Decrease In Best-corrected Visual Acuity Research Articles

Three-Dimensional Retinal Displacement Before and After Macular Pucker Surgery

Purpose: To measure the coronal and sagittal retinal displacement before and after surgery for epiretinal membranes in InfraRed (IR) horizontal foveal sections and Optical Coherence Tomography (OCT) scans and describe displacement tridimensionality, vison loss and metamorphopsia. Methods: Retrospective series with greater than 6-month average follow-up before and after surgery. Record included best-corrected visual acuity (BCVA), OCT, M-charts, IR retinography. Overall, pre- and post-operative coronal and sagittal retinal displacement across the entire field, concentric circles at 0.5, 1.5 and 4.5mm radii and the central horizontal and vertical meridian were calculated as the optical flow of consecutive images. Results: The study comprised 10 patients (4M, 6F), with 22.7±25.2 months follow-up before surgery and 16.2±7.3 months after. BCVA reduced before surgery (0.15±0.67 logMAR to 0.38±0.85 logMAR; p<0.05) and increased afterwards (0.086±0.61 logMAR; p=0.003). Pre-operative coronal displacement was 30.1±29.1 µm versus 67.0±23.4µm after (p=0.002). Sagittal retinal displacement was 140.9±84.6 µm before surgery, 339.7±172.5 µm after (p=0.017), and 357.6±320.8 µm across the entire follow-up. Pre-operative BCVA decrease correlated to the foveal coronal displacement. Vertical metamorphopsia correlated to the average coronal displacement within 4.5mm radius. Pre- and post-operative sagittal displacement correlated to horizontal metamorphopsia (p=0.006 and p=0.026). Post-operative sagittal displacement correlated with post-operative BCVA (p=0.026) and foveal thickness (p=0.009). Conclusion: The study confirms that post-operative displacement is greater than pre-operative and that sagittal displacement is greater than coronal and correlates with BCVA and metamorphopsia changes.

Preschool Vision Screening: Prevalence and Associated Factors of Amblyopia among School Going Children in Dhaka City

Background: Amblyopia is a decrease in best-corrected visual acuity in one or both eyes due to form deficiency or abnormal binocular interaction. It affects infancy and adulthood for the individual and society as a whole. Amblyopia affects academic success, career choice, visuomotor skills, social interaction, psychological development, and economic participation. Unilateral amblyopia increases the likelihood of bilateral vision loss. Ocular media opacity, strabismus, anisometropia, hypermetropia, astigmatism, myopia, and blepharoptosis are risk factors for amblyopia. Ocular screening programs in young children, primarily preschoolers, may detect amblyopia and amblyogenic risk factors like as strabismus, refractive errors, and media opacities early. It prevents and treats amblyopia. It helps children's emotional growth. Diagnosis and treatment of amblyopia at a younger age may result in a better and more stable final VA because to shorter treatment durations, faster VA improvement, and greater treatment adherence. Objective: The purpose of this study was to determine Preschool vision screening, prevalence and associated factors of amblyopia among school going children in Dhaka city. Methods and Material: Between January 1 and June 30, 2022, a cross-sectional survey of a community of Dhaka city residents in the school age range was carried out. Through interviews and physical exams, data were gathered using a pretested structured questionnaire and checklist. Using SPSS 23, descriptive and inferential analysis was performed, and variables with a p value of less than 0.2 were included into multivariate logistic regression. In the multivariable binary logistic regression, significant predictors were defined as variables with a p value of < 0.05. Result: Majority of the student are of 4-5 years age, among the participant 50.8% were male and 45.8% were female. Study showed that majority of the family has 1-2 (49.5%) and 3-4 (45.3%) children. Majority of the mother .......

