Rezultati vitrektomije pri bolnikih z regmatogenim odstopom mrežnice

Izhodišča: Ovrednotili smo anatomski in funkcionalni izid zdravljenja kompleksnega regmatogenega odstopa mrežnice z vitrektomijo pars plana (PPV). Metode: V retrospektivno raziskavo smo vključili 88 oči 88 bolnikov, ki so bili zaradi kompleksnega regmatogenega odstopa mrežnice zdravljeni s PPV. Določili smo anatomski uspeh in funkcionalni izid na podlagi korigirane vidne ostrine (VO) v celotni skupini bolnikov in v skupinah glede na status očesne leče, rumene pege in prisotnosti proliferativne vitreoretinopatije (PVR) stopnje ≥ C1. Z optično koherenčno tomografijo (OCT) rumene pege smo vsaj 6 mesecev po PPV ovrednotili prisotnost prekinitev elipsoidne cone, cistoidnega makularnega edema (CME), epiretinalne membrane (ERM) ali makularne luknje. Rezultati: Anatomski uspeh je bil po primarni PPV 93,2 %. Končni anatomski uspeh je bil dosežen pri vseh 88 bolnikih (100 %). Korigirana VO se je statistično značilno izboljšala iz VO 1,7 ± 1,2 SD logMAR pred operacijo na VO 0,6 ± 0,7 SD logMAR po operaciji (p=0,01). Med skupinama bolnikov je glede na prisotnost PVR izstopal slabši anatomski izid v skupini s PVR stopnje ≥ C1 (89,7 %). Korigirana VO se je po operaciji izboljšala pri vseh skupinah bolnikov, vendar po analizi glede na skupine statistično značilno le v skupini fakih (p=0,019), z odstopom rumene pege, (p=0,016) in s prisotnim PVR stopnje ≥ C1 (p=0,028). Končna VO je bila boljša v skupini psevdofakih (0,75 ± 1,06), v skupini bolnikov z ležečo rumeno pego (0,78 ± 1,30) in pri bolnikih brez PVR (0,80 ± 1,15 logMAR). Analiza OCT rumene pege po operaciji je pokazala prisotnost prekinitev elipsoidne cone v 39 %, CME v 15 %, ERM v 2 % in makularne luknje v 2 %. Primerjava spremenljivk OCT glede na skupine na podlagi statusa očesne leče, rumene pege in prisotnosti PVR stopnje ≥ C1 je pokazala največji delež prekinitev elipsoidne cone v skupini oči s prisotnim PVR stopnje ≥ C1 (58,6 %). Zaključek: Ugotovili smo visoko stopnjo anatomske in funkcionalne uspešnosti zdravljenja kompleksnega regmatogenega odstopa mrežnice z vitrektomijo. Funkcionalni izid je bil boljši pri bolnikih z umetno znotrajočesno lečo, pri bolnikih z ležečo rumeno pego in pri bolnikih brez PVR. Največji delež bolnikov s prekinjeno elipsoidno cono je bil v skupini bolnikov s predoperativno PVR

Clinical Features of Acute Anterior Uveitis with Complicated Course in a Slovenian Patient Population

Purpose. To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and within this group to compare clinical features and outcomes of treatment of HLA-B27+ and HLA-B27− AAU in the population of Slovenian patients. Methods. Retrospective study of hospitalized patients with AAU in the last 39 months at the Eye Hospital in Ljubljana. The data of AAU patients were retroactively studied and compared on the basis of HLA-B27 antigen presence: visual acuity upon admission, visual outcome, the presence of hypopyon, fibrinous reaction, posterior iris synechiae, and complications, such as elevated intraocular pressure, cataract, and cystoid macular edema (CME). We compared the investigations in the diagnostic process, the associated systemic disease, and the treatment administered. Statistical analyses included Student’s t-test Fisher’s exact test, and the Kolmogorov–Smirnov test. A p value of <0.05 was considered statistically significant. Results. A total of 37 hospitalized patients with AAU were included. HLA-B27 antigen was detected in 73% of patients. In the HLA-B27+ group, women were more commonly affected, while the males were more affected in the HLA-B27− group. The occurrence of fibrin was significantly more common in HLA-B27+ patients, as well as hypopyon and posterior synechiae; only fibrin reached the statistical significance (p<0.05). The incidence of cataracts, ocular hypertension, and glaucoma did not differ significantly between the two groups. HLA-B27+ AAU was more often associated with systemic diseases, and patients in this group were more frequently treated with systemic immunomodulatory drugs, however, no difference reached the statistical significance. We did not notice any major differences in the final visual acuity in the comparing groups. Conclusion. Almost ¾ of AAU patients that required hospitalization were HLA-B27+. In this group, disease was more severe, more frequently associated with ocular complications and systemic disease, but final visual acuity was the same in both groups. HLA-B27 typing has no prognostic value in our group of complicated AAU patients, but it eases the decision about necessary diagnostics and treatment

Prognostic factor analysis of visual outcome after vitrectomy for rhegmatogenous retinal detachment

Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. A swept source OCT was used to obtain images at the postoperative visit at least 6 months after PPV. Hierarchical linear regression model was used to evaluate the influence of preoperative factors related to patient, ocular clinical and postoperative OCT macular findings on functional outcomes of PPV for RRD. Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVAp < 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome