Visual Outcomes In Eyes Research Articles

Effect of Fermented Bilberry Extracts on Visual Outcomes in Eyes with Myopia: A Prospective, Randomized, Placebo-Controlled Study

To investigate clinically the effects of yeast-fermented bilberry extract on visual outcomes in myopic eyes. In a prospective, randomized, placebo-controlled, cross-over study, we examined 30 eyes of 30 middle-aged healthy volunteers (mean age±standard deviation, 39.5±7.2 years) with myopia [manifest spherical equivalent, -2.40±1.88 diopters (D)], who were randomly assigned to 1 of 2 oral regimens: fermented bilberry extract (400 mg/day) or placebo. We quantitatively assessed visual acuity, refraction, pupil constriction rate, accommodation, and mesopic contrast sensitivity (CS), before and 1 month after treatment. Only the right eyes were tested. The amplitude of accommodation and CS were measured with an accommodometer (D'ACOMO; WOC) and a CS unit (VCTS-6500; Vistech), respectively. From the CS, the area under the log contrast sensitivity function (AULCSF) was calculated. The mean amplitude of accommodation increased significantly, from 4.62±1.88 D before treatment, to 5.33±2.03 D after treatment in the study group (Wilcoxon signed-rank test, P=0.002). Moreover, the mesopic AULCSF was significantly increased, from 1.04±0.16 before, to 1.13±0.17 after, treatment (P=0.009). However, we found no significant changes in accommodation or AULCSF in the control group (P>0.05), or any significant changes in any other parameters in either group (P>0.05). The present data show that fermented bilberry extract is effective in causing increases in subjective accommodation and in mesopic CS in myopic eyes.

Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia

To compare visual and anatomic outcomes in eyes with type 2 idiopathic macular telangiectasia (Mactel) treated with either intravitreal bevacizumab (IVB), observation, or pars plana vitrectomy (PPV) with internal limiting membrane removal. Retrospective, consecutive, interventional case series of phakic patients with Mactel. Best-corrected Snellen visual acuity (BCVA) and complete ophthalmic exam was obtained prior to treatment and at subsequent 3-month intervals for a minimum of 6 months. Fluorescein angiographic and spectral-domain optical coherence tomography features were examined, and compared to BCVA at treatment initiation and follow-up. Fifty-six eyes of 28 patients were evaluated. Mean age was 65 ± 12 years, and mean follow-up was 24 ± 13 months. Patients were treated with either observation (n = 33), IVB (n = 15), or PPV (n = 8). Mean number of treatments for the IVB group was 2.5 ± 3.5 intravitreal injections. No significant differences in BCVA change were observed between treatment groups via one-way ANOVA (p = 0.49). Presence of inner retinal cysts was not correlated to BCVA (p > 0.05). Discontinuous outer nuclear layer was significantly related to worse initial and final vision, but not to BCVA change. IVB and PPV with ILM removal appear ineffective in improving visual outcome in eyes with non-proliferative Mactel. SD-OCT evidence of disrupted foveal outer nuclear layer is related to decreased BCVA, but not related to BCVA change following treatment.

Six-month visual prognosis in eyes with submacular hemorrhage secondary to age-related macular degeneration or polypoidal choroidal vasculopathy

To determine clinical or imaging prognostic features for visual outcome in eyes with submacular hemorrhage secondary to age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV). A prospective case series of 11 eyes from 11 patients with submacular hemorrhage secondary to AMD or PCV. All participants had measurement of clinical characteristics, fundus angiogram, and indocyanine green angiography, spectral domain optical coherence tomography (OCT, Cirrus, Zeiss) at baseline and 6 months. Median visual acuity improved from 20/132 to 20/63 at month 6. The median improvement in vision was 0.20 LogMAR units. Proportion of eyes with best-corrected visual acuity (BCVA) ≥ 1.0 increased from 6/11 (54.5 %) at baseline to 8/11 (72.7 %) at month 6. Eyes with BCVA > 1.0 were more likely to have larger area of hemorrhage and thinner subfoveal neurosensory retinal thickness at baseline and at month 6. Thinner neurosensory retina demonstrated on OCT at baseline may be a useful prognostic sign for limited visual recovery.

