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1.
David S. Sands Stephanie C.Y. Chan Chloe C. Gottlieb 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(4):349-353
Objective
To assess corticosteroid-sparing and inflammation control in patients with noninfectious scleritis treated with methotrexate.Design
Retrospective review.Participants
Patients who received methotrexate treatment for noninfectious scleritis and who had 12 months of follow-up after treatment initiation were included in this review.Methods
The clinical records of noninfectious scleritis patients presenting at the University of Ottawa Eye Institute between September 1, 2010 and December 31, 2014 treated with methotrexate were retrospectively reviewed. Seventeen patients (21 eyes) were included in the study. Main outcome included inflammation control and corticosteroid-sparing success. Secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity.Results
The proportion of eyes with corticosteroid-sparing success was 69.2% at 3 months and 92.3% at 12 months. The proportion of eyes that achieved inflammation control was 61.9% at 3 months and 90.5% at 12 months. The corticosteroid immunosuppression load at treatment start was 1.9 ± 2.07 and at 12 months was 0.48 ± 1.03 (p < 0.01). There was no statistically significant difference in best-corrected visual acuity.Conclusions
The treatment of noninfectious scleritis with methotrexate appears to be effective at both achieving steroid-sparing success and controlling inflammation during 12 months of therapy. Immunosuppression load decreased significantly over 12 months of therapy while best corrected visual acuity was stable. 相似文献2.
Bo Li Sapna Sharan 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(1):45-48
Objective
To describe the presentation, clinical evaluation, work-up, surgical management, and surgical outcomes in children older than 8 years with spontaneous, comitant, acquired nonaccommodative esotropia (ANAET).Design
Retrospective chart review.Participants
Children who underwent bilateral medial rectus recession surgery for ANAET with initial esotropia onset later than 8 years of age.Methods
The medical records of children older than 8 years presenting with ANAET from 2009 to 2015 were retrospectively reviewed. The clinical presentation, work-up, surgical intervention, preoperative and postoperative deviations, and surgical outcomes were recorded.Results
A total of 7 healthy patients were identified. The average age of onset was 11.9 years. All patients presented with symptoms of diplopia with large-angle esotropia. Most patients had no preceding illness and presented with minimal refractive error. All 7 patients had unremarkable neurological and general pediatric evaluations without findings of acute intracranial pathology on neuroimaging. Bilateral medial recession surgery was performed for all 7 patients with resolution of diplopia and excellent stereopsis postoperatively.Conclusions
Diplopia is the most common presenting symptom among older children presenting with ANAET. Bilateral medial recession surgery achieved excellent postoperative results with resolution of diplopia and excellent stereopsis. 相似文献3.
Mišo Gostimir Rahul A. Sharma Adil Bhatti 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):474-479
Objective
To use the perspectives of undergraduate program directors to assess the current structure and adequacy of undergraduate ophthalmology curricula at Canadian medical schools.Design
Cross-sectional survey.Participants
Undergraduate ophthalmology program directors at each English-speaking Canadian medical school.Methods
Program directors were identified and invited to participate in an online survey. The 18-question survey focused on key areas of undergraduate ophthalmology curricula, including length, timeline, setting, and nature of medical students’ exposure to ophthalmology. A period of 4 months was allowed for responses. Information from medical school web sites was combined with survey responses.Results
Responses were obtained from 7 of the 14 (50%) program directors. All of the respondents represented metropolitan institutions of greater than 100 seats. After combining survey and web site data, only 5 of 14 (35.7%) schools were found to have a mandatory clinical clerkship ophthalmology rotation. In each case, the mandatory rotation is less than 2 weeks. A core curriculum based on the International Council of Ophthalmology (ICO) guidelines is used in only 20% of schools. Extracurricular ophthalmology exposure in the form of research opportunities and interest groups exists in 100% and 71.4% of schools, respectively.Conclusions
The proportion of schools requiring mandatory clerkship ophthalmology rotations is only 35.7%. However, most departments use strategies to optimize the limited time allotted to ophthalmology rotations during medical school. A greater degree of adherence to the ICO curriculum guidelines may help to ensure that medical students develop an appropriate level of proficiency in managing patients with eye disease. 相似文献4.
