Visual Outcomes of Macula-Involving Rhegmatogenous Retinal Detachment in Patients with and Without Age-Related Macular Degeneration

Background Patients presenting with macula-off rhegmatogenous retinal detachment (RRD) with concomitant age-related macular degeneration (AMD) and their treating physicians would benefit from knowledge regarding the visual prognosis after repair. The prognosis for such patients is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD. Methods This was a retrospective chart review of 1,149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls) and 29 AMD eyes. The main outcome measure was postoperative visual acuity in control eyes versus AMD eyes, and this was compared using Fisher’s exact test. Results There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023). More specifically 5.56% of non-AMD eyes and 3.45% of AMD eyes were 20/40 or better, 77.16% of non-AMD and 55.17% of AMD eyes were worse than 20/40 and better than 20/200, 10.49% of non-AMD eyes and 37.93% of AMD eyes were 20/200 or worse, and there were 11 eyes in the non-AMD group with CF, HM, LP, or NLP vision while there was only 1 eye in the AMD group with CF vision. Conclusions Though postoperative visual acuity was worse in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is not likely a clinically significant finding. Rather, it is a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. Our study suggests that approximately 58% of patients with AMD can expect to maintain functional vision better than 20/200. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD. These findings may be helpful in guiding realistic expectations of AMD patients with RRD.

Effect of inverted internal limiting membrane flap technique on small-medium size macular holes

Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for small-medium size MH. We recruited patients who underwent vitrectomy for small-medium size (< 400 μm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score, 21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. We compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for small-medium size MHs and may delay recovery of retinal integrity.

The Impact of Cataract Surgery on Contrast Visual Acuity and Retinal Sensitivity in Patients with Retinitis Pigmentosa

Purpose. To determine the effects of cataract surgery on contrast visual acuity and retinal sensitivity in patients with retinitis pigmentosa. Methods. Retinal sensitivity and contrast visual acuity were determined by microperimetry (MAIA) and contrast sensitivity acuity tester (CAT-CP), respectively, before and after cataract surgery. The significance of the correlations between visual acuity, retinal sensitivity, contrast visual acuity, improvements after surgery, and macular structure before and after cataract surgery was determined. Results. Retinal sensitivity and contrast visual acuity were significantly improved after cataract surgery. The correlations among postoperative visual acuity, postoperative retinal sensitivities, and preoperative ellipsoid zone length were significant. The postoperative retinal sensitivity of the central 10° and the ellipsoid zone length was particularly significantly correlated. Preoperative contrast visual acuity and the amount of improvement and preoperative retinal sensitivity and the amount of improvement were significantly negatively correlated. The contrast visual acuity under both the 100% and 10% photopic and mesopic conditions improved significantly after cataract surgery. Conclusions. Cataract surgery in retinitis pigmentosa patients with preserved ellipsoid zones significantly improved retinal sensitivity and contrast visual acuity. Cataract surgery can be expected to improve retinal sensitivity and contrast visual acuity under various conditions, even if preoperative visual parameters are low, as long as the ellipsoid zone is preserved.

Can a Set of Questions after Routine Cataract Surgery Predict Unexpected Findings and Avoid an Unnecessary Follow-Up Visit?

Background and Objectives: to evaluate whether a set of questions after a routine cataract surgery can predict unexpected findings and avoid an unnecessary follow-up visit. Materials and Methods: single-center, prospective, cohort study included 177 routine cataract surgery cases of two experienced surgeons between November 2019 and December 2020. Inclusion criteria included unremarkable postoperative day one follow-up examination. A set of seven questions regarding complaints with positive or negative answers was presented at the second follow-up visit (PV2)—one week (mean 8.34 ± 1.73 days) after the surgery. The outcome measures were the incidence of unexpected management changes (UMCs) at the PV2 visit (change or addition from a prescribed postoperative drop plan, extra procedures, an urgent referral to an ophthalmologist) and UMCs associations with the answers to a question set. Results: 81.4% of patients had no complaints about postoperative ocular status and answered with negative answers, 18.6% reported one or more complaint (positive answer): dissatisfaction with postoperative visual acuity (6.2%, 11 cases), eye pain (4.0%, 7 cases), increase in floaters after the surgery (4.0%, 7 cases), red eye (4.0%, 7 cases) and others. The prevalence of UMCs at PV2 was 1.7% (3 cases), of which 0.6% (1 case) was the prolonged antibiotic prescription due to conjunctivitis, 0.6% (1 case) was the addition of IOP lowering medication and 0.6% (1 case) was additional medication due to uveitis management. None of the complaints (positive answers) at PV2 were associated with the incidence of UMCs (p > 0.05). Conclusions: there were no associations of UMCs determined with positive answers to the questions. The prediction of UMCs incidence based on the positive answers was not obtained. Thus, we cannot exclude the necessity of a postoperative week one follow-up visit.

