Decline In Best-corrected Visual Acuity Research Articles

Change in visual acuity 12 and 24\xa0months after transscleral ab interno glaucoma gel stent implantation with adjunctive Mitomycin C

PurposeTo analyze changes in best-corrected visual acuity (BCVA) after implantation of the transscleral ab interno glaucoma gel stent (XEN Gel Stent; Allergan, Dublin) in patients with open-angle glaucoma.MethodsIn a single-center, prospective, non-randomized study of 137 eyes with open-angle glaucoma which underwent implantation with XEN, 69 eyes underwent XEN implantation alone (group 1) and 68 eyes underwent XEN implantation and cataract surgery (group 2). BCVA (Bailey–Lovie chart, logMAR scale) was evaluated at baseline, postoperative day 1, weeks 1 and 2, and months 1, 3, 6, 12, and 24. Risk factors for decline in BCVA were analyzed in multivariate models.ResultsBaseline BCVA in group 1 was 0.21 ± 031; the group’s mean BCVA did not change at any postoperative visit, although a ≥ 2-line loss of BCVA was detected in 15% (95% CI 7–29%) and 4% (95% CI 0–20%) after months 12 and 24, respectively. Baseline BCVA in group 2 was 0.33 ± 031; vision increased significantly at months 3 (0.22 ± 0.29, p = 0.015), 6 (0.20 ± 0.26, p = 0.006), 12 (0.18 ± 0.29, p = 0.001), and 24 (0.18 ± 0.29, p = 0.005). A ≥ 2-line loss of BCVA was reported in 4% (95% CI 1–15%) and 7% (95% CI 1–24%) after months 12 and 24, respectively.ConclusionsThere was no deterioration of BCVA in group 1; those in group 2 had an overall significant increase in BCVA. BCVA decrease was lower than is typically reported in the literature post-trabeculectomy.

CAPILLARY NETWORK ALTERATIONS IN X-LINKED RETINOSCHISIS IMAGED ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

To assess foveal and parafoveal vasculature at the superficial capillary plexus, deep capillary plexus, and choriocapillaris of patients with X-linked retinoschisis by means of optical coherence tomography angiography. Six patients with X-linked retinoschisis (12 eyes) and seven healthy controls (14 eyes) were recruited and underwent complete ophthalmologic examination, including best-corrected visual acuity, dilated fundoscopy, and 3 × 3-mm optical coherence tomography angiography macular scans (DRI OCT Triton; Topcon Corp). After segmentation and quality review, optical coherence tomography angiography slabs were imported into ImageJ 1.50 (NIH; Bethesda) and digitally binarized. Quantification of vessel density was performed after foveal avascular zone area measurement and exclusion. Patients were additionally divided into "responders" and "nonresponders" to dorzolamide therapy. Foveal avascular zone area resulted markedly enlarged at the deep capillary plexus (P < 0.001), particularly in nonresponders. Moreover, patients disclosed a significant deep capillary plexus rarefaction, when compared with controls (P: 0.04); however, a subanalysis revealed that this damage was limited to the fovea (P: 0.006). Finally, the enlargement of foveal avascular zone area positively correlated with a decline in best-corrected visual acuity (P: 0.01). Prominent foveal vascular impairment is detectable in the deep capillary plexus of patients with X-linked retinoschisis. Our results correlate with functional outcomes, suggesting a possible vascular role in X-linked retinoschisis clinical manifestations.

Secondary and Exploratory Outcomes of the Subthreshold Nanosecond Laser Intervention Randomized Trial in Age-Related Macular Degeneration: A LEAD Study Report

