Role of Avastin in management of central serous chorioretinopathy

Purpose

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC).

Design

Prospective interventional series non-comparative study.

Setting

Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt.

Methods

The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6 months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25 mg (0.05 mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1–3 injections) 6–8 weeks intervals and follow up for 6 months (range 5–7 months). All finding at baseline and each follow up visit were reported and compared.

Results

The mean age of all patients was 40.3 years ± 6.5 (range 25–50 years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change (P < 0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change (P < 0.002). The mean baseline CRT for all patients was 486 ± 86 μm (range, 386–580), decreased to 316 ± 56 μm (range, 276–368) after 1 months with statistically significance difference change (P < 0.02) and to 272 ± 52 μm (range 220–338) at last follow up with statistically significance difference change from the baseline (P < 0.001).

Conclusions

Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.     

Intravitreal Anti-vascular Endothelial Growth Factor for Typical Exudative Age-related Macular Degeneration in Eyes with Good Baseline Visual Acuity

Purpose

To investigate 12-month treatment outcomes of anti-vascular endothelial growth factor therapy in eyes with typical exudative age-related macular degeneration with good baseline visual acuity.

Methods

This retrospective observational case series included 18 eyes (18 patients) with typical exudative age-related macular degeneration with a baseline best-corrected visual acuity of 20 / 25 or better. Patients were treated with anti-vascular endothelial growth factor monotherapy during the 12-month follow-up period. Baseline visual acuity and central foveal thickness were compared to the values at 12 months.

Results

Patients received an average of 4.4 ± 1.3 intravitreal anti-vascular endothelial growth factor injections. The mean logarithm of minimum angle of resolution visual acuity was 0.08 ± 0.04, 0.08 ± 0.07, 0.12 ± 0.09, and 0.16 ± 0.11 at baseline, three months, six months, and 12 months, respectively. Visual acuity at 12 months was significantly worse than the baseline value at diagnosis (p = 0.017), and the mean central foveal thickness at the defined time points was 270.2 ± 55.6, 204.4 ± 25.4, 230.1 ± 56.3, and 216.8 ± 48.7 µm, respectively. The central foveal thickness at 12 months was significantly less than the baseline value at diagnosis (p = 0.042).

Conclusions

Deterioration in visual acuity was noted in eyes with typical exudative age-related macular degeneration with good baseline visual acuity, suggesting the need for close patient monitoring and prompt treatment even in patients with good baseline visual acuity.     

Scleral buckling surgery using multiple radial buckles: A valid option?

Purpose

To determine whether radial buckling surgery using two or more radial buckles with or without circumferential silicone tires is still a treatment option for rhegmatogenous retinal detachment (RRD) in the current scenario.

Methods

Retrospective chart review. Patients with RRD with two or more horse-shoe tears with/without proliferative vitreoretinopathy up to grade C1 who underwent buckling surgery using at least two radial buckle segments without encircling bands or drainage and with at least a 3 year follow up were included in the study. Data collected included demographics, corrected distance visual acuity (CDVA) at baseline and final follow up, details of the examination, surgical procedure(s) and complications noted, if any. Appropriate statistical analysis was done. Statistical significance was set at p < 0.05.

Outcome measures

Proportion of patients who had an attached retina at final follow up, improvement in CDVA and complications.

Results

25 patients (25 eyes; 12 males and 13 females; 9 pseudophakic) were included.

Median age

35.15 ± 8.32 years. Median baseline CDVA: 1.97 ± 1.12 log MAR. Median final CDVA: 0.65 ± 0.37 log MAR (significant improvement). Most common presenting complaint was decreased vision (87.5%). Number of radial buckle segments placed varied between 2 and 4 per eye. One patient required vitrectomy for persistent retinal detachment. One required buckle removal for infection 5 years after the primary procedure. One patient required strabismus surgery.

Median follow up

12.25 years ± 2.14 years. None of the other patients had any complications.

Conclusion

Radial buckling surgery (two or more segments) is a reasonably safe and valid alternative to vitrectomy for RDs with multiple breaks in different planes.     

The outcome of congenital cataract surgery in Kuwait

Aim

Congenital cataract is the most common cause of treatable blindness in children and the outcome of congenital cataract surgery has not been studied in Kuwait, so the purpose of this study is to evaluate the visual outcome and the postoperative complications.

