Vitreoretinal surgery on the fellow eye: A retrospective analysis of 18 years of surgical data from a tertiary center in England

Purpose: To determine the long-term incidence of fellow-eye surgical involvement in patients who have undergone first-eye vitreoretinal (VR) surgery for a variety of indications. This was a single-institution retrospective, consecutive series. Methods: Eighteen years of electronic surgical data were reviewed at our institution. All patients having surgery for the following indications were included: rhegmatogenous retinal detachment (RRD), macular hole (MH), epiretinal membrane (ERM), proliferative diabetic retinopathy (PDR), vitritis, and dropped nucleus. Primary outcome was the cumulative incidence of fellow-eye surgery at 10 years by Kaplan朚eier analysis. Results: Total follow-up was 29,629 patient-years. Cumulative incidence (� standard error) of fellow-eye surgery at 10 years was 7.2% � 0.6% for RRD, 9.1% � 1.3% for ERM, 7.5% � 1.8% for MH, 30.6% � 1.9% for PDR, 13.7% � 2.9% for vitritis, and 2.8% � 1.6% for dropped nuclei. The hazard for second-eye surgery was greatest in the early postoperative period after first-eye surgery for all indications. For RRD, the hazard was 2.7% � 0.3% at year 1, 1.1% � 0.2% at year 2, and 0.5% � 0.2% at year 5. Risk factors for fellow-eye involvement for RRD were younger age (P < 0.001) and male gender (P < 0.01). Conclusion: We report the long-term risk of fellow-eye involvement in various VR pathologies, which is important in counseling patients regarding their risks as well as planning service provision.

Comparison of Inner Retinal Thickness between the Fellow Eyes of Unilateral Branch Retinal Vein Occlusion and Normal Control

PURPOSE: The purpose of this study was to compare inner retinal thickness and retinal nerve fiber layer (RNFL) thickness between fellow eyes with unilateral branch retinal vein occlusion (BRVO) and normal control eyes. METHODS: Retrospective cross-sectional study including 59 patients diagnosed with unilateral BRVO and 51 control subjects. Using spectral domain optical coherence tomography, we investigated the average, 4 quadrant, and 12 clock-hour RNFL thicknesses and the average, minimum, superior, superonasal, superotemporal, inferior, inferonasal, and inferotemporal thicknesses of the ganglion cell-inner plexiform layer (GCIPL) layer. RESULTS: Patients with unilateral BRVO had a higher incidence of hypertension. In the fellow eyes of the unilateral BRVO patients, 7 and 11 o'clock RNFL thicknesses were significantly thinner than for the control eyes. There was no significant difference in the GCIPL thickness between the two groups CONCLUSIONS: The RNFL thickness of the fellow eyes of the unilateral BRVO patients showed significant decreases in the 7 and 11 o'clock sectors (p=0.005, 0.017, respectively), whereas there was no significant difference in the GCIPL thickness between the two groups. In the RNFL thickness analysis, the 7 and 11 o'clock sectors were found to be dominant locations of decreased RNFL thickness for the open angle glaucoma. Further, glaucomatous change should be carefully monitored in the fellow eyes of unilateral BRVO patients.

Medida del grosor central coroideo con tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT) en ojos contralaterales de pacientes con coriorretinopatía serosa central (CSC) / Central choroidal thickness measured by enhanced depth imaging (EDI OCT) in fellow eyes of subjects with central serous chorioretinopathy (CSC)

