EyeWorld India June 2015 Issue

62 EWAP NEWS & OPINION June 2015 background of uveitis. Of these eyes, 157 eyes (96.9%) underwent phacoemulsification with IOL implantation and 5 (3.1%) underwent planned ECCE with IOL implantation. The major causes of uveitis Dr. Usui found in these were Behçet’s disease (40 eyes, 26 patients, 24.7%) and sarcoidosis (36 eyes, 28 patients, 22.2%). However, the highest percentage of eyes had no discernible etiology (48 eyes, 31 patients, 29.6%). Out of the total 162 eyes, 69 (42.6%) had posterior synechiae. When performing cataract surgery in cases of uveitis, Dr. Usui said timing is important. He recommends performing cataract surgery when cells in the anterior chamber are minimal, either absent or less than +1, and when flare value is less than 100 pc/ms. Furthermore, he said, the eye should have been free of inflammation for 3 to 6 months. In this study, postoperative treatment included systemic administration of betamethasone (2–4 mg/day) for 2–4 days and a nonsteroidal anti-inflammatory drug (NSAID) for 3–4 days, as well as topical administration of steroid (3–5x/day) for 3 months, NSAID (3x/day) for 3 months, and mydriatics (1–2x/day) for 1 month. After surgery, 117 eyes (72.6%) had better than 0.5 visual acuity. Compared to preoperative visual acuity, 120 eyes (74.0%) had a 2-fold increase, 33 eyes (20.4%) had no change, and 9 eyes (5.6%) had a 2-fold decrease in vision. These eyes, Dr. Usui said, are prone to recurrent inflammation. Dr. Usui said that surgeons should carry out the appropriate operation using proper surgical procedures and provide the necessary postoperative care and treatment to control complications including recurrence, cystoid macular edema, ocular hypertension, and posterior synechiae. Arthur Lim Award Lecture posits determinant for visual acuity in idiopathic ERM The APAO presents the Arthur Lim Award in recognition of ophthalmologists who have exhibited exemplary leadership in ophthalmology, leading to substantial improvements in ophthalmic teaching and training in their region and beyond. It honors the late Prof. Arthur Lim , former president and secretary- general of the Academy. This year, the honor of delivering this prestigious lecture went to Young Hee Yoon, MD , Seoul, South Korea. For her Arthur Lim Award Lecture, Dr. Yoon discussed “Microstructural Change in Foveal Inner Retina as a Visual Predictor of Idiopathic ERM,” in which she proposed a hypothesis for the main determinant of visual acuity in idiopathic epiretinal membranes (ERM). In addition, she proposed an approach to manage the condition based on her hypothesis. “In clinical practice, we often witness a discrepancy between the morphologic change and visual acuity in persons with epiretinal membrane,” she said. “Several factors have been associated with visual acuity in ERM patients.” These include central retinal thickness, inner retinal layer thickness, presence of cystoid macular edema, and photoreceptor inner segment/outer segment (IS/ OS) junction layer disruption. “Among these factors, IS/OS disruption has been suspected as the most significant determinant in most retinal diseases,” she said. However, isolating idiopathic ERM from other retinal conditions, IS/OS disruption, she said, is rarely observed. Dr. Yoon presented OCT images from a case with advanced ERM with poor visual acuity. The OCT image showed the IS/OS junction layer to be intact. The partner eye had IS/OS disruption secondary to branch retinal vein occlusion. Numerous diseases, she said, may cause secondary ERM. Among them are those that require fluorescence angiography for accurate diagnosis, including macular branch retinal vein occlusion. What, then, determines visual acuity in idiopathic ERM? Dr. Yoon reviewed eyes with ERM and carefully selected those with idiopathic causes on the basis of fluorescence angiography. In this review, Dr. Yoon and her colleagues reported that central inner retinal layer thickness (CIRLT) of the fovea was the major determinant of visual acuity—they found that eyes with thick foveal centers could still have very good visual acuity if the inner retinal layer at the foveal center was not thickened. In fact, she said, only 2 eyes out of 134 with idiopathic ERM were observed to have IS/OS junction layer disruption. How inner retinal layer thickening in idiopathic ERM affects visual acuity remains the subject of speculation. Dr. Yoon herself hypothesized that “when tangential retinal traction becomes intense, the inward peak of the outer retinal layer is exaggerated, resulting in attachment of adjacent parafoveal inner retinal layers,” she said. “Once the attachment occurs, the cells in these layers lose their normal alignment, failing normal neural transduction.” Dr. Yoon then wondered whether this “blockage” in normal neural transduction can be “reopened” by surgically releasing the traction through ERM removal. In 57 consecutive patients with idiopathic ERM and decreased vision due to abnormally thick CIRLT, best corrected visual acuity (BCVA) and metamorphopsia improved 12 months after surgery. In a multivariate analysis of these cases, CIRLT was the only factor significantly associated with visual acuity apart from initial BCVA. Postoperative visual outcomes, she said, correlated well with postoperative restoration of inner retinal layer configuration after ERM peeling. “Eyes having a thicker inner retinal thickness at the central fovea and a longer duration of disease at baseline tended to restore poorly after surgery,” she added. These findings were recently published in Retina . EWAP The 30th APAO - from page 60