Visual Field Improvement Research Articles

FRI328 Granulomatous Hypophysitis With Magnificent Response To Glucocorticoids

Abstract Disclosure: M. Rodriguez Caballero: None. F. Romero: None. C. Escurra: None. R. Rodriguez: None. R. Rolon: None. E. Valinotti: None. A. Ayala: None. Granulomatous hypophysitis corresponds to 1% of sellar lesions. It maybe primary or secondary to tuberculosis, Pneumocystis carinii, Toxoplasma gondii, Cytomegalovirus or parasitic infections. Non-infectious etiologies include sarcoidosis, vasculitis, dendritic cell disorders, ruptured Rathke cysts or Crohn's disease. A 59-year-old immunocompetent woman was evaluated for decreased visual acuity, diplopia, and palsy of the 6th cranial nerve. Asellar MRI confirmed an 18 x 14 x 12 mm pituitary lesion with chiasmatic compression and visual field involvement. Hormonal evaluation revealed a TSH 0.03 mIU/L, FT4 0.44 ng/dL, random of GH 5.64 ng/mL, FSH 55.2 IU/mL, LH33.1 mIU/mL, and cortisol of 16 ng/dl. There was no evidence of diabetes insipidus. Transsphenoidal resection resulted in visual field improvement with a noticeable residual tumor of 12 x 9 x5 mm within the sellar space on the postoperative MRI. The patient developed panhypopituitarism. Pathology revealed non-caseous granulomatosis, with histiocytic aggregates of giant cells forming granulomas, with negative immunohistochemistry for mycobacteria. Tuberculin test, VDRL, blood cultures, ANA, Anti-DNA, ANCA C and P were negative. Tomography images and PET scan ruled out systemic involvement. The patient was treated with high doses of glucocorticoids under a presumptive diagnosis of isolated pituitary sarcoidosis vs. primary hypophysitis, resulting in complete disappearance of the lesion. Conclusion: Granulomatous hypophysitis is the second most common cause of chronic inflammation of the pituitary gland mimicking pituitary adenomas. Surgical removal and glucocorticoids are often utilized although there is no consensus regarding the treatment. Our case illustrates the importance of considering this diagnosis when confronted with incidental sellar lesions. Pharmacotherapy resulted in symptomatic improvement and complete involution of the pituitary lesion confirming the utility of empiric high-dose glucocorticoid as a therapeutic strategy for granulomatous hypophysitis. Presentation: Friday, June 16, 2023

WITHDRAWN: Retinitis pigmentosa: Significant improvement with photobiomodulation

We describe the case of a 38-year-old patient with retinitis pigmentosa. Diagnosed at the age of 20, she presented a progressive decrease in visual acuity and visual field, until she developed a shotgun barrel campimetry. After starting a photobiomodulation treatment of 9 sessions every other day, the patient reported improvement in visual acuity, night vision and quality of life. Clinical evaluation showed a visual acuity of 10/10 in both eyes and a substantial improvement in visual field.

Restoration of vision by combined experimental antithymocyte therapy, and orbital radiation with high-dose steroids for severe, acute, steroid-refractory, congestive thyroid orbitopathy

