Difference In Mean Best-corrected Visual Acuity Research Articles

Comparison of optical aberrations in keratoconus with scleral versus rigid gas permeable lenses.

to assess optical aberrations under scleral (SL) versus rigid gas permeable (RGP) lenses in patients with keratoconus. A prospective study including 25 eyes of 14 patients. The best-corrected visual acuity (BCVA) with corrective glasses, RGP and SL, stage of keratoconus (Amsler-Krumeich classification), minimum pachymetry, maximum keratometry, and corneal higher-order aberrations (i.e, total HOAs, coma, and trefoil) with RGP and with SL were collected. Aberrometry was performed using iTrace® aberrometer (Tracey Technologies, USA). 80% of the included keratoconus patients were stage 4, with a mean age of 34.3 years (±8.8). There were no significant differences in mean BCVA (logMAR) between SL and RGP. The mean BCVAs were significantly better both with SL (p < 0.0001) and RGP (p < 0.0001) compared with corrective glasses. Total HOAs (p = 0.01), coma (p = 0.003) and trefoil (p = 0.008) were significantly lower with SL compared with RGP. The BCVA decreased with the stage of keratoconus in SL (p = 0.01) and RGP (p = 0.02). The BCVA decreased with decreasing minimum pachymetry in SL (p = 0.02) and RGP (p = 0.002), and with increasing maximum keratometry in SL (p = 0.02) and RGP (p = 0.01). Significant correlations were found between BCVA, total HOAs (p = 0.008), and coma (p = 0.02) in SL. For the same keratoconus patients, total higher order, coma and trefoil optical aberrations were reduced with scleral lenses compared to rigid gas permeable lenses.

Pars Plana Vitrectomy for Retained Lens Fragments After Cataract Surgery: Outcomes Based on Timing of Surgery.

To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery. Retrospective case series of all patients who underwent PPV for RLF at Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery. The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (P = 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (P > 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (P > 0.05). In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.

Comparison of Dexamethasone Implant and Anti-VEGF Agents in the Treatment of Naive Diabetic Macular Oedema: A Prospective Cohort Study

Introduction: Diabetic Retinopathy (DR) is one of the common microvascular complications of diabetes. In patients with DR, the most frequent cause of vision loss is Diabetic Macular oedema (DME). In the present era, anti-Vascular Endothelial Growth Factor (anti-VEGF) agents are the mainstay of treatment for managing DME. A majority of patients show a good response to multiple doses of these agents administered by a pro re nata regimen at regularly spaced fixed intervals. However, the tendency of DME to become chronic and resistant to these agents, as well as the burden of repeated injections, necessitates considering alternative treatment options with similar or better efficacy. As steroids can address these drawbacks of anti-VEGF treatment, the present study compared the efficacy of anti-VEGF agents with dexamethasone implant in the treatment of naïve DME. Aim: To compare the effectiveness of dexamethasone implant with anti-VEGF agents in the treatment of naïve DME. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology at Kalinga Institute of Medical Sciences and Pradyumna Bal Memorial Hospital, Bhubaneswar, Odisha, India from September 2020 to September 2022. A total of 100 eyes with DME, newly diagnosed patients aged 18 years and above, without other macular oedema-causing diseases, were included. A total of 50 eyes in each group were treated with an anti-VEGF agent (Group A) or dexamethasone implant (Group B), and Best Corrected Visual Acuity (BCVA) and Central Foveal Thickness (CFT) were monitored for six months. For statistical analysis, paired t-test and independent t-test were used for within-group and inter-group analysis, respectively. A p-value &lt;0.05 was considered statistically significant. Results: In both groups, post-treatment BCVA showed marked improvement, but there was no significant difference in mean BCVA between the groups (p=0.89) at six months. However, the mean CFT showed significant improvement in Group B at six months. In Group A, the mean CFT reduced from 441.87±54.48 μm to 257.83±25.73 μm, and in Group B, the mean CFT reduced from 464±109.44 μm to 207±22.51 μm at six months (p&lt;0.0001). Adverse events like cataracts and glaucoma were seen in patients treated with the dexamethasone implant and were managed by cataract surgery and topical anti-glaucoma medications, respectively. Conclusion: Dexamethasone implant and anti-VEGF agents are equally effective in improving visual acuity; however, dexamethasone stands superior in reducing macular thickness. Needing fewer injections while treating with a dexamethasone implant improves compliance. The progression of cataract remains a major side-effect with the dexamethasone implant, which is not a concern when treating DME in pseudophakic eyes.

