A.A. Bialasiewicz

In vivo morphometry of corneal endothelial cells in pseudoexfoliation keratopathy with glaucoma and cataract.

Background: This study was designed to define correlations between in vivo morphometric and demographic data of pseudoexfoliation (PEX) keratopathy patients from Omani Arab origin with cataract and glaucoma. Methods: In a non-randomized controlled comparative case series, 69 adult patients (43 males and 26 females) with 78 cataract and 48 glaucoma eyes with corneal PEX material were assessed by confocal biomicroscopy (Confoscan 2, Nidek) and values compared to normative US and Omani Arab population values. Descriptive statistics. Results: The mean age of glaucoma patients was 60.81 ± 8.33 years, of cataract patients 64.65 ± 6.67 years; 109/126 eyes (74%) were from patients >60 years old (14 glaucoma and 95 cataract eyes). Age-adjusted endothelial cell counts were similar to normative values in 108/126 eyes (85.7%). Polymegathism and pleomorphism were abnormal in 124/126 (98.4%) and 122/126 eyes (96.8%), respectively. The correlation of pleomorphism and polymegathism with males (R2 = 0.6378, p = 0.05) was stronger than with females (R2 = 0.6024, p = 0.06), and stronger for patients <60 years (R2 = 0.7268, p = 0.01) than >60 years old (R2 = 0.5805, p = 0.01). Cataracts: Endothelial cell counts were normal (mean 2,483 ± 511.2). Pleomorphism was 33.12 ± 11.44% and different from Omani Arab controls (p < 0.01), polymegathism 58.14 ± 16.58% (p <0.01). Glaucomas: Endothelial cell counts were normal (mean: 2,438 ± 503). Pleomorphism and polymegathism were 37.09 ± 12.43% (p < 0.01) and 59.69 ± 16.79% (p < 0.01), respectively. Pleomorphism and polymegathism were more associated with glaucomas (R2 = 0.7652, p = 0.02) than with cataracts (R2 = 0.6041, p = 0.06). Conclusions: Endothelial cell polymegathism and pleomorphism in PEX keratopathy with glaucoma is more frequently associated with age <60 years and male gender than with cataract.

Visual rehabilitation by scleral fixation of posterior chamber intraocular lenses in Omani children with aphakia

BACKGROUND AND OBJECTIVE To report indications and outcomes of scleral-fixated posterior chamber intraocular lenses (PC IOLs) in Omani children with aphakia. PATIENTS AND METHODS Patients with aphakia who were younger than 16 years, unsuitable for spectacle or contact lens correction, and without capsular support underwent an anterior vitrectomy and 10-0 polypropylene inside-out scleral fixation ofa PC IOL. RESULTS Scleral-fixated PC IOLs were implanted in 28 eyes of 24 patients. Group A comprised 10 (36%) eyes with congenital cataract and 3 (11%) eyes with ectopia lentis and group B comprised 15 (53%) eyes with traumatic cataract. The mean age at implantation was higher in group A (10.5 years) than in group B (7.3 years). Visual acuity improved in 17 of 28 (61%) eyes and remained at the preoperative levels in 11 of 28 (39%) eyes. Mean postoperative refraction was within +/- 2.0 diopters of the predicted refraction in 19 of 28 (68%) eyes. Complications included temporary intraocular pressure increase, vitreous hemorrhage, and iris capture with lens malposition. CONCLUSION Scleral-fixated PC IOLs are beneficial for children with aphakia without posterior capsular support who are lacking other means for visual rehabilitation. Patients with traumatic cataract and lens dislocation are more likely to experience an improvement in visual acuity postoperatively than patients with congenital cataract. However, this procedure is technically more difficult than routine PC IOL implantation and potentially carries greater risks.

En bloc excision of intraocular epithelial cystic downgrowth using syngeneic auricular cartilage

AbstractAimTo describe the surgical management of epithelial cystic downgrowth by en bloc excision and use of syngeneic auricular cartilage in two children.Study DesignRetrospective interventional case series.MethodThe charts of two patients treated for epithelial cystic downgrowth with en bloc excision and auricular cartilage transplant were reviewed. Details of ocular history, preoperative and postoperative visual acuity, intraocular pressure, ocular examination findings, surgical procedure and subsequent management were noted.ResultsTwo children aged 4 and 6 years, with epithelial cysts who underwent en bloc excision were identified. The cysts had developed following penetrating eye injury. Surgery involved en bloc resection of the cyst and associated tissue, and replacement of the excised corneoscleral tissue with syngeneic auricular cartilage. One patient additionally required synechiolysis, discission of a secondary cataract and anterior vitrectomy. In both cases, the epithelial tissue was successfully removed and the auricular cartilage transplant was well-apposed. Visual acuity remained at the preoperative level in the first patient due to amblyopia; in the second patient visual acuity improved to 6/7.5 with mild astigmatic correction.ConclusionEn bloc excision provides the most definitive surgical treatment of cystic epithelial downgrowth. Auricular cartilage may be used for sclerokeratoplasty when donor cornea or sclera is unavailable.

