Retinal Displacement after Scleral Buckle versus Combined Buckle and Vitrectomy for Rhegmatogenous Retinal Detachment: ALIGN Scleral Buckle versus Pars Plana Vitrectomy with Scleral Buckle.

PURPOSE: To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB). DESIGN: Multicenter prospective nonrandomized clinical trial. METHODS: The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael's Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB. RESULTS: Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067). CONCLUSIONS: Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of surgical outcomes after removal of epiretinal membrane associated with retinal break and idiopathic epiretinal membrane.

PURPOSE: To compare the surgical outcomes of epiretinal membranes (ERMs) associated with retinal break and idiopathic ERMs. METHODS: This retrospective study included patients with an idiopathic ERM or an ERM associated with retinal break, who were followed up for ≥ 6 months after ERM removal. The postoperative functional and anatomical outcomes were compared between the groups. RESULTS: A total of 160 and 38 eyes (198 patients) were in the idiopathic and retinal break groups, respectively. There was no significant difference in the baseline anatomical and functional parameters between the groups. At 6 months after surgery and at the final follow-up, best-corrected visual acuity, central foveal thickness, and ectopic inner foveal layer improved significantly in both groups, but there was no significant difference between the groups. In latter 49.0% of patients, tests for metamorphopsia and aniseikonia were performed. There was a significant improvement in the scores of metamorphopsia (0.40 ± 0.38 to 0.27 ± 0.28; p < 0.001) and aniseikonia (6.07 ± 4.46 to 4.11 ± 3.52; p < 0.001) in the idiopathic group at 6 months after surgery, but not in the retinal break group. The idiopathic group had significantly greater circularity of ERM extent compared to the retinal break group (p = 0.025). CONCLUSION: Visual and anatomical improvements after removal of ERMs associated with retinal break and idiopathic ERMs were comparable. However, metamorphopsia and aniseikonia improved only after removal of idiopathic ERMs.

Aniseikonia in various retinal disorders.

PURPOSE: The purpose was to quantify and compare the severity of aniseikonia in patients undergoing vitrectomy for various retinal disorders. METHODS: We studied 357 patients with retinal disorders including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch / central retinal vein occlusion (BRVO-CME / CRVO-CME), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD) as well as 31 normal controls. The amount of aniseikonia was measured using the New Aniseikonia Test preoperatively and at 6 months postoperatively. RESULTS: Of all patients, 59% presented aniseikonia. Preoperative and postoperative mean aniseikonia were 4.0 ± 4.1% and 3.0 ± 3.6%, respectively. In particular, 68% of patients with ERM had macropsia, and approximately half of MH, RVO-CME, DME, and M-off RD patients had micropsia. Preoperative aniseikonia was significantly severe in ERM than in other disorders. Vitrectomy improved aniseikonia only in MH, while visual acuity was improved in all disorders except CRVO-CME. CONCLUSION: More than half of the patients showed aniseikonia preoperatively. A majority of ERM patients exhibited macropsia, whereas MH, RVO-CME, DME, and macula-off RD patients presented micropsia. The aniseikonia score was greatest in ERM patients. In most retinal disorders, surgery significantly improved visual acuity, but not aniseikonia.

Symptomatic aniseikonia in unilateral and bilateral pseudophakia. A projection space eikonometer study.

PURPOSE: To determine the incidence of aniseikonia and aniseikonic symptoms in pseudophakia (intraocular lens implantation after cataract extraction). METHOD: Aniseikonia, stereoacuity, and clinical symptoms were evaluated in patients with unilateral and bilateral pseudophakia. Aniseikonia was determined with the Essilor projection space eikonometer. Eight-seven cases were studied, fifty-four of unilateral pseudophakia and thirty-three of bilateral pseudophakia. Nine of the 87 patients had insufficient stereopsis to be examined or measured for aniseikonia with the Essilor instrument, and were studied with the "Double-D", a two dimensional "direct comparison eikonometer" device programmed and viewed on a computer. Stereoacuity was determined with the Titmus Stereo Test. RESULTS: Thirty-five (40.2%) of all pseudophakes had ophthalmic complaints referable to aniseikonia. The mean aniseikonia in the unilateral pseudophakia group was 4.1%, SD=3.41, while the mean aniseikonia in the bilateral group was 3.2%, SD=2.6. CONCLUSION: Symptomatic aniseikonia is common in pseudophakia. Unilateral pseudophakia has the higher degrees of aniseikonia, and is at a greater risk of loss of binocularity and of asthenopia.

