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Kaiser KP, Bucur J, Jandewerth T, Kohnen T, Lwowski C. Fellow eye data for intraocular lens calculation in eyes undergoing combined phacovitrectomy. Acta Ophthalmol 2024. [PMID: 38994803 DOI: 10.1111/aos.16741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To evaluate whether the intraocular lens (IOL) calculation of the fellow eye (FE) can be used in eyes undergoing combined phacovitrectomy. METHODS In this retrospective, consecutive case series, we enrolled patients who underwent combined phacovitrectomy with silicone oil removal and IOL implantation at the Goethe-University. Preoperative examinations included biometry (IOLMaster 700; Carl Zeiss). We used the IOL calculation of the FE (FE group) to calculate the prediction error compared with the IOL calculation using only the axial length (AL) of the FE (AL-FE group), as well as using the AL of the operated eye (OE group) in addition to the measurable biometric parameters. IOL calculation was performed using the Barrett Universal II formula. We compared the mean (MAE) and median absolute prediction error (MedAE) with each other. Furthermore, the number of eyes with ±0.50, ±1.00 and ±2.00 dioptres (D) deviation from the target refraction was compared. RESULTS In total, 79 eyes of 79 patients were included. MedAE was lowest in the OE group (0.41 D), followed by FE group (1.00 D) and AL-FE group (1.02 D). Comparison between the AL-FE and FE groups showed no statistically significant difference (p = 0.712). Comparing eyes within ±0.50 D of the target refraction, the OE group (63.3%) performed best, followed by the AL-FE group (27.8%) and the FE group (26.6%). CONCLUSION Our results indicate no clinically relevant difference between using the IOL calculation of the FE versus using only the AL of the FE in addition to the measurable parameters for the IOL calculation. A two-step procedure should always be strived for.
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Affiliation(s)
| | - Julian Bucur
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Tyll Jandewerth
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
| | - Christoph Lwowski
- Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany
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Fouad YA, Soliman MK, Elhusseiny AM, Yang YC, Sallam AB. Visual outcomes and complications of combined versus sequential pars plana vitrectomy and phacoemulsification for epiretinal membrane. Eye (Lond) 2024; 38:1707-1713. [PMID: 38486117 PMCID: PMC11156636 DOI: 10.1038/s41433-024-03004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/02/2024] [Accepted: 02/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Symptomatic epiretinal membrane (ERM) often requires surgical intervention via pars plana vitrectomy (PPV), for which cataract development is a common complication. There is insufficient data on the visual outcomes and complications of combined phacovitrectomy (COMB) in comparison to sequential PPV with deferred cataract surgery (SEQ) for ERM. METHODS A retrospective dataset analysis of 8 National Health Service ophthalmology departments. The main outcome measures were postoperative visual acuity (VA), operative complications, postoperative cystoid macular oedema (CMO) and recurrent ERM. RESULTS We included 898 and 299 eyes in the COMB and SEQ groups, respectively. Both procedures resulted in significantly better VA across all follow-up intervals (24 weeks). The proportion of eyes with Snellen VA of at least 20/40 at 12-24 weeks was comparable in both groups (47.8% [COMB] vs. 54.7% [SEQ], p = 0.4456). More eyes in the COMB group experienced posterior capsular rupture (2.9% vs. 0%, p = 0.0009) and iatrogenic retinal trauma (2.4% vs. 0%, p = 0.0023). However, regression analysis revealed that combined surgery did not predict either complication. There were no significant differences in the rates of CMO (6.5% [COMB] vs. 9% [SEQ], p = 0.1522) and recurrent ERM (2.1% [COMB] vs. 3.3% [SEQ], p = 0.2758) between both groups. CONCLUSION Both combined and sequential procedures are comparably effective and safe means for managing eyes with ERM.
