Evaluating the effectiveness of multidisciplinary low-vision rehabilitation.

PURPOSE: To objectively evaluate the changes in vision-specific quality of life (QoL) after multidisciplinary low-vision rehabilitation at the Royal Society for the Blind Low-Vision Clinic. METHODS: The standard care model at the Royal Society for the Blind Low-Vision Clinic is optical management at the initial assessment, with subsequent referral to multidisciplinary services as required. Participants completed the Impact of Vision Impairment Questionnaire (IVI) and Veterans Affairs Low-Vision Visual Functioning Questionnaire (VA LV VFQ-48) before initial assessment, at 30 days (to assess the outcome of optical management) and at 3 months follow-up (to assess the outcome of multidisciplinary services). RESULTS: Seventy-one participants completed the study. Using the VA LV VFQ-48, an improvement (p < 0.05) was seen at 30 days follow-up in overall visual ability, and the reading, visual information, and visual motor subscores. However, at 3 months follow-up, all subscores were not significantly different from pre-rehabilitation levels. In contrast, for the IVI, there was no improvement in both the overall score and the mobility subscale at 30 days follow-up, but a significant improvement at 3 months follow-up. Greater improvements in visual function were seen for those with low vision (<20/60-20/200) compared with those with blindness, those aged >85 years compared with those aged 80 to 85 and <80 years, and those without glaucoma (visual motor subscore). CONCLUSIONS: The VA LV VFQ-48 and IVI demonstrated improvements in QoL after low-vision rehabilitation. The timing of the observed changes varied between the two questionnaires, reflecting the different content of these instruments and the timing of delivery of multidisciplinary services, but also suggests that continued rehabilitation may be warranted to maintain a patient's QoL.

Bilateral uveitis following intravenous immunoglobulin administration.

PURPOSE: To report a case of bilateral acute anterior uveitis in an adult female occurring following the administration of intravenous immunoglobulin (IVIG). OBSERVATIONS: A 44-year-old female patient was commenced on IVIG following presentation to hospital with upper limb neuropathic pain. Within two days, she developed bilateral red, painful photophobic eyes. Examination revealed bilateral acute anterior uveitis and IVIG was ceased. Investigations for autoimmune or infective causes for the uveitis were unremarkable. Complete resolution of the uveitis was achieved with topical corticosteroids and cessation of IVIG. CONCLUSIONS AND IMPORTANCE: Clinicians should be aware of the possibility of uveitis as an adverse effect of IVIG. Early identification of the offending medication and its cessation in this case were associated with a good visual prognosis.

Medium-term Outcomes of Unsutured Scleral Flap Trabeculectomies.

PURPOSE: To examine the clinical characteristics and medium-term outcomes of unsutured scleral flap trabeculectomies. PATIENT AND METHODS: A retrospective review of 45 patients who underwent 50 unsutured scleral flap trabeculectomies by a single ophthalmic surgeon. Information pertaining to each patient's demographic details, preoperative assessment, surgical procedure, and 2 years of postoperative management were obtained. RESULTS: The average age of patients was 72.4±12.5 (range, 30 to 97) years. The diagnosis was primary open-angle glaucoma in 38 (76.0%) cases. The average preoperative, 1 year postoperative and 2-year postoperative intraocular pressure (with number of topical antiglaucoma medications) were 20.8 (2.5), 13.2 (0.4), and 12.6 mm Hg (0.7), respectively. The procedure performed was a trabeculectomy alone in 32 (64.0%) cases, and combined trabeculectomy and phacoemulsification in 18 (36.0%) cases. Four were performed with mitomycin C. Three procedures (6%) had intraoperative complications (2 iris prolapses, 1 subconjunctival hemorrhage). Seven procedures were complicated by a postoperative choroidal detachment, which were managed conservatively and resolved spontaneously over time. There was 1 case (2%) of postoperative hypotony, which failed to resolve (intraocular pressure of <6 mm Hg for >3 months). CONCLUSIONS: The majority of unsutured scleral flap trabeculectomies had an acceptable risk profile and resulted in a decrease in the intraocular pressure at 2 years postoperatively.

A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital.

BACKGROUND: The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery. METHODS: A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient's demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained. RESULTS: Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0%) did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%). An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%). Postoperatively, the most common complications were a decentered intraocular lens (8.3%) and persistent corneal edema (6.0%). Overall, 61 eyes (72.6%) had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8%) achieving vision of 20/40 or better. CONCLUSION: For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability.

A comparison between the amblyopic eye and normal fellow eye ocular architecture in children with hyperopic anisometropic amblyopia.

PURPOSE: To compare the anterior and posterior ocular architecture of amblyopic and normal fellow eyes in children with hyperopic anisometropic amblyopia. METHODS: Fourteen subjects with hyperopic anisometropic amblyopia were examined using the Pentacam and optical coherence tomography. For each participant, the amblyopic eye was compared to the fellow non-amblyopic eye. RESULTS: There were no significant differences (P > 0.05) in the anterior corneal curvature, posterior corneal curvature, central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, peripapillary retinal nerve fiber layer, central macular thickness, and macular volume between the amblyopic eye and fellow eye of the study participants. CONCLUSIONS: The Pentacam and optical coherence tomography revealed no differences in the anterior and posterior ocular architecture between the amblyopic eye and fellow eye in children with hyperopic anisometropic amblyopia.

Systematic Review of Peribulbar Anesthesia Versus Sub-Tenon Anesthesia for Cataract Surgery.

Commonly used anesthetic techniques for cataract surgery include peribulbar and sub-Tenon anesthesia. This evidence-based review compares these techniques, with a particular focus on patient comfort, akinesia, and anesthetic complications. A systematic search of the literature revealed that there is a paucity of robust evidence comparing sub-Tenon and peribulbar anesthesia. Based on the best available evidence, there is no significant difference in the efficacy of peribulbar compared with sub-Tenon anesthesia for cataract surgery; however, the potential complications of peribulbar anesthesia are more serious.

Macular hypoplasia in congenital disorder of glycosylation type ia.

Congenital disorders of glycosylation are a rare group of metabolic disorders that can result in multiorgan disease. This article describes a novel finding of macular hypoplasia in congenital disorders of glycosylation type Ia.

Early imaging of a macular hole following vitrectomy with primary silicone oil tamponade.

BACKGROUND: To describe the morphology of a macular hole in the early postoperative period following vitrectomy with primary silicone oil tamponade. METHODS: A case report with optical coherence tomography (OCT) scans prior to surgery, at 20 minutes postoperatively and then at 17 hours postoperatively. RESULTS: OCT images of a 73-year-old woman with a stage 3 macular hole were obtained. At 20 minutes postoperatively, there was a reduction in intraretinal cysts and a reduction in macular hole size with elevated-open configuration. At 17 hours postoperatively, complete macular hole closure was noted. CONCLUSION: OCT Images of a macular hole in the early postoperative period have been successfully obtained. Macular holes can close within 24 hours postoperatively and show morphological changes that may be predictive of closure within 20 minutes postoperatively.