Acuity In Group Research Articles

Should plasma exchange be offered to patients with multiple sclerosis-associated optic neuritis?

Should plasma exchange be offered to patients with multiple sclerosis-associated optic neuritis?

Clinical outcomes of vitrectomy at different operation times for complicated ocular trauma

Objective To observe the effect of vitrectomy at different operation times on clinical outcomes of complicated ocular trauma. Methods From January 2011 to October 2013 in our hospital, 129 eyes of 129 cases of complicated ocular trauma who underwent vitrectomy were selected. Debridement and vitrectomy was performed in 60 cases (group A) who were less than 7d after injury and debridement. Vitrectomy was performed in 69 cases (group B) who were 7-14d after injury. The surgical effect, complications and vision were compared. Results The functional recovery rates in group A and group B were 70.0% and 87.0% respectively, and there was statistically significant difference (P 0.05); They were successfully followed up for 3-12 months. The visual acuity of the two groups before operation had no statistically significant difference (P>0.05). After following up for 3 months, the visual acuity of the two groups were improved (P<0.05), and the visual acuity of group B was significantly better than that of group A (P<0.05). Conclusion Different operation times of vitrectomy may directly affect the prognosis of complicated ocular trauma, the period of 7-14 days after injury is a suggested choice for better clinical outcome. And selecting the appropriate timing according to the patients' situation can get better surgical efficacy. Key words: Trauma, ocular, complex; Vitrectomy; Timing, operation

Threshold Levels of Visual Field and Acuity Loss Related to Significant Decreases in the Quality of Life and Emotional States of Patients with Retinitis Pigmentosa

Introduction: Retinitis pigmentosa (RP) is an inherited retinal disorder, characterized by photoreceptor degeneration inducing progressive vision loss. This study evaluates its impact on quality of life (QOL) and emotional states of patients affected by RP. Methods: A cross-sectional study was conducted on 60 RP patients diagnosed with rod-cone dystrophy and on 20 control subjects. The RP population has been divided into 3 groups according to visual field (VF) and visual acuity (VA) impairments. Concurrently, scores of self-reported QOL (25-item National Eye Institute Visual Functioning Questionnaire) and of the Hospital Anxiety and Depression Scale for anxiety/depression assessments were collected. Results: For the QOL composite score, we noticed consistent differences between all VF and VA affected groups and their control group. We also found significant differences between both the most affected VF group (VF1: ØVF <20°) and VA group (VA1: VA <0.3) compared to other VF and VA groups. For anxiety/depression scores, consistent differences have been found between the control group and VF1 and VA1, respectively. Conclusions: This work determines that, for RP patients, a significant QOL and emotional state deterioration correlates with a residual VF diameter below 20° and a VA lower than 0.3. It introduces, for the first time, thresholds to be used in visual restoration or visual preservation therapies to improve QOL of RP patients.

Vitrectomy for idiopathic macular hole: outcomes and complications

Purpose The aim of this study was to determine the anatomical closure rate together with the rate of functional success of idiopathic macular holes following vitreous surgery in different optical coherence tomography (OCT) stages. Patients and methods This was a prospective, case series, interventional study. Twenty-two eyes were enrolled in this study conducted at Mansoura University Ophthalmic Center during the period between June 2012 and December 2014 with at least 3 months of follow-up. Eyes with stage 2, 3, and 4 idiopathic macular hole according to the Gass classification were included. All eyes were subjected to 23-G pars plana vitrectomy, inner limiting membrane peeling, fluid-gas exchange, and postoperative positioning. Results Idiopathic macular hole closure was achievable in 18 of 22 cases, with overall 81.4% anatomical success. Type 1 closure (U-shaped closure) was achieved in 13 cases (59.1%), type 2 closure (V-shaped closure) in three cases (13.6%), type 3 closure (irregular closure) in one case (4.5%), and type 4 closure was reported in one case (4.5%). The median postoperative log MAR visual acuity at 3 months was 1.0 (0.9445-1.2073). The overall postoperative visual acuity improvement was strongly statistically significant ( P = 0.000). The visual acuity improvement at 3 months compared with the preoperative visual acuity was statistically significant ( P = 0.000). The delta change in log MAR visual acuity at 3 months was 0.5 (−0.7782 to −0.4331), with greater improvement in log MAR visual acuity in group I (stage 2 OCT) compared with group III (stage 3 and 4 OCT at 3 months; P = 0.05). Retinal breaks were observed intraoperatively in three cases. Retinal detachment was reported in one case 4 months postoperatively. Conclusion Macular hole closure rate and visual acuity markedly improved following vitreous surgery for idiopathic macular holes.

