Best-corrected Visual Acuity Values Research Articles

İris Arkasına İntraoküler Lens İmplantasyonu Uzun Dönem Sonuçlarımız ve Diğer Gözle Karşılaştırılması

Objective: To evaluate the long-term results of primary and secondary posterior iris-claw intraocular lens (IOL) implantation and a comparative analysis with the fellow eye Material and Methods: One hundred-one eye of 99 patients who underwent iris-claw IOL implantation were included in this retrospective study. Data recorded for each subject consisted of preoperative and postoperative spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell count (ECC) values, and biomicroscopic findings. Patients were divided into two main groups according to primary (complicated cases) and secondary (aphakic cases) implantation. The comparison of the groups was made in terms of SE, BCVA, IOP, CCT, and ECC values. Also, postoperative CCT and ECC comparison was made between the fellow eye and irisclaw IOL implanted eyes. Results: Median duration of follow-up was 44.6 (range 1-83) months. While postoperative SE, IOP, CCT values were similar in two groups (p=0.754, p=0.621, p=0.520, respectively), postoperative BCVA and ECC values were statistically higher in the aphakic group than the complicated group (p=0.048, p=0.004, respectively). ECC values in iris-claw IOL-implanted eyes were lower than the same patients' fellow phakic eyes (p=0.003), but there was no statistically significant difference between iris-claw IOL-implanted eyes and the fellow pseudophakic eyes for ECC values (p=0.520). Conclusion: Although retropupillary iris-claw IOL fixation with scleral tunnel might be challenging, it is a safe and effective method with better visual and refractive outcomes.

Automatic prediction of treatment outcomes in patients with diabetic macular edema using ensemble machine learning.

BackgroundThis study aimed to predict the treatment outcomes in patients with diabetic macular edema (DME) after 3 monthly anti-vascular endothelial growth factor (VEGF) injections using machine learning (ML) based on pretreatment optical coherence tomography (OCT) images and clinical variables.MethodsAn ensemble ML system consisting of four deep learning (DL) models and five classical machine learning (CML) models was developed to predict the posttreatment central foveal thickness (CFT) and the best-corrected visual acuity (BCVA). A total of 363 OCT images and 7,587 clinical data records from 363 eyes were included in the training set (304 eyes) and external validation set (59 eyes). The DL models were trained using the OCT images, and the CML models were trained using the OCT images features and clinical variables. The predictive posttreatment CFT and BCVA values were compared with true outcomes obtained from the medical records.ResultsFor CFT prediction, the mean absolute error (MAE), root mean square error (RMSE), and R2 of the best-performing model in the training set was 66.59, 93.73, and 0.71, respectively, with an area under receiver operating characteristic curve (AUC) of 0.90 for distinguishing the eyes with good anatomical response. The MAE, RMSE, and R2 was 68.08, 97.63, and 0.74, respectively, with an AUC of 0.94 in the external validation set. For BCVA prediction, the MAE, RMSE, and R2 of the best-performing model in the training set was 0.19, 0.29, and 0.60, respectively, with an AUC of 0.80 for distinguishing eyes with a good functional response. The external validation achieved a MAE, RMSE, and R2 of 0.13, 0.20, and 0.68, respectively, with an AUC of 0.81.ConclusionsOur ensemble ML system accurately predicted posttreatment CFT and BCVA after anti-VEGF injections in DME patients, and can be used to prospectively assess the efficacy of anti-VEGF therapy in DME patients.

Factors Affecting Visual Gain after Accelerated Crosslinking in Pediatric Keratoconic Cases.