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Affiliation(s)
- Yousef A Fouad
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mohamed K Soliman
- Department of Ophthalmology, Assiut University Hospitals, Assiut, Egypt
- University Hospitals Eye Institute, Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, UK
| | - Ahmed B Sallam
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Wu K, Shi J, Zong Y, Xu G, Zhu H, Jiang C. Outcomes of Secondary Intracapsular Intraocular Lens Implantation in Patients following Rhegmatogenous Retinal Detachment. J Clin Med 2023; 12:7749. [PMID: 38137820 PMCID: PMC10743941 DOI: 10.3390/jcm12247749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
This study reports the outcomes of a secondary IOL implantation technique in patients that suffered from rhegmatogenous retinal detachment combined with a cataract, which included reopening the capsular bag, enabling secondary intracapsular intraocular lens (IOL) implantation. We included consecutive cases with rhegmatogenous retinal detachment (RRD) treated with vitrectomy and silicone oil tamponade, and subsequent secondary IOL implantation during silicone oil removal between September 2019 and June 2022. Demographics, pre- and postoperative clinical data, and complications were collected. Visual and refractive outcomes and IOL position were evaluated. Thirty eyes were included and followed up for a mean of 24.2 ± 5.06 months. Compared with the preoperative values, no significant changes were observed in the intraocular pressure (p = 0.170) and endothelial cell density (p = 0.336); however, the best-corrected visual acuity (Snellen: 20/83 vs. 20/38; logMAR: 0.66 ± 0.23 vs. 0.37 ± 0.32; p < 0.001) and spherical equivalent (p < 0.001) improved significantly. The mean prediction error (ME) was -0.45 ± 0.68 D (-1.9-0.54 D), and the mean absolute prediction error (MAE) was 0.62 ± 0.52 D (0.01-1.9 D). The macula-on subgroup demonstrated significantly better refractive outcomes than the macula-off subgroup (ME, p = 0.046; MAE, p = 0.008). The IOL was well positioned, with a mean horizontal and vertical tilt and decentration of 0.53 ± 0.49° and 0.21 ± 0.16 mm, and 0.54 ± 0.45° and 0.22 ± 0.16 mm, respectively. Secondary intracapsular IOL implantation provided a good and stable IOL position and satisfactory refractive outcomes, and is a feasible treatment option for patients with RRD.
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Affiliation(s)
- Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Jiemei Shi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Gezhi Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Haohao Zhu
- Department of Ophthalmology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
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Hwang SH, Kim H, Lee DY, Nam DH. Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy: efficacy of illuminated chopper-assisted cataract surgery. BMC Ophthalmol 2023; 23:236. [PMID: 37237351 DOI: 10.1186/s12886-023-02982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy. METHODS One university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups. RESULTS Of the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002). CONCLUSIONS The use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Sung Ha Hwang
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Haram Kim
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Dae Yeong Lee
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, 21 Namdong-daero 774-beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
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Daud F, Daud K, Popovic MM, Yeung S, You Y, Pimentel MC, Yan P. Combined versus Sequential Pars Plana Vitrectomy and Phacoemulsification for Macular Hole and Epiretinal Membrane - A Systematic Review and Meta-Analysis. Ophthalmol Retina 2023:S2468-6530(23)00150-1. [PMID: 37030392 DOI: 10.1016/j.oret.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/11/2023] [Accepted: 03/28/2023] [Indexed: 04/10/2023]
Abstract
TOPIC To compare the efficacy and safety between combined and sequential pars plana vitrectomy and phacoemulsification for macular hole (MH) and epiretinal membrane (ERM). CLINICAL RELEVANCE The standard of care for MH and ERM is vitrectomy, which increases risk of developing cataract. Combined phacovitrectomy eliminates the need for a second surgery. METHODS Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched in May 2022 for all articles comparing combined versus sequential phacovitrectomy for MH and/or ERM. The primary outcome was mean best-corrected visual acuity (BCVA) at 12-months follow-up. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and ROBINS-I tool for observational studies. (PROSPERO, registration number, CRD42021257452) RESULTS: Of the 6470 studies found, 2 RCTs and 8 non-randomized retrospective comparative studies were identified. Total eyes for combined and sequential groups were 435 and 420, respectively. Meta-analysis suggested no significant difference between combined and sequential surgery for 12-month BCVA (combined = 0.38 logMAR, sequential = 0.36 logMAR; mean difference (MD) = +0.02 logMAR; 95% CI = -0.04 to 0.08; p = 0.51, I2 = 0%, n = 4 studies, 398 participants), as well as absolute refractive error (p = 0.76, I2 = 97%, n = 4 studies, 289 participants), risk of myopia (p = 0.15, I2 = 66%, n = 2 studies, 148 participants), MH non-closure (p = 0.57, I2 = 48%, n = 4 studies, 321 participants), cystoid macular edema (p = 0.15, I2 = 0%, n = 6 studies, 526 participants), high intraocular pressure (p = 0.09, I2 = 0%, n = 2 studies, 161 participants), posterior capsule opacification (p = 0.46, I2 = 0%, n = 2 studies, 161 participants), posterior capsule rupture (p = 0.41, I2 = 0%, n = 5 studies, 455 participants) and retinal detachment (p = 0.67, I2 = 0%, n = 6 studies, 545 participants). CONCLUSION No significant difference was detected between combined and sequential surgeries for visual outcomes, refractive outcomes, or complications. Given that most studies were retrospective and contained a high risk-of-bias, future high-quality RCTs are warranted.
