B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates

2020 ◽  
pp. bjophthalmol-2020-316962
Author(s):  
Luzia Diegues Silva ◽  
Albert Santos ◽  
Flavio Hirai ◽  
Norma Allemann ◽  
Adriana Berezovsky ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Invasive Procedure ◽  
Functional Results ◽  
Negative Finding ◽  
Electrophysiological Testing ◽  
Electrophysiological Findings ◽  
Boston Type 1 Keratoprosthesis ◽  
Visual Electrophysiology ◽  
Better Than

Background/AimsWe analysed the ability of B-scan ultrasound, ocular electrophysiology testing and videoendoscopic examination for predicting visual prognosis in Boston Type 1 keratoprosthesis (KPro-1) candidates. Indirect anatomical and electrophysiological findings and results from direct endoscopic evaluations were correlated with postoperative functional data.MethodsIn this prospective and interventional study, we included 13 individuals who had previously been indicated for Kpro-1 surgery. All subjects underwent preoperative screening, including ophthalmic evaluation, B-scan ultrasound, electrophysiological testing, and perioperative intraocular videoendoscopic evaluation (VE). B-scan ultrasound, electrophysiological testing, and VE evaluation results were categorised as favourable or unfavourable predictors of postoperative functional results according to predefined criteria. The predictability values of B-scan ultrasound, electrophysiological testing, and VE prognostication were calculated based on the visual acuity level achieved.ResultsAll surgeries and perioperative VEs were uneventful. Preoperative best-corrected visual acuity (BCVA) ranged from light perception to counting fingers. The 1-year postoperative BCVA was better than 20/200 (satisfactory visual acuity result) in 10 eyes (76.9%) and 20/40 or better in 5 eyes (38.5%). B-scan ultrasound presented a positive predictive value (PPV) of 85.7% for satisfactory postoperative visual acuity, electroretinography showed a PPV of 66.7%, and visual evoked potential presented a PPV of 66.7%. The perioperative VE PPV of a negative finding for satisfactory visual acuity was 100%.ConclusionsFundoscopic visualisation by intraocular VE is a minimally invasive procedure that can be used to predict functional outcomes in keratoprosthesis candidates. This technique demonstrated better prognostication in keratoprosthesis candidates than B-scan ultrasound and electrophysiological testing.

Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery

2021 ◽  
pp. bjophthalmol-2020-317483
Author(s):  
Jonathan El-Khoury ◽  
Majd Mustafa ◽  
Roy Daoud ◽  
Mona Harissi-Dagher
Keyword(s):  
Visual Acuity ◽  
Contributing Factors ◽  
Time Duration ◽  
Patient Demographics ◽  
Snellen Visual Acuity ◽  
Boston Type 1 Keratoprosthesis ◽  
The Mean ◽  
Retroprosthetic Membrane

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

scholarly journals Keratoprosthesis Surgery as an Alternative to Keratoplasty

Medicina ◽  
2013 ◽  
Vol 49 (6) ◽  
pp. 46 ◽  
Author(s):  
Vytautas Jašinskas ◽  
Paulius Rudalevičius ◽  
Arūnas Miliauskas ◽  
Darius Milčius ◽  
Ūla Jurkūnas
Keyword(s):  
Visual Acuity ◽  
Success Rate ◽  
Surgical Procedures ◽  
Corneal Transplantation ◽  
Corneal Transplant ◽  
Artificial Cornea ◽  
Boston Type 1 Keratoprosthesis ◽  
The Mean

Corneal transplant surgery after chemical or thermal burns has a very low success rate. Vision in these patients can be restored by using an artificial cornea (keratoprosthesis). In this report, we present 5 clinical cases of implanting a fresh corneal graft with Boston type 1 keratoprosthesis in patients with corneas inappropriate for standard corneal transplantation. The mean follow-up was 26.4 months (range, 12 to 36 months; SD, 13.1). The main measures of outcomes were visual acuity and keratoprosthesis stability. At least 1 year after the operation (5 eyes), vision acuity was >0.1 in 100% of the eyes and >0.4 in 50% of the eyes. Retention of the initial keratoprosthesis was 100%. The results of this study seem to be similar to those reported internationally. The anatomical and visual functions of the eyes were stable after keratoprosthesis implantation, though for a longer follow-up period, additional surgical procedures may be required.

scholarly journals What can visual electrophysiology tell about possible visual-field defects in paediatric patients

Eye ◽  
2021 ◽  
Author(s):  
Siân E. Handley ◽  
Maja Šuštar ◽  
Manca Tekavčič Pompe
Keyword(s):  
Visual Field ◽  
Visual Field Defects ◽  
Invasive Technique ◽  
Central Scotoma ◽  
Non Invasive ◽  
Paediatric Patients ◽  
Electrophysiological Testing ◽  
Electrophysiological Findings ◽  
Visual Electrophysiology ◽  
Subjective Input

AbstractRecognising a potential visual-field (VF) defect in paediatric patients might be challenging, especially in children before the age of 5 years and those with developmental delay or intellectual disability. Visual electrophysiological testing is an objective and non-invasive technique for evaluation of visual function in paediatric patients, which can characterise the location of dysfunction and differentiate between disorders of the retina, optic nerve and visual pathway. The recording of electroretinography (ERG) and visual-evoked potentials (VEP) is possible from early days of life and requires no subjective input from the patient. As the origins of ERG and VEP tests are known, the pattern of electrophysiological changes can provide information about the VF of a child unable to perform accurate perimetry. This review summarises previously published electrophysiological findings in several common types of VF defects that can be found in paediatric patients (generalised VF defect, peripheral VF loss, central scotoma, bi-temporal hemianopia, altitudinal VF defect, quadrantanopia and homonymous hemianopia). It also shares experience on using electrophysiological testing as additional functional evidence to other tests in the clinical challenge of diagnosing or excluding VF defects in complex paediatric patients. Each type of VF defect is illustrated with one or two clinical cases.

