Mean Preoperative Best-corrected Visual Acuity Research Articles

Impact of surgical case order on epiretinal membrane peeling surgery

ObjectiveTo determine whether surgical warm-up affects epiretinal membrane (ERM) peeling complication rates and surgical case times. SettingJewish General Hospital, Montreal, QC, Canada. DesignRetrospective case-control study. MethodsWe assessed consecutive patients who underwent pars plana vitrectomy for ERM peel (macular pucker) by one surgeon at the Jewish General Hospital from January 2006 until March 2016. Cases evaluated were sequential ERM peels performed as the first 2 surgeries of the day. The first case of the day was considered the “warm-up” and the second case was the “post-warm-up.” Baseline demographics, pre-operative characteristics, perioperative and postoperative best-corrected visual acuity (BCVA) at 2 months and 6 months, as well as postoperative complications are described. Results were analyzed using the χ2 test, t test, and Fischer's exact test. Regression models were used to identify any predictors of postoperative BCVA. ResultsThe study reviewed 108 patients. The warm-up group was compared with the post-warm-up group, and there was no significant difference between the mean pre-operative BCVA and the post-operative BCVA at 2 and 6 months. ERM peeling surgery complication rates were not statistically different between the warm-up cases and the post-warm-up cases. There was a tendency for performing complex surgeries that needed phaco procedures in post-warm-up cases (13% vs 2%, p = 0.03). Analysis of simple ERM peeling procedures (with no concomitant phaco procedures) showed no statistically significant tendencies for any of the groups to go beyond the 60 minutes allocated for the surgery (25.4% vs 20.0%, p = 0.27). ConclusionWarming-up does not influence the rate of postoperative complications or the postoperative BCVA in patients undergoing ERM peels. The strongest predictor of post-operative BCVA was pre-operative BCVA.

<p>Outcomes of resident-performed small incision cataract surgery in a university-based practice in the USA</p>

PurposeTo assess outcomes of resident-performed small incision cataract surgery (SICS) at a single academic institute and to determine the availability of SICS-oriented educational resources in residency programs across the USA.Patients and methodsA retrospective chart review was conducted on all patients who underwent SICS performed by postgraduate year 4 residents between January 2014 and January 2018 at the Wilmer Eye Institute, Baltimore, MD, USA. Postoperative visual acuity, intraoperative complications, and postoperative complications were the main outcomes measured. In addition, a survey was administered to all ophthalmology residency program directors in the USA to assess the presence of SICS-related content in their surgical training curriculum.ResultsTwenty-two eyes of 17 patients underwent planned resident-performed SICS, mainly for white cataracts. Intraoperative complications occurred in two (9.1%) eyes. The most common postoperative complication was transient increased intraocular pressure (two eyes, 9.1%). Mean preoperative best-corrected visual acuity (BCVA) was approximately 20/4,000. The large majority (95.2%) of eyes experienced improved BCVA following SICS, with a mean postoperative BCVA of 20/138 over an average follow-up of 4.2 months. Forty-seven programs responded to the survey (40.1% response rate). Residents were trained in SICS in 66.7% of these programs. However, more than half of all the programs did not have SICS-oriented educational resources available for residents.ConclusionResident-performed SICS was found to be a safe and effective technique for cataract management. Considering the limited surgical volume for SICS in the USA, training programs might instead consider implementing SICS-oriented content in their surgical curriculum, including wet labs.

Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL).

Purpose:To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia.Methods:In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant.Results:Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability.Conclusion:We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Intrascleral sutureless fixation of three-piece intraocular lens for aphakia management

Purpose: The aim of this study was to report the technique of sutureless intrascleral fixation (SIF) of three-piece foldable intraocular lens (IOL) in patients with insufficient posterior capsule support.Material and Methods: This study is a retrospective case series. We performed our modified technique on 54 patients. A 27-gauge needle was used to remove the haptics of the IOL from the scleral tunnel. The tips of the haptic were cautherized and then inserted into the scleral tunnel. The preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and complications were evaluated.Results: Fifty-four patients (24 women, 30 men) were included. The mean age was 52.4±14.5 years. The mean follow-up was 12±6.8 months. The mean preoperative BCVA (Snellen) was 20/500. At the postoperative first month, the mean BCVA was 20/80. The mean preoperative IOP was 12.5±3.5 mm Hg, at first month it was 12.8±6.5 mm Hg. Postoperative complications included subconjunctival hemorrhage in 12 patients, hyphema in 2 patients, and vitreous hemorrhage in 1 patient. There was no occurrence of haptic exposure, IOL tilted or decentration during the follow-up in this study.Conclusion: SIF of three-piece IOL is a reliable, rapid and easy to apply method. There are no significant changes in IOP and no permanent complications after surgery. It is also a succesful method in view of the consequential apparent improvement in visual acuity.

