Best-corrected Distance Visual Acuity Research Articles

Impact of vision correction on the visual impairment status and quality of life score in patients with type II diabetes mellitus

Background: Visual impairment (VI) in patients with diabetes mellitus (DM) worsens as the disease progresses. Therefore, quality of life (QOL) may also be affected. Furthermore, in the absence of macular involvement, some patients may benefit from visual intervention. However, not many Malaysians with known DM had their eyes screened or used correctable spectacles. Consequently, the QOL and VI status of patients with DM in Malaysia remain unclear. This study was aimed at determining the impact of optometric intervention on the QOL and VI status of adults with type II DM.
 Methods: This was a quasi-self-controlled, experimental study involving adults with known type II DM. We conducted face-to-face interviews using the low vision quality-of-life questionnaire (LVQOL). The habitual visual acuity (VA) of all participants was recorded. All participants underwent fundus photography to grade diabetic retinopathy (DR) in both eyes. Correctable VA was determined following subjective refraction when the best-corrected distance visual acuity (BCDVA) was 6 /9 and better. After a 3-week adaptation to the prescribed refractive error correction, LVQOL was repeated via a phone interview.
 Results: A total of 47 participants with type II DM, including 16 (34%) men and 31 (66%) women, with a mean (standard deviation [SD]) age of 49.0 (7.9) years were recruited. The age range was 32 – 59 years, and the baseline mean (SD) habitual binocular VA was 0.52 (0.31) decimal. Only 15% (n = 7 patients) of the participants had their vision tested and wore glasses; however, some were uncomfortable with the current corrections. All patients had undercorrected or uncorrected refractive errors, namely, hyperopic astigmatism (47%), myopic astigmatism (38%), hyperopia (6%), myopia (4%), and antimetropia (4%). Among the 47 participants, 89% (n = 42) had uncorrected presbyopia. The mean (SD) LVQOL score at baseline was 91.9 (17.3), which improved significantly with visual intervention to 122.8 (3.2) (P < 0.05). Refractive error corrections significantly improved the VI status (P < 0.05), as all participants achieved a BCDVA of 6 / 9 and better.
 Conclusions: Our findings indicate that optometric intervention is effective in improving the LVQOL and VI status of adults with type II DM. Further clinical optometric studies on type II DM with DR with a longer follow-up should be carried out to understand the clinical characteristics of this cohort and the impact of meticulous refractions on QOL in providing better services in the future.

Visual pathway function in untreated individuals with major depression.

Major depression (MD) is the one of the most debilitating diseases, affecting millions of people all around the world. To establish visual pathway function in untreated individuals with MD. In 29 untreated, newly diagnosed, ophthalmologically asymptomatic individuals (58 eyes) with MD (mean age: 47.3 years) and in 29 (58 eyes) of age-, sexand refractive error-matched healthy controls (mean age: 46.8 years), the following examinations were performed: 1) best corrected distance visual acuity (BCDVA); 2) intraocular pressure (IOP); 3) and 4) biomicroscopy of anterior and posterior segment of eye; 5) macular structure (SD-OCT-Zeiss); and 6) pattern visual evoked potentials (PVEPs) measurements according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standard (ISCEV-standard PVEPs). An analysis of correlation between the parameters of PVEPs and the depression severity (Hamilton Depression Rating Scale (HAMD)) was performed. To estimate the diagnostic power of PVEPs test, a receiver operating characteristics (ROC) curve was used. Data were analyzed with the significance level of p < 0.05. In the study group and in healthy control, the clinical results and macular structure were normal and not different. In the MD group, in PVEPs test (check size: 1°4'and 0°16'), a significant decrease of amplitudes of P100 (AP100), associated with prolonged P100 peak time (PTP100; check size: 0°16', p < 0.004) were detected. The most frequent abnormality in PVEPs examination in the MD group was AP100 reduction (in 69% of individuals) detected using stimulation check size 0°16'. The statistically significant positive correlation between PTP100 (check size: 0°16') and HAMD score was found in severe MD (p = 0.03). The analysis of ROC curve revealed the highest sensitivity of 0.759 and specificity of 1.0 for AP100 (0°16'). The area under the curve (AUC) was 0.841 (p < 0.001). In individuals with newly diagnosed, ophthalmologically asymptomatic and untreated MD, a dysfunction of visual pathway is present without other signs of ocular pathology. The visual pathway dysfunction measured with ISCEV PVEPs has a potential value to be an objective biomarker of MD.

Optical Coherence Tomography Angiography Parameters of the Retina in SARS-CoV-2 Recovered Subjects.