PurposeWe report diagnostic and therapeutic dilemmas in the difficult case of compressive optic neuropathy with severe visual acuity and visual field loss with subsequent visual recovery in both eyes, in a patient with Graves’ orbitopathy (GO) by a combination of experimental antithymocyte therapy, orbital radiotherapy with high-dose steroids.MethodsA 72-year-old man presented with severe vision loss in both eyes. The visual symptoms had appeared over a year before the GO diagnosis. He was initially misdiagnosed with neuroborreliosis and optic neuritis based on brain and orbital magnetic resonance imaging. There was no exophthalmos. The ophthalmological examination included visual acuity, visual field, tonometry in primary and upgaze eye position, optical coherence tomography (OCT), pattern electroretinogram (PERG), pattern, and flash visual evoked potentials (PVEP and FVEP). The patient received experimental therapy with ATG, followed by high-dose of intravenous steroids and orbital radiotherapy.ResultsDelayed VEP peaks became shorter after treatment. After systemic and local therapy lowering of intraocular pressure was achieved. Abnormal PERG has been found three months before ganglion cells atrophy was detected in OCT. Visual acuity and visual field improvement occurred in both eyes after therapy, despite partial left optic nerve atrophy. The patient regained full decimal visual acuity (1.0 right from as poor as 0.3 to 1.0 in the right eye and from hand movements to 0.9 in the left. Severe visual field loss with advanced absolute scotomata has improved to slight relative scotomata. The duration of follow-up time after the treatment was 4 months.ConclusionsIntensive treatment of steroid-resistant Graves’ orbitopathy (GO) may prevent total optic nerve atrophy. Despite severely advanced optic neuropathy, this report emphasizes the necessity of therapy even with nearly complete visual function loss hence there is always a possibility to regain full visual acuity and visual field. Patients with tense orbital septum may not present with significant exophthalmos, thus delaying the correct diagnosis of orbitopathy. A supporting sign of GO was the difference in intraocular pressure in the primary and upgaze eye positions. Electrophysiological examinations are helpful in the diagnosis and monitoring of GO therapy. To our knowledge, this is the first report of this kind presenting visual function restoration and structural recovery in a patient with advanced optic neuropathy in GO.

Clinically Observable Ocular Manifestations of Axonal Transport

This report illustrates and provides a novel explanation for post-trabeculectomy improvements in the visual field, cup disc contours, and apparent deepening of an arcuate nerve fiber layer (NFL) defect after trabeculectomy for open-angle glaucoma. These changes are all plausible manifestations of recovered axonal transport and thickening retina, previously thinned by elevated intraocular pressure (IOP). Serial pre-and post-operative clinical fundus photos in case 1(A,B) demonstrate increased prominence of an inferior temporal arcuate nerve fiber layer defect, improved cup disc ratio, and visual field following eye pressure lowering by + 50% after trabeculectomy. Case 2 (C,D) also demonstrates obvious cup disc improvement in post-operative photos with associated improvement in visual field after trabeculectomy and lowering IOP by + 30%. We suggest that elevated IOP suppresses primarily orthograde axonal transport resulting in nerve fiber layer (NFL) thinning that can recover back to normal thickness when IOP is surgically lowered by the magnitude achieved in these two examples.

EXPLORING THE EFFECT OF A VISUAL TELEREHABILITATION PROGRAM ON VISUAL PERCEPTION IN CHILDREN AND ADOLESCENTS WITH HEMIANOPIA CONSECUTIVE TO A BRAIN TUMOUR, PRELIMINARY RESULTS OF A PILOT STUDY

Abstract Brain tumours (BT) in children often lead to visual impairment, which represents a significant morbidity for long-term survivors. A recent Children Cancer Survivor Study showed that 22.5% of patients with astroglial tumours had visual impairment 5 years after the diagnosis. In the pediatric population with hemianopia, there are no standardized protocols for managing vision loss. In this pilot study, a 6-week home-based visual telerehabilitation program (VTP) evaluated visual changes in 10 children with hemianopia consecutive to a BT. METHOD: The study included 10 patients aged 8-18 years old with hemianopia consecutive to a pediatric BT. Five patients had a chiasmatic tumour (CT), other 5 had a tumour located outside of the chiasm (OCT). Patients followed a 6-week VTP on a virtual reality device at home with remote control of the device from the UHN laboratory. Visual assessments performed at baseline, 2, 4, 6 weeks with follow-ups at 1 and 6 months to check the visual field, contrast sensitivity and reading speed. A quality-of-life (QoL) questionnaire was also filled by patients and parents at every visit. RESULTS: The preliminary results of 8 patients have been analyzed. Four patients (3 CT, 1 OCT) showed visual field improvement with increased luminance perception in the monocular Humphrey test. Four patients (2 CT, 2 OCT) showed visual field improvement in the binocular Esterman field analysis. Reading speed improved in 6 patients (3CT, 3OCT). All patients had significant improvement in contrast sensitivity and QoL. CONCLUSION: Preliminary results of this study showed that this VTP was feasible in children. The program was effective, especially for patients with CT in improving visual field with an impact on contrast sensitivity, reading speed and QoL. Further studies are in development to confirm these results and identify the most appropriate schedules to optimize visual outcomes. POSTER CATEGORIES: BS = BASIC SCIENCE CS = CLINICAL SCIENCE RO = RADIATION ONCOLOGY MO = MEDICAL ONCOLOGY M = MISCELLANEOUS POSTER/TRAVEL AWARDS provided by: BTFC = Brain Tumour Foundation of Canada OHRI = Ottawa Hospital Research Institute

