Visual Rehabilitation Of Patients Research Articles

Refractive approaches to visual rehabilitation in patients with keratoconus.

As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus. Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity. Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.

Visual rehabilitation of patients with corneal diseases

BackgroundAlthough most patients with visual impairment due to corneal diseases can be treated successfully with surgery, some require visual rehabilitation to restore reading ability. To evaluate the best LVAs especially in terms of reading speed and characterize this specific patient group we performed a prospective, randomized cross-over trial.MethodsAll 34 patients underwent a detailed examination (slit-lamp, funduscopy, SD-OCT, ETDRS) as screening. Only patients with corneal diseases without other ocular diseases were included. Reading-speed was assessed with International-Reading-Speed-Texts (IReST) consecutively with five different LVAs (low vision aids) during one day in a randomized cross-over design. Corneal haze was quantified with corneal densitometry (Pentacam).ResultsPatients were either visually impaired (n = 28), severely impaired (n = 4) or legally blind (n = 2). Patients read significantly faster with LVAs (p < 0.0001). Fastest reading speed could be achieved with video magnifier (CCTV). Optical magnifier and portable-electronic magnifier enabled significantly lower reading speeds (p < 0.01). In a subgroup of patients (VA < 3/60,n = 6) black background enabled patients to read significantly faster compared to white background (p = 0.03).ConclusionPatients with low magnification requirement can be treated successfully with optical LVAs and portable-electronic magnifiers. More severely afflicted patients need a CCTV. Black background enables fastest reading-speeds, probably due to less blinding. Visual impairment can be estimated with corneal densitometry. Our trial confirms the capability of LVAs to successfully restore the reading ability in patients with corneal diseases, which is a crucial part of visual rehabilitation.Trial registrationThis trial was registered at the German Clinical Trials Register as DRKS00010887 at 09.08.2016.

On the new classification of eye burns

The currently used classification of eye burns was proposed in 1973 by N.A. Puchkovskaya and V.M. Nepomnyashaya. Recent emergence of the concept of limbal stem cells of the corneal epithelium and its application in clinical practice has significantly expanded the possibilities for diagnosis, treatment, and visual rehabilitation of patients with eye burns. In 1997, Dr. Michael Wagoner proposed a classification of eye burns in which the grade of burn severity is determined by the degree of damage to the limbal stem cells. Considering this approach, the authors conducted a comparative analysis of the classifications of eye burns used in Russia (in different years) and those that have appeared in the Western countries in recent years. In this regard, a new classification of eye burns is being proposed.

Phakic intraocular lens implantation in Keratoconus

AbstractPhakic intraocular lens implantation can be a highly predictable and successful method of refractive correction and functional visual rehabilitation in patients with grade II – III keratoconus who have a stable corneal shape and good spectacle corrected visual acuity. Effective refractive correction has been reported using several types of toric phakic IOLs in keratoconus and also for keratoconus patients with post‐keratoplasty ametropia. A four stage visual rehabilitation pathway for keratoconus has been described: gross shape correction with intracorneal ring segments followed by cross‐linking, toric phakic intraocular lens implantation, and then fine shape correction with topography‐guideded PRK as necessary. The aim of this presentation is to present an update on current indications, methods and outcomes of toric phakic intraocular lens implantation in keratoconus patients.

Cultivated Oral Mucosal Epithelial Transplantation

AbstractBilateral limbal stem cell deficiency (BLSCD) represents a highly demanding challenge for the clinician dealing with ocular surface disease, due to the underlying causes, clinical presentation, as well as lack of a source of autologous limbal stem cells. Cultivated Oral Mucosal Epithelial Transplantation (COMET) has been successfully employed to achieve visual rehabilitation in patients with BLSCD. This talk will focus on indications, technique, clinical results and complications of COMET. Moreover, it will present current disadvantages and limitations of COMET, exploring potential advancements in the future.

Intracorneal Ring Segments in Keratoconus; an Evidenced‐based Approach

AbstractImplantation of intracorneal ring segments (ICRS) is an effective and safe surgical option for visual improvement in keratoconus. ICRS are small, PMMA devices, which are implanted into the cornea aiming to alter its geometry in a manner that it will enhance its refractive properties and thereby will improve visual acuity. Their implantation was initially managed mechanically, but over the last years femtosecond laser‐assisted implantation has been gaining increasing interest and is gradually replacing the conventional mechanical technique. Nowadays, there are implantation nomograms indicating the appropriate ring segment characteristics for each individual case and suggesting, in a customized manner, the most suitable parameters for ICRS implantation. There are also certain indications and contraindications regarding the patient selection in order to maximize the safety and efficacy of the treatment. The purpose of this presentation is to update the current status of ICRS implantation as a modern therapeutic option in the visual rehabilitation of patients with keratoconus, highlighting pearls and pitfalls for both young and experienced corneal surgeons.

