Impaired Acuity Research Articles

Bilateral Disc Edema Heralding Ocular Syphilis: A Case Series (P10-10.006)

<h3>Objective:</h3> To describe five patients presenting with visual symptoms and disc edema who were diagnosed with ocular syphilis. <h3>Background:</h3> The Centers for Disease Control and Prevention (CDC) reported that in 2017–2021, men accounted for 83% of syphilis cases. Gay, bisexual, and other men who have sex with men account for 53% of male cases. Human immunodeficiency virus (HIV) positivity increases a patient’s risk of developing neurosyphilis. <h3>Design/Methods:</h3> Case series <h3>Results:</h3> The mean age of patients was 49 years (range 42–57). All were male. Three patients were positive for HIV but had undetected viral loads at the time of ocular syphilis diagnosis. Patients presented with varying degrees of impaired visual acuity, and each had improvement of visual acuity with treatment. RPR titers were elevated at the time of diagnosis and improved with treatment. CSF VDRL was negative in each case. Each patient was diagnosed with ocular syphilis and treated with 18–24 million units of intravenous aqueous crystalline penicillin daily for 10–14 days. Response to treatment was recorded based on examination and rapid plasma reagin (RPR) titers at 3 months. <h3>Conclusions:</h3> Ocular syphilis and neurosyphilis can be seen even in immunocompetent patients. Isolated ocular syphilis is an uncommon presentation of neurosyphilis, and may be associated with normal CSF evaluation. In our patients, treatment had been initiated prior to sampling of CSF, which could contribute to nonreactive VDRL. It is important to consider ocular syphilis in middle-aged male patients who present with vision loss and disc edema as it is a treatable and potentially reversible cause of vision loss. <b>Disclosure:</b> Dr. Anderson has nothing to disclose. Ms. Hayse has nothing to disclose. Joseph Boss has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Unity Biotechnology . Joseph Boss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eyepoint pharmaceuticals . Dr. Antonio has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. Dr. Antonio has received research support from AAN PALF. The institution of Dr. Antonio has received research support from Trinity Health Foundation. The institution of Dr. Antonio has received research support from AAN IDEAS Grant.

Course of Neovascular Age-related Macular Degeneration that Showed Limited Response to Both Ranibizumab and Aflibercept

Purpose: To evaluate the clinical course of neovascular age-related macular degeneration (nAMD) that has shown limited response to ranibizumab and aflibercept.Methods: This retrospective study included 14 eyes with nAMD that showed a limited response to initial treatment using ranibizumab and aflibercept. The changes in visual acuity (VA) during the follow-up period and the incidence and timing of VA deterioration to the level of 0.1 or worse were identified. In cases involving bevacizumab treatment, the follow-up duration and the proportion of patients maintaining a VA of 0.2 or better were identified.Results: During the mean 43.3 ± 33.2 months of follow-up, the VA deteriorated significantly from a mean logarithm of minimum angle of resolution (logMAR) of 0.42 ± 0.34 at diagnosis to 0.91 ± 0.68 at the final follow-up (&lt;i&gt;p&lt;/i&gt; = 0.021). A logMAR of 0.3 or greater degree of VA deterioration was noted in six eyes (42.9%). Among the 13 eyes exhibiting a VA of 0.2 or better after the initial treatment, a deterioration to a VA of 0.1 or worse was noted in 6 eyes (46.2%) at a mean 29.7 ± 18.3 months. In eight eyes undergoing bevacizumab treatment, four eyes (50.0%) maintained 0.2 or better VA during the 51.4 ± 35.5 months of follow-up.Conclusions: The clinical course of patients with limited response to ranibizumab and aflibercept was generally unfavorable. However, a relatively long period was required for the deterioration in VA to reach 0.1 or worse. In addition, 0.2 or better VA was maintained in approximately half of the patients.

Occurrence of intraocular hemorrhages under monotherapy or combination therapy of antiplatelets and anticoagulants using the Japanese Adverse Drug Event Report database.

