Sequential posterior subtenon injection of triamcinolone acetonide with macular grid/focal photocoagulation for clinically significant diabetic macular edema

PurposeTo evaluate the efficacy of sequential posterior subtenon triamcinolone acetonide (PSTA) injection with macular grid/focal laser photocoagulation for clinically significant diabetic macular edema (CSME).MethodsProspective, interventional clinical trial. Between July 2007 and March 2008, 41 eyes of 32 patients (17 males and 15 females) with Type II diabetes mellitus and diffuse clinically significant macular edema according to the Early Treatment Diabetic Retinopathy Study criteria were recruited. PSTA was used as the first line of treatment, followed by macular focal/grid photocoagulation 2 weeks later. In patients with persistent macular edema, a second dose of PSTA followed by additional focal laser treatment was administered 8–10 weeks later.ResultsBest-corrected visual acuity (BCVA) calculated as logarithm of the minimum angle of resolution (logMAR) unit showed significant improvement both after 3 weeks (0.79 ± 0.27, p = 0.001) and after 6 months (0.77 ± 0.29, p = 0.001) in comparison with the baseline values 0.92 ± 0.24. Central macular thickness (CMT) was significantly reduced both after 3 weeks (336.2 ± 125.8 μm, p = 0.001) and after 6 months (342.2 ± 127.2 μm, p = 0.001) in comparison with the baseline values 437.1 ± 186.5 μm. Total macular volume (TMV) was also significantly reduced both after 3 weeks (10.2 ± 1.8 mm³, p < 0.05) and after 6 months (10.3 ± 2.0 mm³, p < 0.05) in comparison with the baseline values 11.9 ± 2.1 mm³. There were no significant differences in BCVA, CMT, and TMV between 3 weeks and 6 months posttreatment.ConclusionOne or two sessions of sequential PSTA injection and macular grid/focal photocoagulation may improve or stabilize visual acuity, CMT, and TMV for at least 6 months in patients with CSME.     

Comparison of visual outcomes after epiretinal membrane surgery

PurposeTo elucidate the anatomical and visual outcomes of patients with idiopathic epiretinal membranes (ERM) who underwent vitrectomy, membrane removal only, or with internal limiting membrane (ILM) peeling under the assistance of different dyes.MethodsA retrospective chart review of patients with idiopathic ERM who received surgical treatment between January 2004 and December 2009. The patients were grouped according to the usage of staining materials assisting ILM peeling. Group 1 consisted of 61 eyes that underwent conventional vitrectomy and ERM peeling without staining-assisted ILM peeling. Group 2 consisted of 20 eyes with triamcinolone acetonide-assisted ILM peeling following conventional vitrectomy. Group 3 consisted of 23 eyes with indocyanine green-assisted ILM peeling following conventional vitrectomy.ResultsThis study included 104 eyes from 104 patients. There was no significant difference in age, sex, preoperative visual acuity, retinal thickness or follow-up duration among the three groups. Overall, the mean best-corrected visual acuity improved significantly from baseline 0.15 to postoperative 0.41 (p < 0.0001). Among the three groups, the mean logarithm minimum angle of resolution acuity markedly improved. There was no significant difference in postoperative visual acuity among groups. As measured by ocular coherent tomography, the mean central foveal thickness decreased from 465.21 ± 86.18 to 299.16 ± 70.14 μm. Although there was no difference between groups, postoperative retinal thickness was thicker than that observed in the normal population. The incidence of recurrent ERM was 13.1% in Group 1 and 0% in Groups 2 and 3; this incidence was significantly higher than in the conventional surgery group. Visual outcome was statistically more deteriorated in recurrent cases than in non-recurrent cases (p = 0.011).ConclusionsERM surgeries with or without dye-assisted ILM peeling showed similar results. Moreover, the incidence of recurrence is lower in the ILM peeling groups and plays a primary role in determining the final postoperative vision outcome.     