Methods

Medical records of children who underwent congenital cataract surgery between September 2000 and December 2008 at Al-Bahar Eye Center, Ministry of Health of Kuwait were retrospectively reviewed. In 100 eyes that fill the inclusion criteria visual acuity and postoperative complications were recorded. The mean follow up was 3.9 ± 1.7 years with range from 3 to 6 years.

Results

The mean age of congenital/developmental cataract surgery is 8.9 ± 8.7 months for bilateral cases and it was 5.75 ± 4.61 months for unilateral cases. The mean final postoperative BCVA in unilateral cases was 1.0 (20/200) log MAR unit and it was 0.3 (20/40) log MAR unit for the bilateral cases. Four percent of the cases developed postoperative glaucoma and 2% of them developed significant opacification of the posterior capsule.

Conclusion

Our findings provide evidence of recent improvement over time in the visual prognosis in bilateral, and to a lesser degree, unilateral cataract, in children in Kuwait.     

Surgical outcomes of 23-gauge vitrectomy for the management of lens fragments dropped into the vitreous cavity during cataract surgery

Purpose

To assess the clinical features and surgical outcomes of 23-Gauge (G) vitrectomy for lens fragments dropped into the vitreous during cataract surgery.

Methods

A retrospective, non-comparative, interventional case series at a single medical center. The medical records of 45 eyes from 45 consecutive patients who were referred to our hospital for surgical retrieval of phacoemulsification dropped lens fragments and who underwent 23-G vitrectomy were retrospectively reviewed. Data pertaining to patient demographics, pre- and post-operative Snellen visual acuity, and postoperative complications were recorded. Factors associated with dropped lens fragments were also examined.

Results

Mean patient age was 68.18 ± 11.47 years. The preoperative and postoperative mean logarithm of minimum angle of resolution (logMAR) visual acuity was 1.91 ± 0.59 (Snellen equivalent 0.06 ± 0.15) and 0.42 ± 0.51 (Snellen equivalent 0.54 ± 0.31), respectively. Forty-two eyes (93.3%) had dislocated lens fragments <50% of the total lens size. Two eyes (4.4%) had a large and hard lens nucleus, which necessitated the use of a 20-G fragmatome to efficiently and completely remove the lens material. At the final examination, 30 eyes (66.6%) had a visual acuity better than 20/40. Post-vitrectomy complications included elevated IOP for at least 3 months (n = 5 eyes, 11.1%), intraocular lens dislocation (n = 2 eyes, 4.4%), and cystoid macular edema (n = 1 eye, 2.2%). No cases of postoperative endophthalmitis or retinal detachment were observed.

Conclusions

A 23-G vitrectomy is safe and efficient for the surgical management of dropped lens fragments following cataract surgery.     

Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses

Objective

To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy (PPV) to manage dislocated intraocular lenses (IOLs).

Patients and methods

A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded.

Results

Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85 years (mean 52.6). The range of follow-up was 3 to 108 months (mean ± SD 19.4 ± 17.4 months). The final visual acuity was 20/50 or better in 52 (55.3%) eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic (P = 0.0092). There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome (20/200 or better) in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in (90.0%) of eyes with good vision (20/200 or better) compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 (9.6%), glaucoma in 9 (9.6%), bullous keratopathy in 8 (8.5%), retinal detachments in 6 (6.4%) eyes, and relapsing uveitis in 2 (2%).

Conclusion

In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies.     

Intravitreal bevacizumab for pediatric exudative retinal diseases

Purpose

To detect if intravitreal bevacizumab can reduce retinal exudation, improve visual and anatomical outcomes, and facilitate the treatment in various pediatric exudative retinal diseases.

Patients and methods

Prospective, non-randomized, case series of nine eyes of pediatric exudative retinal diseases less than 18 years old which included six eyes with juvenile diabetic retinopathy, two eyes in children with Coats’ disease, and one eye with myopic choroidal neovascular membrane (CNV). All eyes received only intravitreal bevacizumab injection 1.25 mg/0.05 ml as the primary treatment. The need for adjuvant ablative procedures, including laser photocoagulation or cryotherapy, were performed and recorded. The need for supplementary intravitreal bevacizumab injection was recorded. The changes in pre- and post-operative best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded. Serial optical coherent tomography (OCT) and fundus flourescein angiography (FFA) were performed to follow treatment efficacy.