Objectives:This study was designed to evaluate factors affecting visual gain following accelerated crosslinking (A-CXL) in pediatric cases with keratoconus.Methods:Pediatric patients with a diagnosis of keratoconus who underwent A-CXL for 10 minutes ultraviolet A (UV-A) 9 mW/cm2 between February 2015 and May 2019 and had at least 1 year of follow-up data were analyzed retrospectively. Uncorrected visual acuity, best corrected visual acuity (BCVA), and refractive value changes (spherical, cylindrical values) at the preoperative and postoperative 12th month were compared. Correlation analysis was used to evaluate the relationships between visual gain and corneal topography values (K1, K2, Kmaximum [Kmax], anterior elevation, posterior elevation) obtained using a Sirius topography device (Costruzione Strumenti Oftalmici, Florence, Italy).Results:A total of 33 eyes of 22 patients (mean age: 16.85±1.15 years) who underwent A-CXL (9 mW/cm2 UVA irradiation for 10 minutes) were included in the study. The mean BCVA had increased from 0.45±0.27 logMAR to a mean of 0.33±0.24 logMAR at the end of 1 year (p=0.014). Changes to spherical and cylindrical values were not statistically significant (p>0.05). The correlation analysis revealed a statistically significant relationship between visual gain and the preoperative BCVA and the preoperative Kmax.Conclusion:The study results indicated that the visual gain at 1 year after A-CXL (10 minutes at 9 mW/cm2) was associated with preoperative BCVA and Kmax values in pediatric cases of keratoconus.

The effect of amblyopia on clinical outcomes of children with astigmatism.

Background:Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood.Objective:To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism.Methods:We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes.Results:The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes.Conclusion:A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.

Retinal morphological changes during the two years of follow-up in Parkinson's disease.

The study aims to investigate the relationship between the progression of idiopathic Parkinson's disease (IPD) and retinal morphology. The study was carried out with 23 patients diagnosed with early-stage IPD (phases 1 and 2 of the Hoehn and Yahr scale) and 30 age-matched healthy controls. All patients were followed up at least two years, with 6-month intervals (initial, 6th month, 12th month, 18th month, and 24th month), and detailed neurological and ophthalmic examinations were performed at each follow-up. Unified Parkinson's Disease Rating Scale part III (UPDRS Part III) scores, Hoehn and Yahr (H&Y) scores, best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were analyzed at each visit. The average age of the IPD and control groups was 43.96 ± 4.88 years, 44.53 ± 0.83 years, respectively. The mean duration of the disease in the IPD group was 7.48 ± 5.10 months at the start of the study (range 0-16). There was no statistically significant difference in BCVA and IOP values between the two groups during the two-year follow-up period (p> 0.05, p> 0.05, respectively). Average and superior quadrant RNFL thicknesses were statistically different between the two groups at 24 months and there was no significant difference between other visits (p=0.025, p=0.034, p> 0.05, respectively). There was no statistically significant difference in CMT between the two groups during the follow-up period (p> 0.05). Average and superior quadrant RNFL thicknesses were significantly thinning with the progression of IPD.

Evaluation of changes in corneal volume, volume and angle of anterior chamber in keratoconus patients using Pentacam after CXL.

Introduction and Objective:Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of mechanical stability of the cornea and prevention of keratoconus progression. The present study aimed at the evaluation of the changes in the corneal volume (CV), volume, and the angle of anterior chamber in keratoconus patients using the Pentacam after CXL.Methods:This prospective study was performed on 48 eyes of 24 patients (including 12 men, 17–33 years old) with progressive keratoconus undergoing CXL treatment at collagen cross-linking Imam Khomeini Hospital in Ahvaz in 2019. The CV (CV) and anterior chamber parameters such as anterior chamber volume (ACV) and anterior chamber angle (ACA) were measured using the Pentacam before CXL and at 6 and 12 months after CXL. Also, all of the patients were evaluated in terms of best-corrected visual acuity (BCVA), during the follow-up.Results:The pre-CXL values of BCVA was significantly lower than the post-CXL values in 6 and 12 months (0.18 ± 0.11, 0.15 ± 0.10, and 0.11 ± 0.10, respectively, P < 0.0001). In general, there was a significant improvement in the BCVA (P < 0.0001), a significant decrease in the CV (P = 0.001), and a significant increase in the ACV (P < 0.0001), and angle (P < 0.0001) 6 and 12 months after CXL.Conclusion:It seems that CXL has a positive effect on the anterior chamber parameters (ACV and ACA) and CV after 6 months and 1 year in the treatment of keratoconus patients. In addition, the visual acuity improves after CXL. Finally, further studies with a higher sample size and longer follow-up periods are recommended.

The Effect of Cone Localization on Higher Order Aberrations After Corneal Crosslinking for Keratoconus.

