Silicone Oil Tamponade for Therapy of Primary Retinal Detachment in Patients Who Live at High Altitudes.

BACKGROUND: Uncomplicated rhegmatogenous retinal detachment (RRD) is mainly treated with vitrectomy and gas tamponade or, alternatively, scleral buckling surgery. However, gas tamponade inflates at high altitudes, causing significant complications. Silicone oil (SO) tamponade volume is unaffected by atmospheric pressure and may be used in patients who live or must undertake travel at high altitudes. PURPOSE: To determine the anatomical and functional outcomes after pars plana vitrectomy (PPV) with SO tamponade in primary uncomplicated RRD. METHODS: Twenty-eight consecutive cases of patients operated between January 2017 and December 2022 in Jules-Gonin University Eye Hospital in Lausanne were included in this retrospective study. All patients had a follow-up of at least 3 months after SO removal. RESULTS: Primary reattachment was achieved in all 28 eyes. Mean follow-up was 17.2 months (range: 3 - 51 months) after SO removal. Mean age at the time of intervention was 60 years (range: 21 - 80 years). Vision was stabilized or improved in 27 eyes (96%). One patient demonstrated a slight visual acuity decrease due to cataract formation at the last follow-up. In all patients, SO was removed 2 to 5 months after primary repair. In 14 of the 21 phakic patients, concomitant cataract surgery was performed. No surgical complications were encountered. Postoperatively, 5 (18%) patients had ocular hypertension, presumably steroid related, that was successfully controlled with topical treatment. CONCLUSION: PPV with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated RRD in patients living at high altitudes and was associated with good anatomical and functional outcome in our series. However, the need for a follow-up surgery to remove SO should be weighed in these cases.

Harmonizing ophthalmic residency surgical training across Europe: A proposed surgical curriculum.

BACKGROUND: One of the core aims of the European Union of Medical Specialists is to harmonize training across Europe by creating European Training Requirements for all medical specialties including Ophthalmology. The theoretical part is already defined by the EBO, however as ophthalmology also includes surgical skills, we herein propose a surgical minimum curriculum for ophthalmology residents in Europe. METHODS: National and international ophthalmic training curricula which are publicly available in English were reviewed and compared. The final proposal was created from 5 criteria: 1. Disease prevalence; 2. Patient safety; 3. Case-trainee ratio; 4. Skill transfer; and 5. Technical difficulty. RESULTS: In total 7 different training curricula from across the world were compared. Among the surgical procedures, cataract surgery has the highest median number of procedures required to be completed during residency: 86 procedures (50-350). Followed by oculoplastics: 28 procedures (10-40) and panretinal photocoagulation: 27.5 procedures (10-49) Full procedural competence is proposed in 9 surgical skills, including YAG laser posterior capsulotomy, retinal argon laser, intravitreal injection, corneal foreign body removal, removal of corneal sutures, facial and periocular laceration repair, eyelid laceration repair, minor eyelid procedures, and punctal occlusion. These procedures are deemed essential and feasible for all ophthalmology residents in Europe to perform independently upon completion of their training. CONCLUSION: This proposal should be regarded as a recommendation based on comparable surgical curricula in use worldwide to establish standards across European countries and may serve as valuable insight to those responsible for compiling ETRs for ophthalmology, or their national curriculums.

Comparative analysis of European residency programs: benchmarking and harmonizing ophthalmology training in Europe.

BACKGROUND/OBJECTIVES: This study aims to benchmark the training programs of European ophthalmology residents. SUBJECTS/METHODS: An online survey, aimed at European ophthalmology residents in training and those within two years of completion, was sent through the national representatives of the European Society of Ophthalmology, Young Ophthalmologists section (SOE-YO). The study involved 214 subjects representing 36 of the 44 European countries offering ophthalmology training programs. RESULTS: Among the surveyed, 74.8% of participants had an official national curriculum; 55.8% had a national specialty examination to accredit their training as ophthalmologists. 45.8% were satisfied or very satisfied with the clinical skills acquired, while 42.1% were completely dissatisfied with the surgical skills achieved. Considering the 4th year residents (mean duration of the residency), many of them did not perform phacoemulsification surgery (34%), pterygium excision (46.9%), or repair of eyelid laceration (31.3%). CONCLUSIONS: There is great heterogeneity in the competencies achieved by residents in training according to their country of origin, especially in terms of surgical competences.

Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in These Cases.

