Terms Of Visual Outcome Research Articles

Working-Age Cataract Patients: Visual Results, Reading Performance, and Quality of Life with Three Diffractive Multifocal Intraocular Lenses

To compare the visual outcomes, reading performance, and quality of life (QoL) of working-age cataractous patients bilaterally implanted with 3 different diffractive multifocal intraocular lenses (MIOLs). Two-center, randomized, prospective, double-masked study. Sixty-three consecutive patients (126 eyes) seen at Ophthalmology Section, Palermo and Florence University, Italy, randomized to receive the ReSTOR SN6AD3 (Alcon Laboratories, Inc, Irvine, CA) (20patients, group A), ReSTOR SN6AD1 (Alcon Laboratories, Inc) (21 patients, group B), or TECNIS ZMA00 (Abbott Medical Optics, Santa Ana, CA) (22 patients, group C) MIOL. Phacoemulsification. One-year follow-up differences among the 3 MIOL groups in visual acuity, reading performance by MNREAD (Minnesota Laboratory for Low-Vision Research, University of Minnesota, Minneapolis, MN) reading acuity (RA), critical print size (CPS), and maximum reading speed (MRS) under mesopic and photopic conditions. Photopic and mesopic contrast sensitivity (CS) by Pelli-Robson test and patient satisfaction by National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI RQL-42) questionnaire. Mean photopic uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and corrected near visual acuity (CNVA) did not differ among groups, with a preferred reading distance greater in group B (P< 0.0005). Photopic distance-corrected intermediate visual acuity (DCIVA) was best in group B (P= 0.001) and better in group C than in group A. Mesopic UNVA and DCNVA were worse in groups A and B compared with group C (P< 0.0005 in both cases), with better DCNVA in group B than in group A (P= 0.031). Mesopic uncorrected intermediate visual acuity (UIVA) and DCIVA were worst in group A, with better results ingroup C (P< 0.0005 and P= 0.001, respectively). Mesopic MNREAD RA was better in group C (P= 0.02), and mesopic MRS was higher in groups B and C than in group A (P= 0.002). The QoL scores by the NEI RQL-42 test exhibited no differences among groups in 9 over 13 scales. "Near vision" (P= 0.005), "symptoms" (P= 0.001), and "satisfaction with correction" scale scores (P= 0.030) were lowest in group A, and "appearance" scale score was lowest in group B (P= 0.045). Newer-generation aspheric diffractive MIOLs, especially low-add hybrid apodized or full diffractive, are highly suited for working-age cataractous patients in terms of visual outcomes, reading performance, and QoL. Intrinsic optical differences, such as optimization for computer or dim-light working, or night driving, could be useful tools to customize the IOL in each single case.

Effects of smoking on visual acuity of central serous chorioretinopathy patients

Background: The aim of this study was to evaluate the differences, in terms of visual outcome and treatment needs, between smokers and non-smokers central serous chorioretinopathy (CSCR) patients.Methods: The files of 252 patients diagnosed with CSCR who had presented to the Retina Unit of the Ophthalmology Clinic at Dicle University Medical School in Turkey were retrospectively evaluated. Eighty-four smokers, with a known history of smoking of at least one pack-year, and 133 non-smokers were included, whereas 35 patients with additional pathologies were excluded from the study.Results: Of the patients, 192 (88.5%) were male and 25 (11.5%) were female. The mean patient age was 38.8 ± 8.1 years (range: 20–68 years). Visual acuity (VA) of the smoker and non-smoker groups was measured as 0.45 ± 0.35 and 0.24 ± 0.28 logarithm of the minimum angle of resolution (logMar), respectively, at the first visit; 0.19 ± 0.29 and 0.06 ± 0.14 logMar at the sixth month; and 0.07 ± 0.14 and 0.02 ± 0.05 logMar at the ninth month. VA measurements at presentation and during all examinations (1th, 6th and 9th month) were significantly different for the two groups. VA was lower in the smoker group. In 27 patients (12.4%), an additional treatment modality was needed. Of the 27 patients, only 8 (6%) were non-smokers, whereas 19 (22.6%) were smokers. There was no difference between groups in the recurrence rate during follow-up (p = 0.907); 14 (16.7%) smokers and 8 (19.0%) non-smokers experienced a recurrence.Conclusion: This study has shown that patients selected and who are current smokers have poorer vision and need longer treatment.

