Improvement In Best-corrected Visual Acuity Research Articles

Five-Year Outcomes of Lenadogene Nolparvovec Gene Therapy in Leber Hereditary Optic Neuropathy.

Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON). To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration. The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from 2018 to 2022, is the 5-year follow-up study of the 2 phase 3 clinical studies RESCUE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss Up to 6 Months From Onset in LHON Due to the MT-ND4 Mutation) and REVERSE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the MT-ND4 Mutation). At the end of each study, ie, 2 years after gene therapy administration, patients were offered enrollment in the RESTORE trial, a multinational, multicenter, prospective study, for an additional 3 years of follow-up. Patients with LHON due to the MT-ND4 gene variant received lenadogene nolparvovec in 1 eye and a sham injection in the other eye. Lenadogene nolparvovec was administered as a single intravitreal injection in the RESCUE/REVERSE studies. Measures included best-corrected visual acuity (BCVA), quality of life using the National Eye Institute visual functioning questionnaire 25 (NEI VFQ-25), and adverse events. Among the 76 patients who received gene therapy in the RESCUE (n = 39) and REVERSE (n = 37) studies, 72 (94.7%) completed these studies; 62 patients (81.6%) participated in the RESTORE trial, and 55 patients (72.4%) completed the 5-year follow-up. Participants were mostly male (49 [79.0%]) with a mean (SD) age of 35.9 (15.3) years at treatment. At baseline, the mean (SD) BCVA was 1.5 (0.5) logMAR (20/600 Snellen) in eyes to be treated with lenadogene nolparvovec and 1.4 (0.5) logMAR (20/500) in sham eyes. At the end of the RESCUE/REVERSE trials, ie, 2 years after treatment, eyes treated with lenadogene nolparvovec and eyes treated with sham reached a mean BCVA value of 1.4 (0.6) logMAR (20/500). The mean (SD) change from baseline to year 2 was -0.05 (0.6) logMAR (+1 line) and 0.01 (0.6) logMAR (-0 line) in gene therapy-treated and sham eyes, respectively (difference, -0.03; 95% CI, -0.16 to 0.09; P = .60). Five years after treatment, the bilateral improvement from nadir was similar to that observed at 2 years, with a mean (SD) change in BCVA of -0.4 (0.5) logMAR (more than +4 lines) for eyes treated with lenadogene nolparvovec and -0.4 (0.4) logMAR (+4 lines) for eyes treated with sham (difference, -0.05; 95% CI, -0.15 to 0.04; P = .27). An improvement of at least -0.3 logMAR (+3 lines) from the nadir in at least 1 eye was observed in 66.1% of participants (41 of 62). Between 2 and 5 years, intraocular inflammation was noted in 4 participants with 8 events in eyes treated with lenadogene nolparvovec and 1 event in an eye treated with sham. In this analysis of the RESTORE trial, follow-up of patients with LHON due to the MT-ND4 gene variant unilaterally treated with lenadogene nolparvovec demonstrated a sustained bilateral improvement in BCVA and a good safety profile up to 5 years after treatment. This evidence of persistent benefit over time is promising for the use of gene therapy in these patients. ClinicalTrials.gov Identifier: NCT03406104.

Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity.

To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma. Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications. Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes. EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

Epiretinal Membrane and Senile Cataract: Combined vs Sequential Surgery.

To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM). A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery. Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group. Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.

3-year Outcomes of Rotating Suture with Root Z-epicanthoplasty for Lower Lid Epiblepharon