Two- and three-dimensional endoscopic endonasal surgery of large and giant pituitary adenomas-outcome analysis of a series of 62 patients from a single pituitary center.

To analyze the perioperative course and clinical outcome of patients with large (lPA) and giant (gPA) pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery (EETS) using either two-dimensional (2D-E) or three-dimensional (3D-E) endoscopic systems. Single-center retrospective study of consecutive patients with lPA and gPA who underwent EETS between November 2008 and January 2023. LPA were defined as ≥ 3cm and < 4cm in diameter in at least one dimension and a volume of ≥ 10ccm; gPA were defined as larger than 4cm in diameter and with a greater volume than 10ccm. Patient data (age, sex, endocrinological and ophthalmological status) and tumor data (histology, tumor volume, size, shape, cavernous sinus invasion according to the Knosp classification) were analyzed. 62 patients underwent EETS. 43 patients were treated for lPA (69.4%) and 19 patients for gPA (30.6%). 46 patients (74.2%) underwent surgical resection using 3D-E and 16 patients 2D endoscopy (25.8%). Statistical results are referred to the comparison between 3D-E and 2D-E. Patients' age ranged from 23-88years (median 57), 16 patients were female (25.8%), 46 male (74.2%). Complete tumor resection was possible in 43.5% (27/62), partial resection in 56.5% (35/62). Resection rates did not differ between 3D-E (27 patients [43.5%]) and 2D-E (7 patients [43.8%], (p = 0.985). Visual acuity improved in 30 of 46 patients with preoperative deficit (65.2%). In the 3D-E group 21 of 32 patients (65.7%) improved, compared to 9 of 14 patients in the 2D-E group (64.3%). Improvement of visual field was achieved in 31 of 50 patients (62.0%; 22 of 37 patients in the 3D-E group [59.4%] and 9 of 13 patients in the 2D-E group [69.2%]). CSF leak was the most frequent complication and occurred in 9 patients (14.5%, [8 patients 17.4% 3D-E]) without statistical significance. Other surgical complications like postoperative bleeding, infection (meningitis) and deterioration of visual acuity and field were detected without statistical difference. New pituitary anterior lobe dysfunction was observed in 30 of 62 patients (48.4%, 8 patients [50.0%] in the 2D-E group and 22 patients [47.8%] in the 3D-E group). A transient deficit of posterior lobe was detected in 22.6% (14/62). No patient died within 30days of surgery. Although 3D-E may improve surgical dexterity, in this series of lPA and gPA it was not associated with higher resection rates compared to 2D-E. However, 3D-E visualization during resection of large and giant PA is safe and feasible and patient's clinical outcome is not different compared to 2D-E.