The Efficacy and Safety of Air Tamponade in the Repair of Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis

Background: Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy (PPV) combined air tamponade has many advantages compared with PPV combined gas tamponade. However, there are controversial outcomes in RRD cases involving the lower quadrants. Objective: This study aimed to evaluate the efficacy and safety of PPV combined air tamponade in patients with RRD compared with PPV combined gas tamponade and whether it could be a safe alternative to PPV combined gas tamponade. Methods: The PubMed, Embase, and Cochrane Library databases published until September 2022 were comprehensively searched for studies that compared PPV combined with air tamponade and gas tamponade in patients with RRD. The rate of primary treatment success, best-corrected visual acuity (BCVA), and postoperative complications were extracted from the final eligible studies. Study quality was assessed using the Jadad scale and Newcastle-Ottawa scale (NOS). The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals. The systematic review and meta-analysis were prospectively registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/; registration number CRD42022353479). Results: A total of 8 studies with 668 eyes in the air tamponade group and 944 in the gas tamponade group were included. There was no significant difference in the rate of primary treatment success between the air tamponade group and the gas tamponade group (RR = 1.00, p = 0.79). In addition, the subgroup analysis suggested that whether retinal breaks were located above or below, there was no significant difference in either rate of primary treatment success (RR = 0.99, p = 0.89; RR = 1.02, p = 0.45). There was no significant difference in mean BCVA 3 months after surgery (MD = −0.02, p = 0.50). For postoperative complications, mean postoperative intraocular pressure was lower in the air tamponade group at 1 day (MD = −4.24, p < 0.001), and there was no significant difference between the two groups at 7 days (MD = −0.45, p = 0.71), 1 month (MD = −0.69, p = 0.33), and 3 months (MD = 0.69, p = 0.35) after surgery. The rate of epiretinal membrane development was lower in the air tamponade group (RR = 0.48, p = 0.04). Conclusions: For patients with uncomplicated RRD, PPV combined air tamponade is a feasible and safe alternative to PPV combined gas tamponade, regardless of the position of retinal breaks, with a similar primary treatment success rate, postoperative BCVA, and fewer postoperative complications.

Visual Outcomes of Optic Pathway Glioma Treated With Chemotherapy in Neurofibromatosis Type 1.

To analyze the visual outcomes following chemotherapy for optic pathway glioma in children with neurofibromatosis type 1. This was a retrospective cohort study of 58 children with optic pathway glioma between 2003 and 2019. Best corrected visual acuity (BCVA) at diagnosis and at the last follow-up visit were analyzed. Correlation tests were performed to determine whether the final BCVA was predicted by the initial BCVA, initial Dodge stage, or retinal nerve fiber layer (RNFL) thickness stability. The first-line chemotherapy regimen included vincristine plus carboplatin (2003 to 2016) and vinblastine (since 2017). Twenty-four children (41%) received chemotherapy. The median age at diagnosis was 3 years, and 61% of the children were female. From the first visit to the last follow-up visit, there was a statistically significant difference in mean BCVA in eyes in the no treatment group (P = .034) but not in eyes in the chemotherapy group (P = .824). A moderate and weak positive correlation was found (r = 0.58 and r = 0.29, respectively). At the last follow-up visit, BCVA remained stable in 73% and improved in 27% of eyes in the no treatment group, and BCVA worsened in 25%, remained stable in 62%, and improved in 13% of eyes in the chemotherapy group. At the last follow-up visit, BCVA and Dodge stage had a weak negative correlation (r = -0.06 and r = -0.17, respectively). A negative moderate correlation was identified between RNFL thickness and BCVA at the last follow-up visit (r = -0.48 in the no treatment group and r = -0.46 in the chemotherapy group). Children treated with chemotherapy had worse BCVA, although the treatment arrested the decline or improved BCVA in 75% of the patients with no major side effects. [J Pediatr Ophthalmol Strabismus. 2022;59(2):128-135.].