Objectives:This study was designed to evaluate the effects of corneal collagen cross-linking (CXL) on topographic parameters, visual acuity, and corneal high-order aberrations according to the preoperative cone location in keratoconus.Methods:This retrospective study assessed patients with keratoconus who underwent CXL between March 2016 and February 2019. Patients with a history of corneal surgery, corneal hydrops, corneal scar tissue, delayed epithelial healing, and a corneal thickness of <400 μm were excluded. The included eyes were divided into 2 groups according to the preoperative cone location: maximum K in the central 3-mm optical zone (group 1) or the central 3-mm to 5-mm optical zone (group 2). The preoperative and postoperative 24-month, best-corrected visual acuity (BCVA), intraocular pressure, K max, symmetry index front, corneal thickness, and high order aberration findings were recorded.Results:The study included 67 eyes of 67 patients with keratoconus: 39 in group 1, and 28 in group 2. There were statistically significant differences between the groups in the preoperative BCVA values (p=0.04). There was no significant difference between the preoperative and postoperative mean K max between the 2 groups (p=0.08). The mean difference in corneal thickness between preoperative and postoperative measurements was significantly lower in group 2 than in group 1 (p=0.03). The preoperative and postoperative mean spherical aberration was significantly higher in group 1 than in group 2 (p=0.001 and p=0.005, respectively).Conclusion:The preoperative cone location in keratoconus may affect CXL outcomes. At the end of the second year, CXL was found to have a similar efficacy on visual acuity and keratometry parameters in the central and paracentral cone groups, and the recovery in terms of a spherical aberration among high-order aberrations after CXL in the central cone group was better than that of the paracentral cone group.

Evaluation of the Morphology of Ganglion Cell Complex and Functional Outcomes after Internal Limiting Membrane Peeling with Macular Abrasion in Idiopathic Macular Hole.

Aim This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH). Methods This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups. Results Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups (P < 0.01). Contrast sensitivity progressively improved in all patients and was statistically significant (P < 0.01). The reduction in GCC thickness during follow-up was 34%–42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01, respectively. Conclusion Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome.

Evaluation of lens clarity in children with atopic dermatitis: A densitometric analysis with Pentacam.

The association of atopic dermatitis (AD) with a wide variety of ocular complications is known; however, there is no study in the literature that measured lens densitometry in pediatric patients with AD. This study aimed to investigate lens densitometry in children with AD. In order to examine ocular complications in AD, 31 pediatric patients (13 males, 18 females; mean age 12 ± 3 years) with AD and 20 healthy children (9 males, 11 females; mean age 12 ± 2 years), who presented to the dermatology clinic of Istanbul Medipol Mega University between December 2018 and May 2019 were included in this study. The diagnosis of AD was based on the UK Working Party's Diagnostic Criteria for AD. Patients receiving inhaler and systemic steroids were excluded from the study. All children were examined by the same dermatologist and ophthalmologist. The mean values of best-corrected visual acuity, refractive error, and axial length were similar between both groups (P > .05). The lens densitometry values of zone 1, zone 2, and zone 3, as well as the average lens densitometry measurements were found statistically significantly higher in children with AD compared to the controls (P < .05 for all). This is the first study to demonstrate an increase in treatment-independent lens densitometry in children with AD.

Short-Term Results of Ocriplasmin Versus Prompt Vitrectomy for Macular Hole. Which Performs Better?