Evaluation of corneal collagen cross-linking as an additional therapy in mycotic keratitis.

To report the treatment outcomes of mycotic keratitis with collagen cross-linking. Retrospective study. Patients with smear-positive moderate mycotic keratitis. A retrospective case-file analysis was performed to identify cases of moderate mycotic keratitis treated with and without additional collagen cross-linking, in addition to intensive topical antifungal therapy. Patients in which collagen cross-linking was performed on the day of presentation (group 1) were compared with patients who received medical treatment alone in the form of 5% natamycin eye drops (group 2). The primary outcome measure was the time taken for resolution of infection. Overall, 41 cases were included for analysis (group 1, 20 cases; group 2, 21 cases). Mean age of the patients was comparable in both groups (46.5 ± 17.01 vs. 41.2 ± 20.7 years; P = 0.36). Average infiltrate size was 16.35 ± 6.8 mm(2) in group 1 and 17.09 ± 7.4 mm(2) in group 2 (P = 0.83). Overall, Aspergillus was the most commonly isolated organism (n = 4 group 1; n = 6 group 2). Resolution of infection was observed in 18 cases (90%) in group 1 and 18 (85.71%) cases in group 2. The average healing time was 30.85 ± 26.6 days in group 1, while it was 31.28 ± 19.97 days in group 2 (P = 0.94). Final best-corrected visual acuity in group 1 was 1.13 ± 0.55 and 1.25 ± 0.46 in group 2 (P = 0.46). A tectonic keratoplasty was performed in two cases in group 1 and three cases in group 2 (P = 1.00). In our study, additional collagen cross-linking treatment did not have any advantage over medical management in cases with moderate mycotic keratitis.

Fourier-domain optical coherence tomography evaluation of clear corneal incision structure according to blade material

To use Fourier-domain optical coherence tomography (OCT) to evaluate the wound characteristics of clear corneal incisions (CCIs) created with a metal or diamond blade in cataract surgery. Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea. Prospective comparative observational study. Patients who had cataract surgery were randomized into 2 groups based on whether a metal blade (Group 1, 37 eyes) or diamond blade (Group 2, 33 eyes) was used to create a 2.8 mm temporal CCI. One day, 1 week, and 1 month postoperatively, structural characteristics of the CCI were analyzed using RTVue-100 Fourier-domain OCT. Parameters included incision angle, corneal thickness, epithelial or endothelial gaps, and Descemet membrane detachment. Visual acuity, surgically induced astigmatism (SIA), and ocular aberrations were evaluated. There was a significant difference in corneal thickness at the 1.0 mm temporal side from midpoint. The mean uncorrected distance visual acuity in Group 2 (33 eyes) improved significantly over time. In both groups, corneal thickness at the midpoint, 1.0 mm temporal side, and 1.0 mm nasal side from the midpoint of the incision significantly decreased over time. At all timepoints, temporal and nasal thickness in Group 2 was significantly greater than in Group 1 (37 eyes), with the exception of temporal thickness at 1 month. In both groups, wound healing was reliable over time. There were no significant between-group differences in SIA or changes in aberrations. Corneal thickness at the incision site showed a significant difference between the 2 groups. Both groups achieved structural stabilization. No author has a financial or proprietary interest in any material or method mentioned.