Effect and safety posterior scleral reinforcement on controlling myopia in children: a meta-analysis

PurposeThe aim of this meta-analysis was to assess the efficacy of posterior scleral reinforcement (PSR) on the control of pediatric myopia. Electronic databases were systematically searched.MethodsStandardized mean differences (SMDs) of outcomes were calculated. Eight studies with 357 patients with pediatric myopia were included. The SMD for the increase in mean axial length (AL) in the PSR and control group was − 1.19 (95% CI − 1.71, − 0.68). ResultsThe SMD for decrease of best-corrected visual acuity (BCVA) LogMAR in the PSR and control group was 0.85 (95% CI 0.28, 1.43). The SMD for change in intraocular pressure (IOP) at the time of surgery and at the end of the follow-up period in the PSR group was − 0.01 (95% CI − 0.48, 0.47).ConclusionThis meta-analysis indicates that PSR surgery may be an effective therapeutic strategy to control the progression of myopia in childhood with acceptable adverse effects.

Branch retinal vein occlusion treated with anti-VEGF: to switch or not to switch?

ObjectiveTo evaluate visual outcomes after switching from bevacizumab to ranibizumab or aflibercept in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). DesignA retrospective, multi-center, observational study. ParticipantsPatients diagnosed with BRVO and were treated with at least 3 bevacizumab injections, before anti VEGF switch. MethodsThe follow-up period was 36 months, and the primary study outcomes assessed changes in best corrected visual acuity (BCVA) after anti VEGF switch. ResultsA total of 263 eyes of 263 patients with a mean age of 71.5 ± 11.2 years of which 50% were of male gender met the inclusion criteria. Of them, 175 eyes did not undergo switch, whereas 88 eyes underwent anti-VEGF switch. There was not a significant difference in mean age (p = 0.634) and gender (p = 0.269) between the groups. Baseline BCVA of the no-switch group was 0.47 ± 0.43 logMAR (20/59 Snellen) versus 0.6 ± 0.49 logMAR (20/79 Snellen) (p = 0.031) in the switch group, and at 36-months it was 0.41 ± 0.39 (20/51 Snellen) logMAR versus 0.54 ± 0.49 logMAR (20/69 Snellen) (p = 0.035), respectively. The difference between the rate of change in BCVA per year was insignificant between groups (p = 0.414). In multivariate analysis, baseline BCVA was the single significant predictor for switch (beta 0.137, p = 0.035). Patients with more than one anti-VEGF switch suffer from decrease in BCVA. ConclusionsWorse baseline BCVA is a significant predictor for anti-VEGF switch execution, though the switch has no significant impact on the change in BCVA over time. Multiple anti-VEGF switch is not recommended.

Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes.

To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.

Belantamab mafodotin, pomalidomide and dexamethasone in refractory multiple myeloma: a phase 1/2 trial

Due to evolving treatment standards for newly diagnosed multiple myeloma, many patients will be triple-class exposed after initial relapses and have poor survival. Novel therapies and combinations are therefore required to improve outcomes. B cell maturation antigen (BCMA)-targeted biologics have emerged as an important new area of therapeutics for relapsed multiple myeloma. The two-part ALGONQUIN trial evaluated various doses and schedules of the anti-BCMA antibody–drug conjugate belantamab mafodotin plus pomalidomide and dexamethasone for patients who are lenalidomide refractory and proteosome inhibitor exposed. The primary endpoints, including evaluating dose-limiting toxicities, establishing the recommended Part 2 dose (RP2D) and overall response rate for patients treated at the RP2D, were met. Secondary efficacy endpoints included progression-free survival and overall survival. Patients treated on study (N = 87) had a median of three previous regimens and 55.2% were triple-class refractory. At the RP2D the most common adverse events were decrease in best-corrected visual acuity (71.1%), keratopathy (65.8%), fatigue (57.9%), infection (47.4%; 7.9% grade ≥3), neutropenia (39.5%) and thrombocytopenia (39.5%). For RP2D patients (n = 38), the overall response rate was 85.3%, ≥very good partial response 75.7% and estimated two-year progression-free survival 52.8% (95% confidence interval, 33.9% to 82.4%), at a median follow-up of 13.9 months. The RP2D schedule was associated with manageable antibody–drug conjugate-associated corneal adverse events and improved tolerability without compromising efficacy. Belantamab mafodotin plus pomalidomide and dexamethasone induced durable responses with promising overall survival in relapsed multiple myeloma, the results of which are yet to be confirmed in the phase 3 DREAMM-8 study. ClinicalTrials.gov Identifier: NCT03715478.

Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method

Purpose: to assess the functional results of surgical treatment of macular holes (MH) using the authors’ developed technology preserving the internal limiting membrane (ILM) and compare them with the results of traditional surgery technology involving ILM peeling.Material and methods: 150 MH patients aged 50 to 82 were divided into 2 groups: the main group who underwent surgical MH treatment with ILM preservation and the control group, whose traditional surgical treatment involved ILM peeling. After vitrectomy, the main group patients’ macular areas were treated with a bacterial collagenase solution (1 kU) for three minutes, whereupon it was washed out, the vitreal cavity was dried and treated with platelet-rich plasma. In the control group, ILM was stained and removed, whereupon platelet-rich plasma was applied in the air medium. The anatomical result was assessed by optical coherence tomography data. To assess the functional results, the patients were tested for the best corrected visual acuity (BCVA) and subjected to microperimetry. The observation period was 24 months.Results: in all cases, a significant increase in BCVA was achieved after surgical treatment. After 6 months, the control group showed a tendency to a BCVA decrease, while in the main group BCVA remained stable. In the main group, not a single case showed a decrease in the total retinal photosensitivity below the threshold level of the norm of 24 dB, whilst in the control group, 35 cases (47 %) revealed a retinal sensitivity decrease below 24 dB. The total retinal sensitivity turned out to be significantly lower in the control group as compared to the main group over the entire observation period (p < 0.05). Postoperative scotomas were significantly more frequent after ILM peeling. Absolute scotomas were detected in 7 control group cases, whilst in the main group they were not noted in any case.Conclusion. The developed technology makes it possible to practically eliminate the formation of absolute scotomas and to significantly reduce the formation of relative scotomas in the postoperative period, as well as improve functional results against the traditional method of surgical treatment of MH with ILM peeling.

Axial Elongation Trajectories in Chinese Children and Adults With High Myopia

Understanding the long-term axial elongation trajectory in high myopia is important to prevent blindness. To evaluate axial elongation trajectories and related visual outcomes in children and adults with high myopia. In this cohort study, participants in the Zhongshan Ophthalmic Centre-Brien Holden Vision Institute high myopia cohort were followed up every other year for 8 years. Participants with axial length measurements at baseline (2011 or 2012) and at least 1 follow-up visit were included. Participants were grouped according to baseline age as children and adolescents (7 to <18 years), young adults (18 to <40 years), and older adults (≥40 to 70 years). Data were analyzed from November 1, 2022, to June 1, 2023. High myopia (spherical power ≤-6.00 diopters). Longitudinal axial elongation trajectories were identified by cluster analysis. Axial elongation rates were calculated by linear mixed-effects models. A 2-sided P < .05 was defined as statistically significant. A total of 793 participants (median [range] age, 17.8 [6.8-69.7] years; 418 females [52.7%]) and 1586 eyes were included in the analyses. Mean axial elongation rates were 0.46 mm/y (95% CI, 0.44-0.48 mm/y) for children and adolescents, 0.07 mm/y (95% CI, 0.06-0.09 mm/y) for young adults, and 0.13 mm/y (95% CI, 0.07-0.19 mm/y) for older adults. Cluster analysis identified 3 axial elongation trajectories, with the stable, moderate, and rapid progression trajectories having mean axial elongation rates of 0.02 mm/y (95% CI, 0.01-0.02 mm/y), 0.12 mm/y (95% CI, 0.11-0.13 mm/y), and 0.38 mm/y (95% CI, 0.35-0.42 mm/y), respectively. At 8 years of follow-up, compared with the stable progression trajectory, the rapid progression trajectory was associated with a 6.92 times higher risk of developing pathological myopic macular degeneration (defined as diffuse or patchy chorioretinal atrophy or macular atrophy; odds ratio, 6.92 [95% CI, 1.07-44.60]; P = .04), and it was associated with a 0.032 logMAR decrease in best-corrected visual acuity (β = 0.032 [95% CI, 0.001-0.063]; P = .04). The findings of this 8-year follow-up study suggest that axial length in high myopia continues to increase from childhood to late adulthood following 3 distinct trajectories. At 8 years of follow-up, the rapid progression trajectory was associated with a higher risk of developing pathological myopic macular degeneration and poorer best-corrected visual acuity compared with the stable progression trajectory. These distinct axial elongation trajectories could prove valuable for early identification and intervention for high-risk individuals.