5.
Fady Sedarous Helen Dimaras Maram Isaac Myrna Lichter Nasrin N. Tehrani 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):447-452
Objective
To assess the ophthalmic needs of families with children residing in Toronto shelters.Design
Cross-sectional study.Participants
Forty-nine families, including 86 children (age 0–16 years) and 55 adult and youth family members (AYFM) (age >16 years), randomly selected from 5 family shelters in Toronto, Ont.Methods
Ten families with at least 1 child aged 16 years or younger were randomly recruited from each shelter. Data on sociodemographics, medical history, ocular history, and access to eye care were collected through a structured interview. Eye examinations were performed in the shelters for all children and AYFM.Results
The mean age for AYFM was 34.9 ± 9.3 years (range, 17–60 years), and the mean age for children was 6.1 ± 4.3 years (range, 1 month–16 years). Thirty-nine percent of parents reported dissatisfaction with their vision, and 6.7% of children had parents who perceived that their child had eye problems. Overall, fewer parents had accessed care for their own eye problems in the last year than for their children (parents 36.4%, children 81.8%). Examination revealed abnormal ocular findings in 47.3% of AYFM and 24.4% of children. The commonest finding in AYFM was refractive error (30.9%); among children, it was refractive errors (16.3.%) and strabismus (3.5%).Conclusions
We found that a significant percentage of families living in shelters had eye problems that required treatment. We propose a proactive approach to identify these families and their dependent children in order to expedite access to appropriate eye care in a timely fashion for this vulnerable population. 相似文献6.
Milad Modabber Andrei F. Dan Razek G. Coussa Michael Flanders 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(6):621-626
Objective
To characterize the ocular response to retrobulbar anaesthesia and to evaluate the efficacy of retrobulbar anaesthesia for adjustable strabismus surgery in adults.Design
Prospective observational study.Participants
Adult patients undergoing adjustable strabismus surgery under retrobulbar anaesthesia.Methods
Surgical success was defined by ocular alignment within 10 prism diopters (PD) of orthotropia for horizontal rectus surgery and within 5 PD for vertical rectus surgery. After retrobulbar injection of Xylocaine with epinephrine, the onset time and the degree of visual impairment, ocular akinesia, and analgesia were evaluated. Postoperative parameters included the restoration of vision, onset of pain, resolution of ptosis, normalization of pupil, resolution of extraocular motility deficits, and the timing of postoperative adjustment. Perioperative complications were also documented.Results
A total of 33 patients were initially included in this study. Two patients experienced complications (perioperative retrobulbar hemorrhage, postoperative suprachoroidal hemorrhage) and were excluded from data analysis. Of the remaining 31 patients (mean age, 50.2 ± 14.8 years), surgical outcome was satisfactory in 30/31 (96.8%) patients at the first postoperative visit and in 15/19 (78.9%) cases at last follow-up (mean, 6.1 ± 1.6 months). Excellent intraoperative ocular akinesia and analgesia was achieved with retrobulbar anaesthesia. After retrobulbar injection, visual impairment was the first to resolve to preoperative levels within (mean ± SD) 3.7 ± 1.9 hours postinjection, followed by onset of pain at 4.1 ± 1.0 hours, resolution of ptosis at 4.3 ± 1.9 hours, and normalization of pupil reactivity at 6.1 ± 1.0 hours. The resolution of anaesthesia upon extraocular motility occurred within 5.7 ± 1.0 hours postinjection (range, 4.5–8.0 hours), allowing for subsequent same-day postoperative adjustment.Conclusions
Retrobulbar anaesthesia in the context of adult, adjustable strabismus surgery is a relatively safe and effective technique. It provides excellent intraoperative analgesia and akinesia. Retrobulbar anaesthesia enables for same-day suture adjustments to be reliably performed. 相似文献7.