Results

The study included 19 eyes of 11 patients with age equal to or less than eighteen years with exudative retinal diseases including type I DM (n = sixteen eyes), Coats’ disease (n = 2 eyes), and due to myopic CNV (n = 1 eye). Mean pre-injection log MAR for all was 0.605 ± 0.174 and mean post-injection for all log MAR was 0.284 ± 0.247. While Mean pre-injection log MAR for DR and myopic CNV patients was 0.576 + 0.152 SD and mean post-injection log MAR for DR and myopic CNV patients was 0.229 + 0.189 at one year. Serial OCT measurements showed that mean CMT for all eyes was 355.8 ± 35.3 μm SD at baseline, which was decreased to 222.42 + 26.2 μm SD. The two eyes of Coats’ disease needed another two supplementary intravitreal bevacizumab injections. No ocular or systemic complications related to bevacizumab were noted during the entire course of follow-up.

Conclusion

Intravitreal bevacizumab appears to be a well-tolerated treatment for pediatric age group with various exudative retinal diseases. It has the potential as an adjuvant therapy for ablative procedures to improve final visual and anatomical outcome.     

Peripapillary nerve fiber layer thickness changes after macular photocoagulation for clinically significant diabetic macular edema

Purpose

To evaluate the effect of macular photocoagulation (MPC) on peripapillary nerve fiber layer (PNFL) thickness measurement in patients with clinically significant diabetic macular edema (CSME).

Methods

This study was a prospective interventional case series. Patients with CSME underwent MPC. Optical coherence tomography (OCT) was used to measure the PNFL and central macular thicknesses before and 3 months after MPC.

Results

Thirty-three eyes of 25 patients with a mean age of 59.4 ± 7.2 years were included. There was no statistically significant difference between pre- and post-MPC mean best corrected visual acuity (0.35 ± 0.29 and 0.40 ± 0.23 LogMAR, respectively, P = 0.2). Mean baseline and 3 months central macular subfield thickness was 305.9 ± 90.7 and 317.5 ± 112.4 microns, respectively (P = 0.1). Peripapillary nerve fiber layer thickness was 105.7 ± 10.0 before and 106.1 ± 9.9 three months after MPC (P = 0.7). No significant differences were found between pre and post MPC measurements in temporal, nasal, inferior and superior nerve fiber layer thickness in each quadrant around optic nerve head (P > 0.05).

Conclusions

Macular photocoagulation has no statistically significant effect on PNFL thickness measurements in patients with CSME.     

Controlled Cyclophotocoagulation with diode laser in refractory glaucoma and long term follow up at King Abdulaziz University Hospital,Riyadh

Purpose

To evaluate the clinical efficacy and safety of controlled contact transscleral diode laser Cyclophotocoagulation (COCO) procedure in reducing the Intraocular Pressure (IOP) among patients with refractory glaucoma.

Methods

Thirty two patients (35 eyes) with refractory glaucoma in prospective clinical studies were treated with trans-sclera diode laser in a controlled manner. The energy power used was 5 W in adults and 3 W in children, exposure time was 0.5 s, a total of 16 shots were applied over ciliary body and four shots in each quadrant. Pre and postoperative IOP were measured at different postoperative visits. Snellen visual acuity, the number of anti-glaucoma medications and associated complications were also recorded. Student T test was used to compare the pre and post intervention IOPs, while Wilcoxon Signed Ranks test was used, to detect significance change in medication dependency.

Results

The mean (SD) follow up time was 80.2(±9.6) months, range (36–84) m, where the mean IOP was significantly reduced from 35.1 mm Hg (±10.7) before intervention to 18.8 mm Hg (±7.3) after intervention, in the final visit (P < 0.0001). Complete success was achieved in seven eyes (20%), 22 eyes (62.8%) showed qualified successes and complete failure was reported in six eyes (17.1%). The overall success rate was 82.8% (95% CI: 70.4–95.3). Visual acuity improved in three eyes (8.5%), no change took place in 27 eyes (77.1%) and decreased in five eyes (14.2%). The number of anti-glaucoma medications has significantly changed between pre and post intervention (P < 0.0001). No cases of hypotony, phthisis bulbi or sympathetic ophthalmia were reported.