Diseño: Estudio descriptivo y trasversal. Objetivos: Medición del grosor coroideomacular en el ojo contralateral (ojo sano) de pacientes con coriorretinopatía serosa central (CSC), utilizando tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT). Pacientes y métodos: Fueron evaluados 32 ojos de 16 pacientes voluntarios, con diagnostico de coriorretinopatía serosa central (CSC) aguda. Ambos ojos fueron sometidos a estudio de tomografía óptica de dominio espectral con profundidad mejorada (EDI SD-OCT) con el Tomógrafo RTVue® (Optovue, USA). Se realizó escaneo horizontal de alta definición a través de la fóvea, tanto en el ojo afectado, como en el sano contralateral. Se realizaron 5 medidas del grosor coroideo. El promedio del grosor coroideo fue calculado y comparado, entre los ojos con CSC y el ojo contralateral. Resultados: El promedio de edad fue de 40+/-7 (rango entre 29 y 56 años). Quince de los 16 ojos sintomáticos eran derechos. Dos mujeres y 14 hombres. La media del grosor coroideo en el ojo sintomático fue de 470.4+/-35.7µm, y en el ojo contralateral el grosor fue de 413.4+/-47.1µm. La relación entre ambos ojos mostró una alta correlación (0,979) y una correlación estadísticamente significativa (p<0.001). Conclusión: La tomografía óptica coherente de dominio espectral con profundidad mejorada, es una herramienta útil en evaluar el grosor coroideo en pacientes con CSC, donde el grosor coroideo también aparece aumentado en el ojo contralateral.

Design: Descriptive and cross-sectional study. Objective: To measure macular choroidal thickness in fellow eyes of patients with central serous chorioretinopathy, using enhanced depth imaging optical coherence tomography (EDI OCT). Patients and methods: This is a descriptive, cross-sectional study. A total of 32 eyes of 16 patients were evaluated. Sixteen volunteers with acute central serous corioretinopathy (CSC) diagnosis underwent high-definition scanning using SD-OCT (RTVue®, Optovue, USA) with enhanced depth imaging technique (EDI OCT) in both eyes. One horizontal scan across the fovea was selected for each affected and healthy eye, five choroidal thickness measurements were taken. The average choroidal thickness was also calculated and compared among eyes with CSC and fellow eyes. Results: Mean age was 40+/-7 years (range between 29 and 56 years old). Fifteen of 16 symptomatic eyes where right eyes. Two women and 14 men were involved. The mean choroidal thickness in symptomatic eyes was 470.4+/-35.7 µm, and the fellow eyes thickness was 413.4+/-47.1 µm. The matching shows a high correlation (0,979) between paired samples and statistical signifi cance of its correlation (p<0.001). Conclusions: Enhanced depth imaging spectral-domain optical coherence tomography is a helpful tool for assessing choroidal thickness in fellow eyes of patients with CSC, where the choroid is as thickened as in affected eyes.

The Effect of Unilateral Superior Rectus Recession for Dissociated Vertical Deviation (DVD)

PURPOSE: This study analyzed the outcome of unilateral superior rectus recession in patients with asymmetrical dissociated vertical deviation (DVD) in terms of effectiveness and influence on the fellow eye. METHODS: Medical records of 40 patients (40 eyes) who had undergone unilateral superior rectus recession for the treatment of asymmetrical DVD were retrospectively reviewed from February 1993 to March 2009. The minimum follow-up period was 1 year after the operation. RESULTS: The overall success rate in the operated eye was 97.5% at 12 months and 90% at the last follow-up. However, a DVD larger than 10 PD developed in the fellow eye in 20% (8) of the patients. In patients who preoperatively had DVD in their fellow eyes, 50% developed DVD postoperatively in their fellow eyes. In patients who preoperatively did not have DVD in their fellow eyes, 14.7% developed DVD postoperatively in their fellow eyes. Furthermore, the angle of the DVD in the fellow eye increased with the surgical dosage. CONCLUSIONS: Unilateral SR recession is effective in patients with asymmetrical DVD. However, a high incidence rate of DVD in the fellow eye should be considered, especially when preoperatively there is a small DVD in the fellow eye or a large DVD angle in the operated eye, whenever monocular superior rectus recession surgery is performed.