Subjective and quantitative measurement of wavefront aberrations in nuclear cataracts - a retrospective case controlled study.

Purpose: To measure, quantify and compare Ocular Aberrations due to nuclear cataracts. Setting: Department of ophthalmology and school for ophthalmic technicians, college of medicine and health sciences, Sultan Qaboos University, Muscat, Oman. Design: Retrospective case controlled study. Methods: 113 eyes of 77 patients with nuclear cataract (NC) were recruited from outpatient clinic of a major tertiary referral center for Ophthalmology. Patients having NC with no co-existing ocular pathologies were selected. All patients were subjected to wavefront aberrometry (make) using Hartmann-Shack (HS) aberrometer. Consents were taken from all patients. Higher order Aberrations (HOA) were calculated with Zernike polynomials up to the fourth order. For comparison 28 eyes of 15 subjects with no lenticular opacities (control group) were recruited and evaluated in an identical manner. No pupillary mydriasis was done in both groups. Results: Total aberrations were almost six times higher in NC group compared to control (normal) subjects. The HOA were 21 times higher in NC group, and coma was significantly higher in NC eyes compared to normal (control) group. The pupillary diameter was significantly larger in control group (5.48mm ± 1.0024, p<.001) compared to NC (3.05mm ± 1.9145) subjects (probably due to younger control age group). Amongst Zernike coefficients up to fourth order, two polynomials, defocus (Z20) and spherical aberration (Z42) were found to be significantly greater amongst NC group, compared to normal control group. Conclusion: Nuclear cataracts predominantly produce increased defocus and spherical aberrations. This could explain visual symptoms like image deterioration in spite of normal Visual acuity.

Ipsilateral autorotational keratoplasty and cataract extraction in patients with trachoma and trauma in Oman. Report on visual rehabilitation

AIM To report on the results of visual rehabilitation by ipsilateral rotational keratoplasty (IRK) and cataract extraction in 17 patients with trachoma and with trachoma and trauma in Oman over 3 years. PATIENTS Of 25 patients operated from 2001-2004 with IRK, extracapsular cataract extraction, and intraocular lens implantation, 17 eyes of 17 patients with cicatricial trachoma (WHO stage CO) could be followed up after 1 year. Group 1 comprised 11 eyes with ciatricial trachoma. In group 2, six eyes had additional traumatic corneal scars. METHODS Surgery was performed using a motor trephine Keratron (Geuder), the Accurus 800 (Alcon) phacovitrectomy machine, and calculation for intraocular lens implantation (IOL: MZ60BD, Alcon) with a topography (Atlas, Humphrey Zeiss)-supported SRK II formula (OcuScanRxP, Alcon). RESULTS Although only four of 17 patients had preoperative visual acuity (VA) at 5 m and one of 17 had VA at 1 m, postoperatively seven of 17 patients gained VA at 5 m and six of 17 at 1 m. Ambulatory vision was regained in 13 of 17 (78%) patients. Patients with trachoma and trauma benefited more from the surgery [vision increase in trachoma: eight of 11 eyes (73%); trachoma and trauma: five of five eyes (100%)]. Postoperative spherical refraction was -12.0D to +4.0D (median:+4.0D), and astigmatism ranged from 10D to 0.3D (median 5.35D). One eye was lost because of uncontrolled keratitis. CONCLUSIONS IRK with cataract extraction may provide ambulatory vision in patients with cicatricial trachoma and secondary dry eye syndrome living in developing countries where donor grafts are difficult to obtain and where postoperative follow-up of high-risk keratoplasty is impaired.

Ipsilaterale Autorotationskeratoplastik und Kataraktextraktion bei Patienten mit vernarbendem Trachom in Oman

