Final Visual Acuity In Patients Research Articles

Evaluation of Prognostic Factors in Adult Chemical Corneal Injury.

The aim of this study was to evaluate prognostic factors that may be useful in predicting final visual acuity in patients admitted to the clinic with chemical corneal injuries. Data on age, sex, time to admission, irrigation solutions (balanced salt solution or phosphate buffered saline) and type of substance causing chemical injury were recorded. On admission, all patients were evaluated according to Roper Hall and Dua classifications. At the twelfth month after treatment, all measurements were repeated. A total of 131 patients with chemical corneal injuries [group 1 (acid, n = 73) and group 2 (alkaline, n = 58)] were included. The initial best corrected visual acuity (BCVA) level was "20/40 and above" in 32 patients (43.8%) in group 1 and 14 patients (24.1%) in group 2. According to Roper Hall classification, the mean grade was 1.92 ± 0.9 in group 1 and 2.27 ± 1.1 in group 2. According to Dua classification, the mean grade of the patients in group 1 was 2.16 ± 0.9 and 2.58 ± 1.2 in group 2. Posttreatment BCVA level improved to "1/200 to 19/200" in 8 (66.7%) of the patients with an initial BCVA level of "perception of light or hand movements." In univariate analysis, initial visual acuity and posttreatment visual acuity were statistically significant (P < 0.001). It was also statistically significant in multivariate analysis adjusted for sex and age (P < 0.001). In conclusion, the treatment of chemical corneal injuries is a long and exhausting process. The use of initial visual acuity and Dua classification in prognosis prediction may provide high success.

SS OCT and OCT-A Findings in Convalescent Inactive Vogt-Koyanagi-Harada Disease

ABSTRACT Purpose This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A). Methods We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity. Results Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes. Conclusion This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease.

Visual, Anatomic Outcomes, and Natural History of Retinal Nerve Fiber Layer Schisis in Patients Undergoing Epiretinal Membrane Surgery

To evaluate the anatomic and visual outcomes of patients with idiopathic epiretinal membranes (ERMs) complicated by schisis of the retinal nerve fiber layer (sRNFL) in routine clinical practice. Retrospective case-control study. Patients undergoing idiopathic ERM surgery at Cole Eye Institute from 2013 to2021. Patients were grouped by the presence or absence of sRNFL before surgery. Preoperative and postoperative data were collected regarding visual acuity (VA), changes in central subfield thickness (CST) over time, and presence of cystoid macular edema. Frequency of sRNFL in patients undergoing idiopathic ERM surgery. Overall, 48 (53.9%) of 89 patients presented with sRNFL. Schisis of the retinal nerve fiber layer patients presented with significantly decreased VA compared with those without (58.63 ± 12.48 vs. 67.68 ± 7.84 ETDRS letters, P < 0.001, respectively). At the final follow-up after ERM removal, there was no significant difference in final VA in patients with sRNFL compared with those without (71.16 ± 2.93 vs. 74.11 ± 2.76, P=0.467). At presentation, patients with sRNFL had greater CST than those without (454 ± 10.01 vs. 436 ± 0.23, P= 0.23). This difference persisted at the 90-day follow-up after ERM removal (402 ± 8.08 vs. 375 ± 10.19 μm, P= 0.043). The resolution of sRNFL was reported at postoperative week 1 in 30 (96.7%) of 31 cases. Schisis of the retinal nerve fiber layer is a microstructural feature in > 50% of idiopathic ERMs in routine clinical practice and carries visual significance on presentation and anatomic significance postoperatively. Proprietary or commercial disclosure may be found after the references.

Blunt Eye Trauma: Epidemiology, Prognostic Factors and Visual Outcome-A 10-Year Retrospective Study.

The aim of this study is to define the accompanying prognostic factors and evaluate the final visual acuity of patients presenting with blunt eye trauma. The data of this study included the demographic characteristics of the patients, the mechanism of injury, initial and final visual acuities and accompanying pathologies. A total of 259 eyes of 259 patients who presented with blunt eye trauma were included. Eighty-three percent of the patients were male. The most common mechanisms are beaten, accidents, and falls. The visual acuity of the patient at admission was no perception of light, and the final visual acuity was also no perception of light. The incidence of blunt eye trauma was more common in males and in advanced age. A higher final visual acuity level is achieved with successful management of concomitant pathologies.

Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia

BackgroundTo investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO).MethodsWe performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO.ResultsPSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients.ConclusionsWe found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment.

Establishment of a prediction tool for ocular trauma patients with machine learning algorithm.

To predict final visual acuity and analyze significant factors influencing open globe injury prognosis. Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio. The best algorithm was selected to analyze the predicted final visual acuity. We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020. We then applied cross-validation, the permutation feature importance method, and the synthetic minority over-sampling technique to enhance tool performance. The two-class boosted decision tree model showed the best predictive performance. The accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve were 0.925, 0.962, 0.833, 0.893, and 0.971, respectively. To increase the efficiency and efficacy of the prognostic tool, the top 14 features were finally selected using the permutation feature importance method: (listed in the order of importance) retinal detachment, location of laceration, initial visual acuity, iris damage, surgeon, past history, size of the scleral laceration, vitreous hemorrhage, trauma characteristics, age, corneal injury, primary diagnosis, wound location, and lid laceration. Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury. This tool is useful and easily accessible to doctors and patients, reducing the socioeconomic burden. With further multicenter verification using larger datasets and external validation, we expect this model to become useful worldwide.

Evaluate the Prevalence, Natural Course, and Final Visual Acuity in Patients with Stages III or IV of Diffuse Lamellar Keratitis Following Laser in Situ Keratomileusis

Background: And aim: The prevalence of DLK has been reported differently in different centers based onits severity. Hence, the aim of present study was evaluate the prevalence, natural course, and final visualacuity in patients with stages III or IV of diffuse lamellar keratitis following laser in situ keratomileusis.Methods: In the present descriptive study, 3941 eyes files from 2125 patients underwent LASIK surgery;were examined. All patients had a complete ophthalmologic examination before LASIK and had suitableconditions for LASIK.Result: Among the studied cases, 39 eyes (0.98%), out of 16 patients (0.75). The mean time intervalbetween LASIK and DLK diagnosis was 3± 2.4 days. A history of allergy was negative in all patients. Themean post-operative spherical refractive error in all eyes was in the range of 1 diopters and the averagecylindrical refractive error in 33 eyes was -0.66±1.2 diopters. The mean of final spherical refraction in34 eyes was 0.5±1.2 diopter and the mean of final cylindrical refraction in 35 eyes was -0.75±1.3 diopter.Severe turbidity at the flap surface in the first week decreased over time in all patients with stage III and IVDLK. So that only in four eyes (10.25%)Conclusion: The prevalence of stages III and IV in DLK is negligible compared to the large number ofLASIK procedures and all patients respond well to topical and systemic corticosteroid therapy.

Tectonic Keratoplasty in Patients with Non-traumatic, Non-infectious Corneal Perforations

Introduction:The study aims to report clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations.Materials and Methods:The medical records of 12 patients who underwent tectonic penetrating keratoplasty between October 2014 and August 2018 at Ege University Ophthalmology Department were retrospectively reviewed.Results:The mean age of the patients was 52.92±30.34 (range, 2-82) years. The causes of corneal perforation were dry eye (neurotrophic keratopathy (n=4), limbal stem cell deficiency (n=2), exposure keratopathy (n=2) and graft versus host disease (n=1)) in 9 patients. In the remaining 3 patients, the etiology of perforation was not determined. The mean Visual Acuity (VA) was 2.98±0.39 (range, 1.8-3.1) LogMAR before the surgery. Despite conservative treatment, tectonic penetrating keratoplasty had to be performed in all patients in order to manage the perforation. Mean time in between initial examination and surgery was 10.75±12.04 (1-41) days. In 2 patients, allogenic limbal stem cell transplantation; in one patient, lateral tarsorrhaphy and in one patient symblepharon release with amniotic membrane transplantation were performed additional to tectonic keratoplasty. Mean follow-up time was 57.88±55.47 (4-141) weeks. Grafts were clear in 6 eyes and opaque in 5 eyes. The main causes of graft failure among opaque grafts were ocular surface disease (3), allograft rejection (1) and glaucoma-related endothelial failure (1). Phthisis bulbi was detected in one patient with congenital glaucoma due to vitreous loss at the time of perforation. The mean final VA in patients who had clear grafts was 1.83±1.03 (range, 0.8-3.1) LogMAR.Conclusion:To prevent serious complications in non-traumatic, non-infectious corneal perforations, providing anatomic integrity immediately is a must. If conservative treatment is inadequate or the perforation area is extensive, tectonic penetrating keratoplasty is indicated. Besides, it is important to manage the etiological risk factors in order to obtain successful clinical follow up.

Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis.

To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity. Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed. Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (β = 0.736, p = 0.003; β = 0.682, p = 0.002, respectively). Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.

Neuropatía óptica asociada con lesión de Dieulafoy

Objetivo: describir el caso de un paciente del Hospital de San José de Bogotá con hemorragia del tracto digestivo superior secundaria a lesión de Dieulafoy, que presentó cuadro compatible con neuropatía óptica anterior isquémica no arterítica (NOIANA). Se hace una revisión narrativa y búsqueda sistemática de la literatura para determinar las características clínicas, demográficas, tratamiento y pronóstico visual de los pacientes con NOIANA. Materiales y métodos: reporte de caso, revisión narrativa y búsqueda sistemática de la literatura en las bases de datos Medline (vía Ovid) y Embase de NOIANA secundaria a hipovolemia. Se analizaron las variables sociodemográficas, clínicas, diagnóstico, condiciones asociadas, tratamiento y pronóstico visual. El análisis estadístico se realizó mediante frecuencias absolutas y relativas. Resultados: la mejoría de agudeza visual final en los pacientes que presentaron un episodio de NOIANA es incierta. En 42% hubo algún tipo de mejoría de la agudeza visual, independiente del tratamiento recibido. Menos del 50% de los casos clínicos reportados incluidos en este estudio que recibieron tratamiento con corticoides intravenosos mejoraron la visión. Discusión: la NOIANA por choque hipovolémico es una entidad infrecuente y poco reportada que puede generar cambios irreversibles en la agudeza visual, por lo que es importante sospecharla y detectarla para dar un manejo oportuno. Este caso de NOIANA es uno de los pocos descritos como secundarios a hemorragia digestiva y el primero asociado con lesión de Dieulafoy.

Baseline visual acuity and interdigitation zone as predictors in idiopathic epiretinal membranes: A retrospective cohort study.

Determine which functional and anatomical characteristics may be predictors of final visual acuity in patients with idiopathic ERM (iERM) submitted to pars plana vitrectomy (PPV) with ERM and internal and internal limiting membrane (ILM) peeling. Retrospective cohort study. Patients with iERM submitted to PPV between 2016 and 2017. Data regarding the best-corrected visual acuity (BCVA) and the characteristics of the retinal layers observed in SD-OCT were collected preoperatively and until 12 months postoperatively. Central macular thickness (CMT), disorganization of the retinal inner layers (DRIL), outer nuclear layer (ONL) thickness, integrity of subfoveal external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) were evaluated. A total of 128 eyes with iERM from 121 patients were included. BCVA improved significantly (p < 0.001). Significant improvement of BCVA, CMT, DRIL, ONL, ELM, and EZ were obtained. The final IZ was not different from baseline until the end of the study. A significant correlation was observed between the baseline BCVA, EZ, IZ, and the postoperative BCVA (p < 0.001). However, only the baseline BCVA and the integrity of the subfoveal baseline IZ were predictive factors for final BCVA (p < 0.005 and p < 0.001, respectively). PPV provides a significant improvement of BCVA and retinal anatomy recovery in iERM eyes. Baseline IZ didn't change during the 12 months following surgery. Baseline BCVA and subfoveal IZ at baseline were prognostic factors for the final BCVA.