Complete retinal fluid resorption with low visual acuity in patients with diabetic macular edema (DME) over the course of ranibizumab treatment: OCT analysis

AbstractPurpose Intravitreal ranibizumab injections in DME often leads to resorption of edema. Nevertheless, complete resorption of DME is weakly correlated with good visual acuity (VA). The purpose of our study was to investigate the anatomical OCT features of patients treated with ranibizumab for DME with low VA despite of complete dry retina.Methods We included in a retrospective fashion all patients over the course of ranibizumab treatment for DME at Avicenne Hospital (Bobigny, France) with a dry retina after treatment (central foveal thickness (CFT) ≤ 250 μm and presence of foveal pit). We analyzed the characteristics of outer retinal layers in spectral‐domain OCT (Optos OCT SLO) in case of low final VA (best‐corrected VA (BCVA) with dry retina &lt; 5/10 after at least 3 injections).Results We included 40 patients. Complete retinal fluid resorption was achieved for 24 patients (60%). Among these patients, half of them (12 patients ie 30 % of our cohort) had low VA (group 1) and 12 patients had good VA ( group 2). Mean CFT was 713 μm in group 1 (G1) and 666μm (p = 0.64) in group 2 (G2). After treatment, mean CFT in G1 was 165 μm against 174 μm (p = 0.6) in G2. For all patients in G1, anatomical changes were noted on OCT pictures after treatment: loss or thinning of ellipsoid band (n = 6), atrophic cyst (n = 6), exudates (n = 3), epiretinal membrane (n = 2).Conclusion Insufficient improvement of BCVA after complete retinal fluid resorption happened in about 30% of patients over the course of ranibizumab treatment for DME, and was often associated in our study with alterations of outer retinal layers in SD‐OCT imaging.

Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery.

To investigate the correlation of visual acuity with the ganglion cell layer and the photoreceptor layer using spectral-domain optical coherence tomography after surgery for idiopathic epiretinal membrane (ERM). The medical records of 58 eyes were reviewed retrospectively to collect data on visual acuity (VA), ganglion cell complex thickness (GT) and photoreceptor reflectivity (PR) at baseline, 3 months, and 6months after surgery. The GT was adjusted to compensate for tractional thickening by calculating the proportional thickness to the macular thickness (MT). The PR was adjusted to compensate for the shadowing effects from the inner retina, which was achieved by calculating the ratio to the retinal pigment epithelium reflectivity (RR). The relative GT (RGT = GT/MT) and relative PR (RPR = PR/RR) were analyzed to determine their correlation with visual acuity. The GT was segmented correctly in 13 eyes at baseline, and in all eyes after surgery. The RGT and RPR were significantly lower than the normal eye. Thinner RGT correlated with poorer VA at 3 months (R = -0.352, p = 0.007) and 6months (R = -0.324, p = 0.013), but the RPR had correlation with visual acuity only at 6months (R = -0.377, p = 0.004). The area under the receiver operating characteristic curve was significant for VA ≥ 20/30 in both the RGT and RPR, and this significance was present for visual acuity ≥ 0/25 only in the RGT. The postoperative ganglion cell layer was found to be correlated to postoperative VA more consistently than the photoreceptor layer after ERM surgery. The outer retinal damage was a determining factor in the poor VA group.

Correlation of Macular Thickness, Multifocal ERG with Visual Acuity in Oculocutaneous Albinism (OCA)

