

Visian Toric Implantable Collamer Lens for Correction of Compound Myopic Astigmatism

To assess the safety, efficacy, predictability, and stability of a toric posterior chamber phakic intraocular lens for the correction of myopia with astigmatism. A non-randomized, retrospective analysis of 63 eyes of 36 patients with a minimum follow-up of 6 months was performed. The STAAR Toric Implantable Collamer Lens (TICL) was implanted under topical anesthesia through a 3-mm temporal clear corneal incision. Mean preoperative spherical equivalent refraction was -10.71+/-3.55 diopters (D). Median preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25, with a mean sphere of -8.78 D (range: -2.50 to -16.50 D) and mean cylinder of 3.60 D (range: 1.25 to 7.00 D). Postoperative parameters were analyzed at different time points, and vector analysis was performed to calculate surgically induced astigmatism. Fifty-nine (93.6%) eyes had a spherical equivalent refraction within +/-1.00 D and 52 (82.5%) eyes were within +/-0.50 D of emmetropia. Median postoperative uncorrected visual acuity was 20/25 and BSCVA was 20/20. Preoperative keratometric astigmatism was 1.99@178.2 vs 1.82@178.6 postoperative keratometric astigmatism, most likely due to the surgical incision. Preoperative refractive astigmatism was 2.17@93 whereas postoperatively it reduced to 0.38@99.6. No eye lost 2 or more lines of Snellen BSCVA. Twenty-two (34.9%) eyes gained 2 or more Snellen lines of vision. Preoperatively, 45 (71.4%) eyes had a BSCVA of 20/30 or better, whereas 60 (95.2%) eyes were within this range of BSCVA after surgery. The TICL demonstrated good rotational stability in this study. Implantation of the STAAR TICL was an effective, predictable, and safe method for correction of high myopia and myopic astigmatism as shown in this retrospective observational series.