Improvement In Best-corrected Visual Acuity Research Articles

Comparison of Long-term Outcomes of Scleral-fixated IOL: Sutured vs. Suture-less Fixation

Purpose: This study compared the long-term outcomes and complications associated with sutured and suture-less scleral fixed intraocular lenses (SFIOLs), the two primary surgical techniques for scleral fixation of IOLs.Methods: A total of 90 patients were included in the study with 46 in the sutured group and 44 in the suture-less group. These patients underwent SFIOL between January 2019 and June 2023 due to IOL dislocation, aphakia, or crystalline lens dislocation. Collected data included age, gender, axial length, operative time, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive value, refractive error, ocular residual astigmatism, IOL dislocation, recurrent IOL dislocation, IOL tilt, and IOL iris capture. Changes from preoperative status to 1 year postoperatively were assessed.Results: No significant differences were found between the sutured and suture-less groups regarding preoperative BCVA, IOP, and refractive values. However, the suture-less group demonstrated significantly better BCVA at both 1 week and 1 month postoperatively compared to the sutured group (<i>p</i> = 0.010, 0.015, respectively). The refractive error in the suture-less group was also significantly lower at 1 week postoperatively (<i>p</i> = 0.020). Ocular residual astigmatism was consistently lower in the suture-less group across all postoperative intervals (<i>p</i> < 0.001). While the suture-less group showed a shorter average surgical time, there was greater variability in operative duration (<i>p</i> < 0.001, 0.024, respectively). Additionally, a longer axial length was associated with an increased incidence of IOL iris capture (<i>p</i> = 0.004).Conclusions: Suture-less SFIOL is associated with shorter operative times, although with greater variability. Patients in the suture-less group experienced faster BCVA improvement, reduced refractive error, and lower ocular residual astigmatism compared to those in the sutured group.

Efficacy of adalimumab in pediatric non-infectious uveitis with and without anterior segment inflammation

BackgroundThis study aimed to identify the clinical characteristics of cases that is related to the response rate of adalimumab (ADA) treatment.MethodsA retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: those with anterior segment inflammation (ASI+) and those without anterior segment inflammation (ASI-). The primary outcome was treatment success rate. Secondary outcomes including best-corrected visual acuity (BCVA), inflammation parameters [anterior chamber cell (ACC), vitreous haze (VH)], retinal nerve fiber layer (RNFL) thickness, fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed.ResultsThe study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the ASI + group and 15 patients (28 eyes, 25.42%) in the ASI- group. The treatment success rate in the ASI + group was significantly higher than in ASI- patients (93.18% vs. 20%, p < 0.001). Following 6-month of ADA treatment in the ASI + group, there was a significant improvement in BCVA (p < 0.001), inflammation parameters (p < 0.001), reduced RNFL thickness and reduced FA scores (p < 0.001). Conversely, no significant differences were observed in BCVA, inflammation parameters, RNFL thickness and FA scores in the ASI- group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the ASI+ (p < 0.001) and ASI- groups (p < 0.05). Adverse events observed during the study period included abdominal pain, skin erythema, articular symptoms and respiratory infections.ConclusionADA demonstrates superior efficacy in the treating pediatric non-infectious uveitis with ASI + compared to ASI-.

Safety and Vision Outcomes Following Gene Therapy for Bietti Crystalline Dystrophy