The Needs for Visual Improvement of Patients Presented at Low-Vision Center in Wenzhou, China.

Purpose To characterize the needs for visual improvement of new-visit patients with low vision. Methods This cross-sectional study collected detailed information of patients presented at low-vision center of the Eye Hospital of Wenzhou Medical University between January 2015 and January 2017. A questionnaire interview, including demographic information and needs for visual improvement, was conducted before ophthalmology examinations. Results The main need for visual improvement was engagement in hobbies (68.9%), followed by reading (20.9%), engaging in occupation (20.1%), and watching TV or movies (17.1%). Less than 10% of patients mentioned the demand of using public transportation (5.8%), doing housework (3.7%), writing (1.9%), walking on irregular surfaces (1.5%), driving (1.1%), and others (2.4%). Women were significantly associated with a concern for performing hobbies (OR 1.45, 95% CI 1.0–2.0) but associated with lower odds of reading (OR 0.46, 95% CI 0.3–0.7). Older subjects were more willing to choose hobbies (OR 1.35 (per 10-year increase), 95% CI 1.3–1.4), reading (OR 1.11 (per 10-year increase), 95% CI 1.0–1.2), watching TV or movies (OR 1.4 (per 10-year increase), 95% CI 1.3–1.6), and housework (OR 1.21 (per 10-year increase), 95% CI 1.0–1.5) than younger individuals. In comparison with younger participants, older individuals were less likely to choose occupation (OR 0.53 (per 10-year increase), 95% CI 0.5–0.6). No significant association was found between visual acuity and needs for visual improvement. Conclusion Hobbies, reading, engaging in occupation, and watching TV were the most common needs for visual rehabilitation in patients with visual impairment. Gender and age showed a modest influence on the choice of different needs.

Miniscleral lenses in the treatment of patients with dry eye syndrome (first own experience)

Background. Scleral lenses, due to their benefits, hold a specific position among all types of contact lenses. Some years ago, they began to be used successfully not only for the correction of complex types of refractive errors, when other types of correction failed to achieve satisfactory visual function and visual rehabilitation of patients, but also as a therapeutic system in the management of ocular surface disease.&#x0D; Purpose. To evaluate the efficacy of rigid gas permeable miniscleral contact lenses as a therapeutic system in the management of patients with dry eye syndrome by filling the space under the lens with a non-preserved sodium hyaluronate solution.&#x0D; Materials and methods. In the study, 7 patients (11 eyes) with keratectasias after corneal surgery and concomitant dry eye syndrome were included. In the treatment and rehabilitation of these patients, miniscleral contact lenses were used during daytime with additional filling of the space under the lens with a non-preserved sodium hyaluronate solution.&#x0D; Results. As a criterion of the effectiveness of miniscleral contact lens use for therapeutic purposes, along with a significant increase in visual function in patients with complex corneal pathology, the elimination of discomfort due to restoration of the corneal epithelium integrity and improvement of their quality of life is considered.

Visual rehabilitation of patients with irregular cornea

Purpose: To estimate the possibility of optical correction of an irregular surface of a cornea at primary ectasia (keratoconus) and secondary ectasia (a consequence of radial keratotomy (RKT) and Keratoplasty) for improvement of the maximum of visual acuity. Material and methods: In the study the scleral gas-permeable lenses (SGCL) were fitting by the 60 patients, it was 45 men and 15 women from them. The 46 patients had various stage of keratoconus and 14 patients had the keratectasia after RKT. On the 5 eyes of the patients was carried out keratoplasty earlier. Criteria of successful selection of SGCL considered achievement of steadily high visual acuity, comfort of carrying and the optimal clearance in apical zone, in the limbal and landing zone on the conjunctiva also. The results: In the course of the study, the maximum visual acuity in all patients was achieved with mini-SGKL correction irrespective of type of keratoektasia. All patients observed visual comfort compared with spectacle correction or correction with other types of contact lenses. Conclusion: Scleral gas-permeable contact lenses are the main method of correction at patients with irregular corneas and provide the best visual acuity.

