Study of the indications and changing trends of enucleation and evisceration in West Malaysia

AIM: To study the demographic pattern and indications for enucleation and evisceration in West Malaysia, and to evaluate the changing trends of the same over the past three decades. · METHODS: In a retrospective hospital based study, case records of all patients who underwent enucleation and evisceration at University of Malaya Medical Centre over a period of 20 years (1985/2004) were reviewed. Age, gender, ethnicity of patients, indications for enucleation and evisceration were evaluated. · RESULTS: Out of 160 patients, enucleation was done in one eye in 85 patients and evisceration was done in one eye in 75 patients during the study period. The mean age of patients was 36.4 years with a range of 6 months to 90 years. In our study, panophthalmitis (26.9%) and retinoblastoma (18.8%) were the most common causes of evisceration and enucleation respectively. Infections of the eye contributed to 72.0% of eviscerations while tumors contributed to 51.8% of enucleations. There was a significant decrease in the removal of eyes over the past three decades in our hospital. The number of removal of eyes for glaucoma and trauma-related causes significantly reduced while removal for infection- related causes and painful blind eyes significantly increased when compared to the figures reported three decades ago from our hospital. · CONCLUSION: Panophthalmitis and intraocular tumors are the major indications for the removal of eyes. Although the frequency of removal of eye has significantly decreased over time in our country, the indications for the same suggest that there is a need of further improvement of eye care services in Malaysia.     

马来西亚西部眼球摘除术和眼内容摘除术的手术适应证及其变化趋势

目的:通过研究近30a马来西亚西部地区眼球摘除术和眼内容物摘除术的数据统计和手术适应证,观察其近30a的动态变化趋势.方法:通过回顾研究20a(1985/2004)在马来亚大学医学中心接受眼球摘除术和眼球内容摘除术病例资料,对患者的年龄、性别、种族及其手术适应证进行分析.结果:在全部160名患者中,85例单眼行眼球摘除术,75例单眼行眼内容摘除术,患者平均36.4岁(6mo～90岁).全眼球炎(26.9%)和视网膜母细胞瘤(18.8%)是眼球摘除术和眼球内容摘除术共同的病因,72.0%因眼部感染行眼球摘除术,51.8%因眼部肿瘤行眼内容摘除术.与30a前的统计数据相比较,我们医院近30a的眼球摘除率显著降低,因青光眼和眼创伤疾病导致眼球摘除的数量显著减少,而因感染和疼痛性盲眼导致的眼球摘除数量则有显著增加.结论:全眼球炎和眼内肿瘤是眼球摘除术的主要手术适应证,尽管现在在我国需要行眼球摘除术的病例数量较以前有显著降低,但手术适应证比例的变化提示我们,在马来群岛眼部的护理仍需要很大的改进.     

Current indications and resultant complications of evisceration

PURPOSE: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. METHODS: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. RESULTS: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. CONCLUSION: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center.     

Current Indications and Resultant Complications of Evisceration

Purpose: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. Methods: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. Results: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. Conclusion: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center.     

Review of 345 eye amputations carried out in the period 1996–2003, at Rigshospitalet,Denmark

Purpose: The aim of this study was to identify the number of eye amputations, and the causative diagnoses, indications for surgery and surgical techniques applied, and to evaluate a possible change in surgical technique in a tertiary referral centre in Denmark. Methods: The hospital database was screened using surgery codes for patients who had undergone bulbar evisceration, enucleation or orbital exenteration in the period 1996–2003. Patient records were reviewed for gender, age, time since surgery, causative diagnosis (the disease process leading to the indication for amputation), indication for eye amputation, type of surgery and whether an implant was applied. Results: A total of 345 patients were identified as having undergone eye amputation during the 8‐year period. Indications for eye amputation were: painful blind eye (127); neoplasm (119); infection (42); recent injury (25); disfiguring blind eye (25); prevention of sympathetic ophthalmia (5), and other reasons (2). Surgical procedures included 174 eviscerations, 154 enucleations and 17 orbital exenterations. The mean number of surgeries per year was 43.1. An orbital implant was applied in 168 patients. Conclusions: The most frequent indications for eye amputation were painful blind eye (37%) and neoplasm (34%). During the study period, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used in 33% of patients in 1996 and 67% in 2003.     