In this retrospective study, we compared the anatomical and functional changes in patients with vitreomacular traction associated with macular holes between the following groups: (1) Patients who were treated with a single intravitreal injection of ocriplasmin (the OCRIALONE group); (2) those who failed the ocriplasmin treatment and underwent vitrectomy one month later (the OCRIVIT group); and (3) patients who directly underwent par plana vitrectomy (VITREALONE group). A total of 38 patients, 19 in the OCRIALONE group + OCRIVIT group (seven and 12 patients, respectively) and 19 in the VITREALONE group with focal vitreomacular adhesion associated with macular holes were evaluated with spectral domain optical coherence tomography. Functional examinations included best-corrected visual acuity (BCVA) and microperimetry analysis. Visual function changes were compared between the OCRIALONE group + OCRIVIT group and VITREALONE group up to three months. Furthermore, a subgroup analysis compared the OCRIVIT group and the VITREALONE group. BCVA values and the mean retinal sensitivity showed statistically significant improvement in all groups (p < 0.001). Specifically, the retinal sensitivity values at the end of the follow-up were significantly higher in the OCRIALONE group + OCRIVIT group than in the VITREALONE group. These functional findings were also confirmed when the statistical analysis was conducted between the OCRIVIT group and the VITREALONE group. Although the OCRIALONE group + OCRIVIT group exhibited faster retinal thinning than the VITREALONE group (p = 0.006), the analysis of the OCRIVIT group versus the VITREALONE group did not show any statistically significant difference. The better functional results and similar anatomical findings suggest that ocriplasmin can be used as a first-line treatment, and that prompt pars plana vitrectomy as primary surgery does not provide better outcomes in comparison with pars plana vitrectomy after ocriplasmin injection.

Two-year results of a combined regimen of aflibercept treatment in three types of choroidal neovascular membrane in the wet form of age-related macular degeneration: Real-life evidence in the Czech Republic.

To present the results of a 2-year therapy with aflibercept in real-life practice in a mixed regimen in patients with a neovascular form of age-related macular degeneration (nAMD) and to evaluate the treatment response of various types of choroidal neovascular membranes (CNV) - occult (Type 1), classic (Type 2) and minimally classic (Type 4). This was a multicentric, prospective, observational study of a series of cases. Patients diagnosed with the wet form of AMD were treated in a fixed regimen (3 injections at intervals of 1 month and then injections at 8-week intervals) in the first year, and in a pro re nata regimen (PRN) in the second year. The period of investigation was 24 months. The development of the best corrected visual acuity (BCVA) was evaluated by means of ETDRS optotypes (Early Treatment Diabetic Retinopathy Study) and the central retinal thickness (CRT). Measurements were performed prior to the commencement of therapy and then after 4, 8, 12, 16, 20 and 24 months. The therapeutically naïve group consisted of 135 eyes of 135 patients. Sixty-one eyes suffered from CNV of the 1st type, 50 eyes from CNV of the 2nd type and 24 eyes from CNV of the 4th type. The average baseline of BCVA ± SD in Type 1 CNV was 56.1 ± 10.8 letters of ETDRS, and then, respectively, 62.2 ± 12.9 letters, 62.8 ± 15.1 letters and 59.4 ± 13.2 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD for Type 1 CNV was 442.4 ± 194.9 µm, and then 302.5 ± 144.4 µm, 277.7 ± 106.5 µm and 327.6 ± 138.6 µm at months 4, 12 and 24. The average baseline value of BCVA ± SD in Type 2 CNV was 55.6 ± 9.9 letters of ETDRS, and then 62.5 ± 11.1 letters, 62.5 ± 14.2 letters and 60.6 ± 15.1 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 2 CNV was 446.8 ± 159.1 µm, and then 327.4 ± 127.0 µm, 316.7 ± 139.1 µm and 352.5 ± 132.4 µm at 4, 12 and 24 months. In Type 4 CNV, the average baseline value of BCVA ± SD was 56.7 ± 9.0 letters of ETDRS, and then 59.1 ± 10.6 letters, 59.2 ± 12.6 letters and 58 ± 8.8 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 4 CNV was 492.1 ± 187.0 µm, and then 333.3 ± 137.5 µm, 326.7 ± 122.4 µm and 328.4 ± 132 µm at months 4, 12 and 24. All these changes were statistically significant (p < 0.05). Therapy with aflibercept in a mixed regimen in patients with the wet form of AMD during the investigation resulted in a statistically significant improvement in BCVA and decrease in CRT in both the occult and classic type of CNV. Both the functional and anatomical response to therapy was worse in the minimally classic type (Type 4) of CNV. Patients suffering from the neovascular form of age-related macular degeneration were treated with aflibercept in a mixed regimen (fixed in the first year and PRN in the second year). After 24 months of examination, a significant improvement of both morphological and functional results was observed in three types of choroidal neovascular membrane.

Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study.

