Good Visual Acuity Research Articles

The influence of mild posterior capsular opacification on spectral domain optical coherence tomography retinal nerve fiber layer thickness.

Τo investigate whether Yag laser capsulotomy, in addition to restoring ocular media transparency, may also significantly alter retinal nerve fiber layer (RNFL) thickness analysis and spectral domain optical coherence tomography (SD OCT) indices and quality parameters, such as signal strength (SS), in patients with mild, diffuse posterior capsular opacification (PCO). Prospective interventional case series study which enrolled 28 patients with mild PCO and good baseline best-corrected visual acuity (BCVA). All patients underwent a complete ophthalmologic examination, including SD OCT RNFL thickness measurement prior to Yag laser capsulotomy. Following laser intervention, all patients repeated the same complete ophthalmic examination and results were recorded and analysed. Mean RNFL thickness showed a significant postoperative increase from 89.6 to 94.1μm (p = 0.01), which was also confirmed for superior (p = 0.041), nasal (p = 0.011) and inferior quadrants (p = 0.032). SS and BCVA were also significantly increased after laser treatment (p < 0.01). A significant positive correlation was observed between SS and mean RNFL thickness postoperatively (p = 0.043) but not preoperatively (p = 0.059). Similarly, a significant relationship was found between BCVA and average RNFL thickness after (p = 0.017) but not before (p = 0.457) laser intervention. Our study suggests that the presence of even mild PCO may alter the sensitivity of SD-OCT acquisition and lead to inadvertent RNFL thickness underestimation. Clinicians should be alerted to this contingency and take it into consideration when evaluating various optic neuropathies with SD OCT, in pseudophakic eyes.

Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation.

To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.

CASE REPORT: REACTIVATION OF CONGENITAL OCULAR TOXOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT AFTER RECEIVING MEASLES

A case of recurrent ocular toxoplasmosis, presented through diagnostic imaging techniques and laboratory tests. To show the course and development of the clinical picture of ocular toxoplasmosis in a 19-year-old girl with good visual acuity in both eyes, which was accidentally detected during a routine ophthalmological examination for a driver's license. At the University Clinic for Eye Diseases in Skopje, several imaging diagnostic methods have been performed, such as: fundus photography, aurofluorescence, optical coherence tomography (OCT) and fundus fluorescence angiography (FFA). Imaging techniques, along with laboratory tests for specific anti-toxoplasmosis IgG and IgM antibodies, have helped to diagnose this not-so-common entity-ocular toxoplasmosis. The development of the disease was followed by a clinical picture, certain diagnostic methods in a period of seven years. Three recurrences of the parasitosis occurred during that period. The third attack of toxoplasmosis was associated with the occurrence of measles in an otherwise healthy young woman, a possible trigger for reactivation of the disease. Regular laboratory tests of anti-toxoplasma IgG and IgM antibody titers were performed with the help of ELISA at PHI UC for infectious diseases and febrile conditions in Skopje, during the entire process of monitoring. The lesion described by the diagnostic modalities corresponded to the data obtained from the literature and together with the elevated values ​​of anti-toxoplasma IgG and IgM antibodies confirmed the diagnosis of congenital ocular toxoplasmosis. Keywords: toxoplasmosis, ocular toxoplasmosis, therapy, laboratory tests, FFA, OCT &nbsp;

FLUID-BASED VISUAL PROGNOSTICATION IN TYPE 3 MACULAR NEOVASCULARIZATION-FLIP-3 STUDY.