ILUVIEN® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt® RIVER audit.

Persistent diabetic macular edema (DME) remains a problem in clinical practice, with many patients having a suboptimal response to the standard of care (SOC). Evidence supports the long-term efficacy of intravitreal fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients that have responded sub-optimally, although there is still scarce data from real-world Portuguese practices. We aimed to monitor the current SOC in selected Portuguese practices prior to FAc implantation and then assess the long-term effectiveness and safety of the FAc implant. The study included patient data from five Portuguese public hospitals. This was a non-interventional, multicenter audit of data collected from Retina.pt registry from patients with persistent or recurrent DME despite treatment. Outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results were compared at regular times over 36 months. This study included 222 eyes from 152 patients. A significant decrease in BCVA (P < 0.001) and a significant increase in CMT (P = 0.013) were observed prior to FAc. A significant increase in BCVA was registered at 6 months after FAc implant administration (P < 0.001), which was maintained during follow-up. No relevant changes in IOP were observed. Treatment burden was reduced as a result of treatment with FAc (P < 0.001 for anti-VEGF, corticosteroids, or both treatments) in the full population. In Portuguese practice, data showed that pre-FAc implantation, some patients did not respond to SOC treatment and/or they were undertreated. Following FAc implant administration, there were rapid, sustained, long-term visual and anatomical improvements, and a marked reduction in treatment burden.

MORPHOLOGIC CHARACTERISTICS AND PROGRESSION PATTERNS OF MACULAR NEOVASCULARIZATION-RELATED ATROPHY IN EYES WITH PATHOLOGIC MYOPIA.

To investigate the development and progression patterns of macular neovascularization (MNV)-related atrophies in eyes with pathologic myopia. Twenty-seven eyes of 26 patients with MNV followed from its onset to progression to macular atrophy were studied. A longitudinal series of autofluorescence and optical coherence tomography images were examined for the patterns of MNV-related atrophy. Changes in best-corrected visual acuity were determined for each pattern. The mean age was 67.2 ± 8.7 years. The mean axial length was 29.6 ± 1.5 mm. Three patterns of atrophy were identified: multiple-atrophic pattern, 63% of the eyes had small atrophies occurring at multiple sites around the MNV edge; single-atrophic pattern, 18.5% had atrophies occurring only on one side of the MNV edge; and exudation-related pattern, 18.5% had atrophy occurring within a previous serous exudation or hemorrhagic area and slightly away from the MNV edge. Eyes with atrophies in multiple-atrophic and exudation-related patterns progressed to large macular atrophies involving the central fovea and showed decrease in best-corrected visual acuity during the 3-year follow-up period. Eyes with single-atrophic pattern had a sparing of the fovea and had good recovery of the best-corrected visual acuity. There are three patterns of MNV-related atrophy in eyes with pathologic myopia with different courses of progression.

Brolucizumab in Pretreated Neovascular Age-Related Macular Degeneration: Case Series, Systematic Review, and Meta-Analysis

Recalcitrant neovascular age-related macular degeneration (rnAMD) despite intensive intravitreal anti-neovascular endothelial growth factor (VEGF) treatment, can be handled by switching to another anti-VEGF agent. This first systematic review and meta-analysis presents long-term data after switching from another anti-VEGF agent to brolucizumab. Retrospective case series over two years of patients switched to brolucizumab, and a systematic review and meta-analysis of peer-reviewed studies presenting patients switched to brolucizumab. Weighted mean differences based on the random-effects models were calculated for best-corrected visual acuity (BCVA) and central subfield thickness (CST). The systematic review draws on 1200 eyes switched to brolucizumab. The meta-analysis showed a clinically irrelevant decrease in BCVA after one and two months, together with significant decreases in CST for up to one year after the switch but lacking power over 2 years. Of twelve eyes (twelve patients) in our case series, five continued treatment for two years without experiencing significant changes. After switch to brolucizumab, a significant morphological improvement with CST reduction was shown in eyes with rnAMD. The small worsening of BCVA may be owing to the chronically active nature of rnAMD. Brolucizumab thus remains a treatment option in rnAMD despite its potential side effects.

