Poor Postoperative Vision Research Articles

Position Adherence in Patients Underwent Pars Plana Vitrectomy with Silicone Oil Tamponade.

Position adherence of patients with Pars Plana Vitrectomy with Silicone Oil Tamponade after discharge is of positive significance. However, patients undergoing a day surgery makes the quality of discharge teaching and readiness for hospital discharge is insufficient, which will influence their position adherence at home. This study aimed to find the correlation of discharge teaching, readiness for hospital discharge, and position adherence in patients who underwent PPV with silicone oil tamponade from the day ward. This was a cross-sectional survey. One hundred ninety-four patients with day surgery were recruited by convenient sampling from Zhongshan Ophthalmic Center, China. Data were collected using the quality of discharge teaching scale, readiness for hospital discharge scale, and position adherence scale. Patients' education level, residence, poor postoperative vision, ophthalmic surgery history, and quality of discharge teaching are the main factors of readiness for discharge. Only 41(21%) patients had good position adherence, and education level and readiness for discharge are the main factors of position adherence. Discharge teaching improves patients' knowledge and competence of self-care and helps patients prepare for the transition from hospital to home, and readiness for hospital discharge significantly influences position adherence after discharge and indirectly plays a vital role in postoperative vision recovery and surgical effect.

A clinical study of management and visual outcome in lens induced glaucoma

Background: Lens induced glaucoma (LIG) is the cause of poor postoperative vision even after uneventful cataract surgery.Aim: The aim is to know effect of surgery on post-operative visual acuity, intraocular pressure, inflammation including corneal changes and optic disc changes. And also the importance of early diagnosis, and efficient treatment in preventing these vision-threatening lens induced glaucomas.Setting: Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, KarnatakaDesign: Prospective interventional study.Material and Method: This longitudinal study included 50 cases of lens induced glaucoma, admitted in the ophthalmic wards in Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, Karnataka. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. And postoperatively patients were followed up regularly at 2 and 7 weeks interval.Statistical Analysis: The results were tabulated on microsoft excel spreadsheet and data was statistically analysed using various tests such as, Paired ‘t’ test, Chi square test and pooled chi square test wherever applicable and a P value less than 0.05 was considered significant.Conclusion: A delay in presentation of more than two weeks and intraocular pressure of more than 35 mm Hg in association with severe inflammation affects the optic nerve which would ultimately jeopardize vision, in these potentially blinding lens induced glaucomas. This study has highlighted the characteristics, management and their visual outcome in lens induced glaucomas, and also the importance of early diagnosis, and efficient treatment in preventing these vision-threatening lens induced glaucomas.

Changes in visual function and quality of life in patients with senile cataract following phacoemulsification.

Phacoemulsification is the accepted first-line treatment for cataracts. This study aims to explore the changes in visual function and quality of life in patients with senile cataracts following phacoemulsification, and its risk factors. The clinical data of 104 patients (202 eyes in total) with senile cataract who underwent phacoemulsification in our hospital from August 2017 to August 2019 were retrospectively analyzed, and finally 102 cases (198 eyes) were enrolled according to the inclusion and exclusion criteria. These eyes were divided into the low vision group (n=75) and non-low vision group (n=123) The changes in pre- and post-operative visual function and quality of life of patients were compared. Logistic regression was used to analyze the risk factors of visual function of patients with senile cataract after phacoemulsification. The correlation between visual function and quality of life was examined. The postoperative subjective vision, peripheral visual field, visual adaptation, and stereo vision scores, as well as the total score were higher at both 3 days and 3 months compared to the preoperative scores (P<0.05). Also, the postoperative self-care ability, mobility, psychological states, and social ability scores, as well as the total scores were higher at both 3 days and 3 months than the preoperative scores (P<0.05). Age (≥80), preoperative corrected visual acuity (<0.1), a history of glaucoma, postoperative corneal edema, fundus lesions, and a longer phacoemulsification time were independent risk factors affecting the visual function of patients with senile cataract following phacoemulsification (P<0.05). The visual function indexes of patients were positively correlated with the quality of life (P<0.05). Phacoemulsification can improve the short-term visual function of patients with senile cataract and improve their quality of life. Advanced age, preoperative corrected visual acuity (<0.1), a history of glaucoma, postoperative corneal edema, fundus lesions, and a longer phacoemulsification time are independent risk factors that affect the visual function of patients with senile cataract after phacoemulsification. For patients with the aforementioned high-risk factors, enhanced clinical intervention and evaluation is required to reduce the risk of poor postoperative vision.

