Postoperative logMAR Best-corrected Visual Acuity Research Articles

Functional evaluation with microperimetry in large idiopathic macular holes treated by a free internal limiting membrane flap tamponade technique

BackgroundFree internal limiting membrane (ILM) flap tamponade technique is an alternative choice for treating large idiopathic macular holes (IMHs). However, the functional recovery related to this surgical approach is not well-characterized. This study aimed to evaluate morphological and microperimetric outcomes 6 months after free ILM flap tamponade technique for large IMHs.MethodsTwenty-two patients (22 eyes) with large IMHs (minimal diameter > 400 μm) were retrospectively enrolled in this study. All patients underwent 23-gauge pars plana vitrectomy with ILM peeling and free ILM flap tamponade procedures. Snellen best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and MP-1 microperimetry were measured at baseline and 6 months after surgery. Associations of postoperative BCVA with retinal sensitivity were detected.ResultsMacular hole closure was achieved in 21 eyes (95.5%). Dislodgement of free ILM flap was found in non-closed eye. Mean logMAR BCVA improved from 1.10 ± 0.33 at baseline to 0.67 ± 0.32 at 6 months postoperatively (P < 0.001). The mean overall macular sensitivity and foveal fixation stability increased respectively from 8.58 ± 3.05 dB and 65.64 ± 17.28% before surgery to 11.55 ± 2.72 dB and 78.59 ± 13.00% at 6 months after surgery (P < 0.001). The mean change in foveal sensitivity (within 2°) was significantly greater than the change achieved for peri-foveal sensitivity (2° to 10°) by 1.50 ± 2.62 dB (P = 0.014). Linear regression analysis showed that postoperative logMAR BCVA was significantly associated with duration of symptom (B = 0.063, P = 0.001), preoperative logMAR BCVA (B = 0.770, P = 0.000), preoperative peri-foveal (B = − 0.065, P = 0.000) and foveal sensitivity (B = − 0.129, P = 0.000). Moreover, multiple regression model revealed that preoperative foveal sensitivity was independently associated with postoperative logMAR BCVA (B = − 0.430, P = 0.040).ConclusionsVitrectomy combined with ILM peeling and free ILM flap tamponade technique results in effective morphological and functional recovery for large IMHs. Preoperative foveal sensitivity might be a prognostic indicator for postoperative BCVA.

One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane.

To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract. A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane (ERM) peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed. Mean logMAR BCVA improved and CFT decreased significantly (P<0.001) until 6mo after surgery. Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA (r=0.716, P<0.001 at 1mo, r=0.417, P=0.014 at 3mo, r=0.359, P=0.037 at 6mo, and r=0.369, P=0.032 at 12mo post-op respectively), but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA. There was a positive correlation between CFT and logMAR BCVA at 1mo (r=0.346, P=0.045), 6mo (r=0.347, P=0.045), and 12mo (r=0.342, P=0.048) post-operatively. The intra- and postoperative complications were relatively mild, and the incidences were generally low. For severe iERM patients with significant visual symptoms, combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT. Early surgery in selected patients may help preserving better visual function.

The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center.

This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). There were 202 eyes of 198 patients with an average of 22 months' follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more (P = .92). Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.

The macular microstructure repair and predictive factors of surgical outcomes after vitrectomy for idiopathic macular hole.

To evaluate the macular microstructure repair and explore the factors related to those changes and visual improvement after vitrectomy for idiopathic macular hole (IMH). Totally 19 eyes of 18 IMH patients who underwent macular hole (MH) surgery were evaluated with best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) images. All 19 eyes closed at 6mo postoperatively. BCVA was observed gradually improved (P<0.001), with subretinal fluid (SRF) gradually absorbed (P=0.021) and the rate of external limiting membrane (ELM) defects gradually decreased (P=0.011) with follow-up time. Poorer postoperative logMAR BCVA correlated with larger MH minimum diameter (P<0.001), larger MH basal diameter (P=0.008), longer symptom duration (P=0.002) and poorer preoperative logMAR BCVA (P=0.010). More improvement in BCVA correlated only with poorer preoperative in logMAR BCVA (P=0.002). The earlier reconstruction of ELM was associated with smaller MH basal diameter (P=0.022) and shorter symptom duration (P=0.008). In conclusion, smaller basal diameter of MH and shorter symptom duration were key factors in earlier reconstruction of ELM.