This study aims to evaluate retinochoroidal optical coherence tomography angiography (OCTA) parameters in patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This studywas an observational study that included 80 subjects being discharged after having negative reports on the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 to evaluate OCTA parameters of the retina. The subjects underwent an ophthalmic evaluation that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), color vision (CV), contrast sensitivity (CS), and optical coherence tomography (OCT) parameters. OCTA was done for all patients and was evaluated for foveal avascular zone (FAZ) area, perimeter, and circularity index, and vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), outer retina chorio-capillaries (ORCC), chorio-capillaries (CC), and choroid (C) using 3 x 3 mm scans. The OCTA parameters were compared with normative data of the Indian population for various parameters in question. The subjects included 54/80 (67.5%) males and 26/80 (32.5%) females having a mean age of 52.40 ± 15.71 (18-60) years. The systemic evaluation revealed 38.75% of subjects had hypertension, 30% had diabetes, 20% had kidney disease, 5% had tuberculosis, and 3.75% had coronary artery disease.The mean distance BCVA was logarithm of the minimum angle of resolution (LogMAR) (1.17 ± 0.22), mean IOP was 17.0 ± 4.0 mmHg, mean CS was 2.13 ± 0.36, 50.62% of subjects had normal CV on Farnsworth test while 47% had tritanopia, and none of the subjects had red-green CV defect on Ishihara plates. The OCT scan was normal in 90% of eyes while the posterior vitreous detachment was seen in 4% of eyes, broad vitreomacular adhesion in 2.5% of eyes, and the globally adherent epiretinal membrane was seen in 2.5% of eyes. The mean central macular thickness (CMT) measured 245.14 ± 28.41 micrometers. The mean FAZ area measured 0.37 ± 0.15 mm2, the perimeter was 3.28 ± 1.08 mm, and the circularity index measured 0.41 ± 0.10. The average VD in SCP measured 16.06 ± 12.29, in DCPmeasured 9.11 ± 8.75, in ORmeasured 6.38 ± 7.37, in ORCC measured 42.53 ± 12.46, in CCmeasured 25.83 ± 16.31, and in C measured 25.52 ± 17.49. The VD in coronavirus disease 2019 (COVID-19) subjects was significantly lesser than that in the healthy Indian population in all layers except ORCC. The SARS-CoV-2 recovered subjects have a reduced VD in retinochoroidal layersfrom COVID-19, an underlying systemic disease, or both. The CS values fall within normal limits. Several subjects show tritanopia on the Farnsworth test but no red-green CV defect on Ishihara plates.

Three-Month Safety and Efficacy Outcomes for the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT™).

The smaller-incision new-generation implantable miniature telescope (SING IMT™) is the second generation of the IMT™, a telescope prosthesis that is indicated for monocular implantation in patients with stable vision impairment caused by bilateral central scotomas associated with end-stage Age-related macular degeneration (AMD). This non-comparative retrospective study is the first and largest single-surgeon case series to evaluate the short-term (3 months) safety and efficacy of the device in patients with disciform scars or geographic atrophy at baseline. The main outcome measures included best-corrected distance and near visual acuity (CDVA and CDNVA, respectively), endothelial cell density (ECD) loss, and the incidence of complications. At postoperative month 3 in the study eyes, mean CDVA and CDNVA improved by +14.9 ± 7.1 letters and +7.7 ± 3.2 Jaeger levels, respectively. Importantly, 70.83% of patients gained ≥ 2 lines, 58.33% ≥ 3 lines, and 25.00% ≥ 4 lines of CDVA. From baseline, ECD loss in the study eyes was 10.4 ± 13.3% at 3 months, however, ECD was comparable between the study and fellow eyes at all time points. The most common complication was corneal edema. In all, these short-term outcomes suggest that the SING IMT™ delivers lower ECD loss than the first-generation IMT ™, but similar visual outcomes and safety.

Measuring Retinal Thickness and Visual Acuity in Eyes with Different Types of Astigmatism in a Cohort of Hong Kong Chinese Adults.

