No abstract

In this study, the use of mfERG, OCT, and standard automated achromatic perimetry showed changes in macular function and structure postoperatively. These measures of visual function and structure allow for better evaluation of the surgical outcome and understanding of the changes that may occur after ILM peeling.

Purpose: To evaluate the visual and anatomical outcomes of reoperations following failure of pneumatic retinopexy (PR) for rhegmatogenous retinal detachment repair and compare the different surgical techniques used in these cases. Methods: The study included 114 eyes of 114 patients who underwent PR for rhegmatogenous retinal detachment and required subsequent surgery for its repair. These included repeated PR, scleral buckling, vitrectomy with gas or silicone oil, and vitrectomy with scleral buckling. The groups were compared for rates of retinal reattachment, visual improvement, and the occurrence of recurrent rhegmatogenous retinal detachment and any other postoperative complications. Results: In 91 (79.8%) eyes, the retina was reattached with one additional procedure. The success rate was significantly lower in eyes treated by repeated PR than by other surgical techniques (33 vs. 76–90%; P < 0.001). Visual acuity after PR failure was not significantly different than that at presentation and had improved significantly after surgery for retinal reattachment (P < 0.001). Conclusion: Pneumatic retinopexy failure was not associated with visual acuity loss, and the outcomes in 79.2% of cases that required only one additional surgery are comparable with those achieved with primary surgery. Poor outcomes were associated with eyes that required more than one additional surgery and that suffered complications.

Purpose: To report the visual and anatomic outcomes of eyes with exceedingly long-term silicone oil tamponade. Methods: A retrospective chart review of 43 eyes of 41 patients with silicone oil tamponade for 5 years or more. Rates of retinal reattachment, visual acuity, and complications are presented. Further analysis was performed to identify if silicone oil complications are more common in eyes with lower vision. For this, cases were divided into group A-visual acuity of 20/400 or better and group B-visual acuity of less than 20/400. Results: Mean silicone oil duration was 12.6 ± 6.3 years. The etiology at presentation included: recurrent RRD (60.46%), RRD secondary to trauma (25.58%), and TRD (13.95%). Ninety-three percent of eyes underwent at least one ocular surgery before the vitrectomy with silicone oil tamponade. The retinal attachment rate was 55.8%. Mean visual acuity at presentation was 2.03 ± 0.6 logMAR, and at the final follow-up, 1.85 ± 0.78 logMAR ( p = 0.166). Emulsification developed in 33.3% of cases, glaucoma in 28.6%, band keratopathy in 21.4%, and corneal decompensation in 16.7%. In 26.2% of eyes, the final visual acuity was 20/400 or better (group A). In 73.8% of eyes, final visual acuity was worse than 20/400 (group B). The rates of silicone oil emulsification and glaucoma were not statistically significant between groups. Conclusions: Long-term silicone oil tamponade is a possible option in eyes with complicated retinal detachment following multiple intravitreal procedures, although the complication rates are relatively high. In 26.2% of eyes, visual acuity of 20/400 or better can be preserved for many years.

Purpose: To describe the mechanisms and outcomes of open globe injuries (OGIs) in patients 70 years or older. Methods: A retrospective chart review of patients from two large academic centers in Israel who were underwent surgery for OGI. Data was collected from surgical and clinic charts. Anatomical and functional results were recorded as well any additional surgeries and complications. Results: Thirty-two eyes of 32 patients were included. The mechanism of OGI consisted of blunt trauma with ocular rupture secondary to falls. All eyes underwent immediate primary closure of the corneal and scleral lacerations. Additional surgeries were performed in 34.3% of cases. In 31.2% of cases additional surgery was not required, and in 21.9% of cases the damage was so devastating that additional procedures were not recommended. Four patients (12.5%) chose not to undergo additional surgery. Mean visual acuity at presentation was 2.24 ± 0.72 logMAR and it improved to 1.92 ± 0.89 logMAR at final follow-up ( p = 0.002). VA at presentation was significantly correlated to final VA ( p < 0.001). Conclusions: OGI in the elderly represents a unique group. It is mostly related to falls, with a female predominance and a poor visual prognosis. In this patient population, general health concerns and increased risks of anesthesia require special attention. Care should be taken to educate elderly patients and their caretakers on how to avoid falls.