Bietti crystalline dystrophy (BCD) is a severe genetic retinopathy caused by variants in the CYP4V2 gene. Currently, there is no approved treatment for BCD. To evaluate safety and vision outcomes following gene therapy with adeno-associated virus (AAV) encoding CYP4V2 (rAAV-hCYP4V2, NGGT001 [Next Generation Gene Therapeutics]). This open-label, dose-escalation nonrandomized clinical trial was conducted from February 2023 to May 2024 at 2 study sites in China. Patients with genetically confirmed biallelic disease-linked CYP4V2 variants received subretinal injections of rAAV2-hCYP4V2 at 1 of 2 dosage levels and were followed up for 12 months. A single unilateral injection of 1.5 × 1011 or 3.0 × 1011 total vector genomes of recombinant AAV-hCYP4V2 in the worse eye, based on visual acuity letter score. The primary outcome was safety, assessed by clinical examination of ocular inflammation and evaluated by routine clinical chemistry and immunogenicity testing. Secondary outcomes were changes in visual function from baseline in best-corrected visual acuity (BCVA), microperimetry, and contrast sensitivity 12 months after treatment. Among 12 patients with BCD (6 patients per dose group), mean (SD) patient age was 40.5 (7.1) years, and 5 patients (42%) were female. No severe adverse events related to the treatment were observed. However, mild intraocular inflammation was noted in 1 participant. The median (IQR) baseline BCVA letter score for the study eye was 34 (10-53), equivalent to 20/200 Snellen, while the nonstudy eye had a median (IQR) BCVA of 60 (40-67), equivalent to approximately 20/63 Snellen. At 12 months, the study eye improved by a mean (SD) letter score of 13.9 (13.1) compared with 6.3 (7.4) in the nonstudy eye. The 12-month median (IQR) BCVA for the study eye was 53 (37-64) (equivalent to approximately 20/80 Snellen) and 62 (42-70) (approximately 20/50 Snellen) for the nonstudy eye. This open-label, exploratory nonrandomized clinical trial identified no serious safety concerns related to gene therapy over 12 months' follow-up among patients with BCD. While improvement in BCVA was noted, the magnitude was within test-retest values typically noted in eyes with very low levels of visual acuity, and BCVA improvement in both the study and nonstudy eyes could be related to a learning effect, with greater improvement in the study eye possibly related to study eyes' being the worse-seeing eye. ClinicalTrials.gov Identifier: NCT06302608.

Efficacy of Split-Thickness Thin Amniotic Membrane Graft for Closure of Refractory or Large Macular Holes.

To assess the effectiveness of split-thickness amniotic membrane (SAM) grafts in achieving closure of refractory or large macular holes (MH). This retrospective study reviewed data from patients who underwent surgical repair of MHs using SAM grafts between January 2019 and December 2023. Key parameters, including best-corrected visual acuity (BCVA) and MH size, were evaluated both preoperatively and postoperatively. The study included 13 patients (9 females; mean age 63.5 years). Before surgery, the median BCVA was 1.30 ± 0.56 LogMAR (approximate Snellen equivalent: 20/400), and the median MH size measured 717 ± 246.6 µm. After an average follow-up period of 28 months, the median BCVA improved significantly to 1.00 ± 0.52 LogMAR (p < 0.05) (approximate Snellen equivalent: 20/200). All MHs were successfully closed, and no intraoperative complications were observed. SAM grafting is a safe and reliable option for closing refractory or large MHs, resulting in significant improvements in BCVA and successful hole closure. Compared to full-thickness grafts, SAM grafts offer advantages such as increased flexibility in placement and ease of removal post-closure, due to their thinner and more pliable nature, which facilitates easier handling and positioning within the MH.

Topographic changes in macula and its association with visual outcomes in idiopathic epiretinal membrane surgery.

We investigated changes in macular topography and their association with visual acuity and metamorphopsia in the idiopathic epiretinal membrane (iERM). Twenty-four eyes that underwent vitrectomy and ERM removal with internal limiting membrane peeling were included in this study. Best-corrected visual acuity (BCVA) and horizontal/vertical metamorphopsia scores (h and vM-scores in the M-chart) were assessed. The distances of fovea-disc (FD) and fovea-vascular arcade (FV), central subfield macular thickness (CSMT), and foveal location were measured using fundus photography, optical coherence tomography (OCT), and OCT angiography, respectively. The BCVA (logMAR) and vM-scores (P < 0.001, P = 0.014, respectively) improved after surgery. The distance of the FD decreased (P < 0.001) and FVs increased (P < 0.001, both). The fovea moved horizontally toward the disc (P < 0.001). The change in median total FVs (7.114 mm to 7.369 mm, P = 0.001) correlated with the change in BCVA (P = 0.049, Pearson's [r] = -0.404). No topographic parameters were associated with an improvement in the vM score. The macular topography significantly changed after iERM removal; the fovea moved nasally, and the distance between the superior and inferior vascular arcades increased. Such a change was relevant to the improvement in BCVA, but not metamorphopsia.

Visual Outcomes of Central Retinal Artery Occlusion: Exploring Treatment Strategies Beyond the Conventional Time Window.