Successful toric intraocular lens implantation in a patient with induced cataract and astigmatism after posterior chamber toric phakic intraocular lens implantation: a case report

IntroductionWe report the case of a patient in whom simultaneous toric phakic intraocular lens removal and phacoemulsification with toric intraocular lens implantation were beneficial for reducing pre-existing astigmatism and acquiring good visual outcomes in eyes with implantable collamer lens-induced cataract and astigmatism.Case presentationA 53-year-old woman had undergone toric implantable collamer lens implantation three years earlier. After informed consent was obtained, we performed simultaneous toric implantable collamer lens removal and phacoemulsification with toric intraocular lens implantation. Preoperatively, the manifest refraction was 0, -0.5 × 15, with an uncorrected visual acuity of 0.7 and a best spectacle-corrected visual acuity of 0.8. Postoperatively, the manifest refraction was improved to 0, -0.5 × 180, with an uncorrected visual acuity of 1.2 and a best spectacle-corrected visual acuity of 1.5. No vision-threatening complications were observed.ConclusionToric intraocular lens implantation may be a good surgical option for the correction of spherical and cylindrical errors in eyes with implantable collamer lens-induced cataract and astigmatism.

Outcomes After Descemet Stripping Endothelial Keratoplasty in Glaucoma Patients With Previous Trabeculectomy and Tube Shunt Implantation

To describe the incidence of intraoperative and postoperative complications and visual outcomes in eyes with previous penetrating glaucoma surgery undergoing Descemet stripping endothelial keratoplasty (DSEK). A retrospective review of the first 227 cases of DSEK performed by 2 surgeons at a single institution. Data were collected regarding the performance of concurrent ocular procedures, intraoperative complications, postoperative visual outcomes, and postoperative complications, including primary graft failure, donor dislocation, endothelial rejection, and intraocular pressure (IOP) elevation. Fifty-six of the 227 DSEK procedures were performed in 52 eyes with previous trabeculectomy and/or tube shunt implantation. The percentage of procedures performed in eyes with and without a history of penetrating glaucoma surgery that resulted in primary graft failure (5.4% vs. 4.1%; P = 0.71) and donor dislocation (12.5% vs. 15.2%; P = 0.83) were not statistically significantly different. Additionally, the endothelial rejection rate was not significantly different between cases performed in eyes with (1/19.2 eye-years) and without (1/20.1 eye-years) a history of glaucoma surgery (P = 0.99). The incidence of elevated IOP (≥ 25 mm Hg) after DSEK was the highest in eyes with medically controlled glaucoma (47.4%), followed by eyes without a history of glaucoma (18.3%), and was the lowest in eyes with previous glaucoma surgery (11.5%). Postoperative corrected distance visual acuity was improved over the preoperative corrected distance visual acuity in 81%, 95%, and 88% of eyes with previous glaucoma surgery, medically controlled glaucoma, and no glaucoma, respectively. DSEK is an effective procedure to improve vision in the majority of eyes with advanced glaucoma after trabeculectomy and/or tube shunt implantation. The incidence of postoperative complications, such as donor dislocation, primary graft failure, and endothelial rejection, is not significantly higher in eyes with a history of glaucoma surgery before DSEK. Because almost 50% of eyes with medically controlled glaucoma before DSEK experienced IOP elevation after surgery, careful monitoring of the IOP after DSEK is especially important in this patient population.

ENDOPHTHALMITIS CAUSED BY PSEUDOMONAS AERUGINOSA IN TAIWAN

To investigate the clinical settings, treatment given, and visual outcomes for eyes with Pseudomonas aeruginosa endophthalmitis in Taiwan. This is a retrospective, noncomparative, consecutive case series. Medical records were reviewed in 72 eyes of 71 patients with culture-proven P. aeruginosa endophthalmitis between January 1997 and December 2007. The clinical settings included keratitis/scleritis (44.4%), cataract surgery (15.3%), penetrating keratoplasty (13.9%), endogenous source (12.5%), trauma (6.9%), penetrating keratoplasty with cataract surgery (2.8%), trabeculectomy with cataract surgery (1.4%), trabeculectomy (1.4%), and secondary implant (1.4%). Initial visual acuity ranged from counting fingers to no light perception. Final visual acuity was better than 5/200 in 6 of 72 eyes (8.3%), 4/200 to hand motions in 4 eyes (5.6%), and light perception to no light perception in 62 eyes (86.1%). In vitro testing, the susceptibility patterns of organisms isolated were as follows: ceftazidime (100%), cefepime (100%), aztreonam (100%), imipenem (99%), amikacin (94%), and gentamicin (86%). Five of 16 eyes (31.3%) that underwent primary or secondary pars plana vitrectomy with intravitreal antibiotics achieved a final visual acuity of 5/200 or better compared with 1 of 45 eyes (2.2%) treated with 1 or multiple vitreous tap(s) and intravitreal antibiotics (Fisher's exact test, P = 0.004). Despite early diagnosis and treatment with intravitreal antibiotics, visual acuity outcomes were generally poor.