The purpose of this study was to investigate optical coherence tomography (OCT)-measured retinal thickness (RT) and best-corrected distance visual acuity (BCDVA) in eyes with different types of astigmatism. This is a case-control study of 101 participants stratified into With-The-Rule (WTR; n = 41), Against-The-Rule (ATR; n = 25), and control (n = 35) groups by noncycloplegic subjective refraction. Inclusion criteria were ages between 18 and 45 years, spherical-equivalent (SE) refraction ≥-10.00 diopters (D), negative cylindrical power (CYL) ≤-0.75D with axes of 0 to 30 degrees/150 to 180 degrees for WTR and 60 to 120 degrees for ATR, or CYL ≥-0.25D for controls. Participants suffering from ocular diseases related to retinal defects, having a history of ocular surgery, with BCDVA >0.10 LogMAR, or poor OCT imaging quality were excluded. Fovea-centered scans were performed using spectral-domain OCT (SD-OCT), and RT automatically measured by the inbuilt software. Only right eyes were analyzed. Groups were matched for age, gender, SE, axial length, and corneal curvature. One-way ANOVA showed a significant difference in both BCDVA (P = 0.039) and macular RT (P = 0.028) among the three groups. Bonferroni's post hoc test revealed statistically significant between-group differences in BCDVA (WTR vs. controls, P = 0.041), as well as in RT at inner-nasal (WTR vs. ATR, P = 0.034) and outer-temporal subfields (WTR vs. controls, P = 0.042). BCDVA was positively associated with macular RT (r = 0.206, P = 0.041) after adjusting for age, gender, and axial length. Greater RT and poorer BCDVA were found in eyes with WTR astigmatism. Our findings suggest that the effect of astigmatism on retinal thickness and BCDVA may vary depending on not only magnitude, but also axis of astigmatism.

Correlation between recipient age and visual acuity after Descemet’s membrane endothelial keratoplasty in Fuchs endothelial dystrophy

Abstract Objectives: To analyze the correlation between the recipient’s age and best corrected distance visual acuity (BCDVA) after Descemet’s membrane endothelial keratoplasty (DMEK). Materials and Methods: Design: Retrospective study. Setting: Institutional, tertiary care eye hospital. Study Population: All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuchs Endothelial Dystrophy, using a standardized protocol between August 2016 and July 2021, were included. Previous glaucoma surgery, aphakia, or complicated pseudophakia were excluded. Main Outcome Measures: Primary outcomes: Recipient’s age versus BCDVA. Secondary outcomes: Age versus uncorrected distance visual acuity (UCDVA), graft detachment (GD) versus rebubbling rates, and versus percentage endothelial cell loss (ECL) at 6 months. Data were analyzed using Pearson’s correlation analysis. Results: 104 eyes of 72 patients were included. The average age in this study was 71.13 ± 10.41 years (44–88 years). There was a significant and positive correlation between age versus BCDVA and UCDVA. However, there was no correlation between age and GD, rebubbling, and percentage of ECL at 6 months. Conclusions: Uncorrected and best-corrected distance visual acuities are better at younger ages after DMEK in Fuchs endothelial keratoplasty. Age was positively correlated with the best-corrected distance visual acuity after DMEK for Fuchs endothelial dystrophy when performed with the same technique.

Visual acuity changes associated with foveal ischemia detected by optical coherence tomography angiography in type II diabetic patients without diabetic retinopathy

Purpose Diabetic macular ischemia is a vision-threatening complication of diabetes mellitus. Early detection of ischemic changes can preserve the vision. The aim of the study was to detect the early macular ischemic changes in patients with no diabetic retinopathy (NDR), using optical coherence tomography angiography, and to correlate these changes with the best-corrected distance visual acuity (BCDVA). Patients and methods A case–control study was conducted to compare 30 diabetic eyes with NDR with 30 healthy control eyes. The glycemic control was determined by glycosylated hemoglobin level less than 6.5%. The diabetic group was further subdivided into those with normal BCDVA and those with decreased BCDVA. The outcome measures included BCDVA and optical coherence tomography angiography features. Results Compared with controls, the diabetics with decreased BCDVA were found to have significantly thinner central macular thickness (P<0.001), larger foveal avascular zone (FAZ) area (P<0.001) in the superficial and deep capillary plexuses (sFAZ and dFAZ), and lower vascular density (VD) (P<0.05) regarding the central density and the superior, inferior, and temporal quadrants. In addition, they showed significantly larger associated capillary dropout areas in the superficial and deep capillary plexuses and significantly lower foveal and parafoveal VD compared with diabetics with normal BCDVA (P<0.001 and 0.05, respectively). Diabetics with normal BCDVA showed no significant difference from the controls regarding the dFAZ and VD but showed significantly lower sFAZ area (P<0.05). Conclusion Diabetic ischemic microvascular changes including decreased VD and enlarged FAZ areas precede clinically visible retinopathy and might be correlated with decreased visual acuity in patients with NDR.

Severe chemical eye injuries - clinical outcomes and associated socio-economic factors.