Jay C. Wang Christopher J. Rudnisky Michael W. Belin Joseph B. Ciolino 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(3):284-290
Objective
To investigate the visual and anatomical outcomes of Boston keratoprosthesis (Kpro) type 1 reimplantation.Design
Subgroup analysis of multicentre prospective cohort study.Participants
Of 303 eyes that underwent Kpro implantation between January 2003 and July 2008 by 1 of 19 surgeons at 18 medical centres, 13 eyes of 13 patients who underwent reimplantation of Boston Kpro type 1 were compared with 13 eyes of 13 diagnosis-matched patients who underwent initial implantation.Methods
Forms reporting preoperative, intraoperative, and postoperative parameters were prospectively collected and analyzed. Main outcome measures were Kpro retention and logMAR visual acuity.Results
After a mean follow-up time of 17.1 ± 17.6 months, the retention of both initial and repeat Kpro implantation was 92.3% (12/13 in both groups), and 62% of initial implantation and 58% of repeat implantation eyes achieved visual acuity better than 20/200. Vision worse than 20/200 was often due to glaucoma or posterior segment pathology. Best-recorded logMAR visual acuity was significantly improved postoperatively in both groups (p < 0.001), and there was no statistically significant difference in final logMAR visual acuity between the 2 groups (p = 0.89). Sterile keratolysis (n = 4) and fungal infection (n = 5) were the most common causes of initial Kpro failure in the repeat Kpro group. The single failure in the repeat Kpro implantation group was due to fungal keratitis, and in the control group it was related to Kpro extrusion.Conclusions
Repeat Kpro implantation is a viable option after failed initial Kpro, with visual and anatomical outcomes comparable to those of initial procedures. 相似文献8.
Manami Kawai Toshiaki Goseki Hitoshi Ishikawa Miki Hoshina Nobuyuki Shoji 《Japanese journal of ophthalmology》2018,62(6):659-666
Purpose
We evaluated the background and characteristics of elderly patients with binocular diplopia including diseases caused by abnormalities in orbital pulleys.Study design
Retrospective.Methods
The participants were 236 patients aged 60 years or older who visited Kitasato University Hospital complaining of binocular diplopia. We classified strabismus by types and investigated the causes for each group. We diagnosed orbital pulley disorders using magnetic resonance imaging (MRI). Patients with orbital pulley disorders exhibited esotropia and/or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury.Results
Classification of strabismus types was: exotropia (24.2%); esotropia (25.0%); vertical strabismus (30.1%), combined strabismus (20.8%). There were 50.9% cases of strabismus associated with vertical deviation. The causes of disease in each group were as follows: in the exotropia group, 50.9% convergence insufficiency exotropia, 21.1% basic exotropia; in the esotropia group: 35.6% orbital pulley disorder 33.9% sixth cranial nerve palsy; in the vertical strabismus group: 32.4% forth cranial nerve palsy, 31.0% orbital pulley disorder; in the combined strabismus group: 28.6% orbital pulley disorder, 28.6% forth cranial nerve palsy.Conclusions
About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was often caused by orbital pulley disorders. It is the first epidemiological study focusing on orbital pulley disorders diagnosed on the basis of MRI.9.
Howard V. Gimbel Bronson M. LeClair Brice Jabo Hala Marzouk 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):518-522
Objective
Although the literature on the implantable Collamer lens (ICL) suggests an increasing rate of anterior subcapsular cataract (ASC) development with increasing age and decreasing anterior chamber depth (ACD), the exact correlation is not known. We performed a retrospective observation study of 1653 eyes and calculated the incidence of ICL removal with cataract extraction and intraocular lens placement (CE-IOL) as a result of ASC, in correlation to patient’s age and ACD.Design
Retrospective observation study.Setting
The Gimbel Eye Centre, Calgary, Alberta, Canada.Methods
We analyzed ICL V4 model (Visian ICL; STAAR Surgical, Monrovia, CA) implanted in 1653 eyes with myopia from 2000 to 2012 at the Gimbel Eye Centre, Calgary. Myopic patients aged 19 years and older with no history of cataracts were included. The rate of ICL removal with cataract extraction was calculated. Parameters such as age, sex, refractive sphere, refractive cylinder, length of follow-up, and ACD were collected. Cataract-free survival with comparison of FDA and non-FDA cohorts was conducted using Kaplan–Meier survival curves with the log-rank test. In addition, covariates adjusted hazards ratios and 95% confidence intervals were calculated using Cox regression.Results
Of the 1653 eyes included in this study, a total of 46 eyes underwent ICL removal with CE-IOL. The length of follow-up varied between 2 and 14 years.Conclusions
This retrospective study demonstrated that the rate of developing ASCs positively correlated with age and negatively correlated with ACD. 相似文献10.
