Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Exploring association between pseudoexfoliation syndrome and ocular aging.

PURPOSE: Within a population-based follow-up study, to examine the 10-year incidence of pseudoexfoliation syndrome (PEX), possible risk factors for PEX and its association with ocular aging of the cornea, lens and retina. METHODS: The baseline examination was conducted in 2006 on a random sample of 1,033 adult participants from Kaunas city (Lithuania) population of whom 631 had ophthalmic examination data at attendance of the 10-year follow-up in 2016. Detailed examination of the anterior and posterior segment of the eye was carried out. After diagnostic mydriasis PEX was diagnosed by the presence of typical grayish-white exfoliation material on the anterior capsule surface of the lens. The participants were divided to PEX and non-PEX groups. RESULTS: PEX prevalence increased from 9.8 to 34.2% from baseline to 10-year follow-up. Nuclear cataract was common both in the PEX group (66.7%) and in those without PEX (72.2%), but this difference did not reach statistically significantly increased risk of developing cataract in those with PEX (OR 1.2; p = 0.61). Central corneal thickness (CCT) was thinner in the PEX group (529 ± 34 µm) and in the oldest group (525 ± 36 µm) (p < 0.001). Compared to baseline, corneal curvature (CC) became flatter in both groups (7.6 ± 0.27 vs 7.7 ± 0.26 mm; p < 0.001) during the follow-up, but the difference did not reach significance between groups. Corneal astigmatism was most commonly with-the-rule in both groups (37 (50.0%) vs 148 (68.5%); p > 0.05). Age, sex and PEX had no influence on age-related macular degeneration distribution. CONCLUSION: The prevalence of PEX increased significantly with age in our population, with those with PEX having thinner and flatter corneae, but no difference in cataract and age-related macular degeneration characteristics.

Link of ocular pseudoexfoliation syndrome and vascular system changes: results from 10-year follow-up study.

PURPOSE: To examine the 10-year incidence of the pseudoexfoliation syndrome (PEX) in adults in a population-based follow-up study, to determine its link with vascular diseases, and to identify possible risk factors of the PEX. METHODS: The baseline examination was performed in 2006 on a random sample of 1033 participants from Kaunas city (Lithuania) population. In 2016, a follow-up study of 686 participants who returned for the examination was conducted. The respondents filled out a questionnaire, an ophthalmological examination was performed, and the presence of vascular diseases was determined by the anamnesis and electrocardiogram evaluation data. Binary univariate and multivariate logistic regression analyses were conducted with the PEX and vascular diseases as predictors, controlling for age. Odds ratios (OR) and 95% confidence intervals of OR were calculated for the risk of new PEX cases. RESULTS: During 10 years, the prevalence of the PEX in the study population increased from 10.3 to 34.2%. The rates of ischemic heart disease (IHD) and IHD combined with stroke were significantly higher in the PEX subjects than in the non-PEX subjects. The risk of the PEX among persons with IHD was, on the average, by 1.5-fold higher, and among those with IHD and stroke, on the average, by 1.6-fold higher as compared to persons without the aforementioned pathologies (accordingly, p = 0.014 and p = 0.010). CONCLUSION: The prevalence of the PEX increased significantly with age. The risk of the PEX was significantly higher among persons with IHD and even higher among persons with IHD and stroke. In the future, a greater understanding of the cardiovascular, metabolic, and environmental components associated with the PEX may lead to more specific lifestyle-related preventive strategies to decrease the disease burden.

Novel microsurgical management of uveitis-glaucoma-hyphema syndrome.

PURPOSE: To report a series of cases and microsurgical management of rarely occurring uveitis-glaucoma-hyphema (UGH) syndrome in patients with single-piece acrylic intraocular lens (IOL) placed in the capsular bag. METHODS: It was a series of patients with UGH syndrome induced by posterior chamber IOL/capsular bag complex instability (pseudophakodonesis), who underwent IOL fixation to the iris. Visual acuity, intraocular pressure, number of glaucoma medications and IOL status (position) were recorded by the same protocol before and 6 months after the surgical treatment. RESULTS: The case series presents three patients with UGH syndrome caused by single-piece acrylic IOL placed in-the-bag. Each patient had uneventful phacoemulsification with posterior chamber IOL implantation few years ago and pseudophakodonesis caused by weakened zonules from pseudoexfoliation with subsequent development of UGH syndrome. IOL fixation to the iris with satisfactory postoperative results was performed due to the development of UGH. Signs of syndrome did not recur 6 months after the operation. CONCLUSION: UGH syndrome can be induced by unstable in-the-bag IOL due to zonular laxity. Depending on the severity of the syndrome, this condition can be fought by applying a minimally invasive approach-IOL suturing to the iris with direct observation under the surgical microscope precisely in the anticipated location with no or minimal pupil deformation. Symptoms of UGH did not recur due to increased stability of the IOL and, as a result of this, declined irritation of the uveal tissue.

Association of ocular pseudoexfoliation syndrome with ischaemic heart disease, arterial hypertension and diabetes mellitus.

