Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

Abstract Purpose To evaluate the visual outcome and macular anatomic structures on spectral-domain optical coherence tomography (SD-OCT) of patients with epiretinal membrane (ERM) foveoschisis who underwent vitrectomy. Methods A retrospective cohort, interventional, case series. Participants Fourteen patients (14 eyes) with central vision loss from an ERM foveoschisis underwent vitrectomy at Chiang Mai University Hospital from 2017 to 2018 and had a follow-up period of 12 months. Interventions The 23G vitrectomy with ERM and internal limiting membrane (ILM) peeling was performed by a single surgeon. Main outcomes Best-corrected visual acuity (BCVA) and anatomic appearance on SD-OCT were assessed at the time of preoperative evaluations and post-operative follow-ups at 1, 3, 6, and 12 months. Results Fourteen patients with a mean (SD) age of 67.9 (7.9) years and a mean (SD) visual acuity (VA) of 0.6 (0.1) LogMAR units were included in this study. Significant VA improvements were observed at the 3-month (0.43 (0.14) LogMAR unit), 6-month (0.45 (0.16) LogMAR unit) and 12-month (0.37 (0.21) LogMAR unit) post-operative visits compared to baseline, all with P-values < 0.001. At month 12, there were vision improvements of ≥3 lines in 8 (57.2%) patients, vision improvements of 1 or 2 lines in 2 (14.3%) patients, vision remained at the same line of pre-operation in 3 (21.4%) patients, and vision decreased by 1 line in 1 (7.1%) patient. Regarding the anatomical outcomes, 13 (92.9%) patients achieved anatomical foveal restoration, while one had persistent intraretinal schisis at the 12-month follow-up. The median time to achieve a foveal restoration was 3 months. No significant visual impairments were observed post-operatively. Conclusion In patients with central vision loss from ERM foveoschisis, vitrectomy with ILM stripping tended to improve both visual and anatomical outcomes.

Download Full-text

High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-318809 ◽

2021 ◽

pp. bjophthalmol-2021-318809

Author(s):

Tiffany Ma ◽

Joanne L Sims ◽

Sonya Bennett ◽

Shenton Chew ◽

Rachael L Niederer

Keyword(s):

Ocular Hypertension ◽

Vision Loss ◽

Glaucoma Surgery ◽

High Rate ◽

Rapid Progression ◽

Central Vision ◽

Uveitic Glaucoma ◽

Central Vision Loss

AimsTo examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma.MethodsRetrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years.ResultsA total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29–45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery.ConclusionRapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.

Download Full-text

Solar maculopathy: prognosis over one year follow up

BMC Ophthalmology ◽

10.1186/s12886-019-1199-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Marwa Mahmoud Abdellah ◽

Engy Mohammed Mostafa ◽

Mohamed Abdelatif Anber ◽

Islam Saad El Saman ◽

Mohammed Ezz Eldawla

Keyword(s):

Visual Acuity ◽

Case Series ◽

Good Prognosis ◽

Spectral Domain ◽

Ocular Coherence Tomography ◽

The Mean ◽

One Year ◽

Retinal Hole ◽

Sd Oct

Abstract Background To document the visual acuity, spectral domain optical coherence tomography (SD-OCT) findings and prognosis in10 eyes of 6 patients with foveal damage from solar retinopathy in 1 year. Methods This was a prospective, observational case series of patients presented by solar maculopathy at Ophthalmology department, Sohag University. All patients underwent visual acuity (VA) testing, refraction, dilated fundus examination fluorescein angiography (FA) and SD-OCT (spectral Domain ocular coherence Tomography) imaging and follow up for 1 year. Results The mean age was 16.5 years (range 9–27 years, both eyes are affected in 4 patients. The mean spherical equivalent (SE) was – 0.25 ± 0.50 D. The visual acuity of the affected eyes ranged from 0.4 to 0.9 on presentation. At presentation Significant foveal pathology was identified on SD-OCT in 10 eyes, All eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT, Follow up of the cases continued for 1 year.100% of cases showed improvement in VA: 20% eyes regained 1, 50% eyes with VA of 0.9; two eyes 20% 0.8 and one eyes (10%) with 0.4. The improvement began after 1 week and reached its maximum and became stationary after the 6th month of follow up, the outer retinal hole persist in OCT in 80% of cases. Conclusion Solar maculopathy has a good prognosis yet shows no improvement after 6 months. Young age might pose as a risk factor.