Facoemulsificación y trabeculostomía con láser excímero en ojos con hipertensión ocular o glaucoma leve y catarata. Experiencia real,eficacia y seguridad

ObjectiveTo assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension (OHT).MethodsSingle-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥ 20% from preoperative IOP, an IOP ≤ 14 mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP.ResultsMean follow-up was 658 ± 64 days. Mean preoperative IOP was 17.76 ± 4.88 mmHg, it decreased to 15.35 ± 3.10 mmHg at 1 year (n = 37) (P = .006) and to 14.00 ± 3.78 at 3 years (n = 8) (P = .074). Mean number of glaucoma medication requirements decreased from 2.02 ± 1.0 preoperatively to 1.02 ± 0.96 at 1 year (n = 37) (P < .001) and to 1.63 ± 0.92 at 3 years (n = 8) (P = .197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8 years after the procedure due to uncontrolled IOP.ConclusionsCombined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or OHT and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery.     

Effects of lenses with different power profiles on eye shape in chickens

PurposeDefocus imposed to the periphery of the visual field can affect the development of foveal/central refractive errors. To make use of this observation, lenses can be designed to reduce myopia progression, but it is important to know which power profiles of the lenses are most effective. We have studied this question in chickens.MethodsSixty male white leghorn chickens were used. From day 7 after hatching, they were treated for 5 days either with full field −7D or +7D lenses, with −7D lenses with a 4 mm central hole, with hemi-field lenses of the same power, or with two different types of radial refractive gradient (RRG) lenses with increasing positive power from the center to the periphery, which were designed by Rodenstock GmbH, Munich, Germany. A macro file was written for “ImageJ” to trace and average the outlines of several excised eyes after treatment. Shapes of fellow control eyes and lens-treated eyes were compared in the horizontal and vertical meridians. Refractions were determined at −45°, 0°, and 45° over the horizontal visual field, at the beginning and at the end of experiments, using automated infrared photoretinoscopy.Results(1) Eye length, as determined by the new automated eye shape tracing technique, was well correlated with A-scan ultrasound data. (2) The effects of previously tested lens designs were reproduced with the new tracing technique. Full field lenses were by far the most effective (−7D: external axial length +0.24 mm with an increase in eye volume of about 6%, +7D: −0.08 mm, with a decrease in eye volume of about 2%). Hemi-field lenses and negative lenses with a 4 mm central hole induced conspicuous local changes in eye shape. (3) The first type of RRG lenses with a plano zone of about 4 mm (equivalent to about ±12.52° in the visual field for a vertex distance of 5 mm) had no apparent effect on central refractions but induced small hyperopic shifts in the periphery, more significant in the temporal retina (+1.70 ± 1.70D, p < 0.001, paired t-test to untreated fellow eyes). The second type of RRG lenses with a small plano zone of 2 mm (equivalent to ±6.34°) induced peripheral hyperopia but also changed the central refraction (temporal retina +1.50 ± 1.17D, p < 0.001, central retina +0.77 ± 1.15D, p < 0.01, nasal retina +1.47 ± 1.35D, p < 0.001, paired t-test to untreated control eyes).ConclusionsIn the afoveate chick, RRG lenses have an effect on central refraction and eye growth only if the central plano zone is small (<4 mm). For the second type of RRG lens with a central plano zone of about 2 mm, inhibitory effects on eye growth were detected in both the center and periphery even though the optical power of the lenses in the periphery was low.     

Manejo del cristalino subluxado en pacientes jóvenes

ObjectivesTo evaluate visual outcomes in patients treated for lens subluxation. Secondary objectives are to report best corrected visual acuity (BCVA) in LogMAR and compare the outcomes of patients managed conservatively with those treated surgically.MethodsRetrospective comparison of BCVA in patients under 50 years-old with lens subluxation, managed conservatively or surgically.ResultsA total of 49 eyes of 28 patients were included. Demographic characteristics were similar in both groups. Twenty eyes were treated surgically (40.8%) compared to 29 with medical treatment (59.2%). Marfan syndrome (79.6%) was diagnosed in 39 eyes. LogMAR BCVA post intervention was 0.35 ± 0.31 for medical treatment and 0.39 ± 0.32 for the surgical group, with no significant differences (P=.63). Improvements in LogMAR lines were 2.7 ± 4.2 and 4.11 ± 4.2 (P=.35), respectively. Two eyes in the surgery group developed ocular hypertension (0.04%), none with retinal detachment.ConclusionsThe final BCVA showed no significant differences in this group of patients. BCVA depends on the visual potential of the rehabilitated eye rather than a specific type of intervention.     