Implant extrusion in eviscerations

Wills Eye Hospital records for the ten-year period 1973-1983 were examined to compare the extrusion rate of implants from the scleral cavity after evisceration with the rate from Tenon's capsule after enucleation. Seventy-one consecutive extruding-implant surgical cases were examined; 60 (85%) occurred in sockets that had been previously enucleated and 11 (15%) in eviscerated eyes. In the same time period, there were 997 (95%) enucleations and 48 (5%) eviscerations. Fifteen percent of implant extrusions occurred in eviscerated sockets, for a 22% extrusion rate, compared with a 6% extrusion rate after enucleation. In this study, the frequency of extrusions was higher in eviscerations, although many variables, not taken into considerations here, might alter this ratio.     

Comparison after 10 years of two 100-patient cohorts operated on for eviscerations or enucleations

PURPOSE: To compare the indications, surgical techniques, and operative outcome between two 100-patient populations operated on for evisceration or enucleation with a 10-year interval. METHODS: This retrospective study involved 100 patients operated on between 1987 and 1990 (Group 1) compared with another 100 patients operated on between 1996 and 2000 (Group 2). Group 1 included 64 males and 36 females, mean age 49 years; Group 2 included 60 males and 40 females, mean age 53. RESULTS: In Group 1, 19 eviscerations were performed, versus 55 in Group 2. In both groups, half of the indications for surgery were a painful blind eye. In Group 1, endophthalmia (23%) came second, whereas it was trauma (15%) in Group 2. Sixty-eight patients were implanted in Group 1 (silicone spheres 69%) versus 86 in Group 2 (hydroxyapatite spheres 69%). Twenty spheres (20%) were rejected in Group 1 versus 7% in Group 2. DiSCUSSION AND CONCLUSIONS: The proportion of eviscerations increased in 10 years. The number of endophthalmitis-related operations decreased and trauma-related operations increased. The number of implantations increased with hydroxyapatite as the first choice material instead of silicone. This most likely contributed to reducing the number of rejections.     

Height, weight, body mass index and ocular biometry in patients with sickle cell disease

Purpose:  To investigate the effects of physical size on refractive error and the dimensions of optical components in sickle cell disease (SCD).
Methods:  The design was cross sectional. Height and weight of adult patients suffering from SCD were measured, and body mass index (BMI) was calculated. Anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and axial length (AL) were measured using A-scan ultrasonography. Corneal radius of curvature (CR) was measured using a keratometer. Non-cycloplegic refractive error was determined subjectively.
Results:  Subjects with SC genotype were significantly taller than those with SS genotype. In the unadjusted data, height was correlated with VCD [ p  = 0.02, 0.44 mm deeper per 10 cm increase in height, 95% CI (0.65, 8.25)] and AL [ p  = 0.03, 0.42 mm longer for every 10 cm increase in height, 95%CI (0.49, 7.99)]. The relationship between height, VCD and AL was absent after adjustment for age, gender, genotype and weight. BMI (kg m⁻²) was correlated with AL/CR ratio in both unadjusted ( p  = 0.04, −0.10 decrease per 1 kg m⁻², 95% CI (−0.018, −0.001) and adjusted data ( p  = 0.05, −0.10 decrease per 10 kg m⁻², 95% CI (−0.0189, 0.0001). Refractive error was not related to height, weight or BMI.
Conclusions:  Physical size does not affect refractive error or optical components in adult patients with SCD.     