Aniseikonia in relation to strabismus, anisometropia and amblyopia.

PURPOSE: To study the interrelationships among these four entities which are critical to binocular vision and its precision. SUBJECTS AND METHODS: 102 selected patients (for their ability to have stereoscopic depth perception, a requisite for space eikonometry) were evaluated. Patient testing included stereoscopic testing, Essilor Projection Space Eikonometry, ultrasonic echographic axial length measurements and orthoptic evaluation. Aniseikonia was measured on the Essilor Projection Space Eikonometer. RESULTS: 1. Anisometropia alone was correlated with a marked increase in amblyopia, a moderate increase in aniseikonia and no noteworthy increase in strabismus. Statistical analysis (chi square ratio) showed that persons with elevated anisometropic values had a 4.4 fold increased risk of aniseikonia (p=.003). 2. Aniseikonia alone was not responsible for marked variations in strabismus. 3. Amblyopia was correlated with increases in anisometropia and aniseikonia. 4. Adding aniseikonia to anisometropia produced a possible increase in strabismus and a great increase in amblyopia (using Fisher's Exact Test, 2-tailed). 5. Spearman correlations of the "absolute values" (the mean of the mathematical difference between the two eyes of anisometropia and amblyopia) were as follows: anisometropia (abs) vs. aniseikonia r=.294, p=.006; anisometropia (abs) vs. amblyopia (abs) 4=.555, p=<.001; amblyopia (abs) vs. aniseikonia r=.234, p=.02. CONCLUSIONS: Aniseikonia per se does not appear to have a major causal role in amblyopia or strabismus, but anisometropia does for amblyopia. This role is greatly augmented by aniseikonia and this combination may then produce strabismus.

Diplopia secondary to aniseikonia associated with macular disease.

OBJECTIVE: To provide an explanation for diplopia and the inability to fuse in some patients with macular disease. METHODS: We identified 7 patients from our practices who had binocular diplopia concurrent with epiretinal membranes or vitreomacular traction. A review of the medical records of all patients was performed. In addition to complete ophthalmologic and orthoptic examinations, evaluation of aniseikonia using the Awaya New Aniseikonia Tests (Handaya Co Ltd, Tokyo, Japan) was performed on all patients. RESULTS: All patients were referred for troublesome diplopia. Six of the patients had epiretinal membranes and 1 had vitreomacular traction. All 7 patients had aniseikonia, ranging from 5% to 18%. In 5 of the patients the image in the involved eye was larger, and in the other 2 patients it was smaller than in the fellow eye. All patients had concomitant small-angle strabismus and at least initially did not fuse when the deviation was offset with a prism. Response to optical management and retinal surgery was variable. CONCLUSIONS: Aniseikonia caused by separation or compression of photoreceptors can be a contributing factor to the existence of diplopia and the inability to fuse in patients with macular disease. Concomitant small-angle strabismus and the inability to fuse with prisms may lead the clinician to the incorrect diagnosis of central disruption of fusion. Surgical intervention does not necessarily improve the aniseikonia.

Anisophoria and aniseikonia. Part I. The relation between optical anisophoria and aniseikonia.

Part I of this publication demonstrates and explains the close relation between aniseikonia and anisophoria induced by spectacles. It discusses the clinical implications of this relation by discussing certain aspects of aniseikonia theory, prismatic effects during oblique gaze through spectacles as for reading, and a simple formula that presents a comprehensive description of all prismatic effects and prismatic differences produced by a pair of spectacles. It also describes an easy method of specifying iseikonic lenses, as well as some conventional methods of measuring aniseikonia and anisophoria. Part II will deal with the correction and management of anisophoria when induced together with aniseikonia. Parts I and II, together, will convey a new approach toward the management of anisophoric spectacle corrections.

[Aniseikonia and unilateral aphakia]. / Anizeikonie u jednostranné afakie.

The author submits the results of correction of unilateral aphakia which is a special type of anisometropia. For more than 500 examined patients with unilateral aphakia all those who had a refraction of the aphakic eye between 9.0 and 15.0 dpt were subjected to statistical analysis. The groups were classified with regard to the refraction of the aphakic eye. From the analysis ensues that optimal results of binocular vision are in the region round 12.0 and 13.0 dpt which is consistent with clinical results.

