Best-corrected Visual Acuity Levels Research Articles

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.

Evaluation of Prognostic Factors in Adult Chemical Corneal Injury.

The aim of this study was to evaluate prognostic factors that may be useful in predicting final visual acuity in patients admitted to the clinic with chemical corneal injuries. Data on age, sex, time to admission, irrigation solutions (balanced salt solution or phosphate buffered saline) and type of substance causing chemical injury were recorded. On admission, all patients were evaluated according to Roper Hall and Dua classifications. At the twelfth month after treatment, all measurements were repeated. A total of 131 patients with chemical corneal injuries [group 1 (acid, n = 73) and group 2 (alkaline, n = 58)] were included. The initial best corrected visual acuity (BCVA) level was "20/40 and above" in 32 patients (43.8%) in group 1 and 14 patients (24.1%) in group 2. According to Roper Hall classification, the mean grade was 1.92 ± 0.9 in group 1 and 2.27 ± 1.1 in group 2. According to Dua classification, the mean grade of the patients in group 1 was 2.16 ± 0.9 and 2.58 ± 1.2 in group 2. Posttreatment BCVA level improved to "1/200 to 19/200" in 8 (66.7%) of the patients with an initial BCVA level of "perception of light or hand movements." In univariate analysis, initial visual acuity and posttreatment visual acuity were statistically significant (P < 0.001). It was also statistically significant in multivariate analysis adjusted for sex and age (P < 0.001). In conclusion, the treatment of chemical corneal injuries is a long and exhausting process. The use of initial visual acuity and Dua classification in prognosis prediction may provide high success.

A Prospective Comparison of 180 Versus 360-Degree Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes in Pseudoexfoliation Glaucoma.

Analysis of surgical success and intraocular pressure (IOP), best-corrected visual acuity (BCVA), and antiglaucomatous medication (AGM) changes between segmental 180-degree and 360-degree gonioscopy-assisted transluminal trabeculectomy (GATT) in patients with pseudoexfoliation glaucoma (PEXG) showed no significant difference. To compare surgical outcomes of segmental 180-degree and 360-degree GATT in patients with PEXG. Prospective, comparative study of 65 PEXG eyes, who underwent segmental 180-degree GATT (GATT 180-degree group, 31 eyes) and 360-degree GATT (GATT 360-degree group, 34 eyes) in a tertiary academic center over a 12-month of follow-up. Primary outcome was qualified and complete surgical success rates for criterion A (IOP <18mm Hg and >30% reduction) and criterion B (IOP <15mm Hg and >30% reduction). Secondary outcome measures included IOP reduction, BCVA change, AGM use, and postoperative complications. The probabilities of qualified and complete success rates both for criteria A and B did not significantly differ between the groups ( P > 0.05). IOP and BCVA levels were similar at each time point ( P > 0.05). IOP reduction was 59.3 ± 9.5% in the GATT 180-degree group and 55.8 ± 18.1% in the GATT 360-degree group ( P = 0.33). No significant difference in the mean number of AGM was present at the 12-month visit (1.2 ± 1.1 in GATT 180-degree group vs 1.5 ± 1.2 in GATT 360-degree group, P = 0.25). Significantly higher incidences of postoperative hyphema and IOP spikes were observed in the GATT 360-degree group ( P = 0.01 and P = 0.008, respectively). Both segmental 180-degree and 360-degree GATT similarly reduced IOP and AGM with comparable surgical success rates in patients with PEXG at the end of 12 months. Postoperative hyphema and IOP spike rates were significantly higher after 360-degree GATT. Segmental 180-degree GATT may be sufficient to adequately modulate IOP with a lower incidence of postoperative complications in PEXG.