To describe clinical outcomes, management, and socio-economic impact of severe acute chemical eye injuries in a tertiary hospital. 37 patients required emergency admission to the Royal Victoria Infirmary eye ward between April 2013 and September 2015. Demographics, best corrected distance visual acuity (BCDVA), causative agent, degree of limbal stem cell deficiency (LSCD), management and socio-economic data were evaluated. Mean age on admission was 34.5 years (SD 16.3; range 16-82); 30 males (81.1%); 22 bilateral (59.5%). Causative agent: alkali in 30 cases (81.1%); acid in three cases (8.1%); and unknown in four cases (10.8%). Fifteen cases (40.5%) were assaults, 12 (32.5%) work-related accidents, nine (24.3%) domestic accidents and one (2.7%) undetermined. Eleven patients (29.7%) were unemployed, 18 (48.6%) were labourers, three (8.1%) were students, three (8.1%) were retired and two (5.4%) were professionals. Mean admission time was five days (SD 3.2; range 1-12). Mean follow-up time was 170.5 days (range 1-946). Mean cost of admission was £2478 (range £274-5785). Five patients (13%; seven eyes) developed total or partial limbal stem cell deficiency, all being assaults. Main causative agent in our study was alkali, with young men in the working age being most frequently involved. Many patients required prolonged hospital admission and costly follow-up. The majority of cases were assaults, mostly occurring in unemployed patients. All the limbal stem cell deficiency cases were due to assaults. We believe that socio-economic factors play an important role in the cause, severity and cost of chemical eye injuries. Acute chemical eye injuries have a significant and extensive impact on patients' visual function outcomes and vision-related quality of life, with consequent enormous burden to affected individuals, their families and society. We believe that by understanding the socio-economic environment, we may not only be able to enforce safety measures to tackle the increasing rate of severe chemical eye injuries in our community, but also to develop collaborative programmes with the community, educating the population on the seriousness of chemical eye injuries, and with the local authorities, trying to understand the clustering of assaults in areas and tackling the associated socio-economic risk factors, such as unemployment. Given the increasing rate of assaults using chemicals in recent times, it is also important to assess availability of adequate victim support programmes and develop good interaction with relevant local, regional and national authorities to ensure all aspects of community security service are in place to be able to address any potential deficiencies in line with police and home office guidelines. Keeping in mind that the best action plan is always prevention. However, when an ocular injury does occur it is evident that significant morbidity and visual sequelae can result and affect the socio-economic status of the victims despite our best current medical and surgical care.

Myopia Progression Among School-Aged Children in the COVID-19 Distance-Learning Era.

To investigate the effect of online learning and other environmental factors on myopia progression during the Coronavirus pandemic (COVID-19). A retrospective cohort study from 2018 to 2021. Data from children aged 6-14 were gathered during three visits: pre-pandemic, at the beginning, and during the pandemic. Demographics (hours spent on screens for educational, recreational purposes, outdoors, and type of screen), best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), and cycloplegic refraction were gathered. Of 150 patients, 70 [47%] were boys. The mean age was 11 (2.4) years. Participants mainly used mobile phones (62%) and had insufficient outdoor play (88%). Of the 300 eyes, 221 (74%) showed myopia progression. A significant difference in spherical equivalent (SE) was found between pre-pandemic and post-pandemic periods (-0.29 (0.23) D vs -0.40 (0.11) D; p =0.023). Additionally, UCDVA showed a difference between the initial and 1st follow-up visits (0.57 (0.37) vs 0.64 (0.36), p =0.001), and the first and 2nd follow-up visits (0.64 (0.36) vs 0.70 (0.36), p =0.001). Significant hazard ratio for change in SE in patients with higher age (>9 years), (HR [95% confidence interval (CI)], 0.71 [0.51-0.84]), greater recreational screen usage (HR [95% CI], 1.26 [1.15-1.66]), and insufficient outdoor time (HR [95% CI], 1.45 [1.35-1.67]). Myopia progression was accelerated during the COVID-19 pandemic. Younger age, prolonged screen use, and insufficient outdoor time contributed to increased myopia progression. However, the type of device used had no significant effect.

Therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia.