To analyze the effect of fluid on visual acuity in cases of Type 3 macular neovascularization. This multicentric, retrospective cohort study included eyes with treatment-naïve Type 3 macular neovascularization. Analysis of fluid in different compartments was performed. Group A included eyes with isolated intraretinal fluid, whereas Group B included eyes with intraretinal fluid in conjunction with subretinal fluid and/or sub retinal pigment epithelial fluid. Eyes in Group A (31, 55.3%) had better best-corrected visual acuity of 20/50 snellen equivalent (0.42 ± 0.31 logarithm of the minimum angle of resolution) at baseline and 20/50 snellen equivalent (0.40 ± 0.28 logarithm of the minimum angle of resolution) at complete resolution compared with Group B with visual acuity of 20/80 snellen equivalent (0.64 ± 0.35 logarithm of the minimum angle of resolution) (P = 0.0181) at baseline and 20/100 snellen equivalent (0.70 ± 0.40 logarithm of the minimum angle of resolution) (P = 0.0021) at complete resolution. Subfoveal atrophy was more in Group B (82.6% 19/23) at complete resolution in comparison to Group A (16/31, 51.6%). Eyes in Group B needed more anti-vascular endothelial growth factor injections (10.3 ± 9.0) for complete resolution compared with Group A (5.7 ± 4.8). Intraretinal fluid may be associated with good visual acuity in Type 3 macular neovascularization in contrast to other forms of neovascular age related macular degeneration. Furthermore, intraretinal fluid in isolation may need fewer injections and could probably be associated with less subfoveal atrophy.

Visual acuity, contrast sensitivity, and quality of life after bilateral implantation of multifocal diffractive intraocular lens.

To evaluate visual outcomes, satisfaction, and quality of life of patients assisted in a Medical School hospital by the Brazilian Public Health System, who underwent bilateral diffractive multifocal intraocular lens implantation. Case series study with intervention, including 20 patients who underwent bilateral implantation of multifocal IOL EyeDiff® (Eyeol UK, Dunstable, UK). Exclusion criteria were corneal astigmatism >1.5 cylindrical diopters, previous ocular surgery or ocular disease, and intra- or postoperative complications. Patients were evaluated one, three, and six months after surgery. Monocular and binocular visual acuity for distance, intermediate and near, under photopic and mesopic conditions, monocular contrast sensitivity under photopic conditions, defocus curve, and quality of life were assessed. Monocular distance-corrected visual acuity was 0.3 logMAR or better and monocular distance-corrected near visual acuity was J3 or better in all eyes under photopic conditions. Binocular distance-corrected near visual acuity was J1 in all cases. Contrast sensitivity was at the minimum level of normality for low and high spatial frequencies and within normal limits for intermediate spatial frequency. The quality of life questionnaire showed a high level of patient satisfaction. Bilateral implantation of the multifocal intraocular lens EyeDiff® provides patients with good visual acuity and quality of life, besides spectacle independence. The visual acuity and contrast sensitivity progressively improved between one and six postoperative months.

Functional Results without Correction of Cataract Surgery during a Free Campaign at Siguiri Prefectural Hospital in Guinea

Background: Cataract is the leading cause of blindness in the world and its treatment is exclusively surgical. However, the results of cataract surgery are not always as good as is assumed and this aspect of surgical services needs a lot of attention. The purpose of this study is to evaluate the functional results of the free cataract surgery campaign carried out at the Siguiri Prefectural Hospital in Guinea. Patients and Method: This was a descriptive and retrospective cross-sectional study over a period of three months (1 October-31 December 2017). Records of cataract-operated patients during the study period were reviewed. The complete files for the main variables sought were retained. Sociodemographic data and visual acuity without pre- and post-operative correction were assessed. Functional outcomes were analysed according to WHO guidelines and recommendations for post-operative functional outcomes of cataract surgery. The data was collected and processed using Excel version 2010 software. Results: A total of 108 eyes from 102 patients were the subject of this present study on 314 eyes from 289 operated patients. 64 (%) men and 38 women (%) had a follow-up of 6 weeks after cataract surgery, a sex ratio of 1.68 in favor of women. The average age was 62.45 ± 15.20 years with extremes of 25 and 90 years. The age group from 60 to 69 years is the most represented with 46 cases or 45.45%. Housewives and farmers are the most represented strata with 42 cases (41.18%) and 31 cases (30.39%) respectively. The operative technique was Phaco A in 4/5 of the cases. No implant calculations were performed. Functional results indicate that 66% of patients had good visual acuity (≥3/10); 29% of patients had borderline visual acuity (between 1/10 and 2/10) and 13.30% had poor visual acuity (<1/10). Conclusion: The importance of the rate of poor results in our study should draw our attention to the conduct of free cataract surgery campaigns. The problem of cataract blindness is often compounded by poor outcomes of surgical procedures, especially in low-income settings. The use of biometrics, implants of appropriate power as well as compliance with operative indications, surgical protocols and postoperative follow-up by surgeons will improve the visual result without correction.

