OphthalmologyWeb
Retina:
CME, AMD, and Surgery – Rm 122 – Paper Session 2A
Immediate Postoperative Intraocular Pressure Adjustment and Cystoid Macular Edema After Uneventful Cataract Surgery J. S. Jarstad; G. W. Chung; R. A. Tester; L. E. Day
Prospective study with control groups. Stellaris machine. IOP tested immediately postop, day 1, 2 weeks, 3 mos. Oct at 2 weeks
CME defined as > 15 microns increased thickness. 170 eyes. Uncomplicated surgery
3 groups = <16, 16-21, >21
Tonopen, Stratus OCT
Question: does IOP postop after CE affect rates of CME?
8.2% overall rate of CME
1 day postop IOP resembles the immediate postop IOP
IOP <16 has a 2.5 fold increase in CME on OCT (p<0.05)
Summary: In a prospective, controlled study of 170 eyes, the author found that CME rates at 2 weeks post op (as defined by a >15 micron increase in central macular thickness) was significantly increased by 2.5 times in patients with low IOPs (<16 mm Hg) immediately postop.
Postoperative Macular Thickness and Cystoid Macular Edema in Correlation with Light Exposure During Standard Phacoemulsification J. F. Gyory; M. Mehdi; C. Temesvary
Prospective, randomized, controls
Standard phaco
Normal maculas
26 eyes, standard 30,450 lux – 8 min 40 sec
27 eyes, low light, 1660 lux – 8 min, 52 sec
HRT II, e value
3.9% overall, 1 in each group – no stat sig difference
Summary: The author found that there was no statistically significant difference in the rates of CME after uncomplicated phaco with standard light exposure versus low light exposure.
Au Naturel ILM Peel Macular Hole Surgery and Relationship to Cataract Surgery and Cystoid Macular Edema R. D. Bourke; M. A. Bourne
20 and 25G ILM peel for MH surgery
536 cases, 1995-97 20G 100 cases, 300 cases 99-2003 20G, 03-07 136 eyes 25G
No ICG staining
Stage 2-4 holes, C3F8
Got better at peeling through the years
Anatomic success also increased
Time to cataract surgery none, 8.1, 4 mos after ILM peel
Rates of chronic CME 0% at era 3, 1.3% era 2
IVK during cat surgery in Era 3 – may have decreased CME rate
Summary: The author found that success rates of ILM peel have increased over time, rates of CME after ILM peel and cataract surgery have also decreased over time – likely due to the use of intravitreal kenalog at the time of cataract surgery. Rates of cataract surgery after ILM peel have also increased over time.
Efficacy of Vitreous Injection of Bevacizumab for Pseudophakic CME After Cataract Surgery Y. Nakai; Y. Nakai; K. Bessyo; Y. Shono
Avastin 1.25 mg
12 patients
6-12 wks after surgery
Cirrus OCT
1 wk, 1 mo, 3 mos
3.5 mm post to limbus
595, 20/200 à 220 um, 20/20 at 2 mos
765 um mean thickness, 3 mos after mean 225 um
3 mos 20/20
These patients did not respond to steroids and NSAIDs
Summary: In patients with post op CME after phaco who did not respond to topical NSAIDs and steroids, the authors found that 1 intravireal injection of avastin 1.25 mg reduced CME (595 microns average à 220 microns average) with vision 20/20 average at 3 mos after injection.
Last and Lost Frontier: Intraocular Optical Correction of AMD I. Lipshitz
Mirror telescope embedded inside a regular PMMA IOL. Mag 2.5x to 4.0x
In the bag implant, easy to implant
For wet and dry AMD, can use before or after intravitreal injections
5.5-6.5 mm optic
Center magnified and periphery preserved
Standard phaco, the enlarge wound, insert IOL, suture wound
6 cases, 3.66 lines gained, 1.88 SD
Summary: Mirror telescope on PMMA IOL 6.5 mm. Center magnified and periphery preserved. In 6 cases, average of 3.66 lines of vision gained (SD 1.88)
Wavy Artifacts in Line Scanning Image of Optical Coherence Tomography with Multifocal Diffractive IOL M. Inoue; M. Yoshino; H. Bissen-Miyajima
Diffractive multifocal IOLs (ReSTOR, tecnis multifocal)
Cirrus OCT
Horizontal wavy artifacts seen, especially on en face image, OCT fundus image
BUT will NOT be problem for diagnosing retinal disorders
Summary: Multifocal IOLs often cause distortion of the posterior segment view during vitrectomy surgery. They also cause “wavy” artifacts on OCT images; however, they do NOT cause difficulty in diagnosing retinal disorders.
Transscleral Fixation of Posterior Chamber IOL with 25-Gauge Vitrectomy: Initial Experience with Akreos IOL D. A. Adelberg
Akreos IOL
Objectives: PCIOL implant, suture to sclera
25G PPV, scleral flaps,
2 25G trocars at 3 and 9 oclock under flaps
Alcon ZC70BD with eyelets, 9-0 prolene sutures
Pass through one trocar, out, tie to eyelet, in eye, back out other eyelet (no needles on suture)
55 eyes
AO60 Akreos – more eyelets, foldable – smaller incision, less operative time.
3.0 keratome blade
Suture passed only with vitreoretinal forceps
Fold IOL with foreceps and insert through wound
67 eyes
Consider polyester sutures for less possibility of suture breakage
Summary: It is possible to perform a transscleral fixation PCIOL with 25G PPV using an Akreos IOL. Advantages are smaller incision (3.0 mm), lower operative time, and possibility of additional fixation given that it has 4 eyelets/haptics
Pneumatic Retinopexy Revisited C. S. Tan; K. Wee; T. Lim
60-85% success rate (1 procedure)
532 nm LIO
C3F8 instead of SF6. 0.3 cc
7 years, 1 surgeon
Superior 4 clock hours
Break <= 2clock hours
Phakic or pseudophakic
Injection sup temp
Laser on 3-4 day
32 eyes of 30 pts
29 phakic, 3 pseudo
90.6% reattachement rate
100% with 2 procedures
Better with 2 or less tears
VA greater or equal to 20/40 in mac on 100%, poorer outcome with mac off RD
16 days positioning average
Cryo has risk of PVR
Summary: The authors had a 90.6% single-procedure reattachment rate for RRD with C3F8 pneumatic retinopexy if there was an RD in the superior 4 clock hours, break less than or equal to 2 clock hours, and 2 or less tears. Used laser at 3-4 days post injection and an average of 16 days of positioning.
Combined Vitrectomy and Phacoemulsification with 7.0 mm Hybrid Acrylic Foldable IOL Implantation in Diabetic Retinopathy T. Hanemoto
Larger optic better for easier PRP postop in diabetics
X-70 Santen acrylic IOL, foldable
48 eyes, 35 with 20G PPV
3.0 mm keratome incision with injector
Summary: Able to perform combined phaco and PPV in diabetics with a new 7.0mm foldable acrylic IOL (X-70 by Santen). Advantage is improved optics during the vitrectomy and easier PRP after surgery due to the increased optic size.