Rumaisa Aljied Marie-Josée Aubin Ralf Buhrmann Saama Sabeti Ellen E. Freeman 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(3):298-304
Objective
To provide the frequency and potential determinants of eye care utilization over the last 12 months among Canadians between the ages of 45 and 85 years old.Design
Cross-sectional population-based study.Participants
30,097 people in the Comprehensive Cohort of the Canadian Longitudinal Study on Aging.Methods
Inclusion criteria included being between the ages of 45 and 85 years old, community-dwelling and living near one of the 11 data collection sites across 7 Canadian provinces. Eye care utilization was defined as the self-report of a visit to an optometrist or ophthalmologist in the past 12 months.Results
In the last year, 57% of 28 728 adults visited an eye care provider although there was heterogeneity between provinces. The highest eye care utilization was found in Ontario at 62%, whereas the lowest was in Newfoundland and Labrador at 50%. Of concern, 25.3% of people with diabetes above the age of 60 years had not seen an eye care provider in the last year. Our novel finding was that current smokers were less likely to use eye care compared to never smokers (odds ratio [OR] = 0.76, 95% confidence interval [CI] 0.67–0.87). Confirming previous research, men compared to women (OR = 0.67, 95% CI 0.62–0.71), people with less than a bachelor’s degree compared to more than a bachelor’s degree (OR = 0.87, 95% CI 0.79–0.95), and people making less income (linear trend p < 0.05) were less likely to use eye care.Conclusions
Disparities exist in eye care utilization in Canada. Efforts should be made to reduce these disparities to reduce avoidable vision loss. 相似文献11.
Erika Massicotte Salima Hassanaly Marie-Lyne Bélair Karin Oliver Eric Fortin 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):435-440
Objective
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare entity with a potentially poor visual prognosis. Our objective is to review the clinical presentation and long-term outcomes of patients with IRVAN syndrome.Design
This is a retrospective case series.Methods
We reviewed the charts of all the patients diagnosed with IRVAN syndrome at our tertiary care centre from 2002 to 2015.Results
We included the long-term clinical outcomes of 7 eyes (5 patients) diagnosed with IRVAN syndrome. After a mean follow-up of 84.9 months, best-corrected visual acuity was 20/40 or better in the majority of eyes (70%). Four (57.1%) patients had systemic conditions, namely, multiple sclerosis, ischemic stroke, and positive antiphospholipid titres. All eyes were treated with laser photocoagulation. Four (40%) eyes received adjunctive intravitreal bevacizumab injections.Conclusion
IRVAN is an important diagnosis for clinicians to recognize. When treated in a timely manner, long-term visual outcomes can be favourable. 相似文献12.
Verena R. Juncal Mostafa Hanout Filiberto Altomare David R. Chow Louis R. Giavedoni Rajeev H. Muni David T. Wong Alan R. Berger 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(4):408-414
Objective
To report the anatomical and visual outcomes of patients with thick submacular hemorrhage (SMH) treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (t-PA), and pneumatic displacement.Design
Single-centre, retrospective case series.Participants
A total of 99 eyes of 99 consecutive patients with thick SMH secondary to any underlying etiology treated with PPV with subretinal t-PA and pneumatic displacement by 6 vitreoretinal surgeons at St. Michael’s Hospital, Toronto, between July 2004 and August 2016.Methods
All medical records and colour fundus photographs were reviewed for data collection. Blood displacement was evaluated at follow-up visits and classified as complete, partial, or none. Main outcome measures included blood displacement at final follow-up, postoperative Snellen best-corrected visual acuities (BCVA), and complication and recurrence rates.Results
Patients had a mean age of 77.7 ± 12.3 years and were followed up for an average of 18.4 ± 22.3 months. Wet age-related macular degeneration was the most common etiology associated with thick SMH (80.8%). Complete blood displacement was observed by final follow-up in 85.9% of the cases, partial displacement in 12.1%, and none in 2.0%. Mean logMAR BCVA improved from 2.03 ± 0.81 (Snellen 20/2143) at baseline to 1.80 ± 1.00 (Snellen 20/1262; p = 0.009) at final follow-up, and baseline BCVA was a significant predictor of final BCVA (p < 0.001). Early postoperative complications included vitreous hemorrhage in 13 eyes and rhegmatogenous retinal detachment in 8. Recurrent SMH was observed in 12 cases.Conclusions
Vitrectomy with subretinal t-PA and pneumatic displacement seems to be an effective treatment for SMH in terms of blood displacement and visual outcomes. 相似文献13.