PURPOSE: To determine the prevalence of pseudoexfoliation syndrome (PEX) in Lithuanian urban population and its association with ischaemic heart disease (IHD), arterial hypertension (AH) and diabetes mellitus (DM). METHODS: In this population-based study, 1065 participants aged 45-72 years were randomly drawn from the population register of Kaunas, Lithuania. They were classified as having PEX if any pseudoexfoliation material was determined by a slit-lamp examination in at least one eye. The data were acquired from questionnaire; register of myocardial infarction, electrocardiogram, biochemical blood analyses and blood pressure measurement were used to determine IHD, AH, DM and smoking habits. Poststratification weights based on Kaunas population sex and age distribution were applied. RESULTS: Pseudoexfoliation syndrome was estimated in 9% of a population. The AH rate was higher in PEX subjects than in non-PEX subjects (p=0.017) and the rates of IHD, DM and cholesterol levels did not differ statistically significantly. Chi-square linear-by-linear association test found higher AH rate in unilateral PEX subjects and even higher AH rate in bilateral PEX subjects than in non-PEX subjects (p=0.014). Pseudoexfoliation syndrome increased odds for AH by 1.8 times (p=0.021). Median of systolic blood pressure was higher in the PEX group than in non-PEX group (p=0.04). But all associations could not be confirmed after adjusting for age. Smoking duration increased age-adjusted odds for PEX. Pseudoexfoliation syndrome did not increase risk for IHD, AH or DM. CONCLUSIONS: Pseudoexfoliation syndrome prevalence is high in Lithuania. No clear PEX association with IHD, AH and DM was proven after controlling for effect of age.

[Comparison of postoperative results after implantation of hydrophilic acrylic or hydrophobic acrylic intraocular lens: data of one-year prospective clinical study]. / Akriliniu hidrofiliniu ir akriliniu hidrofobiniu intraokuliniu lesiu pooperaciniu rezultatu palyginimas (prospektyviojo klinikinio tyrimo vieneriu metu duomenys).

OBJECTIVE: To evaluate and compare the impact of two sharp-edge optic foldable intraocular lenses (IOLs) of similar design made from different material (hydrophilic acrylic or hydrophobic acrylic) on visual function, anterior and posterior capsule opacification at one-year follow-up after cataract phacoemulsification. MATERIAL AND METHODS: Seventy-two eyes of 72 patients scheduled for cataract surgery were included in a prospective clinical study. Two foldable sharp-edge optic posterior chamber acrylic IOLs of similar design were used. Thirty-nine eyes of 39 patients received a single-piece hydrophilic acrylic (PC 511, Ophtec) IOL and 33 eyes of 33 patients - single-piece hydrophobic acrylic (AcrySof, SA60AT, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsulorrhexis/optic overlapping, and posterior capsule opacification (PCO) were evaluated. The intensity of ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3-mm optic zone were assessed using a photographic image analysis system (EPCO 2000). The patients were examined at one year postoperatively. RESULTS: There were no significant differences in best-corrected visual acuity and capsulorrhexis/optic overlapping between IOL types at 1-year follow-up after surgery. In the single-piece hydrophilic acrylic IOL group, the grade of ACO density was significantly higher in capsulorrhexis rim area (1.56+/-0.71 and 1.00+/-0.75) and in the capsule/optic area (1.62+/-0.67 and 1.00+/-0.75) (P<0.05). PCO values of the entire IOL optic area (0.12+/-0.13 and 0.024+/-0.02) as well as in the central 3-mm optic zone (0.06+/-0.11 and 0.001+/-0.003) was significantly higher in the single-piece hydrophilic acrylic IOL group one year postoperatively (P<0.05). In 33.3% of cases of the single-piece hydrophilic acrylic IOL group, contraction of haptics to IOL optics was present one year postoperatively, which was not present in any case of the single-piece hydrophobic acrylic IOL group. CONCLUSIONS: One-year follow-up after cataract surgery has shown a significant difference in ACO and PCO development comparing single-piece hydrophilic acrylic and single-piece hydrophobic acrylic intraocular lenses. The effect of hydrophobic acrylic foldable lenses on preventing anterior and posterior capsule opacification is mainly a result of the acrylic hydrophobic biomaterial.

[The comparison of visual acuity and contrast sensitivity in patients with cataract and age-related macular degeneration implanted with foldable or rigid intraocular lenses]. / Serganciuju katarakta ir amzine geltonosios demes degeneracija regos astrumo ir kontrastinio jautrumo pokyciu sasaja su implantuotu kietuoju ar sulankstomuoju lesiu.

OBJECTIVE: To evaluate the maximally corrected visual acuity and contrast sensitivity under photopic and mesopic conditions with or without glare in pseudophakic patients implanted with either foldable or rigid intraocular lenses. MATERIAL AND METHODS: A total of 83 patients after cataract surgery were examined at baseline and 8-12 weeks later: 47 patients with age-related macular degeneration (Group 1) and 36 patients without ocular comorbidities (Group 2). Contrast sensitivity was measured using a Ginsburg Box, VSCR-CST-6500. RESULTS: Using logistic regression analysis it was revealed that probability of clinically significant improvement of contrast sensitivity under photopic conditions with and without glare in the patients with implanted foldable lenses increased by 3.1 times (95% PI 1.6-5.9, P<0.001) compared with the patients with rigid lenses. In mesopic conditions with and without glare, it increased by 3.9 and 3.0 times (95% PI 1.9-7.8 and 1.6-5.9, respectively, P<0.001) in the patients with foldable lenses as compared with the patients with rigid lenses. CONCLUSIONS: The foldable intraocular lenses have shown better contrast sensitivity than rigid lenses under both mesopic and photopic conditions with or without glare. Postoperatively, there was no significant difference in visual acuity concerning the types of the implanted intraocular lenses.