AIM To report on the results of visual rehabilitation by ipsilateral rotational keratoplasty (IRK) and cataract extraction in 17 patients with trachoma and with trachoma and trauma in Oman over 3 years. PATIENTS Of 25 patients operated from 2001-2004 with IRK, extracapsular cataract extraction, and intraocular lens implantation, 17 eyes of 17 patients with cicatricial trachoma (WHO stage CO) could be followed up after 1 year. Group 1 comprised 11 eyes with ciatricial trachoma. In group 2, six eyes had additional traumatic corneal scars. METHODS Surgery was performed using a motor trephine Keratron (Geuder), the Accurus 800 (Alcon) phacovitrectomy machine, and calculation for intraocular lens implantation (IOL: MZ60BD, Alcon) with a topography (Atlas, Humphrey Zeiss)-supported SRK II formula (OcuScanRxP, Alcon). RESULTS Although only four of 17 patients had preoperative visual acuity (VA) at 5 m and one of 17 had VA at 1 m, postoperatively seven of 17 patients gained VA at 5 m and six of 17 at 1 m. Ambulatory vision was regained in 13 of 17 (78%) patients. Patients with trachoma and trauma benefited more from the surgery [vision increase in trachoma: eight of 11 eyes (73%); trachoma and trauma: five of five eyes (100%)]. Postoperative spherical refraction was -12.0D to +4.0D (median:+4.0D), and astigmatism ranged from 10D to 0.3D (median 5.35D). One eye was lost because of uncontrolled keratitis. CONCLUSIONS IRK with cataract extraction may provide ambulatory vision in patients with cicatricial trachoma and secondary dry eye syndrome living in developing countries where donor grafts are difficult to obtain and where postoperative follow-up of high-risk keratoplasty is impaired.

Frequenzgedoppelte Technologie (FDT) bei Patienten mit unkontrolliertem Diabetes mellitus

ZusammenfassungZielPatienten mit unkontrolliertem Diabetes mellitus Typ 2 wurden mit Hilfe der frequenzgedoppelten Technologie (FDT) auf frühe neurosensorische Funktionseinschränkungen untersucht.DesignProspektive vergleichende nichtrandomisierte Fallstudie.Methoden und PatientenAn jeweils einem Auge von 20 untherapierten Patienten mit aktuellen Blutzuckerwerten von > 14,5 mmol/1 (Durchschnitt 20,5 mmol/1) zum Untersuchungszeitpunkt wurde die FDT (MATRIX®, Zeiss-Humphrey) im 24-2-5-Überschwellen-Screening mit 5 Grad spatialer und 18 Grad temporaler Frequenz angewendet und mit je einem Auge von 20 alters- und geschlechtsentsprechenden gesunden Probanden verglichen. Klinisch wurde die diabetische Retinopathie nach der EDTRS-Klassifikation eingeteilt. Die statistische Analyse erfolgte mit dem „t“-Test mit unabhängigen Variablen und mit dem Fisher’s-exactTest.Ergebnisse9/20 Patientenaugen wiesen keine Retinopathie, 2/20 eine diabetische Hintergrundsretinopathie, 5/20 eine mit klinisch signifikantem Makulaödem und 4/20 eine proliferative diabetische Retinopathie auf. Bei der mittleren Testdauer zeigte sich ein signifikanter Unterschied zwischen der Patienten-Gruppe (2 min 26 s) und der Kontrollguppe (1 min 46 s) (p = 0,01, t-Test). 2 min und länger (Median 2 min 12 s) wurde bei 11/20 Patientenaugen (55%) gemessen. Ein reproduzierbarer signifikanter Gesichtsfeldverlust konnte bei 16/20 Augen verglichen mit der Kontrollgruppe (4/20) beobachtet werden (p = 0,032, Fisher’s-exact-Test). 6 dieser 16 Augen (37,5%) zeigten keinen klinischen oder angiographischen Anhalt für eine Retinopathie.SchlussfolgerungenBei Patienten mit unkontrolliertem Diabetes mellitus kann die FDT signifikante neurosensorische Funktionsverluste aufzeigen, die auch ohne Vorliegen einer Retinopathie nachgewiesen werden können.SummaryAimTo report on the evaluation of early neurosensory functional deficits in patients with uncontrolled diabetes mellitus type 2 and varying degrees of retinopathy by frequency-doubled technology (FDT).DesignProspective case-controlled study.MethodsSuprathreshold 24-2-5 screening with 5 degrees spatial and 18 degrees temporal frequency was performed in one eye each of 20 diabetic patients without treatment and blood sugar levels at > 14.5 mmol/1 (mean 20.5 mmol/1) by FDT (MATRIX®, Zeiss-Humphrey), and compared to 10 eyes of 20 individuals of an age-matched non-diabetic population. The clinical classification was done according to the ETDRS criteria. The ‘t’ test with independent variables and the Fisher’s exact test were used for statistical evaluation.Results9/20 eyes showed no retinopathy, 2/20 a background retinopathy, 5/20 a clinically significant macular edema and 4/20 a proliferative diabetic vitreoretinopathy. A statistically significant difference was noted in the mean test duration between the patient group (2 min 26 s) and the controls (1 min 46 s) (p = 0.01, by paired “t-test”). An increase in test duration of more than 2 min (median 2 min 12 s) was observed in 11/20 eyes (55%) of the patients. A significant and reproducible visual field loss was observed in 16/20 patient eyes vs. 4/20 controls (p = 0.032, Fisher’s Exact Test). 6 of these 16 eyes (37.5%) with abnormal visual fields showed no clinical or angiographic evidence of retinopathy.ConclusionIn patients with uncontrolled diabetes mellitus FDT can detect a significant loss of neurosensory function even in the absence of retinopathy.