The correlation analysis of morphological parameters and postoperative prognosis in patients with idiopathic macular hole

Objective To evaluate the optical coherence tomograghy (OCT) morphological parameters for predicting anatomical outcomes and postoperative visual acuity in idiopathic macular hole (IMH) after pars plana vitrectomy (PPV). Methods A retrospective study. A total of 26 eyes in 23 IMH patients underwent PPV, internal limiting membrane (ILM) peeling and gas filling surgery were included in this study. The patients included 8 eyes of 7 males and 18 eyes of 16 females, with the mean age of (63.9± 9.4). All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy and three-dimensional optical coherence tomography (3D OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. According to the standard classification system of International Vitreomacular Traction Study (IVTS) Group, 8 eyes were medium full-thickness macular hole (FTMH) and 18 eyes were large FTMH, none of which were with vitreomacular traction (VMT). The minimum diameter (MIN), base diameter (BASE), height (H), left and right arm length (LAL and RAL), diameter of ellipsoid zone absence (DEZA) were measured. Macular hole index (MHI), hole form factor (HFF), tractional hole index (THI), diameter hole index (DHI) were calculated. The average follow-up period were (9.2±9.7)months. The postoperative DEZA were measure at the last time. Anatomical outcomes were divided into 3 groups. The multiple factors related with predicting anatomical outcome and visual acuity were analyzed. Results In the 26 eyes, the hole was closed in 16 eyes of type 1, 7 eyes of type 2, 3 eyes of type 3. The mean pre- and post-operative logMAR BCVA were 0.9±0.3, 0.7± 0.3 respectively. The MIN, BASE, H were (533±176), (1 035±270), (462±138)μm respectively. The MHI, HFF, THI, DHI were 0.46±0.15, 0.72±0.19, 0.95±0.37, 0.52±0.11 respectively. The mean pre- and post-operative DEZA were (1 775±486), (960±138) μm respectively.Postoperative logMAR BCVA were correlated significantly with MHI, THI (all P 0.05). Anatomical prognosis types were significantly correlated with MHI, HFF, THI (all P 0.05). Conclusions For medium and large FTMH in IVTS classification system, MHI, THI have the best correlation with postoperative BCVA and can be considered as key indicators for predicting postoperative BCVA. MHI, HFF, THI have the best correlation with anatomical outcomes and can be considered as key indicators for predicting anatomical outcomes of IMH. Key words: Retinal perforations; Tomography, optical coherence; Vitrectomy; Retina

Combined phacoemulsification, 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for patients with coexisting idiopathic macular hole and age-associated cataract.

The aim of the present study was to assess the curative effect of combined phacoemulsification, 23-gauge pars plana vitrectomy with Brilliant blue G-assisted limiting membrane peeling and gas tamponade in patients with coexisting idiopathic macular hole (IMH) and age-associated cataract. A total of 21 consecutive patients (21 eyes) with coexisting IMH and age-associated cataract were enrolled in the study. All patients were treated by 23-gauge microincision vitrectomy with internal limiting membrane peeling, gas tamponade and combined phacoemulsification. The pre-operative MH diameter, MH index and best-corrected visual acuity (BCVA), as well as events of post-operative MH closure and complications were recorded and analyzed. Anatomic closure of the MH was achieved in 19 eyes (90.4%) with a single surgery. The LogMAR BCVA value at 1 month after surgery and the final follow-up visit was significantly lower than the baseline value (P=0.0036 and P=0.0015, respectively). A significant correlation was identified between the MH index and the post-operative LogMAR BCVA (r=0.869; P<0.001). The combined technique applied in the present study produced favorable anatomic and functional results for patients with coexisting IMH and age-associated cataracts. The pre-operative MH size measured by optical coherence tomography may serve as a predictive factor for the LogMAR BCVA value following MH surgery.

Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane

Objective: To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients. Methods: Retrospective case series study. The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients, 43 male patients, aged 68.1±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed. Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation. All eyes underwent vitecrtomy and macular epiretinal membrane peeling. During the 12 months follow up, the preoperative and postoperative data including best corrected visual acuity (BCVA), foveal thickness, changes of morphology in ellipsoid zone were observed and analyzed. All the patients were divided into two groups, continuous group (52 patients) and discontinuous group (22 patients), based on the preoperative continuity status of ellipsoid zone. The data of preoperative macular retinal thickness, the relationship between age and course of the disease, preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method. The postoperative BCVA were analyzed statistically with t test mtehod, based on the different grouping of continuity status of ellipsoid zone. Results: The preoperative LogMar BCVA, and the postoperative LogMAR BCVA of 1 month, 3 month, 6 month and 12 month after operation were 0.59±0.26, 0.63±0.34, 0.46±0.22, 0.45±0.23, 0.41±0.23 (F=25.122, P<0.05) respectively. The preoperative foveal thickness, and the postoperative foveal thickness of 1 month, 3 month, 6 month and 12 month after operation were (468.12±73.07), (371.57±57.09), (320.57±65.88), (294.85±69.36), (283.5±66.56)μm (F=8.802, P<0.05), the difference between the figures are of statistical significance. The postoperative BCVA of continuous group (0.34±0.27) improved significantly, as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209, P<0.05). There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015, P> 0.015). Seven patients still have macular edema one year after surgery. Conclusion: The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea, and has positive correlation with continuity of ellipsoid zone. (Chin J Ophthalmol, 2018, 54: 258-262).

A comparative evaluation of two commercially available formulations of brilliant blue G in idiopathic macular hole surgery

Aim: The aim of this study is to comparatively evaluate “internal limiting membrane (ILM) blue (0.025% brilliant blue G (BBG) +4% polyethylene glycol” and “Brilliant Peel (0.025% BBG + heavy water)” in idiopathic full-thickness macular hole (FTMH) surgery with respect to anatomical and functional outcome and surgical ease of ILM peeling. Materials and Methods: It was a prospective comparative study. Thirty patients with idiopathic FTMH selected for pars-plana vitrectomy with ILM peeling were included in the study. Cataract extraction was combined with vitrectomy if cataract was significant. Fifteen eyes underwent ILM peeling with ILM blue – Group 1 and fifteen eyes with Brilliant Peel – Group 2. The adequacy of ILM staining was noted intraoperatively. All patients followed up next day, at 1 week, 6 weeks, and 3 months. Macular hole closure rate and gain in visual acuity (VA) and contrast sensitivity (CS) were noted. Statistical Analysis: Student's t-test was used to assess the baseline numeric differences among groups. Repeated measures ANOVA was used to assess VA improvement over time in each group. Chi-square test was used to compare two groups in terms of stage of macular hole. Means test was used to check the effect of lens status in visual recovery. Results: Both groups were well matched in demographic data, baseline VA, stage of macular hole, and percentage of eyes undergoing simultaneous cataract extraction. Macular hole closed in 100% of eyes. Mean pre- and postoperative logMAR best-corrected VA was 0.80 and 0.40 in ILM blue group and 0.993 and 0.527 in the Brilliant Peel group. VA improvement was clinically and statistically significant in both ILM blue (P = 0.004) and Brilliant Peel (P = 0.003) groups. The groups did not differ from each other at 3 months in terms of gain in VA (P = 0.291) and CS. Intraoperatively, both the dyes stained the ILM well. Conclusion: ILM peeling with ILM blue and Brilliant Peel dyes showed comparable intraoperative staining and good postoperative anatomic and functional outcome.

Vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy with or without preoperative Avastin.