Monitored anesthesia care for enucleations and eviscerations

OBJECTIVE: To report the technique and success of using monitored anesthesia care instead of general anesthesia for ocular enucleation and evisceration surgeries. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Twelve enucleated patients (Soparkar and Patrinely) and 146 eviscerated patients (Kulwin and Kersten). METHODS: Surgical logs of two oculoplastic practices were reviewed searching for cases of ocular enucleations and eviscerations performed under monitored anesthesia care between 1990 and 2001. Identified hospital and clinic charts were then reviewed. MAIN OUTCOME MEASURES: Monitored anesthesia care was deemed successful if (1) there were hemodynamic stability and complete analgesia intraoperatively; (2) there was absence of any chart documentation regarding patient or family psychological distress over the anesthesia method used; and (3) patients were discharged from the hospital without the need for observation or treatment > or = 23 hours. RESULTS: Between 1990 and 2001, 146 eviscerations were performed under local anesthesia with monitored anesthesia care by two surgeons (RCK, DRK) as their routine practice pattern. In 1996, Drs. Soparkar and Patrinely began performing enucleations under monitored anesthesia care in selected cases, and from 1996 to 2001, these surgeons enucleated 12 patients under monitored anesthesia care. Four of the enucleated patients requested surgery without general anesthesia. The remaining eight patients had been refused surgery by at least one other specialist because of the patient's perceived high medical risk for complications under general anesthesia. In all 158 patients, the procedures were deemed successful by the preceding criteria. CONCLUSIONS: This four-surgeon case series reports the successful use of local anesthesia with monitored care for ocular enucleation and evisceration procedures, offering several potential advantages over the traditional use of general anesthesia.     

眼内容剜除联合多孔羟基磷灰石义眼座植入术临床分析

目的：评价眼内容剜除术联合羟基磷灰石（Hydroxyapatite HA)义眼座植入术的疗效和安全性。方法：1998．1－2000．5在本中心接受眼内容剜除联合HA植入术的78例病例进行回顾性分析。收集各病例临床资料、手术指征、义眼座的大小、手术疗效和术后并发症。平均随诊时间11．6月（2－24月）。结果：本组共78例患者接受眼内容剜除联合HA植入术,全部病例均获得手术成功。术后无一例患者出现义眼座外露、脱出、移位等并发症。随诊期间无交感性眼炎发生。结论：在严格选择手术适应症的条件下,眼内容剜除术联合HA后置植入术是一种安全而有效的治疗部份无光感疼痛性眼球或萎缩眼球的方法。     

Review of 1028 bulbar eviscerations and enucleations. Changes in aetiology and frequency over a 20-year period.

PURPOSE: To evaluate possible changes in aetiology and frequency of bulbar eviscerations and enucleations. METHODS: A total of 1028 cases from three two-year periods: 1975-76, 1985-86 and 1995-96 collected by the Eye Pathology Institute were reviewed. RESULTS: A significant decrease (p<0.001) in number of enucleations was observed from 358 in 1975-76 to 214 in 1995-96, corresponding to an almost equivalent increase in number of eviscerations from 5 in 1975-76 to 83 in 1995-96. The total number of eye removals decreased significantly (p<0.01) over the last two periods from 368 in 1985-86 to 296 in 1995-96. This was primarily caused by a decrease in the number of glaucoma-related enucleations from 32.7% in 1975-76 to 15.0% in 1995-96. The reduction in number was not fully balanced by the increase in glaucoma-related eviscerations. CONCLUSION: Over the last 20 years there has been a change in choice of operation from enucleation to evisceration.     

Does optic disc topography vary during office hours?

