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.

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.

[Developments in corneal transplants: lamellar techniques emerging]. / Ontwikkelingen in corneatransplantatie: lamellaire technieken in opkomst.

Corneal transplants are the most frequently performed human transplant procedure. In the last decade, we have seen large developments in the field of corneal transplant surgery. Currently, several techniques are being used in the Netherlands, each with its own advantages and disadvantages and with distinct indications. In penetrating keratoplasty all layers of the cornea are replaced by a donor cornea. In so-called lamellar corneal transplantation only the affected layer of the cornea is replaced by donor tissue. The developments in corneal transplantation surgery have resulted in an improved prognosis in terms of vision and fewer complications.

Cataract surgery in patients with nanophthalmos.

PURPOSE: To report the visual outcomes and complications of cataract surgery in a large series of patients with nanophthalmos. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Forty-three eyes with an axial length ≤ 20.5 mm of 32 adult patients who underwent cataract surgery in a tertiary clinic. METHODS: Medical records of patients undergoing cataract surgery between 1994 and 2010 were reviewed. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) at 6 months after surgery and postoperative complications occurring during the entire follow-up period. RESULTS: Forty-three eyes of 32 patients (aged 19-87 years; median, 69 years) were included. Cataract surgery resulted in improvement of ≥ 3 Snellen lines in 19 eyes (44.2%). Two eyes (4.7%) lost ≥ 3 Snellen lines because of corneal decompensation in one and angle-closure glaucoma in the other. During the entire follow-up period, complications occurred in 12 eyes (27.9%). The most frequent complications were uveal effusion (9.3%) and cystoid macular edema (CME) (7.0%). CONCLUSIONS: Cataract surgery in patients with nanophthalmos remains a surgical challenge, and complications often occur in these high-risk eyes.

Steroid injection in addition to macular laser grid photocoagulation in diabetic macular oedema: a systematic review.

OBJECTIVES: This study aimed to evaluate the evidence for the effects of steroid injection in addition to macular laser grid (MLG) photocoagulation versus those of MLG photocoagulation alone on visual acuity (VA) in patients with diabetic macular oedema (DMO). METHODS: An extensive literature search in Medline (PubMed), Experta Medica (EMBASE) and the Cochrane Library (CENTRAL) using synonyms for MLG photocoagulation, steroid injection and DMO found 181 articles. Of the articles that met selection criteria, three studies in which patients receiving MLG photocoagulation were randomized to additional pretreatment with steroids provided the best available evidence. In addition to VA, central foveal thickness (CFT) was measured at baseline and at 6 months in all three studies. RESULTS: Two studies, with total populations of 73 and 42 eyes, respectively, reported no additional effect of steroid injection on VA. One study, with a total of 41 eyes, reported a beneficial effect of pretreatment with steroids on VA of -0.21 ETDRS logMAR units. All three studies reported larger reductions in CFT in eyes pretreated with steroids, the smallest of which was 64 microm. CONCLUSIONS: Although there is a greater reduction in CFT in eyes pretreated with steroids, this does not consistently result in higher VA. The literature search does not provide sufficiently strong evidence to recommend steroid injection before MLG photocoagulation in DMO.

[Vitrectomy: in search of the ideal vitreous replacement]. / Vitrectomie: op zoek naar de ideale glasvochtvervanging.

Pars plana vitrectomy is a form of surgery to remove the vitreous body. It is performed with various eye diseases. Replacement of the vitreous body is necessitated by its removal. After more than 50 years the search for the ideal vitreous replacement has not yet ended. Different materials are used to replace the vitreous body. The advantages, disadvantages and applications of those materials are discussed. The lack of a material to successfully replace the vitreous body is a significant restriction in the treatment vitreoretinal pathologies.