To describe and compare 1. The changes in intraretinal microstructure using serial spectral domain optical coherence tomography (SD-OCT) preceding and following pars plana vitrectomy and delamination of fibrovascular membranes and 2. Intraoperative and postoperative complications in patients with proliferative diabetic retinopathy (PDR) who had preoperative Avastin (group A) or not (group B). This retrospective, interventional case series includes 113 eyes. Outcome measures included LogMAR distance best-corrected visual acuity (BCVA), SD-OCT integrity of photoreceptor inner and outer segments junction (IS/OS), and integrity of external limiting membrane (ELM), intraoperative and postoperative complications. Pre-operative central macular thickness (CMT) was significantly correlated with the final post-operative LogMAR BCVA in group A. Both groups were also categorised into three sub-groups based on post-operative IS/OS integrity (group 0: IS/OS intact; group 1: IS/OS irregular but not completely disrupted; group 2: IS/OS completely disrupted). Mean BCVA improved significantly and IS/OS integrity and ELM integrity postoperatively, were significantly and positively correlated with final BCVA in group A. Intraoperative complications such as iatrogenic tears and haemorrhage and postoperative such as vitreous haemorrhage and neovascular glaucoma were significantly less in group A compared to group B. Pre-operative Avastin reduces the risk of intraoperative and postoperative complications and results in better postoperative anatomic and functional outcomes in fibrovascular delamination surgery for patients with PDR.

Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole

Objective To observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH). Methods This is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C3F8, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C3F8, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months. Results MH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠ of U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18). Conclusion Vitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function. Key words: Retinal Perforations/surgery; Vitrectomy

Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment.

To assess correlation between preoperative and postoperative findings and surgical factors, and postoperative functional outcomes after successful repair of acute macula-off rhegmatogenous retinal detachment (RRD). Forty-four eyes of 44 patients with recent-onset macula-off RRD who had primary pars plana vitrectomy were included in this retrospective study. Best-corrected visual acuity (BCVA) and retinal and choroidal changes on spectral-domain optical coherence tomography (SD-OCT) were evaluated before and after surgery. Correlation between preoperative and postoperative variables such as demographic and clinical data, SD-OCT findings and surgical factors, and postoperative functional outcomes were assessed. Eighteen women and 26 men, whose mean age at the onset of RRD was 51.7±14.4years, were evaluated. The mean preoperative and postoperative logMAR BCVA were 1.1±0.5 (20/250) and 0.14±0.1 (20/30), respectively, after a mean of 16.7±7.2months. Although all factors were evaluated as prognostic factors for functional outcome after surgical treatment of recent-onset macula-off RRD, epiretinal membrane formation was found as the only factor affecting postoperative visual acuity. Satisfactory visual recovery can be achieved after a successful surgery in patients with acute RRD without any association with morphological changes such as increased subretinal fluid, central foveal thickness, subfoveal choroidal thickness, cystic spaces in the inner nuclear layer and/or outer nuclear layer, undulation of separated outer retina, and disruption of the photoreceptor layer. Epiretinal membrane formation may affect visual outcome in these patients.

Descemet stripping automated endothelial keratoplasty versus descemet membrane endothelial keratoplasty: a meta-analysis.

To evaluate the efficacy and safety of descemet stripping automated endothelial keratoplasty (DSAEK) compared with descemet membrane endothelial keratoplasty (DMEK). Databases including PubMed, EMBASE, and Cochrane Library were searched to find studies that compared DSAEK and DMEK outcomes. Efficacy parameters were the postoperative best-corrected visual acuity (BCVA) and spherical equivalent (SE). Safety parameters were postoperative endothelial cell loss (ECL), air injection (rebubbling), graft failure, graft rejection, and high intraocular pressure (IOP). Results from last visit were pooled for the analyses because the follow-up ranged from 3 to 24months. A total of 7 trials including 433 eyes were selected for this meta-analysis. BCVA was reported in all 7 studies, ECL% and rebubbling rate were reported in 6, and the remaining outcomes were reported in only 3 or 2 studies. Postoperative logMAR BCVA was significantly better for DMEK than that for DSAEK (P<0.00001). More patients achieved the postoperative BCVA≥20/25 and 20/20 in DMEK group than that in DSAEK (P>0.001), whereas the proportion of patients whose postoperative BCVA≥20/40 and the amount of SE did not differ statistically (P=0.32 and P=0.50, respectively). The DSAEK group has a significantly lower frequency of rebubbling than the DMEK group (P<0.0001). The postoperative ECL%, graft failure, graft rejection, and high IOP were comparable between the 2 groups (all P values >0.05). Our meta-analysis suggests that DMEK provided better visual outcomes with similar safety when compared to DSAEK. Given the limited sample size, further investigations are needed to validate these findings.