Central retinal artery occlusion (CRAO) is a vision-devastating emergency. However, widely-acknowledged treatment consensus is lacking and prehospital delays commonly occur. Hence, we aimed to investigate the visual outcomes of conservative treatments (CT), local intra-arterial fibrinolysis (LIF) and hyperbaric oxygen (HBO) therapy for non-arteritic CRAO (NA-CRAO) patients beyond the conventional time window. This retrospective comparative study included 99 NA-CRAO patients followed up for over 6 months. The subjects were divided into three groups: the CT (50 patients), LIF (10 patients) and HBO group (39 patients). The primary endpoint was the best-corrected visual acuity (BCVA) change at 6 months compared to baseline. The secondary endpoint was the improvement in BCVA at 1 year and final visits. No heterogeneity regarding demographics was identified. However, the HBO group had a more extended time-to-treatment period (median 6.0 days) and more advanced-stage CRAO cases (41% stage III) than the CT (median 4.0 days, 14% stage III) and LIF (median 0.6 days, 20% stage III) groups. Despite this, the HBO group exhibited a significantly greater BCVA and a higher proportion of patients achieving significant vision improvement than those in the CT group at 6-, 12-month and final exams (51.3% vs. 24.0%, P<0.05). The LIF appeared to improve outcomes more than CT over time without significance. Our study provided a concurrent comparison across 3 approaches and demonstrated that HBO therapy beyond the time window remained more effective in improving vision than CT alone for NA-CRAO patients, which had not been proposed by prior studies.

SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY INSIGHTS INTO IDIOPATHIC EPIRETINAL MEMBRANE SURGERY OUTCOMES.

The aim of this study is to assess the prognostic value of a classification system that includes the presence of ectopic inner foveal layers and other anatomical variables identified in spectral-domain optical coherence tomography for idiopathic epiretinal membrane (ERM) surgery. A descriptive-analytic, longitudinal, retrospective study was conducted on patients with idiopathic ERMs treated with pars plana vitrectomy from January 2017 to December 2021. Clinical data and spectral-domain optical coherence tomography images were reviewed presurgery and 12 months postsurgery. The primary outcome measured was best-corrected visual acuity (BCVA) before and after surgery, analyzing the impact of anatomical factors on BCVA in patients undergoing ERM surgery. This study included 342 eyes from 323 patients. Postsurgical evaluations showed significant reductions in central foveal thickness across all ERM stages, with most Stage 4 ERMs regressing to Stage 3. The mean improvement in BCVA was significant for all stages, with earlier stages showing better results. The presence of macular edema and ellipsoid zone disruption were significant predictors of postsurgical BCVA, while disorganization of the retinal inner layer showed an association with visual recovery but was not conclusively predictive. This study highlights the importance of spectral-domain optical coherence tomography in assessing retinal changes in idiopathic ERMs, demonstrating the prognostic value of ectopic inner foveal layers stage scheme and other anatomical variables such as ellipsoid zone disruption and macular edema presence on BCVA. These findings offer insights into surgical prognostication and the potential for personalized treatment strategies.

Longitudinal Study of Epibulbar Dermolipomas Over Five-Year Follow-Up: Growth Analysis, Refractive Errors, and Surgical Outcomes.

To evaluate the growth, management, and outcomes of epibulbar dermolipomas over a 5-year follow-up period. This was a retrospective chart review of epibulbar dermolipoma patients with a minimum follow-up of 5 years, which analyzed the changes in size, refractive errors (spherical equivalent), best-corrected visual acuity, histology, and surgical outcomes. A total of 61 eyes of 53 patients (32 females) with an average presenting age of 4.4 years were included. Eight patients had bilateral involvement, and 22 (41.5%) had Goldenhar syndrome. Forty-one eyes had corneal and conjunctival involvement, and 12 had only conjunctival involvement. Forty-five eyes (73.7%) had refractive errors, and 39 (63.9%) were amblyopic. The average lesion size was 8.3 ± 6.1 by 7.4 ±4.9 mm and 7.1 ± 5 by 7.5 ±5.4 mm in operated and unoperated eyes, respectively. Of 61 eyes, 30 underwent simple surgical excision with conjunctival autograft (3), amniotic membrane graft (7), partial thickness corneal transplant (18), and amniotic membrane graft plus limbal epithelial transplant (2). Fifty-five (90%) of operated eyes had better cosmesis and a significant change in refractive error (p = 0.003). The best-corrected visual acuity improved in operated eyes by 0.4 logMAR units (p = 0.05). A mean size increase of 0.4 ± 0.8 by 0.4 ± 0.9 mm occurred in 31 eyes managed conservatively, with improved best-corrected visual acuity but no change in refractive errors. Amblyopic eyes showed improvement in best-corrected visual acuity of 0.7 (p = 0.007) after occlusion therapy in 13 unoperated and 26 operated eyes. Epibulbar dermolipomas often have associated refractive errors and amblyopia. Timely surgical excision improves cosmesis and refractive errors. Occlusion therapy for amblyopic eyes should be offered to help improve vision.

