Corrected Snellen Visual Acuity Research Articles

Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis.

To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis (TGU). Patients of cataract with TGU in the membranous (inactive) stage underwent cataract surgery with intraocular lens (IOL) implantation. Preoperative history and ophthalmic examination were conducted for all cases, whereas Schimphlug imaging and corneal topography were done for some patients. Postoperative follow up was done on the 1st, 2nd, and 5th postoperative days after surgery. Then, it was done at least at one, three, and six months postoperatively. Intraoperative and postoperative complications and the methods of their management were reported. Twelve eyes of 12 male children were included in this study ranging from 8 to 16y. The mean best corrected Snellen visual acuity (BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively (P<0.001). Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea. Intraoperative difficulties and complications included the poor dilatability of the drown down pupil, strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema. All cases underwent primary hydrophobic IOL implantation. Surgery for this type of cataract is relatively safe and effective. It is associated with some specific difficulties and complications that should be considered during surgery and follow up.

Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study

To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case–control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM. Epithelialization and Best Corrected Snellen Visual Acuity (BCSVA) were compared between the two groups. At baseline, both groups had comparable age, gender, visual acuity (VA), size and location of corneal ulcer. Patients receiving additional placement of cryopreserved AM had significantly faster epithelialization within 3.56 ± 1.78 weeks vs 5.87 ± 2.20 weeks (p = 0.01) and achieved complete epithelialization in significantly more patients (72.7% vs 23.1% p = 0.04) despite overall larger baseline defect size (32.7 ± 19.5 mm2 vs 21.5 ± 10.7 mm2, p = 0.11). Consequently, the AM group had clinically significant BCSVA (> 3 lines) (81.8% vs 38.4%, p = 0.047) and total VA improvement (log MAR 0.7 ± 0.6 vs 1.6 ± 0.9, p = 0.016) compared to the control group at the time of complete epithelialization. In-office sutureless AM may be an effective adjuvant therapy in treating sight-threatening infectious corneal ulcers by promoting faster corneal epithelialization and overall better recovery of the VA.

THE EFFECT OF CORNEAL TRANSPLANTATION ON VISUAL FUNCTION AND VISION-RELATED QUALITY OF LIFE

Introduction: The success of corneal transplantation surgery is usually determined by graft clarity, absence of complications such as rejection, low astigmatism, and good visual acuity. However, patients are often more concerned about their visual function and its impact on their activities of daily living which are determinants of vision-related quality of life (QOL). Currently it is agreed upon that the real success of a medical intervention can be measured by its effect on the quality of life.[1] The patients’ expectations may not be met, and they may still experience poor functional outcome despite successful corneal transplantion.[2] National Eye Institute Visual Function Index 14 (NEI VF-14) was designed and validated to assess vision-related functioning in patients undergoing cataract surgery, but it has also been validated for use with other eye conditions such as glaucoma, retinal, and corneal diseases.[3][4][5][6] The aim of this study was to assess the QOL and satisfaction of patients who underwent corneal transplantation by using the NEI VF-14. Patients and Methods: Survey data using a modified version of the VFI were collected at the 3rd postoperative month from 38 patients who underwent corneal transplantation in 2018 at Baskent University Faculty of Medicine. The questionnaire was administered by a trained researcher (LA) in a face-to-face manner. The grading was performed as follows: 0, no difficulty; 1, a little difficulty; 2, moderate difficulty; 3, quite difficult; 4, impossible to perform. Sociodemographic and clinical data, including age, sex, initial and follow-up visual acuities, were collected. QOL survey measures were compared with patients’ clinical findings to assess the differences between objective and subjective visual functioning. Results: Mean age of the patients was 54.5±11.4 years. All patients underwent an uneventful surgery and had no complications during follow-up (Figure 1).Fig. 1. Mean best corrected Snellen visual acuity was 0.32±0.21 preoperatively and increased to 0.56±0.24 at the end of the 3rd month. The results of the NEI VF-14 questionnaire are shown in Figure 2.Fig. 2. The most difficult tasks to perform were reading small print, reading traffic signs, doing fine handwork and driving at night. Although there was almost a twofold increase in mean visual acuity, most patients reported difficulty in daily activities with mean scores between 1.07 and 3.82 for different tasks. Discussion: Corneal transplantation patients face difficulties in many daily activities at the 3rd postoperative month and report a low QOL despite increase in vision. Studies have shown that depression is common among adults with visual impairment.[7] This is of relevance to corneal graft recipients and might be the reason for the reported low QOL after corneal transplantation. Conclusion: Corneal graft recipients should receive preoperative counselling helping them to gain a realistic expectation of the outcome following corneal transplantation.