Comparative study of phacoemulsification–subscleral trabeculectomy versus phacoemulsification–deep sclerectomy

PurposeTo compare the surgical outcomes of phacoemulsification–subscleral trabeculectomy versus phacoemulsification–deep sclerectomy with intraoperative mitomycin C in open-angle glaucoma.MethodsThe study was conducted on 40 chronic primary open-angle glaucomatous eyes with senile cataract. They were divided into two groups: group I (n = 20): eyes undergoing phacoemulsification with subscleral trabeculectomy, and group II (n = 20): eyes undergoing phacoemulsification with deep sclerectomy. Intraoperative mitomycin C (0.4 mg/ml for 3 min) was applied in both groups. Postoperative intraocular pressure (IOP), complications, glaucoma medications, visual outcomes, and the bleb appearance were assessed for 12 months.ResultsThe mean postoperative IOP was significantly lower (P < 0.05) in both groups in all time intervals in comparison to their preoperative values. The mean postoperative IOP was 14.1 ± 5.4 mmHg in group I, and 14.8 ± 3.1 mmHg in group II. No major complications were encountered in either procedure, but complications such as shallow anterior chamber, hypotony, and delayed bleb leaks were common in group I, whereas intraoperative perforation of Descemet’s membrane occurred in group II. No significant difference in visual acuity improvement, visual field changes, and surgical success outcome were found between both groups.ConclusionThere was no significant difference in IOP reduction, surgical complications and visual outcomes between subscleral trabeculectomy, or deep sclerectomy with intraoperative mitomycin C in combination with phacoemulsification and intraocular lens implantations in patients with primary open-angle glaucoma.     

Influencia de la longitud axial en el resultado refractivo tras cirugía de catarata

PurposeTo analyse the influence of axial length (AL) and age on refractive outcome after cataract surgery in terms of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and subjective refraction.MethodsA retrospective review of 171 consecutive cases of uncomplicated cataract surgery was done. The refractive outcome was analysed (UCVA, BCVA and postoperative retraction) according AL before surgery (AL < 22 mm, between 22 and 25 mm and AL > 25 mm) and age (< 40, between 40-60 years and > 60 years).ResultsAfter surgery mean UCVA was 0.6 ± 0.33 Diopters (D) and mean BCVA was 0,93 ± 0,23 D. Mean refractive outcome was 0.89 ± 0.78 D. There were no significant differences in post-operative UCVA, BCVA and refraction between the three age groups. There were statistically significant differences (p = 0.004) in UCVA between the three AL groups. The group with AL between 22 and 25 mm had better UCVA. Mean refractive outcome was ?0.95 ± 1.91 D in the group with AL < 22 mm, ?0.36 ± 0.88 D in the group with AL between 22 and 25 mm and 0.23 ± 1.15 D in the group with AL > 25 mm.ConclusionsAL influences refractive outcome and UCVA after cataract surgery. Eyes with AL < 22 mm have a worse refractive outcome.     

Surgical management of non-traumatic pediatric ectopia lentis: A case series and review of the literature

PurposeTo report a small series of pediatric patients with ectopia lentis that underwent limbal-approach lensectomy and vitrectomy and scleral-fixated intraocular lens implantation and to review the literature on the topic of surgical management of ectopia lentis.MethodA retrospective review of 13 eyes of seven patients that underwent lensectomy, vitrectomy, and scleral-fixated intraocular lens implantation and a review of the ophthalmic literature.ResultsIn our series, the average age at surgery was 70.3 ± 13.8 months and the average length of follow-up was 23.8 ± 5.9 months. The mean pre-operative visual acuity was 0.86 ± 0.17 which improved to 0.23 ± 0.09 post-operatively (p < 0.001). No complications were encountered in our series. A review of the literature found that amblyopia was the biggest vision-limiting factor. In general, the literature suggested that a higher percentage of eyes that were left aphakic achieved better vision than those implanted with a scleral-fixated intraocular lens. However, there may be selection bias in that more eyes receiving an intraocular lens may have pre-existing amblyopia. The complication rates for lensectomy or scleral-fixated intraocular lens implantation were low in the literature. In the latter group, suture breakage and resultant intraocular lens dislocation is a worrisome late complication.ConclusionSurgical intervention for ectopia lentis via vitrectomy techniques yields good result. In cases of unilateral aphakia or in settings where compliance with aphakic refractive correction is questionable and amblyopia is a constant threat, scleral-fixated intraocular lens implantation is highly encouraged. However, long-term follow-up is required due to the risk of suture breakage and resultant intraocular lens dislocation over time.     

Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado

IntroductionThere is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon.The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma.MethodsThis retrospective study included 67 eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4 months.ResultsThe mean age was 50.2 years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94 dB ± 4.7. The mean intraocular pressure (IOP) before surgery was 27.16 mmHg ± 8.9.Postoperatively the overall success rate was 93% (IOP < 18 mmHg with stable visual acuity). The mean IOP was 14.25 mmHg ± 4.12 (P < .001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83 ± 4.69 (P = .07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract.ConclusionGlaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.     

Cirugía monocular de 4 músculos extraoculares para la exotropía monocular de gran ángulo

IntroductionRecurrent exotropia is common following surgery for monocular large angle constant sensory exotropia. Surgery is usually limited to operations on the affected eye. Simultaneous oblique weakening surgery may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting forces. We report the results of simultaneous oblique muscle weakening procedures combined with ipsilateral horizontal rectus muscle surgery constant monocular exotropia greater than 35 prism diopters (PD).MethodsRetrospective case series of patients who underwent unilateral lateral rectus recession combined with medial rectus muscle resection and simultaneous weakening of both ipsilateral oblique muscles. Primary outcome measure was ocular alignment in primary position.ResultsTwelve eyes of 12 patients were included. The mean preoperative exotropia improved from 57.9 ± 15.1 (range 35–80; median 60 PD) to 3.3 ± 5.5 (range 0–16; median 0 PD) postoperatively (p < 0.005). Two (66%) patients with a pre-existing vertical deviation had resolution of their vertical misalignment postoperatively. At the last postoperative follow up 92% of the patients had an exodeviation of 10 PD or less (range 0–16 PD median 0 PD), and 7 (58%) measured near and distance orthotropia. Postoperative abduction measured −0.6 ± 1 (0 to −3) and adduction −0.4 ± 0.7 (0 to −2).ConclusionWeakening the ipsilateral oblique muscles may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting vectorial forces when operating for a large angle monocular exotropia. As an additional potential advantage, oblique muscle surgery may be used simultaneously to address associated vertical deviations.     

Terapia láser transescleral de micropulsos en el manejo de los pacientes de glaucoma

ObjectiveTo evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients.MethodsA prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18 mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period.ResultsMicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18 mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session.At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9 ± 14.2%; and 6 months after the second session, it was 36.2 ± 17.5% (P < .001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was + 1.9 ± .8 at 1 day, + 1.0 ± .7 at 1 week, and + .2 ± .4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (P < .001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6 ± 1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7 ± 1.2, and sustained at 6 months follow-up after the last treatment session (P < .001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT.ConclusionsMicroPulse TLT is safe and effective in lowering IOP in a variety of glaucoma types and severity.     

Efecto de la acetazolamida en la vasculatura retiniana y coroidea de la mácula y el disco óptico mediante angiografía OCT

Introduction and objectivesTo investigate the effect of acetazolamide (AZ) on the retinal and choroidal ocular microvasculature in the macula and radial peripapillary capillaries (RPC) of the optic disc with OCT Angiography (OCTA).Materials and methodsNine-month observational cross-sectional study. Forty-five eyes from 45 healthy participants who underwent cataract surgery were recruited. Macular retina and choriocapillaris vessel density (VD) and RPC VD in the optic disc area were compared before and 60 minutes after 250 mg acetazolamide per os. Intraocular pressure (IOP) and systemic blood pressure (BP) were also measured before each scan.ResultsMean age was 73.1 ± 6.9 years. VDs in the superficial (SCP) and deep (DCP) capillary plexus of the retina and the choriocapillaris (CC) in the macular area showed no significant change (p > 0.5, for all parameters). VD in the RPC showed no significant change with AZ (p > 0.5, for all parameters). Foveal and parafoveal thickness increased from 248.98 (±23.89) to 250.33 (±23.74) and from 311.62 (±16.53) to 311.98 (±16.38) (p < 0.001 and p = 0.046), respectively. IOP decreased from 13.2 (±3.0) mmHg to 11.8 (±3.2) mmHg (p < 0.001), while systolic and diastolic BP decreased from 144.8 (±21.8) to 137.7 (±19.0) and from 80.0 (±12.7) to 76.2 (±11.7) (p = 0.021 and p = 0.030), respectively.ConclusionsOCTA imaging did not reveal any significant changes in the VD of the optic disc or the retinal and choroidal VD in the macula with oral AZ one hour after its administration in otherwise healthy participants who underwent cataract surgery.     