Five-Year Outcomes of Lenadogene Nolparvovec Gene Therapy in Leber Hereditary Optic Neuropathy

Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON). To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration. The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from 2018 to 2022, is the 5-year follow-up study of the 2 phase 3 clinical studies RESCUE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss Up to 6 Months From Onset in LHON Due to the MT-ND4 Mutation) and REVERSE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the MT-ND4 Mutation). At the end of each study, ie, 2 years after gene therapy administration, patients were offered enrollment in the RESTORE trial, a multinational, multicenter, prospective study, for an additional 3 years of follow-up. Patients with LHON due to the MT-ND4 gene variant received lenadogene nolparvovec in 1 eye and a sham injection in the other eye. Lenadogene nolparvovec was administered as a single intravitreal injection in the RESCUE/REVERSE studies. Measures included best-corrected visual acuity (BCVA), quality of life using the National Eye Institute visual functioning questionnaire 25 (NEI VFQ-25), and adverse events. Among the 76 patients who received gene therapy in the RESCUE (n = 39) and REVERSE (n = 37) studies, 72 (94.7%) completed these studies; 62 patients (81.6%) participated in the RESTORE trial, and 55 patients (72.4%) completed the 5-year follow-up. Participants were mostly male (49 [79.0%]) with a mean (SD) age of 35.9 (15.3) years at treatment. At baseline, the mean (SD) BCVA was 1.5 (0.5) logMAR (20/600 Snellen) in eyes to be treated with lenadogene nolparvovec and 1.4 (0.5) logMAR (20/500) in sham eyes. At the end of the RESCUE/REVERSE trials, ie, 2 years after treatment, eyes treated with lenadogene nolparvovec and eyes treated with sham reached a mean BCVA value of 1.4 (0.6) logMAR (20/500). The mean (SD) change from baseline to year 2 was -0.05 (0.6) logMAR (+1 line) and 0.01 (0.6) logMAR (-0 line) in gene therapy-treated and sham eyes, respectively (difference, -0.03; 95% CI, -0.16 to 0.09; P = .60). Five years after treatment, the bilateral improvement from nadir was similar to that observed at 2 years, with a mean (SD) change in BCVA of -0.4 (0.5) logMAR (more than +4 lines) for eyes treated with lenadogene nolparvovec and -0.4 (0.4) logMAR (+4 lines) for eyes treated with sham (difference, -0.05; 95% CI, -0.15 to 0.04; P = .27). An improvement of at least -0.3 logMAR (+3 lines) from the nadir in at least 1 eye was observed in 66.1% of participants (41 of 62). Between 2 and 5 years, intraocular inflammation was noted in 4 participants with 8 events in eyes treated with lenadogene nolparvovec and 1 event in an eye treated with sham. In this analysis of the RESTORE trial, follow-up of patients with LHON due to the MT-ND4 gene variant unilaterally treated with lenadogene nolparvovec demonstrated a sustained bilateral improvement in BCVA and a good safety profile up to 5 years after treatment. This evidence of persistent benefit over time is promising for the use of gene therapy in these patients. ClinicalTrials.gov Identifier: NCT03406104.

Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity.

To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma. Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications. Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes. EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

Epiretinal Membrane and Senile Cataract: Combined vs Sequential Surgery.

To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM). A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery. Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group. Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.