Focal laser photocoagulation treatment in polypoidal choroidal vasculopathy: Long‐term follow‐up

AbstractPurpose: To report the long‐term effect and safety of focal laser photocoagulation treatment (FLPT), in a case of polypoidal choroidal vasculopathy (PCV).Methods: We reviewed a 56‐month follow‐up (April 2017–January 2022) of a 54‐year‐old woman with PCV. The diagnosis was made using indocyanine green angiography (ICG‐A). The measured outcomes of the effect of FLPT were changes in best‐corrected visual acuity (BCVA), complications, regression, and recurrence of polypoidal lesions based on fundoscopy, B‐scan swept source optical coherence tomography (SS‐OCT) and ICG‐A.Results: At the time of diagnosis, the patient had extensive subretinal exudation and haemorrhage in the right eye (RE) related to foveal and juxtapapillary polypoidal lesions. She received 12 bevacizumab intravitreal injections and treatment was interrupted because of extensive macular fibrosis. In the left eye (LE), she had extrafoveal polypoidal lesions with a BCVA of 20/25. At 8 months follow‐up, a decrease in BCVA to 20/50 was noted. Therefore, a first round of FLPT associated with three bevacizumab intravitreal injections, was performed. Four months post‐FLPT, regression of the polypoidal lesions was obtained with a BCVA of 20/25. BCVA and multimodal imaging remained stable for 2 years. The left eye showed recurrence of extrafoveal polypoidal lesions 35 months after FLPT, with a BCVA of 20/50. A second round of FLPT was performed, with a regression of the polypoidal lesions after 1 month, and a stabilization of BCVA at 20/30. After 14 months, BCVA was 20/50, and no signs of recurrence were detected on multimodal imaging. No complications were observed after the two rounds of FLPT.Conclusions: FLPT can be efficient and safe in treating eyes with PCV with extrafoveal polypoidal lesions. In this case, it allowed us to obtain the regression of polypoidal lesions and to maintain visual acuity without serious hemorrhagic complications during the 56‐month follow‐up.

LONG-TERM TREATMENT OUTCOMES AFTER BEVACIZUMAB THERAPY FOR MACULAR NEOVASCULARIZATION IN WHITE PATIENTS WITH HIGH MYOPIA.

To report long-term treatment outcomes of intravitreal bevacizumab in myopic macular neovascularization (MNV). Retrospective analysis of longitudinal, clinical data of patients with high myopic MNV treated with intravitreal bevacizumab. One-hundred and seventeen eyes of 106 patients were followed from first injection up to 12 years. Outcome measures were best-corrected visual acuity change during follow-up and myopic MNV recurrence. Mean (±SD) baseline best-corrected visual acuity (0.56 ± 0.46 logMAR, 20/80) significantly improved after first treatment (0.33 ± 0.33, 20/50, P < 0.001). At 4 years (n = 86), best-corrected visual acuity was no longer significantly better than at baseline (0.55 ± 0.57, P = 0.30) and continued to deteriorate to 0.84 ± 0.76 (20/125) at 10 years (n = 27). Of the 27 eyes (23%) who reached 10 years of follow-up, 53% developed MNV-related chorioretinal atrophy. The cumulative incidence of recurrent myopic MNV was 34% at 2 years and 59% at 5 years. Best-corrected visual acuity decrease in eyes with or without recurrent MNV was similar ( P = 0.58). Patchy chorioretinal atrophy (hazard ratio 3.0, P = 0.02) and subfoveal MNVs (hazard ratio 2.5, P = 0.048) were significantly associated with recurrent MNV. This retrospective myopic MNV study revealed that visual improvement after intravitreal bevacizumab injections was not maintained over time. Macular neovascularization recurrences occurred frequently but did not alter the already poor visual prognosis.