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Affiliation(s)
- Fowad Daud
- Kensington Eye Institute, Toronto, Canada
| | | | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | | | - Yuyi You
- Department of Clinical Medicine, Macquarie University, Sydney, Australia
| | - Miguel Cruz Pimentel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Peng Yan
- Kensington Eye Institute, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Grajewski L, Zhmurin R, Carstens J, Krause L. [Functional results and complications in the long-term follow-up after 25-gauge vitrectomy of epiretinal membrane]. DIE OPHTHALMOLOGIE 2023; 120:406-411. [PMID: 36239803 DOI: 10.1007/s00347-022-01738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 04/29/2023]
Abstract
BACKGROUND Idiopathic epiretinal membranes can lead, among other things, to visual impairment and metamorphopsia. The treatment of choice is a pars plana vitrectomy with removal of the membrane. The improvement of visual acuity and postoperative complications have already been described in several studies. OBJECTIVE The aim of this retrospective study is to evaluate the long-term outcome of at least 3 years. MATERIAL AND METHODS In the period from 2011 to 2016, a total of 667 eyes underwent 25-gauge pars plana vitrectomy, membranectomy and peeling of the ILM (Internal limiting membrane) because of epiretinal membrane by the same surgeon. This study included 51 eyes from 51 patients who had returned to our clinic after at least 3 years. For the follow-up, data were collected after 3 months and then annually, if available. The mean follow-up time was 57 months (37-104 months). In the postoperative follow-up visual acuity, intraocular pressure and complications were recorded. RESULTS Of the 51 eyes included 34 had a 25-gauge pars plana vitrectomy with phacoemulsification and artificial lens implantation, 8 eyes without phako and 9 eyes were already pseudophakic. The most common complication in the follow-up period was a persistent macular edema with 5.9% (3 eyes) and a recurrence of epiretinal membrane in 5.9% of cases. The best corrected logMar visual acuity was 0.4 (0.1-1.3; n = 51) preoperatively, at the last examination 0.23 (0-1.0; n = 51, p < 0.001). Three months postoperatively, the logMar visual acuity was 0.29 (n = 41), after 1 year 0.25 (n = 35), 2 years 0.23 (n = 29), after 3 years 0.26 (n = 29), after 4 years 0.27 (n = 27), after 5 years 0.24 (n = 17) and after 6 years 0.24 (n = 13). CONCLUSION The 25-gauge pars plana vitrectomy is a low complication procedure for the removal of epiretinal membranes. The clearest increase in visual acuity can be seen within the first 3 months postoperatively, but then stabilizes. In the long-term follow up a change in visual acuity can also be found after more than 3 years.