Conclusion

Controlled COCO is a simple procedure, safe with minimal complications and fewer side effects.     

Mini-incision cataract surgery and toric lens implantation for the reduction of high myopic astigmatism in patients with pellucid marginal degeneration

Purpose

To evaluate the clinical outcomes, safety, and efficacy of cataract surgery with the implantation of a toric intraocular lens (IOL) in eyes with stable pellucid marginal degeneration (PMD).

Methods

Eleven eyes (eight patients) diagnosed as stable PMD and cataract underwent mini-incision 2.2 mm cataract surgery followed by the implantation of hydrophobic toric aspheric IOL (AcrySof IQ Toric IOL, Alcon, Fort Worth, TX, USA). Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. Paired samples t-tests were used to analyze preoperative and postoperative visual acuity, astigmatism, and spherical equivalent (SE) parameters. Follow-up was 6 months.

Results

The mean CDVA was 0.62±0.26 logMAR preoperatively and 0.07±0.07 logMAR postoperatively. The mean preoperative sphere and cylinder was −3.14±3.58D and −4.84±2.02D, respectively. The mean postoperative manifest refractive sphere and cylinder was −0.30±0.51D and −0.81±1.51D, respectively. There was a significant reduction in refractive astigmatism after toric IOL implantation (P<0.002). The toric IOL axis rotation was <5° in all cases at the final follow-up.

Conclusions

Implantation of hydrophobic toric IOL was a safe and effective surgical procedure to correct mild to moderate stable PMD.     

Mushroom keratoplasty in pediatric patients

Objective

To report the outcome of mushroom keratoplasty for the treatment of full thickness corneal disease in pediatric patients with healthy endothelium.

Methods

A retrospective analysis of pediatric patients who underwent mushroom keratoplasty. The medical records of pediatric patients suffering from full thickness corneal stromal disease with normal endothelium who underwent mushroom keratoplasty at our Institution were included. A two-piece donor graft consisting of a large anterior stromal lamella (9.0 mm in diameter and ±250 μm in thickness) and a small posterior lamella (5–6.5 mm in diameter) including deep stroma and endothelium, prepared with the aid of a microkeratome had been transplanted in all cases. Ophthalmic examination including slit lamp examination, best corrected visual acuity, and corneal topography was performed preoperatively and at each postoperative visit on all patients. The endothelial cells were assessed by specular microscopy in these patients.

Results

Six eyes of six patients (five males and one female) were included. The mean age was 9.3 years (range 5–15 years). Average follow-up was 17.8 months (range 9–48 months).There were no early or late complications recorded. All corneas were clear at the last follow up visit.Preoperative best corrected visual acuity (BCVA) was worse than 20/70 in all six eyes. Postoperatively, four eyes achieved BCVA of 20/40 or better.Endothelial cell loss (n eyes = 3 averaged 24% (range 19–31%). The mean endothelial cell loss was 24% (range 19–31%) among these patients.

Conclusions

Microkeratome assisted mushroom keratoplasty is a viable surgical option for pediatric eyes with full thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large penetrating keratoplasty with the survival advantage of a small penetrating keratoplasty. Furthermore, mushroom keratoplasty exhibits the mechanical advantage of a shaped keratoplasty.     

Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

Purpose:

To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab.

Methods:

Retrospective review of patients with nAMD switched to aflibercept following ≥6 prior intravitreal ranibizumab or bevacizumab injections at 4–8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen.

Results:

Twenty-one eyes of 18 patients who had received a mean of 23.8±18.8 (mean±SD; range 6–62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2±2.9 (range 4–21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35–133 days), as compared with 37±6.1 days (range 29–54 days) with the prior agents (P=0.01). Mean best-corrected visual acuity was preserved (0.42±0.31 vs 0.42±0.23 logMAR; P=0.2). Mean OCT central subfoveal thickness (292.1±83.2 μm to 283.6±78.6 μm; P=0.4) and mean macular volume (7.9±0.95 mm³ to 7.67±0.94 mm³; P=0.16) remained stable.

Conclusion:

Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to >8-week treatment interval with aflibercept while maintaining the anatomic and visual gains.     

Posterior sub-tenon’s bevacizumab injection in diabetic macular edema; a pilot study

Purpose

To evaluate the short-term results of sub-tenon’s injection of bevacizumab in patients with clinically significant macular edema (CSME).