Long term visual outcome after arteriolar constriction in patients with branch retinal vein occlusion

To evaluate the final best corrected visual acuity (BCVA) in patients with branch retinal vein occlusion (BRVO) treated with either (1) laser arteriolar constriction (ACo) or (2) the standard treatment recommended by the Branch Vein Occlusion Study Group (grid laser photocoagulation (GLP) or only observation (if indication criteria for GLP were not met). 358 BRVOs were treated in three different ways: early ACo (n=133) performed ≤9 weeks after onset of BRVO, late ACo (n=62) performed >9 weeks after onset and controls which included GLP and observation (n=163). The groups were further divided according to initial BCVA into: ≤0.1; 0.16-0.3 and ≥0.4. Based on the proportion of 1 year BCVA≤0.1 as a risk category, the results of early ACo (3.8%) were significantly better than for the controls (22.7%, P<0.001) and late ACo (16.1%, P=0.006). The greatest difference in final BCVA was in patients with the worst initial VA (≤0.1). In the intermediate initial BCVA group 0.16-0.3, a significant difference was only found between the early ACo group and controls (P=0.007). There was no significant difference between any treatment group and prevalence of a final BCVA≤0.1 for patients with an initial BCVA≥0.4. Early ACo significantly reduces the prevalence of a final BCVA≤0.1 in patients with BRVO and an initial BCVA≤0.3 compared to controls (standard treatment treated with GLP or observed).

Prevalence of Harmful/Traditional Medication Use in Traumatic Eye Injury

Aim:Ocular trauma of varying aetiologies do occur frequently, however when different traditional/harmful substances are applied before presentation in the hospital, prognosis in terms of visual outcome following treatment may be worse than expected. This study is aimed at determining the prevalence of harmful/traditional eye medication practices among patients with traumatic eye injury in a tertiary institution.Study Design/Setting:It is a retrospective study of patients seen at the eye clinic of the Ekiti State University Teaching Hospital (a state government owned hospital), Ado Ekiti, from January to December 2009.Method:A review of case notes (medical records) of patients with history of ocular trauma both open and closed globe injury and who presented to the eye clinic of the Ekiti State University Teaching Hospital, Ado Ekiti from January to December 2009 was carried out. Demographic data of the patients, nature of the ocular trauma, substances applied to the eyes, visual acuity at presentation and after treatment were extracted. Frequencies and percentages were used in analysing the data.Result:A total of 1420 new patients attended the eye clinic during the study period (January to December 2009). Forty eight (3.4%) applied various substances into their eyes after sustaining ocular injury. Substances applied include Kerosene 25%, cassava water 20.8%, breast milk 12.5%, personal urine 10.8%, and cow urine 8.3%. Nearly half of the patients 23 (47.9%) presented with low vision and after treatment there was no visual improvement in almost all of them, 22 (45.8%). The period before presentation ranges between 1hr -2weeks post injury. However, the number of monocular blindness reduced from 8 (16.7%) to 5 (10.4%) after treatment.Conclusion:Kerosene and Cassava water were the common substances applied to the injured eye. The use of these harmful and traditional eye medications on injured eyes can reduce further the visual prognosis despite ophthalmic intervention.

The Effect of Autologous Serum on Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole

We sought to evaluate the effects of intraoperative adjunctive autologous serum in idiopathic full-thickness macular hole surgeries, and to compare the surgical outcomes with a no-serum control group. In this retrospective, case-control study, 38 consecutive eyes received vitrectomy with internal limiting membrane removal for idiopathic full-thickness macular holes. Two groups were created according to the use of autologous serum. Outcome measures were visual acuity (VA), closure of the macular hole confirmed by optical coherence tomography, and surgical complications. Anatomical closure of the macular hole was achieved in 18 of 19 eyes (94.7%) in the vitrectomy with the autologous serum group, and in 18 of 19 eyes (94.7%) in the control group. The closure rates did not differ significantly between 2 groups (P=1.000; the Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in both groups (SD, standard deviation) [from 1.08 (0.21) to 0.47 (0.21) in vitrectomy with the serum group and from 1.01 (0.32) to 0.44 (0.30) in the control group (both P<0.001; 2 tailed, paired t test)]. There was no significant difference between these 2 groups in terms of visual outcomes (P=0.738; 2-tailed t test). There were no surgical complications, such as retinal detachment and endophthalmitis. The outcome of macular hole surgery did not differ both anatomically and functionally regardless of the use of adjuvant autologous serum. There seemed to be no additive effect with autologous serum.

