Retinal sensitivity following intraocular silicone oil and gas tamponade for rhegmatogenous retinal detachment.

PURPOSE: To investigate whether intraocular silicone oil (SO) tamponade is associated with functional changes in patients with both macula-on and macula-off rhegmatogenous retinal detachments (RRDs). METHODS: Prospective observational cohort study of patients with RRD treated by vitrectomy with gas or SO tamponade at the University Medical Center Utrecht. Outcome was best-corrected visual acuity (BCVA) and retinal sensitivity on microperimetry 2 months after surgery. RESULTS: In total, 40 eyes were included. There are 10 eyes in each of the following groups: macula-on RRD and gas, macula-on RRD and SO, macula-off RRD and gas, and macula-off RRD and SO. Median retinal sensitivity on microperimetry was decreased following SO tamponade compared to gas tamponade for both macula-on and macula-off RRD (p < 0.037). CONCLUSION: Foveal sensitivity was decreased in eyes after SO tamponade compared to gas tamponade. These effects were observed in patients with macula-on as well as macula-off RRD. Although further investigation is warranted to validate our results and to study underlying mechanisms, retinal surgeons need to be aware of these findings after the use of SO tamponade.

Electrolyte composition of retro-oil fluid and silicone oil-related visual loss.

PURPOSE: Up to one-third of patients with intra-ocular silicone oil (SO) tamponade for complex macula-on retinal detachment may experience an unexplained visual loss during or after SO tamponade. Although the underlying mechanism is unknown, previous studies suggested that accumulation of retinal potassium could be involved. Hence, this study tested the hypothesis that intra-ocular potassium levels are elevated during SO tamponade. METHODS: A prospective cohort study was carried out from 13 October 2013 through 5 March 2015. Potassium, sodium, magnesium, chloride, calcium, lactate dehydrogenase (LDH) and glucose levels were measured in retro-oil fluid and paired serum from 16 patients undergoing oil removal, including two patients with SO-related visual loss (SORVL). Vitreous humour and paired serum from 27 patients with macular hole (n = 19) or floaters (n = 8) served as controls. RESULTS: Median potassium levels in retro-oil fluid and vitreous humour were similar. Magnesium and chloride levels were lower in retro-oil fluid compared with vitreous humour (p < 0.01) and LDH levels were elevated in retro-oil fluid (p < 0.0001). One of the two patients with SORVL revealed abnormal high potassium and magnesium levels. The other patient had normal levels. CONCLUSION: Potassium levels are not increased in retro-oil fluid during SO tamponade, making the 'potassium accumulation' hypothesis unlikely. The disturbance in magnesium concentration during SO tamponade warrants further investigation.

INCIDENCE, RISK FACTORS, AND CLINICAL CHARACTERISTICS OF UNEXPLAINED VISUAL LOSS AFTER INTRAOCULAR SILICONE OIL FOR MACULA-ON RETINAL DETACHMENT.

PURPOSE: To investigate the incidence, risk factors, and clinical characteristics of unexplained visual loss after macula-on rhegmatogenous retinal detachment (RRD). METHODS: Retrospective cohort of patients with primary macula-on rhegmatogenous retinal detachment treated by vitrectomy with gas or silicone oil (SO) tamponade in 2011 and 2012. Outcome was unexplained visual loss (>2 Snellen lines) 2 months after the last vitrectomy. RESULTS: Incidence of unexplained visual loss was 0.7% (1/151) in patients treated by gas and 29.7% (11/37) in patients treated by SO (P = 0.001). Visual loss occurred both during SO tamponade and after removal. Cases underwent optical coherence tomography, perimetry, microperimetry, fluorescein angiography, and visual evoked potentials. Patients with unexplained visual loss after SO tamponade showed a small scotoma within the central 2° on microperimetry. Duration of SO tamponade was the only statistically significant factor related to the incidence of unexplained visual loss (P = 0.001). CONCLUSION: Incidence of SO-related visual loss was 30% with duration of tamponade as the only risk factor. This study is the first to apply microperimetry in these patients, which showed a distinct pattern of a small central scotoma. Therefore, microperimetry can be of great value in the diagnostic workup of patients with unexplained visual loss after vitrectomy.