Long-term outcomes of intravitreal anti-VEGF therapies in patients affected by neovascular age-related macular degeneration: a real-life study

PurposeTo describe real-life data from wet age-related macular degeneration (AMD) patients treated with anti-vascular endothelial growth factors (VEGFs) and to compare our results with previous studies and clinical trials.MethodsThis retrospective monocentric cohort study analyzed 865 eyes of 780 wet-AMD patients treated with an anti-VEGF treat-and-extend regimen over a long-term follow-up period. Aflibercept and Ranibizumab were considered first-line agents whereas Bevacizumab was reserved for use on a compassionate basis in patients not meeting treatment criteria. All patients underwent a best corrected visual acuity (BCVA) assessment at each follow-up visit.ResultsOne-year follow-up figures were available for 82.5% of patients, whilst follow-up data was recorded for 55.6%, 37.6%, 25.1%, and 15.0% of the cohort at years 2, 3, 4, and 5 respectively. Patients treated with Bevacizumab received fewer yearly injections than those treated with Ranibizumab. However, no significant difference in the number of injections per year was detected in other comparisons between groups. Whilst our data showed no significant difference in mean BCVA between the three groups, there was a gradual deterioration of visual function over time for the patient cohort as a whole.ConclusionNo significant differences between the 3 anti-VEGF molecules were recorded in wet-AMD patients in real-life conditions. Despite the long-term therapy, we found a slight reduction in visual function especially after the third year of treatment.

Corneal edema recovery after phacoemulsification in type 2 diabetic versus non-diabetic patients

Background. Ultrasound energy during phacoemul-sification can cause mechanical trauma to corneal endothelium which leads to prolonged postoperative recovery. Several studies have reported conflicting results of corneal changes after phacoemuslification in diabetic versus non-diabetic patients. We aimed to assess corneal edema recovery and compare best corrected visual acuity (BCVA) after phacoemulsification in patients with diabetes mellitus type 2 versus patients without type 2 diabetes. Methods. The study included type 2 diabetic and non-diabetic patients who underwent phacoemulsification between November 2018 and May 2019. Assessments of corneal edema recovery were done preoperative and on postoperative day 1, after 1 week and after two months. BCVA were taken preoperative and postoperative after 1 week and 2 months after the surgery. Results. There was no significant difference between groups in corneal status on check-up examinations. Corneal edema recovery was equal between the pa-tients with and without diabetes mellitus type 2. No significant difference in mean BCVA was observed between the studied groups after the operation. Conclusion. Considering the use of modern technology in cataract surgery, there was no difference in postoperative results between non-diabetic and type 2 diabetic patients.

Biomarkers in Usher syndrome: ultra-widefield fundus autofluorescence and optical coherence tomography findings and their correlation with visual acuity and electrophysiology findings.