A retrospective study to assess visual field improvement following augmented trabeculectomy

To explore the visual field (VF) changes two years following augmented trabeculectomy.A retrospective study of patients who underwent augmented trabeculectomy surgery with mitomycin C by a single surgeon at East Lancashire Teaching Hospitals NHS Trust over 3 years. Patients with a minimum of two years postoperative follow-up were included. Baseline characteristics, intraocular pressure (IOP), VF, number of glaucoma medications, and complications were recorded.In total, 206 eyes were included, 97 (47%) patients were female, and the mean age was 73.8 ± 10.3 (range 43 to 93) years. One hundred thirty-one (63.6%) eyes were pseudophakic before trabeculectomy. The patients were divided into three outcome groups according to VF outcome. Seventy-seven (37.4%) patients had stable VF, 35 (17.0%) patients showed VF improvement, and 94 (45.6%) had VF deterioration. The overall mean preoperative IOP was 22.7 ± 8.0 mmHg and postoperative IOP 10.4 ± 4.2 mmHg, with a reduction of 50.2% (P < 0.001). In total, 84.5% of postoperative patients did not require glaucoma medications. A higher number of patients with postoperative IOP ≥15 mmHg had deteriorating VF (P < 0.001). Based on preoperative MD distribution, VF improvement or stability was more achievable with patients with a preoperative VF defect up to -12 dB (n = 41, 59.4%) and in those with greater than -24 dB (n = 25, 64.1%).Trabeculectomy continues to be an effective means of lowering IOP in patients with uncontrolled glaucoma and is important in stabilizing or improving visual fields. We recommend early trabeculectomy to prevent further VF deterioration. This may help in maintaining VF for driving status and, thus, quality of life.

Effect of Steroid Pulse Therapy on Ethambutol-induced Optic Neuropathy

Purpose: This study investigated the effects of high-dose steroid injections for ethambutol-induced optic neuropathy.Methods: A retrospective study examined 13 patients diagnosed with ethambutol-induced optic neuropathy at Wonju Severance Christian Hospital from December 2016 to November 2020. Methylprednisolone was injected at 1,000 mg/day for 3 days. The patients were evaluated before treatment; immediately after it; and at 1, 6, and 12 months. Visual acuity and visual fields were tested (Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA, USA) and the visual field index (VFI) and mean deviation (MD) were recorded.Results: We analyzed 26 eyes of 13 patients (6 males, 7 females; average age 68.7 years). Immediately after treatment, there was no significant improvement in visual acuity, but the VFI improved by 10% or more in 11 eyes and MD improved by 2 dB or more in 16 eyes. After the end of treatment, 13 of 26 eyes showed improved visual acuity of two lines or more in the Snellen table; VFI improved by more than 10% in 16 eyes and MD b y 2 dB or more in 20 eyes. The average differences in the final VFI and MD were 25.96 (standard deviation [SD] = 29.33) and 7.29 (SD = 7.09), respectively.Conclusions: When patients with ethambutol-induced optic neuropathy were treated with high-dose steroid injections, 60% (16/26) showed visual field improvement immediately after treatment and 77% (20/26) ultimately showed improvement. This suggests that steroids have a therapeutic effect in patients with optic neuropathy caused by ethambutol. Further studies are needed.

Acute zonal occult outer retinopathy misdiagnosed as giant cell arteritis: a challenging case

