Cilioretinal artery occlusion.

BACKGROUND: The aim of this study was to evaluate characteristic findings and functional outcome of this rare type of retinal vascular occlusion in a large patient series. PATIENTS AND METHODS: A retrospective chart review of all patients with a cilioretinal artery obstruction (CAO) seen at the University Eye Clinic Mainz (Germany) over a ten-year period between 1/1999 and 12/2008 was undertaken. The mean follow-up amounted to 42 months. RESULTS: Thirty-three eyes were diagnosed with CAO. Three distinct groups were differentiated: (i) isolated CAO in 20/33 eyes; visual outcome achieving 20/50 in 17/20 eyes; (ii) CAO combined with central retinal vein occlusion in 9/33 eyes; visual outcome achieving 20/50 in 5/9 eyes; (iii) CAO combined with anterior ischaemic optic neuropathy in 4/33 eyes; associated with giant cell arteriitis in 4/4 eyes; visual outcome achieving 20/160 in 1/4 eyes. CONCLUSIONS: The visual prognosis of CAO is significantly better than for other types of retinal artery occlusions, with the exception of cases associated with giant cell arteriitis.

Revision of encapsulated blebs after trabeculectomy: Long-term comparison of standard bleb needling and modified needling procedure combined with transconjunctival scleral flap sutures.

PURPOSE: To compare two surgical approaches for treating encapsulated blebs after trabeculectomy with mitomycin C, in terms of the development of intraocular pressure and progression of glaucoma in a long-term follow up: 1. bleb needling alone vs. 2. a combined approach of needling with additional transconjunctival scleral flap sutures, to prevent early ocular hypotony. METHODS: Forty-six patients with failing blebs after trabeculectomy with mitomycin C were enrolled in this study. Patients received either needling revision alone (group 1; n = 23) or a combined needling with additional transconjuctival flap sutures, if intraoperatively the intraocular pressure was estimated to be low (group 2; n = 23). Intraocular pressure (IOP), visual acuity, visual fields, and optic nerve head configuration by means of Heidelberg Retina Tomograph (HRT®) were analysed over time. Results from both groups were compared using Mann-Whitney U-test for single timepoints. RESULTS: IOP did not differ significantly between the two groups during follow-up at three months (P = 0.13), six months (P = 0.12), one year (P = 0.92) and two years (P = 0.57) after surgery. Furthermore, there was no significant difference in the course of glaucoma concerning the optic nerve anatomy between the two groups (Rim Area Change in the Moorfields Regression Analysis of HRT®) till two years after surgery (P = 0.289). No functional impairment in visual acuity and visual fields was found in the groups of the study. CONCLUSIONS: Single needling procedure is a standard successful method for restoring the function of encapsulated blebs. Postoperative hypotony represents a possible hazard, which can be minimized by additional transconjunctival flap sutures. Long-term results suggest that this modification is equally effective in lowering the IOP and preventing the progression of glaucoma as the standard needling procedure. To our knowledge this is the first study to investigate the long-term effect of tranconjunctival sutures for the prevention of hypotony.