Visual outcome of cataract surgery in a tertiary care teaching hospital.

Objectives:To review the visual outcomes after cataract surgery in a tertiary care teaching hospital, Isra University Hyderabad.Methods:This retrospective clinical study was carried out for six months at Isra University Hyderabad from December 2020-May 2021. Total patients included were 982. The data comprised of patients who underwent cataract surgery from Sept 2018 – Aug 2020. Individuals over 40 years were included and who returned for out-patient appointments. Visual acuity before and six weeks after cataract surgery were noted and categorized according to World Health Organization criteria (i-e Good, Moderate and Poor).. Data analysis was done with the help of SPSS version 22.0.Results:Out of 982 patients who underwent Phacoemulsification at Isra University Hospital, the operated eyes were 483 right and 499 left respectively. Meanwhile, 966 had good visual acuity six weeks after the surgery, while 16 had moderate visual acuity noted after six weeks.Conclusion:Clinical audit of cataract surgeries by measuring visual acuity postoperatively is an excellent approach in improving the outcomes and maintaining the good care facilities at a tertiary care hospital.

Efficacy and safety of transscleral diode laser cyclophotocoagulation therapy in advanced glaucoma cases with good visual acuity

Efficacy and safety of transscleral diode laser cyclophotocoagulation therapy in advanced glaucoma cases with good visual acuity

Long-Term Visual Outcomes of Primary Congenital Glaucoma in China

Introduction: The aim of this study was to investigate the long-term visual outcomes and factors associated with vision loss in Chinese patients with primary congenital glaucoma (PCG) after successful intraocular pressure (IOP) control (IOP ≤21 mm Hg). Methods: PCG patients with IOP control who were examined in the glaucoma clinic at Zhongshan Ophthalmic Center from 2019 to 2020 were enrolled. The final visual outcome was evaluated by the best corrected visual acuity (VA). Univariate and multivariate analyses were used to investigate the associations of visual impairment with potential risk factors. The causes for decreased VA (<20/50) were also analyzed. Results: Fifty-nine patients (95 eyes) were included in the cohort, with a mean age of 8.7 years. The mean logMAR VA was 0.62 ± 0.64. The VAs of eyes treated for PCG were good (≥20/50) in 56%, fair (20/60–20/200) in 30%, and poor (<20/200) in 14%. The most common cause of decreased VA was amblyopia (64.3%). Multivariate logistic regression analysis showed that undergoing multiple surgeries (OR: 4.86, 95% CI: 1.11–21.16, p = 0.035) was significantly associated with visual impairment. Conclusion: The results showed that good VA was attainable in approximately half of PCG eyes under IOP control. Prompt and effective treatment of PCG, management of amblyopia and ocular comorbidities may be potential steps toward achieving good visual outcomes in PCG patients.

Sulcus implantation of single-piece foldable acrylic intraocular lens after posterior capsule tear during phacoemulsification: Visual outcome and complications