Effect of preoperative vitreous status on visual outcomes following vitrectomy for epiretinal membrane repair

Objective: To determine the correlation between clinically observed posterior vitreous detachment (PVD) and both surgical status of the hyaloid and the visual outcome following epiretinal membrane (ERM) surgery. Design: Retrospective chart review. Participants: One hundred and nine eyes of 109 consecutive patients who underwent vitrectomy and repair of idiopathic ERM between January 2006 and September 2008. Methods: Preoperative exam notes from selected charts were reviewed for the presence or absence of a PVD. Operative notes were queried to whether the hyaloid was attached or detached at the onset of surgery. The postoperative visual acuity (VA) was correlated with the intraoperative status of the hyaloid. Preoperative observation of PVD was correlated with the hyaloid status at the time of vitrectomy. Results: Hyaloid status did not impact postoperative VA. Eyes with an attached hyaloid at the onset of surgery had an average postoperative best corrected visual acuity (BCVA) of 20/60 and eyes with PVDs found during surgery had an average BCVA of 20/60 +1 ( p = 0.66). Of the 109 patients, 72 had a preoperative fundoscopic examination whose results positively correlated with the intraoperative status of the hyaloid. Conclusions: Having an attached hyaloid did not have a significant impact on postoperative visual outcomes in eyes undergoing ERM when compared with outcomes for eyes having a detached hyaloids prior to surgery. Detection of a PVD on preoperative fundoscopic examination was highly sensitive for a «true« PVD, i.e., actual detachment of the posterior hyaloid membrane as confirmed during surgery.

Double-pass system analysis of the visual outcomes and optical performance of an apodized diffractive multifocal intraocular lens

To evaluate the postoperative ocular optical quality using a double-pass method and assess visual outcomes in eyes with an apodized multifocal intraocular lens (IOL) and to correlate the findings with IOL power. Vissum Corporation, Alicante, Spain. Case series. This study evaluated eyes that had cataract surgery with implantation of an AcrySof ReSTOR SN6AD3 multifocal IOL. Near and far visual acuities were measured postoperatively at 1 month and 6 months. Ocular optical quality was assessed at 1 month using a double-pass system (Optical Quality Analysis System), and the point-spread function (PSF) and modulation transfer function (MTF) were characterized. The study included 38 eyes of 19 patients with a mean age of 63.4 years ± 8.4 (SD). The improvements in uncorrected distance visual acuity (from 0.57 ± 0.31 logMAR preoperatively to 0.11 ± 0.13 logMAR 1 month postoperatively and 0.11 ± 0.12 logMAR at 6 months) were statistically significant (P<.00001), as were the improvements in uncorrected near visual acuity (0.76 ± 0.40 logMAR preoperatively to 0.21 ± 0.11 logMAR and 0.12 ± 0.09 logMAR, respectively) (P<.00001). The IOL power correlated significantly with PSF width (r = 0.57, P = .017) and the MTF cutoff frequency (r = -0.36, P = .05). Furthermore, the lower the IOL power, the better the near and distance visual acuities, especially 1 month postoperatively. The apodized multifocal IOL restored distance and near visual function, although IOL power was a limiting factor to the final visual outcomes and optical quality.

Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls

Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT). Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macular thickness was measured in three circular fields (central subfield, inner and outer circle) from the macular maps. There was no statistically significant difference in VA before surgery, at day 7 or at 6months, but at 6weeks there was a significant difference with lower VA in the diabetic group. Six percent of control and 12% of diabetic eyes developed a clinical CME defined as a loss of >5 letters between day 7 and week 6. Incidence of FA leakage was 23% in control and 76% in diabetic eyes. At 6weeks, 20% of control and 44% of the diabetic eyes had qualitative changes on OCT. A statistically significant increase in thickness was observed for all three macular areas in both groups, part of it remaining at 6months. There were, however, no differences in central macular thickness between the groups at any visit. Retinal thickening had poor correlation with VA. The final visual outcome in eyes with mild to moderate retinopathy, without previous ME, is as good as in normal eyes, but an increased frequency of macular changes may protract recovery of full vision. Changes on OCT or FA are often seen without any obvious effect on VA. OCT is as good as FA at detecting a clinical CME, and is the technique recommended for follow-up before FA is considered.