Comparison of Anti-Inflammatory Effects of Prednisolone versus Nepafenac 0.3% after Phacoemulsification and Intraocular Lens Implantation

Objective: To compare the anti-inflammatory effects and safety profiles of prednisolone acetate 1% and nepafenac 0.3% in patients undergoing phacoemulsification with intraocular lens implantation (IOL). Methods: This cross-sectional study was conducted at Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan from December 2023 to July 2024. The study included patients underwent uneventful phacoemulsification with IOL implantation. Post-operative outcomes were assessed at a single follow-up conducted at 4 weeks. Primary efficacy endpoint was improvement in best-corrected visual acuity, measured as the reduction in Logarithmic Minimum angle of resolution (logMAR) values from baseline to follow-up. Clinically significant improvement was defined as a reduction of ≥0.2 logMAR units. Secondary outcomes included anterior chamber inflammation, graded using Standardization of Uveitis Nomenclature criteria, and incidence of adverse events. Results: Of total 324 patients, mean age was 64.77 ±9.27 years. Mean logMAR change from baseline to follow-up was 0.28 ±0.11 units in the Prednisolone group and 0.30 ±0.11 units in the Nepafenac group, with statistically significant difference (p-value 0.050). The findings of clinical improvement, showed that 121 (48.8%) patients achieved clinical improvement in the Prednisolone group and 127 (51.2%) in the Nepafenac group. The distribution of inflammation grades (0, 1+, 2+, 3+), was similar between the Prednisolone and Nepafenac groups. A total of 76 (23.4%) adverse events were reported, with 40 (52.6%) occurring in the Prednisolone group and 36 (47.4%) in the Nepafenac group. Conclusion: Both prednisolone acetate and nepafenac are effective and safe in managing post-operative inflammation and improving visual outcomes following phacoemulsification.

3-year Outcomes of Rotating Suture with Root Z-epicanthoplasty for Lower Lid Epiblepharon

Purpose: To report the clinical outcomes of Root Z-epicanthoplasty combined with lower eyelid rotation suturing in patients with lower eyelid epiblepharon, focusing on a 3-year follow-up.Methods: Patients who underwent Root Z-epicanthoplasty combined with lower eyelid rotation suturing from March 2012 to February 2020 were included. Patients aged &lt; 15 years, and who had a minimum 3-year follow-up, were included. We assessed changes in best corrected visual acuity (BCVA), cycloplegic refraction, astigmatism, and surgical outcomes. To evaluate the influence of preoperative amblyopia, patients were divided into subgroups based on amblyopic status; surgical outcomes were compared between these groups. In addition, subgroups were divided based on age at operation and astigmatism were compared between subgroups.Results: A total of 55 patients (109 eyes) exhibited successful correction of lower eyelid epiblepharon without recurrence; one case experienced a delayed episode of lower palpebral conjunctival hemorrhage. Significant changes were observed of BCVA improvement, myopic shift of cycloplegic refraction, and astigmatism reduction three years post-surgery (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.024). In the group without preoperative amblyopia (86 eyes), significant changes were noted in BCVA, cycloplegic refraction, and astigmatism (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.025). In patients with preoperative amblyopia (23 eyes), significant improvements were observed in BCVA and myopic shift in cycloplegic refraction (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; = 0.003), whereas astigmatism showed no significant change (&lt;i&gt;p&lt;/i&gt; = 0.431). There is significant reduction of astigmatism in under 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.011) and no significant reduction of astigmatism in over 6-year-old group (&lt;i&gt;p&lt;/i&gt; = 0.589).Conclusions: Root Z-epicanthoplasty with lower eyelid rotation suturing demonstrated a low complication rate and no recurrence over 3-year follow-up, confirming its effectiveness in correcting lower eyelid epiblepharon. The procedure also positively influenced visual development and reduction of astigmatism in pediatric patients.

Short-Term Endotamponade With Perfluorocarbon Liquids for Giant Retinal Tear-Associated Retinal Detachment.