Background and Aim: Ocular albinism is known to have nystagmus and foveal hypoplasia. A study was done to evaluate the correlation of visual acuity with macular thickness (MT) and mf ERG. Materials and Methods: A total of 20 eyes (10 patients) with OCA were selected. Macular thickness was evaluated with optical coherence tomography and mf ERG was done in all the patients. Results: Mean age was 16.1 ± 7.3 years. The patients were divided into three groups based on their visual acuity > 6/12 (group A), 6/18 - 6/24 (group B), 6/36 or less (group C). Mean MT in patients with visual acuity in group A, B and C was 194.8 ± 26.7, 220 ± 12.3 and 243.5 ± 17.3 microns respectively. The amplitudes of first positive wave (P1) and first negative wave (N1) for the central ring in mf ERG in patients of group A, B and C was 1.1 ± 0.5 (P1), 0.7 ± 0.2 (N1), 0.6 ± 0.5 (P1), 0.3 ± 0.2 (N1), 0.7 ± 0.2 (P1), 0.3 ± 0.1 (N1) microvolts respectively. The vision correlated well with the macular thickness. The mf ERG potentials (P1 and N1) do not correlate with the visual acuity. Conclusion: We believe that the visual acuity in albinotic patients is affected by the macular thickness but the electric potentials do not depend on the visual acuity.

Intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation in bilateral diabetic macular edema; application of bivariate generalized linear mixed model with asymmetric random effects in a subgroup of a clinical trial.

Purpose:To compare the efficacy of intravitreal bevacizumab (IVB) injection alone or with intravitreal triamcinolone acetonide (IVB/IVT) versus macular photocoagulation (MPC) in bilateral diabetic macular edema (DME).Methods:In this study we revisited data from a subset of subjects previously enrolled in a randomized clinical trial. The original study included 150 eyes randomized to three treatment arms: 1.25 mg IVB alone, combined injection of 1.25 mg IVB and 2 mg IVT, and focal or modified grid MPC. To eliminate the possible effects of systemic confounders, we selected fellow eyes of bilaterally treated subjects who had undergone different treatments; eventually 30 eyes of 15 patients were re-evaluated at baseline, 6, 12, 18, and 24 months. Using mixed model analysis, we compared the treatment protocols regarding visual acuity (VA) and central macular thickness (CMT).Results:Improvement in VA in the IVB group was significantly greater compared to MPC at months 6 and 12 (P = 0.037 and P = 0.035, respectively) but this difference did not persist thereafter up to 24 months. Other levels of VA were comparable at different follow-up intervals (all P > 0.05). The only significant difference in CMT was observed in favor of the IVB group as compared to IVB/IVT group at 24 months (P = 0.048).Conclusion:Overall VA was superior in IVB group as compared to MPC up to 12 months. Although the IVB group showed superiority regarding CMT reduction over 24 months as compared to IVB/IVT group, it was comparable to the MPC group through the same period of follow up.

Influence of Primary Diagnosis and Complications on Visual Outcome in Patients Receiving a Boston Type 1 Keratoprosthesis

Purpose: To analyse how primary diagnosis and complications affect the evolution of post-operative visual acuity (VA). Methods: We performed retrospective chart analysis on 59 eyes in 57 patients with various diagnoses, most of which were non-standard indications for Boston type 1 keratoprosthesis (Kpro) implantation. The follow-up period was at least 3 months. Patients were classified based on the evolution of post-operative VA: group A demonstrated stable VA improvement, group B lost VA improvement and group C no significant VA improvement. Results: We assigned 46% of our cases to group A with stable VA improvement, 32% to group B with lost VA improvement, and 22% to group C with no VA improvement. The number of graft failures before Kpro implantation did not influence VA outcome. Except for the relatively good VA outcome in chemical burn and radiation injury patients, there seems to be no association between primary diagnosis and positive or negative VA outcome. Only 9% of patients with posterior segment complications and 20% with infections and associated pathologies were assigned to group A. Conclusion: Most cases (78%) showed improvement in VA after Boston type 1 Kpro (groups A and B). Posterior segment complications and infections mostly resulted in persistent loss of vision. These complications should be prevented and carefully treated.