Background: Acute zonal occult outer retinopathy (AZOOR) is a rare autoimmune retinopathy that is challenging to diagnose and treat. It usually presents with subtle fundus changes and severe visual symptoms. Herein, we report a challenging case of AZOOR, emphasizing that multimodal imaging could be valuable in diagnosis and monitoring of treatment response.&#x0D; Case Presentation: A 53-year-old woman presented to the emergency department with a one-week history of subacute, severe, painless vision loss without photopsia in her right eye. Her best-corrected distance visual acuity was 20/800 in the right eye and 20/20 in the left eye. Slit-lamp examination findings were unremarkable, and intraocular pressure was normal in both eyes. Initially, fundus examination findings appeared normal; however, serum levels of inflammatory markers were elevated. Brain and orbital magnetic resonance imaging results were unremarkable. A relative afferent pupillary defect was present in subsequent follow-up examinations at the hospital. The patient initially received a diagnosis of posterior ischemic optic neuropathy secondary to occult giant cell arteritis, underwent steroid treatment, and was evaluated by rheumatology and neurology consultants. Both consultants concurred with the presumed diagnosis. Subsequent multimodal imaging in the ophthalmology clinic revealed a trizonal pattern of fundus autofluorescence. Corresponding to these areas, we noted a loss of the ellipsoid zone on optical coherence tomography, depression on multifocal electroretinogram, and scotoma on visual field testing. Accordingly, the diagnosis of AZOOR was made. The patient was referred back to the rheumatologist for initiation of steroid-sparing treatment, and methotrexate was administered. Five months after the initial presentation, the patient showed significant visual field improvement in both eyes.&#x0D; Conclusions: Eye care practitioners should consider AZOOR in the differential diagnosis of patients with subacute painless severe unilateral vision loss and unremarkable findings on fundus examination. Multimodal imaging could be valuable in diagnosis and monitoring of treatment response, as observed in the current case. Further studies with larger sample sizes are needed to confirm the value of multimodal imaging and the available management options for AZOOR.

Visual field improvement after endoscopic transsphenoidal surgery in patients with pituitary adenoma.

To analyze and predict the possibility of visual field (VF) recovery after endoscopic transsphenoidal surgery (ETSS) in patients with pituitary adenoma, we investigated the factors affecting the improvement of the visual field defect (VFD) and built a nomogram predictive model based on these risk factors. We further investigated specific recovery regions of VF associated with the improvement of VFD. The clinical data of patients who underwent ETSS for pituitary adenomas at a single center between the January 2021 and April 2022 were retrospectively analyzed. Univariate and multivariate analyses were used to determine the predictive factors affecting the improvement in the VF defect and specific recovery regions in patients with pituitary adenomas after ETSS. We enrolled 28 patients (56 eyes) who were hospitalized at our institution. Four clinical features, including compression of the optic chiasm, preoperative mean defect (MD), diffuse defect, and duration of the visual symptom, were chosen from the least absolute shrinkage and selection operator regression analysis to establish the predictive nomogram. The nomogram's area under the curve (AUC) was 0.912, indicating a good degree of differentiation. A calibration plot was used to evaluate the predictive model's calibration, and a decision curve was used to evaluate its clinical application value. The VF defects were improved in the 270-300° range (270-300: RR = 361.00, 95% CI: 21.01-6,202.41). We developed a predictive nomogram model based on significant visual field improvement-associated factors after ETSS in patients with pituitary adenoma. Postoperative visual field improvement is likely to begin at 270-300° in the inferior temporal quadrant. This improvement would enable personalized counselling for individual patients by precisely predicting the visual field recovery after surgery.

Predictors of visual outcome following surgery in sellar lesions

ABSTRACT Purpose: The purpose of the study is to find out the factors affecting visual outcome after surgery in patients with sellar lesions. Methods: We prospectively analyzed 36 patients diagnosed with sellar tumors who underwent surgery between July 2018 and January 2020. Clinical and demographic data including age, sex, pre- and post-operative visual acuity, visual field, and fundus examination was done in these patients. Size of the tumor was also measured radiologically. The size of the tumor was categorized as &lt;2 and ≥2 cm. Results: Larger tumors had significant association with optic disc changes and visual field defects. The mean visual acuity (LogMAR) and field defects (mean deviation) improved postsurgery (paired t-test). Five of the six patients with peripheral constriction showed an improvement in the visual fields after surgery while only one of 15 patients with temporal hemianopia showed improvement in visual fields after surgery (P = 0.009). Patients with a tumor size &lt;2 cm had statistically significant improvement in visual acuity (paired t-test P &lt; 0.001) and visual fields (paired t-test P = 0.008. Conclusion: Tumor size &lt;2 cm was found to be a good predictor of visual outcome after surgery.