Purpose: An intraocular hemorrhage is an adverse event that can lead to visual acuity impairment. Antithrombotic therapy with antiplatelet agents and anticoagulants may increase intraocular hemorrhage. However, since their frequency is low, studies on the risk of intraocular hemorrhage with these drugs, especially under combination therapy, are limited. This study aimed to investigate the occurrence of intraocular hemorrhages under monotherapy and combination therapy with antiplatelets and anticoagulants by analyzing a large pharmacovigilance database. Methods: Intraocular hemorrhage signals with oral antiplatelets and anticoagulants were evaluated by calculating reporting odds ratios and information components using the Japan Adverse Drug Reactions Report database from April 2004 to March 2022. In addition, differences in signals between younger and elderly patients, affecting factors, and time-to-onset from initial antiplatelet and anticoagulant treatments were analyzed. Results: Aspirin, clopidogrel, warfarin, apixaban, and rivaroxaban, but not ticagrelor, ticlopidine, prasugrel, dabigatran, and edoxaban showed intraocular hemorrhage signals under monotherapy. In combination therapy, dual therapy (aspirin + P2Y12 inhibitors, warfarin, direct oral anticoagulants, and P2Y12 inhibitors + warfarin) and triple therapy (aspirin + P2Y12 inhibitors + warfarin) resulted in intraocular hemorrhage signals. Intraocular hemorrhage signals were observed in younger patients receiving monotherapy with aspirin and in elderly patients receiving monotherapy and combination therapy with warfarin. Affecting factors were diabetes mellitus in patients with prasugrel, use of medications for intravitreal injections, and posterior sub-Tenon injections with some antiplatelets and anticoagulants. The median period of intraocular hemorrhage occurrence after starting monotherapy with aspirin, clopidogrel, warfarin, or rivaroxaban was within 90days. Conclusion: In addition to monotherapy with several antiplatelets and anticoagulants, combination therapy using aspirin, P2Y12 inhibitors, and warfarin has the potential risk of intraocular hemorrhage. Particular attention should be paid to the occurrence of intraocular hemorrhages in younger patients taking aspirin, in elderly patients taking warfarin, and within the first 90days of antiplatelet and anticoagulant use.

Evaluation of a new Q-switched Nd:YAG laser on premacular hemorrhage

BackgroundPremacular hemorrhage is among the causes of sudden deterioration of visual acuity. This study aimed to investigate the therapeutic outcomes of a new Q-switched Nd:YAG laser on premacular hemorrhage.MethodsRetrospective, case series study of 16 eyes from 16 patients diagnosed with premacular hemorrhage, including 3 cases of Valsalva retinopathy, 8 cases of retinal macroaneurysm, 3 cases of diabetic retinopathy, 1 case of trauma-related hemorrhage and 1 case with leukemia. A 1064nm Q-switched Nd:YAG laser was performed to puncture the posterior hyaloid and inner limiting membrane to drain the hemorrhage.ResultsThe success rate of 16 patients with premacular hemorrhage drainage was 100% in this study. Improved visual acuity was observed in each patient.ConclusionsIn this case series of 16 patients, the new Q-switched Nd:YAG laser was successful in draining premacular hemorrhage with no serious complications.

Geriatric Syndromes among Patients with Nuclear Cataract Depending on Visual Acuity without Correction

Cataract in patients of older age groups is one of the reasons for the deterioration of geriatric status, the manifestations of which are geriatric syndromes, but insufficient attention paid to the study of the latter.Purpose. To study the prevalence of geriatric syndromes among patients with UC, depending on visual acuity without correction.Patients and methods. Geriatric syndromes were studied in 220 elderly patients with UC, in 240 elderly patients with FC and 200 elderly patients without UC based on methods of complex geriatric assessment. The following geriatric syndromes were analyzed: sarcopenia, hypomobility, malnourishment, pain syndrome, and disorders of general motor activity, psychological problems, cognitive disorders, anxiety-depressive status, sleep disorders and urination.Results. It was found that the deterioration of visual acuity without correction of less than 0.3 is accompanied by an increase in the majority of geriatric syndromes in elderly and senile patients with UC and especially in 75–89 years of hypomobility syndrome to 93.2 ± 2.5 cases of cognitive impairment to 89.3 ± 3.0 cases, malnutrition to 88.3 ± 3.2 cases and psychological problems to 79.6 ± 4.0 cases per 100 examined, which is significantly higher by 2.0–2.4 times compared to patients of the same age with UC with visual acuity without correction more than 0.3. A decrease in visual acuity of less than 0.3 in patients with UC contributes to an increase in the prevalence and average number of geriatric syndromes in old age to 8.2 ± 1.0 cases versus 3.9 ± 0.8 cases in old age with UC with visual acuity of more than 0.3 (P &lt; 0.001).Conclusion. The revealed dependence of the prevalence of geriatric syndromes, taking into account visual acuity, indicates the relevance of timely correction.