Formation and evolution of idiopathic lamellar macular hole-a pilot study

BackgroundThe developmental pathways and subsequent evolutional processes of idiopathic lamellar macular hole (LMH) were studied with spectrum domain optical coherence tomography (SD-OCT).MethodsTwenty-seven eyes of 26 patients of idiopathic LMH with pre-LMH SD-OCT available were retrospectively reviewed. Relevant OCT parameters and best-corrected visual acuity (BCVA) were collected and analyzed.ResultsFour types of developmental pathways of idiopathic LMH were noted. Type 1 (5 cases), involved disruption of a foveal cyst from vitreomacular traction. Type 2 (10 cases), demonstrated rupture of parafoveal cysts or schisis mainly from epiretinal membrane (ERM). In type 3 pathway (5 cases), a central intraretinal cyst formed under tight ERM with subsequent cyst roof dehiscence. Type 4 (7 cases), showed gradual loss of foveal tissue without cystic lesions from ERM traction. There was no statistically significant change in BCVA during LMH formations or subsequent evolutional processes in any types of the developmental pathways. Three cases developed epiretinal proliferation (EP) during evolution, which showed tendency of decrease in BCVA. Among the three cases, one later developed the degenerative configuration.ConclusionsIn summary, four types of tractional developmental pathways of idiopathic LMH were identified. BCVA was relatively stable during LMH formation and follow-up. Deterioration of visual acuity were found in cases that developed EP during evolution. Transformation into degenerative configuration might be possible after LMH formation.

Incidence of adverse events after loading phase of the brolucizumab therapy of neovascular AMD: Real-life evidence in the Czech Republic.

To evaluate the incidence of ocular adverse events after loading phase of the brolucizumab therapy in patients with neovascular age-related macular degeneration (nAMD) in real-life clinical practice - in treatment-naive patients and in patients after switching from another anti-VEGF agent. Another aim was to evaluate treatment outcomes in patients with adverse events. This is a multicentre, retrospective, observational study from 16 application centres in the Czech Republic. Patients diagnosed with nAMD were treated with brolucizumab in a fixed regimen of loading phase (3 injections administered at one-month intervals) and the mean follow-up period was 120 ± 10 days after the first injection. The incidence of adverse events and the development of best corrected visual acuity (BCVA) and central retinal thickness (CRT) in patients with complications were evaluated. A total of 1,098 eyes were followed up, of which 783 were treatment-naive and 315 eyes were after switching from another anti-VEGF agent. Adverse events were recorded in 42 eyes (3.83%), of which 30 eyes were treatment-naive (2.7%) and 12 eyes were post-switch (1.09%). The mean baseline BCVA ± SD was 56.7 ± 10.7 ETDRS chart letters in the group of patients with adverse events, 58.8 ± 10.1 letters in treatment-naive patients, and 51.4 ± 10.2 letters in patients after switch from another anti-VEGF agent. The mean baseline CRT ± SD was 432.2 ± 154.7 μm, being 435.8 ± 137.3 μm in treatment-naive patients and 424.5 ± 186.6 μm in patients after switch from another anti-VEGF agent. At the end of the follow-up, the mean BCVA ± SD was 53.4 ± 9.5 ETDRS charts letters in patients with adverse events, 55.6 ± 10 letters in treatment-naive patients, and 47.6 ± 10 letters in patients after switching from another anti-VEGF agent. The mean CRT ± SD at the end of the follow-up was 300.7 ± 115.7 μm in the total patient cohort, 285.2 ± 78.8 μm in treatment-naive patients and 334.5 ± 165.4 μm in patients after switching from another anti-VEGF agent. We observed the development of adverse events in the form of intraocular inflammation or vasculitis with subsequent decrease in BCVA in 3.83% of cases after loading phase of the brolucizumab therapy. The decrease in BCVA was reversible in most cases after initiation of anti-inflammatory steroid treatment. From a functional and morphological point of view, we did not demonstrate any statistically significant difference between the groups of treatment-naive patients and patients after switching from another anti-VEGF agent.

