Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes.

PURPOSE: To study the predisposing factors for late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes after explantation surgery. METHODS: In this retrospective multicentre study, 61 eyes were enrolled. The main inclusion criterion was in-the-bag spontaneous IOL dislocation after uneventful phacoemulsification cataract extraction. Only eyes with serious dislocation that required IOL explantation were eligible. Follow-up after explantation surgery of at least 3 months was required. Exclusion criteria were complicated cataract surgery, out-of-the-bag IOL dislocation, and dislocations that occurred in the first year after the cataract surgery. The main outcome measures were predisposing factors for dislocation, interval between cataract surgery and dislocation, surgical treatment at the time of explantation, preoperative and postoperative corrected distance visual acuity (CDVA), and postoperative complications. RESULTS: High myopia was detected in 12 cases (19.7%) and it was the main predisposing factor. Mean time interval from cataract surgery to dislocation was 7.5 (SD 5.2) years. The dislocated in-the-bag IOL was replaced with a scleral fixated IOL (36.1%), angle-supported anterior chamber IOL (31.1%), sulcus repositioning (18%), or posterior chamber iris sutured IOL (4.9%). Finally, 9.8% of the patients were left aphakic. Mean CDVA improved significantly after surgery (P=0.005). Final CDVA of 20/40 or better was achieved in 29 cases (47.5%). CONCLUSIONS: High myopia was the main risk factor for late in-the-bag IOL dislocation. Surgical treatment significantly improved the CDVA in our sample and was associated with a low complication rate.

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy.

PURPOSE: To compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography. METHODS: This is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 45°, 90°, and 135° and the bleb height was measured. RESULTS: Sk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles (p(25) 8.25; p(75) 20). The median IOP was 13 mm Hg (p(25) 10; p(75) 15), with no significant differences among implants (P = 0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 45° (r=-0.359; P = 0.004), 90° (r = -0.410; P = 0.001), and 135° (r = -0.417; P = 0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants. CONCLUSION: There was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

[Treatment of the comitant adquired esotropia residual deviation]. / Tratamiento de la desviación residual en la endotropía comitante adquirida.

PURPOSE: To review the therapeutic options in the management of residual esotropia, particularly focusing on the effectiveness of botulinum toxin. METHODS: Retrospective study of cases of post-surgical residual esotropia treated in our hospital from January 1999 to January 2008. Visual acuity and motor outcomes were analysed in the patients who received botulinum toxin injection. RESULTS: Of the 200 cases reviewed, 91% of the patients had a new surgery, 5% of patients refused any treatment, while 8 patients (4%) received botulinum toxin injection. Visual acuity (Snellen) before surgery, before toxin and after toxin injection in the right eye was 0.77 (SD 0.2), 0.86 (SD 0.2) and 0.97 (SD 0.2), respectively, and in the left eye: 0.76 (SD 0.1), 0.91 (SD 0.09) and 0.97 (SD 0.2), respectively. The percentage net change in the angle of deviation at far and near distance after toxin injection in the last follow-up was 41.66% and 10%, respectively. The mean follow-up after botulinum toxin injenction was 30.8 months. The success rate (ocular alignment in primary eye position) after toxin at the end of follow-up was 75%. CONCLUSIONS: Residual esotropia may be managed with further surgery or with botulinum toxin injection. The first option is more common, but in selected cases botulinum toxin injection may provide very successful outcomes with a low incidence of complications.