Clinical observation of sclera buckle and vitrectomy treating different stages of familial exudative vitreoretinopathy associated rhegmatogenous retinal detachment

Objective To observe the outcome of scleral buckle and vitrectomy for familial exudative vitreoretinopathy (FEVR) associated rhegmatogenous retinal detachment (RRD) with different stages. Methods Twenty eyes in 19 patients were included in this study. All the eyes were staged according to the staging system of FEVR. There are 7 eyes at stage 3A, 4 eyes at stage 4A, 6 eyes at stage 4B, and 3 eyes at stage 5. According to classification of retinal detachment (RD) with proliferative vitreoretinopathy (PVR), PVR B was in 5 eyes, PVR C1 in 2 eyes, PVR C2 in 3 eyes, PVR C3 in 7 eyes, PVR D1 in 3eyes. Retinal holes responsible for the RD could be found in every case. Scleral buckle or vitrectomy were chosen according to FEVR staging, PVR classification, location of retinal breaks, extent of RD.Ten eyes (stage 3A in 7 eyes, stage 4A in 3 eyes; PVR B in 5 eyes, PVR C1 in 2 eyes, PVR C2 in 3 eyes) were undergone scleral buckle, the mean preoperative minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) is 0.60±0.32.Ten eyes (stage 4A in 1 eyes, stage 4B in 6 eyes, stage 5 in 3 eyes; PVR C2 in 1 eyes, PVR C3 in 6 eyes, PVR D1 in 3 eyes) were undergone vitrectomy, the mean preoperative logMAR BCVA is 1.81±0.53. The mean follow up was(20.20±7.25) months, range 3 to 30 months. Surgical outcome were estimated by the average number of operation, reattachment of retina and BCVA. Results Final retinal attachment was obtained in 100% of all 20 eyes. The mean postoperative logMAR BCVA of scleral buckle group (0.34±0.32) is improved than preoperative BCVA, the difference wan statistically significant (t=2.932, P=0.017). The mean postoperative logMAR BCVA of vitrectomy group (1.42±0.64) is not changed compare with preoperative BCVA (t=1.812, P=0.103). The mean number of operation of scleral buckle group (1.10±0.32) is less than vitrectomy group′s (2.20±0.42), the difference wan statistically significant (t=6.588, P=0.000). Conclusions Among the patients whose FEVR staging is less than 4A and PVR classification is less than C3, epiretinal membranes or subretinal membranes appears mild, and scleral buckle can achieve high success rate with less number of operations, and the BCVA is improved in most of the cases. For the patients whose FEVR staging is more than 4B and PVR classification is more than C3, proliferative vitreoretinopathy seems to be serious, retina can be effectively reattached via vitrectomy, however, the number of operations required is multiple, and the BCVA is probably unimproved after operation. Key words: Retinal detachment/surgery; Scleral buckling; Vitreoretinal surgery; Retinal diseases/congenital

Spectral domain ocular coherence tomography findings pre- and post vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy.

PurposeTo describe the intraretinal microstructure using serial spectral domain optical coherence tomography (SD-OCT) preceding and following pars plana vitrectomy and delamination of fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR).MethodsThis retrospective, interventional case series includes 28 eyes. Outcome measures included LogMAR distance best-corrected visual acuity (BCVA), SD-OCT integrity of photoreceptor inner and outer segments junction (IS/OS), and integrity of external limiting membrane (ELM).ResultsPre-operative central macular thickness (CMT) was significantly correlated with the final post-operative LogMAR BCVA (Pearson's coefficient r=0.89; P=0.001). The eyes were categorised into three groups based on post-operative IS/OS integrity (group 0: IS/OS intact; group 1: IS/OS irregular but not completely disrupted; group 2: IS/OS completely disrupted). Mean BCVA improved significantly in group 0 (n=9) from 1.13±0.75 preoperatively to 0.34±0.21 (Student's t-test: P=0.06), in group 1 (n=10) the BCVA improved from 0.88±0.56 to 0.58±0.31 (Student's t-test: P=0.053) and in group 2 (n=9) the BCVA improved from 1.64±0.53 to 1.53±0.75 (Student's t-test: P=0.652).IS/OS integrity and ELM integrity at 3 months post operatively, were significantly and positively correlated with final BCVA (Pearson's coefficient: r=0.83, P<0.001 and r=0.72, P<0.001, respectively).ConclusionsPre-operative CMT and post-operative disruption of the IS/OS and ELM are useful prognostic indicators in fibrovascular delamination surgery for patients with PDR.