To investigate the functional and structural biomarkers and their correlation with Usher syndrome (USH). Medical records, imaging and electrophysiology test results of USH patients attending the Save Sight Institute between 2012 and 2017 were reviewed. Best corrected visual acuity (BCVA), ultra-widefield autofluorescence (UW-FAF), spectral-domain optical coherence tomography (SD-OCT), full-field electroretinogram and pattern electroretinogram (pERG) were performed. SD-OCT scans assessed central macular thickness (CMT), greatest linear diameter of preserved outer retinal layers-macular island (MI) and presence of cystoid macular edema (CME). UW-FAF images were qualitatively graded to identify hypo/hyperfluorescence patterns in the peripheral fundus. Thirty-six eyes from 18 subjects were included. Mean BCVA was 0.22 ± 0.3 LogMAR. MI extent was significantly associated with better vision (β = - 0.175 per 1000µm; R2 = 0.487; P = 0.002; Fig.4). A higher pERG P50 was associated with a larger macular island (β = 782 per µV; R2 = 0.238; P = 0.025), while a higher pERG N95 was associated with a smaller macular island (β = - 499 per µV; R2 = 0.219; P = 0.030). Mean CMT was 271 ± 35μm and was significantly associated with better vision (β = - 0.083 per 10µm; R2 = 0.612; P < 0.001). CME was diagnosed in 47.2% (n = 17) eyes. There was no significant difference in mean BCVA for those with CME (0.19 ± 0.2 LogMAR) and without CME (0.40 ± 0.5; R2 = 0.081; P = 0.17). All patients had abnormal UW-FAF. Four main patterns of change were identified (granular 55%, annular 11%, bone spicule 17% and patchy 17%). Patients with the patchy pattern demonstrated worse BCVA in comparison with those with granular (P < 0.0001) and bone spicule (P = 0.0179) patterns. Structural changes identified on OCT and UW-FAF correlated with BCVA and pERG in this cohort representing different stages of the disease. These parameters could represent reliable biomarkers in therapeutic clinical trials on USH.

Comparing the Efficacy of Bevacizumab and Ranibizumab in Patients with Diabetic Macular Edema (BRDME): The BRDME Study, a Randomized Trial

To generate conclusive evidence regarding the noninferiority of intravitreal bevacizumab compared with ranibizumab in patients with diabetic macular edema (DME). Comparative, randomized, double-masked, multicenter, noninferiority clinical trial. Eligible patients were older than 18 years, diagnosed with type 1 or type 2 diabetes mellitus, with glycosylated hemoglobin of less than 12%, central area thickness of more than 325 μm, and visual impairment from DME with a best-corrected visual acuity (BCVA) between 24 letters and 78 letters. From June 2012 through February 2018, a total of 170 participants were randomized to receive 6 monthly injections of either 1.25 mg bevacizumab (n= 86) or 0.5 mg ranibizumab (n= 84). Primary outcome was change in BCVA from baseline to month 6 compared between the 2 treatment arms. The noninferiority margin was 3.5 letters. The difference in mean BCVA between treatment arms was 1.8 letters in favor of ranibizumab after 6 months of follow-up; BCVA improved by 4.9±6.7 letters in the bevacizumab group and 6.7±8.7 letters in the ranibizumab group. The lower bound of the 2-sided 90% confidence interval (CI) was -3.626 letters, exceeding the noninferiority margin of 3.5 letters. Central area thickness decreased more with ranibizumab (138.2±114.3 μm) compared with bevacizumab (64.2±104.2 μm). In a post hoc subgroup analysis, participants with a worse BCVA at baseline (≤69 letters) improved by 6.7±7.0 letters with bevacizumab and 10.4±10.0 letters with ranibizumab, and central area thickness decreased significantly more in the ranibizumab arm of this subgroup compared with the bevacizumab arm. Participants with an initially better BCVA at baseline (≥70 letters) did not demonstrate differences in BCVA or OCT outcomes between treatment arms. Based on change in BCVA from baseline to month 6, the noninferiority of 1.25 mg bevacizumab to 0.5 mg ranibizumab was not confirmed. Only the subgroup of patients with a lower BCVA at baseline showed better visual acuity and anatomic outcomes with ranibizumab. Our study confirmed the potential differential efficacy of anti-vascular endothelial growth factor agents in the treatment of DME as well as the difference in response between patient groups with different baseline visual acuities.

Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial.

To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24weeks of prn-IVB. One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300μm were assigned to continue prn-IVB (group III). Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point. In eyes with pDME after 24weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.

Anti-VEGF versus dexamethasone implant (Ozurdex) for the management of Centre involved Diabetic Macular Edema (CiDME): a randomized study.

To compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection versus dexamethasone implant (Ozurdex) for the treatment of center-involved DME (CiDME). This prospective randomized comparative study included 40 eyes (38 patients) of CiDME. They were randomized into two groups. Patients in group A received the intravitreal anti-VEGF injection (bevacizumab 1.25mg or ranibizumab 0.5mg) and those in group B received dexamethasone implant (0.7mg) pro-re-nata after 4weeks and 3months, respectively. The primary outcome was measured at 3months from the baseline that included improvement in BCVA, reduction in CFT, and adverse effects during the follow-up period. Mean best-corrected visual acuity (BCVA) improved from 0.51 ± 0.275 LogMAR units (20/63) to 0.20 ± 0.185 LogMAR units (20/32) in group A and from 0.56 ± 0.213 LogMAR units (20/80) to 0.141 ± 0.177 LogMAR units (20/32) in group B at 3months. There was no significant difference in mean BCVA between both the groups (p = .27). The mean central foveal thickness (CFT) improved from 443.55 ± 131.536µ to 277.66 ± 76.184µ and from 460.95 ± 125.462µ to 233.25 ± 37.552µ at 3months in group B (p = .02). Both the groups had the similar visual outcome. However, the superior anatomical result was observed in dexamethasone implant group during this short follow-up.

Combination of Grid Laser Photocoagulation and a Single Intravitreal Ranibizumab as an Efficient and Cost-Effective Treatment Option for Macular Edema Secondary to Branch Retinal Vein Occlusion.

Our prospective comparative study of 60 patients aimed to compare the efficacy and feasibility of a single injection ranibizumab versus a single grid laser photocoagulation and versus a combined treatment in macular edema secondary to branch retinal vein occlusion in Asian population. Patients were randomized 1:1:1 (n = 20/group) into grid laser (LAS), the ranibizumab (RAN), and the combination (COM) group. Outcomes were measured as best-corrected visual acuity (BCVA) and central macular thickness (CMT). There were significant differences in mean BCVA between the three groups at 1 week and 1 month (p < 0.05) and in mean CMT at 1 week and 1, 3, 6, and 12 months (p < 0.05). Overall, best results were observed in the combination group. However, the RAN and COM groups achieved very similar results. At 12 months, the CMT in all three groups was decreased compared with baseline (p < 0.05). Our results allow to conclude that the effect of early treatment with a single injection of intravitreal ranibizumab (cost reduction) and the stabilizing effect of grid laser photocoagulation is indeed an effective, feasible, and safe regiment for macular edema secondary to BRVO in Chinese patients, allowing to obviate the need for repeated intravitreal injections and thus reduce the adverse events, therapy duration, patients' malcompliance, and adverse events. A single ranibizumab therapy however is a comparable alternative.

Two-Year Efficacy of Ranibizumab Plus Laser-Induced Chorioretinal Anastomosis vs Ranibizumab Monotherapy for Central Retinal Vein Occlusion

Adding a laser-induced chorioretinal anastomosis (L-CRA) to current treatments for central retinal vein occlusion (CRVO) may improve outcomes and lessen therapy burdens. To determine the 2-year efficacy of intravitreal ranibizumab with an L-CRA vs ranibizumab alone for patients with macular edema caused by CRVO. In this randomized clinical trial conducted at a single university clinic from March 2012 to June 2015, 58 participants with macular edema caused by CRVO were randomized 1:1 to either an L-CRA or sham procedure at baseline. All participants received monthly intravitreal injections of ranibizumab, 0.5 mg. Data were analyzed from April 2017 to September 2017. Random assignment to L-CRA plus monthly injections of intravitreal ranibizumab, 0.5 mg, (combination group; n = 29) or to a sham L-CRA procedure plus monthly injections of intravitreal ranibizumab, 0.5 mg, (ranibizumab alone group; n = 29) for 6 months. From month 7 to month 24, participants were evaluated monthly and received an injection of ranibizumab if a loss of 5 or more letters of best-corrected visual acuity (BCVA) on ETDRS chart from previous highest score occurred or if there was evidence of residual macular edema on optical coherence tomography. Mean number of injections from month 7 to month 24, change in BCVA, and change in central subfield thickness (CST). Of the 58 included participants, 38 (66%) were men, and the mean (SD) age was 68.6 (11.8) years; participants had a mean (SD) BCVA of 57.09 (11.87) ETDRS letters (Snellen equivalent, 20/73) and a mean (SD) CST of 738.36 (175.54) μm. A successful L-CRA was created in 24 of 29 participants (83%) in the combination group. The mean number of injections from month 7 to month 24 was 3.2 (95% CI, 2.5-3.8) in the combination group and 7.1 (95% CI, 6.0-8.0) in the ranibizumab alone group. The ratio of the number of injections in the combination group compared with the ranibizumab alone group was 0.46 (95% CI, 0.36-0.61; P < .001). Mixed-effects regression modeling showed a difference in mean BCVA at 2 years between the combination and ranibizumab alone groups (combination, 70.3 letters [Snellen equivalent, 20/40]; ranibizumab alone, 61.6 letters [Snellen equivalent, 20/60]; difference, 8.8 letters; 95% CI, 0.2-17.3; P = .05). There was also a difference in CST at 2 years between the combination and ranibizumab alone groups (mean CST: combination, 303.6 μm; ranibizumab alone, 394.5 μm; difference, 90.9 μm; 95% CI, 24.3-157.5; P = .01). Four participants (14%) in the combination group required a vitrectomy for early macular traction or vitreous hemorrhage. For macular edema caused by CRVO, an L-CRA significantly reduced the number of ranibizumab injections required. anzctr.org.au Identifier: ACTRN12612000004864.

