[A man with optic disc swelling]. / Een man met onscherpe papillen.

A 60-year-old man presented with deterioration of vision in his right eye. Funduscopic examination showed bilateral optic disc swelling. Ultrasonography revealed optic disc drusen. Optic neuropathy due to optic disc drusen can cause transient and permanent visual impairment.

Postoperative recovery of visual function after macula-off rhegmatogenous retinal detachment.

PURPOSE: To determine which factors affect the recovery of visual function in macula off rhegmatogenous retinal detachment (RRD). METHODS: In a prospective study of forty-five patients with a primary macula-off RRD of 24 hours to 6 weeks duration, the height of the macular detachment was determined by ultrasonography. At 12 months postoperatively, best corrected visual acuity (BCVA), contrast acuity, and color confusion indexes (CCI) were obtained. RESULTS: Macular detachment was present for 2-32 (median 7) days before repair. A shorter duration of macular detachment was correlated with a better CCI saturé (p = 0.0026) and lower LogMAR BCVA (better Snellen visual acuity) (p = 0.012). Also, a smaller height of macular detachment was correlated with a lower LogMAR BCVA (p = 0.0034). A younger age and lower pre-operative LogMAR BCVA at presentation were both correlated with better postoperative contrast acuity in the total group (age: p = 1.7×10(-4) and pre-operative LogMAR BCVA: p = 0.0034). CONCLUSION: Functional recovery after macula-off RRD is affected by the duration and the height of the macular detachment. Recovery of contrast acuity is also affected by age and BCVA at presentation. MEETING PRESENTATION: ARVO annual meeting 2013, May 7, Seattle, Washington, United States of America. TRIAL REGISTRATION: trialregister.nl NTR839.

Design and validation of a method to determine the position of the fovea by using the nerve-head to fovea distance of the fellow eye.

PURPOSE: To measure the nerve-head to fovea distance (NFD) on fundus photographs in fellow eyes, and to compare the NFD between fellow eyes. METHODS: Diabetic patients without retinopathy, (n = 183) who were screened by fundus photography at the University Medical Center Groningen, the Netherlands from January 1(st) 2005 until January 1(st) 2006 were included. The NFD was measured in left and right eyes both from the center and from the rim of the nerve-head. To determine inter- and intra-observer agreement, repeated measurements by one observer (n = 3) were performed on all photographs and by two observers on 60 photographs (30 paired eyes). The effect of age, gender, and refractive error on NFD was analysed. RESULTS: The correlation of NFDs between the left and the right eye was 0.958 when measured from the center of the nerve head (mean difference 0.0078 mm. ±SD 0.079 (95% limits of agreement -0.147-0.163)) and 0.963 when measured from the rim (mean difference 0.0056±SD 0.073 (95% limits of agreement -0.137-0.149)). Using the NFD between fellow eyes interchangeably, resulted in a standard error of 0.153 mm. Intra- and inter-observer variability was small. We found a significant effect of age (center of the nerve-head (P = 0.006) and rim of the nerve head (P = 0.003)) and refractive error (center of nerve-head (P<0.001) and rim of nerve head (P<0.001)) on NFD. CONCLUSIONS: The NFD in one eye provides a confident, reproducible, and valid method to address the position of the fovea in the fellow eye. We recommend using the NFD measured from the center of the nerve-head since the standard error by this method was smallest. Age and refractive error have an effect on NFD.

Artisan toric lens implantation for correction of postkeratoplasty astigmatism.

PURPOSE: To determine the efficacy of Artisan toric iris-fixated lens implantation after penetrating keratoplasty to correct high ametropia and astigmatism. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Artisan toric lens implantation was performed in 16 eyes of 16 patients who were contact lens intolerant or were unable to wear glasses because of anisometropia, high astigmatism, or both. INTERVENTION: Sixteen eyes of 16 patients received Artisan toric lenses for postkeratoplasty astigmatism, anisometropia, or both. MAIN OUTCOME MEASURES: Manifest refraction, uncorrected and spectacle-corrected visual acuity, and corneal topography were performed before surgery and 1, 3, 6, 12, and 18 months after surgery. Efficacy, percent reduction of refractive astigmatism, topographical astigmatism, anisometropia of defocus, and the astigmatism correction index were determined. A patient satisfaction questionnaire and specular microscopy results were assessed. RESULTS: The mean +/- standard deviation of the preoperative refractive cylinder was -6.66+/-1.93 diopters (D; range, -4.0 to -10.0 D), which was reduced to -2.08+/-1.33 D, -2.14+/-1.76 D, -1.98+/-1.65 D, -1.84+/-0.77 D, and -1.42+/-0.78 D at 1 month, 3 months, 6 months, 12 months, and the final follow-up examination (8.4+/-4.9 months), respectively. Spherical equivalent was reduced from -4.90+/-5.50 D before surgery to -0.96+/-0.86 D at the final follow-up. The uncorrected and best-corrected visual acuities were >/=20/40 in 42% and 100% of eyes, respectively. There was no loss of best-corrected visual acuity and a gain of at least 2 lines in 50% of eyes. The percent reduction in refractive astigmatism, topographical astigmatism, and anisometropia of defocus were 78.0+/-11.5%, 20.3+/-34.9%, and 77.0+/-12.0%, respectively. The astigmatism correction index was 102.8+/-18.6%. Satisfaction increased from 3.2 to 8.3 after implantation. The endothelial cell loss was 7.6+/-18.9% at 3 months and 16.6+/-20.4% at the last follow-up. In 1 patient, a reversible graft rejection occurred. CONCLUSIONS: Artisan toric lens implantation after penetrating keratoplasty was effective for reduction of refractive astigmatism and ametropia. All patients were suitable for spectacle correction after implantation. A longer follow-up and a larger number of patients are needed to assess the safety and the effect of the lens on the corneal graft endothelium.

Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment.

BACKGROUND: To analyse vitrectomy results in diabetic eyes with retinal traction detachment and to investigate which variables are associated with a worse visual outcome. METHODS: Forty-four diabetic eyes (33 patients) with central retinal traction detachment were analyzed retrospectively. RESULTS: After a median follow-up of 10 months, median visual acuity significantly improved from 20/800 to 20/160 (P=0.02), despite the fact that the majority of patients had a long-standing macular traction detachment (median 120 days). Twenty-two eyes (50%) achieved a visual acuity of >20/200. The retina was finally reattached in 38 eyes (86.3%). Univariate analysis showed that patients with type 2 diabetes, age older than 50 years, preoperative visual acuity <20/200, iris neovascularisation and macular detachment of >30 days had a significantly worse final visual outcome. After multiple logistic regression analysis, age and iris neovascularisation were the strongest predictors of a worse visual outcome; if both were present, the chance of a obtaining a visual outcome of <20/200 was almost 90%. CONCLUSIONS: Age and iris neovascularisation were the strongest predictors for a low visual outcome. In a review of vitrectomy studies in eyes with severe diabetic traction detachment in the past 2 decades, we found a trend towards higher anatomic success rates, while visual outcome only slightly improved. The current study confirmed the importance of ophthalmic variables, but also indicates the importance of evaluating systemic variables in larger series in order to predict which eyes may truly benefit from vitrectomy.