Pars plana lensectomy combined with pars plana vitrectomy for dislocated cataract

To assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for visual correction of complicated cataract. Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. This retrospective study reviewed the preoperative, intraoperative, and postoperative clinical features in eyes that had PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology (study group). The corrected distance visual acuity (CDVA), reoperations, retinal detachment (RD), and cystoid macular edema (CME) were ascertained. Results were compared with those in a control group of eyes having combined PPV and lensectomy for uncomplicated cataract. In the study group (40 patients), 23 eyes had traumatic lens dislocation, 12 had Marfan syndrome, 7 had idiopathic lens dislocation, and 4 had pseudoexfoliation syndrome. The median corrected distance visual acuity improved from 20/185 (range 20/20 to hand motions) preoperatively to 20/30 (range 20/20 to hand motions) 3 months postoperatively (P<.001). The postoperative CDVA was poorer in cases with an etiology of trauma (P = .018). Complications included RD (6.5%), transient vitreous hemorrhage (13.0%), choroidal detachment (4.3%) and CME (13.0%), which occurred more frequently in eyes with a history of trauma (P = .022). The control group (43 eyes; 42 patients) had 1 (2.3%) RD. Pars plana vitrectomy with lensectomy yielded favorable visual outcomes in eyes with complicated cataract in which standard anterior segment techniques were prohibitive or risky. However, preexisting conditions and postoperative complications may limit visual outcomes. Neither author has a financial or proprietary interest in any material or method mentioned.

Foveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral-Domain Optical Coherence Tomographic Analysis

To evaluate reconstructive changes in foveal microstructures and identify a correlation with visual outcomes in eyes with surgically closed macular holes (MHs). Retrospective, consecutive, observational case series. Forty eyes (40 patients) with surgically closed MHs. Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the foveal microstructural changes 3 and 12 months postoperatively. The correlation between the postoperative best-corrected visual acuity (BCVA) and the integrity of the foveal photoreceptor layer was evaluated. The integrity of the back-reflection lines from the photoreceptor inner segment (IS) and outer segment (OS) junction and the external limiting membrane (ELM) on SD-OCT images and the BCVA measured on the same day. The integrity of the foveal photoreceptor layer was the only postoperative SD-OCT finding significantly associated with the 3-month BCVA (r=0.483; P=0.002). The eyes were categorized into 3 groups according to restoration of the IS/OS junction and ELM signals: 6 eyes (15%) in group A with complete restoration of the IS/OS junction and the ELM; 26 eyes (65%) in group B with a disrupted IS/OS junction and intact ELM; and 8 eyes (20%) in group C with disruption or loss of the IS/OS junction and the ELM. Although the baseline BCVA did not differ significantly (P=0.137) among groups, the mean 3-month BCVA values in groups A and B, both with reconstructed ELM with or without a restored photoreceptor IS/OS, were significantly better than in group C (P<0.05); the difference between groups A and B was not significant (P>0.05). Groups A (P=0.029) and B (P<0.001) had significant visual improvement at 12 months; group C did not have marked visual recovery. Fourteen eyes (54%) in group B had subsequent realignment of the foveal photoreceptor IS/OS; no eyes in group C had a restored IS/OS at 12 months. The presence of the ELM at 3 months is a critical structural feature significantly correlated with the BCVA at 12 months (r=0.832, P<0.001). Reconstruction of the foveal ELM in the early postoperative period helps predict subsequent restoration of the foveal photoreceptor layer and the potential for better visual outcomes.

ENDOPHTHALMITIS IN EYES PRESENTING WITH ORBITAL SIGNS

The purpose of this study was to assess the clinical profile and treatment outcomes in eyes with endophthalmitis presenting with orbital signs. A case-control study of 24 eyes with endophthalmitis and orbital signs at presentation (defined as ocular motility restriction and/or presence of " inverted perpendicular" sign on ultrasonography) was conducted between January 2000 and December 2006. The control group was constituted of 40 age- and sex-matched eyes with endophthalmitis presenting without orbital signs. Optimal structural outcome was defined as resolution of inflammation and infection. Adverse structural outcome was defined as development of phthisis bulbi or need for evisceration or development of retinal detachment. Optimal functional outcome was defined as improvement in postoperative visual acuity to 3/60 or better. The Pearson chi-square test was used with appropriate significance (P < or = 0.05) to compare the mean visual acuity before and after treatment. Twenty-four patients with a mean age of 46.4 years and a mean follow-up of 14.6 months were included. Treatment options included intravitreal antibiotics, vitrectomy, evisceration, and systemic antibiotics. Optimal structural outcome was achieved in 6 (25%) eyes. A total of 70.8% eyes had no light perception, whereas 4 (16.66%) patients regained ambulatory vision (>3/60). There was a statistically significant poor visual (P = 0.05) and structural outcome (P = 0.004), whereas in the control group, 25 patients (62.5%) had vision 3/60 or better (P = 0.001). Orbital signs are independent risk factors for poor structural and visual outcomes in eyes with endophthalmitis.