Neuro-Ophthalmic Injuries With Systemic Neurologic Injury or Traumatic Brain Injury in Operation Iraqi Freedom and Operation Enduring Freedom.

To analyze the final visual acuity (VA) of neuro-ophthalmologic injuries (NOI) in combat ocular trauma and to study the association of NOI with systemic neurologic injury (SNI) and traumatic brain injury (TBI). The Walter Reed Ocular Trauma Database was reviewed. Inclusion criteria were any US service member and Department of Defense civilians who suffered NOI, SNI, or TBI in Operation Iraqi Freedom or Operation Enduring Freedom. The primary outcome measure was the rate of poor final VA in patients with an NOI with secondary outcome measures the rate of SNI and TBI. in patients with NOI. One hundred seventy-eight (20.00%) of 890 eyes had an NOI. Optic nerve injury was observed in 79 (44.38%) eyes, other cranial nerve injury in 68 (38.20%), Horner syndrome in 4 (2.25%), diplopia in 45 (25.28%), and ptosis in 13 (7.30%). In patients with NOI, 76 (42.69%) eyes had a final VA less than 20/200. In injured eyes (n = 359) of patients (n = 251) with TBI, 154 eyes (34.26%) had a final VA less than 20/200. In multivariate analysis, optic nerve injury (P < 0.001), unlike TBI (P = 0.47), was associated with final VA less than 20/200. SNI (n = 229) had a statistically significant association (odds ratio 29.8, 95% confidence interval 19.2-47.8, P < 0.001) with NOI. Optic nerve injury and cranial nerve injury were associated with TBI and SNI (all, P < 0.001). Optic nerve injury and cranial nerve injury are associated with TBI and SNI. Optic nerve injury, but not TBI or cranial nerve injury, is associated with a poor final VA.

Detection of Torque Teno Virus (TTV) and TTV-Like Minivirus in patients with presumed infectious endophthalmitis in India.

Human anelloviruses (Torque Teno Virus (TTV) and TTV Like Mini Virus (TLMV)) are now being reported at a high prevalence across the world, with a controversial disease-inducing potential. The aim of this study was to investigate the role of these anellovirus in vitreous of patients with presumed infectious endophthalmitis. After informed consent, vitreous fluid from patients with endophthalmitis (n = 103) and non-infectious pathologies (n = 102) were analyzed for the presence of TTV and TLMV DNA by qPCR with the limit of quantification defined as 100 copies per reaction. Among the patients clinically diagnosed with endophthalmitis, 29 of the 40 culture proven samples (72.5%) and 42 out of 63 (66.6%) of culture-negative samples were positive for presence of TTV/TLMV. Interestingly, 51 of the 102 (50%) samples in the control group were also positive for TTV/TLMV. Comparing the clinical outcome among patients diagnosed with endophthalmitis, we observed no significant association in the final visual acuity of patients who were positive for presence of TTV/TLMV, however, these patients had significantly higher repeat antibiotic injections (p = 0.03). Further evidence is however needed to correlate TTV / TLMV with a particular pathology or group of pathologies in the eye.

TRAFFIC ACCIDENT-RELATED OPEN GLOBE INJURIES.

To evaluate the clinical characteristics and visual outcomes of patients with traffic accident-related open globe injuries, and to examine preoperative factors influencing the visual prognosis after pars plana vitrectomy, as compared with common open globe injuries. Patients with open globe injuries, who underwent pars plana vitrectomy, were identified. Patients' demographic and clinical data were entered into a computerized database for review and analysis; data included age, sex, initial visual acuity, duration between onset of injury and surgery, information about the type and cause of injury, wound location and length, presence of ocular complications, and final visual acuity. Of the 355 open globe injuries, 14 were sustained during a traffic-related accident; the average age was 50.4 years (range: 20-85) and most (78.6%) were men. Of these 14 patients, 9 (64.3%) presented with rupture and 5 (35.7%) with laceration. Injuries were caused while driving (6 eyes; 42.9%), riding a bicycle (5 eyes; 35.7%), involved in car accident while walking (2 eyes; 14.3%), and riding a motorbike (1 eye; 7.1%). Initial visual acuity was significantly related to final visual acuity (P = 0.003, R = 0.80). The final visual acuity in patients with traffic accident-related open globe injuries was significantly better than that of the total group (P = 0.01). Traffic accident-related open globe injuries had better visual outcomes than common open globe injuries. Visual outcomes in patients with traffic accident-related open globe injuries were related to the initial visual acuity. No eyes developed endophthalmitis in patients with traffic accident-related open globe injuries.