Samuel M. Philbrick Darrell E. Baskin 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(3):222-228
Objective
To determine whether stereoscopic footage of cataract surgery could be captured with smartphones and to develop a procedure for editing and viewing the footage. The authors sought to measure whether subjectively convincing stereo footage could be captured with smartphones, whether it would be possible to sync this footage for stereoscopic viewing, and whether these tasks could easily be performed at lower cost than commercially available options.Design
Brief research report.Participants
The entities studied were phones and programs.Methods
Surgeries were recorded at Fort Belvoir Community Hospital. Two smartphones were attached to the eyepieces of a surgical microscope’s assistant scope. Surgical footage was recorded. Videos from the left and right eyepieces were edited and combined into videos that facilitated stereoscopic viewing.Results
Stereo footage was captured with 2 smartphones and edited to enable 3D viewing with both anaglyph glasses and head-mounted displays. Viewing experience was superior when using head-mounted displays compared to using anaglyph glasses.Conclusions
Stereoscopic footage of operations performed under the surgical microscope may be captured and viewed using inexpensive equipment and simple procedures requiring minimal prior expertise. The techniques described in this paper may enable more training programs to capture and distribute 3D footage of their operations, enhancing the educational value of ophthalmic surgical videos. 相似文献14.
Oded Ohana Igor Kaiserman Yuval Domniz Eyal Cohen Oz Franco Tzahi Sela Gur Munzer David Varssano 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):523-528
Objective
To report the outcomes and complications of combined photorefractive keratectomy (PRK) and collagen crosslinking (CXL).Design
A retrospective cohort study of consecutive patients undergoing combined PRK-CXL between 2011 and 2013 at Care Laser, Inc, Tel Aviv, Israel.Participants
Ninety-eight eyes of 56 patients were included. Only patients without keratoconus were included.Methods
Data were collected from the patients’ files and imaging devices. Main outcome measures were corrected and uncorrected distance visual acuity (CDVA/UDVA); spherical equivalent (SE); refractive, keratometric, and pachymetric stability; and the occurrence of postoperative complications.Results
Mean age was 27.69 ± 6.6 years. UDVA improved from 1.38 ± 0.60 to 0.15 ± 0.24 logMAR (p < 0.001). SE improved from ?4.45 ± 2.87 diopter (D) to +0.20 ± 0.90 D (p < 0.001), and 69% of the patients were within ±0.50 D from emmetropia. Four eyes had significant corneal haze; of them 3 eyes lost more than 2 Snellen lines. No cases of corneal ectasia were recorded.Conclusions
In our cohort PRK-CXL achieved significantly improved UDVA and SE compared to baseline. Corneal haze was a significant complication. Refractive results were less accurate than published for patients undergoing PRK procedures. Although no cases of corneal ectasia were seen, given the rarity of such complication, the added benefit of CXL remains to be proven. 相似文献15.