Scleral buckle surgery in Ghana: a decade comparison of the anatomic and visual outcome.

PurposeTo compare the anatomic and visual outcome of scleral buckle (SB) surgery in Korle Bu Teaching Hospital between 2002 and 2005 and 2011 and 2014.Materials and methodsIn this retrospective comparative study, the medical records of patients who have undergone SB for rhegmatogenous retinal detachment from January 2002 to December 2005 (group A) and from January 2011 to December 2014 (group B) in Korle Bu Teaching Hospital were examined. The clinical history, surgical techniques, and outcomes of treatment were analyzed. The main outcome measures were primary anatomic success (retina reattached for at least 3 months postoperatively after a single procedure), overall anatomic success (combined primary anatomic success and success following revision of SB with at least 3 months follow-up), mean postoperative best-corrected visual acuity (BCVA), and complications.ResultsOne hundred fifty-eight eyes (71 eyes in group A and 87 eyes in group B) were treated with SB in this study. The mean duration of rhegmatogenous retinal detachment was 105.5 days. Thirty-four (21.8%) of fellow eyes had BCVA worse than 6/60 at presentation. The primary anatomic success was comparable between the two groups; 70% in group A and 67.9% in group B (P=0.79). The overall anatomic success was also comparable between the two groups (76.7% in group A vs 79.8% in group B) (P=0.788). The mean postoperative BCVA in logMAR was significantly better than the mean preoperative BCVA (P<0.0001). Group B had significantly better mean BCVA (P=0.002) and longer duration of follow-up (P<0.0001) compared with group A at the last follow-up visit.ConclusionThe anatomic success of SB between the two time periods was comparable. A longer postoperative duration of follow-up was associated with a better visual outcome after SB.

Late-onset uveitis-glaucoma-hyphema syndrome caused by Soemmering ring cataract

To propose a late-onset mechanism for uveitis-glaucoma-hyphema (UGH) syndrome caused by Soemmering ring cataract (SRC) and describe surgical outcomes. Retrospective interventional case series. Patients developing UGH from anterior displacement of a haptic from a SRC. A retrospective chart review was conducted of all patients referred to an anterior segment surgeon (J.C.H.) for intraocular lens (IOL) reposition/exchange between January 2003 and June 2017. Inclusion criteria consisted of all eyes with (i) a diagnosis of UGH syndrome, and (ii) SRC causing anterior displacement of a sulcus-fixated haptic with iris-haptic touch. Outcome measures were change in best corrected visual acuities (BCVA) and resolution of UGH findings. Seven eyes of 7 patients developed UGH secondary to a SRC causing contact between the IOL optic/haptic and the iris/uvea. Diagnosis of UGH was made at a mean 9.1 years after IOL implantation; this was statistically different compared with UGH eyes with other mechanisms from our full UGH cohort (mean 5.4 years; p = 0.0367). The mean preoperative LogMAR BCVA of 0.45 improved to 0.37 after surgical intervention (p = 0.27). Resolution (or nearly full resolution) of UGH findings was achieved in all cases after SRC extraction and lens repositioning/exchange. Late-onset UGH syndrome can be caused by SRC. Surgical removal of the SRC with IOL repositioning within the capsular bag resolves most if not all components of UGH. Anterior segment ultrasound biomicroscopy is a helpful modality for determining if a SRC is present by demonstrating anatomic relationships commonly obscured by a miotic pupil.

Reflectance and Thickness Analysis of Retinal Layers in Patients with Epiretinal Membranes Using Spectral-Domain OCT before and after Vitrectomy with Membrane Peeling