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

PurposeTo identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs).MethodsData from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (Vpostop, logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced.ResultsVpostop was determined to be significantly correlated with the preoperative visual acuity (Vpreop) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of Vpostop was derived from the most accurate regression analysis: Vpostop=0.248×Vpreop+1.1×10-6×A2-0.121×D+0.19.ConclusionsThe length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphology

Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (>or=20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery.

Intra and post operative complications and visual outcomes following cataract surgery in leprosy patients

The occurrence of intra and post operative complications was compared in different groups of leprosy patients. The association between post operative and intra operative complications was studied, and how visual outcomes were affected by these complications. We also share our medical management and surgical techniques that might help minimise intra operative complications and improve visual outcomes. A retrospective analysis of 1024 cataract operations in 786 leprosy patients over an 11 year period from 1995 to 2006 at Kothara Community Hospital, a rural hospital belonging to The Leprosy Mission Trust India, located in the Amravati district of Maharashtra. 3.5% of eyes had intra operative complications and 22% of eyes had post operative complications, with no appreciable difference in incidence of intra operative complications in the various groups of patients studied. Post operative uveitis was higher in the MB (3.2%), smear positive (6.5%), UT (6%), eyes with leprosy related ocular disease (6.4%) and lepra reaction (12%) groups. Overall, eyes with leprosy related complications and eyes operated on during lepra reactions had more post operative complications compared to the group without. Visual outcomes for eyes with intra and post operative complications were poorer than the groups without. Cataract surgery in the hands of a careful and well trained surgeon, who is familiar with ocular leprosy and can modify the surgical technique as necessary, is safe and associated with minimal intra operative and post operative complications.

RETINAL ANGIOMATOUS PROLIFERATION

To investigate the natural history and visual outcome in eyes with untreated retinal angiomatous proliferation, a neovascular form of age-related macular degeneration. Fourteen consecutive white patients (11 women, 78%; mean age, 74 years) with 16 eyes affected by retinal angiomatous proliferation were prospectively followed-up without treatment by means of complete ophthalmologic examinations at regular intervals, including best-corrected visual acuity and dynamic fluorescein and indocyanine green angiography using a scanning laser ophthalmoscope. The patients were observed for a mean of 20 months (range, 6-44 months). Mean visual acuity in the eyes with retinal angiomatous proliferation was 0.48 at the initial examination, decreased to 0.23 after 6 months, and was 0.19 at the final examination, with a mean decrease of 6 lines from baseline. In 13 eyes (81%), visual acuity deteriorated by 2 Early Treatment Diabetic Retinopathy Study lines or worse by the time of the 6-month examination, and 31% of the patients had experienced severe loss of vision; the remaining 3 eyes (19%) showed a relatively stable clinical course and visual acuity. By the time of the final examination, visual acuity had decreased to 0.1 or worse in 11 eyes (69%), and 5 of the 14 patients (36%) were legally blind. At the final examination, 10 eyes (62%) showed a subretinal fibrosis and 9 (56%) showed a retinal choroidal anastomosis. Retinal angiomatous proliferation is a distinct form of neovascular age-related macular degeneration with high vasogenic potential, having its own clinical course and visual prognosis. The poor visual outcome is because of the exudative nature of the retinal angiomatous proliferation, and progression to poor vision is common and rapid (within 3 months in faster cases, and within 1 year in slower cases). The treatment options for this type of neovascular lesion should be planned bearing in mind its unfavorable natural history.

