Benefit of psychiatric evaluation on anxiety in patients with Charles Bonnet syndrome.

OBJECTIVE: Charles Bonnet syndrome (CBS) is defined as an occurrence of visual hallucinations (VHs) in the absence of any psychiatric/neurological disorder. Significantly reduced vision due to age-related macular degeneration (AMD), cataract or glaucoma is the most common cause for CBS. Aim of this randomized controlled study was to assess whether additional treatment by a psychiatrist is beneficial for patients with CBS. METHODS AND ANALYSIS: Patients with visual acuity of 0.5 LogMAR or worse in the better eye were screened. Instruments used were an interview asking about details of the VH, a mental test and a questionnaire on quality of life. Patients with CBS were randomised into two groups: in group 1, a patient-doctor consultation was performed by an ophthalmologist, and in group 2 a consultation and, if needed, additional medical assessment and treatment was given by a psychiatrist. RESULTS: 4900 patients were screened. 390 patients met the inclusion criteria and among these a CBS prevalence of 34 patients (8.7%) was found. The female-to-male ratio was 4:1 and the average age was 79.3 ± 9.7 years. Four different types of VH were observed: 41% humans (n=14), 32% geometrical shapes/patterns (n=11), 15% plants (n=5) and 12% animals (n=4). The change in quality of life in patients with CBS was not significantly different in both groups (p=0.727, ophthalmologist: n=18, psychiatrist: n=16). CONCLUSION: It is essential for medical staff involved with patients suffering from severe vision loss to be aware of CBS. This will help to better identify and interpret symptoms and could also lead to a more adequate treatment for affected patients. DISCUSSION: It is essential for medical staff involved with patients suffering from severe vision loss to be aware of CBS. This will help to better identify and interpret symptoms and could also lead to a more adequate treatment for affected patients.

A Randomized Study of the Impact of a Corneal Pre-Cut During Cataract Surgery on Wound Architecture and Corneal Astigmatism.

INTRODUCTION: The aim of the current study was to assess the effect of a 600-µm corneal pre-cut on wound architecture and its impact on surgically induced astigmatism. The images were acquired intraoperatively and postoperatively with high-resolution spectral-domain optical coherence tomography (SD-OCT). METHODS: This study included patients scheduled for cataract surgery. Preoperatively, optical biometry and corneal topography were performed (IOL Master 500 and Atlas 9000, both Carl Zeiss Meditec AG, Germany). The first eye randomly received a 600-µm corneal pre-cut during cataract surgery, or a single-plane stab-incision and the second eye received the other incision technique. Incision architecture was assessed intraoperatively using a continuous intraoperative optical coherence tomography (iOCT) device (ReScan 700, Carl Zeiss Meditec AG, Germany) at three time points: after the incision, after irrigation/aspiration and after intraocular lens (IOL) implantation. Additionally, OCT (Spectralis, Heidelberg Engineering, Germany) measurements were performed 1 h, 1 week and 1 month postoperatively. RESULTS: Forty eight eyes of 24 patients were analysed. The pre-cut group and the stab-incision group had a significant decrease in wound thickness from the 1-h to the 1-week measurement (p = 0.022 and p = 0.001). Corneal astigmatism showed a vector difference from preoperatively to the 1-week measurement of 0.48 D (SD, ± 0.27) in the stab incision group and 0.49 D (SD, ± 0.24) in the stab incision group. No significant differences were found between the groups. CONCLUSION: To our knowledge, this was the first study which compared the wound alterations in pre-cut and stab-incision groups. TRIAL REGISTRATION: NCT02155270.

Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: Advantages and Limitations.

PURPOSE: Epiretinal membranes (ERMs) are a disorder leading to progressive vision loss and metamorphopsia. The gold standard in therapy is vitrectomy with membrane peeling. The aim of this study was to assess whether the use of intraoperative optical coherence tomography (iOCT), which allows tomographic visualization of the membrane during peeling, enables peeling without staining. METHODS: This prospective study included 30 eyes of 30 patients with idiopathic ERMs scheduled for surgery. Pars plana vitrectomy with iOCT was performed in all cases, whereas staining of ERMs was only performed if needed. Internal limiting membrane (ILM) peeling was performed in case of wrinkled retinal surface after peeling of ERMs. RESULTS: In 63% (n = 19) eyes the ERM could be peeled successfully without use of staining. Nevertheless, in 89% (n = 17) of patients having had ERM peeling without dye, staining of the ILM was performed afterwards for peeling the ILM. Best corrected visual acuity improved in 80% (n = 24) and remained unchanged in 7% (n = 2) 3 months after surgery. There were no significant differences in postoperative results between patients with and without staining for ERM peeling. CONCLUSIONS: Use of iOCT helps to complete ERM peeling in a majority of cases without use of a chromovitrectomy dye, but as iOCT fails to visualize the ILM, chromovitrectomy still facilitates macular surgery in a majority of cases.

Enhanced Penetration for Axial Length Measurement of Eyes with Dense Cataracts Using Swept Source Optical Coherence Tomography: A Consecutive Observational Study.

INTRODUCTION: The aim of this study was to find cases in which the axial eye length could not be measured with partial coherence interferometry (PCI) technology and to assess if it could be measured using swept source optical coherence tomography (ss-OCT) technology. METHODS: All patients were measured at their pre-assessment visit 1 week prior to cataract surgery using conventional optical biometry (PCI technology, IOLMaster 500, Carl Zeiss Meditec AG, Jena, Germany). Patients in whom one or both eyes could not be measured using PCI technology were invited to participate in the study and to be measured with the ss-OCT (IOL Master 700, Carl Zeiss Meditec AG, Jena, Germany) device. RESULTS: Altogether, 1226 eyes of 613 patients were measured consecutively, and 78 eyes were not measured successfully with PCI technology. Among those with unsuccessfully measured eyes, 23 patients were willing to participate in the study, and two of those were also unsuccessfully measured with the ss-OCT device (8.7%, 2/23). However, 91.3% (21/23) of the eyes that were unsuccessfully scanned with PCI technology were measurable with the ss-OCT device. The estimated overall rate of unsuccessful scans with the ss-OCT device was 0.5% (6/1226) ([Formula: see text] < 0.01). CONCLUSION: ss-OCT technology significantly improves the rate of attainable axial eye length measurements, especially in eyes with posterior subcapsular cataracts, but also in eyes with dense nuclear cataracts, except for white cataracts.