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Affiliation(s)
- L Grajewski
- Augenklinik, Städtisches Klinikum Dessau, Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg - Theodor Fontane, Auenweg 38, 06847, Dessau-Roßlau, Deutschland.
| | - R Zhmurin
- Augenklinik, Städtisches Klinikum Dessau, Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg - Theodor Fontane, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - J Carstens
- Augenklinik, Städtisches Klinikum Dessau, Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg - Theodor Fontane, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - L Krause
- Augenklinik, Städtisches Klinikum Dessau, Dessau, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg - Theodor Fontane, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
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Elhusseiny AM, Soliman MK, Shakarchi AF, Fouad YA, Yang YC, Sallam AB. Visual outcomes and complications of combined vs sequential cataract surgery and pars plana vitrectomy: multicenter database study. J Cataract Refract Surg 2023; 49:142-147. [PMID: 36100160 DOI: 10.1097/j.jcrs.0000000000001059] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the visual outcomes and rates of intraoperative complications in eyes that underwent combined cataract extraction (CE) and pars plana vitrectomy (combined group) with those that underwent sequential surgery (sequential group). SETTING Multicenter study. DESIGN Retrospective chart review. METHODS CE data set pooled from 8 UK sites between 2000 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) and the rate of intraoperative complications in both groups. RESULTS 2236 eyes in the combined group and 2270 eyes in the sequential group were included in this study. Mean preoperative VA was 1.0 logMAR in both groups. The mean logMAR postoperative VA was worse in the combined group than in the sequential group ( P < .0001) at all timepoints, however, the differences in visual improvement between both groups decreased with longer follow-up time: 1.0 ± 0.7 vs 0.6 ± 0.6, 0.7 ± 0.6 vs 0.4 ± 0.5, and 0.7 ± 0.6 vs 0.5 ± 0.5 at 0 to 4 weeks, 4 to 12 weeks, and 12 to 24 weeks, respectively. Proportions of eyes that gained >3 logMAR units were 49% in the combined group and 66.2% in the sequential group ( P < .0001). Logistic regression analysis showed that sequential surgery (odds ratio, 2.1) was a predictor for reaching 20/40 vision by 6 months. In the combined group, there was a statistically significantly higher rate of posterior capsular rupture. CONCLUSIONS Postoperative visual gain was less in the combined group with a higher rate of posterior capsular rupture as compared with sequential phacovitrectomy. However, small differences in visual improvements between both groups by 6 months were observed.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- From the Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Elhusseiny, Shakarchi, Sallam); Department of Ophthalmology, University of Tennessee, Memphis, Tennessee (Soliman); Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt (Fouad); Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, United Kingdom (Yang)
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Muns SM, Villegas VM, Murray TG, Latiff A, Gold AS. Clinical Outcomes of Combined Phacoemulsification With Intraocular Lens Placement and Microincision Vitrectomy in Adult Vitreoretinal Disease. JOURNAL OF VITREORETINAL DISEASES 2023; 7:27-32. [PMID: 37008401 PMCID: PMC9954161 DOI: 10.1177/24741264221118185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the safety and clinical outcomes of combined phacoemulsification with intraocular lens (IOL) placement and microincision vitrectomy surgery (MIVS) in adult patients with concomitant cataract and vitreoretinal disease. Methods A consecutive series of patients with comorbid vitreoretinal disease and cataract who had combined phacoemulsification with IOL placement and MIVS was retrospectively analyzed. The main outcome measures were visual acuity (VA) and intraoperative and postoperative complications. Results The analysis comprised 648 eyes of 611 patients. The median follow-up was 26.9 months (range, 12-60 months). The most common vitreoretinal pathology was intraocular tumor (53%). The best-corrected Snellen VA improved from 20/192 at baseline to 20/46 at the 12-month follow-up. The most frequent intraoperative complication was capsule tear (3.9%). The most common postoperative adverse events after 3 months of follow-up (mean, 24 months) were vitreous hemorrhage (3.2%) and retinal detachment (1.8%). No patient developed endophthalmitis. Conclusions Combined phacoemulsification with IOL placement and MIVS is a safe, effective technique to manage a broad range of vitreoretinal diseases in patients with significant cataract.