Prognostic Factors for Long Term Visual Acuity Outcome after Ranibizumab Therapy in Patients with Neovascular Age-Related Macular Degeneration

Purpose: To evaluate whether spectral domain optical coherence tomography (SDOCT) and fluorescein angiography (FA) findings are predictive of visual acuity (VA) outcome after ranibizumab for neovascular age-related macular degeneration (NVAMD). Methods: Best corrected VA of 72 previously untreated eyes with NVAMD were retrospectively collected at baseline, after 3 injections and at 12, 24 and 36 months follow-up, if available. FA and SDOCT images at baseline were qualitatively and quantitatively analyzed using reading center software. The area of CNV lesion components on FA as well as the volume of the neurosensory retina, the outer nuclear layer, subretinal fluid, subretinal hyperreflective material and pigment epithelial detachment (PED) on SDOCT were calculated. VA as well as change in VA from baseline were correlated with all parameters. Results: VA at baseline significantly correlated with final VA as well as change in VA during follow-up. A greater area of total CNV lesion, classic as well as occult CNV lesion components on FA correlated with lower VA during follow-up. Qualitative features that indicated better short-term outcomes included the presence of retinal angiomatous proliferation (RAP) and the absence of cystoid spaces on SDOCT. Eyes with a larger retinal volume demonstrated a greater short-term increase in VA, eyes with larger PED volume and area measurements on OCT demonstrated less VA increase after 12 months. Lower VA outcomes were seen in eyes with larger volume of subretinal hyperreflective material or larger area of PED, as well as lower volume of the outer nuclear layer. No prognostic value could be identified for CNV lesion types other than RAP, subretinal fluid, gender and age. Conclusions: Several FA and SDOCT parameters showed prognostic value for VA outcome after ranibizumab in NVAMD. A larger, prospective dataset will be crucial for defining the relative importance of these parameters.

Intracorneal Ring Segment in Keratoconus: A Model to Predict Visual Changes Induced by the Surgery

We detected keratoconus cases with a significant potential for poor outcomes following intracorneal ring segment implantation (ICRS). We attempted to predict the potential of a case in terms of gain or loss of corrected distance visual acuity (CDVA). In this retrospective and prospective, consecutive, nonrandomized, multicentric study, 58 keratoconic eyes (aged 1756) were implanted with the keraring using the femtosecond laser technology. The follow-up period was 6 months. keratometric, biomechanical, aberrometric, refractive, and visual variables were measured for two different groups: Group A included eyes that gained 0.2 or more in corrected distance visual acuity (CDVA, decimal scale) and group B included eyes that lost more than 0.15. Correlations between clinical parameters and changes in visual acuity were investigated. In addition, a linear regression model was developed using CDVA, apical keratometry (AK), and a new keratometric parameter defined and named by us as K-factor (K(F)). Significant differences between groups preoperatively were found for CDVA (P = 0.002), AK (P = 0.013), and K(F) (P = 0.025). The following predictive model was obtained using these variables: DeltaCDVA = -0.511 + 0.0007K(F)(p)-0.849CDVA(p)+0.008AK(p).$$ Predictability of the model was 0.797. Sensitivity was 88.1% and specificity 83.3%. The mathematical model predicts that this surgery is very effective in patients with preoperative CDVA (decimal scale) in the range of 0.01 to 0.3, predicting a gain of 3, 4, or even 5 lines. Gains are predicted and confirmed for CDVA between 0.3 and 0.5. For preoperative CDVA between 0.5 and 0.75 visual outcomes are doubtful. Higher values of CDVA often are related to a decrease in CDVA. This model may help surgeons to select the best cases for ICRS implantation and exclude the worst in terms of visual outcomes.

