PURPOSE:

To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in children.

DESIGN:

Noncomparative retrospective cohort study.

METHODS:

setting: Institutional practice. patients/intervention procedures: Seven eyes of 4 children without adequate capsular support had posterior chamber iris-claw aphakic IOL implantation between 2007 and 2012. main outcome measures: Visual acuity, endothelial cell changes, intraoperative and postoperative complications.

RESULTS:

The mean age of the 3 boys and 1 girl was 12.0 ± 3.4 (SD) years (range 8-16 years). In all eyes, the mean postoperative best spectacle-corrected visual acuity (0.13 ± 0.17 logMAR) was statistically significantly better at the last follow-up than at 1 day preoperatively (0.60 ± 0.39 logMAR) (P < .05). The mean follow-up was 31 months (range 10-64 months). The mean endothelial cell density decreased from 3013 ± 155 cells/mm(2) preoperatively to 2831 ± 236 cells/mm(2) at last follow-up, representing a mean endothelial cell loss of 6.4%. No corneal decompensation, iritis, secondary glaucoma, or pupillary block occurred after surgery in any eye. Postoperative complications included transient postoperative hypotony in 1 eye and a traumatic dislocation of a posterior aphakic iris-claw IOL in 1 eye.

CONCLUSION:

The posterior implantation technique of aphakic iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used as a reasonable alternative for a wide range of indications in pediatric eyes without adequate capsular support.

PURPOSE:

A specific simulator was used to assess the driving visual performance in patients with dry eye disease (DED) and to determine clinical predictors of visual impairments while driving.

DESIGN:

Prospective case-control study.

METHODS:

The study was conducted in the Center for Clinical Investigation of Quinze-Vingts National Ophthalmology Hospital, Paris, France. Twenty dry eye patients and 20 age- and sex-matched control subjects were included. Vision-related driving ability was assessed using a specific driving simulator displaying randomly located targets with a progressive increase in contrast to be identified. Other examinations included clinical examinations, serial measurements of corneal higher-order aberrations (HOAs), and vision-related quality-of-life questionnaire (Ocular Surface Disease Index [OSDI]). Data collected during driving test (ie, the number of targets seen, their position, and the response time) were compared between groups and analyzed according to clinical data, aberration dynamics, and quality-of-life index.

RESULTS:

The percentage of targets missed as well as average response time were significantly increased in DED patients as compared with controls (P < .01). More specifically, the visual function of DED patients was more impaired in specific situations, such as crossroad or roundabout approaches. In DED patients, the response time was found to positively correlate with the progression index for HOAs (P < .01) and with the OSDI "symptoms" subscale (P < .05).

CONCLUSIONS:

Degradation of ocular optical qualities related to DED is associated with visual impairments during driving. This study objectively has demonstrated the impact of tear film-related aberration changes on activities of daily living in DED.

PURPOSE:

To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab.

DESIGN:

Retrospective observational case series.

METHODS:

A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3 monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed.

RESULTS:

The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3 monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7%) and worsened in 3 eyes (8.3%). A significant average decrease was observed for the central macular thickness after 3 injections of 65 μm (P = 2.9 × 10(-6)), with no significant change in visual acuity.

CONCLUSIONS:

Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.

PURPOSE:

To evaluate subfoveal choroidal thickness in patients with central retinal vein occlusion (CRVO) using enhanced depth imaging optical coherence tomography.

DESIGN:

Retrospective observational study.

METHODS:

We measured bilateral subfoveal choroidal thickness, averaged for 100 scans, in 36 patients (mean age, 66 ± 15 years; 26 women and 10 men) with unilateral CRVO by using the enhanced depth imaging methods of the Spectralis optical coherence tomography system. Twenty-two patients were treated with intravitreal bevacizumab (1.25 mg/0.05 mL), and subfoveal choroidal thickness was measured before and after treatment. Statistical analysis was performed to compare subfoveal choroidal thickness of CRVO and fellow eyes and to compare subfoveal choroidal thickness before and after intravitreal bevacizumab.

RESULTS:

Mean subfoveal choroidal thickness measured in 36 eligible eyes of 36 patients was 257.1 ± 83.2 μm, which was significantly greater than that in fellow eyes (222.6 ± 67.8 μm; P < .01, paired t test). There was strong correlation between CRVO eyes and fellow eyes (r = 0.79, P < .01). Mean subfoveal choroidal thickness after intravitreal bevacizumab was 227.7 ± 65.1 μm, which was significantly thinner than that before intravitreal bevacizumab therapy (266.9 ± 79.0 μm; P < .01, paired t test).

CONCLUSIONS:

Subfoveal choroidal thickness of CRVO eyes was significantly greater than that of fellow eyes and decreased significantly after intravitreal bevacizumab treatment. Enhanced depth imaging optical coherence tomography can be used to evaluate choroidal involvement in CRVO and may assist noninvasive diagnosis and management of this disease.

PURPOSE:

To report the efficacy and safety of outpatient fluid-gas exchange for open macular hole after primary vitrectomy.

DESIGN:

Retrospective interventional case series.

METHODS:

setting: Institutional. patients: Thirty-six patients with primary failed closure or reopened holes after primary vitrectomy. intervention: Fluid-gas excahnge with 15% perfluoropropane (C3F8) or 20% sulfur hexafluoride (SF6) was performed to reclose the hole under topical anesthesia. main outcome measures: The hole closure rate and type, pre- and postexchange best-corrected visual acuity (BCVA), and complication rates were assessed.

RESULTS:

Thirty-two eyes (89%) achieved anatomic success from 1-3 weeks after the fluid-gas exchange. Twenty-two eyes (61%) achieved type 1 closure, 10 eyes (28%) achieved type 2 closure, and 4 eyes (11%) did not achieve closure. The BCVA for type 1 closure improved significantly from logarithm of the minimal angle of resolution (logMAR) 1.66 ± 0.41 to 0.84 ± 0.41, with a P value <.001. The BCVA for type 2 closure improved from logMAR 1.77 ± 0.41 to 1.52 ± 0.41, with a P value of .05. All patients with an unclosed hole after fluid-gas exchange had a stage IV macular hole before the primary vitrectomy and a hole size larger than 1000 μm. The complication related to fluid-gas exchange procedure was transient high intraocular pressure, which responded well to topical antiglaucoma medications. There were 2 retinal detachment cases following the exchange; surgery to reattach the retina was performed, with visual acuity recovery.

CONCLUSION:

Outpatient fluid-gas exchange is an effective treatment option for eyes with open holes following vitrectomy.