Macular hole Delphi consensus statement (MHOST).

PURPOSE: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Prevalence of exfoliation syndrome in Estonia.

PURPOSE: To estimate the prevalence of exfoliation syndrome (XFS) in Estonia. METHODS: A total of 766 residents, representing the demographics of Tartu, Estonia, were chosen by random sampling from the Estonian Population Database, and invited to participate in this study. Each patient underwent careful slit-lamp examination including applanation tonometry before and after pupil dilatation. Presence of XFS was confirmed after mydriasis as typical white-gray fluffy material on the anterior lens surface, and on the pupillary border as well on the corneal endothelium. RESULTS: A total of 424 subjects, 277 female and 147 male, participated in this study. The median age was 70 years (70 years in women and 71 years in men). The overall prevalence of XFS among the study participants in 1 or both eyes was 25.5% (25.2% in men and 25.6% in women). Intraocular pressure measured before and after dilatation was significantly higher in the XFS group. Glaucoma was significantly more frequent in the XFS group than the non-XFS group; 35.7% and 11.3%, respectively. Fifty percent of all patients with glaucoma had exfoliative glaucoma. Cataract was detected in 57.0% of cases in the XFS group compared to 39.5% in the non-XFS group (p=0.002). We found similar prevalence of systemic diseases in both groups for both genders. There was no difference between the 2 groups in visual acuity. CONCLUSIONS: In this population-based cross-section study, XFS was found to be a frequent finding in Estonia. Exfoliation syndrome is a risk factor for glaucoma and cataract formation.

Exfoliation syndrome as a risk factor for corneal endothelial cell loss in cataract surgery.

PURPOSE: To compare the influence of various cataract surgery pre-, intra-, and postoperative characteristics to cornea endothelium and thickness in patients with and without exfoliation syndrome (PEX). METHODS: In this prospective study 27 consecutive patients with and 26 patients without PEX as a control group scheduled for cataract surgery were studied. The corneal endothelial cells were evaluated preoperatively and postoperatively at 1 day and 1 month after surgery using noncontact specular microscopy. Intraoperative parameters of operation time, phacoemulsification (phaco) time, phaco power and amount of balanced salt solution (BSS) were recorded. The effects of age, axial length, anterior chamber depth (ACD), and lens thickness were evaluated. RESULTS: There were no significant preoperative differences in endothelium morphology between the two groups. The mean endothelial cell loss 1 month after surgery was 18.1% in the PEX group and 11.6% in the control group (p = 0.06). Phaco time and used BSS values were significantly higher in patients with PEX but had no significant influence on endothelial cell loss. In regression analysis phaco power (p = 0.02) and age (p = 0.004) had a significant influence on endothelial cell loss. PEX in interaction with overall phaco impact had a negative influence on endothelial cell loss (p = 0.05). CONCLUSIONS: PEX as a main effect was not found to have a negative influence on endothelial cell loss. However, PEX in cases of high phaco impact significantly increases the risk of endothelial cell loss.

Exfoliation syndrome in Estonian patients scheduled for cataract surgery.

PURPOSE: To examine the frequency of exfoliation syndrome (XFS) in Estonian patients scheduled for cataract surgery. METHODS: A series of 305 patients (mean age 71.5 +/- 8.6 years) scheduled for cataract surgery were examined for the presence of exfoliation syndrome, predominant type of lens opacification and intraocular pressure (IOP). RESULTS: Exfoliation material was detected in 108 (35.4%) patients, of whom 51 (47.2%) were bilaterally and 57 (52.8%) were unilaterally affected. In the bilaterally phakic patients exfoliation material was detected in 92 (30.2%) patients, of whom 51 (55.4%) were bilaterally and 41 (44.6%) were unilaterally affected. Intraocular pressure was higher in eyes with exfoliation than in eyes without it (19.2 +/- 6.5 mmHg and 17.1 +/- 3.8 mmHg, respectively; p = 0.006). Nuclear sclerosis predominated in eyes with XFS compared to those without XFS (57.6% and 36.9%, respectively). Cortical (7.6%) and subcapsular (7.6%) cataracts were less common in eyes with XFS than in eyes without XFS (16.9% and 20.2%, respectively). Mature cataract was found in 41.3% of all mixed types of cataracts. CONCLUSION: Exfoliation syndrome is common in Estonian patients. It was detected in 35.4% of the patients scheduled for cataract surgery.