Optic Pathway Gliomas: The Trends of Basic Research to Reduce the Impact of the Disease on Visual Function.

Pediatric optic pathway gliomas (OPG) are low-grade brain tumors characterized by slow progression and invalidating visual loss. Common therapeutic strategies include surgery, radiotherapy, chemotherapy, and combinations of these modalities, but despite the different treatment strategies, no actual treatment exists to prevent or revert visual impairment. Nowadays, several reports of the literature show promising results regarding NGF eye drop instillation and improvement of visual outcome. Such results seem to be related with the NGF-linked prevention in caspase activation, which reduces retinal ganglion cell loss.Reducing retinal ganglion cell loss results clinically in visual field improvement as well as visual electric potential and optical coherence tomography gain. Nonetheless, visual acuity fails to show significant changes.Visual impairment represents nowadays one of the major issues in dealing with OPGs. Secondary to the interesting results offered by NGF eye drop administration, further studies are warranted to better comprehend potential treatment strategies.

Visual Acuity and Visual Field Changes in Patients with End-Stage PACG with Tubular Visual Field after Cataract Surgery

Introduction: To investigate the impact of cataract surgery on visual acuity and visual field (VF) in patients with end-stage glaucoma with tubular VF, and assess the risk of severe visual impairment. Methods: Retrospective analysis of the case data of patients with end-stage glaucoma with tubular VF who underwent cataract surgery in our hospital in the past 7 years. Results: A total of 59 patients with 63 eyes were enrolled, 62 eyes were primary angle-closure glaucoma (PACG) and 1 eye was primary open-angle glaucoma. The last follow-up time was an average of 9 months, and no cases of severe vision loss occurred. Best corrected visual acuity (BCVA) improved significantly after surgery (0.57 ± 0.46 vs. 0.45 ± 0.43 logarithm of the minimum angle of resolution, p < 0.01), and there was a significant drop in intraocular pressure (IOP; 22.85 ± 9.7 vs. 16.07 ± 3.38, p < 0.01), a reduced number of glaucoma medications (2 ± 1.32 vs. 0.5 ± 1, p < 0.01), statistical improvement in VF index (VFI) and mean defect (MD) (12.3% ± 7.65% vs. 16.1% ± 9.84%, p < 0.01; −29.09 ± 2.16 vs. −28.31 ± 3.01, p < 0.01) after surgery. The higher the preoperative VFI and MD were, the better the postoperative BCVA (r = −0.387, r = −0.347, respectively). The degree of postoperative VFI improvement was significantly correlated with preoperative MD (r = 0.372, p < 0.01). During the follow-up period, 5 eyes (8%) underwent anti-glaucoma surgery due to elevated IOP. Conclusion: Cataract surgery can significantly improve visual acuity and VF in patients with end-stage PACG with tubular VF, and no patients have severe visual impairment. The less preoperative VF damage there is, the greater the postoperative visual acuity and VF improvement. Poor IOP control is the main cause of further damage to postoperative visual acuity and VF.

Features of neuro-ophthalmic symptoms in patients with parasellar meningiomas

Goal. To analyze the features of neuro-ophthalmic symptoms and study visual functions recovery following parasellar meningiomas (PM) surgery. Material and methods. We have analyzed the results of treating 47 patients with PM which have been operated in the Romodanov Neurosurgery Institute in 2017 - 2021. The main group included 47 patients (94 eyes) with PM with visual disorders. Clinical-neurological and ophthalmological examination and a range of neuroimaging studies were carried out. To evaluate the visual functions, the results were analyzed according to the recommendations of the German Ophthalmological Society. Results. Binocular visual disturbances have been detected in 34 (72.3%) patients. Among visual field defects, absolute bitemporal hemianopia prevailed in 14.9% of patients and a combination of relative upper quadrant temporal hemianopia with absolute temporal hemianopia in 19.2% of patients. Monocular visual disturbances have been detected in 13 (27.7%) patients. Optic nerve atrophy was found in 38 patients (80.9%): unilateral - 21 patients (21 eyes), bilateral - 17 patients (34 eyes). A probable difference was revealed in the average visual acuity: before treatment 0.55±0.04, after treatment 0.67±0.04 (p&lt;0.05) and the average total loss of sensitivity: before treatment 11.37±0, 78 dB and after treatment 9.14±0.79 dB (p&lt;0.05). Conclusions. Parasellar meningiomas constitute a significant part of extracerebral tumors. As a result of surgical treatment, there is a significant improvement in visual acuity and visual field.

