Purpose: To describe the incidence, clinical features, and long-term outcomes of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in patients who underwent PDT for various indications. Methods: This retrospective observational case series included all cases who developed massive serofibrinous macular exudation within a week after PDT. Medical records of patients with post-PDT exudative events were reviewed for relevant data and imaging abstraction including optical coherence tomography and indocyanine green angiography features and were subjected to analysis. Results: The incidence rate of PAEM was 4.52%, being noted in 8 eyes (out of 177 PDT sessions in 155 eyes) with a mean age of 70.25 ± 6.65 years. Pre-PDT factors commonly associated with PAEM included age ≥65 years (87.5%), clinical diagnosis of polypoidal choroidal vasculopathy (75%), spot size ≥3,500 µm (100%), best-corrected visual acuity of 20/40 or better (87.5%), low-fluence PDT (87.5%), and the first exposure to PDT (75%). Photodynamic therapy–induced acute exudative maculopathy was noted at a mean interval of 2.9 ± 1.7 days (2–7 days) after PDT. Photodynamic therapy–induced acute exudative maculopathy resulted in significant decrease in mean best-corrected visual acuity from logMAR 0.29 ± 0.21 (approximate Snellen equivalent 20/39) to logMAR 0.91 ± 0.37 (approximate Snellen equivalent 20/163) [P = 0.0018], and significant increase in mean central macular thickness from 228.1 ± 71.8 µm to 481.4 ± 154.8 µm (P = 0.0029). Photodynamic therapy–induced acute exudative maculopathy resolved to baseline or even better tomographic status at a mean interval of 4.6 ± 1.2 weeks, resulting in complete visual recovery compared with baseline. During mean follow-up of 77.8 ± 46.4 weeks after PDT, no activity was noted for a mean duration of 26.3 ± 42.5 weeks after resolution. At final visit, mean best-corrected visual acuity and central macular thickness was logMAR 0.49 ± 0.28 (approximate Snellen equivalent 20/62) and 153.6 ± 40.0 µm, respectively, with underlying pathology being stable in 50% of the eyes. Conclusion: Photodynamic therapy–induced acute exudative maculopathy is an uncommon complication with self-resolving course and favorable prognosis. Patients undergoing PDT should be warned of the possibility of PAEM. The factors frequently associated with PAEM include elderly age (>65 years), clinical diagnosis of polypoidal choroidal vasculopathy, larger spot size (≥3,500 µm), pre-PDT best-corrected visual acuity of 20/40 or better, low-fluence PDT, and the first exposure to PDT.
Aims: To study the visual outcome following Nd:YAG laser posterior capsulotomy and to study the complications associated with Nd:YAG laser posterior capsulotomy. Material and Methods: The study included a total of 100 eyes of 100 patients who fulfilled the inclusion and exclusion criteria. Once diagnosed to have posterior capsular opacification they were subjected to a detailed clinical examination. All patients underwent Nd:YAG laser capsulotomy. Patients were followed up at 1 hour, 4 hour, 1 day, 1 week, 1 month, 3 month. At every follow up detailed examination was done. BCVA and any complications were noted. Results: Post-laser, 87% patients had BCVA 6/12 or more at 3 month follow up. 10% patients had BCVA 6/24 to 6/18. Only 3% patients had visual acuity improved to less than 6/24. Out of 3 patients, 1 patient had visual acuity improved to 6/60 & in remaining 2 visual acuity improved to 6/36. The complications were seen in 31 (31%) patients. Most common complication observed was transient rise in IOP. 17 eyes (17%) had transiently raised IOP. Second most common noted was pitting of IOL. Pitting was present in 7 (7%) patients, 3 (3%) patients had ruptured anterior face of vitreous, 2 (2%) patients had iritis, 1 (1%) had hyphema and 1 (1%) developed CME. IOP rise was related to grade of PCO and energy used. Conclusion: Improvement in visual acuity after Nd:YAG laser posterior capsulotomy is excellent. Complications associated with Nd:YAG laser capsulotomy are minimal. Nd: YAG laser capsulotomy is a safe method of restoring vision in patients with posterior capsule opacification.
<p><strong>Aim:</strong> To evaluate correction of pre-existing astigmatism after foldable Toric IOL implantation in patients undergoing cataract surgery.</p><p><strong>Materal & Methods:</strong> In this prospective observational study we included 10 eyes of 10 patients with astigmatism between 2.00D to 6.00D &undergoing cataract surgery. Phacoemulsification was performed with Toric IOL implantation through 2.8mm clear corneal temporal incision. Patients were examined post operatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) & residual refractive astigmatism.</p><p><strong>Statistical Analysis:</strong> Statistical analysis was performed by the SPSS program for Windows, ver.16.0.Continuous variables are expressed as mean ± SD, and categorical variables are presented as absolute numbers and percentage. For the statistical test, a p value less than 0.05 was taken to indicate a significant difference.</p><p><strong>Results:</strong> The UCVA was 6/9 or better in 90% of eyes. 80% eyes achieved 6/6 BCVA. The mean refractive cylinder corrected from -3.4 ± 1.4 D to -0.60 ± 0.27 D which was statistically significant. (p value=0.0001).</p><p><strong>Conclusion:</strong> Toric IOL implantation is an effective, safe surgical option to manage pre-existing corneal astigmatism during cataract surgery.</p>
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