A case-control study to assess aspirin as a risk factor of bleeding in rhegmatogenous retinal detachment surgery.

PURPOSE: The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD). METHODS: Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding. RESULTS: Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09). CONCLUSION: This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.

Comparative prospective study of rhegmatogenous retinal detachments in phakic or pseudophakic patients with high myopia.

PURPOSE: To compare the anatomical and functional results of primary rhegmatogenous retinal detachment in highly myopic phakic or pseudophakic eyes. METHODS: This prospective 2-center study included 191 consecutive eyes (151 phakic and 40 pseudophakic eyes) from a prospective cohort of 835 patients (IRB #5891, between 2004 and 2008). Baseline and follow-up data were systematically recorded at presentation, 1 month, and 6 months or more after surgery. On final examination, two groups were considered based on the need for one or more surgeries to achieve retinal reapplication. End points were primary reattachment rate at the 6-month visit, final anatomical success rate, postoperative visual acuity, and intraoperative and postoperative complications. RESULTS: Pseudophakic eyes differed from phakic eyes in age (60.8 ± 10.4 vs. 49.9 ± 12.3, P < 0.001), smaller pupil dilation (8.0 ± 1.5 vs. 8.5 ± 1.2 mm, P = 0.02), fewer retinal tears seen preoperatively (1.5 ± 1.6 vs. 2.2 ± 2.2, P = 0.06), more frequent use of pars plana vitrectomy (80% vs. 28.5%, P < 0.001), and higher single reattachment rate (92.5% vs. 80.7%). Visual acuity was greater than or equal to 20/40 in 54% of cases with single retinal detachment surgery and 44% of cases with multiple surgeries. Multiple logistic regression analysis showed that only 3 independent variables were significantly predictive of good final visual acuity (20/40): initial visual acuity (<20/400, odds ratio = 0.19; 95% confidence interval, 0.07-0.51; P = 0.002), axial length (odds ratio = 0.57; 95% confidence interval, 0.44-0.75, P < 0.001), and pars plana vitrectomy (odds ratio = 0.33; 95% confidence interval, 0.15-0.71, P = 0.004). CONCLUSION: This prospective study showed similar baseline retinal detachment characteristics of high myopic phakic or pseudophakic eyes, suggesting that high myopia was the main pathogenic factor in both groups. Although high myopic eye presents anatomical characteristics that could favor surgical morbidity, these recent prospective data show that high myopic eyes exhibit functional and anatomical prognosis close to that described in emmetropic eyes.

Keratoconus and the Impact of Treatment on Patients' Quality of Life: A Qualitative Study.

INTRODUCTION: Keratoconus has a significant impact on patients' quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment. METHODS: Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide's main themes. RESULTS: Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: "psychological", "social life", "professional life", "financial costs" and "student life". All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary's model for patient outcomes common to all patients. This conceptual model describes the relationship between patients' characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL. CONCLUSIONS: These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients' QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.

Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment.

PURPOSE: To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less. METHODS: This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid-gas exchange, and a minimum follow-up of 6 months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole, diabetic retinopathy, aphakic eyes, giant tears, or posteriorly located breaks precluding treatment using transconjunctival cryotherapy. RESULTS: Baseline examination disclosed pseudophakia in 77.1%, high myopia in 11.4%, 2.7 ± 2.2 retinal breaks/eye, attached macula in 37.1%, and PVR grade B in 24.3% of the cases. The mean operative time and intraoperative complication rate (11.4%) were similar in both groups. In the 23-G group, we noted three cases of iatrogenic retinal tears and one case of choroidal detachment secondary to a dislodgment of the infusion line. Suturing the sclerotomy sites or the conjunctiva was required in 5.7 and 51% of the eyes, respectively. The single reattachment rate was similar in both groups, 74.3% in the 20-G group, and 80% in the 23-G group. The final anatomical success rate was 97% in the two groups. Mean preoperative VA of 1.2 ± 0.9 logMAR improved similarly in both groups to 0.4 ± 0.4 at the 6-month visit. A final vision of 20/40 or better was achieved similarly in 62.9% of the eyes in the 20-G group and 60% in the 23-G group. CONCLUSIONS: Twenty-three-gauge PPV provides anatomical and visual results similar to the 20-G technique for the management of uncomplicated rhegmatogenous RD.