Analysis of Cytokine Levels Based on Optical Coherence Tomography Findings in Acute and Chronic Central Serous Chorioretinopathy

Purpose: To investigate the characteristics of optical coherence tomography (OCT) and aqueous humor cytokine differences between acute and chronic central serous chorioretinopathy (CSC) and to evaluate the relevance of these findings. Methods: This was a cross-sectional, observational study. Patients with CSC were divided into acute and chronic groups based on the symptom duration and were compared with normal controls. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CT), hyperreflective foci (HF), and cytokines including vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein-10 (IP-10), and monocyte chemoattractant protein-1 (MCP-1) were used as comparison metrics. Results: A total of 62 patients (62 eyes) with CSC (22 with acute CSC and 40 with chronic CSC) and 35 patients as controls were included in this study. The chronic CSC group had significantly older average ages and worse BCVA than the acute CSC group (both p < 0.05). Both CSC groups showed significant increases in CMT and CT (both p < 0.05). In chronic CSC, the CMT was thinner, with more HF in the neuroretina (p = 0.034). VEGF levels were significantly higher in patients with chronic CSC than in those with acute CSC and controls (p < 0.05). The levels of inflammatory cytokines showed no significant difference between the CSC and control groups. Spearman’s correlation analysis showed that the number of HF was positively correlated with disease duration (r = 0.311, p = 0.014), logMAR BCVA (r = 0.487, P < 0.001) and MCP-1 levels (r = 0.256, p = 0.045). Conclusions: Chronicity of CSC could lead to upregulation of VEGF. HF was associated with a more severe visual impairment in CSC patients and had relations with the levels of MCP-1.

Retrospective analysis of cataract surgery outcomes in China from 2009 to 2018: from a national registry system data

ObjectiveTo evaluate patients’ benefits after cataract surgery and to form recommendations for Chinese national health policy decision makers and administration departments based on the quality of cataract treatments.MethodAn observational study...

Determination of Vascular Endothelial Growth Factor-B Concentrations in Aqueous Humor and Plasma of Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy Patients Before and After Anti-VEGF Therapy.

Anti-vascular endothelial growth factor (anti-VEGF) injection was widely used in patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV); however, the systemic and local levels of vascular endothelial growth factor (VEGF)-B were seldom detected before. This study was conducted to detect and compare the aqueous humor and plasma VEGF-B levels in nAMD and PCV before and after anti-VEGF therapy. Concentrations of VEGF-B in aqueous humor and plasma of individuals with nAMD (n = 10), PCV (n = 22), and age-related cataract controls (n = 12) were measured by enzyme-linked immunosorbent assay. Ranibizumab was injected intravitreally in patients monthly for three consecutive months. Before each injection in patients and at the baseline of controls, blood and aqueous humor samples were collected. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were collected before each injection in patient groups. The differences of BCVA, CRT, and VEGF-B levels in aqueous humor and plasma between groups before and after anti-VEGF therapy were compared. VEGF-B was overexpressed in aqueous humor and plasma of nAMD and PCV groups compared with control group (P < 0.05), but no statistically significant difference existed across nAMD and PCV groups (P > 0.05). Moreover, there were no obvious difference in levels of VEGF-B in aqueous humor and plasma within the treatment groups after anti-VEGF treatment (P > 0.05). The mean CRT in the nAMD group was thinner than that in the PCV group at baseline (P < 0.01). After injections, the CRT obviously declined in both groups (P < 0.05). There was no correlation between CRT reduction and high VEGF-B expression in aqueous humorand plasma of treatment groups. Overexpression of VEGF-B locally and systemically in patients with nAMD and PCV indicated that elevated VEGF-B concentrations were relevant to the disease processes. Ranibizumab did not influence the levels of VEGF-B in the real world. CRT might help to distinguish PCV from nAMD.

Analysis of the Cytokine Expression in the Aqueous Humor of Individuals with BRVO-Associated Macular Edema.

