Opaque intraocular lens implantation: a case series and lessons learnt.

PURPOSE: To report the use of opaque intraocular devices in three patients with complex neuro-ophthalmic symptoms. METHODS: A case series of three patients with neuro-ophthalmic symptoms requiring occlusion of one eye when alternative methods had failed to control symptoms. Morcher (Stuttgart, Germany) opaque intraocular implants were used in all patients. RESULTS: All three patients observed an improvement in symptoms following opaque intraocular device implantation. One patient (Case 2) required multiple devices for symptom relief. CONCLUSION: Opaque intraocular occlusive devices are an increasingly popular choice for clinicians in patients with intractable diplopia but we highlight their use in patients with other complex neuro-ophthalmic symptoms. We learned a number of useful lessons in these patients as summarized in this case series.

Vitreoretinal complications of osteoodontokeratoprosthesis surgery.

PURPOSE: To describe the vitreoretinal complications in a cohort of patients with osteoodontokeratoprosthesis (OOKP) and discuss surgical management. METHODS: Review of notes of 35 OOKP cases performed at the Sussex Eye Hospital (Brighton, United Kingdom) between January 1999 and December 2005 was performed. RESULTS: The overall incidence of vitreoretinal complications was 22.8%, which included vitreous hemorrhage (3 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment complicating lamina resorption and optic extrusion (2 patients), and intraoperative choroidal hemorrhage (1 patient). Preexisting aphakia was associated with rhegmatogenous retinal detachment (P < 0.05, chi2 = 4.36). Five patients required pars plana vitrectomy, which was performed either endoscopically (two cases) or using a binocular indirect viewing system (three cases) with one case requiring removal of the OOKP and insertion of a temporary keratoprosthesis. Retinal detachment repair was attempted on four of five patients but was successful for only one. Vitreous hemorrhage without retinal detachment required vitrectomy in one case, while two cases cleared spontaneously. CONCLUSIONS: Eyes receiving OOKP are prone to vitreoretinal complications, with retinal detachment associated with a poor prognosis. Thicker OOKP laminae and lamina bulk screening will hopefully reduce the risk of endophthalmitis due to unexpected resorption.

Observer agreement using the Heidelberg retina tomograph: the Bridlington Eye Assessment Project.

PURPOSE: This study assessed agreement in optic nerve head parameters between 2 investigators independently contouring Heidelberg retina tomograph II (HRT II) optic disc images of normal elderly subjects. PATIENTS AND METHODS: Contours were drawn by both investigators on 550 randomly selected optic discs of 550 normal elderly patients (mean age, 73.1 y) drawn from a population-based study. All subjects had normal intraocular pressures and visual fields. Coefficients of variation were calculated for interobserver and intraobserver variability. RESULTS: The mean disc area was 1.97 mm, with no relationship between magnitude of disagreement and the mean. There was a significant bias between investigators with a mean difference in disc area of -0.06 mm. The 95% limits of agreement of disc area were -0.59 to +0.47 mm. Ninety-five percent coefficients of agreement (1.96 SD of the parameter differences between investigators/mean parameter value x100) were similar for global and sectoral disc areas (26.7% to 32.3%). Respective coefficients for rim area, cup area, and rim volume were much higher at 35.2%, 48.5%, and 76.5% respectively, but much lower for rim/disc area ratio (12.7%). There was no significant correlation between disagreement and grade of cataract or HRT image quality. CONCLUSIONS: Disagreement in contour placement can be substantial, with disproportionate effects on some calculated HRT parameters. Image quality and lens opacity have no significant influence on the degree of disagreement. Rim/disc area ratio is the HRT parameter least affected and may be more useful in comparing normative databases and diagnostic studies between centers.

Specificity of the Heidelberg Retina Tomograph's diagnostic algorithms in a normal elderly population: the Bridlington Eye Assessment Project.