To explore the therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia. A total of 340 patients with juvenile myopia (340 eyes) treated from 2018 to December 2020 were divided into the control group (170 cases with 170 eyes, orthokeratology lens) and observation group (170 cases with 170 eyes, orthokeratology lens combined with 0.01% atropine eye drops). The best-corrected distance visual acuity, best-corrected near visual acuity, diopter, axial length, amplitude of accommodation, bright pupil diameter, dark pupil diameter, tear-film lipid layer thickness, and tear break-up time were measured before treatment and after 1 year of treatment. The incidence of adverse reactions was observed. Compared with the values before treatment, the spherical equivalent degree was significantly improved by 0.22 (0.06, 0.55) D and 0.40 (0.15, 0.72) D in the observation and control groups after the treatment, respectively (p<0.01). After the treatment, the axial length was significantly increased by (0.15 ± 0.12) mm and (0.24 ± 0.11) mm in the observation and control groups, respectively, (p<0.01). After the treatment, the amplitude of accommodation significantly declined in the observation group and was lower than that in the control group, whereas both bright and dark pupil diameters significantly increase and were larger than those in the control group (p<0.01). After the treatment, the tear-film lipid layer thickness and tear break-up time significantly declined in the two groups (p<0.01). Orthokeratology lens combined with 0.01% atropine eye drops can synergistically enhance the control effect on juvenile myopia with high safety.

Distance and intermediate visual acuity after a new generation monofocal intraocular lens compared with the standard monofocal intraocular lens implantation

Purpose The aim of this study was to determine the effectiveness of a novel innovative monofocal intraocular lens (Tecnis Eyhance ICB00) compared with the standard monofocal lens (Tecnis-1-piece ZCB00) in terms of contrast sensitivity, postoperative refraction, intermediate visual acuity (VA), and uncorrected and best-corrected distance VA. Patients and methods This prospective comparative interventional clinical study was conducted from January 2021 to November 2021. It included 40 eyes of 20 patients who were divided into two groups, with 10 patients each. Candidates for bilateral cataract extraction by phacoemulsification were included in this study and underwent thorough preoperative examination and postoperative evaluation at 3 months after the second eye operation. The outcome measures included intermediate and distance VA, near add, contrast sensitivity, and incidence of photic phenomena, which was evaluated using a printed questionnaire. The binocular defocus curves were analyzed. Results The study included 20 patients (seven males and 13 females). Binocular and monocular uncorrected and corrected distance VAs were statistically similar in both groups. The Eyhance group demonstrated significantly higher binocular uncorrected and corrected intermediate VA compared with the TECNIS 1-piece group (P<0.001). Defocus and contrast sensitivity values were not significantly different between the two groups. Conclusion Patients who were bilaterally implanted with the new monofocal intraocular lenses achieved significantly higher intermediate VA outcomes without affection of distance VA, with similar mean contrast sensitivity values and low incidence of photic phenomena like halo and glare compared with the standard monofocal lens.

Remote vision testing of central retinal acuity and comparison with clinic-based Snellen acuity testing in patients followed for retinal conditions.

The unmet need for remote monitoring of visual function with home-based, patient-centric technologies became increasingly palpable during the COVID-19 pandemic. Many patients with chronic eye conditions lack access to office-based examinations. Here, we evaluate the efficacy of the Accustat® test, a virtual application for measuring near visual acuity on any portable electronic device via telehealth. Thirty-three adult subjects from the telehealth remote monitoring service of a retina practice performed the Accustat® acuity testing at home. All patients underwent in-office general eye examination with additional fundoscopic examination and optical coherence tomography retina imaging. Best corrected visual acuity assessment using a Snellen chart was compared with remote visual acuity assessment with the Accustat® test. Visual acuity was analyzed and compared between the best-corrected near visual acuity potential achieved on the Accustat® and in-office distance best-corrected Snellen visual acuity. The mean logarithm of the minimum angle of resolution (logMAR) visual acuities of all eyes tested using the Accustat test was 0.19 ± 024 and for the office Snellen test 0.21 ± 0.21. A linear regression model with 95% confidence intervals reveals that there is a strong linear relationship between Accustat logMAR and office Snellen logMAR. Bland-Altman analysis demonstrated 95.2% significant agreement between Accustat and Office Snellen's best corrected visual acuity. Intraclass correlation coefficient (ICC = 0.94) demonstrated a strong positive correlation between at home versus office visual acuity. There was a high correlation between the visual acuity measured with the Accustat near vision digital self-test and the office Snellen acuity test, suggesting the potential utility of scalable remote monitoring of central retinal function via telehealth.

