Short Term Visual and Refractive Outcome following Surgical Intervention forPosterior Capsule Opacification (PCO) in Children in a Tertiary Eye Hospital

BACKGROUND: PCO occurs commonly postoperatively followingcataract extraction in children, obscuring vision as did the initialcataract. It may require a second surgical procedure when it is dense.It is expected that this results in restoration of vision and it is importantto ascertain that this is the case as well as to examine any significantchanges in refraction thereafter.M ETHODS: A retrospective observational study extractingdemographic and clinical information from case notes of patients whohad membranectomy and/or capsule polishing between October 2017and September 2018.RESULTS: 57 eyes of 51 patients were enrolled. There was a 2:1male: female ratio. Mean age at cataract surgery was 6.33 3.59yearswhilst that for PCO surgery was 9.68 3.89years. Postoperativevisual acuity (by WHO definition) was good (between 6/6 and 6/18)in 33.3%, compared to 8.8% preoperatively. Whereas presenting visualacuity was poor (<6/60) in 61.4% preoperatively, this reduced to30% postoperatively. Visual outcome was influenced by age at cataractsurgery, age at PCO surgery, interval between cataract and PCO surgeryand type of cataract. Children >8 years of age at time of PCO surgeryhad a greater proportion of good post-operative best corrected visualacuity (BCVA) (52.6%), whilst 75% of children younger than 8yearsat time of surgery turned out with poor BCVA after surgery.Developmental cataracts proportionately had the best outcome ofvisual acuity. There was a range of refractive shift of +0.25D to ­5.25D with a mean myopic shift of ­1.51D following membranectomy. CONCLUSION: There was a good proportion of children withsignificant improvement in visual acuity on the short term,and a mildmyopic shift following membranectomy.

All Persistent Pupillary Membranes need not be treated - A case report

Persistent Pupillary Membrane is a common congenital anomaly which appears as a dense network of tissue across the pupil. It is usually asymptomatic, although blurring of vision can be seen in extensive conditions. This is a hospital based case study of an eleven year old girl with bilateral Persistent Pupillary Membrane since birth. The aim of the study is to establish that the treatment approach varies specific to the individual case and when asymptomatic, it can be safely left untreated as in the present study. Surgical Membranectomy, Pupilloplasty, Argon Laser Photocoagulation are the treatment options that can be considered in case of symptomatic conditions.

Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

PURPOSE: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.METHODS: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.RESULTS: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.CONCLUSIONS: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.

A Case of Acute Fibrin Pupillary Block Diagnosed by Ultrasonic Biomicroscopy

PURPOSE: To report a case of fibrin pupillary block diagnosed by ultrasonic biomicroscopy (UBM) and treated by argon-neodymium:YAG (Nd:YAG) laser in a patient with uveitis. CASE SUMMARY: A 56-year-old man visited the hospital for decreasing visual acuity and a sudden onset of pain in the right eye. Best corrected visual acuity was 0.02 in the right eye and 1.0 in the left eye. Intraocular pressure (IOP) was 48 mm Hg in the right eye and 18 mm Hg in the left eye. Slit-lamp examination revealed diffuse corneal stromal edema with Descemet's folds and uniform shallowing of the anterior chamber, with 360 degrees of peripheral iridocorneal touch in the right eye. A fibrin membrane was present across the pupil. UBM showed a fibrin membrane across the pupil, uniform shallowing of the anterior chamber, and peripheral angle closure. The lens was displaced posteriorly. A sequential Nd:YAG laser membranectomy was performed that same day, with immediate deepening of the anterior chamber and normalization of the IOP. CONCLUSIONS: UBM can play an invaluable role in the diagnosis of fibrin pupillary block by showing the presence of a fibrin pupillary membrane, accumulation of aqueous in the posterior chamber, and a clear separation between the iris and the lens. Nd:YAG laser membranectomy can be performed effectively in a fibrin pupillary block.

Remained Macular Edema After Surgical Treatment in Patients With Epiretinal Membrane

PURPOSE: To investigate the clinical features of patients with macular edema persisting for three months after a successful vitrectomy and removal of the epiretinal membrane. METHODS: The authors retrospectively reviewed the records of 32 patients (32 eyes) with epiretinal membranes who underwent pars plana vitrectomies and membranectomies from January 2005 to September 2008. The patients selected for the study underwent optical coherence tomography (OCT) which revealed macular edema. Macular edema is defined as central macular thickness measuring over 300 m. Several factors including age, presence of systemic disorders, preoperative visual acuity, surgical technique, preoperative state of the macula, and the response to treatment for macular edema were reviewed. RESULTS: Eight out of 32 eyes (25%) had no improvement of visual acuity after surgery of the epiretinal membrane. Six out of 32 eyes (18.75%) persisted in their macular edema. No common features were detected. All patients showed no improvement of visual acuity after their vitrectomies. Two of the eyes were treated with intravitreal or subtenon triamcinolone injection or non-steroidal anti-inflammatory eye drops. Only one eye (16.7%) achieved visual improvement as of the last follow-up. CONCLUSIONS: Despite a successful vitrectomy and membranectomy, macular edema can remain without any specific cause. Persistantmacular edema appears to be a main cause of poor visual outcome and tends to resist conventional treatment.