Purpose: To investigate the use of short-term postoperative endotamponade with perfluorocarbon liquids (PFCLs) for the treatment of giant retinal tear-associated rhegmatogenous retinal detachment (RRD). Methods: This retrospective study evaluated patients who had 2-stage surgery, which entailed pars plana vitrectomy (PPV) completed in 2 consecutive surgeries spaced 5 days apart, during which a short-term tamponade with PFCL was used (Group 1), and patients who had conventional single-stage PPV with long-term silicone oil (SO) tamponade (Group 2). Results: The study comprised 74 eyes of 68 patients, 52 in Group 1 and 22 in Group 2. The mean (±SD) patient age at presentation was 48.19 ± 15.73 years. Of the cases, 18.9% had high myopia and 13.5% had previous trauma. The improvement in best-corrected visual acuity (BCVA) was significantly better in Group 1 than in Group 2 at all postoperative visits (P = .004, postoperative day [POD] 15; P = .002, POD 90; P = .00006, final follow-up). Anatomic success (an attached retina) was achieved in 82.7% of patients in Group 1 and in 72.7% of patients in Group 2 (P = .33). At the 6-month postoperative follow-up, 54.5% of patients and 50% of patients, respectively, had a logMAR BCVA of 1.00 or better (P = .721). The mean change in intraocular pressure from baseline was statistically significant in both groups (Group 1, P = .012; Group 2, P = .018). Conclusions: Anatomic and functional outcomes in giant retinal tear-associated RRD can be improved with short-term postoperative endotamponade with PFCLs.

COMBINATION OF DEXAMETHASONE IMPLANT AND ANTI-VEGF IN THE MANAGEMENT OF DIABETIC MACULAR EDEMA: A SYSTEMATIC REVIEW

Background: Anti Vascular Endothelial Growth Factor (anti-VEGF) and dexamethasone implant (DEX) are suggested as the first and second-line therapy for Diabetic Macular Edema (DME). However, persistent DME were found after six months of routine anti-VEGF injection. Intravitreal steroids have the advantage to control the inflammatory component of DME. Combining intravitreal anti-VEGF and DEX may reduce macular edema more effectively and more quickly theoretically. Hence, we aim to review the efficacy of adding DEX to anti-VEGF in treating DME. Methods: Literatures were obtained using comprehensive searching on PubMed and Proquest using the keywords “Dexamethasone implant”, “anti-VEGF therapy”, and “Diabetic Macular Edema” including their synonyms between 2018 to 2023. Non-English studies, animal studies, review articles, case studies, and editorial letters were excluded. This result was presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Results: A total of 3 studies with 265 eyes were included. All of the studies had Central Foveal Thickness (CFT) and Best Corrected Visual Acuity (BCVA) as the main outcomes. Improved CFT was seen in all of the studies (all p&lt;0.05) with ∆CFT (200,40 μm in 6 months and 413 μm in 12 months). Most studies showed improved visual acuity after 8 months of injections which were shown by ∆BCVA (8,84 letters in 6 months and 21,6 letters in 12 months) and increased intraocular pressure as an adverse effect of steroids. Conclusion: Combination of DEX and anti-VEGF showed improvement in CFT and BCVA. Further studies are required due to the controversial intravitreal steroids’ ocular adverse effect.

Anatomical and functional outcome of surgical correction of optic disc pit maculopathy using autologous scleral patch graft: a long-term retrospective analysis