Purpose: To report the clinical outcomes of Root Z-epicanthoplasty combined with lower eyelid rotation suturing in patients with lower eyelid epiblepharon, focusing on a 3-year follow-up.Methods: Patients who underwent Root Z-epicanthoplasty combined with lower eyelid rotation suturing from March 2012 to February 2020 were included. Patients aged &lt; 15 years, and who had a minimum 3-year follow-up, were included. We assessed changes in best corrected visual acuity (BCVA), cycloplegic refraction, astigmatism, and surgical outcomes. To evaluate the influence of preoperative amblyopia, patients were divided into subgroups based on amblyopic status; surgical outcomes were compared between these groups. In addition, subgroups were divided based on age at operation and astigmatism were compared between subgroups.Results: A total of 55 patients (109 eyes) exhibited successful correction of lower eyelid epiblepharon without recurrence; one case experienced a delayed episode of lower palpebral conjunctival hemorrhage. Significant changes were observed of BCVA improvement, myopic shift of cycloplegic refraction, and astigmatism reduction three years post-surgery (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.024). In the group without preoperative amblyopia (86 eyes), significant changes were noted in BCVA, cycloplegic refraction, and astigmatism (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.025). In patients with preoperative amblyopia (23 eyes), significant improvements were observed in BCVA and myopic shift in cycloplegic refraction (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.003), whereas astigmatism showed no significant change (&lt;i&gt;p&lt;/i&gt; = 0.431). There is significant reduction of astigmatism in under 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.011) and no significant reduction of astigmatism in over 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.589).Conclusions: Root Z-epicanthoplasty with lower eyelid rotation suturing demonstrated a low complication rate and no recurrence over 3-year follow-up, confirming its effectiveness in correcting lower eyelid epiblepharon. The procedure also positively influenced visual development and reduction of astigmatism in pediatric patients.

Anatomical and functional outcome of surgical correction of optic disc pit maculopathy using autologous scleral patch graft: a long-term retrospective analysis

BackgroundOptic disc pit (ODP) is a rare congenital anomaly of optic nerve head and is associated with maculopathy. Scleral patch graft (SPG) as a therapeutic option is recently advocated.MethodsThis is a retrospective analysis of 54 patients with ODP maculopathy who were followed up for 12 months post-operatively. The parameters assessed included best corrected visual acuity (BCVA) in LogMAR chart and central macular thickness (CMT) at baseline and at 1-, 3- and 12-months post-surgery.ResultsThe mean age of presentation was 36.36 ± 15.69 years [Median 36, Interquartile range (IQR) 14.75]. 51.85% were female. 53.7% were operated in left eye. The average period of follow-up was 15.37 ± 2.34 months after surgery. The mean presenting BCVA in LogMAR chart was 0.66 ± 0.37 (Median 0.6, IQR 0.4) and average CMT was 677.46 ± 251.57µ (Median 674, IQR 276). On follow up over 1, 3 and 12 months, average BCVA were 0.74, 0.58 and 0.49 LogMAR respectively. The improvement in final BCVA was statistically significant (p = 0.016). The CMT at the corresponding follow-up periods were 461.26 ± 238.3µ (Median 435, IQR 220.5), 362.68 ± 125µ (Median 367, IQR 141) and 287.36 ± 121.9µ (Median 266, IQR 139.5). Decrease in CMT was significant at all follow up visits (p < 0.001). On assessing OCT Biomarkers, Subretinal fluid (57.4%), Intraretinal Fluid (57.4%), macular schitic cavity (79.63%), Outer Lamellar Macular hole (31.48%), Pachychoroid vessels (35.19%), Outer Retinal Layer Disruptions (24.07%) were present in various proportions on presentation. After surgery over the follow-up, retinal fluid and schitic cavities were observed to get regressed over time. Outer Lamellar Macular holes showed excellent regression after surgery over a period of time. On final visit after 1 year of surgery, complete anatomical success in terms of OCT interpretation was achieved in 16 cases (29.63%). Partial anatomical success was achieved in further 24 cases (44.44%). At least some anatomical improvement was seen in 49 patients while in 3 patients it remained almost unaltered and 2 cases worsened. Successful visual rehabilitation was achieved in 45 patients (83.33%)ConclusionsDetailed OCT based and functional analysis in this study with long-term follow-up helps to entitle the importance of scleral patch graft based surgical procedure in managing this challenging surgical condition. This article caters the largest case series with meticulous analyses of the ODP Maculopathy surgically managed using autologous scleral plug.