Background: Posterior capsule tear (PCT) during phacoemulsification affects the type, site, and timing of intraocular lens (IOL) implantation. Aim: The aim was to evaluate the visual outcomes and complications following sulcus implantation of single-piece foldable acrylic IOL after PCT during phacoemulsification. Setting and Design: The retrospective observational study was conducted at a tertiary care center in eastern India. Methods: Records of patients between July 2017 and March 2020 were reviewed. Thirty-six eyes of 36 patients, in whom PCT had occurred during phacoemulsification, were included. Statistical Analysis Used: Microsoft Excel 2007 and SPSS 108 software were used. Preoperative and postoperative visual acuity was compared using paired t-tests. Postoperative visual outcomes and complications were assessed in percentage. Results: Postoperative visual acuity was ≥6/12 in 22 (61.11%) patients on day 1 and 30 (83.33%) patients on day 30, with a statistically significant improvement compared to preoperative vision (P < 0.05). On the first postoperative day, corneal edema was seen in 8 (22.22%) patients, increased anterior chamber reaction in 5 (13.89%) patients, and raised IOP in 4 (11.11%) patients. After 3 months, 2 (5.56%) patients needed antiglaucoma medications for IOP control, 1 (2.78%) had iridocyclitis, and 1 (2.78%) had chronic cystoid macular edema. The mean follow-up duration was 17.44 ± 12.15 months (range: 3–46 months). Conclusion: To conclude, sulcus implantation of posterior chamber IOL during phacoemulsification surgery complicated with PCT may be considered if the adequate lens is not available, and sufficient capsular support exists. Our study revealed a good final visual acuity with minimal complications, though more research to ascertain our results is warranted.

The Importance of IOL Selection in Patients With Young-age Cataracts: a Case Report

Background: A cataract is a type of degenerative change of the lens, which is characterized by the clouding of the lens followed by symptoms of optical deterioration. Over 70 years ago, Sir Harold Ridley implanted the first useable modern-day intraocular lens (IOL) implant. A lot has happened since then. The IOL is arguably the most life-changing and innovative implant in the history of medicine. Currently, there are several types of intraocular lenses on the market. The main classification could be monofocal lenses, multifocal, trifocal, extended depth of focus (EDOF) lenses, and toric lenses. Objective: The aim of this case report is to report the importance of IOL selection in patients with young-age cataracts. Case report: A 35-year-old patient presented first time at our Clinic. In the last six months, he noticed poor vision in his left eye, even with spectacles. The right eye was operated on in another institution in 2020, due to the presence of a young-age cataract. After a complete preoperative ophthalmological examination, we discovered the presence of a cataract in the left eye. UDVA of the left eye was 0.4, and CDVA was +0.50/+0.50/30°=0.5. UNVA and DCNVA was J2. We decided to implant TECNIS Synergy™ IOL (Johnson &amp; Johnson Vision, Santa Ana, CA, USA) during the cataract surgery. That EDOF IOL bridges the gap between the performance of monofocal and multifocal IOLs and delivers continuous high-contrast vision for patients with cataracts from far through near, even in low-light conditions. There were no intraoperative or postoperative complications. On a 7-day, check-up UDVA of the left eye was 1.0, and UNVA was J1. The patient was satisfied with the vision in the left eye, so he wanted to correct the vision of the right eye which was implanted with SENSAR® IOL (Johnson &amp; Johnson Vision, Santa Ana, CA, USA), with a residual diopter of +2.00/+1.00/120 for distance, and +4.50/+1.00/120 for near vision. This choice of IOL in the other institution was not an ideal solution for this patient due to his young age and occupation. The capsular bag was already in slight fibrosis, so the explantation of the existing IOL and implantation of the new one was not a reasonable option. We decided to go with the multifocal AddOn® toric lens (1stQ GmbH, Mannheim, Germany), the refractive-surgery platform for vision enhancement of pseudophakic eyes, that also correct residual astigmatism. On a 7-day check-up, this patient’s UDVA was 1.0 and UNVA was J1. The result was a happy patient, who could go back to his everyday life without spectacle independence. Conclusion: Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. We should be aware of patient expectations and demands, especially when having a patient with young-age cataracts. Often more time should be spent on preoperative IOL planning than cataract surgery itself.

Dysphotopsia and functional quality of vision after implantation of an intraocular lens with a 7.0 mm optic and plate haptic design.

