scholarly journals Microsurgical Management of Tuberculum Sellae Meningiomas by the supraorbital keyhole eyebrow approach: Surgical Outcome

2017 ◽  
Vol 14 (3) ◽  
pp. 26-32
Author(s):  
Robin Bhattarai ◽  
Liang CaoFeng ◽  
Guo Ying
Keyword(s):  
Visual Acuity ◽  
Visual Fields ◽  
Visual Outcome ◽  
Skin Incision ◽  
Impairment Score ◽  
Eyebrow Incision ◽  
Tuberculum Sellae ◽  
The Mean

The aim of this study was to evaluate (surgical) visual outcomes in patients treated via supraorbital keyhole eyebrow incision approach. Data from 14 patients with TSMs (Tuberculum Sellae Meningioma) who underwent microsurgical treatment by a supraorbital keyhole eyebrow skin incision between September 2006 and September 2013 were retrospectively collected and analyzed. Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. To quantify the extent of ophthalmological disturbances Visual impairment score was used to analyze visual acuity and visual fields, which range from 0 (best) to 100 (worst). Change in visual function was assessed as the main outcome. The mean age of the 10 women and 4 men enrolled in the study was 56.50years (range, 42~74 years). The presenting symptom was asymmetrical visual loss in 71.4% of the patients.And examination revealed decreased visual acuity (Snellen notation) in 100% and impaired visual fields (Goldmann perimetry) in 58.3 % (7/12 cases, central scotoma and temporal anopia n=1, classical bitemporal hemianopia n=4, incongruent homonymous hemianopia n=2 , 2 cases data N/A) of the patients. Simpson grades I resection via a supraorbital keyhole eyebrow skin incision approach, were achieved in 100% of the patients. Quality of life was assessed according to Karnofsky scale and was 86.67 (range: 70~100). The mean follow-up duration was 51.73 months (range: 27~91 months).No recurrent tumors were observed during this period. According to the findings of this study, this approach provides a pleasing cosmetic outcome and also decreases brain manipulation while minimizing the likelihood of procedure-related morbidity. A favorable visual outcome was observed in most of the patients in the late postoperative period. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page : 26-32

scholarly journals Limited Treatment Response during Follow-up after Switching to Aflibercept in Neovascular Age-related Macular Degeneration

2021 ◽  
Vol 62 (9) ◽  
pp. 1218-1226
Author(s):  
Gon Soo Choe ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Macular Degeneration ◽  
Treatment Response ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
The Mean

Purpose: To investigate the limited response to aflibercept after switching to aflibercept in neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 70 eyes with neovascular AMD that were initially treated with ranibizumab and then switched to aflibercept. The incidence and timing of the limited response to aflibercept were identified and visual outcome was compared between eyes with and without limited response. In addition, factors predictive of limited response were analyzed. Results: A limited response to aflibercept was noted in approximately 1/5 of the patients who underwent switching to aflibercept in neovascular AMD. Switching to aflibercept was performed at a mean of 16.2 ± 12.7 months after diagnosis. During the mean 34.7 months of follow-up after switching, limited response was noted in 15 eyes (21.4%) at a mean of 22.0 ± 13.9 months after switching. The degree of reduction in visual acuity was mean logMAR 0.34 ± 0.41 in eyes with limited response and mean 0.06 ± 0.20 in eyes without (p = 0.002). In addition, the duration between the diagnosis and the switching was shorter (p = 0.012), and the number of ranibizumab injections before switching was lower (p = 0.016) in eyes with limited response than in eyes without. Conclusions: Patients who showed limited response to aflibercept after switching to aflibercept showed a worse visual outcome. The probability of having a limited response is higher when the switching is performed earlier.

scholarly journals Outcomes of implantable collamer lens V4 and V4c for correction of high myopia – a case series

2016 ◽  
Vol 7 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Smita Karandikar ◽  
Vipul Bhandari ◽  
Jagdeesh Reddy
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
High Myopia ◽  
Case Series ◽  
Visual Outcome ◽  
Visual Disability ◽  
Implantable Collamer Lens ◽  
Distant Visual Acuity ◽  
The Mean