Successful treatment of ciliary body medulloepithelioma with intraocular melphalan chemotherapy: a case report

BackgroundIntraocular medulloepithelioma is commonly treated with primary enucleation. Conservative treatment options include brachytherapy, local resection and/or cryotherapy in selected cases. We report for the first time the use of targeted chemotherapy to treat a ciliary body medulloepithelioma with aqueous and vitreous seeding.Case presentationA 17-month-old boy with a diagnosis of ciliary body medulloepithelioma with concomitant seeding and neovascular glaucoma in the right eye was seen for a second opinion after parental refusal of enucleation. Examination under anesthesia showed multiple free-floating cysts in the pupillary area associated with iris neovascularization and a subluxated and notched lens. Ultrasound biomicroscopy revealed a partially cystic mass adjacent to the ciliary body between the 5 and 9 o’clock meridians as well as multiple nodules in the posterior chamber invading the anterior vitreous inferiorly. Fluorescein angiography demonstrated peripheral retinal ischemia. Left eye was unremarkable. Diagnosis of intraocular medulloepithelioma with no extraocular invasion was confirmed and conservative treatment initiated with combined intracameral and intravitreal melphalan injections given according to the previously described safety-enhanced technique. Ciliary tumor and seeding totally regressed after a total of 3 combined intracameral (total dose 8.1 μg) and intravitreal (total dose 70 μg) melphalan injections given every 7–10 days. Ischemic retina was treated with cryoablation as necessary. Three years later, ab interno trabeculotomy followed by 360° gonioscopy-assisted transluminal trabeculotomy 6 months later was performed for uncontrolled intraocular pressure despite antihypertensive drugs combined to cyclophotocoagulation and 7 intravitreal anti-VEGF injections for recurrent iris neovascularization. Cataract was removed at the same operative time. The child has remained disease- and metastasis-free at a 5-year follow-up since the last melphalan injection (25-month follow-up after the combined lensectomy-trabeculotomy) with a controlled intraocular pressure under topical quadritherapy and a best corrected Snellen visual acuity of 0.08.ConclusionsWe report for the first time complete regression of a non-infiltrating ciliary body medulloepithelioma with seeding achieved with only a small number of intracameral and intravitreal melphalan injections. Concomitant secondary neovascular glaucoma and cataract needed appropriate management to allow long-term eye and vision preservation.

Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

The Disease Course of Bilateral Endogenous Fungal Endophthalmitis

Purpose: To report the dynamic disease course of a case of bilateral endogenous fungal endophthalmitis, which was successfully treated. Case Report: A 54 year old Chinese man with a history of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy was referred to our center. After 1 week, his best corrected Snellen visual acuity (BCVA) values were 20/100 and 20/25; the interface between the posterior vitreous face and the retinal surface appeared to be rough in the right eye, and a similar, larger, low-rounded circumscribed apophysis could be observed in the left eye. During the 2nd week, his BCVA values decreased to 20/400 and 20/32. He was diagnosed with bilateral endogenous Candida albicans endophthalmitis after a vitreous biopsy and then underwent binocular pars plana vitrectomy (PPV) with silicone oil injection in both eyes. Postoperatively, his BCVA values were 20/63 and 20/32, and fundoscopy and optical coherence tomography (OCT) showed a regular and smooth interface and retina surface after the removal of the silicone oil at 3 months. Conclusions: We concluded that the rough interface between the posterior vitreous face and the retinal surface is one of the early typical sign of endogenous fungal endophthalmitis, which was treated with PPV with silicone oil injection and antifungal reagents.

Benchmarks for outcome indicators in pediatric cataract surgery.