To investigate the prognostic factors associated with functional and anatomical outcomes and to assess the longitudinal course of visual acuity and retinal morphology after vitreoretinal surgery for idiopathic epiretinal membrane (ERM). This multicenter, retrospective study included a total of 634 eyes who underwent surgery for idiopathic ERM in 22 academic centers nationwide in Turkey. Data on best-corrected visual acuity (BCVA) and optical coherence tomography features (central foveal thickness (CFT), ERM and foveal contour morphology, ellipsoid zone (EZ) integrity) were collected and compared at baseline, 6-month, 12-month, and 24-month follow-ups. Prognostic factors for functional (having ≥ 20/25 Snellen BCVA) and anatomical (having normal/shallow foveal contour) recoveries after surgery were investigated by means of multivariate regression analyses. A cutoff value of preoperative BCVA optimizing functional recovery was calculated using receiver operating characteristic curve analysis. At a median follow-up of 24months, 37.4% of the eyes achieved ≥ 20/25 BCVA and 54% regained normal or shallow foveal contour. Functional recovery was more likely in eyes with better baseline BCVA and intact EZ (R2 = 0.356, p < 0.001). The cutoff baseline BCVA value for good visual prognosis was 0.35 logarithm of the minimum angle of resolution (Snellen 20/44) (sensitivity 60%, specificity 85%, p < 0.001). Anatomical recovery was negatively associated with advanced age, higher baseline CFT, foveal herniation-type ERM morphology, and internal limiting membrane (ILM) peeling (R2 = 0.225, p < 0.001). The negative effect of ILM peeling on anatomical recovery was not significant after the first postoperative year (p = 0.05). Mean BCVA values and foveal morphology progressively improved at each visit. Cases with convex baseline foveal contour continued to change towards normal foveal depression over 24months of follow-up, which took longer than the eyes with shallow/flat contoured cases. One-third of eyes with severe baseline EZ defects showed recovery at follow-up and achieved significantly greater visual acuity gains than the remaining eyes with persistent defects (p < 0.001). Functional and anatomical restoration of the eyes appears to be a slow process after ERM surgery. This process may take much longer in eyes with worse foveal morphology at baseline. Although photoreceptor disruption may be reversible in some eyes, full functional recovery is unlikely when it persists.

Subthreshold micropulse laser versus intravitreal anti-VEGF for diabetic macular edema patients with relatively better visual acuity.

To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th, and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience.

To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011-2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectral-domain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of ≥ 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8years-old. Median (range) follow-up was 21 (3-92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%). The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01-1.02) independently predicted a final BCVA (logMAR) < 0.3 units. Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome.

Optical Coherence Tomography Biomarkers of Inflammation in Diabetic Macular Edema Treated by Fluocinolone Acetonide Intravitreal Drug-Delivery System Implant.

IntroductionThe fluocinolone acetonide (FAc) intravitreal drug-delivery system implant is a recent, second-line, intravitreal drug for the management of diabetic macular edema (DME). FAc acts against DME with a major anti-inflammatory effect. Despite the already proved efficacy, a number of patients still show persistent DME and require anti-VEGF retreatment. The main aim of the present study was to assess the relationship between quantitative biomarkers of inflammation and both DME recovery and the need for additional anti-VEGF in eyes treated by FAc implant.MethodsThe study was designed as prospective and interventional with 1 year of follow-up. We analyzed structural optical coherence tomography (OCT) quantitative biomarkers of inflammation, namely choroidal hyperreflective foci (HF) and the choroidal vascularity index (CVI), and we assessed the relationship with other clinically relevant biomarkers and the outcome achieved after 1 year. Moreover, we stratified DME eyes in good and poor responders to FAc implant to highlight clinically relevant differences.ResultsOur study included 50 eyes (50 patients) treated by FAc implant. We found significant best-corrected visual acuity (BCVA) and central macular thickness (CMT) improvements after 1 year. Good responders started with worse visual acuity and higher CMT than poor responders, but gained letters significantly at the end of the follow-up, whereas poor responders showed stable BCVA values. Good responders were characterized by significantly higher choroidal HF and lower CVI than poor responders. Poor responders required significantly higher additional anti-VEGF treatments.ConclusionsQuantitative structural OCT biomarkers of inflammation allowed distinguishing different inflammatory profiles of DME. The inflammatory component helped to categorize DME eyes in good and poor responders to FAc implant.