Tratamiento de la desviación residual en la endotropía comitante adquirida / Treatment of the comitant adquired esotropia residual deviation

ObjetivoAnalizar las actitudes terapéuticas en casos de endotropía residual, en particular la efectividad de la toxina botulínica.MétodosEstudio retrospectivo en casos de endotropía residual tras cirugía tratados en nuestro centro desde enero de 1999 hasta enero de 2008. En los casos tratados con toxina botulínica se analizó la agudeza visual y la evolución de la desviación tras el tratamiento.ResultadosDe los 200 casos revisados, el 91% de los pacientes fueron tratados quirúrgicamente de nuevo, el 5% rehusaron ser tratados mientras que 8 pacientes (4%) fueron tratados con toxina botulínica. La agudeza visual (Snellen) prequirúrgica, pre-toxina y post-toxina en el ojo derecho fue respectivamente: 0,77 (DE 0,2), 0,86 (DE 0,2) y 0,97 (DE 0,2) y en el ojo izquierdo: 0,76 (DE 0,1), 0,91 (DE 0,09) y 0,97 (DE 0,2). El cambio neto en la desviación de lejos tras la inyección de toxina fue del 41,66%, en la desviación de cerca fue el 10%.El tiempo medio de seguimiento tras la inyección de toxina botulínica fue de 30,8 meses.El 75% de los pacientes tratados con toxina fueron éxitos (alineamiento ocular en posición primaria de la mirada) al final del seguimiento.ConclusionesEl manejo de la endotropía residual puede ser quirúrgico o con inyección de toxina botulínica. A pesar de que la cirugía es la opción preferida, la toxina aplicada en casos seleccionados consigue resultados exitosos y con muy bajo riesgo de complicaciones(AU)

PurposeTo review the therapeutic options in the management of residual esotropia, particularly focusing on the effectiveness of botulinum toxin.MethodsRetrospective study of cases of post-surgical residual esotropia treated in our hospital from January 1999 to January 2008. Visual acuity and motor outcomes were analysed in the patients who received botulinum toxin injection.ResultsOf the 200 cases reviewed, 91% of the patients had a new surgery, 5% of patients refused any treatment, while 8 patients (4%) received botulinum toxin injection. Visual acuity (Snellen) before surgery, before toxin and after toxin injection in the right eye was 0.77 (SD 0.2), 0.86 (SD 0.2) and 0.97 (SD 0.2), respectively, and in the left eye: 0.76 (SD 0.1), 0.91 (SD 0.09) and 0.97 (SD 0.2), respectively. The percentage net change in the angle of deviation at far and near distance after toxin injection in the last follow-up was 41.66% and 10%, respectively.The mean follow-up after botulinum toxin injenction was 30.8 months.The success rate (ocular alignment in primary eye position) after toxin at the end of follow-up was 75%.ConclusionsResidual esotropia may be managed with further surgery or with botulinum toxin injection. The first option is more common, but in selected cases botulinum toxin injection may provide very successful outcomes with a low incidence of complications(AU)

Visual field index rate and event-based glaucoma progression analysis: comparison in a glaucoma population.

AIMS: The aim of the study was to compare event-based glaucoma progression analysis (GPA) I with new GPA II software and pattern deviation-based trend analyses (visual field index [VFI]) to detect progression in a glaucoma population. METHODS: This was a retrospective study that included 90 eyes of 90 patients with a minimum of five reliable visual field tests and a follow-up period of at least 2 years. RESULTS: Event-based GPA II detected progression in 16.7% of eyes in which trend analysis VFI failed. GPA detected progression 6.8 months earlier than VFI. GPA I and II showed excellent agreement (k = 0.94). Agreement between VFI and mean deviation (MD) linear analysis and with GPA criteria was k = 0.52 and k = 0.48, respectively. Mean rates of progression of MD and VFI were -0.41 dB and -1.30% annually, respectively (rho = 0.824; p<0.0001). Using VFI, mean follow-up time was 6.12 and 4.89 years (p = 0.004) and the mean number of visual field tests was 7.33 and 6.01 (p = 0.023) in eyes with and without progression, respectively. CONCLUSIONS: Event-based software GPA I and II had excellent agreement. Event analysis showed earlier and greater sensitivity for detecting progression than VFI analysis and both had only moderate agreement. Trend analysis VFI is likely to detect progression in patients with a greater number of visual field tests and a longer follow-up time. The VFI analysis seems to be more accurate than MD analysis for determining rate of progression.