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Affiliation(s)
- Sofía M. Muns
- Department of Ophthalmology, University
of Puerto Rico, San Juan, PR, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University
of Puerto Rico, San Juan, PR, USA
- Bascom Palmer Eye Institute, University
of Miami Miller School of Medicine, Miami, FL, USA
- Department of Surgery, Ponce Health
Sciences University, School of Medicine, Ponce, PR, USA
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Meng B, Li S, Wang K, Huang Y, Wang Y, Zhao L. Systematic review of the efficacy and safety of stage I or II IOL implantation in patients with diabetic retinopathy. Medicine (Baltimore) 2022; 101:e32406. [PMID: 36595831 PMCID: PMC9794241 DOI: 10.1097/md.0000000000032406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraocular lens (IOL) implantation is required after vitrectomy combined with cataract surgery in diabetic retinopathy patients. However, the question of whether an IOL should be implanted in stage I after vitrectomy or stage II during silicone oil filling has been controversial, and there has been no systematic review of this clinical issue. METHODS WanFang, SinoMed CNKI, VIP, PubMed, Embase, and Cochrane Library databases were systematically searched for relevant studies. The deadline was May 8, 2021. All studies of stage I or II IOL implantation in patients with diabetes who underwent vitrectomy were included. Revman 5.3 software was used for the meta-analysis. RESULTS Four studies, involving 253 eyes, were included. This study analyzed the literature with a common outcome index by meta-analysis and systematically evaluated the literature without a common outcome index. Four studies compared the efficacy and safety of the 2 sequential surgical methods in patients with diabetic retinopathy. The results of the meta-analysis showed that there was no significant difference in the efficacy and safety of stage II IOL implantation when compared with stage I IOL implantation (P > .05). One study showed that stage II cataract surgery with oil extraction resulted in better postoperative visual acuity and fewer complications than stage I cataract surgery with vitrectomy. One study showed that stage II IOL implantation during oil extraction had better postoperative visual acuity than stage I IOL implantation during vitrectomy without increasing surgical complications. CONCLUSION Vitrectomy combined with stage II IOL implantation is safer and more effective than stage I in patients with diabetic retinopathy; however, more clinical studies are needed to verify this.
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Affiliation(s)
- Bo Meng
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuang Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kang Wang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yingxiang Huang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lu Zhao
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
- * Correspondence: Lu Zhao, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing 100050, China (e-mail: )
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Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study. J Ophthalmol 2022; 2022:1553719. [PMID: 35529168 PMCID: PMC9076353 DOI: 10.1155/2022/1553719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To identify predictive factors of visual outcomes in the eyes after successful macular hole (MH) surgery. Methods It is a retrospective monocentric study of the eyes that underwent successful vitrectomy for full-thickness MH in an academic, tertiary care center (CHU de Québec–Université Laval, Québec, Canada) between 2014 and 2018. We included a single eye per patient and excluded the eyes with ocular comorbidities. Clinical and anatomical features of patients were collected, including demographics, MH duration, baseline MH size, baseline visual acuity (VA), and final VA. Multiple logistic regressions were performed to determine predictive factors of VA ≥70 ETDRS letters (Snellen equivalent: 20/40) and VA gain ≥15 ETDRS letters at final follow-up. Areas under the receiver operating characteristic curve (AUC) were used to determine the performance of each model and identify the Youden index maximizing performance at a given threshold. Results A total of 460 eyes were included in this study; 274/460 eyes (60%) achieved final VA ≥70 ETDRS letters and 304/460 eyes (66%) had a VA gain ≥15 ETDRS letters at 24 months follow-up. Multiple logistic regression analyses showed that the main predictive factors for final VA ≥70 ETDRS letters (model AUC = 0.716) were baseline VA (OR = 1.064; p < 0.001), MH duration (OR = 0.950; p=0.005), and age (OR = 0.954; p=0.004). Predictors of VA gain ≥15 ETDRS letters at final follow-up (model AUC = 0.615) were baseline VA (OR = 0.878; p < 0.001), MH duration (OR = 0.940; p < 0.001), and MH size (OR = 0.998; p=0.036). Thresholds for the final VA ≥70 ETDRS letters model and the VA gain ≥15 ETDRS letters model were VA ≥55.5 ETDRS letters (Snellen equivalent: 6/30) and MH size of 237 μm, respectively. Conclusion The eyes with shorter MH duration, smaller MH size, and higher preoperative VA achieved better visual outcomes after successful MH surgery.
