Part of the book: Age Related Macular Degeneration
Part of the book: Age-Related Macular Degeneration
Currently, spectral domain optical coherence tomography (SD-OCT) is a basic tool in diagnosing and monitoring diabetic macular edema (DME), which is the most frequent cause of visual impairment in the diabetic patients. OCT technology has changed the classification of DME from the traditional criteria. Macular thickness measured on OCT is considered an outcome measure to evaluate the structural and functional outcome of various therapeutic means used in DME. SD-OCT evaluates ultrastructural retinal parameters, such as the ellipsoid zone, photoreceptor outer segment length and quantifies the individual layers according to various algorithms. The aim is to present the way in which SD-OCT technology has changed our clinical practice during the last years, in diagnosing, classifying and treating DME and to illustrate its impact with practical cases.
Part of the book: OCT
Retinopathy of prematurity (ROP) is a largely preventable cause of visual impairment in children. The golden standard of treatment in ROP is the laser photocoagulation of the non-vascularized retina. The most vulnerable period when ROP is at high risk of rapid progression is comprised between 34 and 35 weeks postconceptional age (PCA) and 36–37 weeks PCA. We carried out a retrospective study in which we included all the ROP cases treated by indirect diode laser photocoagulation between January 1, 2006, and December 31, 2017, totalizing 110 premature infants of which, 60 were males (54.54%) and 50, females (45.45%). Mean gestational age (GA) was 28.30 weeks and mean birth weight (BW) was 1121 grams in our series. Of the 110 preterm infants, 74 were the result of single pregnancies (67.27%) and 36 of multiple pregnancies (32.72%). At the moment of treatment, the mean postnatal age (PNA) was 8.38 weeks and the mean PCA, 37.02 weeks. ROP regressed after laser treatment in 185 eyes (88.09%). Statistical tests proved that regression rate was significantly worse in aggressive posterior ROP as compared with stage 3 zone 2 and stage 3 zone 1 ROP (odds ratio = 13.53, relative risk = 7.79, P < .001).
Part of the book: Laser Technology and its Applications
Preterm babies may develop retinopathy of prematurity (ROP) in various stages. Most of them regress spontaneously without treatment, and a small proportion develops severe ROP that can lead to visual loss if not treated promptly. Less than 10% of the ROP cases require treatment worldwide. Before 1980, the only treatment for ROP was vitreoretinal surgery for retinal detachment in advanced stages of the disease. Around this time, cryotherapy started to be used in order to ablate the peripheral retina and interrupt the pathogenic chain in ROP, but there were no indications correlated with the severity of the disease. Few years later, cryotherapy was replaced by indirect laser photocoagulation of the nonvascular retina that became the golden standard of treatment for ROP. During the last years, efforts have been made in order to find therapeutic methods to induce the regression of new vessels with minimal side effects. Among these, intravitreal injections of anti-vascular endothelial growth factor (VEGF) became increasingly popular in the treatment of ROP worldwide. Personal experience in treating aggressive posterior ROP (APROP) with laser versus intravitreal anti-VEGF is presented. Intravitreal anti-VEGF proved its superiority in treating APROP as compared to laser, with no systemic and/or local side effects in our series.
Part of the book: Neonatal Medicine
Currently, ideal cataract surgery should end with the placement of an intraocular lens (IOLs) in the bag. However, in the clinical setting we have to manage cases without enough capsular support to allow the physiological IOL placement. Progress has been made in terms of IOL designs and implantation techniques. The options should be analyzed not only in accordance with surgeon’s experience but also with patient’s age, local, and systemic comorbidities. Thus, in the absence of an appropriate capsule, IOL can be placed in the anterior chamber, fixated to the iris or to the sclera wall. In this paper, the personal experience of one surgeon with ab externo scleral-fixated IOLs is presented, with the aim to outline the place of this surgical technique in the correction of aphakia. A retrospective study was carried out, including 57 patients in which an IOL was fixated to the sclera, throughout January 2015–April 2019. The causes of aphakia, preoperative and postoperative best-corrected visual acuities (BCVA), and intra- and postoperative complications are analyzed. Statistical tests were applied in order to draw significance. In most instances, BCVA has remained stable, with no significant complications, making sclera fixation IOL a viable solution in the correction of aphakia.
Part of the book: Intraocular Lens