Management of choroidal neovascularization following laser photocoagulation for central serous chorioretinopathy

Little is known about the natural history and management of choroidal neovascularization (CNV) which developed as a complication of laser photocoagulation for central serous chorioretinopathy (CSC). We experienced two patients with CNV which developed after laser treatment for CSC. Submacular membranectomy was performed on both cases after the confirmation of subretinal CNV with optical coherence tomography. One patient received photodynamic therapy for recurrent CNV. The vision of both patients has been improved over 6 months of follow up. These cases suggest that active intervention, including submacular surgery, improves the visual prognosis of this condition.

Clinical Study on Chronic Subdural Hematoma

We have done clinical analysis of 92 cases with chronic subdural hematoma, admitted to our department from August 1, 1984 to July 31, 1987. The following results were obtained; 1) The ratio of male versus female was 3.6:1, and 6 cases(71.7%) were over 50 year-old age. 2) 50 cases(75.7%) in older group(over 50) had head trauma history, and 11 cases(42.3%) in younger group(under 50). 3) The major clinical symptoms and signs in older group were mental deterioration and hemiparesis, in younger group headache and vomiting. 4) The hematoma densities in CT on admission were hyperdense 1.0%, isodense 33.7%, hypodense 39.3%, and mixed 25.9%. The shapes were biconvex 45.7%, planoconvex 35.8%, and crescenteric 18.5%. 5) The operation method was either burr hole drainage, or craniotomy with membranectomy, according to patient's physical condition and CT findings. In postoperative results there was no significant difference in both.

A Clinical Analysis of Chronic Subdural Hematoma in Aged Person

A series of 41 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Catholic Medical College Hospital from May 1, 1980 to May 1, 1984 is presented. The following results were obtained : 1) Male were more frequently involved than female with the ratio of 4.9:1. The over 50 years old age group were predominately 75.6%. 2) The etiologic factors reveal younger group(under 50) has mainly unidentified factors, but older group(over 50) has mainly head trauma history and alcoholism. 3) Older group had more frequently focal neurologic deficit such as hemiplegia, however younger group presented as increased intracranial pressure signs such as headache and vomiting. 4) The hematoma density of C-T scan on admission was hypodense 50%, isodense 30%, mixed 28%, hyperdense 2% and no correlation to age. 5) Younger group performed burr hole with drainage, and older group performed craniotomy with removal of hematoma, but post-operative results were significantly good in older group with craniotomy.

A Clinical Analysis of Chronic Subdural Hematoma with Special Reference to the Follow-up CT-scan and Osmolarity of Hematoma

A series of 70 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Kyung Hee University Hospital from Aug. 1, 1977 to July 31, 1982 is presented. The following results were obtained. 1) Males were more frequently involved than female with the ratio of 4.8 : 1. Peak age incidence was 6th and 7th decade. Bilateral subdural collections were only 4 cases and others were unilateral. 2) Older age(more than 50) had more frequently focal neurologic deficit such as hemiplegia, however younger age(less than 50) presented as increased intracranial pressure signs such as headache and vomiting. 3) The hematoma density of CT-scan on admission was hypertense, 3 cases(4.9%); mixed density, 20 cases(32.8%); isodense, 18 cases(29.8%); and hypodense, 20 cases(32.8%) respectively. 4) The operative method between simple burr hole drainage and craniotomy with membranectomy didn't affect the postoperative results. The operative mortality was 2.9%. 5) Follow-up CT scanning was performed in 32 patients, only 8 of them showed normal CT findings within one month after operation. One patient still showed remnant of hematoma on 50th postoperative day. 6) Osmolarities of the hematoma and systemic venous blood were measured simultaneously 10 times in 8 cases. Hematoma osmolarities were isosmolar 1, hyperosmolar 6 and hyposmolar 3 compared with systemic venous blood.

Clinical Observation, of Chronic Subdural Hematomas (Burr hole, Drainage and Craniotomy, Membranectomy)

The authors have presented 44 cases of chronic subdural hematoma which were diagnosed by brain computerized tomographic (CT) scan at the Department of Neurosugery, Keimyung University, School of Medicine from May 1980 to July 1982. There were 42 men and 2 women. The common incidence of age was between fourth and fifth decade. Most of the cases(80%) had a history of head injury and nearly all cases complained headache(93%). The most common sign was papilledema(71%) in relatively young age patients and mental change(62%) in old age patients. All cases performed brain CT scan, which showed hypodense(41%), isodense(21%), hyperdense(21%) and mixed dense(18%) lesion. The thickness of hematoma which was measured by brain CT scan revealed 10 mm-30mm in most cases and showed the tendency of increase in old age patients. Of 44 cases, 23 cases were treated with craniotomy and membranectomy, 18 cases with burr hole and drainage, and 3 cases which were bilateral lesion with both methods. There was not any different result in both methods and most of all cases showed good postoperative course except 3 cases of poor preoperative state.