PurposeThe purpose of this study was to establish benchmarks for outcome indicators that may help ascertain the quality of pediatric cataract surgery with primary intraocular lens (IOL) implantation.Patients and methodsA retrospective chart review of patients older than 2 years undergoing cataract surgery with primary IOL implantation, by multiple surgeons in a tertiary-care center, from November 2005 to February 2016 was conducted. Patients with ocular comorbidities that would affect the outcomes were excluded. The outcome measures chosen were as follows: (1) final best corrected Snellen visual acuity (BCVA) in patients who had bilateral cataract surgery analyzed at the last clinic visit; (2) prediction error (PE)=expected refraction-actual refraction. Mean PE and mean absolute PE were assessed 1 month postoperatively, irrespective of age or laterality.ResultsMean age at surgery was 8.3±4.6 years and mean follow-up duration was 3.7±2.7 years. The results of outcome measures were as follows: (1) BCVA was 20/40 or better in 96% (n=124 eyes, mean patient age: 8.3±4.6 years). Remaining five eyes had amblyopia with two eyes having BCVA worse than 20/100 that did not respond to amblyopia treatment. (2) Mean PE was 0.3±1.1 D and mean absolute PE was 0.9±0.7 D. PE was within ±0.5 D in 43.0%, ±1.0 D in 66%, and ±2.0 D in 95% (n=235 eyes).ConclusionGood visual acuity after cataract surgery should be expected for children with bilateral cataracts, setting a high benchmark similar to that recommended in adult cataract surgery. Prediction error is greater in pediatric eyes than in adult eyes, setting a lower benchmark. This study establishes benchmark for outcome indicators in pediatric patients older than 2 years undergoing cataract surgery with primary IOL implantation.

A novel homozygous c.1154+3_1151+6delAAGT mutation in CERKL causes autosomal recessive retinitis pigmentosa with a special phenotype in a consanguineous Tunisian Family

PurposeThe aim of our study was to assess the clinical phenotype and to determine the causative gene in a Tunisian family with an autosomic recessive retinitis pigmentose (arRP).MethodsAll accessible members of a consanguineous Tunisian family were included and underwent full ophthalmic examination with best corrected Snellen visual acuity, fundus photography, optical coherence tomography (SD‐OCT) and full field electroretinography (ERG). Index patient was selected for whole exome sequencing (WES) followed by homozygosity mapping. All detected variations were confirmed by direct Sanger sequencing.ResultsThe clinical data of the patients showed typical hallmarks of RP symptoms for which affected individuals initially experienced night blindness with progressive visual loss and hemeralopia since the first decade of life. Visual acuity at baseline ranged from 1/10 to 5/10. Funduscopy revealed essentially mild optic disc and retinal atrophy and virtually no clumped pigmentation. Macula was normal in young patients and showed atrophic alteration in advanced stages. ERG was unrecordable in scotopic conditions and the cone responses were markedly hypovolted. Homozygosity mapping and whole exome sequencing identified a 4‐pb deletion, c.1154+3_1151+6delAAGT, located in the donor splice site of intron 8 of CERKL. The mutation impacts pre‐mRNA splicing of CERKL. This new deletion was present at a homozygous state in the two affected sons and was heterozygous in the parents. It was not present in the unaffected sister.ConclusionsMutations in CERKL gene have been reported in patients with retinitis pigmentosa, c.1154+3_1151+6delAAGT is a novel splicing variant associated with arRP. Extending the mutation spectrum of CERKL with additional families is important for genotype‐phenotype correlations.

Stem Cell Ophthalmology Treatment Study (SCOTS): improvement in serpiginous choroidopathy following autologous bone marrow derived stem cell treatment.

We report results in a 77-year-old male patient with visual loss from long-standing serpiginous choroidopathy treated with bone marrow derived stem cells (BMSC) within the Stem Cell Ophthalmology Treatment Study (SCOTS). SCOTS is an Institutional Review Board approved clinical trial and the largest ophthalmology stem cell study registered at the National Institutes of Health to date (ClinicalTrials.gov Identifier: NCT01920867). Eight months after treatment by a combination of retrobulbar, subtenon, intravitreal and intravenous injection of BMSC, the patient's best corrected Snellen acuity improved from 20/80– to 20/60+1 in the right eye and from 20/50– to 20/20–3 in the left eye. The Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity continued to improve over the succeeding 8 months and the optical coherence tomography macular volume increased. The increases in visual acuity and macular volume are encouraging and suggest that the use of BMSC as provided in SCOTS may be a viable approach to treating serpiginous choroidopathy.