To determine the impact of an intraocular lens (IOL) with a 7.0 mm optic and plate haptic design on incidence of dysphotopsia and visual functions after cataract surgery. Day-care clinic. Prospective monocentric randomized patient-blinded comparative clinical study. Following preoperative measurements, patients underwent cataract surgery with implantation of 2 IOL designs-with 7.0 mm optic and plate haptics (Group 1) or with 6.0 mm optic and C-loop haptics (Group 2). In month 1, 3, and 12 follow-ups, patients were examined, answered a questionnaire regarding satisfaction, spectacle dependence, frequency, and extent of positive and negative dysphotopsia, and underwent contrast sensitivity (CS), mesopic vision, and glare sensitivity testing. The data were analyzed as nominal, ordinal, and metric with chi-square, Mann-Whitney U, Wilcoxon, and t tests. Out of a total number of 120 eyes (86 patients), Group 1 comprised 57 eyes (43 patients), Group 2 comprised 63 eyes (43 patients). Corrected distance visual acuity was the same between groups throughout the study. Group 1 showed significantly lower incidence of positive and negative dysphotopsia in month 1 follow-up (P = .021 and .015, respectively) and a higher satisfaction rate in month 3 follow-up (P = .006). Mean CS and mesopic vision with and without glare were the same in both groups. Positive dysphotopsia cases in month 12 follow-up revealed lower photopic CS (P = .005, .036, and 0.047, respectively), longer axial length, and greater preoperative pupil dynamics (P = .04 and .06). The IOL design with 7.0 mm optic diameter and plate haptics reduced dysphotopsia and provided good visual acuity, CS, mesopic vision with and without glare, and high patient satisfaction.

Comprehensive overview of IRVAN syndrome: a structured review of Case Reports and Case Series.

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare spectrum of retinal vasculitis, aneurysms, and neuroretinitis affecting young individuals in their third decade. Most of our current knowledge is based on case reports, case series, and a handful of collaborative studies. There is much diversity in treatment approaches and outcomes in the reported literature. We have aggregated published case reports and case series into quantitative and narrative synthesis to draw evidence-based conclusions toward clinical features, atypical and rare findings, systemic associations, disease course, and treatment outcomes. The analysis suggested the disease mostly affects young individuals with a female predilection. Anterior chamber and vitreous inflammation are common than previously believed. The most prevalent pattern of retinal vasculitis in IRVAN eyes is mixed vasculitis, followed by arteritis and phlebitis. Most eyes at the time of presentation have capillary nonperfusion and require treatment. Most eyes retain good visual acuity; however, treatment is required to maintain visual function. Intravitreal antivascular endothelial growth factors administered as an adjunct to retinal laser photocoagulation are more likely to improve visual outcomes. Besides, we have discussed the different hypotheses on the etiopathogenesis of the disease and stronger evidence suggests an inflammatory origin of the disease.

A Rare Case of Conjunctival Squamous Cell Carcinoma in a Patient on Longterm Azathioprine Therapy: Cause or Coincidence

Autoimmune Polyglandular Syndrome (APS) is a cluster of endocrine abnormalities that occur in discreet patterns in subjects with immune dysregulation and that permit treatment and anticipation of associated systemic or other hormonal deficiencies. It is classified into four subtypes based on the extent of autoimmune manifestations. APS type 3 is characterised by the presence of an autoimmune thyroid disease and another autoimmune illness, excluding Addison’s disease. Ocular manifestations of APS include keratoconjunctivitis, dry eye, corneal scarring, cataract, retinopathy and optic atrophy. Here, a case of a 23-year-old male patient with APS has been presented with a growth in the left eye for four months, with no other associated symptoms. The patient was a known case of APS type 3 with Autoimmune Haemolytic Anaemia (AIHA) since the age of 5 years. The patient was treated with long-term oral steroids and Azathioprine for 18 years. His visual acuity was 6/6; N6 in both eyes. A gelatinous lesion measuring 8x4 mm was located on the nasal bulbar conjunctiva of left eye, extending 3 mm onto the cornea. The lesion demonstrated intrinsic vascularity, feeder vessels and pigmentation, clinically suggestive of Ocular Surface Squamous Neoplasia (OSSN). Ultrasonography defined the extension of the lesion to involve the episclera, sclera and posterior cornea. Incisional biopsy established the diagnosis of conjunctival squamous cell carcinoma in-situ. Surgical excision was deferred in view of good visual acuity and deep scleral and corneal involvement. The patient was treated with topical Mitomycin C 0.04%, and remained on close follow-up for six months. A possible contribution of long-term intake of systemic Azathioprine to the occurrence of conjunctival neoplasia can be considered.