Short-term impact of glycaemic control and intravitreal ranibizumab treatment on serum cytokine levels and diabetic macular edema in patients with unregulated blood glucose

Objective: To evaluate the short-term effect of glycaemic control and intravitreal ranibizumab treatment on diabetic macular edema (DME) and to assess the correlation between HbA1c and certain serum cytokines. Design: A prospective study of 43 participants with HbA1c levels exceeding 53 mmol/mol (7%) and with DME, as detected by spectral domain optical coherence tomography (SDOCT). Subjects: Participants were grouped according to their initial best corrected distance visual acuity (BCVA). Group 1 was treated with three monthly doses of intravitreal ranibizumab (0.5 mg) injections, and Group 2 was followed without treatment. Methods: Serum cytokine levels, including interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1(MCP-1), and vascular endothelial growth factor (VEGF) were analysed at the beginning and at the end of 3 months, using enzyme-linked immunosorbent assays (ELISA). Results: A significant decrease in macular thicknesses (except for one quadrant) was observed in Group. Changes in serum cytokine levels were not correlated with HbA1c decrease. Serum VEGF level was significantly increased in Group 1, despite the intravitreal treatment. Conclusion: Short-term glycaemic control alone had limited value in the treatment of DME. The therapeutic effect of intravitreal treatment on DME supports the role of the local cytokine milieu in the pathophysiology.

A 10-year review of the visual outcomes of early versus late pars plana vitrectomy in eyes with dropped lens fragment or nucleus during phacoemulsification

Background: Pars plana vitrectomy (PPV) is a routine surgical option for the removal of dropped lens fragment or nucleus in the vitreous cavity due to complicated cataract surgery; however, its optimal timing is controversial. Therefore, we aimed to determine the visual outcomes of early versus late PPV in eyes with dropped lens fragment or nucleus due to complicated phacoemulsification cataract surgery.&#x0D; Methods: This descriptive-analytical retrospective study collected data of patients who underwent early (less than or equal to 1 week) versus late (&gt; 1 week) PPV for the management of dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery over a 10-year period at Imam Khomeini Tertiary Referral Hospital, Ahvaz, Iran. Demographic characteristics, the interval between complicated phacoemulsification and PPV, pre- and postoperative intraocular pressures, best-corrected distance visual acuity (BCDVA), and postoperative complications were extracted from each patient’s record.&#x0D; Results: Fifty-one eyes of 51 patients with a mean (standard deviation [SD]) age of 64.66 (6.54) years and a male-to-female ratio of 33 (64.7%) to 18 (35.3%) were included over 10 years. The mean (SD) BCDVA before PPV was 1.87 (0.53) logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.54 (0.46) logMAR at the final postoperative visit (P &lt; 0.001). The mean (SD) BCDVA was significantly better after early PPV than after late PPV (0.41 [0.30] versus 0.62 [0.52] logMAR; P &lt; 0.05). There was no significant difference in the final BCDVAs among the three methods of lens fragment removal (P &gt; 0.05). The rates of post-PPV complications were as follows: 29 (56.9%) eyes with corneal edema, 16 (31.4%) eyes with uveitis, 10 (19.6%) eyes with cystoid macular edema, 8 (15.7%) eyes with rhegmatogenous retinal detachment, and 8 (15.7%) eyes with other complications (optic nerve atrophy, choroidal neovascularization, vitreous hemorrhage, or epiretinal membrane formation). No significant differences were observed in the rates of complications according to the time interval between complicated phacoemulsification and PPV (all P &gt; 0.05). The frequency of corneal edema was significantly higher when removing lens fragments using the trans-limbal method than using the other methods (P &lt; 0.05), yet the rates of other complications were comparable among the three methods of lens fragment removal (all P &gt; 0.05).&#x0D; Conclusions: Early PPV and removal of a dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery are recommended to achieve better visual outcomes. Future studies with longer follow-up, greater sample sizes, and analysis of other parameters of visual function, such as contrast sensitivity, visual field, color vision, and stereopsis, could provide more conclusive results and help verify our preliminary findings.

Macular function in patients with medium myopia

PurposeThis work aims at assessing whether electrophysiological functional changes in the macular region appear in medium myopia, even in the presence of a normal macular OCT scan and how axial length correlates with macular OCT parameters in medium myopia.MethodsThe study included right eyes of 17 patients with myopia of medium degree (SE < − 6D to > − 3D). Control group consisted of 20 eyes of patients of age and sex that matched healthy controls with normal macular and optic nerve OCT results and normal axial length. Full ophthalmic examination (the distance best-corrected visual acuity, intraocular pressure, refractive error, the anterior and posterior segment of the eye in a slit lamp, the axial length of the eyeball) with OCT of the macular and optic disk and the PERG test were performed in the study and control groups. Only the patients with normal ophthalmic and OCT examination results were qualified. The interview covering questions on risk factors of myopia onset and progression such as prematurity, family history of myopia was carried out in both groups. In myopic group, the question relating to time of near work was also asked. Study and control groups were tested with the use of Shapiro–Wilk, Mann–Whitney, Student’s t test, Pearson and Spearman's rank correlation tests.ResultsAL was significantly longer in myopia group (p < 0.01), and SE value was lower (p < 0.01). Longer implicit time of P50 was found in the study group, but amplitudes of P50 and N95 waves were not significantly reduced (p < 0.05). AL showed correlations with P50 implicit time (p < 0.05) and with reduction in retinal fiber nerve layer and ganglion cells and inner plexus layer (p < 0.05).ConclusionPatients with myopia of medium degree have a dysfunction of retinal cone system of the macular region even when OCT scans show no abnormalities. Elongation of AL correlates with reduction in retinal fiber nerve layer and ganglion cells and inner plexus layer. Longitudinal follow-up studies may answer the question whether this increase in implicit time may be indicative of a faster myopia progression or of myopic retinal pathology, i.e., whether it may help to determine which patient would benefit from earlier or more intensive management of myopia progression.