To evaluate the secondary and exploratory outcomes of the Laser Intervention in Early Stages of Age-Related Macular Degeneration (LEAD) study, a 36-month trial of a subthreshold nanosecond laser (SNL) treatment for slowing the progression to late age-related macular degeneration (AMD) in its early stages. Multicenter, randomized, sham-controlled trial. Two-hundred ninety-two patients with bilateral large drusen. Participants were randomly assigned to receive SNL or sham treatment to the study eye at 6-month intervals. The secondary outcome measure of the LEAD study was the time to development of late AMD, defined by multimodal imaging in the non-study eye. The exploratory outcome measures were the rate of change in best-corrected visual acuity (BCVA), low-luminance visual acuity, microperimetric mean sensitivity, drusen volume in the study and non-study eyes, and participant-reported outcomes based on the Night Vision Questionnaire and Impact of Vision Impairment questionnaire. Progression to late AMD in the non-study eye was not significantly delayed with SNL treatment (hazard ratio, 0.83; 95% confidence interval, 0.40-1.71; P= 0.611). There was no evidence of effect modification based on the coexistence of reticular pseudodrusen; interaction P= 0.065). There was no significant difference between study groups in the rate of change of low-luminance visual acuity, microperimetric mean sensitivity, and drusen volume in the study or non-study eyes, and Night Vision Questionnaire and Impact of Vision Impairment questionnaire scores (all P ≥ 0.167). The rate of BCVA decline was slightly higher for participants in the SNL group compared with the sham treatment group in the study eye (-0.54 and 0.23 letters/year, respectively; P < 0.001) but not the non-study eye (-0.48 and -0.56 letters/year, respectively; P= 0.628). Subthreshold nanosecond laser treatment of one eye did not have an effect on delaying progression to late AMD in the fellow eye and did not, in general, have an impact on the exploratory structural, functional, and participant-reported outcomes.

Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma

ObjectiveTo determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma.Methods and analysisRetrospective case...

Aflibercept for Radiation Maculopathy Study: A Prospective, Randomized Clinical Study

To evaluate 2 treatment approaches to intravitreal vascular endothelial growth factor antagonist therapy in radiation maculopathy comparing aflibercept delivered by either a 6-week treatment interval or treat-and-adjust interval. Randomized, prospective clinical trial. Forty consecutive patients were enrolled in an institutional review board-approved clinical trial and randomized to aflibercept treatment via 1 of 2 regimens: (1) fixed, every-6-weeks treatment or (2) variable, treat-and-adjust treatment centered around 6 weeks. All patients had a diagnosis of treated uveal melanoma with documented tumor control. All patients showed visually compromising radiation maculopathy confirmed by a decline in best-corrected visual acuity (BCVA) and spectral-domain (SD) OCT documentation of radiation maculopathy. Best-corrected visual acuity and SD OCT central retinal thickness at 1 year. Thirty-nine of 40 patients completed the trial (97.5%) with 1 year of follow-up. Baseline study entry BCVA was 20/63 and was maintained at 20/62 at study conclusion at 60 weeks (1 year). At baseline, SD OCT mean central retinal thickness was 432 μm and improved to 294 μm at 60 weeks (P < 0.02). At the study conclusion, 42.5% of eyes (17/40) showed better than 20/50 BCVA, and only 5% of eyes (2/40) showed a BCVA worse than 20/200. In the every-6-weeks interval treatment arm, patients received 9 injections, whereas in the treat-and-adjust study arm, patients received 8.4 injections (P= 0.88, not significant). One patient experienced an inflammatory response after aflibercept injection, but this did not occur again for this patient, nor for any other study injections (1/400 injections [0.0025%]). No patients demonstrated endophthalmitis or metastatic disease or died during the study window. Aflibercept seems to limit vision loss associated with radiation maculopathy. In this randomized, prospective clinical study, no difference was found between a fixed 6-week treatment interval and a variable treat-and-adjust interval because virtually all patients required treatment every 6 weeks and were not able to extend. Remarkably, almost half of all treated patients maintained BCVA of 20/50 or better throughout 1 year of treatment. Aflibercept is effective in treating radiation maculopathy, but requires an ongoing treatment approach.

Vitreoretinal Complications and Outcomes in 92 Eyes Undergoing Surgery for Modified Osteo-Odonto-Keratoprosthesis: A 10-Year Review