Twice weekly atropine as a primary treatment for amblyopia: How does this compare with daily atropine?

Aim: This paper presents a service review giving results of twice weekly atropine treatment compared with daily treatment for amblyopia in a clinical setting and compares the results with our previous research. Methods: In a retrospective case note review 70 patients treated with twice weekly atropine for amblyopia were compared with a previous cohort treated with daily atropine. Results: Seventy patients were included in the data analysis for twice weekly treatment. Mean (SD) starting visual acuity (VA) of the amblyopic eye was 0.676 (0.337). The mean (SD) VA immediately after treatment improved to 0.368 (0.307). The number of log units’ improvement was 0.308. Anisometropic amblyopia responded more positively than strabismic amblyopia and mixed amblyopia ( p = 0.021). Those with moderate amblyopia had a better end visual outcome than those with a severely reduced starting acuity ( p = 0.0004). Results showed that 49% of patients treated with twice weekly atropine achieved a cure VA, with a further 30% showing a significant improvement. Conclusions: We found no statistical or clinical significance between the two treatment options ( p value = 0.962) in terms of visual outcome. Treatment duration, rate of adverse events and failure-to-attend rates were also comparable. The cost of drug treatment for the average 4 month duration of treatment was significantly cheaper for the twice weekly option. Overall, looking at the successful VA outcomes, low incidence of adverse events, excellent parental compliance and reduced treatment costs, twice weekly atropine proves a favourable option as a first-line treatment for all levels and types of amblyopia compared with daily atropine.

Long term visual outcomes, graft survival and complications of deep anterior lamellar keratoplasty in patients with herpes simplex related corneal scarring

AimsTo report long term visual outcomes, complications and graft survival of patients undergoing deep anterior lamellar keratoplasty (DALK) to treat corneal scarring secondary to herpes simplex virus (HSV) keratitis.MethodsRetrospective, non-comparative...

Long term visual outcomes in laser treated threshold retinopathy of prematurity in Central Saudi Arabia

PurposeTo assess the long term visual outcomes and refractive status of patients who underwent diode laser for threshold retinopathy of prematurity (ROP) and to investigate the risk factors leading to poor visual outcomes. MethodsFifty-seven patients (114 eyes) with threshold ROP who underwent laser therapy were contacted for reassessment. A chart review was performed for all patients to collect data on visual acuity, retinal status and strabismus. A favorable visual outcome was defined as ⩾20/160 (Snellen acuity) for young adults (cooperative patients), and ⩾CSM for children (uncooperative patients) while unfavorable visual outcome was defined as <20/160 or <CSM. Vision in uncooperative children was graded as central, steady, maintain. Descriptive and inferential analyses were conducted. Chi2 and odds ratios were calculated whenever appropriate. A P value <0.05 was considered as statistically significant. ResultsThe mean age at reassessment was 5.2±2.5years (range, 1–10years) where 36 (63.2%) patients were males and 21 (36.8%) were females. Out Of the 114 laser treated eyes, 73 (64%) were myopic, with mean spherical equivalent (SE) of −6.69 (5.9), range (−0.25 to −21) diaopters, 8 (7%) were emmetrope, while other 33 (29%) were hyperopic with mean SE of +2.43 (3.04), range (+0.25 to +17) diaopters. Strabismus was present in 31 patients (54.4%) of whom 81% (25/31) were esotropic. Retina was found to be normal in 77.1% of the examined eyes, while the remaining eyes had either macular dragging or retinal detachment. Almost 70% of the eyes with a normal retinal examination had favorable visual outcome. Thirteen (11.4%) eyes had zone 1 retinopathy, 83 (72.8%) eyes had zone 2 retinopathy and 2 (1.8%) eyes had zone 3 retinopathy. Vitreous hemorrhage was present in 7 (6.1%) eyes prior to laser treatment. The relationship between final retinal status and visual outcome was statistically significant (P<0.0001). There was no statistically significant correlation between visual outcome and the zone of the retinopathy (P=0.448). ConclusionThe majority of patients who underwent diode laser therapy for threshold ROP had favorable anatomical and visual outcomes. However, high refractive error and strabismus may be clinically the pertinent causes of visual impairment.

Predictors of long‐term visual outcome after chemoreduction for management of intraocular retinoblastoma

To determine the predictors of long-term visual outcome after chemoreduction for management of intraocular retinoblastoma. Retrospective case series. One hundred and forty eyes of 96 new retinoblastoma patients. The clinical records were reviewed for demographical profile, tumour characteristics, treatment methods, treatment side effects and final visual outcome. Multivariate analysis was used to evaluate factors predictive of final visual acuity. The clinical data were analysed for main outcome measures of good vision (visual acuity ≥6/12) or ambulatory vision (visual acuity ≥6/60). The correlation among predictor variables was determined using Pearson's product moment correlation for continuous variables, and t-test and analysis of variance test for categorical baseline variables. Follow-up ranged from 2 years to 14 years (median 75 months). The final mean logarithm of minimum angle of resolution visual acuity was 0.79. Ambulatory vision (≥6/60) was achieved in 100 of 140 (71%) eyes, and vision of ≥6/12 was seen in 52 eyes (37%). Extrafoveolar tumour and greater number of tumours in the eye were the only predictors of visual acuity ≥20/40. Greater number of tumours correlated with smaller mean basal tumour diameter. The mean basal tumour diameter was 9.8 mm in eyes with multiple tumours and 12.2 mm in eyes with single tumours (P = 0.03). Long-term ambulatory vision (≥6/60) was achieved in the majority (71%) of retinoblastoma containing eyes not requiring enucleation after treatment with chemoreduction and adjunctive therapy. Absence of foveolar involvement and greater number of tumours were the predictor of long- term visual outcome of 6/12 or better.

TYPE 2 IDIOPATHIC MACULAR TELANGIECTASIA

To describe the natural course of Type 2 idiopathic macular telangiectasia in terms of visual outcomes, causes of visual loss, and incidence of subretinal neovascular membranes (SRNV). This retrospective observational case series consisted of chart review of 104 outpatients (203 eyes; 66 women, 38 men) who were diagnosed to have Type 2 idiopathic macular telangiectasia by clinical examination and fluorescein angiography between January 2000 and December 2008. Visual and anatomic outcomes were analyzed during a minimum follow-up of 1 year. The mean age of the patients was 57 years (range, 40-74 years). Nineteen eyes (18 patients) presented with SRNV; the number increased to 29 eyes (14%; 23 patients) by the final visit (mean follow-up, 31 months). Diabetes was common (59%) though retinopathy was initially absent or mild to moderate in 99% patients. Mean logarithm of the minimum angle of resolution best-corrected visual acuity declined from 0.35 to 0.43 by the last visit (P < 0.0001) overall; final mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.61 (20/80) in the eyes with SRNV and 0.40 (20/50) in eyes without SRNV. The latter group started with better best-corrected visual acuity than SRNV group and remained better at 1-year, 2-year, and final follow-ups (P ≤ 0.0002). Overall, 30 eyes (15%; 24 patients) lost ≥ 2 Snellen lines, the main causes being SRNV and intraretinal pigment migration. Of 128 eyes (including SRNV) with best-corrected visual acuity ≥ 20/40 at baseline, 98 (77%) retained stable visual status; 74 (71%) patients retained best-corrected visual acuity of 20/40 or better at least in 1 eye. Over a follow-up of approximately 3 years, most eyes with Type 2 idiopathic macular telangiectasia starting with good vision were found to retain status quo; sight-threatening complications developed in a minority of eyes; most patients retained good vision at least in 1 eye.

Graft survival and endothelial outcomes in the new era of endothelial keratoplasty