Clinical Characteristics of Pregnancy-Associated Central Serous Chorioretinopathy in the Chinese Population

Purpose To investigate the clinical characteristics of pregnancy-associated central serous chorioretinopathy (CSC) in the Chinese population. Methods The medical records of patients diagnosed with pregnancy-associated CSC from February 2012 to October 2019 were retrospectively reviewed. Best-corrected visual acuity (BCVA), symptom duration, pregnancy-related medical information, and optical coherence tomography (OCT) images were collected. Results Nine patients (11 eyes) were included. Five women were in their first pregnancy and four were in their second pregnancy, two of whom experienced CSC in their first pregnancy as well. The mean age was 35.00 ± 3.97 years. The mean symptom duration at the initial visit was 19.73 ± 13.65 days. The mean gestational age at the time of development of CSC was 27.11 ± 2.09 weeks. The mean BCVA (logarithm of the minimum angle of resolution (logMAR)) at the initial visit was 0.36 ± 0.18 (Snellen 20/45, range 20/100–20/25). All eyes showed subretinal hyperreflective fibrin on OCT images at the initial visit. Four patients (4 eyes) were lost to follow-up before fluid resolution. The mean BCVA at the final visit was logMAR 0.10 ± 0.15 (Snellen 20/25, range 20/50–20/20)). One eye in the oldest patient had persistent subretinal fluid at 26 months postpartum. The subretinal fluid resolved completely after half-dose photodynamic therapy (PDT); however, the ellipsoid zone at the fovea remained discontinuous at 30 months after half-dose PDT. The remaining six eyes all showed spontaneous resolution of subretinal fluid around delivery and regained intact ellipsoid zone. Conclusions Pregnancy-associated CSC in Chinese developed mostly in the third trimester and usually recovered spontaneously around delivery with good final visual acuity. However, patients might require long-term follow-up until complete resolution of subretinal fluid and to detect recurrences. Half-dose PDT can be administered early if there is little reduction in the amount of subretinal fluid after delivery.

Histomorphological Study of The Pons and Medulla Oblongata of African Striped Group Squirrel (Xerus erythropus)

The study was undertaken to investigate the histological and functional relationships between the pons and Medulla Oblongata of African Striped Ground Squirrel (Xerus erythropus). Twenty (20) adult African striped ground squirrels were divided in to two groups: 10 males and 10 females. The ground squirrels were obtained from the surrounding villages of Zaria Local Government, Kaduna State Nigeria. Each Squirrel was euthanized using ketamine hydrochloride at dose 80mg/kg BW followed by gentle perfusion with neutral formal saline. A pair of scissors, chisel and scalpel blade was used to gently extract the brain (craniotomy). The extracted brain was fixed in bouins solution for 24hours and processed histologically. The pons and medulla are composed of conspicuous nucleus abducens, nucleus facialis and nucleus trigeminal. The nucleus facialis was found dorsal to the paramedian pontine reticular formation as group of large multipolar neurons. A conspicuous nucleus abducens was found as clusters of medium neurons located lateral to the trigeminal nucleus. In myelencephalon, the cuneate fascicles, intermediate sulcus and lateral sulcus were not evident on dorsal surface but there were grossly visible pyramids and olivary prominence on the ventral surface. Similarly, the nucleus olivary were prominent, nucleus cochlearis and spinal nucleus trigemini were well developed, nucleus hypoglossi, raphe obscurus, lateral reticular nucleus, gigantocellular reticular nucleus were all very distinct. In conclusion, the presence of distinct nuclei in the pons and medulla oblongata gives squirrels fine voluntary skills with good motor coordination and balance and good visual acuity for improved diurnal adaptation.