Clinical aspects of Autosomic Recessive Retinitis Pigmentosa Caused by USH2A Mutations in Consanguineous Tunisian Families

PurposeTo assess the clinical phenotype in consanguineous Tunisian families with non syndromic autosomic recessive retinitis Pigmentosa (arRP) caused by an USH2A mutation.MethodsAll accessible members of families were included and underwent full ophthalmic examination with best corrected Snellen visual acuity, kinetic visual field testing, fundus photography, optical coherence tomography and full field electroretinography. Haplotype analyses were used to test linkage in the families to 20 arRP loci, including ABCA4, LRAT, USH2A, RP29, CERKL, CNGA1, CNGB1, CRB1, EYS, RP28, MERTK, NR2E3, PDE6A, PDE6B, RGR, RHO, RLBP1, TULP1.ResultsThirty‐four patients from five families were ascertained for the study. Twelve of the 34 members were clinically affected with arRP without hearing loss. Age range at baseline was 27–68 years (mean age was 42.5 years). For all affected members, night blindness appeared during the second decade. Visual acuity at baseline ranged from 20/40 to 20/32. Kinetic visual field was severely constricted. Fundus examination revealed typical RP changes with bone spicule‐shaped pigment deposits in the mid periphery along with atrophy of the retina, narrowing of the vessels and waxy optic discs. Tomograms showed a thinning and even loss the outer nuclear layer of the fovea. ERG was unrecordable in scotopic conditions and the cone responses were markedly hypovolted.ConclusionsFor these families, changes were typical of those that have been described in patients with moderate to severe forms of non syndromic recessive RP. Our findings support the need to consider possible involvement of USH2A not only in patients with Usher syndrome but also in patients with non syndromc arRP. Despite consanguinity, the presence of non‐homozygous mutants illustrates the complexity of molecular analysis.

Posterior Pole Detachment Technique for the Management of Full Thickness Macular Hole

Purpose: To investigate the clinical characteristics, visual and anatomical outcomes of a series of large full thickness macular holes treated by vitrectomy, ILM peeling and gas tamponade augmented by retina expansion. Methods: Prospective, non-comparative, interventional case series of seven eyes of seven patients with Gass Stage 3 or above full thickness macular hole presenting to a vitreo-retinal unit of a tertiary eye hospital. All patients underwent 23 gauge pars plana vitrectomy, peeling of the internal limiting membrane, retina expansion through detachment of the posterior pole with injection of balanced salt via a 41-gauge subretinal cannula, and gas tamponade with sulfur hexafluoride gas. The main outcome measures were: anatomical closure of the macular hole and post-operative visual acuity. Results: Six cases were Gass Stage 3, and one Gass Stage 4. Preoperative visual acuity ranged from hand movement to 6/36. Patients were followed post operatively for a minimum of 6 months. Anatomical closure of the full-thickness macular hole was successfully achieved and confirmed on optical coherence tomography in six of the seven cases. All patients in our case-series recorded improved visual acuity by 6 months follow up. Six patients attained a postoperative best corrected Snellen visual acuity of 6/24 or better. Conclusion: The retina expansion technique has demonstrated promising results in improving anatomic and visual outcomes in patients with large, chronic, full thickness macular hole. The proposed mechanism is the undermining of the retina by fluid to facilitate approximation of the hole edge and aid migration of glial cells to close the foveal defect.

Effects of three consecutive monthly intravitreal injection of ranibizumab for polypoidal choroidal vasculopathy in Korea.

To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy (PCV) in Korea. A retrospective chart review of 25 patients (27 eyes) with PCV was conducted. Patients received three initial monthly intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12mo between January 2010 and October 2011. Reinjection of ranibizumab after three initial monthly loading was administered on an as-needed basis, guided by the optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA). The main outcomes were the changes of the mean best corrected Snellen visual acuity (VA), central macular thickness (CMT) by OCT, the changes of polyps and branching vascular network by FA and ICGA, and total number of injections received by patients during the 12mo. The mean best corrected Snellen visual acuities at baseline, 1, 3, 6 and 12mo after primary injection were 0.77±0.59, 0.76±0.53, 0.70±0.47, 0.63±0.43, 0.61±0.43, 0.62±0.42 logMAR, respectively, and showed significant improvement at 3, 6, 12mo (P=0.003, P=0.002, P=0.018, Wilcoxon signed-rank test). The mean CMT at baseline, 1, 2, 3, 6, and 12mo was 312.41±66.38 µm, 244.59±71.47 µm, 232.32±69.41 µm, 226.69±69.03 µm, 228.62±37.07 µm, 227.59±51.01 µm respectively, and showed significant reduction (all P<0.001, Wilcoxon signed-rank test). Polypoidal lesions resolved on ICGA in 3 eyes (11.1%) and a branching vascular network remained in all 24 eyes (88.9%). A total of 106 injections were given in the 12-month period, which equaled to a mean of 3.92 (range, 3-6) times. Sixteen of the 27 treated eyes had additional 1.56±0.91 injections. The others (11 eyes) had just 3 consecutive injections. An initial loading dose of three monthly ranibizumab injections is a safe and effective method in treating PCV, with visual and anatomical improvement over one year follow-up.