Purpose:  To investigate whether there is variation in optic disc topography as measured by the Heidelberg Retina Tomograph (HRT), in normals during office hours.
Methods:  Thirty normal subjects (22 females and 8 males, median age 28 years, range 18–58) underwent Goldmann tonometry and optic disc analysis with the HRT. Three HRT readings were taken at each visit and a mean topographic image (MTI) produced. Measurements were performed in the morning (07.00–09.00 hours) and were repeated later the same day (17.00–19.00 hours). We studied the following topographic parameters: cup-to-disc area ratio (CDR), rim volume (RV), cup shape measure (CSM), and retinal nerve fibre layer thickness (RNFLT) in relation to time of day and the change in intraocular pressure (IOP).
Results:  The median changes in the topographic parameters were as follows (a negative value indicates a larger value in the evening): CDR (median 0.001, 95% CI: −0.007 to 0.007), RV (median 0.003, 95% CI: −0.021 to 0.016), CSM (median: −0.003, 95% CI: −0.015 to 0.007) and RNFLT (median 0.006, 95% CI: −0.010 to 0.009). No parameter exhibited statistically significant change. The median morning IOP was 14 mmHg (95% CI: 13–16 mmHg) and was not significantly different (Wilcoxon's W  = 234; p  = 0.27) to evening IOP when it was 13 mmHg (95% CI: 12–15 mmHg). The median difference in IOP was 1 mmHg higher in the morning than the evening (range 6 mmHg higher in the morning to 4 mmHg higher in the evening). The parameter changes between the morning MTI and the evening MTI were independent of IOP changes using Kendall's tau statistic for each parameter.
Conclusions:  There was no variation in HRT parameters when measured during office hours. Small intraindividual changes in IOP do not significantly affect optic disc topography.     

Diagnostic accuracy and variability of autorefraction by the Tracey Visual Function Analyzer and the Shin-Nippon NVision-K 5001 in relation to subjective refraction

Purpose:  To determine the accuracy of distance autorefractions obtained by two 'open field' devices, the Tracey Visual Function Analyzer and the Shin-Nippon NVision-K 5001, by comparison with subjective refraction.
Methods:  Both eyes of 50 healthy phakic participants underwent subjective refraction. Autorefractions were then performed on undilated pupils using the Tracey and a modified Shin-Nippon autorefractor and these were repeated within 50 days. Agreement with subjective refraction was calculated for sphere, mean spherical equivalent (MSE) and cylindrical vectors J ₀ and J ₄₅. Intratest and intertest variability were also evaluated.
Results:  The mean age of the participants was 37.4 years. Subjective refraction MSE ranged from −6.25 D to +3.62 D, mean −0.49 D ± 1.79 D. Bias between subjective refraction and Tracey was −0.001 D, +0.045 D, +0.017 D, and −0.015 D for sphere, MSE, J ₀ and J ₄₅ respectively; these were not significant. Bias between subjective refraction and Shin-Nippon was +0.004 D, +0.033 D, +0.106 D, and −0.021 D; only the J ₀ vector was significantly different ( p  < 0.0001) although this difference was small. Intratest variability for Tracey was low, measured at 0.189 D for sphere and 0.178 for MSE, and for the Shin-Nippon 0.099 D and 0.086 D respectively. Tracey intertest variability revealed small, statistically significant bias for sphere and MSE (+0.071 D and +0.070 D, p  = 0.011, 0.013). Shin-Nippon reproducibility showed no significant bias.
Conclusions:  Autorefraction measurements captured by both the Tracey and Shin-Nippon devices agree well with subjective refraction. The Shin-Nippon shows lower intratest variability.     

Goldmann tonometry versus the Tono-Pen XL for intraocular pressure measurement: an evaluation of the potential impact on clinical decision making in glaucoma

Aim:  To assess the validity of the Tono-Pen XL as an alternative to the Goldmann applanation tonometer (GAT) for the measurement of intraocular pressure (IOP) in patients with ocular hypertension (OHT) and glaucoma.
Methods:  Over a 3 month period, patients with OHT or glaucoma attending a general clinic had IOP measurements taken using the Tono-Pen XL and the GAT. Tono-Pen measurements were taken by suitably trained nursing staff, while Goldmann tonometry was performed by the examining ophthalmologist.
Results:  There were 124 eyes of 62 patients in this study. Overall, mean IOP was 18.3 ± 4.8 mmHg using GAT and 18.8 ± 5.5 mmHg using the Tono-Pen. Using the Bland–Altman method, the upper and lower limits of agreement between the two devices were +10.6mmHg and −9.6 mmHg, respectively. Significant over- and under-estimates of IOP were noted in 10 (16%) patients.
Conclusion:  Our findings suggest that the Tono-Pen XL cannot be used as a substitute for GAT in the management of patients with glaucoma or OHT.     