Scleral gas permeable contact lenses as a possible way of visual rehabilitation of patients with age-related macular degeneration

Low visual acuity, loss of the central visual field, metamorphopsia, distortion of lines and decreased contrast sensitivity cause reduced quality of vision in patients with age-related macular degeneration (AMD). Currently existing methods of visual rehabilitation for patients with AMD, such as telescopic intraocular and scleral lenses, are functionally and cosmetically unacceptable. The use of intraocular telescopic lenses is limited by the high risk of postoperative complications, low functional parameters, as well as by difficult ophthalmoscopy and lasting adaptation of patients. Telescopic scleral lenses have а low resolution, contain impermeable to oxygen parts and require wearing special switching glasses. However, scleral lenses have potential in developing an optimal method for vision correction in patients with AMD due to the presence of following advantages: wide optical zone, gas permeability, correction of refractive astigmatism in presbyopic patients and alleviation of dry eye symptoms. In conclusion, further clinical researches are required to develop a method for improving the quality of vision in patients with AMD by using scleral lenses with an objective test for evaluating the effectiveness of correction – the 3D computer-automated threshold Amsler grid test (3D-CTAG).

Argus II retinal prosthesis system: a review of patient selection criteria, surgical considerations, and post-operative outcomes.

Retinitis pigmentosa (RP) is a group of heterogeneous inherited retinal degenerative disorders characterized by progressive rod and cone dysfunction and ensuing photoreceptor loss. Many patients suffer from legal blindness by their 40s or 50s. Artificial vision is considered once patients have lost all vision to the point of bare light perception or no light perception. The Argus II retinal prosthesis system is one such artificial vision device approved for patients with RP. This review focuses on the factors important for patient selection. Careful pre-operative screening, counseling, and management of patient expectations are critical for the successful implantation and visual rehabilitation of patients with the Argus II device.

Electro-spun polyethylene terephthalate (PET) mat as a keratoprosthesis skirt and its cellular study

Artificial keratoprostheses are indispensable for visual rehabilitation in patients with end-stage corneal blindness. This study aimed to assess the biocompatibility of polyethylene terephthalate nanofibrous mats and its potential as a novel synthetic keratoprosthesis skirt material for corneal tissue engineering. Nanofibrous mats were prepared by an electrospinning method and were first treated with the CO2 plasma to yield carboxylic groups on the surface; finally, the modified PET mat was cross linked with collagen using water-soluble carbodiimide as a coupling agent. The samples were evaluated by ATR-FTIR, scanning electron microscope (SEM), contact angle, and cell culture. The cross-linking of collagen on PET surface was confirmed by ATR-FTIR spectroscopy and SEM images The 79° difference was obtained in the contact angle analysis, obtained for the collagen-cross-linked nanofibrous mat than the non-modified nanofibrous mat. Cellular investigation showed limbal epithelial progenitor cells (LEPCs) has been better adhesion, cell growth, and proliferation of collagen-crosslinked nanofibrous samples than other samples. The bioavailability of PET fibers with covalently attached collagen was found to be identical to that of PET fibers with covalent attachment is a suitable method for enhancing the biocompatibility of scaffolds special as a good skirt in keratoprosthesis designs.

Visual rehabilitation of patients with oculocutaneous albinism Type I (OCA1): Results in 85 patents

Visual rehabilitation of patients with oculocutaneous albinism Type I (OCA1): Results in 85 patents

Прогнозирование уровня восстановления зрительных функций у больных с анатомическим прилеганием сетчатки после эндовитреальной хирургии регматогенной отслойки сетчатки с пролиферативной витреоретинопатией

Прогнозирование уровня восстановления зрительных функций у больных с анатомическим прилеганием сетчатки после эндовитреальной хирургии регматогенной отслойки сетчатки с пролиферативной витреоретинопатией

Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation

to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Visual rehabilitation of patients with oculocutaneous albinism type IA (OCA 1A): results in 85 patients

Visual rehabilitation of patients with oculocutaneous albinism type IA (OCA 1A): results in 85 patients

Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion.