Impact of Bevacizumab on Visual Function, Tumor Size, and Toxicity in Pediatric Progressive Optic Pathway Glioma: A Retrospective Nationwide Multicentre Study.

Bevacizumab (BVZ) is used as a subsequent line of treatment for pediatric optic pathway glioma (OPG) in the case of progression. Data on the treatment effect concerning tumor progression and visual function are scarce and nationwide studies are lacking. We performed a retrospective, nationwide, multicentre cohort study including all pediatric patients with OPG treated with BVZ in the Netherlands (2009-2021). Progression-free survival, change in visual acuity and visual field, MRI-based radiologic response, and toxicity were evaluated. In total, 33 pediatric patients with OPG were treated with BVZ (median 12 months). Visual acuity improved in 20.5%, remained stable in 74.4%, and decreased in 5.1% of 39 of all analysed eyes. The monocular visual field improved in 73.1%, remained stable in 15.4%, and decreased in 7.7% of 25 analysed eyes. Radiologic response at the end of therapy showed a partial response in 7 patients (21.9%), minor response in 7 (21.9%), stable disease in 15 (46.9%), and progressive disease in 3 (9.3%). Progression-free survival at 18 and 36 months after the start of BVZ reduced from 70.9% to 38.0%. Toxicity (≥grade 3 CTCAE) during treatment was observed in five patients (15.2%). Treatment of BVZ in pediatric patients with OPG revealed stabilisation in the majority of patients, but was followed by progression at a later time point in more than 60% of patients. This profile seems relatively acceptable given the benefits of visual field improvement in more than 70% of analysed eyes and visual acuity improvement in more than 20% of eyes at the cessation of BVZ.

Predicting visual outcomes after decompression of pituitary tumours based on stratified inner-retinal layer thickness and age.

The purpose of the study was to evaluate the potential role of stratified preoperative optical coherence tomography (OCT) measurements and age in predicting postoperative visual field (VF) improvement among adult patients with chiasmal compression due to pituitary tumours after decompression surgery. Postoperative visual outcomes were analysed using mean deviation of the VF test. Eyes were divided into three groups based on preoperative OCT parameters including peripapillary retinal nerve fibre layer (pRNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness: groups 1, 2 and 3 with pRNFL thickness <65 μm, 65 μm or morebut <85 μm, and 85 μm or more, respectively. The GCIPL thickness was also divided into three groups based on values ranging from 55 to 77 μm. Each group was further categorized according to age: 20 years or older but younger than 40 years, 40 years or older but younger than 60, and 60 years or older. This study included 197 eyes of 197 patients with chiasmal compression due to pituitary tumours. No patient showed complete VF recovery in group 1 with a preoperative pRNFL thickness <65 μm or a GCIPL thickness <55 μm regardless of age. These groups showed the worst VF outcome (pRNFL, p = 0.0001; GCIPL, p < 0.0001). However, a significant recovery in VF (greater than 2dB) was observed in 45% of group 1 patients based on pRNFL thickness and in 61.54% of group 1 patients according to GCIPL thickness. In groups 2 and 3 with a preoperative pRNFL thickness of 65 μm or more and a GCIPL thickness of 55 μm or more, the rate of complete VF recovery decreased as subjects' ages increased. Group 3 with a preoperative pRNFL thicknessof 85 μm or more and a GCIPL thickness of 77 μm or more were 2.5-fold and 4.0-fold more likely to completely recover VF, respectively, compared with group 2. Stratified preoperative pRNFL and GCIPL thicknesses measured via OCT in different age categories are effective biomarkers for predicting visual functional outcomes.