Tromsø eye study: prevalence and risk factors of diabetic retinopathy

To determine the prevalence of visual impairment, retinopathy and macular oedema, and assess risk factors for retinopathy in persons with diabetes. The present study included 514 participants with diabetes aged 46-87 years from the Tromsø Eye Study, a sub-study of the population-based Tromsø Study in Norway. Visual acuity was measured using an auto-refractor. Retinal images from both eyes were graded for retinopathy and macular oedema. We collected data on risk factor exposure from self-report questionnaires, clinical examinations, laboratory measurements and case note reviews. Regression models assessed the cross-sectional relationship between potential risk factors and diabetic retinopathy. The prevalence of visual impairment (corrected Snellen visual acuity <20/60 in the better-seeing eye) was 1.6%. The prevalence of diabetic retinopathy was 26.8% and macular oedema 3.9%. In a multivariable logistic regression model, retinopathy was associated with longer diabetes duration (odds ratio, OR 1.07, 95% CI 1.03-1.11), insulin use (OR 2.14, 95% CI 1.19-3.85), nonfasting glucose (OR 1.07, 95% CI 1.00-1.15) and microalbuminuria (OR 1.89, 95% CI 1.28-2.81). Sub-group analyses showed association between retinopathy and even low levels of microalbuminuria (1.16 mg/mmol). The findings suggest that low levels of microalbuminuria may be a useful risk predictor for identifying individuals with diabetes at high risk of retinopathy. The study confirms previous findings that insulin use, longer diabetes duration and higher levels of blood glucose are associated with retinopathy in persons with diabetes. The prevalence of diabetic retinopathy was similar as reported in other studies.

The Effect of Optic Asphericity on Visual Rehabilitation of Corneal Ectasia With a Prosthetic Device

To study the effect of optic asphericity on visual rehabilitation of corneal ectasia with a prosthetic device. Subjects with corneal ectasia treated with a fluid-ventilated gas-permeable prosthetic device of diameter 18.0-19.0 mm, who had subjective improvement of good Snellen vision with introduction of optic asphericity, were studied. Best corrected Snellen visual acuity (BCVA) under standard illumination, high contrast visual acuity (HCVA), low contrast visual acuity (LCVA), and wavefront aberrations were measured in a sequence of devices that varied per patient only in presence or amount of ellipsoidal front surface optical eccentricity (FSE). Five eyes of 5 subjects were studied. (M:F = 3:2; Age: 20-76). Mean steepest SimK was 57.72±8.30 D. BCVA was ≥20/30 in all eyes in all prosthetic devices, regardless of FSE. Although FSE improved BCVA, HCVA, and LCVA in each patient, no optimal amount could be identified in this small series. Asphericity in the form of 0.6 or 0.8 FSE improved HCVA, LCVA, or both in each patient. FSE was associated with a trend toward reduction of higher-order aberrations, particularly coma. Optic asphericity shows promise for optimization of vision in the rehabilitation of corneal ectasia with a prosthetic device.

Peripheral exudative haemorrhagic chorioretinopathy complicated with acute onset of visual loss

AbstractPurpose To report a case of unilateral peripheral exudative haemorrhagic chorioretinopathy (PEHCR) complicated with acute onset of visual loss.Methods A 64‐year‐old female presented with a one week history of sudden onset of visual loss in her left eye. There was no other relevant medical or family history. Best corrected Snellen visual acuity (BCVA) was documented and full ophthalmic examination was performed.Results BCVA was 1.0 in her right eye and hand movements in the left eye. Complete ophthalmic examination of her right eye was normal. Anterior segment examination of her left eye was unremarkable. There was no view of her left fundus. B‐scan ultrasonography revealed vitreous haemorrhage with no evidence of retinal detachment. Pars plana vitrectomy was performed few weeks later. At follow up examination fundoscopy revealed extensive subretinal and sub‐RPE haemorrhage in the retinal periphery temporal to the macula. Fundus fluorescein angiography (FFA) revealed patchy blockage of the background choroidal fluorescence corresponding to the suretinal/sub‐RPE haemorrhage. Indocyanine green angiography revealed no further pathology. Visual acuity was finally improved to 1.0 and disciform retinal degeneration was documented at the temporal periphery. Seventeen months later the patient remained stable.Conclusion PEHCR is a haemorrhagic retinal degenerative process, which can be complicated with vitreous haemorrhage and sudden visual loss. Differential diagnosis from choroidal melanoma or other vascular lesion is of major importance.