Baseline morphological characteristics as predictors of final visual acuity in patients with branch retinal vein occlusions: MARVEL report no. 3.

Purpose:To determine the predictive values of baseline optical coherence tomography (OCT) abnormalities on 12-month visual acuity changes in eyes with macular edema (ME) caused by branch retinal vein occlusions (BRVO).Methods:We performed a post hoc analysis of data from 75 participants in the 12-month MARVEL trial. OCT abnormalities at baseline, including ganglion cell layer cystoid spaces (GCL), intraretinal hyper-reflective dots, and central subfield thickness (CST), were correlated with improvements in visual acuity and the number of anti-vascular endothelial growth factor injections required using a multivariate regression model.Results:Eyes with baseline CST > 500 μm had greater visual gains compared to those with CST <500 μm (+21.09 vs +16.08 letters, P = 0.04). Eyes with hyper-reflective dots (+13.97 vs +19.93 letters, P = 0.02), and GCL cysts (+9.8 vs +18.9, P = 0.003) had inferior gains in visual acuity. Neurosensory macular detachments at the baseline did not affect gains in visual acuity. Ninety percent of the gain in visual acuity was recorded after two injections and was maintained until month 12.Conclusion:Baseline OCT of <500 μm, hyper-reflective dots, and GCL cystoid spaces are associated with poorer gains in visual acuity. Most of the visual gain occurs after two injections.

Efficacy Profile of Intracameral Amphotericin B. The Often Forgotten Step.

The objectives of this study were to assess visual and structural outcomes in mycotic keratitis after conventional treatment (topical and systemic antifungals) and intracameral amphotericin B (ICAMB), and to evaluate any complications. This was a prospective, nonrandomized, nonblinded interventional study. This study was conducted on 104 eyes of 104 patients with fungal corneal ulcers. Patients were categorized into 2 groups: group A, who received conventional topical and systemic antifungal medications, and group B, who received ICAMB in the dose of 5 to 10 μg in 1 mL of 5% dextrose. Response to treatment was evaluated. Results of the 2 groups were compared with appropriate statistical indices. The mean final visual acuity in patients in group B receiving ICAMB was 1.22 ± 0.31 logMAR units. The improvement in mean visual acuity was 1.40 ± 0.2 logMAR units. In group A, mean visual outcome was 1.25 ± 0.73 logMAR units. There was an improvement by 0.55 ± 0.30 logMAR units. Healing with varying degrees of opacification occurred in a significant number of patients (81.48%) treated with ICAMB as compared with conventional treatment (Z = 2.24, P < 0.05). Complications, such as sloughing, occurred in significantly fewer patients treated with ICAMB as compared with conventional treatment (Z = 2.29, P < 0.05). In cases of keratomycosis where response to local and systemic antifungal treatment is not evident after 7 days, ICAMB can be safely administered to prevent the progression of ulcers and the development of complications.

Prognostic Factors for Open Globe Injuries and Correlation of Ocular Trauma Score in Tianjin, China.

Purpose. To investigate prognostic factors that influence the final visual acuity (VA) and to correlate the ocular trauma score (OTS) with the final VA in open globe injuries. Methods. A retrospective review of 298 patients with open globe injuries admitted to Tianjin Medical University General Hospital was carried out from January 1, 2010, till December 31, 2014. Prognostic factors influencing the final VA in patients with open globe injuries and the correlation between OTS and the final VA were examined. Results. Three hundred and fourteen eyes from 298 patients with open globe injuries were analyzed. Males had a higher rate of open globe injury than females (83.56% versus 16.44%). Mean age was 45.46 ± 17.48 years (5–95 years). In a univariate analysis, prognostic factors influencing the final VA included initial VA, relative afferent papillary defect (RAPD), vitreous hemorrhage, lens injury, endophthalmitis, hyphema, retinal detachment, and the zone of injury. In a multiple logistic regression analysis, initial VA, RAPD, and the zone of injury were considered to be independent risk factors. The OTS correlated with final VA (r = 0.988, p = 0.000). Conclusion. In our study, the most important prognostic factors influencing the final VA were initial VA, RAPD, and the zone of injury. The OTS was of great importance for patients and ophthalmologists.