BackgroundOptic disc pit (ODP) is a rare congenital anomaly of optic nerve head and is associated with maculopathy. Scleral patch graft (SPG) as a therapeutic option is recently advocated.MethodsThis is a retrospective analysis of 54 patients with ODP maculopathy who were followed up for 12 months post-operatively. The parameters assessed included best corrected visual acuity (BCVA) in LogMAR chart and central macular thickness (CMT) at baseline and at 1-, 3- and 12-months post-surgery.ResultsThe mean age of presentation was 36.36 ± 15.69 years [Median 36, Interquartile range (IQR) 14.75]. 51.85% were female. 53.7% were operated in left eye. The average period of follow-up was 15.37 ± 2.34 months after surgery. The mean presenting BCVA in LogMAR chart was 0.66 ± 0.37 (Median 0.6, IQR 0.4) and average CMT was 677.46 ± 251.57µ (Median 674, IQR 276). On follow up over 1, 3 and 12 months, average BCVA were 0.74, 0.58 and 0.49 LogMAR respectively. The improvement in final BCVA was statistically significant (p = 0.016). The CMT at the corresponding follow-up periods were 461.26 ± 238.3µ (Median 435, IQR 220.5), 362.68 ± 125µ (Median 367, IQR 141) and 287.36 ± 121.9µ (Median 266, IQR 139.5). Decrease in CMT was significant at all follow up visits (p < 0.001). On assessing OCT Biomarkers, Subretinal fluid (57.4%), Intraretinal Fluid (57.4%), macular schitic cavity (79.63%), Outer Lamellar Macular hole (31.48%), Pachychoroid vessels (35.19%), Outer Retinal Layer Disruptions (24.07%) were present in various proportions on presentation. After surgery over the follow-up, retinal fluid and schitic cavities were observed to get regressed over time. Outer Lamellar Macular holes showed excellent regression after surgery over a period of time. On final visit after 1 year of surgery, complete anatomical success in terms of OCT interpretation was achieved in 16 cases (29.63%). Partial anatomical success was achieved in further 24 cases (44.44%). At least some anatomical improvement was seen in 49 patients while in 3 patients it remained almost unaltered and 2 cases worsened. Successful visual rehabilitation was achieved in 45 patients (83.33%)ConclusionsDetailed OCT based and functional analysis in this study with long-term follow-up helps to entitle the importance of scleral patch graft based surgical procedure in managing this challenging surgical condition. This article caters the largest case series with meticulous analyses of the ODP Maculopathy surgically managed using autologous scleral plug.

A Tertiary Centre's Experience With Using Ranibizumab Biosimilar Compared to Aflibercept for Neovascular Age-Related Macular Degeneration: A Retrospective Study.

Objective This study aims to evaluate the real-world efficacy of ranibizumab biosimilar (Ongavia), compared to aflibercept (Eylea), in the treatment of treatment-naïve neovascular age-related macular degeneration (nAMD) at a busy tertiary eye care centre. Methods A retrospective analysis of medical records from August 2022 to August 2024 was conducted, comparing treatment outcomes in treatment-naive nAMD patients who received either Ongavia or Eylea intravitreal anti-VEGF (vascular endothelial growth factor) injections under a treat-and-extend protocol. Initial and 12-month outcome measures post-treatment initiation were collected, including best-corrected visual acuity (BCVA), central retinal thickness (CRT), prescribed treatment intervals, actual injection frequency, and the average total number of injections per eye over 12 months. Results A total of 62 eyes met the inclusion criteria. Over 12 months of follow-up, patients receiving Eylea (n = 36) showed a significantly greater improvement in BCVA (7.08 ± 4.12), p = 0.018, compared to Ongavia (n = 26) (-1.9 ± 3.31). CRT reductions were also more substantial for Eylea (-116.21 µm ± 35.61 µm) than for Ongavia (-51.14 µm ± 22.21 µm), p = 0.002. The average number of injections was 6.55 for Ongavia and 5.75 for Eylea over the 12-month follow-up. Excluding the initial three loading doses, observed injection intervals averaged 9.49 weeks for Eylea and 8.17 weeks for Ongavia. Notably, for the total study period, 164 out of 171 (96%) Ongavia injections were prescribed at four-week intervals, compared to 110 out of 207 (53%) for Eylea. However, capacity constraints impacted adherence to prescribed dosing schedules, affecting efficacy. Conclusion Our study indicates reduced visual and morphological outcomes with Ongavia compared to Eylea in treating nAMD when monthly injections cannot be provided as prescribed. Given clinical capacity constraints, Eylea's greater potency and durability prove advantageous, allowing extended intervals and reducing the reliance on strict monthly dosing. This highlights the need for additional resources to support frequent biosimilar administration and ensure effective ranibizumab treatment. A comprehensive cost-benefit analysis is warranted to assess whether increased clinic capacity offsets Ongavia's lower per-injection cost, compared to Eylea.

Subfoveal neurosensory detachment flattening and observe (SNF-Ob) approach for the management of Ci-DMO - a multicentric study.