Purpose This study aimed to determine the expression levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in the aqueous humor of patients with macular edema (ME) caused by branch retinal vein occlusion (BRVO), as well as to investigate the relationship between the cytokines as mentioned earlier and best-corrected visual acuity (BCVA), ME, and the degree of ME from the molecular level. Methods In a prospective observational study, fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were used to classify 58 patients with non-ischemic BRVO-ME into three groups according to the degree of ME: 14-mild, 17-moderate, and 27-severe. The specific concentration of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor was detected using the BD CSCanto™ II Flow Cytometer (US). Spearman or Pearson correlation analysis was used to test the correlation between the levels of BCVA and severity of ME and the expression levels of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor. Results According to the obtained data, BCVA did not correlate with the severity of ME, and these four cytokines expression levels in patients' aqueous humor (P > 0.05). Moreover, BCVA did not correlate with mild, moderate, or severe ME as well (P > 0.05). However, the levels of these four cytokines were correlated with the severity of the ME. These underlined cytokines were linked to the mild, moderate, and severe degrees of ME. VEGF was also significantly correlated (r > 0.8, P < 0.0001) with the severity of ME. Conclusions This study suggests that the severity of ME in BRVO-ME patients is significantly correlated with the expression levels of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor. Lowering the level of disease-associated cytokines may potentially reduce the degree of ME. Therefore, an in-depth study of the levels and the relationship may provide some evidence for the pathogenesis, treatment, and prevention of BRVO-ME.

Factors for recurrence in acute central serous chorioretinopathy patients underwent one-third dose verteporfin photodynamic therapy

To investigate the factors for recurrence in acute central serous chorioretinopathy (aCSC) for patients who underwent one-third dose verteporfin photodynamic therapy (PDT). A retrospective study was performed in aCSC patients treated with one-third dose PDT and followed up for 36 months. Demographic information and clinical features were compared. A logistic regression model was used to evaluate the associated factor of aCSC recurrence. There were 162 patients with aCSC included in current study. 36-month after one-third dose PDT, good recovery was identified in 131 patients (80.86%), whereas 31 cases (19.14%) developed recurrence. Significant between-group differences were observed in baseline age, the right, left and both eyes, best-corrected visual acuity (BCVA), presenting with pigment epithelium detachment (PED), retinal pigment epithelium (RPE) damage and subfoveal choroidal thickness (SCT) level (P=0.005, P<0.001, P < 0.001, P < 0.001, P=0.006, and P < 0.001, respectively). The recurrence of aCSC was associated with presenting with PED (odds ratio=1.78; 95% CI, 1.45-1.98; P < 0.001), RPE damage (OR=1.13; 95%CI: 1.08-1.23; P < 0.001), baseline BCVA (OR=0.96; 95%CI: 0.95 - 0.99; P=0.001), and SCT level (OR=1.18; 95%CI: 1.02-1.20; P<0.001). In acute CSC after treatment of one-third dose PDT, recurrence is associated with RPE damage, baseline BCVA and SCT level. Our findings will assist clinicians to evaluate aCSC in clinical practice and provide insights into the prevention of recurrence.