Upper Eyelid Skin Laxity in Elderly Patients: Correction Surgery With Eyelid Marginal Incision.

Laxity of the upper eyelid skin in the elderly usually leads to an aged appearance and visual field defect, which affects their quality of life. However, there are very few reports on the evaluation and treatment strategy for upper eyelid skin redundancy in elderly Asians. Hence, this article describes an upper eyelid skin laxity correction surgery using an innovative parallel palpebral margin incision to improve ptosis and enlarge the visual field. From August 2012 to March 2021, 87 patients with severe eyelid laxity and ptosis presented to the Plastic Surgery Department of the Zhongda Hospital Affiliated to Southeast University. Upper eyelid skin laxity correction surgery with eyelid marginal incision was performed to correct the excessive tissue between the eyebrow and the upper eyelid and improve patients' vision field. Thereafter, a postoperative follow-up was conducted to observe the results in terms of skin laxity, eyelid shape changes, visual field improvement, postoperative scars, and patients' satisfaction. During the follow-up, information was collected between 3 months and 1 year after surgery. No visible scars were seen in patients after the operation, and the sagging skin of the upper eyelid was corrected. In addition, the effect of correcting visual field defect is stable, with no recurrence within 1 year. The operation was effective, and patients were satisfied. This surgical strategy significantly improved severe upper eyelid skin laxity with inconspicuous postoperative scars. After the operation, patients felt satisfied, and their quality of life was notably improved.

Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial

PurposeWe developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis.MethodsIn a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients’ Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities.ResultsVR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = −0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01).ConclusionsThis pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment.Translational RelevanceIn this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.

Efficacy of pterygopalatine fossa injection with local anesthetic agent and adrenaline in reduction of intra-operative bleeding during endoscopic sinus surgery

BackgroundThis study aimed to assess the effect of pterygopalatine fossa injection via greater palatine canal with xylocaine and adrenaline on intra-operative surgical field bleeding and overall blood loss during FESS.MethodsWe are doing this randomized blinded study on 60 patients who underwent FESS. Infiltration with 2 ml of xylocaine 2% with 1:100,000 adrenaline was slowly injected on one side and the surgeon was asked to assess the surgical field using a Boezaart scale.ResultsOperative time is significantly less in injected cases than the other cases with a P value < 0.001. blood loss in injected side was significantly less than Non-injected side with a P value < 0.001.ConclusionThere was a significant decrease in blood loss, duration of surgery, and improvement in visual field using Boezaart score in injection group (cases) who underwent pterygopalatine fossa injection of xylocaine/adrenaline compared to the other non-injected group.

Retinal morphological and functional response to Idebenone therapy in Leber hereditary optic neuropathy.

Leber hereditary optic neuropathy (LHON) is a mitochondrial disease leading to optic atrophy due to degeneration of the retinal ganglion cell. A curative treatment is not available at the moment, but a new antioxidant drug, Idebenone, is expected to reduce the progression of the disorder. Two male patients, genetically confirmed with LHON, were clinically, morphologically, and electrophysiologically evaluated, before and three, six, nine and 12 months after starting the treatment. The patient with 3460G>A mutation in mitochondrially-encoded nicotinamide adenine dinucleotide, reduced form (NADH):ubiquinone oxidoreductase core subunit (mtND)1 gene showed an improvement in visual acuity, visual field, and visual evoked potentials with no effect on morphological examinations, while the patient with 11778G>A mutation in mtND4 gene showed no functional, nor morphological recovery after one year of treatment. This study demonstrates that Idebenone, depending on the genetic profile of the disease, may be effective in functional improvement in patients with LHON.