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Radeck V, Helbig H, Maerker D, Gamulescu MA, Prahs P, Barth T. Rhegmatogenous retinal detachment repair-does age, sex, and lens status make a difference? Graefes Arch Clin Exp Ophthalmol 2022; 260:3197-3204. [PMID: 35501490 PMCID: PMC9477924 DOI: 10.1007/s00417-022-05674-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/28/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze the correlation between lens status, age, and sex in the epidemiology and success rates of rhegmatogenous retinal detachment (RRD) surgery. METHODS The files of all consecutive patients undergoing vitreoretinal surgery for uncomplicated RRD between Jan 2005 und Dec 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment occurring within 3 months after surgery. RESULTS 5502 eyes with uncomplicated primary RRD were included. Mean age of the patients was 61.1 years (± 13.6 SD). In the age group over 40 years, a male predominance was found. The percentage of pseudophakic RRD increased from 25 to 40% during the 15 years observation period. In the age group 50 to 69 years, patients with pseudophakic detachments were male in 786 out of 1079 cases (72.9%). In the same age group, 1285 of 2110 (60.9%) patients with phakic RRD were male. Overall, primary success rate after one procedure was 91.2% (5018 of 5502). In the phakic eyes, the primary success rate was higher in those eyes that underwent combined phacovitrectomy (93.0%), compared to those without simultaneous cataract surgery (88.7%; p = 0.002). CONCLUSION The ratio of male and female patients with RRD varies between age groups. The proportion of pseudophakic RRD has increased within 15 years. The male predominance in RRD is stronger in pseudophakic than in phakic eyes. In phakic eyes with RRD, a combined phacovitrectomy yielded better anatomical results.
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Affiliation(s)
- Viola Radeck
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany.
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - David Maerker
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Teresa Barth
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
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Liu R, Li H, Li Q. Differences in Axial Length and IOL Power Based on Alternative A-Scan or Fellow-Eye Biometry in Macula-Off Rhegmatogenous Retinal Detachment Eyes. Ophthalmol Ther 2022; 11:347-354. [PMID: 34878642 PMCID: PMC8770769 DOI: 10.1007/s40123-021-00439-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study was performed to observe the potential refractive prediction error based on alternative A-scan ultrasound and fellow-eye biometry for phacovitrectomy in macula-off rhegmatogenous retinal detachment (RRD) eyes. METHODS Phakic macula-off RRD eyes without axial length (AL) measurements obtained using IOLMaster were included. Vitrectomy without lens extraction was performed for RRD repair. Preoperative AL was measured using alternative A-scan ultrasound (AL-US). Postoperative AL was obtained in eyes with silicone oil tamponade (AL-SO) and preoperative fellow-eye biometry (AL-FE) using IOLMaster. Other eyes that faced the same preoperative situation but underwent phacovitrectomy based on fellow-eye biometry were recruited as controls. RESULTS AL-US, AL-FE, and AL-SO were 25.39 ± 2.14 mm, 25.85 ± 2.16 mm and 26.08 ± 2.53 mm, respectively. The Bland-Altman agreement among AL-US, AL-FE and AL-SO was good (95.5%, 21/22 of cases were in the LoA). The mean IOL power calculated using AL-US (Power-US), AL-FE (Power-FE) and AL-SO (Power-SO) was 16.81 ± 7.19 D, 14.74 ± 6.95 D and 13.54 ± 8.32 D, respectively. The difference between AL-US and AL-SO was significant (P < 0.05), while that between AL-FE and AL-SO was not (P > 0.05). The difference between Power-US and Power-SO was significant (P < 0.05), while that between Power-FE and Power-SO was not (P > 0.05). Nine eyes underwent phacovitrectomy based on fellow-eye biometry and had a final postoperative myopic shift of 0.64 ± 0.78 D. CONCLUSIONS Alternative A-scan ultrasound led to a significant difference in AL and a prediction error in IOL power, while fellow-eye biometry provided similar results to silicone oil-filled eyes after RRD repair.