To analyze vitreoretinal (VR) complications and treatment outcomes in eyes undergoing modified osteo-odonto-keratoprosthesis (OOKP) surgery. Retrospective case series. All patients who underwent modified OOKP (mOOKP) surgery at a tertiary eye-care center from March 2003 to February 2013 were included. Medical records were reviewed for relevant medical history, best-corrected visual acuity (BCVA), slit-lamp examination, ultrasound scan, oral examination findings, and VR complications. The BCVA at the last visit. Optimal anatomic outcome was attached retina with a normal intraocular pressure at the last visit. A total of 92 eyes of 90 patients were included. Indications for OOKP included Stevens-Johnson syndrome (n= 53), chemical injury (n= 36), and ocular cicatricial pemphigoid (n= 3). A total of 41 eyes of 39 patients developed VR complications, including vitritis (n= 21), retinal detachment (RD) (n= 12; primary RD= 5), retroprosthetic membrane (RPM) (n= 10; primary RPM= 2), endophthalmitis (n= 8), vitreous hemorrhage (VH) (n= 5; primary VH= 1), serous choroidal detachment (n= 5), hemorrhagic choroidal detachment (n= 2), and leak-related hypotony (n= 1). Mean interval from mOOKP surgery to occurrence of VR complication(s) was 43.8 months (median, 41.9 months; range, 0.2-95.5 months). After treatment of VR complication, visual improvement was seen in 17 eyes (42%) (mean improvement= 1.2 logarithm of the minimum angle of resolution [logMAR]; median, 0.8 logMAR; range, 0.1-2.5 logMAR), visual decline in 7 eyes (14%) (mean decline in BCVA= 0.6 logMAR; median, 0.4 logMAR; range, 0.3-1.8 logMAR), and no change in BCVA in 17 eyes (42%). However, BCVA ≥6/60 was retained in 19 eyes and ≥6/18 was retained in 9 eyes after final VR treatment. Vitreoretinal complications constitute a significant cause of visual morbidity in eyes undergoing mOOKP surgery and pose a challenging situation to manage. However, appropriate and timely intervention can achieve encouraging results.

Neovascular age-related macular degeneration management in the third year: final results from the TREX-AMD randomised trial

Background/AimsProspectively evaluate outcomes in the third year of neovascular age-related macular degeneration (AMD) management using ranibizumab with continued treat and extend (TREX) dosing compared with monthly visits with retreatment upon...

One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

AimTo evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.MethodsThis retrospective study included 16 eyes (14...

Intravitreal ziv-aflibercept for the treatment of choroidal neovascularisation associated with conditions other than age-related macular degeneration

AimTo report the short-term outcomes of eyes with choroidal neovascularisation (CNV) associated with causes other than age-related macular degeneration (AMD) after treatment with intravitreal ziv-aflibercept (IVZ) injections.MethodsThis retrospective study included...

Clinical Characteristics, Choroidal Neovascularization, and Predictors of Visual Outcomes in Acquired Vitelliform Lesions

To quantify the temporal properties of the acquired vitelliform lesion (AVL) life cycle, define the clinical characteristics of choroidal neovascularization (NV) in this setting, and determine the predictors of long-term visual outcomes. Retrospective cohort study. Clinical and imaging data from 199 eyes of 124 consecutive patients with AVLs associated with age-related macular degeneration (AMD) and adult-onset foveomacular vitelliform dystrophy (AOFVD) were analyzed. Volumetric calculations of vitelliform material were determined using spectral-domain optical coherence tomography and the temporal properties of the AVL life cycle were quantified. The clinical characteristics of NV were assessed, as were the predictors of final best-corrected visual acuity (BCVA) and change in BCVA. Mean age was 79.2 ± 12.1 years. AVLs grew and collapsed at approximately the same rate (P= .275). Fifteen eyes (7.5%) developed NV, of which all were type 1. In 13 of these eyes, NV occurred during the collapse phase of the AVL life cycle, after the peak AVL volume was reached. The risk of NV (P= .006) and the decline in BCVA (P= .001) were both significantly greater among eyes with AMD. Foveal atrophy was the characteristic most significantly associated with final BCVA and change in BCVA from baseline (both P < .0005). The development of NV was not predictive of long-term visual outcomes (all P= .216). Complications associated with AVLs typically occur during the collapse phase of the AVL life cycle. Visual outcomes and risk of NV are related to the underlying disease associated with AVLs.

To investigate the safety and efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes

To observe the efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes(IMEM). Retrospectively studied 60 patients with IMEM who all underwent the surgery of vitrectomy combined with internal limiting membrane peeling from 2011 to 2013. Best corrected visual acuity (BCVA), intraocular pressure(NCT), slit-lamp examination, fundus photography, optical coherence tomography (OCT) were committed. Patients were followed for 6 months. They were divided into two groups according to whether indocyanine green(ICG) was used or not with 32 members in ICG group and 28 members in none ICG group. They were divided into two groups according to the intergrity or disruption of the ellipsoid zone (EZ band) with 26 members in EZ band intergrity group and 34 members in EZ band disruption group. Age ranged from 28 to 79 years and the average age was 60.3 ± 10.9. Twenty-five males and 35 females were included. Twenty-five left eyes and 35 right eyes were incorporate. Among the 60 patients, 38 cases (63.33%) underwent visual acuity improvement after operation(BCVA improved at least 2 rows) and 21 (35%)patients' vision remained the same(BCVA changes less than 2 rows), while only one patient(1.67%) experienced decreased visual acuity(BCVA decline at least 2 rows). Average best corrected visual acuity (BCVA) (LogMar)and central retina thickness(CRT) (μm)of all patients preoperationwere 0.85 ± 0.44 and 578.45±144.61 respectively, which were 0.57±0.40 , 466.31±87.80 for one month and 0.54±0.42, 442.33± 98.92 three and six months postoperation(P<0.05). Compared to group of disruption EZ band, the BCVA of group of integral EZ band was better(P<0.05). 15 of 26 members in group of integral EZ band came up with EZ band cells loss in one month after operation and recovered by three or six months later. There was no statistical significance in BCVA and CRT between ICG group and none ICG group(P<0.05). Indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling in the treatment of IMEM is safe and effective. The symptoms of decreased vision, metamorphopsia were greatly ameliorated. Besides, retinal organization structures showed a certain extent of improvement. The transient occurrence of EZ band disruption postoperation could recovery 3 to 6 months later. And internal limiting membrane peeling assisted with ICG is a promising approach to the accomplishment of surgery without obvious toxicity. (Chin J Ophthalmol, 2016, 52:366-372).

Long-term variable outcome of myopic choroidal neovascularization treated with ranibizumab.

The purpose was to evaluate the long-term efficacy of ranibizumab for the treatment of myopic choroidal neovascularization (CNV) in a clinical setting. This was a retrospective, monocentric, noncomparative analysis of 51 eyes of 51 patients with naïve juxtafoveal or subfoveal myopic CNV treated with intravitreal ranibizumab (IVR) on a pro re nata basis for at least 24months. The patients' demographic data were recorded, including the best-corrected visual acuity (BCVA) measured with an ETDRS chart, location of the CNV, grade of myopic changes, central foveal thickness (CFT), and number of administered IVR. Outcome measures were to determine the changes in BCVA, identify the factors influencing the visual outcome, compare the best visual gain obtained for each treated eye with the final visual gain, and identify the cause of the relative decline in the visual acuity, when present. BCVA improved from 58.7±19.0 letters at baseline to 66.3±16.2 letters at the final visit (P=0.001; mean visual gain: +7.6±15.6 letters). Multivariate analysis did not identify any correlation between the visual gain and age, sex, grade of myopic fundus changes, CNV location, or initial protocol. The mean IVR number was 3.5±2.8 injections (range 1-12; median 3) for a mean follow-up of 39.3±11.3months (range 24-69). Twenty-one eyes experienced a relative decline in BCVA during the follow-up, which was attributable in 16 cases to myopic atrophic changes. Intravitreal ranibizumab resulted in long-term efficacy in the treatment of myopic CNV. However, some eyes may present a long-term relative decline in their initial visual gain.

Long-term outcomes of rheohaemapheresis in the treatment of dry form of age-related macular degeneration.

Purpose. Determining long-term effects of rheohaemapheresis on the dry form of age-related macular degeneration. Methods. This study evaluates 19 patients, average age of 67.6 years, treated with rheohaemapheresis and 18 patients, average age of 72.8 years, comprising the control group. Minimum follow up period was 3.5 years. Each treated patient received a series of 8 sessions of rheohaemapheresis of 1.5 plasma volumes within 10 weeks. We measured the drusenoid pigment epithelium detachment (DPED), best-corrected visual acuity (BCVA), electroretinography (ERG), and rheological parameters. Results. In the treatment group, the baseline BCVA was 0.74 (0.36–1.0) 95% CI and BCVA after 3.5 years was 0.79 (0.41–1.0) 95% CI (P = 0.726). In the control group, the baseline BCVA was 0.71 (0.15–1.0) 95% CI and BCVA after 3.5 years decreased to 0.7 (0.32–0.87) 95% CI (P = 0.031). Baseline DPED was 6.78 ± 3.79 mm2; after 3.5 years, it decreased to 4.13 ± 3.84 mm2 (P < 0.001). In the control group, the baseline DPED was 4.09 ± 3.48 mm2; after 3.5 years, it increased to 6.69 ± 4.2 mm2 (P = 0.001). We noted increasing levels of positive wave peaking at 50 milliseconds (P50) after treatment (P = 0.022) and a stable amplitude of photopic responses of treated patients. Conclusion. Over the long term, rheohaemapheresis reduced the DPED, improved the function of photoreceptors, and prevented the decline of BCVA.