Influence of extraocular muscle imbalance on binocular performance.

In assessing binocular performance, it is possible that extraocular coordination is more significantly involved than presently recognized. Dynamic phorometry or phorometric testing in the nine cardinal directions of gaze is advised for evaluating the extraocular muscular system. These case reports used interrelation of phorias to evaluate binocular problems. The interpretation of these data helps determine the amount of horizontal prism necessary to reduce compensating vergences. Although a control group was not used, the elimination of associated vertical fixation disparity in these cases seemed to ameliorate binocular stress.

Binocular anomalies and reading problems.

This paper reviews and evaluates the research literature on the relationship of binocular anomalies to reading problems. The weight of the evidence supports a positive relationship between certain binocular anomalies and reading problems. The evidence is positive for exophoria at near, fusional vergence reserves, aniseikonia, anisometropia, convergence insufficiency, and fixation disparity. There is some weak positive evidence for esophoria at near and mixed evidence for stereopsis. The evidence on lateral phorias at distance is negative.

Aniseikonia for near vision with unilateral aphakia corrected by intraocular lenses.

1. Our methods for calculation of aniseikonia for near vision allow one to determine it in every patient with an intraocular lens. 2. With an eye with an artificial lens there is a correlation between the amount of accommodation used by the phakic eye and aniseikonia changes subject to the distance from the object. Calculations for aniseikonia for near vision in 43 patients showed that with accommodation used by the normal eye aniseikonia was increased by 3.0% to 7.8% as compared with aniseikonia for distance. With accommodation of the phakic eye lacking, aniseikonia for near vision did not differ much from its value for distance. 3. Calculations for aniseikonia for near vision showed the advantage of intraocular lens implantation for obtaining iso-iconia for distance or tolerable aniseikonia not more than 2.5% to 3.0%. 4. For obtaining iso-iconia for near vision it is necessary to correct the phakic eye to switch off its accommodation partially or completely (with emmetropia, correction +2.0D for near vision).

Aniseikonia in patients with a unilateral artificial lens, measured with Aulhorn's phase difference haploscope.

Aniseikonia was measured in unilaterally pseudophakic patients using Aulhorn's phase difference haploscope. Mean values of aniseikonia were 1.5% horizontally and 2.0% vertically without correction, and 2.1% horizontally and 2.3% vertically with correction. With spectacle correction, the greater the dioptric difference between two eyes, the greater the amount of aniseikonia. In either case, patients tolerated these amounts of aniseikonia according to our criteria of aniseikonia tolerance.

Amount of aniseikonia compatible with fine binocular vision: some old and new concepts.

Random Dot Stereograms (RDS) are useful, but are sometimes misleading in assessing the degree of binocular cooperation in the presence of aniseikonia. RDS may give positive results up to 15% aniseikonia, whereas a fine central binocularity is not possible with more than 5% image-size difference. It is suggested that stereopsis may not be the only parameter to test; stress is given to the importance of peripheral motor fusion in maintaining the eye alignment.

Iseikonic lens implantation in anisometropia.

The implantation of an iseikonic prepupillary intraocular lens in unilateral aphakia usually requires a slight (2 D) myopia of the implanted eye if the two eyes are isometropic. On the other hand, the implantation of an iseikonic implant in one eye of a anisometropic (asymmetric) eye pair can result in unexpectedly high changes in spectacle ametropia, due to differences in axial length or corneal power. The changes in ametropia after iseikonic lens implantation are discussed in relation to preoperative corneal and axial anisometropias. Alternative procedures to iseikonic implantation are described.

The binocular confusion in unilateral aphakia.

The first 4 symptoms of binocular confusion concern primarily daytime vision and the fifth symptom concerns nighttime vision. Even with a conventional contact lens correction, symptoms of binocular confusion occur, especially with high optical aniseikonia for near or far distance. In addition, diplopia occurs in the presence of strabismus. The important result of our research is the fact that unilateral aphakes are severely disturbed by the 5 symptoms of binocular confusion described above. These disturbances can be eliminated completely with an appropriate spectacle-contact lens combination based on echometry and intraocular optics.