Prognostic Factors Associated with Visual Outcome after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane.

PURPOSE: Pars plana vitrectomy with internal limiting membrane peeling for idiopathic epiretinal membrane has shown varying results. More data are needed on the factors associated with visual outcome. METHODS: We extracted baseline clinical characteristics, optical coherence tomography (OCT) characteristics and 3-month postoperative best-corrected visual acuity (BCVA). Linear regression analysis was used to evaluate whether baseline and OCT characteristics are associated with BCVA at 3 months as well as BCVA difference. RESULTS: Out of 82 operated eyes, 66 (80%) had a 3-month follow-up, and 47 (71%) showed a 3-month postoperative improvement. Preoperative BCVA was an independent determinant of postoperative BCVA (r = 0.31; p < 0.01) and BCVA difference (r = 0.68; p < 0.01). Other baseline and OCT characteristics showed no independent associations with postoperative outcome. CONCLUSION: Better preoperative BCVA predicts better postoperative BCVA. Other baseline and OCT characteristics are not associated with visual outcome 3 months after surgery.

Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review.

The aim of this study was to review the literature on predictive factors for postoperative visual acuity (VA) in surgery for idiopathic epiretinal membrane (ERM). A systematic review of the literature in the databases of PubMed and Embase was performed. The risk of bias was assessed based on predefined criteria and the results were summarized. In total, 1927 studies were retrieved of which 35 were potentially eligible. Nineteen studies were of adequate quality in terms of bias. Preoperative VA, central foveal thickness (CFT) and inner segment/outer segment (IS/OS) integrity on optical coherence tomography (OCT) were most extensively studied. Other preoperative factors studied were severity of metamorphopsia, several OCT parameters, fundus autofluorescence and multifocal electroretinogram. In the current literature, preoperative VA is the only variable consistently associated with postoperative VA. IS/OS integrity on OCT is probably associated, and the severity of metamorphopsia, cone outer segment tips integrity and fundus autofluorescence are possibly associated with postoperative VA. CFT is not associated with postoperative VA. Further studies with adequate methodological quality are needed to confirm these findings. Therefore, an overall prediction model, including different parameters, is still awaited.

The value of measuring urinary ß2-microglobulin and serum creatinine for detecting tubulointerstitial nephritis and uveitis syndrome in young patients with uveitis.

IMPORTANCE: Tubulointerstitial nephritis and uveitis (TINU) syndrome is characterized by tubulointerstitial and ocular inflammation. Thus far, the value of noninvasive diagnostic tests is not known. OBJECTIVE: To determine whether urinary ß2-microglobulin (ß2M), urinary protein, and serum creatinine have predictive value for detecting TINU syndrome in young patients with uveitis. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted July 2010 through February 2013 at a tertiary care referral center in Utrecht, the Netherlands. Forty-five consecutive new patients with uveitis aged 22 years or younger were enrolled. EXPOSURES: Urinary ß2M, urinary protein, and serum creatinine were measured prospectively, and the estimated glomerular filtration rate was calculated. MAIN OUTCOMES AND MEASURES: A post hoc analysis was performed to determine whether urinary ß2M, urinary protein, serum creatinine, estimated glomerular filtration rate, and/or pyuria were correlated with definitive and probable cases of TINU syndrome. RESULTS: Eighteen of the 45 patients (40%) in our cohort had elevated urinary ß2M levels, and 10 patients (22%) had elevated serum creatinine levels. Twenty of 43 patients (47%) had proteinuria. Eight of the 45 patients were diagnosed by a pediatric nephrologist as having renal dysfunction that suggested acute interstitial nephritis. Of these 8 patients, 2 were definitively diagnosed as having TINU syndrome (confirmed by renal biopsy). After excluding other causes of renal dysfunction, the remaining 6 patients with uveitis and renal dysfunction fulfilled the criteria of probable TINU syndrome. The 8 patients with definitive or probable TINU syndrome had higher urinary ß2M levels than patients with normal renal function (median ß2M, 1.95 mg/L; 95% CI, 1.26-5.16 mg/L vs 0.20 mg/L; 95% CI, 0.19-0.21 mg/L; P < .001; Mann-Whitney U test). Our analysis revealed that the positive predictive value of increased ß2M combined with increased serum creatinine was 100% for detecting definitive and/or probable TINU syndrome. CONCLUSIONS AND RELEVANCE: These data suggest that urinary ß2M and serum creatinine levels are sensitive and relatively simple diagnostic screening tools for detecting renal dysfunction to diagnose TINU syndrome in young patients with uveitis similar to those evaluated in this study.

Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone.

PURPOSE: To compare the donor site complication rate and length of hospital stay following the harvest of bone from the iliac crest, calvarium, or mandibular ramus. MATERIALS AND METHODS: Ninety-nine consecutively treated patients were included in this retrospective observational single-center study. RESULTS: Iliac crest bone was harvested in 55 patients, calvarial bone in 26 patients, and mandibular ramus bone in 18 patients. Harvesting of mandibular ramus bone was associated with the lowest percentages of major complications (5.6%), minor complications (22.2%), and total complications (27.8%). Harvesting of iliac crest bone was related to the highest percentages of minor complications (56.4%) and total complications (63.6%), whereas harvesting of calvarial bone induced the highest percentage of major complications (19.2%). The length of the hospital stay was significantly influenced by the choice of donor site (P = .003) and age (P = .009); young patients with the mandibular ramus as the donor site had the shortest hospital stay. CONCLUSIONS: Harvesting of mandibular ramus bone was associated with the lowest percentage of complications and the shortest hospital stay. When the amount of bone to be obtained is deemed sufficient, mandibular ramus bone should be the first choice for the reconstruction of maxillofacial defects.

The effect of an Ahmed glaucoma valve implant on corneal endothelial cell density in children with glaucoma secondary to uveitis.

PURPOSE: To assess the effect of Ahmed glaucoma valve implants on corneal endothelial cell density (ECD) in children with uveitic glaucoma. DESIGN: Cross-sectional study. METHODS: setting: Institutional. patientpopulation: Eighty eyes from 42 patients diagnosed with uveitis before the age of 16. Twenty-eight eyes had an Ahmed glaucoma valve implant because of secondary glaucoma. Fifty-two eyes without an implant served as controls. intervention orobservationprocedure(s): Corneal ECD was examined cross-sectionally using a noncontact specular microscope. Univariate and multivariate generalized estimating equations analyses with correction for paired eyes were performed. mainoutcomemeasure(s): Correlation of ECD with the presence of an Ahmed glaucoma valve implant and with the time following implantation. RESULTS: ECD was significantly lower in the Ahmed glaucoma valve group than in controls (2359 and 3088 cells/mm(2), respectively; P < .001) following an average of 3.5 years after Ahmed glaucoma valve implantation. Presence of an Ahmed glaucoma valve implant, previous intraocular surgery, age, duration of uveitis, and history of corneal touch by the implant tube were all significantly associated with decreased ECD. Following a multivariate analysis, presence of an Ahmed glaucoma valve implant (B = -340; adjusted P < .011) and older age (B = -58; adjusted P = .005) remained independently associated with decreased ECD. Within the implant group, the age-adjusted time interval following Ahmed glaucoma valve implantation was highly correlated with decreased ECD (B = -558, P < .001). CONCLUSIONS: Ahmed glaucoma valve implants in children with uveitic glaucoma are independently associated with decreased ECD, and this effect is associated with the time interval following Ahmed glaucoma valve implantation.