Headache, vision changes and cranial nerve palsy after head trauma.

A 43-year-old female was brought to the hospital after a ground level fall and her Glasgow Coma Scale was 15. Non-contrast head computed tomography (CT) scan showed small bilateral subdural hematomas, left traumatic subarachnoid hemorrhage, left occipital bone and left longitudinal temporal bone fractures. She was managed conservatively. Interval repeat non-contrast head CT scans showed resolution of the hemorrhage. Two and a half months later she presented to the hospital with headaches, intermittent diplopia, blurry vision and a right lateral gaze palsy. Non-contrast head CT scan showed mild hyperattenuation in the cavernous sinus. Subsequently, a CT angiogram of the head was obtained that showed opacification of the bilateral cavernous sinus and distention of the orbital veins (Figure 1A,B). Evaluation with diagnostic cerebral angiogram showed direct bilateral carotid-cavernous fistulas (CCFs) (Figures 2 and 3). She underwent staged embolization of the CCFs. Direct CCF is the abnormal connection between the internal carotid artery and the cavernous sinus.1, 2 CCFs can present with the classic triad of chemosis, pulsatile proptosis and ocular bruit.3, 4 Other symptoms include orbital pain, abducens nerve palsy, deterioration of visual acuity and ophthalmoplegia.4, 5 Causes of CCF formation are traumatic, iatrogenic, connective tissue disorders and spontaneous.2, 6-9 Traumatic CCFs formation occurs in up to 1.25% of patients with traumatic brain injury or facial and skull base fractures.10, 11 Bilateral CCF formation is rare after trauma and symptoms develop in a delayed fashion.10-15 Treatment options include conservative management, open surgery, endovascular procedures and radiosurgery.16-18

Оценка эффективности вторичной профилактики пациентов с ранней стадией возрастной макулярной дегенерации

Age-related macular degeneration (AMD) is one of the leading medical and social problems worldwide. The purpose of this study was to evaluate the effectiveness of drug prevention in patients with early-stage AMD lutein-zeaxanthin containing vitamin and mineral complex. Material and methods. The clinical study included 50 patients of the main group who took lutein-zeaxanthin containing a vitamin and mineral complex 1 capsule 1 time a day for 3 months 2 times a year, for 3 consecutive years, and 50 patients of the control group who did not receive drug therapy. Results. In the main group of patients, there was an increase in visual acuity, an improvement in indicators according to OCT data, and an improvement in the subjective perception of their own visual functions. At the same time, the patients of the control group had a deterioration in visual acuity, the progression of the disease according to OCT, which was manifested by the transition to the next stage of AMD. Conclusion. Drug therapy of early-stage AMD has a preventive effect on the progression of the pathological process in the macular zone. Keywords: age-related macular degeneration, vitamins, minerals, lutein, zeaxanthin

Ocular manifestations of vitiligo: a systematic review

Vitiligo is a disorder characterized by loss of epidermal melanocytes, resulting in depigmented macules and patches. While the relationship between ocular pathology and vitiligo has been demonstrated in conditions such as Vogt-Koyanagi-Harada and Alezzandrini syndromes, the ocular associations of non-syndromic vitiligo are incompletely understood. We conducted a systematic review to comprehensively describe the structural and functional changes seen in the eyes of patients with vitiligo, to identify patients at heightened risk for ocular disease, and to provide an approach to management of ocular manifestations of vitiligo. Overall, the strongest link between vitiligo and ocular pathology seems to lie with dry eye disease and pigmentary abnormalities of various ocular structures, especially the retinal pigment epithelium. Normal-tension glaucoma may also be more prevalent in the vitiligo population. The available literature did not provide conclusive evidence for increased risk of cataracts or uveitis. Aside from the impact of symptomatic dry eye disease, it seems unlikely that there are significant functional consequences of these ocular manifestations such as impaired visual acuity or visual fields.

