Anatomical and functional outcomes in combined rhegmatogenous retinal and choroidal detachment pre-treated with systemic corticosteroid: a case series.

BACKGROUND: Combined rhegmatogenous retinal and choroidal detachment (CRRCD) is a rare phenomenon. It is important that CRRCD is recognised preoperatively so that corticosteroids may be administered as this may make repair surgery easier to do. AIMS: We here report on the anatomical and visual outcomes of 3 patients treated for CRRCD. METHODS: Retrospective review of 3 eyes of 3 patients with CRRCD which underwent scleral buckle, vitrectomy, and silicone oil insertion. Data including visual acuity, intraocular pressure, ocular inflammatory status, the presence of subretinal fluid, the presence of retinal breaks, the presence of proliferative vitreoretinopathy, demographic information, medical and ophthalmic history, administration of perioperative corticosteroids, surgical techniques, and complications was collected. RESULTS: Patients were aged 60, 66, and 62 years old at the time of surgery. There was a minimum follow-up time of 20 months. Initial visual acuity was 4/60. Initial intraocular pressure was 3 mmHg, 7 mmHg, and 7 mmHg. All eyes had deep, inflamed anterior chambers at the time of presentation. All eyes underwent 20-gauge vitrectomy, scleral buckle, and silicone oil insertion. All patients received a perioperative course of oral corticosteroids. Final visual acuity was 6/12, 6/7.5, and 6/18. CONCLUSION: These 3 patients had good anatomical and functional results following surgery for CRRCD. All patients had visual acuity of 6/18 or better at last review.

A retrospective evaluation of bilateral medial rectus recession for management of accommodative esotropia according to prism-adapted motor response preoperatively.

The prism adaptation test (PAT) is a preoperative tool that may fine-tune surgical dosage and reduce under- and overcorrection in pediatric partially accommodative esotropia; however, it is resource intensive and the benefits are uncertain. PAT involves correction of esodeviation with prisms, with subsequent assessment for and quantification of change in angle of esodeviation, thereby augmenting the surgical target angle in a subset of patients. We evaluated PAT response and postoperative outcomes in a cohort of children who underwent bilateral medial rectus recession and found that 36% of patients showed a requirement for increase of prism dosage to retain orthotropia during PAT; these patients did better than those whose deviation was stable, with postoperative rate of motor success (defined as ≤10Δ esotropia) of 100% versus 56%. PAT may be a useful positive prognostic test, and it also identifies a substantial patient population who may avoid undercorrection, the prism builders. However, this cohort may do better postoperatively regardless of the target angle for surgery. Additional randomized studies are required to demonstrate definitive benefit of PAT. Identification of the builder phenotype prior to commencing adaptation may reduce the workload involved in the PAT technique.

Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms.

PURPOSE: Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined. METHODS: Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation. RESULTS: Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40 % showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM. CONCLUSION: Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.