Comparison of foveal-sparing with foveal-involving photodynamic therapy for myopic choroidal neovascularization

To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia in eyes treated with photodynamic therapy (PDT), and to determine the effect of lesion location and foveal involvement on visual prognosis. Interventional case series of 24 consecutive patients with myopic CNV treated with PDT. The main outcome measure was final LogMAR visual acuity (VA). Of 24 eyes, the CNV lesion was subfoveal in 11 and extrafoveal in 13. Overall, the mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved significantly better final VA compared with subfoveal CNV (LogMAR 0.45 vs 1.05, P=0.012). Eyes with extrafoveal CNV lesions were subdivided into foveal-sparing PDT (where the PDT laser spot did not involve the foveal center) and foveal-involved PDT (where the PDT laser covered the fovea). At all time points, the group with foveal-sparing PDT had significantly better VA compared with the foveal-involved group. The final LogMAR VA for the foveal-sparing PDT group was 0.26 compared with 1.00 for the foveal-involved PDT group (P=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥ 20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P=0.006). For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared with those with foveal-involved PDT. Foveal-sparing PDT may be of value for treatment of myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.

Comparison of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation

Objective To compare the effect of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation.Methods 42 eyes of 35 patients with cataract were divided into two groups randomly:group A,received temporal clear corneal incision(18 eyes of 18 cases),group B,received superior(11:00) clear corneal incision (24 eyes of 17 cases).Patients were examined preoperatively and 1 day,1 week,1 month and 3 months postoperatively by using slit-lamp microscope and corneal topography,and visual acuity also was examined.Results The visual acuity in group A was better than that in group B at 1 day postoperatively.But at 1 week,1 month,2 months postoperatively,the difference of visual acuity between two groups was not statistically significant.At 1 day preoperatively and at 1 day,1 week,1 month,2 months postoperatively,the mean astigmatism were (0.543 ± 0.264) D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690±0.283)D,(0.657 ±0.233)D and (0.51 ±0.27)D in group A respectively.And at the same time points,the mean astigmatism in group B were (0.568 ± 0.243)D,(1.092 ± 0.357) D,(0.987 ± 0.257) D,(0.934 ± 0.312) D and (0.866 ± 0.371) D respectively.The mean astigmatism in group A was lower than in group B,and the difference was statistically significant (P ＜0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision group.Conclusion The visual acuity in the temporal incision group was better than that in superior incision group at 1 day postoperatively.And the mean astigmatism changes in group A was lower than in group B. Key words: Phacoemulsification, cataract; Incision, corneal; Refraction, corneal

Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials

To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD). Prospective cohort study within a randomized clinical trial. Participants in the Comparison of Age-related Macular Degeneration Treatments Trials. Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes. Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA. Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features. Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD. Proprietary or commercial disclosure may be found after the references.

Branch retinal vein occlusion-associated subretinal hemorrhage

To study the pathomorphology of subretinal hemorrhage (SRH) seen in eyes with branch retinal vein occlusion (BRVO) and its association with visual prognosis. We retrospectively reviewed 42 consecutive patients (42 eyes) with BRVO that affected the fovea. Retinal structural changes were examined by spectral domain optical coherence tomography (SD-OCT). On SD-OCT sections, serous retinal detachment was seen at the fovea in 35 eyes, 18 of which accompanied foveal SRH. While initial detection of foveal SRH had no correlation with initial visual acuity (VA), it was correlated with poorer final VA (r = 0.361, P = 0.019). Our patients were classified into two groups by the initial detection of foveal SRH, and initial VA was not different between these two groups. At the final examination, damaged lengths in the foveal photoreceptor layer were significantly longer in the SRH-positive group than those in the SRH-negative group (P = 0.004), and final VA in the SRH-positive group was significantly worse than that in the SRH-negative group (P = 0.019). Foveal SRH is not an uncommon feature in BRVO and may cause subsequent damage to the foveal photoreceptor layer, resulting in poor visual function.