Download Full-text

Reduction of collinear inhibition in observers with central vision loss using anodal transcranial direct current stimulation: A case series

10.1101/2020.11.09.375600 ◽

2020 ◽

Author(s):

Rajkumar Nallour Raveendran ◽

Amy Chow ◽

Katelyn Tsang ◽

Arijit Chakraborty ◽

Benjamin Thompson

Keyword(s):

Visual Cortex ◽

Visual Processing ◽

Vision Loss ◽

Peripheral Vision ◽

Case Series ◽

Cortical Inhibition ◽

Peripheral Retina ◽

Central Vision ◽

Direct Stimulation ◽

Central Vision Loss

AbstractPeople with central vision loss (CVL) due to macular degeneration are forced to rely on their residual peripheral vision and often develop a preferred retinal locus (PRL), a region of intact peripheral retina that is used for fixation. At the PRL, visual processing is impaired due to crowding (cluttering of visual objects). The problem of crowding still persists when images are magnified to account for the lower resolution of peripheral vision. We assessed whether anodal transcranial direct stimulation (a-tDCS), a neuro-modulation technique that alters cortical inhibition, would reduce collinear inhibition (an early component of crowding) when applied to the visual cortex in patients with CVL. Our results showed that applying a-tDCS to the visual cortex for 20mins reduced crowding in three patients with CVL and that the effect was sustained for up to 30mins. Sham stimulation delivered in a separate session had no effect. These initial observations mandate further research into the use of a-tDCS to enhance cortical processing of residual retinal input in patients with CVL.

Download Full-text

Perspective on Vision Science-Informed Interventions for Central Vision Loss

Frontiers in Neuroscience ◽

10.3389/fnins.2021.734970 ◽

2021 ◽

Vol 15 ◽

Author(s):

Marcello Maniglia ◽

Kristina M. Visscher ◽

Aaron R. Seitz

Keyword(s):

Visual Acuity ◽

Vision Loss ◽

Health Concern ◽

Western World ◽

Large Individual ◽

Central Vision ◽

Vision Science ◽

Low Level ◽

Central Vision Loss ◽

Effective Interventions

Pathologies affecting central vision, and macular degeneration (MD) in particular, represent a growing health concern worldwide, and the leading cause of blindness in the Western World. To cope with the loss of central vision, MD patients often develop compensatory strategies, such as the adoption of a Preferred Retinal Locus (PRL), which they use as a substitute fovea. However, visual acuity and fixation stability in the visual periphery are poorer, leaving many MD patients struggling with tasks such as reading and recognizing faces. Current non-invasive rehabilitative interventions are usually of two types: oculomotor, aiming at training eye movements or teaching patients to use or develop a PRL, or perceptual, with the goal of improving visual abilities in the PRL. These training protocols are usually tested over a series of outcome assessments mainly measuring low-level visual abilities (visual acuity, contrast sensitivity) and reading. However, extant approaches lead to mixed success, and in general have exhibited large individual differences. Recent breakthroughs in vision science have shown that loss of central vision affects not only low-level visual abilities and oculomotor mechanisms, but also higher-level attentional and cognitive processes. We suggest that effective interventions for rehabilitation after central vision loss should then not only integrate low-level vision and oculomotor training, but also take into account higher level attentional and cognitive mechanisms.

Download Full-text

Anatomical and Visual Outcome following Macular Hole Surgery at a Tertiary Eye Care Centre in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.24 ◽

2011 ◽

Vol 51 (183) ◽

Author(s):

R Thapa ◽

G Paudyal

Keyword(s):

Visual Acuity ◽

Success Rate ◽

Macular Hole ◽

Vision Loss ◽

Case Series ◽

Eye Care ◽

Case Series Study ◽

The Mean ◽

Anatomical Success

Introduction: Macular hole (MH) leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal. Methods: This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8) from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA) and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT) at six weeks, three months and at the last follow-up following surgery were recorded. Results: A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D) were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D). Idiopathic macular hole comprised of 31 cases (86.1 %) and traumatic of five cases (13.9 %). The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 %) at six weeks and in 28 cases (77.8%) at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 %) than in the traumatic (60 %) and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases. Conclusions: The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic. Keywords: Anatomical success, macular hole, perfluoropropane gas, visual acuity, vitrectomy

Download Full-text

Ophthalmological findings in children with non-syndromic craniosynostosis: preoperatively and postoperatively up to 12 months after surgery

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000677 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000677

Author(s):

Evangelia Ntoula ◽

Daniel Nowinski ◽

Gerd Holmstrom ◽

Eva Larsson

Keyword(s):

Visual Acuity ◽

University Hospital ◽

Cranial Sutures ◽

Sagittal Craniosynostosis ◽

Syndromic Craniosynostosis ◽

Disc Oedema ◽

Before And After ◽

Congenital Condition ◽

Skull Deformity

AimsCraniosynostosis is a congenital condition characterised by premature fusion of one or more cranial sutures. The aim of this study was to analyse ophthalmic function before and after cranial surgery, in children with various types of non-syndromic craniosynostosis.MethodsChildren referred to Uppsala University Hospital for surgery of non-syndromic craniosynostosis were examined preoperatively. Visual acuity was measured with Preferential Looking tests or observation of fixation and following. Strabismus and eye motility were noted. Refraction was measured in cycloplegia and funduscopy was performed. Follow-up examinations were performed 6–12 months postoperatively at the children’s local hospitals.ResultsOne hundred twenty-two children with mean age 6.2 months were examined preoperatively. Refractive values were similar between the different subtypes of craniosynostosis, except for astigmatism anisometropia which was more common in unicoronal craniosynostosis. Strabismus was found in seven children, of which four had unicoronal craniosynostosis.Postoperatively, 113 children were examined, at mean age 15.9 months. The refractive values decreased, except for astigmatism and anisometropia in unicoronal craniosynostosis. Strabismus remained in unicoronal craniosynostosis. Two new cases with strabismus developed in unicoronal craniosynostosis and one in metopic, all operated with fronto-orbital techniques. No child had disc oedema or pale discs preoperatively or postoperatively.ConclusionOphthalmic dysfunctions were not frequent in children with sagittal craniosynostosis and preoperative ophthalmological evaluation may not be imperative. Children with unicoronal craniosynostosis had the highest prevalence of strabismus and anisometropia. Fronto-orbital techniques used to address skull deformity may be related to a higher prevalence of strabismus postoperatively.

