Hana Leiba

Cystoid macular oedema following cataract extraction in patients with diabetes.

The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.

The Course of Age-Related Macular Degeneration Following Bilateral Cataract Surgery

BACKGROUND AND OBJECTIVE Progression of age-related macular degeneration (AMD) following cataract surgery has been described. The aim of this study was to investigate whether an uneventful postoperative maculopathic course in one eye (the first eye) may predict a similar prognosis for the fellow eye (the second eye). PATIENTS AND METHODS Thirty-three patients with bilateral, similar, early AMD (defined by the presence of drusen and/or pigmentary abnormalities on fundal examinations and by the absence of late leakage as documented by fluorescein angiography) who had undergone unilateral cataract surgery, had had a stable postoperative maculopathic course following the first operation, and were scheduled for cataract surgery in the second eye were prospectively observed for at least 1 year after the second operation. The course of maculopathy of the second eye was compared with that of the first eye during the follow-up period of the second eye. RESULTS A total of 9 of the second eyes (27.2%) showed progression to wet AMD. Of these, 1 patient (3%) had progression in both eyes and 8 patients (24.2%) had progression in the second eye only. The conditions of 2 of the first operated on eyes (6.1%) deteriorated (P < .05). Hypertension (P < .05), soft drusen (P < .01), and Nd:YAG laser capsulotomy (P < .05) were risk factors for development of wet AMD. CONCLUSION In this study, 24.2% of the patients with early AMD who underwent bilateral cataract surgery and had an uneventful maculopathic course in the first eye had wet AMD in the second eye. Thus, patients with early AMD and soft drusen undergoing bilateral cataract surgery should be monitored for early detection of progression of maculopathy. Further prospective studies are needed to determine the course of maculopathy following cataract surgery.

The course of diabetic retinopathy following cataract surgery in eyes previously treated by laser photocoagulation

The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.

Long-term follow-up of occlusion therapy in amblyopia.

OBJECTIVE To determine whether the results of occlusion therapy for amblyopia are maintained into adulthood. DESIGN Prospective, observational case series. PARTICIPANTS Fifty-four patients, who were successfully treated in childhood for unilateral amblyopia by occlusion, were followed up to the age of 9 years, were evaluated in 1984 for long-term results 6.4 years on average after cessation of treatment, and accepted our invitation for reevaluation in 1999. METHODS All patients were given a complete eye examination. The visual acuity (VA) was measured. RESULTS The average period of follow-up was 21.5 years (range, 17.2-25.1 years). The mean age at the most recent examination was 29.0 +/- 2.1 years (range, 25.1-34). At this examination, a best-corrected visual acuity (BCVA) of 20/40 or better was achieved by 72.3% of the patients. The mean BCVA was 20/35 (20/25-20/70) at the end of occlusion therapy, 20/45 (20/20-20/300) in 1984, and 20/34 (20/15-20/100) at the present examination. Relative to the results at the end of therapy, BCVA at the present examination was maintained or improved in 66.7% of the patients. Relative to 1984, the BCVA in 1999 was maintained or improved in 87% of the patients. MAIN OUTCOME MEASURE Visual acuity. CONCLUSION Comparative evaluation of BCVA at a long-term follow-up examination, performed 21.5 years on average after cessation of occlusion therapy, showed that VA was maintained or improved in two thirds of patients who had been successfully treated by occlusion for unilateral amblyopia in childhood.

Results of treatment with topical mitomycin C 0.02% following excision of primary pterygium.

AIMS--The effectiveness of instillation of mitomycin C eyedrops on the recurrence rate of pterygium was assessed in patients undergoing primary pterygium surgery. Any side effects were also noted. METHODS--Primary pterygia in 38 consecutive patients were surgically excised during July to December 1992. After surgery, mitomycin C 0.02% eyedrops twice daily for 5 days as well as dexamethasone 0.1% four times tapered for the next 6 weeks were instilled. Postoperative follow up ranged from 6 to 11 months. RESULTS--In one patient the pterygium recurred after 3 months (recurrence rate 2.6%). The side effects encountered were: avascularised sclera in 13 cases between 1-10 months postoperatively; ocular discomfort and lacrimation in five cases; superficial punctate keratitis during the first month in three cases; pyogenic granuloma in two cases. In one patient steroid induced increased intraocular pressure was found 4 weeks after surgery. The adverse side effects were all mild, self limiting, and easily treated. CONCLUSION--This study suggests that postoperative instillation of mitomycin C 0.02% eyedrops twice daily for 5 days following excision of primary pterygium is an effective and safe treatment to obviate pterygium recurrence.

Prophylactic laser photocoagulation in stickler syndrome

The ocular manifestations in a family with Stickler syndrome and the results of laser photocoagulation as preventive treatment for retinal detachment are described. Forty-two family members with Stickler syndrome were retrospectively reviewed; 22 had ocular abnormalities, 22 had myopia and 16 had high myopia. Ten patients had developed retinal detachment and 9 of them were blind in one or both eyes because of irreparable detachment. Only 2 eyes had been operated on successfully. Ten eyes were lasered prophylactically. In eyes with extensive vitreoretinopathy laser burns were applied 360° around the peripheral retina at the border between the pathological and normal retina. Eyes with isolated lesions received focal treatment around the pathological areas. Four eyes received 360° laser photocoagulation and 6 eyes received focal treatment. Of the treated cases, 9 retinas remained attached for a follow-up period ranging from 1 to 15 years. One patient was lost to follow-up, and 5 years later developed retinal detachment in one eye from a new non-lasered lesion. In conclusion, in this particular family the incidence of retinal detachment was significantly higher in non-lasered eyes than in lasered eyes (p<0.025).