Comparison of Culture-Positive and -Negative Microbial Keratitis

Objectives:To evaluate and compare the risk factors, presenting features, and outcomes of patients with culture-positive and culturenegative microbial keratitis (MK) who presented to a tertiary referral center.Materials and Methods:We conducted a retrospective review of the medical records of 314 patients who were diagnosed with MK in our clinic between 2012 and 2019.Results:Among 314 patients, 142 had positive cultures (45.2%). The mean ages of the culture-positive and -negative patients at the time of diagnosis were 51.39±21.31 (range, 14-90) years and 56.68±21.34 (7-94) years, respectively (p=0.028). The mean best corrected visual acuity (BCVA) of the culture-positive and -negative patients were1.74±1.25 (0-3.1) LogMAR and 1.91±1.23 (0-3.1) LogMAR prior to treatment and increased to 1.21±1.30 (0-3.1) LogMAR and 1.27± 1.29 (0-3.1) LogMAR at last visit, respectively. There was no statistically significant difference between culture-positive and -negative patients’ BCVA levels at presentation or last visit. Ninety-two patients (64.7%) were infected with bacteria and 50 patients (35.2%) with fungi. The most common pathogen was Pseudomonas aeruginosa (18.3%), followed by Streptococcus pneumoniae (11.2%) and Fusarium spp. (11.2%). Keratitis foci were either centrally or paracentrally located in 105 eyes (73.9%) of culture-positive patients and 149 eyes (86.6%) of culture-negative patients. Multiple foci were present mostly in culture-positive patients (p=0.001). There was no significant difference between the culture-positive and -negative groups in terms of hypopyon presence (p=0.364). The proportion of contact lens (CL) wearers was 33% (n=47) among culturepositive MK patients and 13.3% (n=23) among culture-negative MK patients, respectively (p<0.001). Culture positivity was found to be significantly higher in keratitis associated with CL use (p=0.0001).Conclusion:Microbiological analysis and culture evaluation are important steps in order to manage proper treatment in microbial keratitis. Prognosis mostly depends on the infectivity of the microbiological agent.

Efficacy comparison of combined trabeculectomy with MMC and gonioscopy-assisted transluminal trabeculotomy.

To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy combined with cataract surgery (PGATT) and trabeculectomy combined with cataract surgery (PTRAB) in open-angle glaucoma patients. A multi-centered, retrospective, non-randomized study included 67 PGATT patients and 70 PTRAB patients. We compared preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with early and final IOP, medication numbers, and BCVA levels. Success was determined as IOP reduction > 20% from baseline, IOP between 5 and 21mmHg, preoperative IOP of higher than 21mmHg with medication and postoperative IOP of less than 21mmHg without medication for surgeries performed for intolerance to medication, postoperative IOP < 21mmHg as well as < 18mmHg separately without medications, and no need for further glaucoma surgery. Preoperative IOP values were 28.61 ± 6.02mmHg in PTRAB group and 23.99 ± 8.00mmHg in PGATT group (P < 0.0001). Early postoperative IOP values were found lower in PTRAB group as 12.19 ± 3.41mmHg and as 15.69 ± 4.67mmHg in PGATT group (P < 0.0001). Last follow-up IOP reading were lower in PGATT group (P = 0.009). IOP difference values were found higher both in early and last postoperative periods in PTRAB group (respectively, P < 0.0001, P = 0.018). Success rates were found higher in both at lower than 21 and 18mmHg levels in PGATT group (respectively, P = 0.014, P = 0.010). We found the PGATT combined procedure to be a well-tolerated, effective procedure that can lower IOP both early and late in the postoperative period with different rates of IOP success compared with the combined PTRAB procedure.

The impact of phacoemulsification surgery on vision-related quality of life in senile cataract patients.

Background:Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests.Purpose:To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests.Methods:The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality.Results:Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly (p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health (p = 0.235) and driving (p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses (p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status (p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses (p > 0.05 for all).Conclusion:Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.

Long Non-Coding RNAs Gene Variants as Molecular Markers for Diabetic Retinopathy Risk and Response to Anti-VEGF Therapy.