Application value of optical coherence tomography in predicting visual outcome after vitrectomy for idiopathic macular epiretinal membrane

Background Idiopathic macular epiretinal membrane (IMEM) shows a high incidence and affects visual function of patients.The primary management of IMEM is vitrectomy, but the study on prediction of visual acuity after operation by optical coherence tomography (OCT) is seldom. Objective This study was to evaluate the predicting ability of OCT for preoperative visual outcome for IMEM patients who received vitrectomy. Methods The clinical data of IMEM patients with vitrectomy from March 2009 to May 2013 were retrospectively analyzed in People's Hospital Peking University.Forty-nine eyes of 48 cases were divided into continuous group (19 eyes of 18 cases) and discontinuous group (31 eyes of 31 cases) based on whether the extraretinal layers were intact on OCT, including retinal pigment epithelium (RPE), inner and outer segment of photoreceptors (IS/OS) and external limiting membrane (ELM).Central foveal thickness (CFT) by high-resolution spectral-domain OCT and best corrected visual acuity (BCVA) (LogMAR) before surgery and 12 weeks after surgery were recorded and compared between the two groups, and the correlations of shift of CFT with the shift of LogMAR vision was analyzed by unitary linear regression to evaluate the value of OCT in predicting postoperative vision.Writen informed consent was obtained from each patient prior to any medical operation.Written informed consent was obtained from each patient before surgery. Results In 12 weeks after operation, reflective strips of RPE layer, IS/OS and ELM layer were intact in 18 eyes of the continuous group after vitrectomy.The number of eyes with discontinuous strip in RPE layer decreased to 1 eye after operation from 6 eyes before operation, and the number of eyes with IS/OS reflective strip discontinue decreased to 19 eyes after operation from 29 eyes before operation, and that with ELM layer discontinue decreased to 15 eyes after operation from before operation in the discontinuous group.The improvement of LogMAR BCVA was increased with the decline of CFT values with a negative correlation between them (R2=0.298, B=0.001, P=0.000), and postoperative LogMAR visual acuity improved 1 line whenever CFT reduced by 100 μm.LogMAR BCVA was 0.4±0.19 before surgery and 0.36±0.21after surgery in the continuous group, showing a insignificant difference between them (t=0.876, P=0.393).In the discontinuous group, the postoperative logMAR BCVA was significantly higher after operation (0.46±0.26) than 0.82±0.41 after operation (t=6.206, P=0.000).The increase value of LogMAR after vitrectomy was 0.3 in the discontinuous group, which was superior to 0.0 of the continuous group. Conclusions The continuity of extraretinal layers and CFT by OCT are closely associated with the improvement of vision after vitrectomy in the eyes with IMEM. Postoperative vision is better in IMEM eye with continuous retinal reflective strips before operation, and majority of IMEM eyes can improve vision after operation. Preoperative OCT seems to be an important diagnostic tool for the selection of patients who benefit or not from surgery to certain extent. Key words: Computerized tomography; Optical coherence tomography; Visual outcome; Prognosis; Idiopathic macular epiretinal membranes; Vitrectomy

Postoperative vision-related quality of life in macula-off rhegmatogenous retinal detachment patients and its relation to visual function.

ObjectiveTo determine the vision-related quality of life (VR-QOL) after surgery for macula-off rhegmatogenous retinal detachment (RRD) in relation to visual acuity, contrast acuity, and color vision.MethodsIn a prospective observational study, we included 55 patients with a macula-off RRD. Best corrected visual acuity (BCVA), color vision (saturated and desaturated color confusion indices (CCI)) and contrast acuity were measured at 12 months postoperatively in both the RRD eye and the fellow control eye, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was filled out.ResultsOperated and fellow control eyes differed significantly in mean LogMAR BCVA (P<0.0001), median Log contrast acuity (P<0.0001), saturated CCI (P = 0.009), and desaturated CCI (P = 0.016). Significant correlations were observed between the NEI VFQ-25 overall composite score and postoperative LogMAR BCVA (R = −0.551, P<0.0001), contrast acuity (R = 0.472, P<0.0001), saturated CCI (R = −0.315, P = 0.023), and desaturated CCI (R = −0.283, P = 0.044).ConclusionsA lower VR-QOL was highly correlated to a worse postoperative BCVA and contrast acuity and to a lesser extent to color vision disturbances.