Methods

In this prospective non-comparative interventional case series, sub-tenon’s injection of 2.5 mg/0.1 ml bevacizumab was performed for eyes with CSME. Macular thickness and best corrected visual acuity measurements were performed before and one month after injections.

Results

Nineteen eyes of twelve patients with a mean age of 59.8 ± 5.7 years were evaluated. Thirteen eyes (68.4%) had center-involving macular edema. No significant difference was observed between pre- and post-injection central subfield retinal thickness measurements (P = 0.3). Central subfield thickness measurements improved or remained unchanged in 13 eyes (68.4%). Baseline BCVA of 0.48 ± 0.35 LogMAR improved to 0.36 ± 0.26 LogMAR after injection (P = 0.01). Improvement of >2 lines in BCVA was found in 5 eyes (26.3%), and no eye lost >2 lines of BCVA. No complication associated with sub-tenon’s injection was observed.

Conclusion

Sub-tenon’s injection of bevacizumab resulted in significant short-term visual improvement in eyes with CSME. Retinal thickness changes were not significant.     

Management of moderate and severe corneal astigmatism with AcrySof? toric intraocular lens implantation – Our experience

Purpose

Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism.

Setting

Cataract services, Shroff Eye Centre, New Delhi, India.

Design

Case series.

Method

This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months.

Results

The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was −0.04 (SD = 0.76).

Conclusion

We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.     

Corneal spherical aberration and its impact on choosing an intraocular lens for cataract surgery

Purpose

To analyze the post operative results of targeting zero spherical aberration by selecting the best-fit aspheric intraocular lens (IOL), based on preoperative corneal spherical aberration of patients with phacoemulsification surgery.

Setting

AlHokama Eye Specialist Center, Riyadh, Saudi Arabia.

Period

From the 1st of October 2012 until the 10th of April 2013.

Methods

Fifty-three eyes, were subjected to phacoemulsification cataract surgery and divided into two groups, 34 eyes were implanted with aspheric IOLs based on their corneal spherical aberration targeting post operative zero total spherical aberration, whereas 19 eyes were implanted with neutral aspheric IOLs regardless of their corneal spherical aberrations (CSAs). As a pre and post routine examination, patients underwent: slit lamp testing, intraocular pressure (IOP) measuring, fundus examination, best spectacle corrected visual acuity (BSCVA), manifest refraction, pupillometry, axial length, contrast sensitivity, and corneal aberration measurement using Pentacam HR (OCULUS, Germany) at the 6-mm optical zone. Post operatively, visual function questionnaire (VF-14) was asked to all patients.

Results

Fifty-three eyes of 45 patients, whose age ranged from 45 to 90 years old, were available for analysis, the selected group was implanted with: Tecnis ZA9003 or ZCB00 (Abbott Medical Optics) IOLs in 17 eyes with corneal spherical aberration of more than 0.27 μm, AcrySof IQ SN60WF (Alcon Laboratories Inc.) IOLs were implanted in 4 eyes with CSA = (0.2–0.27) μm, and Rayner 970C, 920H or 620H IOLs with spherical aberration (SA) = 0 in 13 eyes with CSA less than 0.20 μm. The other group of 19 eyes was implanted with aspheric IOLs that have zero spherical aberration (Rayner 970C or 920H) regardless of their CSA. Root mean square (RMS) of total corneal aberration positively correlates to the pupil diameter (P = 0.0031, r = 0.3989). A low negative correlation was found between the corneal spherical aberration of the fourth ordered (Z40) and the axial length (r = −0.2009, P = 0.1492). There was no significant difference between the selected and non-selected group in contrast sensitivity, best spectacle corrected visual acuity, and visual satisfaction (P = 0.5316, P = 0.3919, P = 0.7667).

Conclusion

Customized selection of aspheric IOLs based on the eyes’ corneal spherical aberration has no significant importance comparing their results with the non-selected group.     

Surgery for sight: outcomes of congenital and developmental cataracts operated in Durban,South Africa

Purpose

To study the visual outcomes of congenital and developmental cataract surgery and determine variables for presentation for pediatric cataract surgery in KwaZulu Natal province of South Africa.

