Quantitative evaluation of metamorphopsia with M-CHARTS™ and evaluation of retinal morphologic changes by optical coherence tomography before and after pars plana vitrectomy in patients with idiopathic epiretinal membrane.

PURPOSE: We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores. MATERIALS AND METHODS: This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (group1) and patients with decreasing metamorphopsia scores as the other group (group 2). RESULTS: In "group 2", preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (P: 0.028) higher than in "group 1". CONCLUSION: A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery.

Nonarteritic anterior ischemic optic neuropathy in young patients.

PURPOSE: To determine and report the demographic and clinical features of patients younger than 50 years with nonarteritic anterior ischemic optic neuropathy (NAION). MATERIAL AND METHODS: In this comparative study, we retrospectively reviewed the medical records of 120 patients with NAION. Patients were divided into two groups according to their age; in group I, 44 patients were younger than 50 years, and in group II, 76 patients were older than 50 years. RESULTS: The gender distribution was similar in both main groups. Involvement was bilateral in 50% and 26.3% of patients, respectively (P<0.0001). Diabetes mellitus was present in 63.6% of patients in group I and 47.3% of patients in group II (P=0.009). We found hypertension as a frequent risk factor in group II (P=0.019). There was no significant difference in the initial and final visual acuities of patients between the two groups. Both groups had a significantly thinner peripapillary nerve fiber layer (RNFL) in every quadrant. The relative loss was greatest in the superior quadrant in both groups. We generally observed inferior altitudinal defect and superior RNFL thinning in two groups. In group I, 30 eyes (68.1%) demonstrated angiographically diffuse optic disc filling delay of ≥5seconds after choroidal filling confirming ischemia, and 14 (31.8%) eyes with segmental optic disc filling delay. In group II, diffuse optic disc filling delay was seen in 56 of 76 (73.6%) eyes. Segmental optic disc filling delay was present in 20 eyes (26.3%). There was no significant difference in angiographic findings between the two groups (P=0.67). CONCLUSION: We observed that age did not play a significant role in prognosis of NAION. Diabetes is an increased risk for NAION in the young age group, and HT for NAION in the older group. Fellow eye involvement is more frequent in young patients. These patients should be followed closely.

A survey of the management of neuromuscular blockade monitoring in Australia and New Zealand.

This survey of anaesthetists in Australia and New Zealand aimed to investigate their attitudes and practice relating to the management of neuromuscular blockade monitoring. All medical practitioner members (3188) of the Australian and New Zealand Societies of Anaesthetists were invited to complete an anonymous survey, which was available online for two months. A total of 678 survey questionnaires were completed (response rate 21%). Most respondents (71.4%) underestimated the incidence of residual neuromuscular blockade and 63.2% believed this to be a significant clinical problem. Objective monitoring of neuromuscular function was used routinely only by 17% of respondents, although 70% believed routine monitoring would reduce the incidence of residual neuromuscular blockade. Only 25% of respondents correctly indicated that quantitative train-of-four counts of greater than 90% were the accepted criteria for safe extubation, with 52% using clinical judgement only. Only 29% of respondents believed neuromuscular function monitors should be part of minimum monitoring standards; quantitative neuromuscular function monitors were not available in 42% of the hospitals in which the respondents practiced. Despite the low response rate, the large sample size and heterogeneity of respondents make the findings of this survey concerning. There is a need for more education, availability of appropriate monitoring equipment and evidence-based guidelines for management of neuromuscular blockade in Australia and New Zealand.