Subfoveal Choroidal Thickness in Fellow Eyes of Patients with Central Serous Chorioretinopathy

PURPOSE: To determine the relationship between subfoveal choroidal thickness of fellow eyes and choroidal vascular hyperpermeability in unilateral central serous chorioretinopathy (CSC). METHODS: Thirty patients with unilateral CSC and 28 normal subjects underwent enhanced depth imaging spectral-domain optical coherence tomography to evaluate bilateral subfoveal choroidal thickness. The subfoveal choroidal thickness was measured from the outer RPE border to the inner sclera border. Choroidal vascular hyperpermeability was visualized with indocyanine green angiography (ICGA) and analyzed. RESULTS: The mean subfoveal choroidal thickness in the affected eyes (439.6 +/- 136.5 microm) was significantly thicker than that in fellow eyes (340.0 +/- 103.3 microm, p = 0.002), and both showed statistically significant difference compared with normal subjects (266.5 +/- 111.5 microm, p < 0.001, p = 0.019). The subfoveal choroidal thickness of fellow eyes with choroidal vascular hyperpermeability was 370.0 +/- 176.5 microm, which differed significantly (p = 0.037) from the choroid without choroidal vascular hyperpermeability. The choroidal thickness of acute CSC was 441.6 +/- 118.6 microm, and that of chronic CSC was 454 +/- 166.5 microm, a difference that was not statistically significant (p = 0.676). CONCLUSIONS: The subfoveal choroid with hyperpermeability was thicker than that without hyperpermeability on ICGA in the fellow eyes of patients with unilateral CSC. Enhanced depth imaging spectral-domain optical coherence tomography can indirectly evaluate the effects of choroidal hyperpermeability by noninvasively measuring the choroidal thickness.

Follow-up of laser peripheral iridotomy in fellow eyes with unilateral acute attack of primary angle closure glaucoma / 中华实验眼科杂志

Background Laser peripheral iridotomy(LPI) is used as the primary therapy for the eyes at risk of angle closure.But there are still 28% eyes with primary angle closure suspect occur angle closure within 2 years after LPI.It is necessary to explore the associated factors of the efficacy of LPI.Objective The aim of this study was to explore the changes of intraocular pressure(IOP) and anterior chamber angle in the fellow eyes of patients with unilateral acute attack of primary angle closure glaucoma (PACG) and analyze the relevant factors influencing the successful rate of LPI.Methods Eighty-seven fellow eyes received LPI from 87 patients with unilateral acute attack of PACG were included in this study and retrospectively analyzed.The IOP and gonioscopy were performed before and 1 week,3,6,9,12 months after LPI.Successful signs of LPI were defined as an IOP 6-21mmHg without any anti-glaucoma medication,none of glaucomatous neuropathy and the coincident visual field loss,and no need of additional glaucomatous medication or surgery.This study was approved by Ethic Committee of the First Hospital of Xinxiang Medical College,and written informed consent was obtained from each patient.Results Seventy-nine eyes of 79 cases finished the medical visit throughout the follow-up duration with the age 61.4±0.4 years and 33(41.8%) males and 46(58.2%) females.The mean IOP was lowed in various time points after LPI in comparison with before operation with the general difference among different time visiting groups(F=4.056,P＜0.01).Shaffer grade was increased in superior,temporal and nasal quadrants and significant differences were found between 1 week group,3 months group or 6 months group and before operation group (P＜0.05).LPI lessened the range of appositional angle closure (AAC) in postoperative 1 week group and 3 months group compared with pre-operative group (P＜0.05),but no statistically significant reduce was seen in range of AAC from 6 months through 12 months after LPI in comparison with pre-operation (P＞0.05).LPI was determined as successful in 61 cases (77.2%) during one-year fellow-up period.Several variables,such as preoperative IOP,Shaffer grade of each quadrant,mean Shaffer grade and the extent of AAC,were significantly different between LPI success and failure group(P＜0.01).Cox stepwise regression analysis found that the success rate was significantly associated with the extent of AAC (Wald=48.150,RR=1.963,P＜0.01) rather than pre-IOP,Shaffer grade of each quadrant,mean Shaffer grade,age and gender (P＞0.05).Conclusion LPI can widen the anterior chamber angle and low IOP in the fellow eyes of PACG attack eyes.The success rate of LPI is associated with the extent of pre-AAC,suggesting that it is necessary for LPI in consideration of the extent of pre-AAC.