Associations Between Macular Findings by Optical Coherence Tomography and Visual Outcomes After Epiretinal Membrane Removal

To identify characteristics measured by optical coherence tomography (OCT) that are correlated with visual outcome after epiretinal membrane (ERM) removal by pars plana vitrectomy (PPV). Interventional, prospective, randomized case series. One hundred and one eyes of 101 patients with idiopathic ERM underwent PPV for ERM removal. Ophthalmic evaluations included best-corrected visual acuity (BCVA) and Stratus OCT preoperatively at 3 and 6 months postoperatively. Relations between three OCT features including integrity of junction between inner and outer segments of photoreceptors (IS/OS junction), macular thickness, foveal contour and the three visual acuity parameters such as preoperative BCVAs, postoperative BCVAs, and the differences between preoperative and postoperative BCVAs (BCVA differences) were evaluated with respect to time. Eyes with disruption of IS/OS junction had significantly lower postoperative BCVA and BCVA differences than those without disruption (P < .0001, respectively). "Same" (increment or decrement of BCVA up to 1 Snellen line) and "Better" (visual increment of at least 2 Snellen lines) BCVA outcome groups were significantly different with respect to the status of IS/OS junction (P < .005). An increase in the proportion of eyes with photoreceptor disruption was observed at 3 months postoperatively, and this proportion was maintained afterward. Preoperative macular thicknesses showed a positive correlation with BCVA differences, and postoperative macular thicknesses negatively correlated with postoperative BCVA (r > 0.25; P < .05, respectively). Thickness difference and foveal contour were not correlated with the three parameters of visual outcome (P > .05, respectively). Photoreceptor disruption detected by OCT was found to be a predictor of poor visual outcome in eyes with idiopathic ERM, and it was found that this disruption may be irreversible. Thus, early membrane removals may beneficially prevent further progression of photoreceptor damage in ERM patients with photoreceptor disruption.

Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial

Aim:To determine the effect of internal limiting membrane (ILM) peeling on anatomical and functional success rates in stage 2 and 3 idiopathic macular hole surgery (MHS).Methods:Randomised clinical trial of stage...

Standardized surgical procedure in complicated retinal detachment

Abstract Purpose Within the last ten years the surgical procedures have been refined in patients with complex retinal detachments resulting in a better anatomical outcome. The reported reattachment rates vary from 54‐96 %. Limited information about the final outcome of the complete cohort of complicated retinal detachment eyes after silicone oil removal is available. Several risk factors for redetachment have been identified: the number of previously unsuccessful surgeries, an incomplete removal of the vitreous base, the absence of an encircling element and the lack of a 360° laser retinopexy. However, the additional use of relaxing retinotomies, an encircling band and lens removal were up to the surgeons discretion. Based on the conclusions of these previous studies the present study investigated the impact of a standardized treatment approach on the anatomical and visual outcome in eyes with PVR grade C2 following unsuccessful retinal detachment surgery. Methods The standardized treatment comprised of vitrectomy, placement of an encercling band, 360° laser retinopexy and silicone oil endotamponade in every eye combined with a small incision cataract surgery, if the patients were phakic. More than 50 eyes of 50 patients with failed prior scleral buckling procedure were included in this study. Results Reoperations had to be performed in 25% of the eyes. The final reattachment rate 6 months after silicone removal was 95.8%. Macular pucker was found in 12%. 70% (43 patients) achieved a visual acuity of 20/200 or better. Conclusion Standardized approach had no impact in the number of reoperation or the incidence of macular pucker. However it improves the final reattachment rate and consequently ameliorates the visual results.

Standardized surgical procedure in complicated retinal detachment

Purpose Within the last ten years the surgical procedures have been refined in patients with complex retinal detachments resulting in a better anatomical outcome. The reported reattachment rates vary from 54-96 %. Limited information about the final outcome of the complete cohort of complicated retinal detachment eyes after silicone oil removal is available. Several risk factors for redetachment have been identified: the number of previously unsuccessful surgeries, an incomplete removal of the vitreous base, the absence of an encircling element and the lack of a 360° laser retinopexy. However, the additional use of relaxing retinotomies, an encircling band and lens removal were up to the surgeons discretion. Based on the conclusions of these previous studies the present study investigated the impact of a standardized treatment approach on the anatomical and visual outcome in eyes with PVR grade C2 following unsuccessful retinal detachment surgery. Methods The standardized treatment comprised of vitrectomy, placement of an encercling band, 360° laser retinopexy and silicone oil endotamponade in every eye combined with a small incision cataract surgery, if the patients were phakic. More than 50 eyes of 50 patients with failed prior scleral buckling procedure were included in this study. Results Reoperations had to be performed in 25% of the eyes. The final reattachment rate 6 months after silicone removal was 95.8%. Macular pucker was found in 12%. 70% (43 patients) achieved a visual acuity of 20/200 or better. Conclusion Standardized approach had no impact in the number of reoperation or the incidence of macular pucker. However it improves the final reattachment rate and consequently ameliorates the visual results.