Corneal endothelial cells do not proliferative in vivo sufficiently to enable endothelial regeneration, and thus diseases of the corneal endothelium, which cause poor vision and discomfort, require treatment by transplantation of cadaveric donor corneal endothelial cells. The two major goals of any corneal transplant procedure are to restore vision and to promote longevity of the donor cornea by maintaining a healthy donor endothelial cell density. Over the last decade, the surgical treatment for endothelial disease has rapidly evolved toward endothelial keratoplasty, or selective tissue transplantation, and away from full-thickness penetrating keratoplasty (PK). While endothelial keratoplasty offers distinct advantages over PK in terms of visual outcomes and a smaller incision, the new surgical manipulations of the fragile donor tissue cause significant donor endothelial cell trauma. As a result, donor endothelial cell loss is much higher during the first month after Descemet stripping endothelial keratoplasty (DSEK) compared to after PK, and the primary (or more appropriately, iatrogenic) graft failure rate of 5% remains unacceptably high. Nevertheless, the rate of endothelial cell loss rapidly decreases beyond 6 months after DSEK, and thus endothelial cell loss at 5 years after DSEK appears to be lower than that at 5 years after PK. In the absence of primary (iatrogenic) graft failure, graft survival through 5 years after DSEK is similar to that after PK. Given the promising longer-term endothelial outcomes of DSEK, the quest for optimizing the visual outcomes has spurred interest in Descemet membrane endothelial keratoplasty (DMEK). While early results after DMEK suggest better visual outcomes than after DSEK, the technique needs to be simplified, and longer-term outcomes must show an advantage over DSEK with respect to vision, endothelial cell loss, and graft survival. DMEK also has a high rate of primary (iatrogenic) graft failure, and additional donor tissue wastage occurs when preparation of DMEK grafts is unsuccessful. This review discusses endothelial keratoplasty techniques and the associated endothelial outcomes.

Long term visual outcomes, device retention and complications observed with the use of Type 1 Boston keratoprosthesis

Long term visual outcomes, device retention and complications observed with the use of Type 1 Boston keratoprosthesis

Idiopathic Intracranial Hypertension: Changing Trends

ABSTRACTIdiopathic intracranial hypertension (IIH) is a disorder of raised ICP without any obvious underlying brain pathology. Early intervention remains the key to success. The patients with BIH and vision threatening papilloedema should be taken up for optic nerve fenestration and the results are favorable in terms of visual outcome. The procedure is safe with few intraoperative or postoperative complications.

Radiation Retinopathy and Neuropathy following Plaque Therapy of Small Choroidal Melanoma

Despite yielding excellent local tumor control, the long term visual outcome following plaque radiotherapy is poor. The purpose of this study is to examine the incidence of radiation retinopathy (RR) and radiation optic neuropathy (RON) following I-125 and Ru-106 plaque therapy for the treatment of small choroidal melanomas as a function of radiation dose to the macula and optic disc.

Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study

To compare visual acuity and macular morphology after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling. We studied a retrospective interventional case series of 40 eyes in 40 patients with ERM. All patients underwent standard three-port pars plana vitrectomy. In 19 eyes, the ERM alone was removed. In 21 eyes, the ERM was removed and ILM peeling was performed. Mean best-corrected visual acuity improved significantly in both the non-ILM peeling and the ILM peeling groups (P = 0.001, P = 0.000). Mean central macular thickness (CMT) decreased significantly in both groups (P = 0.001, P = 0.001). However, there was a significant difference in postoperative CMT between the two groups (P = 0.025). The mean postoperative CMT was significantly higher in the ILM peeling group than in the non-ILM peeling group. Sixteen eyes (84.2%) in the non-ILM peeling group had a normal foveal contour with a foveal depression on postoperative optical coherence tomography (OCT), while nine eyes (42.9%) in the ILM peeling group had a foveal depression (P = 0.01). Postoperative OCT revealed that thickening of the macula with loss of the normal foveal contour was more frequent in the ILM peeling group. However, these morphological differences did not result in functional differences in terms of visual outcome.

A retrospective comparison of efficacy and safety of 680 consecutive lasik treatments for high myopia performed with two generations of flying-spot excimer lasers