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling.

The effectiveness of internal limiting membrane (ILM) peeling in the surgical treatment of tractional diabetic macular edema (DME), although widely examined, remains controversial. This study aimed to assess the efficacy of pars plana vitrectomy (PPV) in the management of tractional DME and to highlight any benefits of additional ILM peeling. This was an open-label, prospective, comparative, and interventional study that enrolled 50 eyes with tractional DME that underwent PPV and allocated each to one of two groups: group A consisted of 25 eyes that had no ILM peeling and group B consisted of 25 eyes that underwent ILM peeling. Postoperative assessments of best-corrected distance visual acuity (BCDVA) in the logarithm of minimal angle of resolution (logMAR) notation and central macular thickness (CMT) were performed at 1, 3, and 6 months postoperatively. At baseline, the two groups were comparable in terms of sex ratios, phakic status, insulin use, coexistence of hypertension, and mean (standard deviation [SD]) age, BCDVA, CMT, duration of diabetes mellitus, and glycosylated hemoglobin (HbA1c) levels. In group A, the mean (SD) BCDVA improved significantly from 0.89 (0.12) logMAR preoperatively to 0.64 (0.24) logMAR (P < 0.001), and the mean (SD) CMT declined significantly from 471.28 (80.83) µm to 228.20 (26.45) µm (P < 0.001), at the 6-month postoperative assessment. Likewise, in group B, the mean (SD) BCDVA improved significantly from 0.83 (0.10) logMAR preoperatively to 0.58 (0.24) logMAR (P < 0.001), and the mean (SD) CMT decreased significantly from 496.84 (89.82) µm to 226.20 (18.04) µm (P < 0.001), after 6 months. There were no significant differences between groups A and B in the changes in BCDVA (Delta BCDVA) or CMT (Delta CMT) at 1, 3, and 6 months postoperatively with respect to the baseline values (all P > 0.05). Postoperative complications were comparable between the two groups. A significant negative correlation was detected between the preoperative HbA1c level and BCDVA improvement in all participants (r = - 0.82; P < 0.001). PPV is an effective treatment for tractional DME. Additional ILM peeling was not significantly associated with functional and anatomical benefits over a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in patients with diabetes. Further long-term studies are required to verify our findings.

Absorbable suture for band tightening of scleral buckling in pseudophakic rhegmatogenous retinal detachment: a modified surgical technique and a 6-month follow-up.

Rhegmatogenous retinal detachment (RRD) is a separation of the neurosensory retina from the retinal pigment epithelium as a result of liquid vitreous passing through a retinal break. Scleral buckling surgery (SB) is a conventional treatment for RRD. In SB, a silicon explant is used to indent the sclera, reduce vitreous traction, and close the retinal break, and an encircling band is used circumferentially, leading to myopia. This study aimed to evaluate the functional and biometric outcomes after SB with absorbable band-tightening sutures in patients with pseudophakic RRD. In this prospective interventional study, we included pseudophakic eyes with RRD treated surgically with SB and a temporary encircling band using a 6-0 absorbable Vicryl suture to tighten the band, instead of conventional permanent suture tightening. Anterior chamber depth (ACD), axial length (AL), intraocular pressure (IOP), spherical equivalent refractive error (SER), and best-corrected distance visual acuity (BCDVA) were measured preoperatively and at 1 day, 2 weeks, 3 months, and 6 months postoperatively. We included 30 eyes of 30 patients with a mean (standard deviation [SD]) age of 66.1 (10.5) years who underwent SB with an absorbable band-tightening suture for pseudophakic RRD. Significant increases in AL and ACD were observed at 2 weeks after surgery, with a significant decline in values thereafter; however, at the 6-month follow-up, the values were significantly higher than those at baseline (all P < 0.05). Based on the Vicryl tension and its hydrolysis, mean (SD) SER at 2 weeks postoperatively was significantly more myopic than at baseline (-5.8 [1.6] D versus +1.3 [1.8] D). However, the mean (SD) SER decreased significantly throughout the 6-month follow-up (all P < 0.05), and it reached -1.8 (0.9) D, which was comparable with the mean baseline SER (P = 0.140). The participants experienced significant improvement in BCDVA throughout the follow-up period (all P < 0.05). Using an absorbable suture to tighten the encircling band in patients with pseudophakic RRD can reduce postoperative myopia without adversely affecting the anatomical or functional outcomes. Future comparative studies with larger sample sizes and longer postoperative follow-up are needed to verify these findings.