Primary pituitary lymphoma successfully treated with Bruton’s tyrosine kinase inhibitor monotherapy: case report

Introduction: Primary pituitary lymphoma (PPL) is a rare disease characterized by lymphoma confined to the sella or parasellar region without systemic involvement. The clinical symptoms of PPL may include headache, hypopituitarism, visual field disturbance and visual impairment. To date, there is no established standard treatment for this condition. Here, we present a case of successful treatment with a Bruton’s tyrosine kinase (BTK) inhibitor. Case report: A 78-years-old man with a history of severe left renal insufficiency caused by retroperitoneal fibrosis, and sequential right nephrostomy, underwent brain magnetic resonance imaging (MRI) due to the altered hormonal status. An enlarged pituitary stalk was noted and led to a diagnosis of lymphocytic hypopituitarism. Six months later, visual field disturbance and visual acuity deterioration developed, and an MRI revealed a neoplastic lesion and further enlargement of the stalk and the pituitary itself, with an obvious optic nerve compression. Expedited transsphenoidal partial resection was performed to relieve the compression. Pathohystology led to the diagnosis of the large B-cell lymphoma of the germinal center origin. Because of the patient’s poor renal function, high-dose methotrexate therapy was not an option; rather, the patient was treated with a BTK inhibitor - tirabrutinib. Symptoms improved within a week, and a follow-up MRI confirmed a marked reduction of the pituitary lesion. Conclusion: BTK inhibitors may be considered as a first-line treatment option for PPL, especially in patients with contraindications for other treatment protocols.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study.

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits. The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education). Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained. Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.

Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study

ObjectiveTo investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain. DesignCross-sectional study. SettingInterdisciplinary outpatient rehabilitation clinic for back and neck pain. ParticipantsPatients with chronic neck pain (n=30), patients with chronic low back pain (n=30), and age- and sex-matched asymptomatic control subjects (n=30; N=90). InterventionsNot applicable. Main Outcome MeasuresPatients and asymptomatic control subjects completed a test procedure for the JPS of the cervical spine, lumbar spine, and ankle in a randomized order. Between group differences were analyzed with the univariate analysis of variance and associations of the JPS with clinical features using the Pearson's correlation coefficient. ResultsBoth patients with chronic neck pain (P<.001) and patients with chronic low back pain (P<.01) differed significantly from asymptomatic controls in the JPS of the cervical spine, lumbar spine and ankle joint, regardless of the painful area. No difference was shown between patient groups (P>.05). An association of the JPS with clinical characteristics, however, could not be shown. ConclusionThese results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.

The factors influencing postoperative efficacy of anterior clinoidal meningioma treatment and an analysis of best-suited surgical strategies.

To explore the influence of the type of anterior clinoidal meningioma on surgical strategy planning, surgical approach selection, and postoperative efficacy. We conducted a retrospective analysis of the clinical data of 63 cases, including data on visual function, extent of tumor resection, and postoperative follow-up. Grade I and II approaches were selected according to the type of tumor. A univariate analysis of the factors influencing the extent of tumor resection, postoperative visual function, and postoperative relapse and complications was conducted. Simpson Grade I-II total resection was seen in 48 cases (76.2%), with an overall relapse/progression rate of 12.7%. The tumor type and texture and the relationship between the tumors and adjacent structures were the main factors influencing total tumor resection (P < 0.01). The overall postoperative visual acuity improvement, stabilization rate, and deterioration rate were 76.2, 15.9, and 7.9%, respectively. Postoperative visual acuity level was significantly correlated with preoperative visual acuity level and tumor type (P < 0.01). Determining the type of tumor at a preoperative level and whether the optic canal and cavernous sinus are invaded can aid in the planning of detailed individualized surgical strategies.

Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data.

To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level. National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease. 55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors. Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.

