Predicting postoperative visual outcomes in cataract patients with maculopathy.

PURPOSE: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. STUDY DESIGN: Prospective interventional clinical trial. PATIENTS AND METHODS: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25-0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60-70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. RESULTS: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1-0.5). The mean PAM score was 0.442 ± 0.24 (0.1-1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17-1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively). CONCLUSION: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies.

Idiopathic macular epiretinal membrane surgery and ILM peeling: anatomical and functional outcomes.

PURPOSE: Evaluation of the visual and anatomical outcomes following idiopathic macular epiretinal membrane (ERM) removal, with or without internal limiting membrane (ILM) peeling, and review of the literature. METHODS: A retrospective study of 39 eyes operated for idiopathic ERM was conducted. Pars plana vitrectomy was combined with ERM removal and Indocyanine green (ICG) assisted ILM peeling in 24 eyes. RESULTS: In Group A (without ILM peeling), mean preoperative BCVA was 0.48 logMAR (0.3 in decimal units), whereas mean postoperative BCVA was 0.37 logMAR (0.4 in decimal units). In Group B (with ILM peeling), mean preoperative BCVA was 0.58 logMAR (0.25 in decimal units), whereas mean postoperative BCVA was 0.31 logMAR (0.5 in decimal units). No statistically significant difference was observed between Groups A and B regarding preoperative or postoperative BCVA (p>0.1, Student's t-test). OCT measurement of postoperative foveal thickness reveled a significant decrease in thickness in both groups; however, no correlation was observed between postoperative BCVA and postoperative foveal thickness (Pearson's correlation coefficient = 0.139; p>0.1). CONCLUSIONS: In spite of final visual acuity improvement following idiopathic ERM removal, recovery of a normal foveal thickness is not achieved in the majority of the cases. ICG assisted ILM peeling does not affect the functional outcome of idiopathic ERM removal.

Anterior lens capsule versus mitomycin-C as an adjunct to trabeculectomy in combined phacotrabeculectomy.

AIM: Efficacy of using the anterior lens capsule removed during combined phacotrabeculectomy as an adjunct to trabeculectomy and comparing it to Mitomycin-C. METHODS: Prospective randomized study. Two site phacotrabeculectomy and at the end of the surgery, the removed anterior lens was placed under the scleral flap in group I and Mitomycin C in group II. RESULTS: No significant difference between the intraocular pressure, antiglaucoma medications, or visual acuity. No complications were related to anterior lens capsule. CONCLUSIONS: Anterior lens capsule is effective in phacotrabeculectomies.

Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction.

OBJECTIVES: Arteriogenic erectile dysfunction (ED) is a target organ disease of atherosclerosis, and therefore might be a predictor of systemic atherosclerosis. Being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. We investigated the possible correlation between penile cavernosal artery blood flow and retinal vascular findings in patients with arteriogenic ED. PATIENTS AND METHODS: Sixty patients with ED were divided according to the peak systolic velocity (PSV) in their penile cavernosal arteries into two groups; Group A included 30 patients with PSV less than 25 cm/sec, and Group B included 30 patients with PSV more than 35 cm/sec. Blood flow in the penile cavernosal artery was measured with color Doppler ultrasonography. All patients were assessed by ocular fundus examination under amydriatic conditions to evaluate retinal vascular atherosclerotic changes using Hyman's classification. RESULTS: Evidence of retinal vascular atherosclerotic changes was found in 19 patients (63.3%) in Group A and in 10 patients (33.3%) in Group B. CONCLUSIONS: Our study confirms the possibility of predicting penile arterial vascular status in patients with ED from their retinal vascular findings by using amydriatic simple, practical funduscopy.

Comparison of clear lens extraction and collamer lens implantation in high myopia.

AIM: To compare the outcomes of clear lens extraction and collamer lens implantation in high myopia. PATIENTS AND METHODS: Myopic patients younger than 40 years old with more than 12 diopters of myopia or who were not fit for laser-assisted in situ keratomileusis were included. Group 1 comprised patients undergoing clear lens extraction and Group 2 patients received the Visian implantable collamer lens. Outcome and complications were evaluated. RESULTS: Postoperative best corrected visual acuity was -0.61 +/- 0.18 in Group 1 and 0.79 +/- 0.16 in Group 2. In Group 1, 71.4% achieved a postoperative uncorrected visual acuity better than the preoperative best corrected visual acuity, while only 51.8% patients achieved this in Group 2. Intraocular pressure decreased by 12.55% in Group 1, and increased by 15.11% in Group 2. Corneal endothelial cell density decreased by 4.47% in Group 1 and decreased by 5.67% in Group 2. Posterior capsule opacification occurred in Group 1. In Group 2, lens opacification occurred in 11.11%, significant pigment dispersion in 3.7%, and pupillary block glaucoma in 3.7%. CONCLUSION: Clear lens extraction presents less of a financial load up front, and less likelihood of the need for a secondary intervention in the future. Clear lens extraction is a more viable solution in developing countries with limited financial resources.

