Non-Mydriatic Ultra-Wide Field Imaging Versus Dilated Fundus Exam and Intraoperative Findings for Assessment of Rhegmatogenous Retinal Detachment

Background: to compare the extent of the detached retina and retinal tears location in rhegmatogenous retinal detachment (RRD) among non-mydriatic ultra-wide field (UWF) imaging, dilated fundus exam (DFE), and intraoperative evaluation. Methods: this retrospective chart review comprised 123 patients undergoing surgery for RRD. A masked retina specialist analyzed the UWF fundus images for RRD area, status of the macula, and presence and location of retinal breaks. The same variables were collected from a database including DFE and intraoperative recordings. Evaluation methods were compared. Results: mean age was 59.8 ± 14.9 years. Best-corrected visual acuity improved from 0.25 ± 0.3 (Snellen) to 0.67 ± 0.3 at 12 months (p = 0.009). The RRD description and assessment of macula status (34.5% macula-on) did not differ between UWF, DFE, and intraoperative examination. The inferior quadrant was involved most frequently (41.5%), followed by the superior (38.9%), temporal (27.8%) and nasal quadrant (14.8%). Intraoperative exam detected 96.7% of retinal tears compared with DFE (73.2%, p = 0.008) and UWF imaging (65%, p=0.003). UWF imaging and DFE did not differ significantly. Conclusion: RRD extent on DFE and UWF images was consistent with intraoperative findings. UWF and DFE detection of peripheral retinal tears was similar, but 25% of retinal breaks were missed until intraoperative evaluation.

Effect of Prophylactic Brimonidine on Bleeding Complications after Cataract Surgery

Purpose

To evaluate the effect of prophylactic brimonidine on bleeding complications after cataract surgery.

Methods

The authors performed a prospective, double-masked, two-surgeon study of 137 patients (137 eyes) who underwent phacoemulsification and intraocular lens implantation with or without prophylactic brimonidine before cataract surgery. The authors also compared the effect of brimonidine among patients with systemic diseases such as diabetes mellitus (types I and II), hypertension, and anticoagulant or antiplatelet treatment.

Results

Subconjunctival hemorrhage was observed in 73.70% of the patients not treated with brimonidine before surgery and in only 23.75% of the patients who were given prophylactic brimonidine (p<0.001, χ2). The grade of hemorrhage was also statistically significant (p<0.001, Mann-Whitney). No statistically significant difference with regard to the presence of hemorrhage in diabetic patients or in the anticoagulant or antiplatelet treatment group was observed. However, a statistically significant difference (p<0.027, χ2) was found between hypertensive patients treated and not treated with prophylactic brimonidine before cataract surgery.

Conclusions

This study suggests that brimonidine administered before cataract surgery may significantly reduce subconjunctival hemorrhage in the general population. It has been shown to be beneficial in hypertensive patients. A strong statistical trend, but not significance has been found in diabetic patients or in patients treated with antiplatelet or anticoagulant drugs, but further studies are needed to reach conclusive results.

Implantation of iris devices in congenital and traumatic aniridias: surgery solutions and complications

PURPOSE

To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up.

METHODS

Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months).

RESULTS

All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve.

CONCLUSIONS

Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.