Prognostic factors of cytomegalovirus retinitis after hematopoietic stem cell transplantation.

To identify the visual prognostic factors in patients with cytomegalovirus (CMV) retinitis after hematopoietic stem cell transplantation (HSCT). This retrospective cohort study included 4241 patients who underwent HSCT from April 1, 2010 to March 31, 2019 at Seoul St. Mary's Hospital. Of them, 1063 patients presented CMV viremia, and 67 patients (93 eyes) were diagnosed with CMV retinitis. We enrolled 66 patients (91 eyes). The main outcomes included the initial best-corrected visual acuity (BCVA), BCVA at the diagnosis of retinitis and last visit, involved retinal zone, peak CMV DNA levels in the peripheral blood and aqueous humor, time between HSCT and the diagnosis of retinitis, time between the diagnosis of viremia and retinitis, complications, recurrence, survival, and so on. The mean BCVA (logarithm of the minimum angle of resolution) values before HSCT, at the time of retinitis diagnosis, and at the last visit were 0.041 ± 0.076, 0.262 ± 0.529, and 0.309 ± 0.547, respectively. Multiple regression analysis revealed that the involved zone (P = 0.001), time between HSCT and retinitis diagnosis (P = 0.019), and survival status (P = 0.001) were associated with the final visual acuity. The final visual prognosis was worse in patients with greater invasion of the central retinal zone, those with a longer interval between HSCT and the diagnosis of retinitis, and those who died. Prompt diagnosis of CMV retinitis through periodic fundus examinations of patients with CMV viremia can prevent severe vision loss. Once CMV viremia is confirmed, we recommend fundus examinations to be immediately performed and repeated every 2 weeks for at least 2 months, even if the CMV DNA titer in the peripheral blood becomes negative.

Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis.

The aim of this study was to compare the effectiveness of intravitreal ranibizumab (IVR) injections for the treatment of diabetic macular edema (DME) in eyes with and without previous vitrectomy. The medical records of 28 eyes (11 vitrectomized and 17 nonvitrectomized) of 28 patients (mean age, 59.0 ± 9.6 years; male to female ratio 1 : 1) who were diagnosed with DME and had received IVR treatment were reviewed retrospectively. The indications of vitrectomy in 11 vitrectomized eyes were intravitreal hemorrhage (n = 8) and epiretinal membrane (n = 3). The best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) were measured at baseline and at months 6, 12, 18, and 24 of the follow-up. The number of IVR injections, the duration between diagnosis of DME and IVR injection, and the hemoglobin A1c (HbA1c) level at baseline were also recorded. Baseline demographics, HbA1c, BCVA, CMT, and TMV values were similar between two groups (p > 0.05). The duration between diagnosis of DME and IVR injections was similar in both groups (16 ± 5 months vs. 13 ± 4 months, respectively; p=0.11). IVR injection was performed 6.3 times in vitrectomized eyes and 6.1 times in nonvitrectomized eyes during the 24-month period (p > 0.05). The mean BCVA improved significantly during the 24-month period in both groups. The improvements in BCVA, in CMT, and in TMV were more significant at month 6 (p=0.036) group, at month 12 (p=0.013), at month 12 (p=0.021), and month 24 (p=0.021) in nonvitrectomized eyes, respectively, while there was no difference in improvements of BCVA, CMT, and TMV in vitrectomized group at each visit. Treatment effected by time in terms of BCVA, CMT, and TMV values in all groups (p=0.0004, p < 0.0001, p < 0.0001, respectively), not by time-group interaction and group (all p values >0.05). In conclusion, IVR treatment for DME is equally effective in both groups. However, the response to treatment is seen earlier in nonvitrectomized eyes compared to vitrectomized eyes.

Prediction of Function in ABCA4-Related Retinopathy Using Ensemble Machine Learning.