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Affiliation(s)
- Rui Liu
- Department of Ophthalmology, Shanghai Jing'an District Shibei Hospital, Shanghai, 200443, China
| | - Hongrong Li
- Aier Eye Hospital Group, Hangzhou Aier Eye Hospital, Hangzhou, 311202, Zhejiang Province, China
| | - Qingchen Li
- Department of Ophthalmology and Vision Science, Eye, Ear, Nose and Throat Hospital of Fudan University, 83# Fenyang Road, Xuhui District, Shanghai, 200031, China.
- Key Laboratory of Myopia of State Health Ministry, Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 200031, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
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Faraldi F, Lavia CA, Nassisi M, Kilian RA, Bacherini D, Rizzo S. Swept-source OCT reduces the risk of axial length measurement errors in eyes with cataract and epiretinal membranes. PLoS One 2021; 16:e0257654. [PMID: 34550998 PMCID: PMC8457472 DOI: 10.1371/journal.pone.0257654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS To compare the biometric data from partial coherence interferometry (PCI) and swept-source OCT (SS-OCT) in patients with age-related cataract and epiretinal membrane (ERM): ERM, ERM with foveoschisis and macular pseudohole. METHODS 49 eyes of 49 subjects including 36 ERM, 9 ERM foveoschisis and 4 macular pseudohole were analysed to evaluate the axial length (AL) measurements and the presence of AL measurement errors, defined basing on the shape of the biometric output graphs and on the concordance of AL values between instruments. Eyes with ERM were divided in four stages according to OCT features (i.e. presence/absence of the foveal pit, presence of ectopic inner foveal layers, disrupted retinal layers). RESULTS The devices provided similar mean AL measurements in all subgroups, with differences <0.1 mm in 41/49 cases (83.6%). AL measurement errors were observed in ERM stages 3 and 4, characterized by ectopic inner foveal layers, and were significantly more frequent with the PCI (8/17, 47%) as compared with the SS-OCT device (2/17, 12%), p = 0.02. The refractive prediction error in cases with AL measurement errors was significantly greater using the PCI compared to the SS-OCT device (p<0.05). CONCLUSION Both devices provide reliable biometric data in the majority of patients and can be used in the preoperative assessment of patients with age-related cataract and ERM. In eyes with ectopic inner foveal layers, attention should be paid as AL measurement and refractive prediction errors may occur, more frequently with the PCI device.
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Affiliation(s)
- Francesco Faraldi
- Surgical Department, Ophthalmology Service, Azienda Sanitaria Locale TO5, Chieri, Italy
| | | | - Marco Nassisi
- Ophthalmological Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Raphael A. Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Pisa, Italy
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[25-Gauge macular surgery: comparison with and without combined phacoemulsification and artificial lens implantation]. Ophthalmologe 2021; 119:176-180. [PMID: 34297191 DOI: 10.1007/s00347-021-01461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the surgical methods continuously developed in recent years, macular surgery has become an increasingly less traumatic procedure for the eye. For patients with additional lens opacification, a 1-stage procedure with combined cataract surgery is recommended. OBJECTIVE The aim of this retrospective study was to record the functional results and complications after elective macular surgery with and without combined phacoemulsification and artificial lens implantation. MATERIAL AND METHODS The retrospective study included all patients who were operated on with a pars plana vitrectomy (ppV; 25 gauge) for epiretinal membrane, macular hole or vitreoretinal traction between 2010 and 2016 and who had a follow-up period of at least 3 months. The functional results and possible risk factors as well as complications that occurred were then recorded. RESULTS A total of 781 eyes were identified of which 517 (66%) had a phacoemulsification and artificial lens implantation with a 25-gauge vitrectomy, membranectomy, ILM peeling and SF6 gas or air tamponade. The mean follow-up time was 17 months. The mean logMAR visual acuity was 0.59 preoperatively and 0.4 postoperatively. From 64 phacic eyes which did not receive a combined phacoemulsification and artificial lens implantation 40 (62.5%) required phacoemulsification and artificial lens implantation within 13.6 months due to complicated cataract, 18 even within 6 months. In terms of complications, there were comparable results between ppV alone and the combined operation, particularly with respect to an IOL dislocation or iris capture. CONCLUSION Overall elective macular surgery is a procedure with few complications both without and above all with combined phacoemulsification and artificial lens implantation. Therefore, a combined operation makes sense in terms of surgical management and postoperative rehabilitation, especially in times of a pandemic with limited surgical resources.