To compare the visual refractive outcome and complication of laser in situ keratomileusis (LASIK) carried out with a Carl Zeiss-Meditec MEL-70 Excimer laser and a MEL-80 laser for treatment of high myopia. Journal records of 680 consecutive eyes that underwent LASIK with a Schwind Supratome microkeratome and a MEL-70 Excimer laser (Group A), or a Moria M2 microkeratome and a MEL-80 Excimer laser (Group B) were reviewed. Manifest refraction, uncorrected and best spectacle-corrected visual acuity (BSCVA), corneal topography and central corneal thickness (CCT) were recorded before and 3 months after treatment. Pre- and postoperative complications, visual and refractive outcome and frequency of retreatments were registered. Mean preoperative spherical equivalent refraction was -8.52 dioptres (-5.50- -18 dioptres), and the mean attempted laser correction was -8.02 dioptres (-5.50- -11 dioptres). Three months after LASIK, the average treatment error (difference between achieved and attempted correction) was 1.20 (SD=1.19) dioptres of under correction in Group A and 0.52 (SD=1.00) dioptres in Group B. Four eyes lost more than two lines of BSCVA (0.6%). In 110 eyes (16%), a re-LASIK procedure was performed to reduce remaining myopia after the primary procedure. Laser in situ keratomileusis treatment for high myopia can effectively reduce high degrees of myopia. Under correction was observed in both treatment groups but Group B has a slightly better predictability. Significant loss of BSCVA occurs infrequently after LASIK for even considerable grades of myopia (0.6% in each group).

A Review Of Anterior Interhemispheric Subfrontal Approach In Management Of Suprasellar Meningiomas With Endoscopic Assistance

Objective: The aim of this paper is to review the anterior interhemispheric subfrontal approach for resection of suprasellar meningiomas and to study the use of endoscope in achieving near complete resection. Methods: All cases of suprasellar meningiomas operated trans-cranially during last 13 years were analyzed retrospectively. Majority presented with visual complaints. The outcome was assessed after surgery and at follow up (ranging from 1-12 yrs) in terms of visual outcome, extent of resection and mortality & morbidity of the procedure. There were a total of 36 cases of which 15 were planum sphenoidale, 7 were tuberculum sellae, 4 were anterior clinoidal, 1 was a diaphragma sellae meningioma. In 9 cases there was a wider attachment to more than one place.25 patients underwent anterior interhemispheric subfrontal approach, 9 were operated from pterional approach and 2 were operated from unilateral sub-frontal approach. Endoscopy was used whenever required.Results: The meningiomas were excised completely in 33 cases (Simpson grade I and II) while subtotal excision was done in 3 cases. The visual recovery was observed in 60% of the patients while it was preserved in 40% cases. One patient died after 1 month of an uneventful discharge due to a seizure episode while bilateral anosmia was seen in 2 patients.Conclusions: Anterior interhemispheric subfrontal approach for suprasellar meningiomas is one of the key surgical approaches for management of larger midline lesions. The use of endoscope can further help in achieving near total resection. Although this approach has not been amongst the preferred ones off late, meticulous technique and adequate precautions can help in achieving optimal results with little morbidity.

Implantation of intraocular lens in children with uveitis : long term visual outcome and prognosis

Abstract Purpose To evaluate long term visual acuity, intra ocular inflammation and late complications for children with chronic uveitis who underwent cataract surgery with posterior chamber intra ocular lens (IOL) implantation. Methods Retrospective, monocentric study of children under 16 with chronic uveitis and who underwent cataract surgery between january 1996 and december 2001. Surgical protocol included : phacoaspiration with posterior capsulorhexis, anterior vitrectomy and IOL implantation. Visual acuity, intra ocular pressure, slight lamp examination, laser flare photometry and anti inflammatory treatment were analyzed at different time points. Results 17 eyes of 12 children (8 boys, 4 girls) were included. Uveitis was bilateral in 6 cases. The mean age at surgery was 10.5 years (ranged from 4 to 15) and the mean follow up time was 8.9 years (from 7 to 13). Diagnosis of uveitis was idiopathic juvenile arthritis in 8 cases (64.7%), sarcoidosis in 1 case and finally no etiology was identified in 3 cases (29.4%). Seven years after surgery, the mean visual acuity was 0.33 logMAR and 82% of children had still an immuno modulatory treatment. Late complications were : glaucoma (11.7%) , Elschnig perls (11.7%) , giant cells on IOL (35%) and CME (6%) of cases. Conclusion IOL implantation in children with chronic uveitis prevents amblyopia and allows rapid visual recovery. Complete surgical procedure in this group of children has interesting results on visual acuity and rehabilitation. Strict and long‐term control of intraocular inflammation is mandatory in order to prevent major complications and blindness. Implantation should not be proposed in young children with JIA‐associated uveitis.