Acute keratoconus: clinical cases

Indrė Rašinskaitė1 , Saulius Galgauskas1,2 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania 2Vilnius University, Faculty of Medicine, Institue of Clinical Medicine, Clinic of Era, Nose, Throat and Eye Diseases, Center of Eye Diseases, Vilnius, Lithuania Abstract Background. Keratoconus is chronic ectatic corneal disease. The progressive thinning of corneal stroma causes corneal cone shape and impaired vision. The etiology of the disease is associated with genetic, environmental factors, allergic and atopic diseases. Keratoconus usually progresses slowly firstly affecting one eye. Acute course of the disease is rare, manifested by acute swelling of the cornea. Clinical case No.1. 21 y.o. man presented at emergency department with decreasing visual acuity of the right eye. Complaints appeared two weeks ago, during that time he used artificial tears. One week after the onset of symptoms, the patient was consulted by an ophthalmologist and diagnosed with acute right eye keratitis. Swelling of the right corneal stroma, descemetitis was observed during admission to the hospital. Topographic revealed greater corneal curvature in the lower right eye. Clinical case No.2. 28 y.o. patient with Down syndrome was consulted due to impaired left eye visual acuity, tearing lasting five days. Ophthalmologist observed corneal edema, viral keratitis was suspected and levofloxacin drops and aciclovir tablets were prescribed. During objective examination, a strong swelling of the left corneal stroma, bulls, rupture of the Descemete’s membrane were observed. Keratoconus was diagnosed by corneal topography. Conclusion. Acute corneal hydrops is a rare complication of keratoconus. The diagnosis of keratoconus is complicated if acute hydrops occurs as the first symptom following eye irritation, pain, photophobia. The main diagnostic method of keratoconus is topography. Keywords: keratoconus, corneal hydrops, ectasia, corneal topography Full article https://doi.org/10.53453/ms.2023.2.6

Childhood Chronic Idiopathic Uveitis in a Multicentre International Cohort

ABSTRACT Importance Idiopathic uveitis makes up around 50% of non-infectious uveitis but the clinical characteristics in children are poorly understood. Objective To report the demographic, clinical characteristics, and outcomes of children with idiopathic non-infectious uveitis (iNIU) in a multicentric retrospective study. Results There were 126 (61 female) children with iNIU. The median age at diagnosis was 9.3 years (3–16 years) . Uveitis was bilateral in 106 patients and anterior in 68.At onset,impaired visual acuity and blindness in the worse eye were reported, in 24.4% and 15.1% patients but at 3 years of follow-up, there was a significant improvement in visual acuity (mean 0.11 SD ±0.50 vs 0.42 SD ± 0.59 p < .001). Conclusions and relevance There is a high rate of visual impairment at presentation in children with idiopathic uveitis. The majority of patients have a significant improvement in vision, but 1 in 6 had impaired vision or blindness in their worse eye at 3 years.

Association Between Contrast Sensitivity and Physical Function in Cognitively Healthy Older Adults: The Brain Networks and Mobility Function Study.

To evaluate whether contrast sensitivity is associated with lower extremity physical function in cognitively intact older adults. Cross-sectional analysis of the relationship of binocular and worse eye log contrast sensitivity (LCS) to expanded Short Physical Performance Battery (eSPPB) and its components (gait speed, narrow walking speed, chair stand pace, and balance) in 192 cognitively healthy older adults. The association of LCS with postural sway and gait was also tested with tasks that further challenged functional reserve. Mean age was 76.4 years with 56% identifying as female and over 98.5% having good corrected visual acuity. Lower LCS was significantly associated with worse performance on the eSPPB, 4-M gait speed, narrow walking speed, and balance time in unadjusted and adjusted models. The relationship between worse eye LCS and larger postural sway was 3 times greater on a foam surface (beta 1.07, 95% CI [0.35, 1.80]) than a firm surface (beta 0.35, 95% CI [0.05, 0.65]), and both were robust to adjustment for confounders; similar findings were observed with binocular LCS. Lower binocular LCS had a greater decremental effect on gait velocity during the fast pace (beta -0.58, 95% CI [-0.90, -0.27]) than the usual pace (Beta -0.39 [-0.63, -0.15]) gait task. These findings suggest that cognitively unimpaired older adults without significant visual acuity impairment can have subtle preclinical deficits in contrast sensitivity and physical function that could place them at risk of mobility and balance issues. Future studies should determine whether this subset of older adults may benefit from targeted intervention to prevent disability.