Keratoconus Unmasked by Unilateral Ptosis Repair

Astigmatic changes have been shown to occur after ptosis repair due to the altered vector forces on the underlying cornea from the repositioned upper eyelid. The astigmatic change is usually transient, but it may affect a patient's vision for at least the first few months after surgery. The authors present a case of a patient who underwent ptosis repair and subsequently developed postoperative decline in best-corrected visual acuity due to previously undiagnosed keratoconus. The patient's irregular astigmatism seems to have been masked by the ptotic upper eyelid, which we postulate to have acted similar to a stenopaic slit. Correction of the upper eyelid ptosis unveiled previously asymptomatic irregular astigmatism including vertical coma, leading to alteration in the optical wavefront and resultant image degradation.

Postfiltration Hypotony Maculopathy in Young Chinese Myopic Women With Glaucomatous Appearing Optic Neuropathy

To describe management and surgical outcomes of 3 young women of Chinese origin with advanced glaucomatous optic neuropathy. Three 36 to 48-year-old female patients. A retrospective medical records review of 3 Chinese women with prior diagnoses of glaucoma treated with trabeculectomy was performed. Optic nerve imaging and standard automated perimetry were also reviewed. Mean follow-up period was 4 years. All patients had arcuate scotomas bilaterally at the time of initial ophthalmic examination. Two patients were highly myopic (>or= -6.00 diopter spherical equivalent) with tilting of the optic nerve head and parapapillary atrophy. Cup-to-disc ratios ranged from 0.4 to 0.9. Trabeculectomy with mitomycin C was performed in the right eye of all patients with subsequent hypotony related complications requiring surgical treatment. All patients experienced long-term decline in best-corrected visual acuity after trabeculectomy. No patient had a new area of field loss on standard automated perimetry, although the density of the preexisting scotomas increased in the nonoperated eye of all patients. High myopia, optic nerve head tilting, and parapapillary atrophy are likely associated with the increased susceptibility to damage of dependent axons. Axons outside of the area of tilt may be relatively protected. As young myopes are more likely to suffer from hypotony related complications after trabeculectomy, the risk of an increase in preexisting field defect density should be weighed against the risk of long-term vision loss after filtration surgery. The development of a new area of field loss may be an appropriate indication for surgery in some such patients.

Photodynamic therapy with verteporfin for age-related macular degeneration or polypoidal choroidal vasculopathy: comparison of the presence of serous retinal pigment epithelial detachment

Aim:To evaluate outcomes after photodynamic therapy (PDT) with verteporfin in Japanese patients with age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) and compare results with the presence/absence of a...

Relationship of AcrySof acrylic and PhacoFlex silicone intraocular lenses to visual acuity and posterior capsule opacification

Purpose: To compare the changes in visual acuity and the development of posterior capsule opacification (PCO) with AcrySof® acrylic intraocular lenses (IOLs) (Alcon Laboratories) and second-generation PhacoFlex® silicone IOLs (Allergan ). Setting: Eye Associates of New Mexico and Southwest Colorado, Albuquerque, New Mexico, USA. Methods: Medical charts of patients having cataract extraction with implantation of an AcrySof MA30BA or MA60BM (MA30/60) or PhacoFlex SI-30NB or SI-40NB (SI-30/40) IOL between January 1995 and June 1997 were abstracted. Analyzed were the changes in visual acuity and development of PCO 1 month postoperatively and at the last available ophthalmologist visit or the visit before neodymium:YAG (Nd:YAG) capsulotomy. Results: Patients with MA30/60 acrylic IOLs were significantly older, had a worse preoperative best corrected visual acuity (BCVA), and had more concomitant ocular diseases than those with SI-30/40 silicone IOLs. The change in BCVA from preoperatively to 1 month postoperatively was equivalent in the 2 lens groups. The BCVA declined from 1 month postoperatively to the last recorded or pre-Nd:YAG visit. This decline was greater in eyes with SI-30/40 silicone IOLs than in those with MA30/60 acrylic IOLs. Although the decrease in BCVA between IOL types was not significantly different, eyes with a SI-30/40 silicone IOL were significantly more likely to develop PCO and have Nd:YAG capsulotomy. Eyes developing PCO had a statistically significant decline in BCVA from 1 month postoperatively to the last/pre-Nd:YAG visit. Conclusions: The MA30/60 acrylic lenses were associated with lower PCO and Nd:YAG capsulotomy rates than second-generation SI-30/40 silicone IOLs. Patients with MA30/60 IOLs also tended to have less of a decrease in visual acuity than patients with SI-30/40 silicone lenses, probably as a result of the difference in PCO rates between groups.