Peripapillary and Macular OCTA Predictors of Visual Improvement in Patients Treated with Vitrectomy for Idiopathic Epiretinal Membrane

Introduction: We investigated the changes of peripapillary and macular microvasculature in idiopathic macular epiretinal membrane (iERM) eyes before and after pars plana vitrectomy (PPV), aiming to identify potential optical coherence tomography angiography (OCTA) predictors of visual acuity improvement. Methods: Fifty-seven eyes diagnosed with iERM were enrolled and underwent PPV with ERM and Internal limiting membrane (ILM) peeling. Data were collected before surgery and during the twelve-month postoperative period. OCTA analysis focused on radial peripapillary capillary (RPC) vessel density (VD), superficial and deep capillary plexus (SCP and DCP, respectively). Functional, and OCT structural outcomes, including best-corrected visual acuity (BCVA) and macular thickness, were also recorded. Results: Multivariate linear regression analysis revealed that higher preoperative RPC VD, lower SCP VD, and lower BCVA were predictors of postoperative BCVA improvement (p&lt;0.001, p=0.047, and p&lt;0.001, respectively). Throughout the follow-up period, there was an observed increase in intradisc RPC VD, whole-disc VD, and parafoveal DCP VD (all p&lt;0.001). BCVA and central macular thickness (CMT) demonstrated significant improvement (p&lt;0.001) within the first month following vitrectomy, which then stabilized from the third month onwards. Conclusions: Preoperative microvascular measurements in iERM patients can forecast postoperative BCVA. OCTA findings reveal that both increased RPC density and reduced SCP density at baseline could serve as predictors of better visual outcomes after surgery. Enhanced RPC density may reflect a healthier optic nerve with greater potential for visual recovery, while a less dense SCP could indicate less iERM contraction, both contributing to more favorable postoperative visual results.

Anti-Vascular Endothelial Growth Factor Combined with Ocular Steroid Therapy for Persistent Diabetic Macular Edema: A Systematic Review and Meta-Analysis

Purpose: Our purpose was to appraise the efficacy and safety of intravitreous vascular endothelial growth factor inhibitor (anti-VEGF) therapy combined with steroids for persistent diabetic macular edema. Methods: A systematic review was conducted of the research evaluating the combination therapy of anti-VEGF and steroids for persistent diabetic macular edema compared to anti-VEGF alone. A meta-analysis was performed using a protocol registered in PROSPERO (CRD42023476333). Continuous and binary variables were extracted. Results were expressed as the mean difference (MD) and risk ratio (RR). Results: A total of 9 trials with 537 eyes were included. The MDs of improvement in best-corrected visual acuity (BCVA) at 1/2/3/6/9/12 months between the combined and monotherapy groups were 1.33 (95% CI [−1.31,3.96]), 3.03 (95% CI [0.01, 6.06]), −0.37 (95% CI [−4.74, 4.00]), −1.37 (95% CI [−4.65, 1.91]), 1.05 (95% CI [−3.68, 5.77]), and 1.70 (95% CI [−3.52, 6.93]). The MDs concerned with a central retinal thickness (CMT) decline in at 1/2/3/6/9/12 months between the two groups were −47.33, 95% CI [−94.35, −0.32]), −89.19 (95% CI [−114.38, −64.00]), −58.84 (95% CI [−96.93, −20.74]), −57.23 (95% CI [−102.62, −11.84]), −40.59 (95% CI [−80.59, −0.58]), and −38.89 (95% CI [−77.38, −0.40]), respectively. Furthermore, the combined group obtained higher relative risks of experiencing events with high intraocular pressure and progressed cataracts. Conclusions: Anti-VEGF combined with ocular steroids showed a significant advantage in improving the retinal anatomical structure compared to anti-VEGF monotherapy for persistent diabetic macular edema. However, as the treatment period extended, the combination treatment was no more effective than monotherapy after 2 months, with more severe side effects.

Predictive risk scores for visual prognosis after photodynamic therapy for central serous chorioretinopathy.