The purpose of this study was to evaluate the impact of intravitreal dexamethasone implant (Ozurdex) on macular morphology and functions in eyes with macular edema (ME) secondary to retinal vein occlusion. Efficacy outcomes of the treatment were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety outcomes were intraocular pressure and cornea endothelial cell density. The study was conducted by the prospective analysis on 36 patients (17 women and 19 men) aged 28–77 years (the average age was 58±15 years) treated with the injection of dexamethasone implant because of the persistent ME at the Department of Ophthalmology and Ophthalmology Outpatient Clinic of the University Centre of Ophthalmology and Oncology in Katowice. The studied group included 16 patients with central retinal vein occlusion (16 eyes), and 20 patients with branch retinal vein occlusion (20 eyes). We found a significant increase of BCVA after first, second, and third month of treatment. Six months after the treatment, BCVA decreased, although not significantly compared with the value obtained in the third month. Two months after the intravitreal implantation of dexamethasone delivery system, CRT was 338±163 μm and was significantly lower compared with pretreatment value. Between third and sixth month after the treatment, we found insignificant increase of CRT compared with thickness observed in second month. Two months after the treatment, we found an increase in intraocular pressure in 36% of cases and a further decrease during the final visit 6 months after the treatment. During the treatment, there were no significant differences in endothelial cell density in branch retinal vein occlusion and central retinal vein occlusion. We found the intravitreal dexamethasone implant to be safe, well tolerated, and likely to lead to fast morphological and functional improvement of the macula and visual rehabilitation in patients with ME due to retinal vein occlusion.

Application of Graphene as Candidate Biomaterial for Synthetic Keratoprosthesis Skirt.

Synthetic keratoprostheses are required for visual rehabilitation in patients with end-stage corneal blindness. This study aimed to assess the biocompatibility of graphene material and its potential as a novel synthetic keratoprosthesis skirt material for corneal tissue engineering. Human corneal stromal fibroblasts were cultured on material surfaces including pristine graphene film, graphene foam, pristine titanium (Ti) discs, and tissue culture plastic surface (TCPS). Cell attachment was assayed by immunostaining of paxillin and vinculin. Cell viability and proliferation were assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and Click iT 5-ethynyl-2'-deoxyuridine (EdU) assays. The growth of fibroblasts on three-dimensional graphene foam was examined by scanning electron microscopy, and cytokine release was analyzed by enzyme-linked immunosorbent assay. Graphene films were implanted into rabbit corneal stromal pockets and examined by slit-lamp biomicroscopy, anterior segment optical coherence tomography, in vivo confocal microscopy, and histology. Pristine graphene demonstrated good biocompatibility with human stromal fibroblasts in terms of cell adhesion, viability, and proliferation. Cells on graphene films showed higher number than on TCPS control. Cells grown on graphene had 10% more proliferation than on Ti. The expression levels of IL-6 and IL-8 were reduced when cells were seeded on graphene foam as compared to Ti and graphene film. Implantation of graphene film into rabbit stroma (n = 6) did not show any signs of infection, neovascularization, or inflammation. Graphene displayed excellent short-term biocompatibility with corneal cells and tissue. This demonstrates that graphene can be developed as a tissue engineering material for use in cornea.

Femtosecond-assisted intrastromal corneal single-segment ring implantation in patients with keratoconus: a 12-month follow-up.

To determine visual rehabilitation in patients with keratoconus who received femtosecond-assisted intrastromal corneal single-segment ring implantation. This prospective study was conducted on 62 eyes of 45 patients with keratoconus who received single-segment Intacs. The FS200 femtosecond laser was used for tunnel creation. Patients were examined for astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent (MRSE) before the operation and 1, 6, and 12 months after operation. Scheimpflug imaging including minimum keratometry reading (min-K), maximum keratometry reading (max-K), average of minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), asphericity (Q-value), index of surface variance (ISV), index of vertical asymmetry (IVA), keratoconus index (KI), center keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD), and minimum sagittal curvature (Rmin) was performed before and 12 months after the operation. The mean preoperative UCVA was 20/130, which increased to 20/62 1 year after the operation (P < 0.001). The mean BCVA in the last follow-up was 20/32, which improved when compared with preoperative BCVA (20/40) (P = 0.008). One year after the operation, MRSE and cylinder decreased to 1.33 ± 1.90 diopter (D) and 0.46 ± 1.50 D, respectively (P < 0.001 for both). Min-K, max-k, and mean-k reduced to 1.67 ± 0.1.40 D, 2.08 ± 1.84 D, and 1.85 ± 1.30 D (P < 0.001 for all). Q-value decreased to 0.81 ± 1.14 (P < 0.001). In contrast, CKI had a significant increase of 0.02 (P = 0.002). Other evaluated indexes did not show any significant differences. Implantation of the single-segment ring in patients with keratoconus improved vision because of regularizing the cornea and centralization of the corneal cone.

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications.

To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents. Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported. Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy. These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.