Small-gauge vitrectomy for advanced diabetic eye disease: outcomes and predictive factors for poor postoperative vision

Objective: To evaluate the anatomical and visual outcomes of small-gauge vitrectomy in patients with advance diabetic eye diseases (ADED) and the predictive factors for poor visual outcome.&#x0D; Materials and methods: A retrospective study was conducted from 2009 to 2014. Data at baseline, 6 months, and 12 months post-surgery were collected along with baseline demographic data, indications of surgery, systemic associations, visual and anatomical outcome, and postoperative complications. Poor visual outcomewas defined as visual acuity worse than 6/36.&#x0D; Results: A total of 158 eyes from 133 patients were recruited. Mean age was 54.01 ± 11.57 years and mean follow-up was 9.9 ± 3.7 months. Indications for vitrectomy were vitreous haemorrhage (VH, 77 eyes [48.7%]), tractional retinal detachment (TRD) with macular involvement (75 eyes [47.5%]), and other causes in 6 eyes (3.8%). There was visual improvement in 59.3% of patients, 23.6% worsened, and 17.1% stabilized at 12 months post-surgery. Patients with VH (75.4%) showed significant improvement compared to patients with TRD (48.3%). Successful anatomical outcomes were achieved in VH (98.2%) and TRD (96.7%). However, patients with TRD were found to have a 2.4-fold higher risk of having poor visual outcomes.&#x0D; Conclusion: Small-gauge vitrectomy for ADED resulted in excellent visual and anatomical outcomes. Eyes with TRD were at a higher risk of developing poor visual outcomes.

A comparative study of post-operative astigmatism induced by phacoemulsification and manual small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery.AIM: The aim of the study was to compare the effect of surgically induced astigmatism in SICS and Phacoemulsification after taking the incision in the steepest meridian.Setting: Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, Karnataka.Design: Prospective observational study. Material and Methods: A total of 200 eyes of 200 patients with mean age of 62 years were included in the study. Consecutive patients with cataract were randomly assigned to undergo phacoemulsification or manual SICS by a single surgeon experienced in both techniques. Group A underwent SICS (Small Incision Cataract Surgery) and group B had phacoemulsification. Surgically induced astigmatism was analyzed by SIA software.Statistical analysis: Non-parametric method (Mann whitney U test).Results: The measurement of induced astigmatism was taken: dK, the net keratometric change in corneal toricity. Average dK for Group A (SICS) was +0.05 D and for Group B (Phacoemulsification) was -0.53 D. There was a difference of -0.49 D between the two groups in terms of induced keratometric astigmatism. The SICS group actually demonstrated on the average a greater iatrogenic astigmatism than the phacoemulsification group keratometrically. This is clinically or statistically significant (P

Analysis on cause of poor postoperative visual acuity after vitrectomy for severe proliferative diabetic retinopathy

Objective To analyse the cause of poor postoperative vision acuity after vitrectomy for the treatment of proliferative diabetic retinopathy. Methods The data of 29 eyes of 22 patients with proliferative diabetic retinopathy were enrolled and analyzed retrospectively, they were in stable condition after vitrectomy. All cases were divided into visual acuity improved group (group 1) and no improved group (group 2)according to visual acuity postoperative. The follow-up time was 6-12 months.The related factors of poor visual acuity and surgical complications were analyzed. Results The glycated hemoglobin level in group 2 of (8.21±1.57)% was significantly higher than that of (7.11±1.18)% in group 1. The glycated hemoglobin level was significantly associated with poor visual acuity and the creatinine level was significantly associated with diabetic macular edema by logistic regression analysis. Conclusion The poor glucose regulation may indicate worse visual acuity after successful vitrectomy for severe diabetic retinopathy. Key words: Retinopathy, diabetic, proliferative; Vitrectomy; Macular edema, diabetic; Complication

A longitudinal study to evaluate effect of surgically induced astigmatism after phacoemulsification clear corneal incision placed in the steepest meridian on eyes with preexisting astigmatism