To compare thickness and reflectance of retinal layer findings in patients with idiopathic epiretinal membranes (ERMs) before and after surgery with those of normal controls. Retrospective study. Patients with ERMs before and after surgery and healthy controls. Spectral-domain (SD) OCT imaging of eyes with ERMs before and after surgery and of healthy eyes were analyzed for morphologic appearance and using a customized algorithm to measure retinal layer reflectance and thickness. Findings were correlated with visual acuity outcomes. Retinal layer thickness and reflectance. Thirty-four ERM and 12 healthy eyes were identified. Mean preoperative best-corrected visual acuity (BCVA) improved from 0.53±0.31 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/68) to 0.41±0.25 logMAR (Snellen equivalent, 20/51) after surgery (P= 0.030). Differences in reflectance and thickness of retinal layers were identified among the preoperative ERM, postoperative ERM, and healthy eyes. High preoperative reflectance of the internal limiting membrane (ILM) to outer plexiform layer (OPL) was correlated with better postoperative BCVA (r= -0.451; P= 0.007). A larger improvement in BCVA was correlated with preoperative thick measurements of the outer nuclear layer (r= 0.514; P= 0.002), high reflectance of the group of layers from the ILM to the OPL (r= 0.426; P= 0.012), and low reflectance of the photoreceptor layer (r=-0.453; P= 0.007). Using linear regression analysis, better postoperative BCVA was associated with better preoperative vision (standardized regression coefficient, 0.553; P= 0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.526; P= 0.001). A larger improvement in BCVA was associated with worse preoperative BCVA (standardized regression coefficient, -0.539; P < 0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.428; P=0.001). Quantitative differences in reflectance and thickness among preoperative, postoperative, and normal SD OCT imaging allow assessment of retina layer changes secondary to ERMs. High reflectance of the ILM to OPL correlated with and was associated with better postoperative BCVA and improvement in BCVA.

Treatment of primary full-thickness macular hole by intravitreal injection of expansile gas.

To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH). Prospective interventional case series. Twenty-six eyes of 26 patients in Peking Union Medical College Hospital with primary FTMH underwent IVI of perfluoropropane (C3F8) 0.2 ml, followed by 7-14 days' face-down positioning. The macular hole closure rate, post-operative visual acuity, and the incidence of surgical complications were observed. The correlation between the patients' age, macular hole diameter, pre-operative best-corrected visual acuity (BCVA), status of the vitreous, and the macular hole closure rates were analyzed. A total of 17 cases (65.4%) had hole closure after IVI of C3F8 alone. The closure rate of small, medium, and large FTMH was 85.7, 80, and 33.3%, respectively. Pre-operative OCT examination showed that 10 cases (37%) had vitreomacular traction (VMT), and all of them achieved vitreous-macula separation after IVI of the gas. The diameters of the hole (P = 0.024) and the status of the vitreous (P = 0.038) had a significance difference for hole closure. The mean pre-operative and post-operative BCVA was 0.84 ± 0.29 and 0.49 ± 0.36 (logMAR), respectively (P < 0.01). One myope with persistent hole developed rhegmatogenous retinal detachment (RRD) 2 months after the surgery. Another myope with hole closure developed RRD 10 months after the surgery. They achieved hole closure and retinal reattachment after vitrectomy and scleral buckling, respectively. Intravitreal injection of C3F8 gas alone was an effective treatment for small-sized and medium-sized primary FTMH, but further large prospective studies are needed.

Submacular hemorrhage secondary to age-related macular degeneration managed with vitrectomy, subretinal injection of tissue plasminogen activator, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning

PurposeTo investigate the outcomes of vitrectomy, subretinal tissue plasminogen activator (tPA) injection, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning, in hemorrhagic neovascular age-related macular degeneration (AMD) patients. MethodsIn this retrospective case series, we reviewed the records of patients who were diagnosed as having submacular hemorrhage (SMH) secondary to neovascular AMD between January and June 2016. The main outcome measure was the difference between preoperative and postoperative best corrected visual acuity (BCVA). ResultsIn 9 eyes of 9 patients, mean preoperative and postoperative BCVA at the last follow-up were 1.65 and 1.49 LogMAR, respectively (p = 0.1), after a mean follow up time of 12.4 ± 1.0 months. The SMH was successfully displaced in 5 of the 9 patients (55.5%). Four out of 9 patients (44.4%) gained ≥3 lines. The duration of SMH was 3.6 ± 2.1 days (range 1–7) in the successfully displacement group, and was 10.0 ± 1.8 days (range 8–12) in the group in which was SMH could not be displaced (p = 0.002). The mean SMH area was smaller in the successfully displacement group than the group in which was SMH could not be displaced (p = 0.04). ConclusionVitrectomy, subretinal tPA injection, hemorrhage displacement with liquid perfluorocarbon, gas tamponade and face-down positioning was associated with improved visual outcomes in patients with hemorrhagic neovascular AMD. The duration and area of the SMH seemed to be related to the success of displacement.