Methods

Care-givers of children presenting with cataract to a quaternary centre were asked when they first detected the condition. The reasons for delay between detection and surgery were studied. The children underwent a comprehensive eye examination and then appropriate surgery. They were prospectively followed up for 3 months and visual acuity and stereopsis were noted. Delay in presentation for surgery and visual outcomes were co-related with demographic and clinical factors.

Results

Eighty-three non-traumatic cataract surgeries in 50 children were studied. Twenty-six (52%) were males, mean age was 3 years 10 months (SD 3yrs 4 months). The mean delay between identification and surgery was 20.7 months (SD 18 months). Twenty-six (52%) children had >15 months interval between diagnosis and surgery. Only mother''s occupation was significantly associated with delay (P=0.017). Post-surgery 17/69 (24.7%) had visual acuity ≥6/18, 20/69 (29.0%) had vision between 6/24–6/60, whereas 32/69 (46.3%) had visual acuity ≤6/60. The final vision was associated with age (P=0.031), delay between diagnosis and surgery (P<0.001), type of surgery (P=0.046) and preoperative vision (P<0.001).

Conclusion

Although the children''s vision improved substantially, a longer follow-up and amblyopia treatment would be necessary to optimize the visual outcome, which depended on age and preoperative vision. Health promotion activities aimed at mothers are important in improving visual outcomes.     

Safety and efficacy of Ahmed glaucoma valve implantation in refractory glaucomas in Northern Indian eyes

Purpose

To evaluate the safety and efficacy of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma in Northern Indian eyes.

Background

The success rate of trabeculectomy remains low in cases of refractory glaucoma even with the use of antifibrotics. Glaucoma drainage devices have proven to be more efficacious in reducing intraocular pressure (IOP) in these glaucomas.

Methods

Retrospective records of 55 consecutive patients who underwent AGV implantation at Dr. Shroff’s Charity Eye Hospital, New Delhi, India from January 2003 to December 2012 were reviewed. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications, number of prior incisional surgeries, visual acuity and IOP on medical treatment. Postoperative data included visual acuity and IOP on day one, 1 week, 1 month, 3 months, 6 months, 1 year and yearly thereafter, number of anti-glaucoma medications, any complication or additional surgical intervention required. Success was defined as IOP >5 and <22 mmHg with or without treatment.

Results

Mean IOP decreased from 39.71 ± 8.99 pre-operatively to 17.52 ± 5.72 mmHg at last follow-up (p < 0.001) and number of medications reduced from 3.27 ± 0.84 to 1.25 ± 0.88 (p < 0.001). Visual acuity remained within one Snellen line or improved at last follow-up in 47 cases (85.4%). The cumulative probability of success was 85.45% at 1 year and 79.63% at 3 years. The incidence of post-operative complications was 25.45%.

Conclusion

AGV implantation has proven to be safe and is effective in controlling IOP in refractory glaucoma in Northern Indian eyes.     

Short-term safety and efficacy of intravitreal 0.7-mg dexamethasone implants for pseudophakic cystoid macular edema

Aims

To determine the feasibility, safety, and clinical efficacy of intravitreal 0.7-mg dexamethasone implants (Ozurdex) in patients with refractory cystoid macular edema after uncomplicated cataract surgery.

Methods and materials

In this study, 11 eyes of 11 patients affected by pseudophakic cystoid macular edema refractory to medical treatment were treated with a single intravitreal injection of a dexamethasone implant. Follow-up visits involved Early Treatment Diabetic Retinopathy Study visual acuity testing, optical coherence tomography imaging, and ophthalmoscopic examination.

Results

The follow-up period was six months. The mean duration of cystoid macular edema before treatment with Ozurdex was 7.7 months (range, 6–10 months). The baseline mean best corrected visual acuity (BCVA) was 0.58 ± 0.17 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.37 ± 0.16 logMAR (p = 0.008) and 0.20 ± 0.13 logMAR (p = 0.001) after 1 and 3 months, respectively. At the last follow-up visit (6-month follow-up), the mean BCVA was 0.21 ± 0.15 logMAR (p = 0.002). The mean foveal thickness at baseline (513.8 μm, range, 319–720 μm) decreased significantly (308.0 μm; range, 263–423 μm) by the end of the follow-up period (p < 0.0001). Final foveal thickness was significantly correlated with baseline BCVA (r = 0.57, p = 0.002). No ocular or systemic adverse events were observed.