To comprehensively evaluate baseline characteristics of patients with central serous chorioretinopathy (CSC) and develop predictive risk scores to identify visual prognosis. This single-institute, retrospective cohort study included 144 eyes of 144 patients with CSC who underwent photodynamic therapy and achieved serous retinal detachment resolution. We developed and assessed the performance of several risk scores for best-corrected visual acuity (BCVA) outcomes six months post-treatment: i) BCVA improvement (≤-1.0 logMAR), and ii) BCVA deterioration (≥+ 1.0 logMAR). The BCVA improvement models used photoreceptor outer segment thickness, loss of photoreceptor outer segment, and neurosensory retinal thickness (NSRT), while the BCVA deterioration models included outer nuclear layer thickness and NSRT. The BCVA improvement models demonstrated a corrected area under the curve (AUC) of 0.786 (95% confidence interval [CI]: 0.699-0.864), with 80.4% sensitivity, and 71.2% specificity. The BCVA deterioration models achieved a corrected AUC of 0.864 (95% CI: 0.742-0.958), with 85.7% sensitivity, and 83.5% specificity. The predictive models for CSC exhibited favorable performance in predicting individual visual prognoses. A thinner outer nuclear layer may be associated with BCVA deterioration, whereas preservation of the photoreceptor outer segment may be correlated with BCVA improvement. WHAT IS KNOWN : Pre-treatment best-corrected visual acuity, thickness of each sensory retinal layer, time fromonset to treatment, and macular atrophy were each found to be associated with visualprognosis for patients with central serous chorioretinopathy (CSC). The current study comprehensively assessed potential prognostic factors and precisely identified individual likelihood of visual prognosis. The study found that different regions of the sensory retina were associated with either worsening or improving visual acuity. Accurately predicting visual outcomes after photodynamic therapy for CSC would help healthcare providers create personalized treatment plans and enable patients to make informed decisions about their treatment based on their expected visual results.

Thirteen year experience of vitrectomy and air tamponade for primary retinal detachment repair with clinical outcomes.

To report outcomes of pars plana vitrectomy (PPV) with air tamponade for primary rhegmatogenous retinal detachment (RRD) and investigate the impact of vitreous cortex remnants (VCR) on surgical outcomes. A retrospective review of 900 patients treated for uncomplicated primary RRD between 2007 and 2020. Exclusion criteria included axial length > 26mm, prior retinal surgery, giant retinal tear, PVR grade > B, and inadequate follow-up. Primary outcomes were retinal reattachment rate and best-corrected visual acuity (BCVA). Of 900 patients, 397 met inclusion criteria. Primary reattachment rate was 88.4%, with significant BCVA improvement. Forty-six eyes experienced RRD recurrence. Complications included cataracts (38.8%), IOP rise (11.4%), and macular edema (8.3%). Better final BCVA was associated with preoperative macular non-involvement and absence of reinterventions. No significant association was found between RRD recurrence and various factors, including VCR removal. Air tamponade is a safe and effective option for primary RRD treatment. It has no negative effect on the environment and creates less discomfort for patients. VCR removal did not significantly reduce RRD recurrence in the overall number of cases. Further research will help determine the role of VCR in RD recurrence and define in which cases their removal might be beneficial.

Predictive factors of long-term visual outcomes after primary Descemet's membrane endothelial keratoplasty (DMEK): retrospective study.

To determine predictive factors of higher levels of best-corrected visual acuity (BCVA) in the long-term after primary Descemet's membrane endothelial keratoplasty (DMEK). Retrospective, single-surgeon case series of 129 successful primary DMEK eyes without graft failure and with a minimum postoperative follow-up of 12months. Mixed effect model for repeated measurements (MMRM) analysis was performed to determine recipient, donor, surgical and postoperative factors associated with BCVA ≤ 0.10 logMAR (≥ 20/25 Snellen). After primary DMEK, there was a statistically significant improvement in BCVA with a global reduction in logMAR BCVA (p < 0.00001). There was also a global tendency towards increasing proportion of eyes with BCVA ≤ 0.10 logMAR at all time points (p < 0.00001), from 1.6% before DMEK to 64.4% in eyes with more than 5years of F-U. Absence of retinal disease was associated with a decrease of 0.10 logMAR in postoperative BCVA after primary DMEK, maintaining constant the rest of variables (p < 0.001). The variables age (OR 0.960), postoperative time (OR 1.083), preoperative BCVA ≥ 0.375 logMAR (OR 0.162) and indication for DMEK (OR 5.412) were included in the predictive MMRM model of BCVA ≤ 0.10 logMAR. Primary DMEK is associated with statistically and clinically significant improvement in BCVA that occur early in the postoperative period and are continuous over time. Eyes with retinal comorbidities have increased risk of worse postoperative BCVA after DMEK. Younger recipient age, Fuchs' dystrophy eyes and eyes with better preoperative BCVA are more likely to achieve postoperative BCVA ≤ 0.10 logMAR.

Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency

Purpose: To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD). Methods: Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes. Results: Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23–0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes. Conclusions: This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.

CATARACT SURGERY RESULTS IN BRAIN TUMOR DIAGNOSIS: A CASE REPORT

The article outlines a diagnostic investigation following phacoemulsification of early age-related cataract in patients who exhibited no improvement in best-corrected visual acuity and reported “floating spots” in the postoperative period. Optical coherence tomography of the optic disc showed a lesion in the peripapillary nerve fiber layer, symmetrically located on the temporal side of both eyes. Computer perimetry revealed bitemporal hemianopsia. Neuroimaging (MRI with intravenous contrast) confirmed the presence of a lesion in the chiasmatic-sellar region. In this article, we present a variant of postoperative management and additional examination of a patient as an example of differential diagnostic search for a possible non-ophthalmological cause of decreased visual acuity. It demonstrates the importance of an interdisciplinary approach as a key to early diagnosis of brain tumors.

The safe lowest effective power of subthreshold micropulse laser treatment in Chinese patients with acute or chronic central serous chorioretinopathy.

To assess the safe, lowest effective laser power of subthreshold micropulse laser (SML) for treating acute and chronic central serous chorioretinopathy (CSC) in Chinese patients. Patients were distinguished with acute or chronic CSC based on focal or diffuse retinal pigment epithelium (RPE) leakage on fundus fluorescein angiography (FFA), with or without widespread RPE decompensation. Patients were categorized into five groups and treated with 577 nm yellow SML according to 50% titration power. The change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were set as primary outcomes. A linear regression model assessed the correlation between different factors and outcome indicators. A total of 103 patients with 127 eyes (61 with acute CSC and 66 with chronic CSC) were enrolled. The baseline characteristics were balanced between the five groups (all p > 0.05). The decrease of CMT and the improvement of BCVA were related to the CMT at baseline (all p < 0.05). We found that the lowest effective laser power for acute CSC was 425 mW (-225.50 μm vs. -171.24 μm vs. -114.50 μm vs. -130.54 μm vs. -68.00 μm, p < 0.001), showing a significant CMT reduction at this power, but no significant increase in BCVA (-0.15 ± 0.10 logMAR vs. -0.20 ± 0.16 logMAR vs. -0.14 ± 0.11 logMAR vs. -0.17 ± 0.30 logMAR vs. -0.11 ± 0.14 logMAR, p > 0.05). For chronic CSC, the lowest effective laser power was 375 mW (p = 0.01), the change of CMT was significant in 375 mW (-93.91 ± 109.06 μm, -119.32 ± 105.56 μm, -88.67 ± 67.26 μm, -60.89 ± 106.86 μm, and -99.11 ± 157.32 μm, p = 0.04). The change of BCVA was similar trend (-0.54 ± 0.66 logMAR vs. -0.17 ± 0.23 logMAR vs. -0.10 ± 0.21 logMAR vs. -0.02 ± 0.30 logMAR vs. 0.05 ± 0.19 logMAR, p < 0.001). In this study, our results suggested 425 mW and 375 mW laser power is the lowest effective SML power for treating acute and chronic CSC in Chinese patients respectively, And the power of SML for chronic CSC requires lower power than acute CSC.

Comparative Analytical Study of Intravitreal Triamcinolone Acetonide Versus Bevacizumab in Managing Diabetic Macular Edema: Insights From a Tertiary Eye Care Facility in India.