Objective: To evaluate the visual outcomes and intraocular pressure changes after Visian Implantable Collamer Lens (ICL) implantation V4b and V4c (with centraflow technology) for correction of myopia. Materials and methods: A prospective, consecutive, comparative interventional case series of V4b and V4c ICL implantation done for correction of high myopia (>-6 diopter D) in patients unsuitable for laser vision correction. The outcome measures that were evaluated included preoperative and postoperative uncorrected distant visual acuity (UDVA), best spectacle corrected distant visual acuity (CDVA), endothelial cell count (ECC), presence of lens opacification, intraocular pressure (IOP) and ICL vaulting. A follow-up of upto 1 year was done. A questionnaire was given at the end of follow-up period. Results: A total of 30 eyes (24.56±4.8 years) underwent V4b ICL implantation (10 non-toric, 20 toric ICL-TICL) with intraoperative peripheral iridectomy (PI) and 34 eyes (26.13±3.8 years) had implantation of V4c ICL with centraflow (12 non-toric, 22 TICL). The mean preoperative manifest spherical equivalent (MSE) was 8.98±2.8 D and 9.24±2.4 D in the V4b and V4c groups respectively which reduced to postoperative values of -0.28±1.3 D and -0.19±1.18 D respectively. The mean preoperative astigmatism was -1.8±1.2 diopter cylinder (Dcyl) and -1.9±1.6 Dcyl which respectively reduced to -0.8±0.8 Dcyl and -0.9±0.3 Dcyl. At the end of 1 year follow up, mean ECC loss was 7.6% and 7.1%, mean vault was 583.12±231.12 μ and 602±241.24μ respectively in the V4b and V4c groups. Anterior subcapsular opacities were present in 6.66% and 2.94% of eyes with V4b and V4c groups respectively. Two eyes from both V4b (10%) and V4c (8.33%) had rotation of more than 30 degrees and required re-rotation surgery done successfully. Two eyes (6.66%) with V4b ICL implantation had high postoperative IOP (>35 mm Hg) and required Nd:Yag laser iridotomy later done with successful control of IOP. The safety indices were 1.12 and 1.15 and efficacy indices were 1.5 and 1.6 in the V4b and V4c groups respectively at the end of 1 year. The most common visual complaint was glare and haloes in 24% and 27% in the two groups respectively. However, they were not annoying enough to cause visual disability. Conclusions: Both V4b and V4c Visian ICL implantations are comparable in terms of visual outcome and safety profile for correction of high myopia. However, V4c ICL offers these advantages without the requirement of an additional PI. 

Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life

2018 ◽  
Vol 29 (3) ◽  
pp. 304-308 ◽  
Author(s):  
Sonam Yangzes ◽  
Savleen Kaur ◽  
Parul Chawla Gupta ◽  
Manu Sharma ◽  
Jitender Jinagal ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Lens ◽  
Congenital Cataract ◽  
Retrospective Chart Review ◽  
Visual Outcome ◽  
Intraocular Lens Implantation ◽  
Visual Axis ◽  
Lens Implantation ◽  
The Mean

Purpose: To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. Methods: A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Results: Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age ( p = 0.310), sex ( p = 0.475) or laterality ( p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40–60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children ( n = 31) achieved best corrected visual acuity or 20/80 or better. Conclusion: The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.

scholarly journals Visual outcome of Anti-Vascular Endothelial Growth Factor Injections at the University College Hospital, Ibadan

2020 ◽  
Author(s):  
Tunji Sunday Oluleye ◽  
Yewande Olubunmi Babalola ◽  
Oluwole Majekodunmi ◽  
Modupe Ijaduola ◽  
Adeyemi Timothy Adewole
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Visual Outcome ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
The Mean ◽  
One Year ◽  
Endothelial Growth Factor ◽  
Number Of Injections

AbstractAimTo evaluate the four-year outcome of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in an eye unit in sub-Saharan Africa.MethodologyThis retrospective study included 182 eyes of 172 patients managed in the vitreoretinal unit between 2016 and 2019 who were treated with intravitreal anti-VEGF Bevacizumab (1.25 mg/0.05 ml) with at least one year of follow up. The outcome measures were change in best-corrected visual acuity (BCVA) over one year of follow-up, the number of injections taken and complications.ResultsThe mean age was 61.1 ± 16.3 years (M: F of 1:1.1) and about 62.1% were > 60 years. A total of 330 injections were given during the period audited. The mean number of injections was 1.8 ± 0.93. Ninety-four (51.7%) eyes had only one injection while 33 (18.1%), 50 (27.5%) and 5 (2.7%) had 2, 3 and 4 injections, respectively. About 78.5% had moderate-severe visual impairment at baseline and 44.5%, 16.4%,12.6% and 7.1% at 1, 3, 6- and 12-months post injections, respectively. The mean BCVA improved for all eyes from 1.67 ±0.91 logMAR at baseline to 1.50±1.27 logMAR at one year. The logMAR letters gained was 23 at 1 month and 8.25 at 1 year with a statistically significant association between increasing number of injections and improved visual outcome (p= 0.015). One patient each developed endophthalmitis (0.6%) and inferior retinal detachment (0.6%) post-injection.ConclusionVisual acuity gain was recorded in patients who had at least two intravitreal Anti-VEGF injections in 1 year.