Predictability and stability of refraction with increasing optical zone diameter in hyperopic LASIK.

OBJECTIVE: We undertook a prospective nonrandomized study to assess refractive outcome and patient satisfaction with hyperopic laser in situ keratomileusis (LASIK) using variable optical zone diameters in correction of hyperopia of more than 4.00 diopters. METHODS: Fourteen adults (comprising 28 hyperopic eyes) underwent hyperopic LASIK correction for hyperopia of more than 4.00 diopters. The sample was divided into two groups. Group 1 included the right eyes of the 14 patients who underwent hyperopic LASIK using a 6.5 mm optical zone diameter. Group 2 comprised the left eyes of the same patients with the only difference being that the optical zone diameter was 6.0 mm. RESULTS: The mean age of the patients was 36.42 +/- 5.10 years. Group 1 eyes had a median (range) preoperative uncorrected visual acuity (UCVA) of 0.79 (0.52) and best-corrected visual acuity (BCVA) of 0.15 (0.08). Group 2 had a median preoperative UCVA of 0.79 (0.60) and BCVA of 0.15 (0.08). The median postoperative UCVA in Group 1 was 0.17 (0.21) and BCVA was 0.15 (0.13). In Group 2, the median postoperative UCVA was 0.30 (0.32) and BCVA was 0.15 (0.26). Group 1 had a median preoperative refraction of +5.37 (1.75) diopters and the median postoperative refraction at one week was -0.23 (1.25) diopters, at three months was +0.75 (0.75) diopters, and at six months was +0.75 (1.00) diopters. Group 2 had a median preoperative refraction of +5.00 (1.75) diopters, and the median postoperative refraction at one week was +0.13 (1.5) diopters, at three months was +1.00 (0.75) diopters and at six months +1.25 (1.25) diopters. The difference was statistically significant between groups 1 and 2. The difference within each group was also significant. Group 1 eyes were stabilizing after the three-month period in contrast with Group 2 in which the refractive changes continued throughout the follow-up period. CONCLUSION: Larger optical zone diameter in correction of hyperopia of more than 4.00 diopters was more predictable, stable and safe.

Assessment of phacoaspiration techniques in clear lens extraction for correction of high myopia.

PURPOSE: To evaluate various phacoaspiration techniques in clear lens extraction for the incidence of intraoperative difficulties and complications. PATIENTS AND METHODS: This was a prospective study in which bilateral clear lens extraction was performed on 40 eyes of 20 patients, to correct high myopia. The patients were divided into 2 groups: group A underwent supracapsular phacoaspiration; group B were the contralateral eyes of the same patient. These patients were operated on with endocapsular phacoaspiration with the divide and conquer (D and C) technique. Preoperative ocular examination data were recorded and tested for significance. Intraoperative difficulties and complications such as nucleus cracking, capsule rupture and vitreous loss, and repeated chamber collapse were recorded. Postoperative examination data were recorded. RESULTS: Mean age was 35.65 +/- 5.85 years. Mean follow-up time was 17.1 +/- 8.56 months. In group A mean myopia was -17.3 +/- 5.07 diopters; in group B myopia was -17.9 +/- 4.20 diopters. Mean preoperative uncorrected visual acuity (UCVA) was 0.04 +/- 0.0167, while the mean postoperative UCVA was 0.435 +/- 0.1442. There was a significant difference in pre- and postoperative BCVA within both groups, but not between the two groups. In both groups endothelial cell count (ECC) showed a significant difference between pre- and postoperative data; however, there was no statistically significant difference between both groups in postoperative ECC. The effective phacoaspiration time for group A was 4.6 +/- 1.6 seconds, and for group B 9.90 +/- 2.27 seconds (P < 0.005). No cases of capsule rupture occurred in group A, but 3 cases occurred in group B (15 %) (not significant, P = 0.231). Nucleus cracking did not occur in group A, but in group B 13 cases occurred (65%). Chamber collapse occurred in 4 cases (20%) in group A and 5 cases (25%) in group B (not significant, P = 1.000). Three cases of moderate postoperative iritis were recorded in group B in (15%), in which posterior capsular rupture also occurred. No cases of iritis were recorded in group A (not significant, P = 0.231). Two cases of cystoid macular edema were recorded in group B (10%) and none in group A (not significant, P = 0.487). CONCLUSIONS: Supracapsular phacoaspiration for clear lens extraction in correction of high myopia seems to present no risk for the posterior capsule, although there is a marginal risk to the ECC.