BackgroundLong non-coding RNAs (lncRNAs) play essential roles in molecular diagnosis and therapeutic response in several diseases.PurposeFor the first time, we aimed to evaluate the association of four lncRNAs TUG1 (rs7284767G/A), MIAT (rs1061540T/C), MALAT1 (rs3200401C/T), and SENCR (rs12420823C/T) variants with susceptibility to diabetic retinopathy (DR), disease severity, and early therapeutic response to intravitreous anti-vascular endothelial growth factor aflibercept therapy.Patients and MethodsThis case-control study enrolled 126 adult patients with type 2 diabetes. TaqMan assays using Real-Time PCR were run for genotyping. Multivariable regression analyses were applied to assess the role of each polymorphism after the adjustment of covariates.ResultsCarriers of TUG1 A/G and MIAT T/C and C/C genotypes were more likely to develop DR [OR=3.15 (95% CI=1.15–8.64), and OR=4.31 (95% CI=1.78–10.47)], while MALAT1 T/C conferred protection (OR=0.40, 95% CI=0.16–0.99). For TUG1, MALAT1, MIAT, and SENCR genotype combinations, GTCT and GCCC had a higher disease risk (P=0.012). For disease severity, MIAT T/T homozygosity was associated with higher DR grade [33.3% (T/T) vs 10% (C/C) and 4.2% (C/T) carriers, P=0.012]. Otherwise, patients with the SENCR T variant exhibited better pre-treatment best-corrected visual acuity level (p=0.021). Following aflibercept administration, carrying the TUG1 A or MIAT T/C was associated with a poor therapeutic response (OR=5.02, 95% CI=1.60–15.76, and OR=10.23, 95% CI=1.51–69.15, respectively).ConclusionThe lncRNAs TUG1 (rs7284767G/A) and MIAT (rs1061540T/C) were associated with increased DR susceptibility and poor response to aflibercept treatment, while MALAT1 (rs3200401C/T) conferred protection to DR. These genetic determinants could be useful in DR risk stratification and pharmacogenetics after validation in large-scale studies.

Visual Acuity and Age of Symptom Onset in a Large Chinese Cohort of Patients with Stargardt Disease

Stargardt disease is the most common form of juvenile-onset inherited macular dystrophy, with high phenotypic heterogeneity. There are limited data documenting the characteristics of Best Corrected Visual Acuity (BCVA) and age of symptom onset of patients with Stargardt disease in Chinese population. In this study, 169 patients with clinical and genetic diagnosis of Stargardt disease were recruited. BCVA, age, age of symptom onset, disease duration time and genetic information were collected and analyzed. We found that the average BCVA was 1.16±0.61 logMAR, 63.6% of patients with severe visual impairment (≤1 logMAR); the mean age of symptom onset was 13.63±12.72 years (yrs) old, 61.36% of patients had an onset earlier than 12; BCVA level was associated with genotype and disease duration, but had no direct correlation with neither age of symptom onset nor age; severe genotype (≥2 severe variants, severe variants were defined as those predicted to introduce a premature truncating codon in the protein or to affect splicing) was also associated with earlier age of symptom onset. Our data will serve as a well-founded reference for genetic counseling and better management of these patients.

Device-Dependent Medical Intervention is Not a Panacea: Analysis of Cataract Surgery Outcomes in China from 2009 to 2018 Based on Data From the National Cataract Recovery Surgery Information Registration and Reporting System