Comparison of Visual Acuity Charts in Young Adults and Patients with Diabetic Retinopathy

To compare visual acuity (VA) assessed in healthy eyes and eyes with diabetic retinopathy (DR) using three different logMAR charts: the Sloan letter European-wide chart, the tumbling E chart, and the Landolt C chart. Measurements on one eye of 40 volunteers (aged 29 ± 4 years) without visual impairment and 31 DR patients (aged 70 ± 9 years) with mild/moderate visual impairment were included. Visual acuity was assessed, with habitual refractive correction, using each of the three charts. Bland-Altman charts were constructed, and 95% limits of agreement were calculated to measure agreement. Mean VA in the group of young adults was -0.05 ± 0.10 (Sloan letter), -0.02 ± 0.13 (tumbling E), and 0.00 ± 0.12 (Landolt C) logMAR. Average VA estimates differed to a statistically significant extent between all charts. Mean VA in the DR group was 0.46 ± 0.25 (Sloan letter), 0.48 ± 0.26 (tumbling E), and 0.59 ± 0.28 (Landolt C). A statistically significant difference was observed for average Sloan letter versus Landolt C (p < 0.001) and tumbling E versus Landolt C (p < 0.001) acuities. Moreover, in healthy eyes, a moderate correlation (r = -0.38, p = 0.015) was found between the discrepancy in Sloan letter and Landolt C acuity and the mean VA estimate. The 95% limits of agreement were wide (more than approximately 0.2 logMAR for each comparison) and wider in the DR group chart comparisons than in healthy eyes. Landolt C charts resulted in worse VA estimates compared with letter and tumbling E charts in both young adults and visually impaired subjects with DR. These differences seem more pronounced in DR patients who exhibit worse VAs. The specific study population must be considered in comparing outcomes from different clinical practices.

Outcomes of surgery for retinal detachment in eyes having choroidal coloboma

PurposeTo study the anatomical and visual outcomes of surgery for retinal detachment (RD) in patients with choroidal coloboma. MethodsForty-six eyes of 46 patients underwent surgery for RD with choroidal coloboma. Patients were divided into three groups, according to the extent of choroidal coloboma: Coloboma not involving the disc and macula (Group A), coloboma involving the disc (Group B), and coloboma involving the disc and macula (Group C). Thirty-eight eyes underwent pars plana vitrectomy with silicone oil (SO) (Group 1) and eight eyes underwent scleral buckling surgery (Group 2). SO removal was carried out in 18 eyes at final follow up. ResultsAfter a mean follow-up of 16.2 months, 40 eyes (86.9%) had an attached retina and the best corrected visual acuity (VA) improved from a preoperative median of 20/800 to 20/250 (p = 0.001). Thirty-four eyes (74%) recovered ≥20/400 VA. The final median VA in Group A (20/200) was better than in Group B (20/800) and Group C (light perception and hand movement) which was statistically significant (p = 0.01). Redetachment occurred in 10 eyes (21.8%), of which 7 eyes (18.91%) belonged to Group 1 and 3 eyes (37.5%) belonged to Group 2, and all of these eyes underwent resurgery. Of these 10 eyes, 9 had an attached retina at final follow up. ConclusionPostoperative visual recovery in RD with choroidal coloboma is dependent upon the involvement of the disc and macula with the colobomatous area. Resurgery following redetachment improves the final anatomical outcomes.

Profile of sight-threatening infectious keratitis: a prospective study

To prospectively study patients presenting with sight-threatening corneal ulcers with a view to identify the predisposing factors, causative organisms, clinical signs and treatment outcomes. Prospectively, over 3-year period, all cases with serious infective keratitis presenting to Queens Medical Hospital in Nottingham, UK, were recruited. Detailed information on the aetiology, culture results, signs & symptoms, the treatment given and the patient's response was collected and statistically analysed. One hundred and forty-three eyes of 129 patients were enrolled. Thirty-one patients were managed as out-patients, and 98 were treated as in-patients. The mean duration of admission was 9 ± 13 days but was significantly higher in older patients and in Acanthamoeba keratitis cases. The important risk factors were ocular surface disease (32%), contact lens wear (26%) and previous ocular surgery (20%). Old age, deep infiltration, steroid use and poor initial vision were risk factors for prolonged course of treatment in bacterial keratitis. Corneal scrapings were done in 89% of the cases, but positive results were obtained only in 41.7%. Staphylococcus aureus was the most common isolated bacteria (18.8%). Acanthamoeba and Pseudomonas aeruginosa were the second and third common causative organisms (16.6% and 15%, respectively). Overall, 8.3% needed corneal grafting, which survived in 83.3% and eradicated infection in 100%. Microbial keratitis is an important cause of ocular morbidity. Previous ocular disease is an important predisposing factor. Old age, steroid use and poor presenting visual acuity are important prognostic indicators. Corneal grafting is an effective option for managing recalcitrant corneal infections.