Efficacy of different dry eye treatments with artificial tears or ocular lubricants: a systematic review

Purpose:  To objectively review the outcome of clinical studies where rose bengal stain (RB) has been used as an outcome measure to assess the efficacy of artificial tears (AT) in patients with dry eye.
Methods:  From peer-reviewed articles published between 1947 and 2008, information was sought on dry eye status, as reported using a grading scheme, after use of RB as a diagnostic test, before and after use of a specific regimen of artificial tears or ocular lubricants for approximately 30 days. Mean baseline scores and post-treatment scores were calculated, along with the net change and the percentage change in the RB scores.
Results:  From a total of 33 suitable data sets, published between 1985 and 2006, the group mean pre-treatment RB score was 4.25 ± 1.55 (±S.D.), which decreased to 2.84 ± 1.24 after 30 days of treatment. This represented a net change of −1.43 (95% CI of −1.04 to −1.45). For use of traditional AT (saline, hypromellose, etc), the net change was −0.95, it was −1.33 for use of carbomer (polyacrylic acid) gels and −2.10 for hyaluronic acid (HA) products. These changes represented net improvements of 25.9 ± 18.4%, 38.0 ± 20.7% and 41.8 ± 16.3% respectively. The greater change with HA was not associated with a lower final outcome score, but with higher pre-treatment scores.
Conclusions:  Based on RB grading schemes used by numerous different clinicians over many years, treatment of dry eye with artificial tears or ocular lubricants can be expected to improve the condition of the exposed ocular surface. Assuming no improvement without treatment, a 30 days treatment period can be projected to produce an overall improvement of around 25%, but with no unambiguous statistical differences between product types.     

The porous polyethylene (Medpor) spherical orbital implant: a retrospective study of 136 cases

PURPOSE: To evaluate complications and risk factors associated with the placement of wrapped and unwrapped porous polyethylene (PP) spherical implants after evisceration, enucleation, or secondary implantation. METHODS: A retrospective, interventional, noncomparative case series of consecutive cases of PP implant placement after anophthalmic socket surgery performed by three surgeons over a 5-year period. A PP spherical implant was placed in 133 patients, 61 women (2 bilaterally) and 72 men (1 bilaterally). There were 91 enucleations, 30 eviscerations, and 15 secondary implant placements. Sixty-six (48.5%) implants were wrapped prior to placement. Parameters evaluated included: age, sex, prior ocular surgery or radiation treatment, indications for surgery, procedure performed, size of PP sphere, material used to wrap the implant, and complications. RESULTS: A total of 17 of 136 (12.5%) cases had documented postoperative complications, with implant exposure being the most common. In 5 patients (3.7%), implant exposure developed: 1 after evisceration and 4 after primary enucleation. Three of the five exposures were small and resolved with either observation alone or in one case with surgical revision of the socket. In two cases, the exposures were large enough that removal of the implant was indicated, one after evisceration and the other after enucleation with placement of a wrapped PP sphere. CONCLUSIONS: Our series revealed no significant difference in exposure rate between wrapped and unwrapped PP sphere implants, nor was the exposure rate affected by whether an eye was eviscerated or enucleated.     

Enucleation versus Evisceration in Ocular Trauma: A Retrospective Review and Study of Current Literature

Abstract

Purpose: To compare variables and outcomes from ocular trauma leading to either enucleation or evisceration to better inform surgical decision making.

Design: Retrospective chart review.

Methods: We reviewed 441 patients between 2001 and 2012 presenting with ocular trauma to a Level 1 trauma center in Queens, New York; of these, there were 16 enucleations and 6 eviscerations. Retrospective chart review noted age, gender, mechanism of injury, initial and final visual acuity, time to surgery, length of follow-up, pain, degree of motility, and complications. A review of literature in the context of our study was performed.