Intravitreal PRN ranibizumab treatment for macular edemadue to branch retinal vein occlusion.

To evaluate the effect of intravitreal pro re nata (PRN) ranibizumab treatment from the start on the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) in macular edema (ME) due to branch retinal vein occlusion (BRVO). Patients with ME secondary to BRVO, who were treated on a PRN basis after a single intravitreal ranibizumab injection, were retrospectively evaluated. The main outcome measures were changes in BCVA and CRT as measured by optical coherence tomography. The number of injections over 6 months was 2.43 ± 1.16. The mean BCVA of the patients was 0.84 ± 0.10 logMAR at baseline and 0.41 ± 0.06 at the 6th month (P < 0.001). Mean BCVA of the ischemic BRVO group was 1.06 ± 0.68 logMAR at baseline and 0.44 ± 0.30 logMAR at the 6th month (P < 0.05). Similarly, the mean BCVA of the nonischemic BRVO group was 0.77 ± 0.53 logMAR at baseline and 0.41 ± 0.36 logMAR at the 6th month (P < 0.05). Between groups, there was no significant difference in mean BCVA at any examination. Intravitreal ranibizumab is a safe and effective treatment option for ME due to ischemic and nonischemic BRVO using PRN from the start.

Descemet Membrane Endothelial Keratoplasty as Treatment for Graft Failure After Descemet Stripping Automated Endothelial Keratoplasty

To investigate the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with graft failure after Descemet stripping automated endothelial keratoplasty (DSAEK). Retrospective cohort study. setting: Institutional. Fifteen eyes of 15 patients that underwent DMEK for graft failure with corneal decompensation following DSAEK were analyzed; 15 eyes with primary DMEK for Fuchs corneal dystrophy were included as control group. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), and rebubbling rate. DMEK surgery was successful in all cases of both groups. Mean BCVA (logMAR) before DMEK was 1.27 ± 0.34 in the DMEK after DSAEK group and 1.0 ± 0.40 in the Primary DMEK group. After DMEK, mean BCVA increased significantly to 0.23 ± 0.21 (P= .012, DMEK after DSAEK group) and 0.29 ± 0.23 (P= .042, Primary DMEK group) after 3months. There were no significant differences in mean BCVA between both groups at each visit. The rebubbling rate was 13% in the DMEK after DSAEK group and 40% in the Primary DMEK group (P= .1). Mean CCT decreased significantly in both groups 1month after DMEK (P < .05). Mean ECD and change of ECD did not differ significantly between both groups at each visit (P > .05). The results after DMEK as a procedure to treat graft failure after DSAEK were as good as in patients that underwent DMEK as primary intervention to treat advanced Fuchs dystrophy. This indicates that the optical quality can be reestablished by DMEK in patients with failed DSAEK.