Nicolas Cadet Isabelle Hardy Diana Dudek Krystyna Miszkiewicz Patrick Boulos Quyhn Nguyen Jamie Wong 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(1):29-33
Objective
To evaluate the effectiveness of a topical silicone gel on scars in patients who had undergone bilateral direct brow lift surgery.Design
A randomized double-blind clinical trial with a placebo applied to one scar and topical silicone gel (Dermatix Ultra; Valeant Pharmaceuticals, Laval, Que.) used on the other scar for 2 months.Participants
Twelve patients (for a total of 24 surgical scars evaluated) were included in the study.Methods
This study was performed in 2 academic hospitals of the University of Montreal in Montreal, Que. (Maisonneuve-Rosemont Hospital and Notre-Dame Hospital). Inclusion criteria were all bilateral direct brow lift surgeries performed in our hospitals. Exclusion criteria included revision surgery, silicone or latex allergy, and wound infection. Each patient received 2 tubes (1 with silicone gel and 1 with placebo) and applied 1 tube to their right brow scar and the other tube to their left brow scar, following the preassigned instructions. The patient and surgeon were blinded to the nature of the substance that was applied to each scar. At each visit, pictures of both scars were taken, and a questionnaire titled “The Patient and Observer Scar Assessment Scale” was filled out by the patient and the surgeon. A grade ranging from 0 to 10 was given on the multiple criteria in the questionnaire, and the sum of these grades was subsequently used for the data analysis. A lower sum was interpreted as improved scarring. At the end of the study, an independent evaluator graded both scars based on pictures. Follow-up visits were held on day 7, week 6, month 3, and month 6 after surgery. A comparison of the experimental and placebo group was performed with nonparametric tests of Wilcoxon signed rank.Results
A total of 24 scars of 12 patients were analyzed (based on 4 follow-up visits). General improvement of scars was reported by the patient, the surgeon, and based on pictures. No statistically significant difference was found between the group treated with silicone gel and the group treated with placebo. All tests had a p value ≥0.08.Conclusions
We did not find a statistically significant difference between scars treated with silicone gel and scars treated with the placebo after direct brow lift surgery. 相似文献16.
Vinay Kansal Sangsu Han James Farmer Danah Albreiki 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(1):39-44
Objective
Temporal artery biopsy (TAB) is the gold standard for confirming the diagnosis of giant cell arteritis (GCA) when positive. However, the clinical significance of healed/healing (HH) arterial injury on TAB is not well understood. The purpose of this study was to evaluate the clinical significance of this finding on TAB by determining its association with seromarkers typically predictive of GCA.Design
Single-centre, retrospective, investigational cohort study.Participants
A total of 385 consecutive TABs for clinical suspicion of GCA between January 2009 and January 2016.Methods
Elevations in erythrocyte sedimentation rate, C-reactive protein, and platelet count were compared between patients with negative TAB, GCA-positive TAB, and HH arterial injury using statistical trend testing. Odds ratios of seromarker elevations for HH arterial injury versus GCA were calculated.Results
Seventy-six GCA-positive, 69 HH, and 240 negative TABs were identified. Mantel-Haenszel tests of trend indicated that platelets >400 000/µL (p < 0.01), erythrocyte sedimentation rate ≥50 mm/hr (p < 0.01), and C-reactive protein ≥24.5 mg/L (p < 0.01) occurred with intermediate frequency in the HH TAB group. The odds of HH TAB were 3.6 times greater (95% CI 1.5–8.5) with platelets >400 000/µL.Conclusion
HH arterial injury is a heterogenous group that requires treatment in the appropriate clinical setting. From our study, we found that the HH group is intermediate between GCA-positive and GCA-negative biopsy with respect to serology markers only. Thrombocytosis is an independent predictor of HH TAB. With further studies, this marker may be considered when making treatment decisions. Further studies are required to better understand this entity. 相似文献17.
Verena R. Juncal David R. Chow Natàlia Vilà Michael A. Kapusta R. Geoff Williams Amin Kherani Alan R. Berger 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):441-446
Objective
To compare the anatomical and visual outcomes of patients with bilateral macular holes (MH) who have been treated with pars plana vitrectomy in one eye and intravitreal ocriplasmin in the fellow eye.Design
Multicentre, retrospective case series.Participants
Twenty-two eyes of 11 patients with bilateral MH treated with vitrectomy in one eye and ocriplasmin in the other were included. Patients were followed-up by 5 vitreoretinal surgeons from 3 retinal practices in Canada.Methods
All charts were reviewed for data collection, and optical coherence tomography (OCT) scans pre- and posttreatment were evaluated.Results
MH closed primarily in 36.4% (n = 4) of the ocriplasmin-treated eyes and in 90.9% (n = 10) of the vitrectomy-treated eyes (p = 0.031). The 4 successfully treated ocriplasmin MH were preceded by a vitreomacular traction (VMT) release. Three additional ocriplasmin-treated eyes achieved a VMT release without MH closure. All persistent MH (100%) closed with subsequent vitrectomy, with no significant difference in final best-corrected visual acuity (BCVA) between those who achieved MH closure with primary or secondary interventions (p = 0.073). Final BCVA improved from logMAR 0.85 ± 0.34 to 0.37 ± 0.22 (p = 0.005) in the vitrectomy eyes and from 0.56 ± 0.28 to 0.28 ± 0.16 (p = 0.009) in the ocriplasmin eyes, with no significant difference in final BCVA between treatments (p = 0.306). Postoperative ellipsoid zone disruption persisted more frequently in vitrectomy-treated eyes.Conclusion
Both procedures were associated with improved visual outcomes, but eyes initially treated with vitrectomy had a higher primary MH closure rate. On OCT, patients had more outer structural changes in vitrectomy eyes than in ocriplasmin eyes. 相似文献18.