To understand subfoveal neurosensory detachment flattening and observe (SNF-Ob) strategy and its relationship with visual acuity in the management of centre-involved diabetic macular oedema (Ci-DMO). This was a multicentric retrospective observational study. We reviewed data of 188 eyes of 130 patients who presented with Ci-DMO with subfoveal neurosensory detachment (NSD) and treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents or steroids. The primary outcome was best corrected visual acuity (BCVA) measured at the time of the first subfoveal neurosensory detachment flattening (SNF) and at the end of follow-up. Eyes that achieved 20/50 (LogMAR = 0.40) or better at first SNF had mean LogMAR BCVA 0.38 ± 0.21, 0.24 ± 0.11 and 0.21 ± 0.15 at baseline, at the time of first SNF, and at the end of the last follow-up respectively. Mean LogMAR BCVA significantly improved from baseline to first SNF (p < 0.0001; 95% CI 0.115-0.183) and at the end of the last follow-up (p < 0.0001; 95% CI 0.126-0.213) with a change of Early Treatment Diabetic Retinopathy Study (ETDRS) 10 letters. There was no significant difference in improvement in BCVA from the first SNF and at the end of the last follow-up (p = 0.0781; 95% CI -0.002 to 0.046). Eyes presenting with Ci-DMO and subfoveal NSD are unlikely to improve at SNF with BCVA > 20/50 (LogMAR = 0.40). Further evidence is needed before the combination of good BCVA and SNF may be considered as endpoint of pharmacological therapy for DMO.

Central Retinal Thickness Variability as a Predictive Factor for Visual Acuity After Dexamethasone Implant in Retinal Vein Occlusion.

Investigate central retinal thickness (CRT) variability and changes in best-corrected visual acuity (BCVA) after 12 months in patients with retinal vein occlusion (RVO) treated with dexamethasone intravitreal implants. Post hoc analyses of two randomized trials in patients with macular edema associated with branch or central RVO treated with a 0.7-mg dexamethasone implant. Central retinal thickness standard deviation (CRT-SD) and central retinal thickness amplitude (CRT-A) were measures of variability. Analyses included multinomial and simple linear regression. In 400 patients, CRT-SD and CRT-A were significantly associated with central RVO, second dexamethasone implant, and baseline CRT. Baseline BCVA was associated with CRT-A. CRT-SD and CRT-A were significantly correlated with a 12-month change in BCVA (effect sizes of -0.032 and -0.013 letters/µm; P < 0.001). Patients in the highest CRT-SD quartile gained significantly fewer letters (+1.88 letters; 95% CI: -0.46 to 4.23). Greater CRT variability was associated with smaller BCVA improvements in patients with RVO treated with dexamethasone implants. [Ophthalmic Surg Lasers Imaging Retina 2024;55:722-729.].

Peripapillary and Macular Optical Coherence Tomography Angiography Predictors of Visual Improvement in Patients Treated with Vitrectomy for Idiopathic Epiretinal Membrane

Introduction: We investigated the changes of peripapillary and macular microvasculature in idiopathic macular epiretinal membrane (iERM) eyes before and after pars plana vitrectomy (PPV), aiming to identify potential optical coherence tomography angiography (OCTA) predictors of visual acuity improvement. Methods: Fifty-seven eyes diagnosed with iERM were enrolled and underwent PPV with ERM and internal limiting membrane (ILM) peeling. Data were collected before surgery and during the 12-month postoperative period. OCTA analysis focused on radial peripapillary capillary (RPC) vessel density (VD), superficial and deep capillary plexus (SCP and DCP, respectively). Functional and OCT structural outcomes, including best-corrected visual acuity (BCVA) and macular thickness, were also recorded. Results: Multivariate linear regression analysis revealed that higher preoperative RPC VD, lower SCP VD, and lower BCVA were predictors of postoperative BCVA improvement (p < 0.001, p = 0.047, and p < 0.001, respectively). Throughout the follow-up period, there was an observed increase in intradisc RPC VD, whole-disc VD, and parafoveal DCP VD (all p < 0.001). BCVA and central macular thickness demonstrated significant improvement (p < 0.001) within the first month following vitrectomy, which then stabilized from the third month onward. Conclusions: Preoperative microvascular measurements in iERM patients can forecast postoperative BCVA. OCTA findings reveal that both increased RPC density and reduced SCP density at baseline could serve as predictors of better visual outcomes after surgery. Enhanced RPC density may reflect a healthier optic nerve with greater potential for visual recovery, while a less dense SCP could indicate less iERM contraction, both contributing to more favorable postoperative visual results.