Characterization of the Structural and Functional Alteration in Eyes with Diabetic Macular Ischemia

To investigate the relative effect of disorganization of the retinal inner layers (DRIL) and ellipsoid zone (EZ) loss on visual function in diabetic macular ischemia (DMI). Prospective cross-sectional observational study. Patients with stable treated proliferative diabetic retinopathy (PDR) without center-involved diabetic macular edema were recruited at the Moorfields Eye Hospital from December 2019 to November 2021. The main inclusion criteria were best-corrected visual acuity (BCVA) of ≥ 40 ETDRS letters (Snellen equivalent 20/160) with OCT angiography (OCTA) evidence of DMI in ≥ 1 eye. Each eligible eye of the recruited patients was assessed for BCVA, OCT, and OCTA metrics. The prespecified OCT parameters were DRIL and subfoveal EZ loss. Generalized estimating equations were used. The frequency of DRIL and EZ loss, their relative contributions to vision loss, and their associations with microvascular alterations were evaluated. A total of 125 eyes of 86 patients with PDR were enrolled; 104 (83%) eyes had a BCVA of ≥ 70 letters. Disorganization of the retinal inner layers was more prevalent than EZ loss (46% [58 eyes] vs. 19% [24 eyes]). On average, the presence of DRIL had a more pronounced impact on vision, retinal thickness, and microvascular parameters than EZ loss. After multivariable adjustment, the odds of coexisting DRIL increased by 12% with every letter decrease in BCVA; however, there was no statistically significant association of subfoveal EZ loss with BCVA. In eyes with DRIL in the absence of EZ loss, the BCVA declined significantly by 6.67 letters compared with eyes with no DRIL nor EZ loss (95% confidence interval [CI],-9.92 to-3.41; P < 0.001). However, if DRIL and EZ loss coexisted, the resultant BCVA was 13.22 letters less than eyes without these structural abnormalities (95% CI,-18.85 to-7.59; P < 0.001). In patients with DMI with a Snellen visual acuity of 20/160 or better, eyes with DRIL were associated with more visual function loss and retinal blood circulation alterations than those with subfoveal EZ loss only.

A Randomized, Controlled Trial of Treat-and-Extend vs. Pro Re Nata Regimen for Neovascular Age-Related Macular Degeneration.

PurposeTo compare the efficacy and safety of conbercept using a treat-and-extend (T&E) regimen vs. a pro re nata (PRN) regimen in Chinese patients with neovascular age-related macular degeneration (nAMD).MethodsThis was a randomized, multicenter, non-inferiority study. After an initial loading phase of three consecutive monthly intravitreal injections of 0.5 mg Conbercept, the patients were treated to PRN or T&E regimen. The prespecified retreatment criteria was defined as a more than 5-letter decrease in BCVA from the previous visit or any evidence of new retinal hemorrhages, or the presence of any IRF and any SRF of more than 200 μm in height at the sub-foveal center. The primary outcome was the mean change in best-corrected visual acuity (BCVA) from baseline to 24 months, with a prespecified non-inferiority limit of −5 letters.ResultsFrom July 2016 through August 2018, 141 participants were allocated and treated (T&E, n = 69; PRN, n = 72). About one fifth of the overall participants were dropped out during the 12-month follow-up (28/141, 19.9%), and about one thirds of the overall participants were lost during the 24-month follow-up (51/141, 36%). At 2 years, mean BCVA letter improvement was + 4.0 in the T&E group vs. + 5.1 in the PRN group, and T&E regimen was not non-inferior to PRN regimen [difference, −1.169 letters; 95% confidence interval (CI): −6.864 ∼ 4.526]. Subgroup analyses also demonstrate the similar results in PCV patients, naive patients and no-naive patients. The mean decrease in central subfield thickness were 180 ± 165 μm in the T&E group and 247 ± 230 μm in the PRN group, respectively. The patients in the PRN group had required significantly fewer injections than those in the T&E group (12.4 vs. 14.6 injections, P = 0.041). The types and rates of adverse events were comparable in the two treatment groups.ConclusionThese findings suggest that the T&E regimen was not non-inferior to the PRN regimen in patients with nAMD in terms of BCVA outcomes through 24 months.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02802657.