Tarek Ibrahim Phillip Goernert Guillermo Rocha 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(1):56-59
Objective
To determine the time needed to perform a femtosecond laser–assisted cataract surgery (FLACS) and its effect on the efficiency of cataract surgery flow in a Canadian public health centre.Design
Retrospective chart review.Participants
Patients who had cataract surgery performed in the first 3 months of femtosecond laser (FSL) technology use were compared with patients who had conventional phacoemulsification in the 3 months before FSL installation at Brandon Regional Health Centre (Brandon, Man.).Methods
The primary outcome measure was the time needed to complete FLACS versus the time needed to complete conventional phacoemulsification. Secondary outcome measures were the time the patient spent in the operating room (time in and time out) and the number of cataract surgeries done per surgical day before and after FSL was implemented systemwide.Results
There were 235 FSL cases and 199 conventional cases. Operating room time, total surgery time, and manual time were significantly longer in patients who underwent FLACS compared with patients who underwent conventional phacoemulsification (p < 0.001). Manual times and FSL suction times on the first day of implementing FLACS surgery were significantly longer than those on day 23 (p < 0.03), which suggests a learning curve effect. The number of cases per surgical day dropped by 28.6% in the first operative day and by 7.1% in the second and third operative days of FSL use, then reverted to pre-FSL levels.Conclusion
The addition of FLACS results in longer time per case than traditional cataract surgery. Although statistically significant, the results may not be indicative of practical differences. 相似文献19.
Saba Samet Luminita Tarita-Nistor Esther G. González Mark S. Mandelcorn Efrem D. Mandelcorn Martin J. Steinbach 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(3):229-235
Objective
Patients with bilateral central field loss develop peripheral retinal loci (PRLs) in the functional eccentric retina. PRL characteristics and visual performance in the better-seeing eye (BE) of these patients have previously been reported. In this study, we determined the test-retest repeatability of fixation parameters, including fixation stability, PRL eccentricity, and PRL span in the worse-seeing eye (WE).Design
Retrospective consecutive case series.Participants
Thirty-six patients with bilateral central field loss referred from the Toronto Western Hospital Retina Clinic, who had completed 2 consecutive fixation examinations on the same day.Methods
Fixation stability was recorded using the Nidek MP-1 microperimeter (Nidek Technologies Srl., Padova, Italy). For each fixation recording, the following parameters were retrieved: (i) 68.2% bivariate contour ellipse area (BCEA), (ii) PRL span (major and minor axes of the BCEA), (iii) PRL meridian (polar angle), and (iv) PRL eccentricity. Test-retest repeatability for each parameter was assessed using Bland-Altman plots to determine 95% limits of agreement.Results
The mean difference between the fixation trial pairs and the 95% limits of agreement for fixation stability, PRL major axis, PRL minor axis, PRL meridian, and PRL eccentricity were 0.06 ± 0.47 log deg2, 0.05° ± 1.42°, 0.07° ± 0.63°, ?0.44° ± 66.0°, and ?0.23° ±1.56°, respectively.Conclusions
The fixation parameters in the WE showed robust repeatability, comparable to that of the BE as determined from previous studies. The WE’s fixation repeatability should be considered in the interpretation of fixation outcome measures subsequent to treatment interventions. 相似文献20.
Kyung Jun Choi Min Joung Lee 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(4):384-390