Context: Surgically induced astigmatism (SIA) is the cause of poor postoperative vision even after uneventful cataract surgery. Aims: (1) To evaluate the effect of SIA after phacoemulsification clear corneal incision in the steepest meridian on the magnitude of preexisting astigmatism (PEA). (2) To map the magnitude of SIA by incisions in superior (S) and temporal (T) positions. Settings and Design: KLES Dr. Prabhakar Kore Hospital and Medical Research Centre (MRC), Belagavi, Karnataka. Longitudinal study. Subjects and Methods: The present 1-year study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, on patients undergoing cataract surgery during the period of January 1, 2014,-December 31, 2014. The patients undergoing phacoemulsification with PEA ranging from 0.5 D to 1.5 D were selected for the study to evaluate SIA after phacoemulsification clear corneal incision in the steepest meridian on the magnitude of the PEA. Statistical Analysis Used: Paired t -test was used to calculate mean SIA. Results: The result showed average SIA recorded was 0.54 ± 0.34 D with P P = 0.145). On taking temporal incision, the mean keratometric difference was 1.03 ± 0.96, which was statistically significant. On taking superior incision, the mean keratometric difference was 0.92 ± 0.95, which was statistically significant. Conclusions: Choosing the clear corneal incision site based on the preoperative steepest meridian significantly decreased keratometric astigmatism at the temporal and superior locations. As well as, temporal incision is evidently better than superior incision in minimizing SIA.

Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury

Purpose:To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury.Materials and Methods:Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded.Results:Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes).Conclusion:Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted.

Evaluation and comparison of surgically induced astigmatism between phacoemulsification and small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Aim: The aim of study was to compare the incidence, amount, type, and course of surgically induced astigmatism and visual acuity in temporal 5.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included in the study. Cases were randomly divided into two groups. Group A had undergone 5.5-mm temporal clear corneal phacoemulsification and group B had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in group A was 61 (±8) years and in group B was 63 (±10) years. Mean surgically induced astigmatism in group A was 1.05 (±0.58) D, 1.13 (±0.52) D, 1.13 (±0.56) D, and 1.08 (±0.52) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. The change from 1 st to 45 th day was not significant. The same in group B was 0.75 (±0.58) D, 0.81 (±0.54) D, 0.88 (±0.49) D, and 0.91 (±0.47) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule type of astigmatism post-operatively in the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher in the 5.5-mm temporal clear corneal group than in the superior scleral group. Clinical outcome of both surgeries was same, as there was no significant difference in the uncorrected postoperative visual acuity in between the groups.

Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy

Objective:To study the preoperative characteristics, complications and outcomes of vitrectomy for proliferative diabetic retinopathy and to identify any factors that may predict visual outcome.Methods:Prospective study of 174 consecutive vitrectomies in...

Visual Outcomes and Associated Risk Factors of Cataract Surgeries in Highly Myopic Taiwanese

Aims: The purposes of this study were to describe the visual outcome of highly myopic eyes undergoing cataract surgery, to investigate associated risk factors for poor postoperative vision, and to assess postoperative complication frequency among the prevalent myopic Taiwanese population. Methods: We conducted a retrospective, noncomparative case series study at the Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan. High myopia was defined as axial length of 26.0 mm. Main study outcomes were visual acuity for the initial 6-month postoperative period (including visual acuities and improvement of postoperative vision), and postoperative complications (including subsequent cataract formation and postoperative retinal detachment). Results: Fifty-two highly myopic eyes were registered between January 2002 and December 2004. Mean follow-up interval was 43.3 ± 20.2 weeks (range 25–103). Thirty-two eyes (61.5%) had good postoperative visual improvement (≧4 line Snellen chart). Thirty-seven eyes (71.2%) achieved good postoperative vision (20/40 or better). Fifteen eyes (28.8%) demonstrated poor postoperative vision. Pre-existing maculopathy was an independent risk factor for failure to achieve good postoperative vision (odds ratio, OR, 6.84, 95% confidence interval, CI: 1.12–41.8) and improvement (OR 16.1, 95% CI: 2.2–119.9). Diabetic history was considered another independent risk factor for poor postoperative vision (OR 15.6, 95% CI: 0.97–267.6). Six eyes (11.5%) developed subsequent posterior capsular opacification requiring Nd:YAG laser capsulotomy. Two eyes (3.8%) developed retinal detachment during follow-up. Conclusions: Most of highly myopic eyes achieved good visual improvement and good postoperative visual acuity after cataract surgery. Pre-existing maculopathy was an independent risk factor of postoperative visual improvement and status. It is crucial to examine retinal status prior to cataract surgery to prevent poor vision improvement, poor postoperative vision, or retinal complications.