Bilateral macular coloboma in a patient with retinitis pigmentosa like changes

AbstractPurpose To report a case with bilateral macular coloboma and RP (retinitis pigmentosa) like changes.Methods A 46‐year‐old female presented with macular coloboma in both eyes. There was a history of strabismic amblyopia in her right eye but no other contributory medical or family history.Best corrected Snellen visual acuity (BCVA) was measured and full ophthalmic examination was performed. Visual field testing, optical coherence tomography (OCT) and international‐standard electrophysiological (ISCEV) evaluation, including pattern and full‐field electroretinography (PERG and FFERG), were also performed.Results BCVA was hand movements in the right eye and 0.5 in her left eye. Fundoscopy revealed an oval sharply‐ demarcated defect at the macula with bare sclera at its base and pigment clumping, mainly in the right eye, resembling macular coloboma. There were also severe retinal vessel attenuation and scattered retinal pigmentary changes, occasionally resembling bone spicule RPE changes, in the retinal periphery in both eyes. Optic discs were pale bilaterally. Visual field testing demonstrated bilateral scotomas. OCT revealed a crater‐like depression at the macula with atrophic neurosensory retina and absence of retinal pigment epithelium (RPE) and choroid, more extensive in her right eye, where scleral excavation was also documented. Pattern ERG as an indication of macular function was extinguished in the right eye and severely affected in her left eye. Full field ERG was extinguished bilaterally for both scotopic and photopic responses.Conclusion Bilateral macular coloboma associated with RP like changes, an abnormal electroretinography and no relevant family history, may be indicative of a developmental retinal abnormality.

Modified haptic externalizing technique for repositioning dislocated 1-piece acrylic posterior chamber implants.

To describe a novel vitreoretinal technique and the results of repositioning dislocated 1-piece acrylic posterior chamber intraocular lenses (PCIOL). This retrospective study included 7 eyes of 7 patients (ages 41 to 82) who underwent repositioning surgery with vitreoretinal methodology for dislocated 1-piece acrylic PCIOL between 2003 and 2005. Repositioning surgery involved temporary haptic externalization via anterior sclerotomies and passing curved needles of 9-0 or 10-0 polypropylene sutures through soft distal knobs of haptics before reinternalization for sulcus fixation. All 7 repositioned PCIOL remained centered and stable after 12 to 28 months of follow-up (mean = 17.6 months). Mild anterior-posterior intraocular lens (IOL)-tilting developed in 1 eye, but the IOL remained centered and secured in the sulcus with good vision. One PCIOL was exchanged with an anterior chamber intraocular lens (ACIOL) 1 year after repositioning because of recurrent intraocular hemorrhage and cystoid macular edema. Preoperative best corrected Snellen visual acuity (BCVA) ranged from 20/40 to 5/200 (median = 20/70). Postoperative BCVA ranged from 20/20 to 20/200 (median = 20/40). Capsular defect was the cause of IOL dislocation for all cases. Four of 7 eyes (57.1%) had axial myopia. This repositioning technique for dislocated all-acrylic PCIOL prevents suture slippage and allows secured sulcus fixation. Repositioned haptics should be sutured more than 1 mm from the limbus to avoid iris chafing.

Prospective multicenter trial assessing effectiveness, refractive predictability and safety of a new aberration free, bi-aspheric intraocular lens

To determine the effectiveness and safety of the Softec HD IOL; and to present refractive outcomes for lenses manufactured at an IOL power tolerance of 0.11 D. Three-hundred and ninety adult patients requiring removal of a cataractous lens with implantation of a monofocal IOL in at least one eye were eligible for study participation across eight US investigative sites. Patients were enrolled unilaterally. After routine surgery, subjects were examined for adverse events (AEs), best corrected visual acuity (BCVA) and manifest refraction correction at 12 months postoperatively. Three-hundred and sixty-six (95%) of patients completed the 12-month postoperative visit. The percent of patients achieving best corrected Snellen acuity 20/40 or better was 98.9%, and 81.1% of patients achieved best corrected Snellen acuity 20/25 or better. Of those patients (80%) implanted with a lens available in 0.25 D increments (manufactured at a tolerance of 0.11 D) 40.9%, 69.8% and 93.8% of patients were within ±0.25 D, ±0.50 D and ±1.0 D of predicted target refraction respectively. Overall incidence of cumulative and persistent IOL Grid AEs was 2.2% with no AE meeting or exceeding the FDA Grid of Historical Controls. The Softec HD IOL is a safe and effective lens. The high manufacturing tolerance of the lens appears to enhance refractive outcomes.