Development, Optimization, and Validation of a Multiplex Real-Time PCR Assay on the BD MAX Platform for Routine Diagnosis of Acanthamoeba Keratitis.

The reported number of cases of Acanthamoeba amebic keratitis (AK) is continually increasing. Molecular diagnosis has become the first choice of ophthalmologists for identifying and confirming this clinically problematic diagnosis. However, in-house molecular diagnostic procedures are time-consuming and may not be compatible with the urgency of the situation. In this study, a previous in-house AK-PCR technique was adapted for use on BD MAX (Becton Dickinson, Heidelberg, Germany), a fully integrated, automated platform for molecular biology, for the rapid routine diagnosis of AK. Different protocols were compared to optimize DNA extraction from Acanthamoeba cysts. The analytical parameters of the AK-BD MAX PCR were evaluated. Thirty-two samples were simultaneously tested with AK-BD MAX PCR and the original AK-PCR from which it was developed. A thermal-shock pretreatment protocol was validated. The analytical parameters obtained with BD MAX were similar to those obtained with the previous in-house AK-PCR method. The performance of AK-BD MAX PCR was then assessed for routine testing on 40 clinical samples, mostly corneal scrapings. Frozen, ready-to-use, in-house PCR premixes were stable over 8 months. Overall, 34 of the 40 clinical samples (85%) were considered to be true negatives; 4 (10%), probable AK; and 2 (5%), possible AK. This newly developed AK-BD MAX PCR is reliable, rapid, and efficient, and should facilitate Acanthamoeba keratitis diagnosis.

Pythiosis: Case report leading to new features in clinical and diagnostic management of this fungal-like infection.

A 21-year-old man developed infectious keratitis after swimming in Spain whilst wearing contact lenses. Mycelial growth from a corneal sample suggested keratomycosis, but a drastic worsening of the patient's condition was observed on antifungal drugs. On day 38, panfungal PCR identified Pythium insidiosum, which is an aquatic organism belonging to the oomycete family. Based on the recent literature, this patient was promptly prescribed a systemic and local antibiotic regimen and cure was ultimately achieved. In order to facilitate P. insidiosum identification in future cases, we have generated the first matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) reference spectrum for P. insidiosum. It is planned to deposit this MALDI-TOF MS reference spectrum on an open-access platform and this should allow immediate identification of the pathogen. Finally, this case report also demonstrates that P. insidiosum is emerging outside tropical and subtropical areas. Clinicians and microbiologists should have better knowledge to accurately manage and diagnose this sight-threatening infection.

Effect of a New Matrix Therapy Agent in Persistent Epithelial Defects After Bacterial Keratitis Treated With Topical Fortified Antibiotics.

PURPOSE: To evaluate the effect of topical application of a matrix regenerating agent (RGTA) in subjects with a persistent epithelial defect after bacterial keratitis treated with topical fortified antibiotics. METHODS: In this prospective case series of 14 subjects (14 eyes) with a persisting corneal ulcer after the cessation of fortified antibiotics, subjects were treated with an RGTA at a dose of 1 drop every other day. The main outcome measure was the proportion of subjects with complete corneal healing 1 month after initiation of treatment. The secondary outcome measures were the size and depth of corneal ulceration at 1 month, the duration from treatment initiation to complete healing, pain, and tolerability. The ulceration depth was measured with anterior segment optical coherence tomography. RESULTS: Complete corneal healing was observed in 11 (78.6%) of the 14 patients after 1 month and in 14 of the 14 (100%) patients after 3 months. Mean logarithm of the minimum angle of resolution visual acuity improved from 1.22 ± 0.59 at inclusion to 0.57 ± 0.68 at 1 month and to 0.55 ± 0.68 at 3 months (P < 0.01). Pain according to a visual analog scale decreased from 0.34 ± 0.25 to 0.05 ± 0.09 at 1 month and to 0 at 3 months (P < 0.001). Amniotic membrane transplantation was not required for any patients. There were no RGTA-related side effects, and none of the patients reported pain or discomfort during instillation of the drops. CONCLUSIONS: The RGTA seems to be efficient for the treatment of a persistent epithelial defect after bacterial keratitis treated with topical fortified antibiotics.