Background: During the last decade, support to public welfare programs, development of device-dependent techniques and increased awareness of public health have all caused rapid growth in the number of cataract surgeries performed in China. However, cataract surgery outcomes and the applicability of device-dependent interventions for cataract patients nationwide are still unknown. This study aimed to evaluate the outcomes of cataract surgeries, from a health administration perspective. The data analysed were based on the National Cataract Recovery Surgery Information Registration and Reporting System. The final objective was to provide a roadmap for future health service policies for cataract surgeries. Methods: The data source of this study is the National Cataract Recovery Surgery Information Registration and Reporting System. All cataract cases receiving any surgical treatment, both in medical services and institutes nationwide, should be registered and reported online within four days of the surgery. The variables included: medical institute settings, clinical characteristics of patients, pre-surgical examinations of the cataract-operated eyes, surgical information, and post-surgical visual status. A case-control design was adopted for this study based on the data collected from the electronic registered report system. A descriptive analysis was conducted to analyse the tendency of cataract surgery in the past decade. With LogMAR transferred, the pre-surgical best-corrected visual acuity (BCVA) level was stratified to compare the BCVA improvement level before and after the surgery. The multinomial logistic regression model was used to explore the influencing factors of 3-day post-surgical BCVA improvement, and Normogram visualisation was used to predict the prognosis of cataract surgery. Findings: A total of 1,4157,463 original records were reported from July 1st 2009 to the 31st of December 2018. The mean age of the reported data was 69.7 years, with 69% of the cases in the 61-80 years group. Female accounted for 58.0%. The median of pre-surgical LogMAR transferred BCVA was 0.2, while those of the post-surgery 3-day and 3-month were 0.5 and 0.6, respectively. Cataract surgery had a very good effect on improving post-surgical BCVA. From binary logistic regression analysis, history of hypertension (OR = 0.916) or diabetes (OR = 0.912), pre-surgical pupil abnormality (OR = 0.571), high intraocular pressure (OR = 0.578) did not affect post-surgical BCVA improvement (BCVA ≥ 6/18), while male sex (OR = 1.113), better pre-surgical BCVA level (OR = 5.996 for 0.5-0.7 and OR = 2.610 for 0.2-0.4 taken ≤ 0.1 as reference), age-related cataract (OR = 1.825), and intraocular lens implantation (OR = 1.886) were statistically beneficial for post-surgical BCVA improvement. Considering the surgery types, compared with the ECCE with large incision, the ECCE with small incision (OR value = 1.810) and the phacoemulsification (OR = 1.420) significantly improved the benefit probability. Among the hospital administration affiliation, compared with the provincial medical institutions, the benefit probability of county medical institutions was doubled, with an OR value of 2.084 (95% CI 2.029-2.140). Interpretation: ECCE with small incision has comparable effects on post-surgical BCVA improvement of phacoemulsification. Therefore, it could be an alternative cataract surgical treatment in economically underdeveloped areas in China. Funding Statement: None. Declaration of Interests: All authors claimed no conflict of interest. Ethics Approval Statement: Due to the application of the electronic data from the system, we deemed and were granted ethical approval for the study plan, data management plan and an exemption of informed consent. The approval was provided by the Ethics Committee of the National Institute of Hospital Administration in China (Ethics NO. 1015).

Restitution of potential visual acuity in low vision patients with the use of yoke prisms

PurposeTo determine the efficacy of prisms when used for redirection of incoming images towards the preferred reinal loci (PRLs) for restitution of potential visual acuity (PVA) in low vision cases with age-related macular degeneration (AMD).MethodsRetrospective comparative interventional case series review. Low vision rehabilitation (LVR) protocol used included best corrected visual acuity (BCVA), PVA, topographic PRL identification and use of prisms to produce image redirection to the presumed PRL. The primary outcome measure selected for analysis was BCVA for viewing distance targets after use of yoke prisms.ResultsImage relocation with prisms in patients with AMD resulted in significantly better BCVA levels (t32 = 8.57, p < 0.0001) in the better eye. Distance BCVA levels achieved were almost identical to PVA levels (t32 = 0.415, p < 0.681) (y= -0.136 + 1.195x, r = 0.8333, p < 0.001).ConclusionsUse of yoke prisms for image redirection towards a peripheral identifiable PRL may result in PVA restitution in most cases.

Low Luminance Visual Acuity and Low Luminance Deficit in Proliferative Diabetic Retinopathy.

This study aimed to determine the relation of best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) in proliferative diabetic retinopathy (PDR) following treatment with either aflibercept or pan-retinal photocoagulation (PRP). The study was conducted as a post-hoc analysis of the CLARITY trial in which naïve and PRP treated PDR patients were randomised to receive either aflibercept or PRP. BCVA and LLVA were assessed at baseline and at week 52. Our analyses showed that the BCVA and LLVA correlate well in treatment naïve PDR with an average low luminance deficit of 11.79 Early Treatment Diabetic Retinopathy Score (ETDRS) letters. However, LLVA at lower levels of BCVA showed more variance. Post aflibercept therapy, the mean change in BCVA and LLVA at 52 weeks after aflibercept was +2.1 (SD 6.05) letters and +0.39 (SD 5.6) letters, respectively. Similarly, after PRP, it was −2.5 (SD 4.9) letters and −1.9 (SD 8.7) letters, respectively. When comparing treatment arms, BCVA change was found to be statistically significant (p < 0.001) whereas LLVA was not (p = 0.11). These findings show that LLVA does not respond as well as BCVA following any treatment for PDR, even though BCVA and LLVA both test foveal function.