This study aims to compare the effects of intravitreal triamcinolone acetonide (IVTA) and bevacizumab (IVB) in diabetic macular edema (DME) management. A prospective interventional study was conducted at a tertiary eye care hospital in Tamil Nadu, India. The study received approval from the institutional ethics committee, and informed consent was obtained from all participants. Inclusion criteria comprised patients aged 18 years and above, diagnosed with macular edema attributable to non-proliferative diabetic retinopathy (NPDR), exhibiting best-corrected visual acuity (BCVA) worse than 6/18, and presenting a medical indication for either IVTA or IVB. Exclusion criteria included the presence of other ocular diseases, proliferative diabetic retinopathy, ocular inflammation, prior interventional treatments for DME, and pregnancy. Baseline assessments were comprehensive and included evaluations of BCVA, intraocular pressure (IOP) measurements, slit-lamp biomicroscopy, fundus photography, and optical coherence tomography (OCT). Participants in both groups adhered to standardized injection protocols and post-injection care routines, with follow-up monitoring scheduled at one week and one, three, and six months post-treatment. The primary outcome measures comprised changes in BCVA, IOP, findings from slit-lamp, and fundus examinations, alongside assessments of macular thickness through OCT and fundus photography. Statistical analyses were performed in SPSS Statistics version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.), ensuring rigorous evaluation of the collected data. A study involving 50 patients with NPDR and clinically significant macular edema compared the effects of IVTA and IVB. In Group I (IVTA), significant improvements in BCVA were observed at both one and three months; however, there was a slight decline in vision by six months. The reduction in central foveal thickness (CFT)was sustained in this group, but IOP increased, with one case necessitating surgical intervention. In Group II (IVB), BCVA improvement was quicker at one and three months, yet by six months, both vision and CFT worsened significantly. Notably, IVB maintained stable IOP throughout the study. While IVTA demonstrated a more prolonged effect on macular thickness, it was associated with higher risks related to IOP, whereas IVB provided faster, albeit less durable, outcomes. Both IVTA and IVB effectively enhance visual acuity and reduce macular edema in diabetic retinopathy. IVB demonstrates superior short-term gains in visual acuity (over one to three months). In contrast, IVTA is more effective in decreasing CFT, thanks to its broader mechanism of action, including inhibition of vascular endothelial growth factor and cytokines. The longer half-life of IVTA provides more sustained anatomical benefits but is associated with higher IOP, necessitating careful monitoring. Conversely, IVB presents fewer complications, making it a safer option for certain patients. Treatment choice should consider the patient's risk profile, balancing efficacy with potential side effects.

Brolucizumab in patients with neovascular age-related macular degeneration: Real-life outcomes from a tertiary care eye hospital.

To report real-world clinical evidence of brolucizumab in treating neovascular age-related macular degeneration (nAMD). This study included 37 eyes with nAMD treated with intravitreal injections of brolucizumab. The main outcomes were best corrected visual acuity (BCVA) changes, central retinal thickness (CRT), and serious ocular adverse events. Intraretinal fluid (IRF) and subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci, macular atrophy, and retinal pigment epithelial tears were evaluated. The mean BCVA of all patients showed a post-treatment value of 0.47 ± 0.33 log of minimum angle of resolution (LogMAR), compared to a baseline measure of 0.50 ± 0.28 LogMAR ( P = 0.372). For treatment-naïve patients, a non-statistically significant improvement in BCVA was observed ( P = 0.116). Both treatment-naive patients and the entire patient cohort exhibited a statistically significant improvement in the mean CRT after injections. Majority of patients exhibited improvements in optical coherence tomography findings, specifically in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes experienced ocular adverse events in the form of intraocular inflammation. Brolucizumab did not yield a substantial improvement in BCVA, but it exhibited efficacy in reducing CRT in the entire study population and treatment-naive patients with nAMD. Our study identified intraocular inflammation as a significant adverse event with brolucizumab. Thus, precise patient selection, education, and vigilant inflammation monitoring are crucial for patients undergoing this treatment.

Real world treatment outcomes in polypoidal choroidal vasculopathy in a Caucasian population of British ethnicity.