PURPOSE: To determine the specificity of the Moorfields regression analysis (MRA) and R. Burk (RB) and F. S. Mikelberg (FSM) linear discriminant functions (LDFs) in classifying the optic discs of normal elderly patients imaged with the Heidelberg Retina Tomograph. DESIGN: Cross-sectional study. PARTICIPANTS: Optic nerve head analysis of 459 eyes of 459 normal elderly patients was performed by 2 operators. All patients were consecutive in a cohort screened for eye disease. Normals were defined as having a normal visual field (VF) on automated suprathreshold screening, normal intraocular pressure, and normal visual acuity. MAIN OUTCOME MEASURES: Specificity of the optic nerve head classification by MRA and the RB and FSM LDFs. RESULTS: Subjects' mean age (262 female, 197 male) was 72.6 years. Males were found to have significantly larger cups than females. Eighty-three percent, 11.3%, and 5.7% of discs were classed as within normal limits, borderline, and outside normal limits by MRA. Percentages of optic discs classified as outside normal limits in the smallest and largest quartiles for disc size were 0.9% and 14.9%. The association of disc size with the classification of outside normal limits was significant in males only. Agreement in MRA classification between 2 investigators separately placing the optic disc contour was moderate (Cohen's kappa = 0.54, P<0.001). The RB and FSM LDFs classified 6.8% and 11.8% of discs as diseased. The RB LDF was significantly more likely to return a diagnosis of disease in larger discs, though only in males. The FSM LDF tended to the same drop in specificity, although not significantly. CONCLUSIONS: Using the MRA and RB/FSM LDFs, specificity fell dramatically with increasing disc size, particularly in males. This may reflect the finding of significantly larger cups in males than in females in the normal elderly population. This divergence was not predicted by these diagnostic functions, which were developed on samples of younger subjects.

Asymmetry in optic disc morphometry as measured by heidelberg retina tomography in a normal elderly population: the Bridlington Eye Assessment Project.

PURPOSE: To define the normal range of asymmetry in optic disc parameters measured by the Heidelberg Retina Tomograph (HRT II; Heidelberg Engineering GmbH, Dossenheim, Germany) in a normal elderly population. METHODS: Optic disc analysis of 918 eyes of 459 normal elderly patients was performed. All patients were consecutive in a cohort screened for eye disease. Normality was defined with a normal visual field on automated suprathreshold screening, intraocular pressure less than 22 mm Hg, and minimum corrected visual acuity of 6/12. Asymmetry measures were calculated by subtracting the values of the smaller disc from those of the larger disc. RESULTS: Subjects' mean age (262 female and 197 male) was 72.6 years (range, 65.5-89.3). There was no significant difference in disc area or rim area between the right and left eyes. Neither rim-to-disc area ratio asymmetry nor rim measurement asymmetries were significantly affected by age or sex. Rim-to-disc area ratio asymmetry was much less affected by the increasing difference in disc size than was absolute rim asymmetry. The 2.5th and 97.5th percentile limits of normality for the rim-to-disc area ratio asymmetry in the global and temporal-inferior analyses were -0.212 and 0.154, and -0.331 and 0.261, respectively. CONCLUSIONS: The normal range of parameter asymmetry in an age group relevant to glaucoma may be useful in the discrimination of normal from early glaucoma. Asymmetry analysis may improve discriminatory ability by reducing parameter variability based on disc size. The rim-to-disc area ratio asymmetry measure is likely to be the most useful parameter in describing normality with consistency.

Laser scanning tomography of the optic nerve head in a normal elderly population: the Bridlington eye assessment project.

PURPOSE: To assess optic nerve head topographic parameters using the Heidelberg Retina Tomograph (HRT) II (Heidelberg Engineering GmbH, Dossenheim, Germany) in a normal elderly population. METHODS: Optic nerve head analysis of 918 eyes of 459 normal elderly patients was performed. All patients were consecutive in a cohort screened for eye disease. Normal subjects were defined with a normal visual field on automated suprathreshold screening, intraocular pressure less than 22 mmHg, and minimum corrected visual acuity of 6/12. All optic discs were contoured by two investigators and the mean parameters analyzed. The effects of age, sex, and disc size were assessed. RESULTS: Subjects' (262 women and 197 men) mean age was 72.6 +/- 5.1 (SD) years (range, 65.5-89.3). Mean +/- SD global disc area, cup/disc area ratio, and neuroretinal rim area were 1.98 +/- 0.36 mm2, 0.22 +/- 0.14, and 1.52 +/- 0.31 mm2, respectively. Disc area did not differ significantly based on eye side or sex. The women were found to have a significantly larger rim volume, mean retinal nerve fiber layer (RNFL) thickness, and cross-sectional area than the men and tended to have smaller cup areas/volumes and cup/disc area ratios. Most tomography parameters were found to be significantly influenced by disc size. CONCLUSIONS: To the authors' knowledge, this is the first large study of optic nerve head parameters in the elderly normal population using the HRT II. This age range is particularly relevant to glaucoma detection and pertinent to discriminant analyses separating normal subjects from glaucoma in screening for the disease. Given the systematic differences between the parameters in men and women, reference ranges should be quoted by sex.