scholarly journals Long-Term Anatomical and Functional Survival of Boston Type 1 Keratoprosthesis in Congenital Aniridia

2021 ◽  
Vol 8 ◽  
Author(s):  
Ariann Dyer ◽  
Alix De Faria ◽  
Gemma Julio ◽  
Juan Álvarez de Toledo ◽  
Rafael I. Barraquer ◽  
...  
Keyword(s):  
Retention Rate ◽  
Functional Results ◽  
Long Term Results ◽  
Cumulative Probability ◽  
Congenital Aniridia ◽  
Boston Type 1 Keratoprosthesis ◽  
The Mean ◽  
Retroprosthetic Membrane

Purpose: To analyze the long-term anatomical survival, functional survival, and complications of Boston type 1 keratoprosthesis (KPro) in the eyes with congenital aniridia-associated keratopathy (AAK).Methods: A retrospective review of 12 eyes with congenital aniridia that underwent a Boston type 1 KPro surgery was conducted. A Kaplan–Meier analysis was performed. Anatomical and functional success criteria were KPro retention and a best corrected visual acuity (BCVA) ≤1.3 LogMAR (≥0.05 decimal) at the end of a follow-up period. Postoperative complications were recorded.Results: The mean preoperative BCVA was 2.1 ± 0.9 (range: 3.8–1) LogMAR, and glaucoma was a comorbidity in all the cases. Five years after the surgery, the overall retention rate was 10/12 (83.3%), and 50% had functional success. Only three (25%) of the 12 cases did not achieve a BCVA ≤1.3 LogMAR. The cumulative probability of anatomical success was 92, 79, and 79% after 1, 5, and 10 years, respectively. The cumulative probability of functional success was 57 and 46% after 1 and 5 years, respectively. The mean anatomical and functional survival time was 10 ± 1.3 (95% IC = 7.5–12.3 years) and 3.8 ± 0.9 years (95% IC = 1.8–5.8 years), respectively. The most common postoperative complication was retroprosthetic membrane (RPM) formation in 8/16 cases (66%). The mean number of complications per case was 2.4 ± 1.8 (0–6).Conclusions: The Boston type 1 KPro is a viable option for patients with AAK with good anatomical and functional long-term results. Glaucoma is an important preoperative condition that affects functional results. Retroprosthetic membrane formation seems to have a higher incidence in this condition.

scholarly journals Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

2021 ◽  
pp. 92-97
Author(s):  
Paola Cirafici ◽  
Maria Musolino ◽  
Michela Saccheggiani ◽  
Carlo Enrico Traverso ◽  
Massimo Nicolò
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Multimodal Imaging ◽  
Diagnostic Errors ◽  
Wide Field ◽  
Vascular Changes ◽  
Macular Telangiectasia ◽  
First Choice ◽  
Idiopathic Macular Telangiectasia

This is a report of 3 patients diagnosed with idiopathic macular telangiectasia type 1 (MacTel 1) at Medical Retina Center of the University of Eye Clinic of Genova and then prospectically followed for a mean time of 26 months between 2016 and 2019. It is the first report of patients affected by MacTel 1 treated with dexamethasone (DEX) implant as a first choice of treatment. Aim of our study is to better characterize the disease using a multimodal wide-field imaging and to determine efficacy of DEX implant on MacTel 1 in terms of central macular thickness (CMT) and best-corrected visual acuity (BCVA). MacTel 1 is a rare unilateral disease, characterized by telangiectatic retinal capillaries, cystoid macular edema, and lipid deposition occurring temporal to the fovea. Patients underwent a comprehensive ophthalmic examination, BCVA, swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), ultra-widefield (UWF) color, and fluorescein angiography (FA) fundus photograph. All the patients presented monolateral reduced BCVA and macular edema with increased CMT evaluated by SS-OCT. With SS-OCTA, we showed that the telangiectasia-associated vascular changes originate in the deep retinal vascular plexus and as a consequence macular edema and exudation develop causing vision loss. Furthermore, UWF imaging helped us to highlight vascular changes typical of Coats Disease at the far retinal periphery. All the patients were treated with DEX intravitreal implant, showing a decrease in CMT and a stabilization of visual acuity. Due to the recurrent nature of macular edema, patients underwent a mean of 4 DEX implants during the follow-up period. In order to address the clinical features of this uncommon disease avoiding diagnostic errors, it might be important to use a multimodal imaging approach. The anatomical and functional beneficial effects of DEX implant were well evident although transient.

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

2022 ◽  
Author(s):  
P. Barrett Paulk ◽  
Dala Eloubeidi ◽  
John O. Mason III ◽  
Christine A. Curcio ◽  
Jason N. Crosson ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Degeneration ◽  
Rhegmatogenous Retinal Detachment ◽  
Age Related Macular Degeneration ◽  
Light Perception ◽  
Postoperative Visual Acuity ◽  
Age Related ◽  
Functional Vision ◽  
Better Than

Abstract 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.

scholarly journals Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

2018 ◽  
Vol 1 (1) ◽  
pp. 07-13
Author(s):  
Ogugua Ndubuisi Okonkwo ◽  
Adekunle Olubola Hassan ◽  
Olufemi Oderinlo
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Vital Role ◽  
Symptom Duration ◽  
Flap Technique ◽  
Macular Holes ◽  
Snellen Visual Acuity ◽  
Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

Sign in / Sign up

Export Citation Format

Share Document