Effect of Inverted Internal Limiting Membrane Flap Technique on Normal Size Macular Holes

Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for normal size MH. We recruited patients who underwent vitrectomy for normal size (< 400 µm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score,21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. we compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for normal size MHs and may delay recovery of retinal integrity.

Factors Affecting Visual Outcome in Post-Operative Cases of Lens Induced Glaucoma - A Prospective Study

BACKGROUND Lens induced glaucoma is common in India. By early identification and removal of cataract, vision loss due to lens induced glaucoma can be prevented. Of the 12.5 million blind people in India, 50 - 80 % is due to cataract. In developing countries like India financial, cultural, and psychosocial constraints still exist to access excellent surgical services. This study was undertaken to determine factors affecting postoperative visual acuity in patients with lens induced glaucoma and to estimate the proportion of cases attaining good visual acuity. METHODS This prospective cohort study was conducted in 85 cases of lens induced glaucoma admitted in Regional Institute of Ophthalmology during a period of 1 year from May 2018 - April 2019. All patients underwent a complete ophthalmic examination preoperatively as well as postoperatively. All patients underwent cataract surgery and postoperatively patients were followed up regularly at 1 day, 1 week and 4 week and were evaluated. RESULTS Majority of patients were in the age group of 70 - 79 years (35.3 %). Females outnumbered males by 13 %. Most of the patients had a preoperative intraocular pressure between 21 – 30 mmHg (37.6 %). On analysis of the impact of duration of symptom on postoperative visual acuity, 70.4 % patients attained visual acuity > 6 / 24 when presented within 3 days. This was statistically significant with a P value of 0.011. When preoperative visual acuity was hand movements vision or better, 79.2 % patients attained visual acuity > 6 / 24 and it was significant with a P-value of < 0.01. CONCLUSIONS Delayed presentation, elderly age and sustained rise in preoperative intraocular pressure are the factors leading to poor visual prognosis. As majority of the patients were pseudophakic in the fellow eye, it is necessary to council all patients regarding timely surgery in the second eye at the time of discharge. KEYWORDS Cataract, Secondary Glaucoma, Visual Outcome

Postoperative outcomes of idiopathic epiretinal membrane associated with foveoschisis

AimsTo analyse the prevalence and postoperative outcomes of a particular form of epiretinal membrane (ERM) with foveoschisis-like stretched hyporeflective spaces in emmetropic eyes.MethodsA retrospective study of all consecutive eyes operated for primary ERM over a 46-month period was conducted. The presence of foveoschisis-like stretched hyporeflective spaces was assessed on the preoperative optical coherence tomography B-scan in all eyes. Highly myopic eyes were excluded. Preoperative and postoperative characteristics of eyes with foveoschisis were compared with those of a control group of 100 consecutive eyes with primary ERM without cystoid spaces.ResultsOf 544 eyes with primary ERM, 17 had foveoschisis, corresponding to a prevalence of 3.1%. After a mean postoperative follow-up of 17.9±10.9 months, the foveoschisis had completely resolved in 76.5% of eyes (n=13/17). In the four eyes (23.5%) with persistent foveoschisis, the remaining hyporeflective cystoid spaces were located exclusively in the inner nuclear layer. The postoperative visual acuity and central macular thickness did not differ between both groups at the final visit. However, an acute postoperative macular oedema occurred in 24% (n=4/17) of cases (vs 3% in the control group; p=0.0084).ConclusionFoveoschisis was found in about 3% of eyes with idiopathic ERM. After peeling, the foveoschisis usually resolves completely with functional outcomes similar to those achieved with other primary ERM. However, this feature was associated with a higher risk of postoperative macular oedema (in 1/4 of cases).

Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

Objective: To analyze cataract surgery outcomes and related factors in eyes presenting with good visual acuity. Subject and Methods: Retrospective longitudinal of patients undergoing phacoemulsification between the years 2014-2018 in Moorfields Eye Hospital and satellite units. Pre- and postoperative visual acuity (unaided, with glasses, with pinhole) were analyzed. Inclusion criteria were age≥40 years and pinhole visual acuity ≥6/9 preoperatively. Exclusion criteria were no postoperative visual acuity data. VA change variable was also defined according to postoperative visual acuity being above or below the Snellen 6/9 threshold. Results: 2720 eyes were included in the analysis. The unaided LogMAR visual acuity improved from 0.54 to 0.20 (p<0.001), the LogMAR visual acuity with glasses improved from 0.35 to 0.05(p<0.001) and the LogMAR pinhole visual acuity improved from 0.17 to 0.13(p<0.001). 8.1% of patients had Snellen visual acuity <6/9 postoperatively. Mean follow up period was 23,6±9.9 days. In multivariate logistic regression, factors associated with visual acuity <6/9 postoperatively were: age [OR=0.96, 95% CI (0.95, 0.98), p<0.001], vitreous loss [OR=0.21, 95% CI (0.08, 0.56), p=0.002] and iris trauma [OR=0.28, 95% CI (0.10, 0.82) p=0.02]. No significant adverse events occurred. Conclusions: Visual acuity improved significantly overall in this group of patients, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.