Combined umbilical cord patching with amniotic membrane graft for corneal surface reconstruction.

Umbilical cord patch (UCP) grafts have been successfully used for glaucoma shunt tube coverage and conjunctival surface reconstruction. In recent years, the technique has emerged as a novel alternative for the reconstruction of corneal perforation and descemetocele. This study aimed to evaluate the effectiveness of combined UCP grafting and human amniotic membrane (HAM) transplantation for the management of corneal perforation or descemetocele. This prospective, non-comparative, interventional case series included nine eyes of nine patients with corneal descemetoceles and 28 eyes of 28 patients with corneal perforations, all in a clinically quiescent state. UCP grafting and HAM transplantation were combined to treat all patients. We re-examined the patients daily throughout the first week, weekly for 1 month, and then monthly for the first 6 months using slit-lamp examination and anterior segment optical coherence tomography. We included 37 eyes with descemetocele or corneal perforation in a clinically quiescent state. The mean (standard deviation) ages of patients with corneal descemetocele and corneal perforation were 56.3 (18.8) years and 54.3 (18.1) years, respectively. The male-to-female ratios in patients with corneal descemetocele and corneal perforation were 56% to 44% and 61% to 39%, respectively. Postoperative corneal thickness increased significantly in eyes with descemetocele compared to preoperative values (P < 0.001). Postoperative best-corrected distance visual acuity improved significantly compared to preoperative values in eyes with descemetocele or corneal perforation (both P < 0.001), with relief of accompanying ocular symptoms. We did not observe any recurrence or complications such as rejection, infection, suture-related problems, or severe inflammation and all had a formed anterior chamber up to the final follow-up visit. Combined UCP grafting and HAM transplantation could be a promising alternative treatment for corneal perforation or descemetocele in clinically quiescent eyes, providing satisfactory reconstruction and functional outcomes. Further studies with robust designs, larger sample sizes, and longer follow-up are needed to verify the efficacy and safety of this modified surgical technique in enhancing vision and restoring anterior segment anatomical integrity in compromised corneas.

Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome.

To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). A 10-year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best-corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Twenty-five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B-scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub-retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra-ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer-assisted SRF drainage was the favored surgery. The median period of follow-up was 6.5 months (0.1-76 months), and the mean distance BCVA at the last follow-up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). UES can be suitably managed both medically and surgically based on clinical presentation.

One-dioptre toric IOL versus spherical IOL in eyes with low preoperative corneal astigmatism

PurposeTo investigate the advantages/disadvantages of a 1.0 D toric IOL vs spherical IOL after regular phacoemulsification in eyes with preoperative astigmatism ≤ 1 D.MethodsRetrospective comparative series involving pseudophakic eyes with preoperative topographic astigmatism ≤ 1.0 D implanted either with monofocal 1.0 D Toric IOL (T-group), or with spherical IOL (S-group). The postoperative refractive astigmatism (PRA, i.e. surgically induced + corneal) was the main outcome; also considered in the analyses were the uncorrected and best-corrected distance visual acuity (VA). The data were referred to the last postoperative follow-up visit, 2 to 4 months after surgery.ResultsA total of 60 eyes were included: 30 in the T-group and 30 in the S-group, matched for patient’s age, laterality, and axial length. Before surgery, the mean corneal astigmatism was 0.62 ± 0.39 D in the T-group and 0.54 ± 0.33 D in the S-group (p = 0.4). In the S-group, PRA was 0.73 ± 0.37 D, higher than the corresponding preoperative corneal astigmatism (p = 0.040). In the T-group, PRA was 0.58 ± 0.31 D; the variation was not statistically significant. Uncorrected VA was significantly better in the T-group vs the S-group (p = 0.007), and the best-corrected VA was comparable in the two groups.ConclusionThe present study indicated that in eyes with very low preoperative astigmatism, 1.0 D toric IOLs were able to limit the increase of the PRA instead of those observed with the spherical IOLs. This could support the better uncorrected VA recorded in the T-group.