Contrast sensitivity and foveal microstructure following vitrectomy for epiretinal membrane.

To evaluate contrast sensitivity (CS) in patients with epiretinal membrane (ERM) following vitrectomy and to investigate the relationship between CS and foveal microstructures with spectral-domain optical coherence tomography (SD-OCT). Thirty-one eyes of 31 patients with ERM were included. We examined CS with a CSV-1000E chart, a logMAR best-corrected visual acuity (BCVA), and foveal microstructure by using SD-OCT before and at 6 months after surgery. From the CS data, the area under the log contrast sensitivity function (AULCSF) was calculated. Based on the OCT images, we quantified the mean thickness of the ganglion cell layer (GCL), the inner nuclear layer (INL), and the outer retinal layer (outer nuclear layer and outer plexiform layer [ONL+OPL]). The status of the photoreceptor inner and outer segment junction (IS/OS) and external limiting membrane (ELM) was also evaluated. Vitrectomy significantly improved logMAR BCVA and AULCSF. Even in patients with poor improvement of visual acuity (changes in logMAR BCVA by surgery was ≤0.2), postoperative AULCSF significantly increased by treatment (P < 0.05). Postoperative AULCSF showed a significant correlation with preoperative (P < 0.05) and postoperative (P < 0.05) ONL+OPL thickness, whereas other parameters were not relevant. Postoperative logMAR BCVA significantly correlated with postoperative status of IS/OS (P < 0.05) and preoperative ONL+OPL thickness (P < 0.05). In patients with ERM, CS improved even though their visual acuity did not recover significantly by vitrectomy. CS was associated with the thickness of outer retinal layer.

Comparison of Outcomes of Primary Anterior Chamber Versus Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Cataract Surgeries

To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Retrospective, comparative study. A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .336). The primary ACIOL group had more early postoperative complications (P < .001). No difference in late postoperative complications was observed between the 2 groups (P = .100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P = .927), while the presence of late complications was associated with a worse final visual outcome (P = .000). This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate.

Retinotomy with retinal turnover to remove subretinal membranes under direct visualization for proliferative vitreoretinopathy

PurposeThe purpose of the study was to report the outcomes for cases of proliferative vitreoretinopathy (PVR) that received retinotomy and removal of subretinal proliferative tissue under direct visualization using retinal turnover.MethodsNineteen eyes with posterior and/or anterior grade C1–12 PVR that had undergone retinotomy and retinal turnover were reviewed. Main outcomes included the retinal reattachment rate, final best-corrected visual acuity (BCVA), postoperative intraocular pressure, extent of retinotomy, and complications.ResultsFinal retinal reattachment rates with silicone oil tamponade were 100%. The mean logarithm of the minimal angle of resolution (logMAR) BCVA was significantly improved (P = 0.001). Positive correlation was found between the extent of retinotomy and both preoperative logMAR BCVA (r = 0.663, P = 0.002) and postoperative logMAR BCVA (r = 0.619, P = 0.005). There was no correlation between the extent of retinotomy and the change in preoperative and postoperative logMAR BCVA (r = −0.267, P = 0.268). Negative correlation was found between preoperative logMAR BCVA and the change in logMAR BCVA (r = −0.587, P = 0.008). There was no correlation between the extent of retinotomy and the intraocular pressure at the final visit (r = −0.316, P = 0.188). Corneal decompensation due to silicone oil in the anterior chamber occurred in one eye.ConclusionRemoval of subretinal proliferative tissue with retinal turnover seems to be an effective procedure.

Hemi-automated lamellar keratoplasty (HALK)

AimTo describe a hybrid technique for anterior lamellar keratoplasty in corneas with topographical irregularities that circumvents the limitations of the microkeratome, namely reproduction of surface irregularities in the lamellar cut...