ABSTRACT
Objective: To improve vision prognosis after ocular trauma by evaluating the indications for pars plana vitrectomy [PPV], the appropriate timing for surgery, and to find the key predictors of outcomes
Methods: This is a retrospective study. The medical charts of 48 patients presenting with blunt or penetrating eye injury and necessitating a PPV between 2009 and 2016 were reviewed. We studied the indications to operate and the timing of the surgery. The outcome depended on the comparison of the best corrected visual acuity [BCVA], evaluated according to the log-MAR scale before surgery and at 1 week and 6 months post surgery
Results: Forty-eight patients [42 males, 6 females] with mean age 32.4 +/- 17.3 years were recruited; 42 subjects had a penetrating eye injury out of which 21 presented with an intraocular foreign body [IOFB], and 6 had a blunt trauma. Mean preoperative BCVA was at 2.35 [logMAR], 2.25 at 1 week postoperatively, and 1.45 at 6 months. An epiretinal membrane [ERM] and drop of lens material in the vitreous were more likely to develop after blunt traumas. Initial assessment of retinal detachment [RD] was associated with the need to perform a 2[nd] vitrectomy [p = 0.011], poorer BCVA at 6 months [p = 0.001], and lower postoperative intraocular pressure [IOP] [p = 0.014]. Moreover, preoperative BCVA was worse in eyes with posterior scleral perforation [p = 0.008]. Shorter intervals between the trauma and the 1[st] PPV predicted a more frequent need to perform a 2[nd] vitrectomy [p = 0.045]. Patients who developed proliferative vitreoretinopathy [PVR] had poorer vision preoperatively and at 1-week post-op [p = 0.04 and p = 0.01 respectively]. The BCVA preoperatively, at 1 week, and at 6 months were positively correlated. Preoperative BCVA could be regarded as an important forecaster of outcome at 6 months [p = 0.009]; whereas the timing of PPV and of IOFB removal did not show any significant correlation with the final BCVA [r = 0.358, p = 0.132]
Discussion: The major indications for post-traumatic PPV are RD, IOFB, vitreous hemorrhage, retinal tear, ERM, and PVR. An initial RD resulted in poorer visual outcome at 6 months and increased the need for a 2[nd] PPV. Posterior scleral perforation caused inferior vision at presentation. The existence of a PVR lowered the vision initially and at 1 week post-op
Conclusion: The shorter the delay between the trauma and the 1[st] PPV, the more often a 2[nd] PPV was needed. The BCVA at the 3 points in time were positively correlated. Finally, the initial BCVA is a key predictor of outcome, contrarily to the timing of PPV or of the foreign body removal
ABSTRACT
Diabetes and diabetic retinopathy [DR] are nowadays a major public health threat. The aim of this study is the screening of DR and diabetic maculopathy [DM] in a primary medical care center in Lebanon. We study also the interest of retinography and of SD-OCT in a tele-medicine screening program. This is a transversal study of patients with type 2 diabetes and with a regular follow-up in a primary medical care center in Beirut. For every patient, a retinography and an SD-OCT of the macula were obtained. Photos were sent by Internet to the Ophthalmology Department of Hotel-Dieu de France to be evaluated by a retina specialist. Visual acuity and DR risk factors were assessed. 119 patients were included in this study. Mean age was 51.7 +/- 10.2 years [54 females and 65 males]. Mean diabetes duration was 12.15 years [SD 6.2]. Mean of last three measurements of glycated hemoglobin was 8.1 +/- 1.34%. Diabetic retinopathy was detected in 36 patients by retinography [30.3%]. Diabetic maculopathy was confirmed by SD-OCT in 13 patients. Visual acuity was significantly correlated with central macular thickness. Mean diabetes duration, mean of last three measurements of glycated hemoglobin, peripheral neuropathy, positive macroalbuminuria and treatment with insulin were independently associated to diabetic retinopathy. Teleophthalmology is an efficient way for screening diabetic retinopathy in the Lebanese population. National screening program should be undertaken to adapt teleophthalmology on a larger scale