Life Quality in Patients with Impaired Visual Acuity Undergoing Intravitreal Medication Applications

This cross-sectional study aims to examine the quality of life and difficulties in the daily functioning of patients with impaired visual acuity treated with intravitreal drugs. The survey included 180 adult respondents (78 male and 102 female). The standardized, validated questionnaire VFQ 25 version 2000 was used to measure the quality of life. Results show that, in general, regarding visual functioning, men are significantly more satisfied than women, they rate less intensity of pain, and their distance vision is better. Men report fewer restrictions than women, better color, peripheral vision, and overall visual functioning. The best vision results are in individuals under the age of 60 who also report significantly better social functioning, mental health, fewer restrictions, and less dependence on others. The only significant association between the number of drug applications and the scale of visual functioning is driving motor vehicles-the more applications of the drug they received, the less likely they are to drive a car. The quality of life in patients with chronic ophthalmic diseases treated with intravitreal drugs is reduced, particularly in elderly and female patients who have poorer visual acuity, poorer health in general, and limited social roles.

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema.

Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Twenty-seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples - 12 (44.4%). Group 2 included patients with >3 months between the two samples -15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post-dexamethasone in group 1, but not in group 2. Interleukin (IL)-4, IL-6, IL-10, vascular endothelial growth factor (VEGF), IL-1β, interferon-gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), and IL-2 decreased post-injection in group 1. But cytokines increased post-dexamethasone in group 2, except IL-10. When compared to baseline, IL-6 reduced to half in group 1 (P-value 0.814) and it tripled in group 2 ( P-value 0.009). The level of VEGF in the first and second samples was not different in either group. Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL-6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia.

The COVID-19 pandemic brought the world to a standstill in 2020. Many countries have imposed lockdowns, known as the movement-control order (MCO) in Malaysia, to prevent transmission of the disease. The objective of this study is to evaluate the impact of the MCO on the management of glaucoma patients in a suburban tertiary hospital. We conducted a cross-sectional study of 194 glaucoma patients between June 2020 and August 2020 in the glaucoma clinic at Hospital Universiti Sains Malaysia. We evaluated the patients' treatment, visual acuity, intraocular pressure (IOP) measurements, and potential signs of progression. We compared the results with those of their last clinic visits prior to the MCO. We studied 94 (48.5%) male and 100 (51.5%) female glaucoma patients with a mean age of 65 ± 13.7. The mean duration between pre-MCO and post-MCO follow-up was 26.4 ± 6.7 weeks. There was a significant increase in the number of patients with deterioration of visual acuity, and one patient lost his vision after the MCO. There was also a significant elevation of the mean IOP of the right eye: pre-MCO, 16.7 ± 7.8 mmHg, compared to post-MCO, 17.7 ± 8.8 mmHg (p = 0.027). The cup-to-disc ratio (CDR) for the right eye increased significantly from pre-MCO, 0.72 ± 0.18, to 0.74 ± 0.19 post-MCO (p < 0.001). However, there were no significant changes in IOP or CDR in the left eye. Twenty-four patients (12.4%) missed medications during the MCO period, and 35 patients (18%) required additional topical medications due to the progression of the disease. Only one patient (0.5%) required admission due to uncontrolled IOP. Lockdown, as a preventive step in the COVID-19 pandemic, indirectly caused the progression of glaucoma and uncontrolled IOP.

Insulin-regulated serine and lipid metabolism drive peripheral neuropathy

Diabetes represents a spectrum of disease in which metabolic dysfunction damages multiple organ systems including liver, kidneys and peripheral nerves1,2. Although the onset and progression of these co-morbidities are linked with insulin resistance, hyperglycaemia and dyslipidaemia3–7, aberrant non-essential amino acid (NEAA) metabolism also contributes to the pathogenesis of diabetes8–10. Serine and glycine are closely related NEAAs whose levels are consistently reduced in patients with metabolic syndrome10–14, but the mechanistic drivers and downstream consequences of this metabotype remain unclear. Low systemic serine and glycine are also emerging as a hallmark of macular and peripheral nerve disorders, correlating with impaired visual acuity and peripheral neuropathy15,16. Here we demonstrate that aberrant serine homeostasis drives serine and glycine deficiencies in diabetic mice, which can be diagnosed with a serine tolerance test that quantifies serine uptake and disposal. Mimicking these metabolic alterations in young mice by dietary serine or glycine restriction together with high fat intake markedly accelerates the onset of small fibre neuropathy while reducing adiposity. Normalization of serine by dietary supplementation and mitigation of dyslipidaemia with myriocin both alleviate neuropathy in diabetic mice, linking serine-associated peripheral neuropathy to sphingolipid metabolism. These findings identify systemic serine deficiency and dyslipidaemia as novel risk factors for peripheral neuropathy that may be exploited therapeutically.