Functional outcome of subthreshold versus threshold diode laser photocoagulation in diabetic macular oedema

To compare the efficacy of subthreshold diode laser photocoagulation with conventional threshold diode laser in clinically significant macular oedema (CSME) in diabetics. Prospective randomised controlled trial. Thirty eyes of 20 patients with CSME having central macular thickness (CMT) >or=250 microm on optical coherence tomography (OCT) and best corrected Snellen visual acuity (BCVA) of 20/80 or better were randomly assigned to receive subthreshold diode laser (group A) or threshold laser (group B). The clinical course of BCVA, CMT on OCT, photo stress recovery time (PSRT), contrast sensitivity (CS) using Pelli Robson chart, and central visual field (10-2 VF, Humphrey Field Analyser II) were monitored regularly for 18 weeks after intervention. Both groups showed significant (P=0.03) and comparable improvement in mean BCVA at 18 weeks visit. There were also significant and comparable reductions (P<0.01) in mean CMT at all visits compared with baseline in both groups. PSRT and CS (75+/-16 (mean+/-SD) and 0.72+/-0.3 in group A and 81+/-12 and 0.68+/-0.2 in group B pre-laser) were significantly better in group A at the final visit (66+/-17 and 1.04+/-0.3) as compared to group B (78+/-11 and 0.73+/-0.3). One patient in group B showed a paracentral scotoma on 10-2 VF after the laser, which persisted till the end of follow-up. Subthreshold diode laser photocoagulation is as effective as conventional threshold laser in reducing or eliminating diabetic macular oedema (on OCT) and in improving BCVA. Recovery of macular function as assessed by CS and PSRT maybe better with subthreshold laser.

Intravitreal ranibizumab and bevacizumab for the treatment of nonsubfoveal choroidal neovascularization in age-related macular degeneration

To investigate the efficacy of vascular endothelial growth factor-specific (VEGF) monoclonal antibodies in the treatment of choroidal neovascularization secondary to age-related macular degeneration (AMD) that does not extend beneath the foveal center (nonsubfoveal CNV). The study design was a retrospective chart review of consecutive patients over a two-month period under active treatment with bevacizumab and/or ranibizumab for neovascular AMD. Patients with neovascularization within the macula that did not extend beneath the center of the foveal avascular zone, along with at least one large drusen (>125 micro) or many intermediate size (63-124 micro) drusen were included. Best corrected Snellen visual acuity and optical coherence tomography (OCT) analysis of the central macular thickness was recorded for each visit. Serial injections of bevacizumab and/or ranibizumab were administered until there was resolution of subretinal fluid clinically or by OCT. Data over the entire follow-up period were analyzed for overall visual acuity and OCT changes. All patients had follow-up since diagnosis of at least 6 months (mean=9.6 months). Of the thirteen included patients, eleven had reduction of retinal thickening in the area involved by the CNV. The remaining two patients did not have OCT data available but had no fluid or activity on clinical examination at last follow-up. One patient (8%) lost one line of vision; one (8%) remained stable, and eleven (84%) gained one or more lines of visual acuity. Three patients (23%) gained three or more lines. The average treatment outcome for all patients was a gain of 1.7 +/- 1.3 lines of Snellen acuity. Both therapeutic agents were effective, with an average gain of 1.6 +/- 0.6 lines for patients treated with bevacizumab, 1.5 +/- 1.9 lines gained for patients treated with ranibizumab and 2.5 +/- 0.7 lines gained in the two patients who received both agents over the course of their treatment. The use of intravitreal anti-VEGF agents for nonsubfoveal CNV in AMD is effective. Our results are comparable to published results from large-scale trials of anti-VEGF therapy for subfoveal CNV. Our data support the idea that bevacizumab or ranibizumab appear to be the treatment of choice for AMD patients with nonsubfoveal CNV.