Macular microstructure and relation with visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage

Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage.Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent micro-invasive vitrectomy were enrolled in this retrospective study.The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded.The central foveal thicknesses (CFT) were measured after surgery by spectral domain-optical coherence tomography (SD-OCT).The median follow-up time was (12.81-8.22) months,ranging from six to 36 months.According to the results of SD-OCT at last follow-up time,macular edema (ME),epiretinal membrane (ERM),interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed.The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed.The correlation between BCVA and macular microstructure were analyzed.Results The CFT was ranged from 103.00 μm to 498.00 μm,with the mean of(251.12 ±90.23) μm.Macular abnormalities were observed in 37 eyes (69.8％),and normal macula in 16 eyes (30.2％).Among 37 eyes with macular abnormalities,there were 20 eyes (37.7％) with ME,12 eyes (22.6％) with ERM,33 eyes (62.3％) with interrupted IS/OS,and 20 eyes (37.7％) with interrupted ELM.The BCVA of ME eyes decreased significantly than that in non-ME eyes (t=-2.09,P＜0.05).The difference of BCVA in ERM and non-ERM eyes was not statistically significant (t=-1.10,P＞0.05).The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes (t=-4.33,P＜0.05).The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58,P＜ 0.05).The postoperative BCVA correlated positively with integrity of the IS/OS junction,CFT,and whether ME or not (r=7.65,8.21,4.99; P＜0.05),but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01,0.82; P＞0.05).Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT,the status of IS/OS junction,whether ME or not,but not related to integrity of the ELM or whether ERM or not. Key words: Diabetic retinopathy/complications; Vitreous hemorrhage/surgery; Tomography,optical coherence

HYBRID 20/23-GAUGE PARS PLANA VITRECTOMY FOR RETAINED LENS FRAGMENTS AFTER CATARACT SURGERY

To evaluate the outcome and surgery-associated risks in patients undergoing 23-gauge pars plana vitrectomy (PPV) for retained lens fragments. Retrospective analysis of 42 eyes of 42 consecutive patients at a tertiary teaching hospital in Sydney (Australia) during a period of 4 years. Evaluation of final visual acuity, complications, differences in patients receiving an intraocular lens at the primary cataract surgery, and differences in final visual acuity regarding the usage of a phacofragmatome and analysis of pars plana vitrectomy-related complications. The majority (83.3%) achieved a visual acuity of 0.3 (logarithm of the minimum angle of resolution) or better, and 19 eyes (45.2%) achieved a final visual acuity of 0 (logarithm of the minimum angle of resolution). Overall, 95.2% of the eyes had a better postoperative visual acuity compared with the preoperative visual acuity. There were no differences in proportions regarding the final visual acuity in patients who had an intraocular lens at the time of the pars plana vitrectomy and those who had a secondary lens implant. A retinal detachment after the lens fragment removal was observed in 2 eyes. Dropped lens fragments because of complicated cataract surgery can be managed well with 23-gauge pars plana vitrectomy: The majority of patients achieve a good visual acuity despite 2 surgeries at a rather low rate of retinal complications.

Cons of steroids use in optic neuritis

AbstractPurpose To discuss benefits and risks of steroids use in optic neuritis.Methods Analysis of evidence based studiesResults Steroids do not influence the final visual acuity in patients with optic neuritis. Their possible adverse effects will be discussed in detail.Conclusion Intravenous steroids might be considered in the treatment of optic neuritis after detailed examination of patient’s general health status and when possible benefits overcome the risks of adverse effects.