To assess treatment response of Polypoidal choroidal vasculopathy (PCV) in a Caucasian population of British ethnicity with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections alone and with a combination of anti-VEGF injections and photodynamic therapy (PDT). Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, United Kingdom. Retrospective review of 95 Caucasian patients in a single centre with diagnosis of PCV between 2013 and 2018 were included. Best corrected visual acuity (BCVA), central retinal thickness (CRT), indocyanine green angiography (ICGA) characteristics, numbers and type of treatment were analysed at baseline and at 1 year. One hundred and one eyes included from 95 patients received either anti-VEGF injections (n = 79, 78.2%) alone or combination therapy with anti-VEGF and PDT (n = 6, 6%). A third untreated group was also observed (n = 16, 15.8%). Five eyes were excluded from the study due to structural retinal damage. Mean number of injections was 7.3 in the monotherapy group and 6.5 in the combination group. Both treatment groups showed improvement in BCVA at 1 year and this was statistically significant in the monotherapy group with a mean gain of 8.3 letters (p < 0.001). Mean CRT decreased in all treatment groups at twelve months and this change was significant (p < 0.01). In the observation group, vision and CRT remained stable. This study demonstrates significant improvements in BCVA at one year in our Caucasian cohort of British ethnicity with PCV in the treatment group.

Spontaneous closure of full-thickness macular hole after pars plana vitrectomy for retinal detachment: evidence of ellipsoid zone restoration.

To describe a case of full-thickness macular hole (FTMH) occurred after pars plana vitrectomy (PPV) for a macula-sparing rhegmatogenous retinal detachment (RRD), which showed a spontaneous closure associated with outer retinal layers restoration. Case report. A pseudophakic 69-year-old man underwent PPV for a macula-sparing superior RRD in the right eye (RE). Best corrected visual acuity (BCVA) was 20/20 before surgery. Three weeks after treatment the patient complained about visual impairment, and a FTMH was detected at fundus examination as well as confirmed by optical coherence tomography (OCT) scan. The patient was scheduled for a repeated surgery, but FTMH spontaneously closed eighteen days after its occurrence as demonstrated at OCT showing only a point break of the ellipsoid zone (EZ) and Verhoeff membrane. The subsequent macular OCT scan showed a point-like irregularity at the Verhoeff membrane and regeneration of EZ, associated with a progressive improvement in BCVA. Forty-days after the FTMH occurrence, all the retinal layers were completely restored with a complete clinical recovery. FTMH formation and closure after macula-sparing RRD repair is a rare event that could be characterized by spontaneous and gradual anatomical restoration of the EZ associated with visual acuity improvement, underlying the retinal physiology recovery.

Safety and Efficiency of Anti-VEGF with Dexamethasone Intravitreal Implant for Non-Ischemic Retinal Vein Occlusion: A Prospective, Case-controlled, Cohort Study.

This study aimed to assess the efficacy and safety of anti-VEGF combined with dexamethasone implant for the retinal vein occlusion patients with macular edema. In this prospective, case-controlled, cohort clinical trial (Register ID: ChiCTR2400080048), patients with non-ischemic retinal vein occlusion were enrolled from the Sanmenxia Central Hospital from August 2020 to April 2023. The patients were randomized into two groups. All the patients received ranibizumab intravitreal injection in the first 3 consecutive months. For the ranibizumab group, anti-VEGF injections were as needed thereafter in case of recurrence of macular edema; For the combination group, the patients received an intravitreal dexamethasone implant injection at 15 days after the first ranibizumab injection. The primary outcome measurements were improvement in best corrected visual acuity (BCVA) and reduction in central macular thickness (CMT). The secondary outcomes were recurrence of macular edema, number of intravitreal injections, and injection interval. Safety profiles were also recorded. A total of 124 patients were included, of which 73 patients completed all follow-ups. Both the ranibizumab monotherapy and the combination therapy significantly improved BCVA at all time points, compared to the baseline. The combined group achieved more BCVA improvement in 3 months, 6 months, and 12 months, compared to the ranibizumab alone group. Compared to the baseline, both groups achieved significant reductions in CMT at all follow-ups. However, the combination group showed more CMT reduction at 1 week post injection, compared to the ranibizumab group. The combination group had a significantly longer injection interval, lower injection time, and recurrence of macular edema. Ocular hypertension was the most common adverse events. Lastly, intraocular pressure was all well controlled by 1-3 glaucoma medications without surgical intervention. The combination therapy could significantly improve the BCVA and reduce the CMT with a good safety profile.