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Katz G, El Zhalka F, Veksler R, Ayalon A, Moisseiev E. The Role of Anterior Chamber Depth on Post-operative Refractive Error After Phacovitrectomy. Clin Ophthalmol 2021; 15:2111-2115. [PMID: 34045847 PMCID: PMC8144168 DOI: 10.2147/opth.s309302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose To investigate the effect of phacovitrectomy on the post-operative anterior chamber depth (ACD) and refractive outcomes, and to analyze the potential differences between vitreous filling with BSS, air and gas. Methods Patients who underwent phacovitrectomy were included in this study and invited for repeated post-operative examination including refraction and biometry at least 3 months after the surgery. Data retrieved included demographic information, indication for phacovitrectomy, surgical details, type of vitreous filling (BSS, air or gas), pre-operative and post-operative biometric data including K-readings, axial length (AL), and ACD, as well as spherical equivalent (SE) values of the target and final refraction. Results Forty-three eyes of 43 patients were included in this study, including 10 eyes filled with BSS, 18 with air and 15 with gas. The mean difference between the final measured spherical equivalent (SE) and the SE of the intended target refraction was 0.61±0.68 D (p = 0.019). Only 58.1% of eyes had a final SE within ±0.5D of the target refraction. Following surgery, AL remained unchanged, while mean pre-operative ACD increased significantly from 3.11±0.34 mm to 4.77±0.47 mm (p < 0.001). There was no difference in refractive error between the vitreous fillings and no correlation with AL or ACD. Conclusions Phacovitrectomy is associated with lower accuracy of post-operative refraction compared to cataract surgery. This may be attributed to a significant change in ACD, influencing the effective lens position of the IOL, and may require adjustment of the pre-operative calculations.
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Affiliation(s)
- Gabriel Katz
- Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, TelAviv University, TelAviv, Israel
| | - Fidaa El Zhalka
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Ronel Veksler
- Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel
| | - Anfisa Ayalon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Elad Moisseiev
- Sackler School of Medicine, TelAviv University, TelAviv, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
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The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation. Graefes Arch Clin Exp Ophthalmol 2021; 259:2193-2201. [PMID: 33528646 DOI: 10.1007/s00417-021-05102-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To analyze the functional impact of ectopic inner foveal layers (EIFL), along with other clinical and optical coherence tomography biomarkers, on patients with epiretinal membrane (ERM) and preserved foveal layers' segmentation undergoing ERM removal. METHODS Retrospective review of consecutive patients with ERM who underwent pars plana vitrectomy with ERM peeling from December 2018 to December 2019. Baseline factors including age, gender, lens status, phacoemulsification at the time of surgery, tamponade agent, dye used for ERM and internal limiting membrane (ILM) enhancement, ILM peeling, best-corrected visual acuity (BCVA) and central macular thickness (CMT), presence and thickness of EIFL, thickness of outer nuclear layer (ONL), presence of a cotton ball, subfoveal state of photoreceptors, and presence of cystoid macular edema were included in a multivariable model having the BCVA at 12 months as the main outcome. The changes in EIFL and ONL thickness over time were also analyzed. RESULTS Fifty-one patients (58 eyes, 23 eyes in the no EIFL group, and 35 eyes in the EIFL group) were enrolled. The BCVA significantly improved over 12 months after surgery, regardless of the presence of EIFL (p < 0.001). Eyes with no EIFL had better BCVA at month 3 (p = 0.04), but this difference was no longer detectable at 6 and 12 months. The presence of EIFL was not associated with the final BCVA (p = 0.9), while the CMT at 12 months correlated with EIFL thickness (r = 0.8, p = 0.008). CONCLUSION Patients with EIFL could reach optimal visual acuity in the absence of disorganization of the inner retinal layers but should be warned of potentially longer healing times. None of the morphologic signs included in this study precluded good visual recovery on long-term follow-up.
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