Gonioscopy-Assisted Transluminal Trabeculotomy Following Failed iStent Surgery.

We describe 4 cases of eyes initially treated with phacoemulsification and iStent trabecular microbypass (Glaukos Corporation). These patients subsequently required further surgery and were successfully treated with the removal of the iStent device followed by gonioscopy-assisted transluminal trabeculotomy (GATT), using the iTrack catheter (Ellex Medical Lasers Ltd). Three of the cases had prior first-generation iStent (G1), and 1 had prior second-generation iStent (G2). This case series demonstrates that in selected cases, a further angle procedure in the form of a GATT can show efficacy and durability in the medium term. Our patients had controlled intraocular pressures (IOPs) at 1-year post-GATT: 2 on IOP-lowering therapy and 2 without any IOP-lowering medications. Three patients had transient hyphema and 2 with high IOP in the immediate postoperative period. No patients experienced a decrease in best-corrected visual acuity postoperatively. To the best of our knowledge, there is no prior literature describing this surgical strategy. This series demonstrates that GATT could potentially be an effective procedure in the case of a failed initial iStent microtrabecular bypass.

Surgical management of glaucoma following different keratoplasty techniques.

To investigate the results of surgical management of glaucoma following different keratoplasty techniques. Medical records of 628 cases who underwent keratoplasty were reviewed. One hundred and eighty-eight patients (29.9%) who developed post-keratoplasty glaucoma were evaluated. Patients who could not be controlled with maximal medical treatment and underwent glaucoma surgery were included in this study. Trabeculectomy, Ahmed glaucoma valve (AGV) implantation or diode laser cyclophotocoagulation (DLC) were applied. Glaucoma surgery was performed in 55 (29.3%) patients who had uncontrolled post-keratoplasty glaucoma. In penetrating keratoplasty group (n = 42), DLC was applied to 30 (71.4%) eyes, AGV to 11 (26.2%) eyes, and trabeculectomy in 1 (2.4%) eye. InDescemet'smembrane endothelial keratoplasty group (n = 8), DLC was applied to 4 (50%) eyes, trabeculectomy for 3 (37.5%) eyes and AGV for 1 (12.5%) eye. In deep anterior lamellar keratoplasty group (n = 5), DLC was applied to 2 (40%) eyes, trabeculectomy to 2 (40%) eyes and AGV to 1 (20%) eye. While a statistically significant decrease was found in intraocular pressure (IOP) and anti-glaucomatous medication after surgery (p < 0.05 for each), no significant difference was found in best corrected visual acuity (BCVA). During follow-up, DLC was applied as re-glaucoma surgery in 19 (34.5%) cases. A significant reduction in IOP together with number of anti-glaucomatous medications was found with re-operation; however, a significant decrease in BCVA was noted (p < 0.05 for each). Glaucoma surgeries after keratoplasty are effective in decreasing IOP and the number of anti-glaucomatous medication. While BCVA doesn't change after the first glaucoma surgery, after re-operation significant decrease may occur.

Efficacy of intravitreal conbercept injection on short- and long-term macular edema in branch retinal vein occlusion

To observe the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) repeatedly after the intravitreal injection of conbercept (IVC) for treating cystoid macular edema (CME) in branch retinal vein occlusion (BRVO) and explore the relationship between the duration of CME and visual outcome. Subgroup analysis was performed to compare short-term (within 90d of CME onset) and long-term (over 90d of CME onset) macular edema in BRVO. After an initial IVC, a pro re nata (PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA. Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6mo after IVC. Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME. There were statistical significances between and within groups of the BCVAs at different time points (P<0.001). The interaction was found between group and time (P=0.006), indicating the difference in the speed of BCVA improvement between groups. In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group. There were significant differences between and with groups of the CFT at different time points (P<0.001). However, the interaction between group and time in relation to CFT had no significant differences (P=0.59). IVC treatment for CME following BRVO is effective and safe. The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO. The improvement of vision might be faster with early IVC treatment than with delayed treatment.