Internal limiting membrane peeling during vitrectomy for idiopathic epiretinal membrane: a meta‐analysis

PurposeTo study the effect of internal limiting membrane (ILM) peeling in removal of idiopathic epiretinal membranes (ERMs) through meta‐analysis.MethodsWe searched PubMed for studies published until 30/4/2018. Inclusion criteria included cases of idiopathic epiretinal membranes, treated with vitrectomy with or without ILM peel. Exclusion criteria consisted of coexisting retinal pathologies and use of ICG to stain the ILM. We conducted a meta‐analysis of 16 published studies as well as a case series of 50 eyes with epiretinal membrane (ERM) treated in our department. We compared the results of surgical removal of epiretinal membrane, with or without ILM peel, in terms of best‐corrected visual acuity (BCVA) and anatomical restoration of the macula (central foveal thickness—CFT). Studies or subgroups of patients that had indocyanine green (ICG) used as an ILM stain were excluded from the study, due to evidence of its retinal toxicity.ResultsThere was a consistency in results for post‐operative/pre‐operative BCVA and CFT levels in both groups of patients (with or without ILM peel). In all cases, we found a statistically significant increase (p &lt; 0.05) in post‐operative BCVA and decrease (p &lt; 0.05) in post‐operative CFT levels versus pre‐operative levels.ConclusionsVitrectomy for the removal of ERM combined with ILM peeling is an effective method for the treatment of patients with idiopathic ERM.

Altered visual functions, macular ganglion cell and papillary retinal nerve fiber layer thickness in early-treated adult PKU patients

PurposeRetinal changes are poorly described in early treated phenylketonuria (ETPKU). We aimed to investigate possible visual functional and ocular microstructural changes in adult patients with ETPKU. Optical coherence tomography (OCT) and its angiography (OCTA) data from patients with PKU were compared to healthy controls.MethodsIn this prospective, monocentric, cross-sectional, case-control study 50 patients with ETPKU and 50 healthy subjects were evaluated with OCT and OCTA. Measurements were performed on right eyes. The following visual function parameters were studied: best corrected visual acuity (BCVA), spherical equivalent (SE), contrast sensitivity and near stereoacuity; microstructural parameters: retinal nerve fiber layer thickness (RNFLT), ganglion cell layer (GCC) thickness, focal loss of volume (FLV), global loss of volume (GLV), peripapillary, papillary vessel density (VD), ocular axial length (AL) and intraocular pressure (IOP).ResultsAmong functional tests there were significant differences in contrast sensitivity at 1.5 (p < 0.001), 6 (p < 0.013), 12 (p < 0.001), 18 (p < 0.003) cycles per degree, in near stereoacuity (Titmus Wirt circles, p < 0.001) and in best corrected visual acuity (BCVA, p < 0.001). A statistically significant, moderate positive linear correlation was observed between BCVA and average Phe levels over the last ten years (β = 0.49, p < 0.001). The average (p < 0.001), superior (p < 0.001) inferior GCC (p < 0.001), the FLV (p < 0.003), GLV (p < 0.001) and the average RNFLT (p < 0.004) values of the PKU group were significantly lower than the controls. The serum phenylalanine level (Phe) in the PKU group negatively correlated with inferior (−0.32, p < 0.007), superior (r = −0.26, p < 0.028) and average (−0.29 p < 0.014) RNFL and with AL (−0.32, p < 0.026). In AL we detected a significant difference (p < 0.04) between the good and suboptimal dietary controlled group. There was no significant difference between the ETPKU and control group in the measured vessel density parameters and in IOP.ConclusionsOur results suggest that functional and ocular microstructural defects are present in patients with PKU, and some of them may depend on dietary control. The mechanism is unclear, but the correlation indicates the importance of strict dietary control in terms of preservation of retinal functions.