Postoperative Changes in Amniotic Membrane as a Carrier for Allogeneic Cultured Limbal Epithelial Transplantation

To investigate the morphologic changes and outcomes of the amniotic membrane as a carrier for allogeneic cultivated limbal epithelial transplantation. Prospective, noncomparative, interventional study. A total of 16 eyes receiving allogeneic cultivated limbal epithelial transplantation with amniotic membrane as a carrier were enrolled. Morphologic changes in the amniotic membrane were observed by confocal microscopy and RTVue optical coherence tomography. The paired t test was employed to compare the mean best corrected visual acuity (BCVA) and corneal stromal thickness. Of the 16 eyes, 12 had stable ocular surfaces (group A), while the other 4 eyes had failed surgeries due to immune rejection (group B). Confocal microscopy showed residual amniotic membrane tissues in 8 eyes in group A at 1 year. However, the amniotic membrane was not detected in group B at 8-10 months. RTVue optical coherence tomography showed discontinuous amniotic membrane tissues in all eyes in group A at 1 year, while highly reflective opacity was seen in the corneal stroma in group B. There were no statistically significant differences in mean BCVA and corneal stromal thickness in group A at 1 month and 1 year after transplantation (P > 0.05), but the mean BCVA showed a statistically significant difference at 1 month and after the disappearance of the amniotic membrane in group B (P < 0.05). For eyes with stable ocular surfaces after cultivated limbal epithelial transplantation, the amniotic membrane can be present in the cornea for at least 1 year, with no impact on visual acuity or corneal stromal thickness. Chronic inflammation and neovascularization on the ocular surface may accelerate the disappearance of the amniotic membrane.

Monthly Versus As-Needed Ranibizumab Injections in Patients with Retinal Vein Occlusion: The SHORE Study

To compare pro re nata (PRN) and monthly injections of 0.5 mg ranibizumab in retinal vein occlusion (RVO) patients stabilized by monthly injections. Randomized, open-label, vision-examiner masked, 15-month study. Subjects with macular edema secondary to branch or central RVO. Subjects received monthly injections of 0.5 mg ranibizumab for 7 months and those meeting stability criteria between months 7 and 14 were randomized (1:1) to PRN injections versus continued monthly injections. Non-randomized (NR) subjects (never met stability criteria) received monthly injections. The primary endpoint was the slope of change in best-corrected visual acuity (BCVA) between months 7 and 15. There was no significant difference in the slope of change in BCVA between months 7 and 15 in patients treated PRN versus those treated with monthly injections (P = 0.509). Mean (± standard deviation) change from baseline BCVA in Early Treatment Diabetic Retinopathy Study letter score at month 15 was 21.0 ± 14.1 in the PRN group (n = 82) versus 18.7 ± 14.1 in the monthly group (n = 80) and 14.5 ± 14.7 in NR subjects (n = 13). The percentage of subjects who achieved BCVA ≥ 20/40 at month 15 was 76.8% in the PRN group, 71.3% in the monthly group, and 46.2% in NR subjects. The mean (± standard deviation) change from baseline central subfield thickness was -247.8 ± 207.5 μm in the PRN group, -289.9 ± 177.2 μm in the monthly group, and -93.2 ± 225.2 μm in NR subjects. There were no significant differences in mean BCVA gains or central subfield thickness reductions at month 15 between the PRN and monthly injection groups (all > 0.05). After edema resolution from 7 or more monthly ranibizumab injections in RVO subjects, visual outcomes at month 15 were excellent and not significantly different in subjects treated PRN versus those who continued monthly injections.