Full-field electroretinogram (ERG) and best corrected visual acuity (BCVA) measures have been shown to have prognostic value for recessive Stargardt disease (also called “ABCA4-related retinopathy”). These functional tests may serve as a performance-outcome-measure (PerfO) in emerging interventional clinical trials, but utility is limited by variability and patient burden. To address these limitations, an ensemble machine-learning-based approach was evaluated to differentiate patients from controls, and predict disease categories depending on ERG (‘inferred ERG’) and visual impairment (‘inferred visual impairment’) as well as BCVA values (‘inferred BCVA’) based on microstructural imaging (utilizing spectral-domain optical coherence tomography) and patient data. The accuracy for ‘inferred ERG’ and ‘inferred visual impairment’ was up to 99.53 ± 1.02%. Prediction of BCVA values (‘inferred BCVA’) achieved a precision of ±0.3LogMAR in up to 85.31% of eyes. Analysis of the permutation importance revealed that foveal status was the most important feature for BCVA prediction, while the thickness of outer nuclear layer and photoreceptor inner and outer segments as well as age of onset highly ranked for all predictions. ‘Inferred ERG’, ‘inferred visual impairment’, and ‘inferred BCVA’, herein, represent accurate estimates of differential functional effects of retinal microstructure, and offer quasi-functional parameters with the potential for a refined patient assessment, and investigation of potential future treatment effects or disease progression.

Comparative Results of “Epi-Off” Conventional versus “Epi-Off” Accelerated Cross-Linking Procedure at 5-year Follow-Up

Purpose The aim of our study was to compare the long-term efficacy and safety of “epi-off” conventional and “epi-off” accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods “Epithelial-off” (“Epi-off”) CXL using the conventional technique (3 mW/cm2, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and “epi-off” accelerated method (9 mW/cm2, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. Results In both groups, Kflat presented similar results: decrease at 1 year (p=0.465), at 2 years (p=0.672), at 3 years (p=0.198), at 4 years (p=0.32), and at 5 years (p=0.864). In both groups, Ksteep presented a similar decrease at 1 year (p=0.709), at 2 years (p=0.455), at 3 years (p=0.43), at 4 years (p=0.57), and at 5 years (p=0.494), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p=0.18 at 1 year, p=0.093 at 2 years, p=0.57 at 3 years, p=0.154 at 4 years, and p=0.247 at 5 years). Kmax had a similar decrease in both groups at 1 year (p=0.06), at 2 years (p=0.09), at 3 years (p=0.126), at 4 years (p=0.113), and at 5 years (p=0.114). There was no statistically significant difference between the cylinder decrease in both groups (p=0.349 at 1 year, p=0.6782 at 2 years, p=0.299 at 3 years, p=0.0943 at 4 years, and p=0.144 at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p < 0.05). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. Conclusion “Epi-off” accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.

Combined Intrastromal Voriconazole and Amphotericin B Treatment for Persistent Fungal Keratitis.

To evaluate the clinical outcomes of combined intrastromal voriconazole and intrastromal amphotericin B for the treatment of persistent fungal keratitis. Patients who received combined corneal intrastromal voriconazole (0.05 mg/0.1 mL) and intrastromal liposomal amphotericin B (0.01 mg/0.1 mL) injections in addition to topical therapy for treatment of persistent fungal keratitis were included in the study. Persistence was described as no improvement or progression in the clinical findings despite treatment with combined topical voriconazole (1 mg/0.1 mL) and topical amphotericin B drops (0.15 mg/0.1 mL) hourly for at least 10 days. The healing of keratitis was considered as the complete closure of epithelial defect with complete resolution of a corneal infiltrate. Thirty-two eyes of 32 patients who met the inclusion criteria were included in this study. Predominant organisms in fungal isolates were Aspergillus species. Combination therapy of intrastromal amphotericin B and intrastromal voriconazole in addition to topical therapy resulted in complete resolution of persistent fungal keratitis in 28 (87.5%) patients. The mean number of intrastromal injections was 9.3±6.4 and ranged from 1 to 18. The mean best-corrected visual acuity values improved from 2.17±0.43 to 1.76±0.77 logarithm of the minimum angle of resolution units (P=0.003). The mean duration of complete epithelial closure was 45.3±16.3 days. Four patients required therapeutic penetrating keratoplasty because of persistence of fungal keratitis (3 patients) and progression of keratitis (1 patient). There was no need for evisceration. Combination therapy with intrastromal voriconazole and intrastromal amphotericin B may be an effective adjunct treatment for persistent fungal keratitis.