Download Full-text

Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Pars Plana ◽

Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

Download Full-text

Driving Habits in Older Patients with Central Vision Loss

Ophthalmology ◽

10.1016/j.ophtha.2013.09.042 ◽

2014 ◽

Vol 121 (3) ◽

pp. 727-732 ◽

Cited By ~ 18

Author(s):

Sabyasachi Sengupta ◽

Suzanne W. van Landingham ◽

Sharon D. Solomon ◽

Diana V. Do ◽

David S. Friedman ◽

...

Keyword(s):

Older Patients ◽

Vision Loss ◽

Central Vision ◽

Central Vision Loss

Download Full-text

Combined Hamartoma of the Retina and Retinal Pigment Epithelium in a Patient with Gorlin Syndrome: Spontaneous Partial Resolution of Traction Caused by Epiretinal Membrane

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/2312196 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

José L. Sánchez-Vicente ◽

Miguel Contreras-Díaz ◽

Trinidad Rueda ◽

Enrique Rodríguez de la Rúa-Franch ◽

Fredy E. Molina-Socola ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Pigment Epithelium ◽

Epiretinal Membrane ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Spontaneous Resolution ◽

Fundus Examination ◽

Gorlin Syndrome ◽

Clinical Context

Purpose. To describe the case of spontaneous resolution of epiretinal membrane in a patient with Combined Hamartoma of the Retina and Retinal Pigment Epithelium (CHR-RPE), in the clinical context of Gorlin Syndrome (GS).Methods. Observational case report of a 12-year-old female patient is presented. The diagnosis of CHRRPE was made by OCT and fundus examination, which showed a mound of disorganized tissue originating from retina and retinal pigment epithelium. Epiretinal membrane (EM) was also detected. Genetic study was performed to confirm the diagnosis of GS.Results. The patient was observed for 39 months, showing spontaneous resolution of the traction caused by the EM and improvement in visual acuity (VA), which was 20/80 at initial presentation, rising to 20/40 after follow-up period.Conclusions. The presence of EM in CHR-REP is a cause of reduction of visual acuity. Management of this condition is controversial; however, we would like to highlight that spontaneous resolution of the traction caused by EM is possible, resulting in recovery of VA.

Download Full-text

Sub-Threshold Micro Pulse Laser (810NM): Treatment for Chronic Central Serous Retinopathy

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i2.1152 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Mariam Shamim Kashif ◽

Najia Uzair ◽

Lubna Feroz ◽

Asaad Mehmood

Keyword(s):

Retinal Thickness ◽

Case Series ◽

Central Retinal Thickness ◽

Central Serous Retinopathy ◽

Invasive Treatment ◽

Micropulse Laser ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity ◽

Sd Oct

Purpose: To find the effectiveness of sub-threshold (810nm) micropulse diode laser treatment (SMT) in chronic central serous retinopathy (CSR). Study Design: Interventional case series. Place and Duration of Study: Layton Rahmatulla benevolent trust eye hospital, from April 2019 to July 2020. Methods: The patients of chronic CSR (≥ 6 months) participated in the study. We used Spectral Domain Optical coherence tomography (SD-OCT) to record baseline central retinal thickness (CT). Best corrected visual acuity (BCVA) was recorded with Snellen’s chart and converted to Log MAR for statistical analysis. All patients underwent treatment with sub-threshold laser (810nm) in micropulse mode with 5% duty cycle (DC). Results: Twenty five eyes with chronic CSR were enrolled in the study. The patients were treated with laser and final assessment was made at 6 months. Mean BCVA at presentation was 0.46 Log MAR ± 0.12 and a mean baseline CT of 362.2 μm ± 32.6µm. At final follow-up there was a mean decrease in CT of 97.2 μm ± 21.8 from the baseline. After treatment mean BCVA was 0.33 Log MAR ± 0.12 and mean CT was 266 μm ± 20.9. Nineteen out of twenty-five eyes (76%) achieved a gain of vision between 1 to 3 lines and gain of 3 lines was achieved in 8% of cases. At the final follow-up there was incomplete resolution of sub retinal fluid in 4 eyes (16%) with no improvement in BCVA. Conclusion: SMT (810 nm) is an effective and minimally invasive treatment modality for chronic CSR. Key Words: Sub-Threshold micropulse laser, Central serous retinopathy, Central retinal thickness, sub retinal fluid.

Download Full-text