Surgical outcomes of macular hole and epimacular membrane treatment in patients with intraoperative amaurosis under sub-Tenon's anesthesia.

OBJECTIVE: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. METHODS: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). RESULTS: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. CONCLUSION: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.

What and where in the auditory systems of sighted and early blind individuals: Evidence from representational similarity analysis.

Separated ventral and dorsal streams in auditory system have been proposed to process sound identification and localization respectively. Despite the popularity of the dual-pathway model, it remains controversial how much independence two neural pathways enjoy and whether visual experiences can influence the distinct cortical organizational scheme. In this study, representational similarity analysis (RSA) was used to explore the functional roles of distinct cortical regions that lay within either the ventral or dorsal auditory streams of sighted and early blind (EB) participants. We found functionally segregated auditory networks in both sighted and EB groups where anterior superior temporal gyrus (aSTG) and inferior frontal junction (IFJ) were more related to the sound identification, while posterior superior temporal gyrus (pSTG) and inferior parietal lobe (IPL) preferred the sound localization. The findings indicated visual experiences may not have an influence on this functional dissociation and the cortex of the human brain may be organized as task-specific and modality-independent strategies. Meanwhile, partial overlap of spatial and non-spatial auditory information processing was observed, illustrating the existence of interaction between the two auditory streams. Furthermore, we investigated the effect of visual experiences on the neural bases of auditory perception and observed the cortical reorganization in EB participants in whom middle occipital gyrus was recruited to process auditory information. Our findings examined the distinct cortical networks that abstractly encoded sound identification and localization, and confirmed the existence of interaction from the multivariate perspective. Furthermore, the results suggested visual experience might not impact the functional specialization of auditory regions.