Single-pass four-throw pupilloplasty for secondary angle-closure glaucoma associated with silicon oil tamponade.

To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade. The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser's slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases. Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p < 0.001). The mean preoperative and postoperative intraocular pressure was 38.2 ± 4.97 and 13.0 ± 2.35 mm Hg, respectively. There was a significant decrease in intraocular pressure and marked improvement in visual acuity in all the cases. Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.

Macular buckle without vitrectomy for myopic macular schisis: a Canadian case series

ObjectiveTo determine the effectiveness of a macular buckle procedure without vitrectomy for the treatment of symptomatic myopic macular schisis. DesignRetrospective case series. Participants and methodsAll patients who underwent surgery with placement of an NPB macular buckle (AJL Ophthalmic, Miñano, Álava, Spain) without vitrectomy for symptomatic myopic macular schisis were included. Visual acuity and anatomical outcomes based on optical coherence tomography (OCT) were reviewed. ResultsEight consecutive eyes from 7 patients were included. Six of the 7 patients were female and the mean age was 59 ± 6 years (range, 49–66 years). The mean follow-up duration was 11 ± 7 months (range, 3–23 months). Mean preoperative axial length was 29.54 ± 1.28 mm (range, 27.88–31.96 mm). Mean preoperative best-corrected visual acuity (BCVA) was 0.71 ± 0.29 logMAR (Snellen equivalent 20/103); mean postoperative BCVA was 0.46 ± 0.44 (Snellen equivalent 20/58; p = 0.19) and 87.5% of patients maintained or improved vision. Pre- and postoperative OCT images are included and discussed within. Preoperative ellipsoid zone status and postoperative central macular buckle indentation appear to be important in visual outcomes. Two patients required a buckle repositioning for persistent schisis. One patient developed a macular hole postoperatively that resolved with subsequent vitrectomy. There were no other complications. ConclusionsThe macular buckle is an effective and promising therapeutic option for myopic macular schisis.

Visual outcome and complications of cataract extraction after pars plana vitrectomy.

PurposeTo evaluate the visual outcomes and complications of phacoemulsification in previously vitrectomized eyes.Patients and methodsA retrospective analysis of 87 consecutive vitrectomized eyes (87 patients) which had undergone phacoemulsification with intraocular lens implantation between 2013 and 2016.ResultsThe mean interval from pars plana vitrectomy (PPV) to cataract surgery (CS) was 18.8 months. Mean age at CS was 61.5 years. Intraoperative complications included anterior rhexis tear (1 eye) and hyphema (1 eye). Postoperative complications included macular edema (17.2%, mean 42 days), posterior capsule opacification (13.8%, mean 14 months), ocular hypertension (11.5%), and anterior uveitis (1.1%). Preoperative mean best-corrected visual acuity improved from 20/50 to 20/25. Ninety-one percent of the eyes gained 2 or more lines, and 95% achieved visual acuity ≥20/40 after CS. Preoperative mean spherical equivalent improved from −4.35 to −0.17. Eyes with clear lens prior to the PPV had later CS (clear lens 27.1 vs no clear lens 9.7 months; p=0.016). Patients >55 years with clear lens at PPV (n=21) had earlier CS than younger ones with clear lens (n=24) (11.8 vs 40.5 months; p=0.033). Mean follow-up was 14.5 months.ConclusionPhacoemulsification is a safe procedure in vitrectomized eyes, with substantial gains in vision in most cases. Patients of advanced age and eyes without clear lens prior to the PPV had earlier CS.

Suturing technique for scleral fixation of toric intraocular lens in the traumatic aphakic eye with corneal astigmatism.

To describe the clinical outcomes of traumatic aphakic eyes with corneal astigmatism after using a novel technique for toric intraocular lens suture fixation. In total, 12 eyes of 12 patients who underwent a new scleral suture fixation technique of one-piece toric intraocular lens (SN6AT series, Alcon Inc., TX, USA) were included in our retrospective study. Preoperative patient status, postoperative visual acuity and refractive outcomes, postoperative intraocular lens rotation, tilt, decentration, and complications were analyzed. The mean follow-up was 11.6 ± 1.0 months. The mean preoperative best-corrected visual acuity was 0.55 ± 0.32 in the logarithm of minimum angle of resolution equivalent; the postoperative best-corrected visual acuity was 0.45 ± 0.34. The mean preoperative total corneal astigmatism was 2.51 ± 1.67 D. The mean postoperative residual astigmatism was 0.77 ± 0.54 D. The mean intraocular lens rotation was 3.33° ± 1.37° (range, 1°-6°). The mean intraocular lens tilt in horizontal direction was 3.64° ± 1.02° (range, 2.6°-6.3°) and in vertical direction it was 3.19° ± 1.07 ° (range, 1.6°-5.2°). The mean intraocular lens decentration in horizontal direction was 0.14 ± 0.03 mm (range, 0.089-0.192 mm) and in vertical direction it was 0.15 ± 0.02 mm (range, 0.113-0.181 mm). One patient had mild vitreous hemorrhage and two other patients had high postoperative residual sphere and astigmatism, respectively. But no other serious complications were observed. Scleral suture fixation of foldable toric intraocular lens to correct corneal astigmatism can be a safe and effective alternative technique to manage traumatic aphakic eyes that lack adequate capsular support.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