Clinical observation of the AcrySof Toric intraocular lens correcting corneal astignatism

Objective To observe the efficacy and rotational stability of AcrySof Toric lens(IOL)implantation; To explore ways to reduce postoperative astigmatism axis deviation,Methods This prospective observational study included 120 eyes from 120 consecutive patients,who were randomly divided into two groups.60 cases in group A were implanted with the AcrySof Toric IOL,another 60 cases(group B)were implanted with the monofocal classic IOL,the AcrySof SA60AT.Outcomes of uncorrected visual acuity (UCVA),total astigmatism and[OL rotation after 3 months and 6 months follow-up were evaluated respectively.Visual acuity of patients in the two groups were analyzed and compared.The lens stability in the capsular bag and ways to reduce postoperative astigmatism axis deviation were assessed.Results All the patients had improved visual acuity after surgery.The UCVA after 3 months follow-up was 0.78 ± 0.15 in group A,and 0.53 ± 0.11 in group B.The UCVA after 6 months follow-up was 0.73 ± 0.16 in group A,and 0.51±0.12 in group B.There were significant differences between the two groups among the follow-up times(P ＜ 0.05).The visual acuity of group A patients improved was better than that of group B.The total astigmatism of group A reduced from 2.07D to 0.67D after 6 months follow-up.There was no significant improvement compared with preoperative in group B.The mean rotation of IOL in group A was(3.66 ± 2.81)°after 3 months follow-up,and(3.65 ± 2.74)°alter 6 months follow-up.There was no significant difference between the two foLlow-up times(P ＞ 0.05).Conclusion The AcrySof of Toric IOL can significantly reduce postoperative astigmatism.It can make cataract patients with corneal regular astigmatism get a good visual effects.It has good rotational stability.The reasons for axial astigmatism deviation were closely related to the manipulation of the surgeon. Key words: AcrySof Tofic IOL; Astigmatism,corneal,regular; Rotation; Astigmatism axis

Long-Term Effect of Surface Light Scattering and Glistenings of Intraocular Lenses on Visual Function

To investigate the long-term effect of surface light scattering and glistenings of various intraocular lenses (IOLs) on visual function and optical aberrations after cataract surgery. Case-control study. Thirty-five eyes that underwent implantation of a hydrophobic acrylic, silicone, or polymethyl methacrylate (PMMA) IOL more than 10 years ago were recruited. The scattering light intensity of the surface and internal matrix of the optic was measured using Scheimpflug photography. Visual acuity (VA) was measured using VA charts, and contrast VA and that with glare (glare VA) were examined using a contrast sensitivity tester. Ocular higher-order aberrations (HOAs) were measured using a Hartmann-Shack aberrometer. Mean scattering light intensity of the surface and internal matrix of the optic was significantly higher in the acrylic group than in the silicone and PMMA groups (P < .0001). Mean uncorrected VA, photopic and mesopic contrast VA and glare VA, and HOAs did not differ significantly among groups, although mean corrected VA in the acrylic group was significantly better than that in the other groups (P = .0023). Scattering light intensity of the surface and internal matrix did not correlate with VA, contrast VA, or glare VA, and did not correlate with ocular and internal optic HOAs in the acrylic group. At more than 10 years postoperatively, visual function, including contrast sensitivity, and ocular HOAs were comparable among eyes that received acrylic, silicone, and PMMA IOLs. Surface scattering and glistenings with the acrylic IOLs were not significantly correlated with visual function and optical aberrations.