Good Visual Acuity Outcome from an Ocular Blast Injury with Proper Management in Dr. Soetomo General Hospital Surabaya, Indonesia

Introduction: Ocular blast injury related to fireworks most often causing corneal erosion (29%), conjunctival erosion (11%), and conjunctival foreign body (10%) with children are more often than adults (65.9%:34.1%), and males far more often than female (71.9%:28.1%). Knowing proper management is very important to achieve the best result. Case presentation: We describe an ocular blast injury that experienced broad erosion and multiple foreign bodies on the corneal and pericorneal surface in the left eye and visual acuity decreased. The foreign body was scattered, and the fluorescein test was positive. We did proper foreign body extraction, irrigation, and ocular bandage. It was treated with chloramphenicol 0.5% eye ointment and homatropine eye drop. In two months, the patient’s left eye had clear cornea with a small scar formation near the visual axis. The visual acuity was 6/7 and BCVA was 6/6 with S-0.5 C-0.5 A 50° correction. Conclusions: Patients with ocular blast injury limited to superficial cornea erosion and and conjunctival erosion have a reasonable probability of achieving the best visual acuity. Foreign body extraction, proper irrigation, and topical medication show promising results. Scar formation near the visual axis can disrupt visual acuity however can be corrected in this case it can be corrected with glasses. Furthermore, public promotion and regulation to control firework using are very important.

Higher Visual Function Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity.

In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child’s visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the “not applicable” response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.

Motion Processing Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity.

PurposeWe sought to characterize neural motion processing deficits in children with cerebral visual impairment (CVI) who have good visual acuity using an objective, quantifiable method (steady-state visual evoked potentials [SSVEPs]).MethodsWe recorded SSVEPs in response to three types of visual motion – absolute motion and more complex relative and rotary motion, comparing them to form-related vernier and contour responses. We studied a group of 31 children with CVI diagnosed via detailed clinical examinations and 28 age-matched healthy controls.ResultsUsing measurements made at the appropriate response harmonics of the stimulation frequency, we found significant deficits in cerebral processing of relative and rotary motion but not of absolute motion in children with CVI compared with healthy controls. Vernier acuity, in keeping with good recognition acuity in both groups, was not different, nor were contour-related form responses.ConclusionsDeficits for complex motion but relative sparing of elementary motion and form-related signals suggests preferential damage to extra-striate visual motion areas in children with CVI. The fact that these preferential losses occur in the absence of significant acuity loss indicates that they are not secondary to reduced visual acuity, but rather are an independent vulnerability in CVI. These results corroborate parental and caregivers’ reports of difficulties with tasks that involve motion perception in children with CVI.

Classification of good visual acuity over time in patients with branch retinal vein occlusion with macular edema using support vector machine.

To identify the eyes with macular edema (ME) due to a branch retinal vein occlusion (BRVO) that have good visual acuity during the continuous anti-vascular endothelial growth factor (anti-VEGF) treatment based on the patients' clinical information and optical coherence tomography (OCT) images by using machine learning. Sixty-six eyes of 66 patients received 1 anti-VEGF injection followed by repeated injections in the pro re nata (PRN) regimen for 12months. The patients were divided into two groups: those with and those without good vision during the 1-year experimental period. Handcraft features were defined from the OCT images at the time of the first resolution of the ME. Variables with a significant difference between the groups were used as explanatory variables. A classifier was created with handcrafted features based on a support vector machine (SVM) that adjusted parameters for increasing maximal precision. The age, best-corrected visual acuity (BCVA) at the baseline, BCVA at the first resolution of the ME, integrity and reflectivity of the external limiting membrane (ELM), the ellipsoid zone (EZ), and area of the outer segments of the photoreceptors were selected as explanatory variables. The classification performance was 0.806 for accuracy, 0.768 for precision, 0.772 for recall, and 0.752 for the F-measure. The use of the SVM of the patient's clinical information and OCT images can be helpful for determining the prognosis of the BCVA during continued pro re nata anti-VEGF treatment in eyes with ME associated with BRVO.