Herabsetzung der retinalen Sensitivität bei Patienten mit unkontrolliertem Diabetes mellitus Typ 2 — eine Studie zur Mikroperimetrie der Makula

ZusammenfassungZielEvaluierung der Makulafunktion bei Patienten mit Diabetes mellitus Typ II.StudiendesignNichtrandomisierte kontrollierte Fallserie.MethodenBei 25 Patienten mit 50 Augen und nachgewiesenem Diabetes mellitus Typ II wurden das Fixationsund das Sensitivitätsmuster der Makula und die Testantwort (Latenz) mit Hilfe des Mikroperimeters MP-1 (Fa. Nidek) evaluiert und mit klinischen Befunden, aktuellen Blutzuckerwerten und fluoreszenzangiographischen Daten korreliert. Fundusveränderungen wurden anhand der ETDRS-Kriterien klassifiziert. Die Statistik erfolgte mit chi2-Tests.Ergebnisse20 Augen (40%, Grp. 1) hatten keinen Hinweis auf eine diabetische Retinopathie, 13 Augen (26%, Grp. 2) hatten eine nichtproliferative Retinopathie ohne und 17 Augen (34%, Grp. 3) eine nichtproliferative Retinopathie mit klinisch signifikantem Makulaödem. 9 Augen (36%) hatten ein seitenungleiches klinisches Bild. Abnormales unstabiles Fixationsmuster: Grp. 1: 8 (40%), Grp. 2: 7 (54%), Grp. 3: 17 (100%), reduzierte retinale Sensitivität Grp. 1: 4 (24%), Grp. 2: 8 (62%), Grp. 3:17 (85%) und verzögerte Testantwort Grp. 1: 8 (40%), Grp. 2: 4 (30%), Grp. 3: 17 (100%). Eine statistisch signifikante Anzahl von Augen (p < 0,0001) in der Studiengruppe zeigte damit unstabile Fixation, verzögerte Testantwort und subnormal retinale Sensitivät und korrelierten mit den klinischen Befunden je nach Erkrankungsstadium.SchlussfolgerungenAbnormales Fixationsmuster, reduzierte retinale Sensitivität und verzögerte Testantwort weisen auf einen stadienabhängigen Defekt der intraretinalen Ganglienzellen bei unkontrollierten hohen Blutzuckerwerten hin. Eine frühe Diagnose makulärer Komplikationen bei unkontrolliertem Diabetes kann durch die Mikroperimetrie ermöglicht werden.SummaryAimTo evaluate the macular function in patients with diabetes mellitus type II.Study designNonrandomized controlled case series.Methods25 patients (50 eyes) with diabetes mellitus Type II and 25 age-matched controls without were randomly subjected to evaluation of the fixation, retinal sensitivity and test response patterns of the macula using the Nidek Microperimeter. The findings were correlated with blood sugar levels and fluorescein angiography. Fundus changes were classified based on ETDRS criteria. Chi square test was applied for statistical analysis.Results20 eyes had no evidence of diabetic retinopathy, 13 eyes (26%) had background changes, and 17 eyes (34%) macular edema. 9 patients (36%) had an asymmetrical clinical picture. Abnormal fixation patterns: Grp. 1: 8 (40%), Grp. 2: 7 (54%), Grp. 3: 17(100%), reduced retinal sensitivity Grp. 1: 4 (24%), Grp. 2: 8 (62%), Grp. 3: 17 (85%), and delayed test response: Grp. 1: 8 (40%), Grp. 2: 4 (30%), Grp. 3: 17 (100%). A statistically significant number of eyes (p < 0.0001) in the study group showed unstable fixation, delayed test responses and subnormal retinal sensitivity correlating with the disease process.ConclusionAbnormal fixation pattern, reduced retinal sensitivity and prolonged test response indicate defective macular function and is related to the disease process in diabetics. Very early detection of diabetic macular complications in uncontrolled diabetics seems to be possible by microperimetry.

Chirurgische Behandlung vitreoretinaler Erkrankungen in Oman@@@Vitreoretinal surgery in Oman

PURPOSE Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment. METHODS Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests). RESULTS From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery. CONCLUSIONS The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.

Chirurgische Behandlung vitreoretinaler Erkrankungen in Oman

PURPOSE Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment. METHODS Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests). RESULTS From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery. CONCLUSIONS The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.