Outcomes of Anterior Chamber Intraocular Lens Implantation in Patients Undergoing Pars Plana Vitrectomy

To assess outcomes and complication rates in patients undergoing pars plana vitrectomy (PPV) and implantation of an anterior chamber intraocular lens (ACIOL). Retrospective chart review. A total of 50 eyes that underwent secondary ACIOL placement in the setting of concurrent PPV from October 2000 to August 2016 were included. A retrospective chart review was conducted. The primary outcome measure was the occurrence of postoperative complication including persistently elevated intraocular pressure, persistent or recurrent hyphema, persistent or recurrent vitreous hemorrhage, persistent corneal edema, or persistent uveitis, macular edema, epiretinal membrane, lens dislocation, retinal tear, or retinal detachment. The secondary outcome measure was best-corrected visual acuity (BCVA). Postoperative complications occurred as follows: persistently elevated intraocular pressure in 4 eyes (8%), persistent corneal edema in 1 eye (2%), persistent postoperative uveitis in 1 eye (2%). Seven eyes (14%) had new macular edema and 2 eyes (4%) had new epiretinal membranes after combined PPV and ACIOL surgery. No patient had persistent postoperative hyphema, vitreous hemorrhage, retinal tear, retinal detachment, or lens dislocation after ACIOL placement. Mean preoperative BCVA was 20/200 (logarithm of the minimum angle of resolution 0.96) and improved to 20/40 (logarithm of the minimum angle of resolution 0.28, P ≤ 0.0001) at 1 year postoperatively. Whereas there is a recent emphasis on new intraocular lens placement techniques in the setting of PPV including sutured and scleral-fixated intraocular lenses, ACIOL placement in the setting of concurrent PPV is a safe procedure, with few eyes developing long-term complications if careful case selection is employed.

Photorefractive keratectomy influences the angle of ocular deviation in strabismus patients with hyperopia.

To evaluate refractive, binocular vision and ocular alignment outcomes of photorefractive keratectomy (PRK) for the treatment of hyperopia in esotropic patients. Medical charts of hyperopic patients with full or partial accommodative esotropia (FAE or PAE) or consecutive exotropia (CE) undergone PRK from 2011 to 2014 were reviewed. The primary outcome was to assess the efficacy of PRK in improving ocular alignment. The secondary outcomes were the assessments of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE) and stereoacuity. Sixty-four eyes of 32 hyperopic patients were included. Three patients were affected by FAE, 24 by PAE and 5 by CE. All FAE patients and 4 PAE patients underwent only PRK; the remaining 25 patients underwent PRK plus strabismus surgery. After PRK, the mean corrected esodeviation decreased significantly in the overall esotropic population [7.15 ± 9.42 prism diopters (PD) vs. 5.04 ± 8.83PD; p = 0.03] and in particular in the group with small-angle esodeviation (< 20PD). Conversely, the only 2 patients with an angle of strabismus ≥20 PD as well as all CE patients did not show any postoperative variation of the deviation angle. Mean preoperative BCVA did not differ from postoperative UCVA (p = 0.19), while the mean postoperative SE decreased significantly after PRK (p < 0.0001). Our study confirmed that PRK eliminates the accommodative component of the deviation. In addition, this procedure seems to reduce or eliminate also the non-accommodative component of esodeviation (especially in small-angle deviation), thus suggesting to postpone strabismus surgery after PRK when esotropia and hyperopia coexist.