Evaluación de la calidad de vida y la presencia de síntomas de depresión y ansiedad en pacientes con degeneración macular asociada a la edad neovascular

PurposeTo assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD).MethodsA cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered.ResultsFifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67 to 93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44 to 95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = .608; P < .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = –0.438).ConclusionsThis study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms.     

Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante

PurposeTo evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy.MethodsObservational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (group A). A control group (group B) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up.ResultsMean IOP decreased from 25.69 ± 8.11 preoperatively to 15.73 ± 4.16 mm Hg postoperatively in group A (p < 0.001). In group B, mean IOP decreased from 26.66 ± 5.93 preoperatively to 18.19 ± 5.93 mm Hg postoperatively (P < .001). Differences between groups in postoperative IOP was statistically significant (P < .001). At 12 months after surgery, 13.27% and 52.83% of eyes in groups A and B required topical antihypertensive therapy (P < .001). The rate of absolute success after surgery was 87.5% and 47.17% in groups A and B, with significantly higher rate of relative success in group B (P < .001). No significant differences among groups were found in the complication rate (P = .960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups.ConclusionsSpurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications.     

Concordancia entre la tonometría de Goldmann,Icare Pro y Corvis ST

PurposeTo compare intraocular pressure (IOP) between the new non-contact tonometer Corvis ST (CST), the Goldmann applanation tonometry (GAT) and Icare Pro rebound tonometer (PRO).MethodsA total of 178 eyes of 178 healthy subjects were selected for the study. Measurements of IOP were made in a random order with GAT, PRO and CST. Central corneal thickness (CCT) was determined by ultrasound pachymetry. The mean of three valid measurements of each variable was used in the statistical analysis. The relationship between the tonometers was established using Bland-Altman plots.ResultsMean IOP was 15.5 ± 2.8 mmHg for GAT, 15.4 ± 2.8 mmHg for CST, and 14.6 ± 2.3 mmHg for PRO. The mean differences between pairs of tonometers were: GAT-PRO = 0.9 ± 1.7 mmHg (P<.001), GAT-CST: 0.1 ± 2.2 (P=.398), and PRO-CST: −0.8 ± −0.7 mmHg, p<0.001. A positive relationship was detected between CCT and the three tonometers: GAT: r = 0.325, P<.001; PRO: r = 0.385, P<.001, and CST: r = 0.428; P<.001.ConclusionsThe differences found between PRO and GAT were significantly higher than those found between CST and GAT, which showed non-significant differences. The measurements of the three tonometers were affected by the CCT.     

Factores asociados al desprendimiento de retina pseudofáquico: seguimiento a largo plazo en una población colombiana

ObjectiveTo identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery.MethodsRetrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes).ResultsAge at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; P < .0001). Age at retinal detachment was 59 ± 13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (< 50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95% CI] = 5.92–54.87; 50–59 years: aOR = 10.09, 95% CI = 3.37–30.23; and 60–69 years: aOR = 5.48, 95% CI = 1.88–15.93), male sex (aOR = 3.71, 95% CI = 2.54–5.44), anterior vitrectomy (aOR = 3.26, 95% CI = 1.16–9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95% CI = 3.15–15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95% CI = 3.54–15.69).ConclusionsThis is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.     

Estudio mediante biomicroscopia ultrasónica de pacientes intervenidos de esclerectomía profunda no perforante con implante supraciliar

ObjetiveTo evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM)Material and methodsThis study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant.ResultsThere was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=−.05: P=.71) and vertical diameter (r=−.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=−.08; P=.79), the thickness (r=−.07; P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24).ConclusionsThe insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study.     