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Glaucomatous Optic Nerve Damage in the Fellow Eyes of Acute Angle-Closure Glaucoma

PURPOSE: To determine whether glaucomatous optic nerve damage occurs in the fellow eyes of patients with unilateral acute primary angle-closure glaucoma. METHODS: This study included both eyes of 75 subjects with unilateral acute primary angle-closure glaucoma in one eye, and 92 eyes of age- and refraction-matched normal controls. The presence or absence of qualitative signs for differentiating between normal and glaucoma eyes, vertical cup to disc ratio, and extent of zone beta were recorded. All subjects underwent examination with a Humphrey Field Analyser. RESULTS: Twelve fellow eyes (16%), 28 attacked eyes (37.3%), and no eyes in the control group had a vertical cup to disc ratio of 0.7 or greater (p<0.05). Thinnest rim width outside the temporal sector, rim shape alteration (alteration of ISN'T rule), baring of circumlinear vessel, and abnormal form of peripapillary atrophy were detected more frequently in fellow eyes than in normal controls (P<0.05). After excluding the attacked eyes with vertical cup to disc ratios of 0.69 or less and their fellow eyes, interocular correlation of mean deviation (r=0.31), corrected pattern standard deviation (r=0.32), extent of zone beta (r=0.57), and vertical cup to disc ratio (r=0.38) for attacked and fellow eyes were significant (p<0.05). CONCLUSIONS: Some of the fellow eyes of patients with unilateral acute primary angle-closure glaucoma had glaucomatous optic nerve damage, particularly the fellow eyes with a large cup to disc ratio.

Clinical Analysis of Glaucoma Patients Undergone Filtration Surgery

PURPOSE: We evaluated clinical aspects of the glaucoma patients who had undergone trabeculectomy. METHODS: We analyzed 211 patients' medical records who had undergone trabeculectomy in Chungbuk National University Hospital from August 1991 to December 1999 retrospectively. RESULTS: The mean age of the patients was 57.1+/-16.3 years and the 119 eyes (56.4%) had bilateral glaucoma. Among them, 57 eyes (47.9%) had primary open-angle glaucoma. Cataract was the most common cause of decreased vision in the fellow eye during the mean follow-up period of 25.4+/-22.3 months. The number of patients whose visual acuity in the fellow eyes less or equal to hand movement before surgery were 25 eyes (11.8%) and they resulted from glaucoma (18 eyes) and trauma (4 eyes). CONCLUSIONS: The fellow eyes of the glaucoma patients who had undergone trabeculectomy were easily subject to high prevalence of glaucoma that may lead to blindness. Therefore, more thorough and periodic ocular examination and appropriate treatments are mandatory to prevent further progress in these eyes with more advanced glaucoma.

The Change in Palpebral Fissure Height of Bilateral Eyes after Uniateral Cataract Operation

To investigate the change in upper eyelid position after cataract operation, We studied 40 eyes of 40 patients prospectively who underwent phacoemulsification and intraocular lens implantation. Levator function and vertical palpebral lid fissure height were measured preoperatively and at postoperative day 1, 7, 28 and 56 in and the surgical and the fellow eyes. Postoperative mean vertical lid fissure height decreased compared with preoperative mean vertical lid fissure height in both eyes. The postoperative decrease in vertical lid fissure height tended to decrease with times and these trends had statistically significant correlation between both eyes. This suggests that both eyes are affected by factors unassociated with the cataract surgery and it is most apparent in the immediate postoperative period. In conclusion, we recommend not only the surgical eye but the fellow eye should be evaluated preoperatively and postoperatively to understand the eyelid position after cataract operation.