Results: 20 patients were male and 2 patients were female; average age was 44 (SD: 20.0, range 18–91). 9/16 patients were enucleated to prevent sympathetic ophthalmia, whereas only 1/5 patient was eviscerated for this indication (p?=?0.1619). No cases of sympathetic ophthalmia were reported over an average follow-up of 316 days. Average length of follow-up varied significantly between the two groups, with an average of 370.4 days (SD: 566.9, range 0–1870) for enucleated eyes and 172.7 days (SD: 146.3, range 0–422) for eviscerated eyes (p?=?0.42). Medpor implants were preferred in eviscerations (5/6 eviscerations), whereas hydroxyapatite implants were preferred in enucleations (10/16 enucleations, p?=?0.04).

Conclusions: Surgical decision-making in ocular trauma is largely based on surgeon preference and experience, with minimal evidence in the literature to support either enucleation or evisceration. We recommend evisceration over enucleation in cases of reliable patient follow-up due to the low incidence of sympathetic ophthalmia.     

Macular thickness and systemic markers for diabetes in individuals with no or mild diabetic retinopathy

Background:  The relationship between diabetic risk factors and macular thickness in individuals without clinically detectable diabetic macular oedema has yet to be formally explored. The purpose of this study was to assess the correlation between macular thickness and diabetes control and duration.
Methods:  This was a prospective, cross-sectional study. All subjects underwent digital retinal imaging and Stratus OCT macular thickness scanning both eyes. Mean retinal thickness was determined for quadrants, rings, hemispheres, and for the central fovea (CFT), total fovea (TFT) and total macula (TMT).
Results:  We evaluated 92 non-diabetic controls, 92 diabetic subjects with no diabetic retinopathy (DR) and 24 subjects with mild DR at the Veteran's Hospital in Jamaica Plain, MA. In subjects with diabetes, there was a significant negative correlation between retinal thickness and diabetes duration in all macular quadrants, rings and hemispheres, and for CFT, TFT and TMT (CFT: P  = 0.0025, r  = −0.28; TFT: P  = 0.0062, r  = −0.25; TMT: P  = 0.0026, r  = −0.28). There was no significant relationship between retinal thickness and HbA1c level (average of last three readings), systolic or diastolic blood pressure, or triglyceride levels. Additionally, no significant differences in retinal thickness were found between controls, subjects with no DR and subjects with mild DR.
Conclusions:  In subjects with no or mild DR, macular and foveal thickness is significantly thinner with longer duration of disease. This may reflect neurodegenerative changes in the diabetic retina.     

The effect of treatment zone diameter in hyperopic orthokeratology

Purpose:  To investigate the time course of treatment zone (TZ) diameter changes in hyperopic orthokeratology (OK) lens wear from 1 h in the open eye through to seven nights in the closed eye.
Methods:  Twelve subjects were fitted with rigid hyperopic OK lenses. Lenses were worn in the open eye for 1 h then one night in the closed eye, separated by a washout period of 4 days. Changes in best corrected visual acuity (BCVA) and corneal topography (Medmont E-300) were measured on lens removal. The TZ, comprising the central steepened zone (CSZ) and surrounding annular flattened zone (AFZ), was measured from corneal topography. Subsequently, ten subjects wore the same lens design overnight for seven nights, and measurements were taken on lens removal and 8 h later on Days 1 and 7.
Results:  Both CSZ and AFZ were apparent after 1 h of hyperopic OK lens wear. CSZ decreased while AFZ increased with longer periods of lens wear. BCVA reduced with longer periods of lens wear and was associated with decreasing CSZ ( r  = −0.866, p  < 0.001) and increasing AFZ ( r  = 0.447, p  < 0.05).
Conclusions:  The association of changes of treatment zone size with reductions in BCVA suggests that increasing CSZ may lead to better visual outcomes in hyperopic OK.     

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIM: To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. METHODS: A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. RESULTS: There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005). CONCLUSION: Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.