scholarly journals Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal

2012 ◽  
Vol 4 (2) ◽  
pp. 248-255
Author(s):  
S Bajimaya ◽  
B R Sharma ◽  
J B Shrestha ◽  
I M Maharjan ◽  
H Matsushima ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Postoperative Complications ◽  
Corneal Edema ◽  
Visual Outcome ◽  
Corneal Epithelial ◽  
Corneal Epithelial Defect ◽  
Posterior Capsule Rupture ◽  
The Mean ◽  
Phaco Time

Introduction: A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). Objective: To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. Materials and methods: A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. Results: A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet’s membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60.Conclusion: Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6540 Nepal J Ophthalmol 2012; 4 (2): 248-255 

Long-Term Assessment of the Quality of Visually-Related Daily Activities After ICL (V4c) Implantation for Myopia and Myopic Astigmatism

2020 ◽  
Vol 10 (11) ◽  
pp. 2654-2659
Author(s):  
Shaorong Linghu ◽  
Taixiang Liu ◽  
Yilu Liao ◽  
Rong Shi ◽  
Le Pan
Keyword(s):  
Visual Acuity ◽  
Daily Activities ◽  
Uncorrected Visual Acuity ◽  
Post Operation ◽  
Icl V4c ◽  
The Mean ◽  
Myopic Astigmatism

This study was performed to evaluate the long-term quality of visually related daily activities after Central Hole Collamer Lens Implantation to treat myopia and astigmatism. This study included 46 eyes (in 23 patients) that received ICL-V4c implantation. The follow up time was at least 24 months. Moreover, patient satisfaction related to daily vision activities were recorded at 6 and 24 months. The parameters measured included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, eye axis, intraocular pressure (IOP), endothelial cell density (ECD) and vault. The mean spherical equivalents were –0.14 ± 0.21 D and –0.12 ± 0.33 D at 6 and 24 months after surgery, respectively. All the eyes were better postoperative (UCVA) than preoperative (BCVA). The BCVA at 6 and 24 months after implantation was –0.03 ± 0.08 LogMAR and –0.03 ± 0.11 LogMAR, which is statistically better (P = 0.031) than the pre-operation value 0.07 ± 0.12 LogMAR. There was no significant (P > 0.05) difference between the pre-operation and post-operation ECD. At 24 months post-operation, 10% of the patients complained about difficulty driving at night; meanwhile, most patients expressed satisfaction or were very satisfied. Approximately 13% of the patients worried about long term safety and efficacy after the ICL-V4c implantation. Patients are very satisfied with daily related vision activities after ICL-V4c implantation.

scholarly journals PHACOEMULSIFICTION

2018 ◽  
Vol 25 (10) ◽  
pp. 1605-1609
Author(s):  
Shabeer Ahmad Bhutto ◽  
Naeem Akhtar Katpar ◽  
Safdar Ali Abbasi
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Visual Outcome ◽  
Diabetic Control ◽  
Diabetic Patients ◽  
Significant Discrepancy ◽  
The Mean ◽  
Medical University

Objectives: The objective of this study is to evaluate visual outcome afterphacoemulsification in diabetic patients. Study Design: Prospective study. Setting:Ophthalmology department of Shaheed Mohtarma Benazir Bhutto Medical University Larkana.Period: January 2017 to April 2018. Method: Over a period of 15 months, all diabetic patientshaving cataracts were part of the study. All these patients would undergo phacoemulsificationfor cataract removal by a single ophthalmologist. A total of 76 participants were includedand their consent was taken. Visual acuity and progression of diabetic retinopathy would beassessed 12 months post-operatively. Results: The data included 76 patients, among which32 were females (43%) and 44 males (57%). The mean age of females were 58 + 6.8 yearsand that of males were 62.5 + 9.3. Mean hbA1c of 76 patients were 9.2. At the end of firstpost-operative year of the 76 operated eyes, 46 eyes (60.52%) indicated no progression ofdiabetic retinopathy, whereas 30 eyes (39.47%) showed no progression of retinopathy. Therewas no significant discrepancy in progression of retinopathy in the number of operated andun-operated eyes post-operatively. Retinopathy progression was related to higher mean hbA1cOE p= 0.001 NOE p=0.015). Conclusion: The number of people having diabetes mellitus isincreasing exponentially. Early diagnosis and good diabetic control is associated with slowdevelopment of cataract. Uncomplicated phacoemulsification leads to good visual outcomeand better quality of life.