The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification.

To investigate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) with or without cataract extraction (CE) in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEX) patients. A retrospective, non-randomized study included 108 eyes of 108 patients, with a mean age of 65.96 ± 14.84years, who underwent GATT to treat open-angle glaucoma. We have compared two groups, GATT alone or GATT combined with CE and followed-up minimum for 12months. Preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with final IOP, medication numbers, and BCVA levels. Surgical success was determined as IOP reduction > 20% from baseline, IOP between 5-21mmHg, if surgery was done for intolerance to medications, preoperative < 21mmHg with medications, postoperatively < 21mmHg without medications, and no need for further glaucoma surgery. Also, we defined success with medications and success without medications. High success is defined as IOP < 16mmHg without medications. Success percentiles were found 87.5% for GATT and 83.8% for GATT with CE group (P = 0.811). IOP percentile changes were - 44.25 ± 21.32 in GATT group, - 32.29 ± 23.41 in GATT with CE group, statistically higher change observed in GATT group (P = 0.009). Final IOP levels were found statistically indifferent for comparing GATT and GATT with CE groups and between PEX and POAG groups (respectively, P = 0.412, P = 0.335). We observed GATT alone has a superior lowering effect on IOP than combined surgery. Final IOP values and success percentiles show us combined surgery is also effective.

Comparison of Two Different Accelerated Corneal Cross-linking Procedure Outcomes in Patients with Keratoconus

Background:Corneal cross-linking treatment is the unique treatment method that can cease the progression of keratoconus disease. Because of the long duration of conventional treatment, accelerated cross-linking treatment methods are being developed.Aims:To compare two different accelerated corneal cross-linking protocols in terms of postoperative visual acuity and topographic findings (higher-order aberrations and keratometry values).Study Design:Retrospective comparative study.Methods:Sixty-five eyes of 43 patients (30 men and 13 women) who underwent two different accelerated corneal cross-linking protocols (10 min, 9 mW/cm2 and 5 min, 18 mW/cm2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups according to the accelerated corneal cross-linking treatment protocol: group 1 (10 min, 9 mW/cm2, 32 eyes of 21 patients) and group 2 (5 min, 18 mW/cm2, 33 eyes of 22 patients). Uncorrected visual acuity and best-corrected visual acuity values and topographic findings (central corneal thickness and flat and steep keratometry values) were recorded preoperatively and 6 months after corneal cross-linking treatment. High-order aberration values measured with Pentacam preoperatively and 6 months after corneal cross-linking were also recorded.Results:In both groups, a significant improvement was detected in the uncorrected visual acuity and best-corrected visual acuity levels preoperatively and 6 months postoperatively (group 1: p=0.001, p=0.001 and group 2: p=0.001, p=0.001, respectively). In addition, central corneal thickness values decreased significantly in both groups (p=0.006 and 0.001). Trefoil values showed no significant difference preoperatively and 6 months postoperatively in group 1 (p=0.160 and 0.620, respectively). In groups 1 and 2, coma values were found to decrease significantly in the 6th postoperative month compared with preoperative values (p=0.001 and 0.020, respectively). There was no significant difference between preoperative and 6th month postoperative horizontal and vertical trefoil values in both groups (p=0.850 and 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and 6th month postoperative higher-order aberrations, refractive errors, keratometry values, and uncorrected visual acuity and best-corrected visual acuity levels.Conclusion:Both accelerated corneal cross-linking procedures provide similar improvement in topographic findings, coma values and visual acuity.