Relación entre el test de sensibilidad al contraste y el nivel de gravedad en pacientes con esclerosis múltiple

ObjectiveTo assess the importance of the Pelli-Robson contrast sensitivity test in multiple sclerosis patients according to the Expanded Disability Status Scale (EDSS).Material and methodsA total of 62 patients with multiple sclerosis were included in a retrospective study. Patients were enrolled from the Neurology Department to Neuroophthalmology at Virgen de la Victoria Hospital. Patients were classified into 3 groups according to EDSS: group A) lower than 1.5, group B) between 1.5 and 3.5 and group C) greater than 3.5. Visual acuity and monocular and binocular contrast sensitivity were performed with Snellen and Pelli-Robson tests respectively. Twelve disease-free control participants were also recruited. Correlations between parameter changes were analyzed.ResultsThe mean duration of the disease was 81.54 ± 35.32 months. Monocular and binocular Pelli-Robson mean values in the control group were 1.82 ± 0.10 and 1.93 ± 0.43 respectively, and 1.61 ± 0.29 and 1.83 ± 0.19 in multiple sclerosis patients. There were statistically significant differences in the monocular analysis for a level of significance P<.05. Mean monocular and binocular Pelli-Robson values in relation to gravity level were, in group A: 1.66 ± 0.24 and 1.90 ± 0.98, group B: 1.64 ± 0.21 and 1.82 ± 0.16, and group C: 1.47 ± 0.45 and 1.73 ± 0.32 respectively. Group differences were statistically significant in both tests: P=.05 and P=.027.ConclusionsMonocular and binocular contrast discrimination analyzed using the Pelli-Robson test was found to be significantly lower when the severity level, according EDSS, increases in multiple sclerosis patients.     

Comparison of central corneal thickness measurements by Pentacam,noncontact specular microscope,and ultrasound pachymetry in normal and post-LASIK eyes

PurposeTo compare central corneal thickness (CCT) measurements taken with Pentacam, noncontact specular microscope (NCSM), and ultrasound pachymetry (US) in normal and post-laser in situ keratomileusis (LASIK) eyes and to assess the agreement between the three devices.DesignProspective clinical trial.Patients and methodsCentral corneal thickness (CCT) was measured in 94 eyes of normal volunteer and in 72 eyes of post-LASIK patients. Measurements were made with the three devices.ResultsIn normal eyes, the mean (±SD) CCT taken with Pentacam, NCSM, and US was 552.6 ± 36.8 μm, 511.9 ± 38.6 μm, and 533.3 ± 37.9 μm, respectively. The average values of CCT taken with the three instruments were significantly different. In post-LASIK eyes the mean CCT with Pentacam, NCSM, and US was 483.02 ± 6.03 μm, 450.7 ± 5.3 μm, and 469.5 ± 5.8 μm, respectively. The average values of CCT taken were significantly different for Pentacam vs. NCSM (P = 0.046) and Pentacam vs. US (P = 0.02), but not significant for NCSM vs. US (P = 0.352). The Bland and Altman method for assessing clinical agreement between 3 instruments showed that in normal eyes, the mean values and paired differences of the three CCT devices were found to be statistically independent. In post-LASIK eyes, there was significant association between the difference and the mean of the Pentacam and NCSM, and US and NCSM.ConclusionThe three devices cannot be used interchangeably in normal and post-LASIK eyes. Pentacam tends to give significantly thicker reading than ultrasound pachymetry.     

Análisis de nervios estromales en pacientes con queratocono

ObjectiveTo evaluate the differences in stromal corneal nerves between normal patients and keratoconus patients.Material and methodsA total of 140 eyes of 70 normal patients (group A) and 122 eyes of 87 keratoconus patients (group B) were examined with the confocal microscope, with a central scan of the total corneal thickness being taken. The morphology and thickness of the corneal stromal nerves were evaluated by using the Navis v. 3.5.0. software. Nerve thickness was obtained from the mean between the widest and the narrowest portions of each stromal nerve.ResultsCorneal stromal nerves were observed as irregular linear hyper-reflective structures with wide and narrow portions in all cases. Mean corneal stromal nerves thickness in group A was 5.7 ± 1.7 (range from 3.3 to 10.4 μ), mean corneal stromal nerves thickness in group B was 7.2 ± 1.9 (range from 3.5 to 12.0 μ). There was a statistical significant difference (P<.05) in stromal corneal nerves thickness between group A and group B.ConclusionStromal corneal nerves morphology was similar in both groups, but stromal nerves were thicker in keratoconus patients.