scholarly journals Ocularis syphilis

2020 ◽  
Vol 161 (45) ◽  
pp. 1927-1935
Author(s):  
Zsuzsanna Géhl ◽  
Béla Tamási ◽  
András Bánvölgyi ◽  
Zoltán Zsolt Nagy
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Visual Outcome ◽  
Posterior Uveitis ◽  
Syphilis Infection ◽  
Appropriate Treatment ◽  
The Mean ◽  
The Right ◽  
Clinical Records

Összefoglaló. Bevezetés és célkitűzés: A syphiliseredetű uveitis szemészeti és általános tüneteinek ismertetése, a prognózis elemzése olyan esetek kapcsán, amelyekben az uveitis kivizsgálása során derült fény a syphilisre. Módszer: 2011 és 2019 között 14 uveitises beteg vizsgálata során derült fény syphilisre (13 férfi, 1 nő), a tünetek 25 szemen jelentkeztek. A betegek adatait retrospektíven elemeztük. Eredmények: A betegek átlagéletkora 46 év volt (23–72 év). A szemészeti diagnózis felállítását követően 2 beteg nem jelent meg a további bőrgyógyászati és szemészeti vizsgálaton, 1 beteget más intézetben kezeltek. A gondozott 11 betegnél a gyulladásban érintett szemeken az első alkalommal észlelt átlagolt látóélesség a jobb szemen 0,71 (0,001–1,0), a bal szemen 0,53 (0,04–1,0) volt. A követési idő átlagosan 22 hónap (1–72) volt. A követési idő végén az átlagolt látóélesség a jobb szemen 0,9 (0,15–1,0), a bal szemen 0,82 (0,08–1,0) volt. A leggyakoribb szemészeti manifesztáció a hátsó uveitis volt, amely papillitis, chorioretinitis vagy kombinált formákban volt megfigyelhető, összesen 20 szemen. A neurosyphilis-protokoll alapján alkalmazott penicillinkezelés után a gyulladásos tünetek minden betegnél megszűntek, a követési idő végén a betegek többségénél a látóélesség teljes volt. A gyengébb látóélesség hátterében látóideg-atrophia, illetve a macula károsodása állt. Következtetés: Eseteinkben a betegek főként középkorú férfiak voltak. Bár jellemző volt a hátsószegmentum-érintettség, megfelelő kezelés mellett a prognózis jónak volt mondható. Orv Hetil. 2020; 161(45): 1927–1935. Summary. Introduction and objective: To describe the ocular and general characteristics and to assess prognosis of patients with uveitis, whose syphilis infection was revealed during uveitis workup. Method: Between 2011 and 2019, 14 uveitis patients were diagnosed with syphilis (13 males, 1 female) with symptoms in 25 eyes. Patients’ clinical records were analyzed retrospectively. Results: The mean age of patients was 46 years (range 23–72 years). 2 patients did not show up for further dermatological and ophthalmic examinations, and 1 patient was treated at another institute. In the 11 patients we treated, the mean visual acuity observed for the first time in the eyes affected by inflammation was 0.71 (0.001–1.0) in the right eye and 0.53 (0.04–1.0) in the left eye. The mean follow-up was 22 months (1–72). At the end of the follow-up period, the mean visual acuity was 0.9 (0.15–1.0) in the right eye and 0.82 (0.08–1.0) in the left eye. The most common ocular manifestation was posterior uveitis (papillitis, chorioretinitis, or in combined forms) in a total of 20 eyes. After receiving penicillin therapy according the neurosyphilis protocol, inflammatory symptoms resolved in all patients, and at the end of the follow-up, the majority of patients had complete visual recovery. Lower visual acuity was due to optic nerve atrophy and macular damage. Conclusion: In our case series, the patients were predominantly middle-aged men. Although most patients showed posterior segment involvement, with appropriate treatment the visual outcome was good. Orv Hetil. 2020; 161(45): 1927–1935.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

Retinotomy and retinectomy for anterior inferior proliferative vitreoretinopathy: Can visual outcome be improved?

2021 ◽  
pp. 112067212110128
Author(s):  
Mumin Hocaoglu ◽  
Murat Karacorlu ◽  
M. Giray Ersoz ◽  
Isil Sayman Muslubas ◽  
Serra Arf
Keyword(s):  
Proliferative Vitreoretinopathy ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Clinical Stage ◽  
Case Series ◽  
Visual Outcome ◽  
Attachment Rate ◽  
Good Visual Outcome ◽  
The Mean

Purpose: To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR). Methods: Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated. Results: Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 ( p < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA ( p = 0.02), previous vitrectomy with gas tamponade ( p = 0.007), and was negatively correlated with number of previous RD operations ( p = 0.01), larger extent of RD ( p = 0.02) and more extensive retinotomy/retinectomy ( p = 0.04). Conclusions: An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.

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