Corneal 'dellen' as a complication of strabismus surgery

PURPOSE: This paper presents results of an analysis on patients operated on for strabismus in order to evaluate frequency and clinical characteristics of corneal alterations. In our experience, this kind of complication occurs more frequently after reoperation and/or after surgery for esotropia in sixth nerve palsy using transposition procedures. METHODS: A retrospective analysis was made of 655 consecutive patients operated on for strabismus on the recti muscles with a limbal approach from January 2001 to July 2003 (30 months). RESULTS: We found 30 corneal dellen out of the 184 eyes (16.30%) reoperated on medial rectus muscles, 7 corneal dellen out of the 37 eyes (18.92%) operated on using transposition procedures, 4 corneal dellen out of the 101 eyes (3.96%) operated of lateral rectus muscle recession combined with medial rectus muscle resection and no corneal dellen in the other 976 eyes operated of using different surgical procedures on the recti muscles. All patients had been operated on using a conjunctival limbal approach. All corneal dellen disappeared in about 10-15 days, using topical antibiotics and a firm bandage applied to the eye at night, leaving permanent alterations in corneal homogeneity in 8 eyes (19.51%). CONCLUSION: This study showed that this kind of complication is relatively frequent after reoperations and/or transposition procedures, thus indicating that it is possible to identify surgical procedures which might play a role in the development of corneal dellen. Therefore, the post-operative monitoring of patients at risk should not be delayed for more than one week, in order to avoid possible corneal perforation

Surgical results of pars plana vitrectomy combined with phacoemulsification

Objectives: To evaluate the technical feasibility, safety, outcome, and incidence of complications after combined clear corneal phacoemulsification (PEA) with intraocular lens (IOL) implantation and vitreoretinal surgery. Methods: Combined operations of PEA and PPV were performed on 52 eyes of 52 patients with cataract and vitreoretinal diseases. Results: The mean follow-up time was (10.3±2.8) months. Postoperatively, visual acuity improved in 46 eyes (88.5%); was unchanged in 6 eyes (11.5%). The best-corrected visual acuities (BCVAs) were the following: 20/40 or better (9 eyes), 20/50 to 20/100 (24 eyes), 20/200 (5 eyes), 20/400 (10 eyes), and fingers counting (FC) to light perception (LP) (4 eyes). In 38 eyes BCVA was 20/200 or better, and in 9 eyes it was 20/40 or better postoperatively. Postoperative complications included posterior capsual opacification (7 eyes); secondary glaucoma (1 eye); and retinal detachment (2 eyes). Conclusion: Although further studies are indicated, our study suggests that the combined operation of PPV, PEA and IOL implantation is safe and effective for patients. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique

Evaluation of discomfort glare in the 50+ elderly: experimental study

Objectives: The aim of the study was to analyze discomfort glare sensation in subjects aged 50 years and more in comparison with younger subjects (i.e. younger than 35 years of age). Material and Methods: The experiments were performed on a computer workstation placed in controlled lighting environment where 2 discomfort glare conditions were modeled. Each participant performed for about 1 h specially designed visual tasks, including the tests with Landolt's rings presented on the screen by a computer program. The glare evaluation method consisted of subjective evaluation of discomfort glare on the semantic glare rating scale, tests of mesopic contrast and glare sensitivity, subjective assessment of lighting quality and asthenopic symptoms. The time needed to perform the task and the number of mistakes were also recorded. The subjective evaluation of glare was compared with the Unified Glare Rating (UGR) index calculated by the DIALux simulation program. Results: A higher percentage of the younger group subjects assessed glare after the experimental session as uncomfortable and intolerable than in the 50+ group, who more often assessed glare as acceptable. The assessment of discomfort glare in the younger group corresponded to higher UGR value compared to UGR value calculated by DIALux. In the 50+ group, such correlation was found only for lower discomfort glare (UGR = 19). The results showed that younger participants more frequently suffered from visual fatigue and assessed lighting as less comfortable. However, the mesopic glare sensitivity increased significantly after the experiments only in the 50+ group under both glare conditions. Conclusions: The obtained results showed that discomfort glare sensation changes with age. The younger population seems to be more sensitive and demanding than the older one in relation to discomfort glare limiting, in spite of the lack of significant objective measures of fatigue. The exposure of the elderly to bigger discomfort glare could adversely affect the objective measures of fatigue like mesopic glare sensitivity and visual performance