BACKGROUND: Marfan Syndrome is an autosomal dominant disease with multiple ocular abnormalities including ectopia lentis and a high incidence of rhegmatogenous retinal detachment (RRD). The management of RRD may be challenging in cases of aphakic patients with Marfan. PURPOSE: To report on the management of four cases of simultaneous RRD and aphakia with vitrectomy, silicone oil tamponade, and retropupillary iris-claw intraocular lens (IOL) implantation in patients with Marfan that have been operated at the Jules-Gonin Eye Hospital between 2019 and 2020. HISTORY AND SIGNS: Ages at presentation were 20, 30, 32, and 31 years, respectively. All patients had a history of extraction of a dislocated lens. None of the patients had a previous posterior vitrectomy. Two patients had records of previous measurements for IOL calculation by optical biometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) about 1 year prior to the RRD development. In two cases, measurements for IOL calculation by optical biometry were based on the contralateral eye. THERAPY AND OUTCOME: All patients underwent 23 G vitrectomy, peripheral iridotomy, and retropupillary iris-claw IOL. No intraoperative complications were encountered. All patients had silicone oil tamponade, one of which required heavy silicone oil. Silicone oil was removed 3 months following primary surgery. Minimum follow-up was 1 year. The single surgery anatomic success rate was 100%. All patients had visual acuity of at least 0.8 at the last follow-up (1.25, 1.0, 0.8, and 0.8 respectively). The targeted refractive results were accurately achieved in all four cases postoperatively. One patient presented ocular hypertension 2 weeks after surgery due to presumed steroid response and was managed conservatively. None of the patients had silicone oil migration into the anterior chamber. CONCLUSION: Retropupillary iris-claw IOL implantation in cases of RRD and aphakia creates a barrier to tamponades from the posterior segment, effectively preventing them from entering the anterior segment of the eye. Therefore, the management of aphakia and retinal detachment with simultaneous vitrectomy and a retropupillary iris-claw IOL may be a successful strategy in reducing postoperative complications in patients with Marfan syndrome.

APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE.

PURPOSE: We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery. METHODS: In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]). RESULTS: One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41). CONCLUSION: The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.

An in vitro Model of Human Retinal Detachment Reveals Successive Death Pathway Activations.

PURPOSE: was to create an in vitro model of human retinal detachment (RD) to study the mechanisms of photoreceptor death. METHODS: Human retinas were obtained through eye globe donations for research purposes and cultivated as explants. Cell death was investigated in retinas with (control) and without retinal pigment epithelium (RPE) cells to mimic RD. Tissues were studied at different time points and immunohistological analyses for TUNEL, Cleaved caspase3, AIF, CDK4 and the epigenetic mark H3K27me3 were performed. Human and monkey eye globes with retinal detachment served as controls. RESULTS: The number of TUNEL-positive cells, compared between 1 and 7 days, increased with time in both retinas with RPE (from 1.2 ± 0.46 to 8 ± 0.89, n = 4) and without RPE (from 2.6 ± 0.73 to 16.3 ± 1.27, p < 0.014). In the group without RPE, cell death peaked at day 3 (p = 0.014) and was high until day 7. Almost no Cleaved-Caspase3 signal was observed, whereas a transient augmentation at day 3 of AIF-positive cells was observed to be about 10-fold in comparison to the control group (n = 2). Few CDK4-positive cells were found in both groups, but significantly more in the RD group at day 7 (1.8 ± 0.24 vs. 4.7 ± 0.58, p = 0.014). The H3K27me3 mark increased by 7-fold after 5 days in the RD group (p = 0.014) and slightly decreased at day 7 and was also observed to be markedly increased in human and monkey detached retina samples. CONCLUSION: AIF expression coincides with the first peak of cell death, whereas the H3K27me3 mark increases during the cell death plateau, suggesting that photoreceptor death is induced by different successive pathways after RD. This in vitro model should permit the identification of neuroprotective drugs with clinical relevance.

CHANGES IN VISUAL ACUITY AND PHOTORECEPTOR DENSITY USING ADAPTIVE OPTICS AFTER RETINAL DETACHMENT REPAIR.