Recurrent pterygium treatment using mitomycin C, double amniotic membrane transplantation, and a large conjunctival flap

PurposeThe aim of this study was to evaluate the clinical outcomes of surgery for recurrent pterygia using mitomycin C (MMC), double amniotic membrane transplantation (AMT), and a large conjunctival flap.Patients and methodsThis retrospective case series included 31 eyes in 31 patients with recurrent pterygia. All patients underwent pterygium excision, application of MMC, double AMT, and placement of a large conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus.ResultsThe patients’ mean age was 68.2 years. The mean follow-up period was 3.6 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.23 and 0.13, respectively. There was a significant difference between the mean preoperative (−3.85 D) and postoperative (−2.22 D) astigmatism. The recurrence rate was 3.2% (1/31 cases).ConclusionSurgical pterygium excision with application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia.

Descemet Membrane Endothelial Keratoplasty: Outcomes in the First Year of Experience.

We aimed to report the clinical outcomes of Descemet membrane endothelial keratoplasty in our first year of experience. Patients who underwent Descemet membrane endothelial keratoplasty at the Baskent University Faculty of Medicine, Department of Ophthalmology, between 2015 and 2016 were included in the study. Patient demographics, cause of endothelial dysfunction, best-corrected visual acuity, central corneal thickness, graft survival, follow-up duration, and intraoperative and postoperative complications were recorded. Five eyes of 5 patients (4 female, 1 male) with a mean age of 53.4 ± 12.7 years were included. Cause of endothelial dysfunction included corneal endothelial dystrophy in 3 patients, pseudophakic bullous keratopathy in 1 patient, and endothelial graft failure after previous penetrating keratoplasty in 1 patient. Pre-stripped Descemet membranes obtained from the Ankara State Hospital Eye Bank were used. Mean duration of postoperative follow-up was 7.4 ± 3.7 months. Mean preoperative Snellen best-corrected visual acuity and central corneal thickness were 0.24 ± 0.15 and 625.5 ± 97.4 μm. Mean best-corrected visual acuity increased to 0.67 ± 0.26 (P = .02) in the first month and to 0.84 ± 0.11 (P < .01) at the end of follow-up. Mean central corneal thickness decreased to 546.6 ± 28.4 μm (P = .03). Graft detachment was observed in 1 patient on the first postoperative day, and it was reattached successfully by injection of air into the anterior chamber. There were no intraoperative complications. All corneas were clear at the end of follow-up. Descemet membrane endothelial keratoplasty provides a new and exciting option for endothelial transplant and has the potential to become the primary procedure for surgical management of Fuchs endothelial dystrophy and corneal endothelial disease. Rapid visual rehabilitation with few and manageable complications and good visual outcomes are the major advantages of this procedure.

Long-term outcomes of the aphakic snap-on Boston type I keratoprosthesis at the Bascom Palmer Eye Institute.

PurposeTo determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro).DesignRetrospective, non-comparative case series.MethodsForty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed.ResultsThe most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers–hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR).ConclusionMost patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications.

Double-infusion cannula technique for glued fixation of intraocular lens with endothelial keratoplasty

ObjectiveTo describe double-infusion cannula technique (DICT) that involves the placement of 2 infusion cannulas in a combined surgical approach of glued intrascleral haptic fixation of intraocular lens (glued IOL) with endothelial keratoplasty (EK) in patients with aphakic bullous keratopathy. DesignProspective, single-centre, interventional study. ParticipantsFive eyes of 5 patients. MethodsThe first cannula placed for fluid infusion at pars plana stabilises the globe and facilitates vitrectomy with the glued IOL procedure. Secondary IOL fixation compartmentalises the eye into anterior and posterior chamber and a continuous posterior fluid infusion prevents globe collapse in an already vitrectomized eye. The second cannula is placed at the level of limbus for pressurised air infusion that facilitates an EK procedure. When the donor graft is being unfolded, air infusion is stopped and fluid from the posterior infusion pushes up the iris IOL diaphragm and facilitates graft unfolding. ResultsThe mean follow-up was 14 ± 5 months (range 9–21 months). The donor age ranged from 35–57 years, and the mean percentage of endothelial cell loss calculated at 9 months follow-up was 27.32% ± 3.65%. The mean preoperative and postoperative best-corrected visual acuity was 1.02 ± 0.164 and 0.276 ± 0.173 logMAR, respectively (p = 0.000). No incidence of primary graft failure, graft rejection, or retinal detachment was reported during the entire follow-up period in any of the eyes. ConclusionDICT prevents hypotony and intraoperative pressure fluctuations, assists graft unrolling, promotes adherence to the recipient bed tissue, and prevents seepage of air into the vitreous cavity and loss of air tamponade in the anterior chamber.