Optic nerve head blood flow measurements in non-arteritic anterior ischaemic optic neuropathy

Purpose To determine whether a decrease in blood flow, measured by the Heidelberg retiinal flowmeter, can characterise a disc at risk and predict the occurrence of non-arteritic anterior ischaemic optic neuropathy (NAION).Methods Blood flow, volume and velocity were measured in the optic nerve heads of 14 unaffected fellow eyes of patients with unilateral NAION, and compared with those of the affected eyes and of the eyes of 7 age- matched healthy controls.Results The affected eyes were found to differ from the unaffected eyes in all three haemodynamic parameters. Flow (measured in arbitrary units) is the most important parameter to be taken into consideration. Blood flow was significantly lower in affected than in unaffected eyes (upper rim, p < 0.05; lower rim, p < 0.025). It was also significantly lower in the unaffected eyes than in the healthy control eyes (p < 0.005, upper and lower rims), and in the affected eyes than in the control eyes (p < 0.00005, upper and lower rims).Conclusion Decreased blood flow in the optic nerve head may indicate a risk for NAION and be considered a characteristic of the disc at risk.

Vigabatrin therapy in infantile spasms: Solving one problem and inducing another?

That is, most of the children with infantile spasms have symptomatic etiology and later mental deficiency, but all of the mentally retarded patients were excluded in the studies of Gaily et al. (2009) and Vanhatalo et al. (2002). 4. The same investigators that were involved in the Gaily et al. (2009) study have also reported VAVFL of older children in only 4 of 53 patients (8%) at the University Hospital of Helsinki (Rintahaka et al., 2000). It is not clear to me why the patients in this population have a much smaller risk of VAVFL compared to patients in other reports, where the prevalence in children appears to be similar to that seen in adults (Spencer & Harding, 2003). The prevalence of VAVFL in six series of children was 35% (63 of 186 children); in 15 published series of adults, the prevalence was 39% (354 of 896 adults) (Sorri, 2001). Is there a genetic difference between the populations of children in these latter studies and the population examined by Gaily et al. (2009)? Or was the kinetic perimetry test not used appropriately in the studies of Rintahaka et al. (2000) and Gaily et al. (2009)? The reliability of the kinetic perimetry has been criticized on the grounds that the operator might (consciously or subconsciously) attempt to obtain a ‘‘correct’’ field, which in turn could cause a bias in the results. The reliability of the kinetic perimetry depends on the examiner’s skills. 5. The long-term use of VGB treatment by Gaily et al. (2009) of up to 29.8 months in children with idiopathic spasms, is surprising given that half of these patients stopped having spasms within a few days of the start of VGB therapy. 6. Even just one child with mild VAVFL is too many. He or she will never receive a driver’s license. Moreover, reports from animal experiments have been alarming. Drugs that increase brain c-aminobutyric acid (GABA) levels, such as the GABA transaminase inhibitor VGB, can cause apoptotic degeneration during the brain growth-spurt period (Bittigau et al., 2003). 7. The earliest sustained onset of the VGB-induced retinal defect in infants is 3.1 months (Ovation Pharmaceuticals Inc., 2007), and retinal defects ranged from 15– 31% (University of Toronto, 2007). The lowest total dose of VGB (914 g) was associated with VAVFL in one study (Vanhatalo et al., 2002), and detected at the time of the first visual field defect (VFD) test. It is possible that VFDs develop even earlier. Although it has been recommended that ‘‘infants should be tested at baseline and at 3-month intervals for the first 18 months of treatment, and then every 6 months thereafter with electroretinography (ERG)’’ (Ovation Pharmaceuticals Inc., 2007; Willmore et al., 2009), such procedures would be impractical because ERG requires sedation. In conclusion, available data suggest that VFDs after VGB therapy in children might be as frequent as in adults, and no safety period can yet be given. To address this issue, it remains important that infants treated with VGB for infantile spasms be studied in larger numbers when they are old enough to cooperate.

Parainfectious optic neuritis: manifestations in children vs adults.

Background: Parainfectious optic neuritis may appear at any age. The aim of our report was to compare the clinical manifestations and outcomes of this form of optic neuritis between children and adults. Methods: The study sample consisted of all patients diagnosed with parainfectious optic neuritis evaluated by 2 neuro-ophthalmology services between 2005 and 2012. Data were collected retrospectively from the medical files. Findings were compared between patients aged 0–18 years and 19 years or older. Results: Ten children (50% female) and 8 adults (50% female) met the study criteria. Mean duration of follow-up was 29.4 months (range, 2–72 months) in the pediatric group and 14.2 months (range, 5–80 months) in the adult group. Respective rates of bilateral disease were 50% and 38%, and all patients had optic disc swelling. The associated pathogen was identified in 60% of the pediatric group, mainly Mycoplasma pneumoniae, and 75% of the adult group, in which no microorganism predominated. The interval from the febrile illness to symptom onset was 6 days (range, 1–14 days) in the pediatric group and 19.5 days (range, 14–30 days) in the adult group. Acute disseminated encephalomyelitis (ADEM) was diagnosed in 40% (4/10) of the children and none of the adults. Final visual outcome was 20/30 or better in all patients. There was a higher frequency of bilateral disease in prepubescent vs postpubescent children. Conclusions: Parainfectious optic neuritis is associated with a favorable visual prognosis regardless of age. Children tend to manifest visual symptoms sooner after the antecedent infectious illness and more often bilaterally and in conjunction with ADEM. The causative agent is isolated less frequently in children compared with adults.

Outcome of posterior capsulotomy in late capsular block syndrome with posterior capsular opacification

Background:  To examine the results of neodymium:yttrium‐aluminium‐garnet (Nd:YAG) laser posterior capsulotomy in eyes with late or previously unrecognized capsular block syndrome (CBS) presenting with deterioration of vision owing to posterior capsular opacification (PCO).