PURPOSE: To quantify changes in photoreceptor density using adaptive optics fundus camera in patients after retinal detachment (RD) and to correlate them with macular involvement and best-corrected visual acuity. METHODS: At 1 and 3 months (M1 and M3) after vitrectomy, 194 patients underwent adaptive optics imagery in both eyes, at 5 locations, that we matched between time points using anatomical landmarks. Twenty-two patients (10 fovea-OFF [OFF] and 12 fovea-ON [ON]) had matched and analyzable adaptive optics images. We used analysis of variance for repeated measures. RESULTS: Best-corrected visual acuity (logarithm of the minimum angle of resolution and Snellen equivalent [SE]) was significantly different between OFF and ON RDs at baseline: 2.0 (2.3-0.95) (SE: 20/2000) versus 0 (0.1-0) (SE: 20/20); at M1: 0.35 (0.5-0.1) (SE: 20/40) versus 0.05 (0-0.1) (SE: 20/25); and at M3: 0.25 (0.3-0.1) (SE: 20/32) versus 0 (0-0) (SE: 20/20). We observed that cone density was stable in fellow eyes between M1 and M3 (P = 0.67); decreased in treated eyes than in fellow eyes (P < 0.05); and increased postoperatively in the ON group (P = 0.02) but not in the OFF group (P = 0.97). Visual acuity and RD type were independently correlated with cone density (P = 0.004, P = 0.000). CONCLUSION: Postoperative cone density was reduced in OFF RD, but also in the ON group, although the drop recovered during the 3-month follow-up. Cone density was significantly correlated with both visual acuity and type of RD at both time points.

EVOLUTION AND PATTERNS OF CHOROIDAL THICKNESS CHANGES IN RHEGMATOGENOUS RETINAL DETACHMENT.

PURPOSE: To evaluate the changes in choroidal thickness (CT) before and after a successful pars plana vitrectomy for rhegmatogenous retinal detachment (RD), and to compare the evolution of CT with respect to the extent of RD. METHODS: Fifty-four patients were divided into three groups: peripheral macula-on RD (>3 mm from the fovea; 14 eyes); paracentral macula-on RD (fovea-sparing; ≤3 mm from the fovea; 14 eyes); and macula-off RD (involving the fovea; 26 eyes). Choroidal thickness was measured at 1 month (M1) and 3 months (M3) postoperatively, preoperatively in macula-on RDs, with enhanced depth imaging optical coherence tomography, from the nasal side (+2.5 mm) to the temporal side (-2.5 mm) of the fovea. RESULTS: In peripheral macula-on RD, the intereye difference in CTs showed thickening throughout follow-up (subfoveally: preoperatively = 19.6% ± 43.9%, M1 = 22.9% ± 27.5%, M3 = 18.2% ± 35.6%). In paracentral macula-on RD, the intereye difference in CTs showed a thinning throughout follow-up (subfoveally: preoperatively = -7.8% ± 21.9%, M1 =-5.5% ± 26.1%, M3 = -9.3% ± 19.4%), as well as in the macula-off RD (subfoveally: M1 = -14.1% ± 18.7%, M3 = -9.9% ± 15%). CONCLUSION: The extent of RD was related to the evolution of the CT before and after surgery. Further studies are necessary to clarify the relationship between the changes in CT and the effects of circulatory alterations, vitrectomy, and RD.

Primary rhegmatogenous retinal detachment: risk factors for macular involvement.

PURPOSE: Rhegmatogenous retinal detachment (RD) has diagnostically been divided into macula-OFF or macula-ON. The aim of this study was to describe the demographics and primary outcome of patients with RD following surgery with respect to the macular status, and to determine risk factors for macular involvement. METHODS: This prospective, observational, mono-centric cohort study was conducted at the Jules-Gonin Eye Hospital, from February 2015 until March 2017. The study included 194 eligible patients with primary RD. All patients underwent surgical treatment after baseline clinical examination. The dataset was analyzed using descriptive and analytic statistics. RESULTS: A total of 52.6% (102/194) of patients presented with macula-OFF RD. Mean age was 63.9 ± 12.0 vs. 59.7 ± 11.2 years in the OFF and ON group, respectively. There were 129 men (66.5%) and 65 (33.5%) women, and there were significantly more right eyes affected [right vs. left eyes 123 (63.4%) vs. 71 (36.6%), p = 0.000]. Significantly more myopes (<-3D) presented with a macula-ON RD (p = 0.04). There were more phakic patients in the cohort (55.7%), and phakic eyes were more likely to present with macula-ON RD (p = 0.01). Multivariate modeling showed that pseudophakic lens status and eyes with axial length less than 25 mm (p = 0.06) are independent predictive factors for macula-OFF RD (p = 0.02), whereas sex and laterality were not risk factors for macular involvement. CONCLUSION: Pseudophakic lens status and axial length < 25 mm are independent predictive factors for macula-OFF RD. While pseudophakic lens status is a recognized risk factor for RD, shorter axial length has not been previously identified as a risk factor for the macula-OFF RD.