Insights Into Cataract Surgery Outcomes In Age-Related Macular Degeneration: Real-World Perspectives Across Severity Grades

PurposeCataract and age-related macular degeneration (AMD) share age as a main risk factor and thus have a high coincidence. Both conditions substantially reduce visual acuity. This study aimed to assess the impact of cataract surgery on visual acuity, retinal morphology, and vascular-endothelial-growth-factor (VEGF) inhibitor therapy in patients with AMD. DesignThis study was designed as a retrospective, monocentric, real-world study. SubjectsPatients diagnosed with either dry AMD or neovascular AMD undergoing cataract surgery at Charité Campus Benjamin Franklin. MethodsTreatment data were extracted from the Berlin Macular Registry. Best-corrected visual acuity (BCVA) and macular optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), macular volume (MV), presence of macular edema, intraretinal or subretinal fluid and pigment epithelial detachment were assessed. Main Outcome MeasuresPrimary outcome measure was the postoperative BCVA. Secondary outcomes included postoperative CRT, MV, changes in qualitative OCT parameters, alterations in anti-VEGF-therapy interval and postoperative complications. ResultsA total of 418 eyes of 418 patients were included in the analysis with a mean follow-up time of 18.8 (2-62) months. They were classified into a neovascular AMD (n=85) and a dry AMD (n=333) cohort. Mean BCVA improved significantly in the neovascular AMD cohort from 0.69 ±0.45 logMAR to 0.47 ±0.42 (p= <0.001) and in the dry AMD cohort from 0.53 ±0.47 logMAR to 0.27 ±0.32 (p= <0.001) at the two-month follow-up. Improvements in BCVA were sustained to the final visit (18.9 ±19.5 months post-surgery) with BCVA at 0.46 ± 0.38 logMAR (p= <0.001) and 0.26 ± 0.34 logMAR (p= <0.001), respectively. Temporary postoperative increases in CRT and MV were observed, reverting to preoperative levels by six months post-surgery. The need for anti-VEGF therapy did not change postoperatively in patients with neovascular AMD. ConclusionsWithin this retrospective analysis, on average patients with coincident AMD of all severity grades meeting the inclusion criteria benefited from cataract surgery. Transient increases in retinal thickness and macular volume returned to baseline within six months post-surgery. The need for intravitreal injections in neovascular AMD subjects was unchanged post-surgery. Overall, the study suggests no adverse long-term macular changes attributable to cataract surgery.

Suprachoroidal Umbilical Cord-Derived Mesenchymal Stem Cell Transplantation for the Regeneration of Glaucomatous Optic Neuropathy: A Preliminary Investigation

Objective: This preliminary research presents clinical findings from patients with advanced Glaucomatous Optic Neuropathy (GON) who underwent transplantation of Umbilical Cord-Derived Mesenchymal Stem Cells (UCMSCs) into the suprachoroidal space. Methods: This prospective, single-center study included 17 eyes of 17 patients diagnosed with GON, who received suprachoroidal UCMSC implantation. Patients were registered if their visual acuity and/or Visual Field (VF) deteriorated despite maintaining good intraocular pressure control with anti-glaucomatous treatments. Evaluations were conducted at baseline, on the first postoperative day and at 1 month, 6 months and 1 year after surgery. Best Corrected Visual Acuity (BCVA), anterior segment and fundus examination, color photography, Optical Coherence Tomography (OCT), Retinal Nerve Fiber Layer (RNFL) analysis, VF testing and Pattern Visual Evoked Potential (PVEP) assessments were performed at baseline and during follow-up visits. Results: All 17 participants completed the 12-month follow-up period. No systemic or serious ocular complications were recorded. The study showed significant improvements in BCVA, VF results, RNFL measurements and PVEP amplitudes at the end of the follow-up period. Conclusion: Although the sample size is limited, suprachoroidal UCMSC therapy appears to be safe, with encouraging improvements. Further studies with larger patient groups and longer follow-up periods are required to assess the impact of stem cell delivery on visual acuity and quality of life in glaucoma patients.