Conclusions

Short-term results suggest that the intravitreal dexamethasone implant is safe and well tolerated in patients with pseudophakic cystoid macular edema. Treated eyes had revealed a significant improvement in BCVA and decrease in macular thickness by optical coherence tomography.     

Choroidal thickness profile in Retinitis Pigmentosa – Correlation with outer retinal structures

Purpose

To compare the choroidal thickness (CT) of subjects with Retinitis Pigmentosa (RP) with age-matched healthy subjects and to correlate the visual acuity with retinal parameters including central macular thickness (CMT), inner segment/outer segment junction (IS/OS junction) integrity, external limiting membrane (ELM) integrity and choroidal thickness in subjects with RP.

Methods

Eighty-eight eyes (69 patients) with typical RP and 188 eyes of 104 healthy subjects were enrolled between September 2012 and January 2013.All subjects underwent a comprehensive ocular examination including choroidal imaging using enhanced depth imaging with spectral domain optical coherence tomography. Outcome measures were CT difference between RP and age-matched healthy subjects; and correlation of various factors such CMT, IS/OS junction integrity, ELM integrity, and CT with visual acuity.

Results

Among RP subjects, mean age was 31.39 ± 13.4 years with a mean BCVA of 0.99 ± 0.94 logMAR. Mean spherical equivalent was −0.6 ± 1.6D. Mean CMT was 148.48 ± 119 μm. Mean subfoveal CT was 296.9 ± 72 μm. Mean IS/OS and ELM integrity was 42.2 ± 46.6% and 43.75 ± 45.7%, respectively. The mean age was 40.0 ± 13.5 years with a mean spherical equivalent of 0.18 ± 0.6D for the normal age-matched healthy group. Mean subfoveal CT was 283.1 ± 47.8 μm.CT at various locations in patients of various ages in the RP group did not show any statistical significant difference (P = ≫0.05) in comparison with age-matched healthy subjects. On multivariate regression, ELM percentage integrity had the strongest association with best corrected visual acuity, followed by IS/OS junction percentage integrity. Subfoveal choroidal thickness had very weak correlation with visual acuity as well other retinal parameters.There was a significant difference in the outer retinal structure integrity (p = 0.002) and CMT (p = 0.02) between the eyes with good (⩾20/200) and poor vision (<20/200), but not in subfoveal choroidal thickness (p = 0.3).

Conclusions

Our study results did not show any significant difference in choroidal thickness between subjects with RP and age-matched healthy subjects. Choroidal thickness correlated better with the age but not with the vision or outer retinal structures in eyes with RP. Outer retinal structure integrity and CMT had a better correlation with visual acuity.     

Effects of advanced surface ablations and intralase femtosecond LASIK on higher order aberrations and visual acuity outcome

Background/aims

To study the changes in wavefront (ocular) and corneal higher order aberrations (HOAs) and visual acuity (VA) outcome following wavefront-guided advanced surface ablation (ASA) techniques and intralase femtosecond LASIK (iLASIK) in myopia treatment.

Methods

Ocular aberration and corneal topography of 240 eyes in the ASA techniques (this was equally divided into a flap-on group where the epithelial flap was preserved and reapplied to the photoablated stromal bed and a flap-off group when the epithelial flap was discarded during the procedure), and 138 eyes in the iLASIK group were obtained before and 3 months following treatment. The correlation of aberrations with best spectacle-corrected visual acuity was analyzed.

Results

At 3 months, there was statistically significant (P < 0.001) surgically induced increase in spherical aberration (SA) in each of the techniques for both ocular and corneal analysis. iLASIK induced significantly less ocular and corneal HOAs (P < 0.001). The mean manifest refractive spherical equivalent was closer to attempted correction compared to other groups (P < 0.001). Eighty-three eyes (70%) of flap-on, 80 (67%) flap-off and 94 eyes (68%) in the iLASIK group achieved 20/20 uncorrected VA. Fifteen eyes (11%) accomplished 20/12.5 or better in iLASIK compared to 4 (3%) for flap-on and 7 (6%) for flap-off ASA group. Only the flap-off treatment showed a consistent correlation between the corrected aberrations and visual performance.

Conclusion

At 3 months, all procedures resulted in a significant increase in HOAs and SA. All had comparable 20/20 VA and 11% of iLASIK patients achieved 20/12.5 or better level.