Visual Outcomes and Associated Risk Factors of Cataract Surgeries in Highly Myopic Taiwanese

Aims: The purposes of this study are to describe the visual outcome of highly myopic eyes undergoing cataract surgery, to investigate associated risk factors for poor postoperative vision and to assess the postoperative complication frequency among the myopic Taiwanese population. Methods: We conducted a retrospective, noncomparative case series study at the Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan. High myopia was defined as axial length ≧26.0 mm. The main study outcomes were visual acuity for the initial 6-month postoperative period (including visual acuities and improvement of postoperative vision) and postoperative complications (including subsequent cataract formation and postoperative retinal detachment). Results: Fifty-two highly myopic eyes were enrolled between January 2002 and December 2004. The mean follow-up interval was 43.3 ± 20.2 weeks (range 25–103). Thirty-two eyes (61.5%) had good postoperative visual improvement (≧4 lines of Snellen chart). Thirty-seven eyes (71.2%) achieved good postoperative vision (20/40 or better). Fifteen eyes (28.8%) demonstrated poor postoperative vision. Pre-existing maculopathy was an independent risk factor for failure to achieve good postoperative vision [odds ratio (OR): 6.84, 95% confidence interval (CI): 1.12–41.8] and improvement (OR: 16.1, 95% CI: 2.2–119.9). Diabetic history was considered another independent risk factor for poor postoperative vision (OR: 15.6, 95% CI: 0.97–267.6). Six eyes (11.5%) developed subsequent posterior capsular opacification requiring Nd:YAG laser capsulotomy. Two eyes (3.8%) developed retinal detachment during follow-up. Conclusions: Most highly myopic eyes achieved good visual improvement and good postoperative visual acuity after cataract surgery. Pre-existing maculopathy was an independent risk factor of postoperative visual improvement and status. It is crucial to examine retinal status prior to cataract surgery to prevent poor vision improvement, poor postoperative vision or retinal complications.

Postoperative Intraocular Pressure Abnormalities in the Silicone Study: Silicone Study Report 4

Chronically abnormal intraocular pressure (IOP) may follow surgery for proliferative vitreoretinopathy (PVR), using either long-acting gas or silicone oil tamponade. Its prevalence and clinical significance are unclear. In the Silicone Study, 241 eyes with severe (> or = C-3) PVR were treated with vitrectomy, randomized to perfluoropropane gas (C3F8) or silicone oil, and followed for 6 months or longer. Chronic IOP abnormalities, based on findings at two consecutive or any three postoperative visits, were defined as (1) low IOP (hypotony), 5 mmHg or less, or (2) elevated IOP, more than 25 mmHg. Eleven (5%) eyes had chronically elevated IOP and 58 (24%) had chronic hypotony. Chronically elevated IOP was more prevalent in eyes randomized to silicone oil than in those randomized to C3F8 gas (8% versus 2%; P < 0.05). Chronic hypotony was (1) more prevalent in eyes randomized to C3F8 gas than in those randomized to silicone oil (31% versus 18%; P < 0.05); (2) more prevalent in eyes with anatomic failure (48% versus 16%; P < 0.01); and (3) correlated with poor postoperative vision (P < 0.0001), corneal opacity (P < 0.001), and retinal detachment (P < 0.001). Factors prognostic of chronic hyotony included preoperative hypotony (P < 0.01), diffuse contraction of the retina anterior to the equator (P < 0.01), rubeosis (P = 0.02), and large retinal breaks (P = 0.02). In a multivariate analysis, diffuse contraction of the retina anterior to the equator remained an independent factor prognostic of chronic hypotony (odds ratio = 4.2), regardless of whether the retina was attached postoperatively. Intraocular pressure abnormalities are a common postoperative complication in eyes with PVR, and may occur with either C3F8 gas or with silicone oil. The presence of diffuse contraction of the retina anterior to the equator should alert the vitrectomy surgeon that the eye is likely to be hypotonus postoperatively.

Intraocular Lens Removal During Penetrating Keratoplasty for Pseudophakic Bullous Keratopathy

Pseudophakic bullous keratopathy is now the most common reason for penetrating keratoplasty. In previous reports, the type of intraocular lens (IOL) most frequently encountered in these eyes was the iris plane IOL. The authors reviewed 27 cases of IOL removal during penetrating keratoplasty. Lenses were removed if they were dislocated or associated with iritis, recurrent hyphema, glaucoma, or persistent cystoid macular edema. The IOL encountered most often was the anterior chamber lens (in 22 eyes); closed thin loop, semiflexible or flexible anterior chamber lenses accounted for 19 of these. Iris plane lenses were removed from five eyes. No posterior chamber lenses were removed. Clear grafts were obtained in 24 of 27 cases (89%); visual acuity improved or remained the same in 24 cases, to 20/60 in 11 cases. The most common causes of poor postoperative vision were retinal disease (6/27 cases) and glaucoma (6/27 cases). The association between anterior chamber lenses and pseudophakic bullous keratopathy is probably the result of both the increase in use of these lenses and the documented propensity of the closed loop semiflexible anterior chamber lenses to cause complications.