Intravitreal bevacizumab versus panretinal photocoagulation for treatment‐naïve proliferative and severe nonproliferative diabetic retinopathy

Editor, Panretinal photocoagulation (PRP) is the treatment of choice for proliferative diabetic retinopathy (PDR) and severe nonproliferative diabetic retinopathy (NPDR) (Early Treatment Diabetic Retinopathy Study Research Group 1991). PRP has limitations, including vision loss, visual field defects and nyctalopia. Macular oedema can occur or worsen after PRP (McDonald & Schatz 1985). Media opacities such as cataract and vitreous haemorrhage occasionally preclude adequate laser therapy. An alternative treatment could ameliorate these difficulties. Intravitreal bevacizumab combined with PRP resulted in better regression of Neovascularisation (NV) and less vision loss compared with PRP alone (Mason et al. 2008; Tonello et al. 2008). We investigated intravitreal bevacizumab injections alone without prior PRP in a prospective, paired-eye, randomized pilot study. Potential benefits of intravitreal bevacizumab include preventing macular oedema, treating both PDR and macular oedema concurrently prior to performing PRP, and temporising until vitreous haemorrhage cleared to allow adequate PRP. Patients with type 2 diabetes mellitus and symmetric untreated severe NPDR or PDR without macular oedema or prior intraocular surgery were included. Informed consent was obtained which clearly explained that the standard treatment for their condition was PRP. The patients were notified the eye treated with intravitreal bevacizumab probably would require PRP at the end of the study. Best corrected visual acuity (BCVA), ophthalmologic examination, macular OCT, fundus photography and fluorescein angiography were performed at baseline and serially. Patients were evaluated every 2 months for 12 months total follow-up. The right eye was randomly assigned to treatment with PRP or intravitreal bevacizumab, and the left eye received the other treatment. Eyes randomized to bevacizumab 2.5 mg (0.1 ml) (Avastin, Genentech, San Francisco, CA, USA) were injected every 2 months during the study. Fellow eyes randomized to PRP were treated in two sessions, with a third session only if there was angiographic evidence of neovascular activity at month 4. Fifteen patients were enrolled. Unfortunately, five patients were lost to follow up between the baseline exam and the 2-month visit, and we were unable to ascertain the reasons these patients left. Ten patients (20 eyes) were followed for 12 months. Seven were women and the average age was 53 ± 9 years. Five patients had PDR and five had severe NPDR. Baseline BCVA and central macular thickness (CMT) were not statistically different between groups (p = 0.67 and p = 0.38, Mann–Whitney U test). None of 10 eyes with severe NPDR developed PDR. In 10 eyes with PDR, neovascular leakage completely resolved in four of five eyes treated with bevacizumab and in one of five eyes treated with PRP (p = 0.11, chi-square mid-P exact). Final CMT was significantly less in eyes treated with bevacizumab compared to those treated with PRP, 197 ± 17 μm versus 243 ± 49 μm, respectively (p = 0.012). BCVA (logMAR) pretreatment was −0.12 ± 0.22 and −0.14 ± 0.23 compared with −0.14 ± 0.19 and −0.17± 0.10 post-treatment (p = 0.52 and 0.64, bevacizumab and PRP groups, respectively). None of 10 eyes treated with bevacizumab injections every 2 months developed a complication. Two eyes treated with PRP developed vitreous haemorrhage. Three of 10 eyes treated with PRP developed macular oedema compared with none in the bevacizumab group. As this was a fellow eye controlled study, the effects of glycaemic and blood pressure control would equally impact both eyes of each patient. Intravitreal bevacizumb 2.5 mg injections every 2 months effectively controlled NV and resulted in a thinner CMT than PRP at 1 year. There were no differences in mean BCVA, which was expected given the good baseline vision and the small sample size. In a total of 60 bevacizumab injections, there were no complications, such as endophthalmitis or tractional retinal detachment. The main limitations of this study are the small sample size and the large proportion of patients lost to follow up. Despite the small sample size, the difference in final CMT achieved statistical significance. In summary, repeated intravitreal bevacizumab injections controlled NV in treatment-naïve eyes with PDR and severe NPDR for 1 year, but this finding needs to be confirmed by a larger study. PRP remains the gold-standard treatment for these eyes. In the future, longer-lasting anti-VEGF agents may be able to avoid the complications associated with PRP. Intravitreal bevacizumab may be a useful temporising measure in eyes with macular oedema or vitreous haemorrhage until adequate PRP can be performed, but further study is required.