[Pars plana vitrectomy with extraction of intraocular foreign body in patients with siderosis of the eye: report of two cases].

INTRODUCTION: Penetrating injury is characterized by the existence of entry wound only, and it can be with or without an intraocular foreign body (IOFB). IOFB can lead to a mechanical injury of the eye and to cause infection or to manifest other toxic effects on intraocular structures. Iron and copper can dissolve and cause siderosis, i.e. chalcosis of the eye. Ocular siderosis is diagnosed by clinical and electroretinogram (ERG) findings. OUTLINE OF CASES: The first patient was a 37-year-old male who was injured by a metal foreign body. He presented at the Clinic two years after the injury. Visual acuity of the right eye (VOD) on admission was VOD=L+P+ (light projection). Pars plana phaco-vitrectomy with IOFB extraction was done. Visual acuity on discharge was VOD=3/60 cc + 7.50 Dsph=0.2. The second patient was a 55-year-old male who presented at the clinic 18 months after injury. On admission visual acuity in his left eye was VOS 1/60. Pars plana phacovitrectomy with IOFB extraction was done.Visual acuity on discharge was VOS=0.7 through the stenopeic slit. CONCLUSION: In penetrating injuries caused by a metal IOFB pars plana vitrectomy with IOFB extraction is indicated. In cases with IOFB, when visual acuity is preserved, the lens is transparent, while the eye is without signs of infection, urgent pars plana vitrectomy is not necessary. Such patients need regular followup with obligatory ERG findings.

Estimation of functional recovery in patients after hip fracture by Berg Balance Scale regarding the sex, age and comorbidity of participants.

AIM: To evaluate the functional status measured by Berg Balance Scale (BBS) in elderly aged more than 65 years after hip fractures, and to evaluate the influence of sex, age and comorbidity on balance function improvement. METHODS: The study included 203 patients with hip fractures. Functional status was evaluated by BBS: at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). We analyzed three age groups: Group 65-74 , Group 75-84 and Group 85-up; female and male sex separately; and for severity index value (SI; total cumulative illness rating scale for geriatrics score divided by number of endorsed categories): group between 0-1.99 (SI1 ) and group ≥ 2 (SI2 ). RESULTS: BBS values significantly declined in all male groups and female Group 2 and Group 3 in SI2 (P < 0.01). Group 65-74 and Group 85-up had a significant BBS values decline in Group 2 and Group 3, whereas Group 75-84 had a significant decline in all groups in the SI2 group (P < 0.01). Females and males had a significant BBS values increase in the SI1 groups (P < 0.01), and non-significant BBS values increase between Group 2/Group 3 for SI2 . Group85-up had a significant BBS values increase in SI1 (Group 1/Group 2 and Group 1/Group 3; P < 0.01); a non-significant increase between Group 1/Group 2 and Group 1/Group 3, and a non-significant decline between Group 2/Group 3 in SI2. CONCLUSIONS: Male sex, increased comorbidity and age more than 85 years could be considered with lower functional recovery capacity potential after hip fracture, and thus should be individually assessed and continuously monitored. Functional status estimation by BBS could be taken as a sensitive predictive value for the evaluation of functional improvement in these patients.

Persistent submacular fluid diagnosed with optical coherence tomography after successful scleral buckle surgery for macula-off retinal detachment.

Crataegus species have been widely used in herbal medicine, especially for the hearth diseases. In the present study, the effect of Crataegus aronia var. dentata Browicz extract on partially hepatectomized rats was investigated with biochemical and TUNEL apoptosis assays. The extracts of the plant at the concentrations of 0.5 and 1 ml/100 g body weight/day were administered orally to the two experimental groups including partially hepatectomized rats for 42 days. At the end of the experimental period, animals were sacrificed, blood was collected for the assessment of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), and the liver tissue was used for TUNEL assay. In biochemical assay, it was found a significant decrease in the levels of serum ALT and AST in the experimental groups. On the other hand, the plant extract did not cause any significant changes in the level of GGT in these groups. In apoptosis assay, TUNEL positive hepatocytes could not be detected in both experimental groups. The present findings can suggest that Crataegus aronia var. dentata Browicz extract can decrease the levels of serum ALT and AST and play a role in apoptosis of hepatocytes in the liver of partially hepatectomized rats. However, further studies are required to confirm the effects of the plant extract on hepatoprotection and apoptosis in the regenerating liver after partial hepatectomy in animal models.