Improvement In Visual Outcomes Research Articles

Nurse-led counselling programme on the adherence to eye patch application among children with amblyopia: a randomised control trial

ObjectiveTo assess the impact of the nurse-led counselling programme on eye patch application for improvement of adherence to eye patch application and vision among children with amblyopia.Material and methodsA randomised...

Sutureless Scleral Fixation of Intraocular Lens in Aphakia: Characteristics and Visual Outcomes

Introduction & ObjectivesSutureless scleral fixation (SSF) surgery is one of the secondary intraocular lens (IOL) implantationprocedures for aphakic patients with absent or deficient capsular bag support that is beingincreasingly performed these days. This study aimed to describe the characteristics, indications for,and visual outcomes of patients who had undergone sutureless scleral fixation of intraocular lensesat Sardjito Hospital.
 MethodsA retrospective cross-sectional study of 43 eyes that SSF intraocular lens at Sardjito Hospital,Yogyakarta. The data were collected from electronic medical records of patients from October 2020to December 2022. The data were analyzed descriptively by presenting numbers and percentages forcategorical variables and mean ± standard deviation (SD) for numerical variables. Outcomesincluded pre- and postoperative uncorrected visual acuity (UCVA).
 ResultsThere were 43 eyes obtained from 40 patients who underwent SSF intraocular lens in this study,consisting of 35 males (79.55%) and 9 females (20.45%). The mean age of the subjects was 50.04 ±19.2 years. Lens subluxation was the most common indication for surgery (32.5%), followed bydropped nucleus (20.45%), intraocular lens luxation (18.18%), lens luxation (15.91%), intraocularlens decentration (9.09%), and endophthalmitis (4.55%). Before surgery, most of the patients hadvisual acuity of less than 3/60 (81.4%) and after surgery, 32.56% had ?6/18, 34.88% had <6/18-6/60,and 18.60% had <6/60-3/60.
 ConclusionMales predominantly underwent SSF intraocular lens surgery at Sardjito Hospital. Lens subluxationwas the most common indication for the surgery. There was an improvement in visual outcome.

Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review.

We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision. In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022-9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results. A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01). For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.

Visual outcome in retrofixated iris claw lens for aphakic eye

Aim of this study was to assess the visual outcome and complications in retropupillary iris claw lens implantation in aphakic patients. Retrospective case series of aphakic patients who underwent retrofixation of iris claw lens, over a period of two years were collected and analysed. The study comprised of 9 patients with unilateral aphakia. The follow up period was 6 months with mean uncorrected visual acuity (VA) was significantly improved at one month postoperatively (-0.69 logMAR P &amp;#60; 0.001) compared to preoperative value. The mean preoperative Spherical equivalent was -3.04±4.2D which significantly reduced to -1.01+/-2.66 post-operatively. Results showed that the retrofixation of iris claw lens was an effective method for correction of aphakia with significant improvement in visual outcome.

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.

Vasoproliferative retinal tumors: Clinical presentation and treatment outcome.

To study the clinical presentation and treatment outcomes of patients with vasoproliferative retinal tumor (VPRT) in India. Retrospective study of 50 eyes in 47 patients. Of the 50 eyes, 25 (50%) were primary and 25 (50%) were secondary. Common ocular pathologies related to secondary VPRT included retinal detachment (n = 8, 32%) and Coats disease (n = 7, 28%). Overall, the mean age at presentation was 35 years (range; 3-74 years) and included 30 (64%) males and 17 (36%) females. The lesions were unilateral in 44 (94%) patients. Secondary retinal features included intra/subretinal exudation (n = 41, 82%), vascularity (n = 32, 64%), subretinal fluid (n = 21, 42%), retinal neovascularisation (n = 9, 18%) and vitreous hemorrhage (n = 8, 16%). Thirty-four eyes (68%) underwent cryotherapy, of which 16 eyes (47%) received adjunct intravitreal anti-VEGF (12 eyes) or corticosteroid injection (4 eyes). Primary surgery included vitrectomy with/without encirclage and cryotherapy (n = 12, 24%) and plaque brachytherapy (n = 3, 6%). At last follow-up (mean 9.7 months, range 3-67 months), 42 eyes (84%) had complete tumor regression with no improvement in visual outcomes when comparing presenting and final best corrected visual acuity. Comparing primary versus secondary VPRT, secondary VPRT presented a decade earlier (31 vs 40 years), needed surgical intervention (48% vs 20%), had poor tumor control (72% vs 92%) and worse visual outcomes (p < 0.05). VPRTs commonly present as a unilateral lesions in the adult population with equal prevalence of primary and secondary variants. Compared with primary VPRT, secondary VPRTs require surgical treatment and are associated with poor visual outcome.

Update on Femtosecond Laser-Enabled Keratoplasty.

The application of femtosecond lasers to corneal transplantation is an intriguing proposition with many potential benefits to patients with various corneal diseases. The customized trephination pattern for donor and host matching offers many advantages regarding wound integrity and high precision of donor and recipient match at the interface, which should lead to faster healing and visual rehabilitation. Femtosecond laser-enabled keratoplasty (FLEK) is an advancement of conventional trephination penetrating keratoplasty, and in large clinical cohorts to date, there are meaningful improvements in visual outcomes and a lower risk of graft rejection. Femtosecond laser-enabled deep anterior lamellar keratoplasty (Femto-DALK) combines the advantage of a customized trephination pattern with the deep anterior lamellar keratoplasty procedure, which eliminates the risk of endothelial rejection. Furthermore, the precision of the femtosecond laser may offer additional novel approaches to lamellar keratoplasties. In time, advancements in femtosecond laser platforms will help cornea surgeons realize the added benefits and better optimize outcomes for patients, such that the cost-benefit calculus shifts toward wider accessibility for patients. Prospective randomized-controlled trials are needed to definitively determine the impact of femtosecond laser-enabled keratoplasties on long-term outcomes.

Macular oedema after uncomplicated phacoemulsification

Background: Recent development of cataract surgery has led to the improvement of visual outcomes. However, pseudophakic cystoid macular oedema (CME), which is also known as Irvine–Gass syndrome, remains a usual cause of unexpected visual disturbance after both complicated and uncomplicated cataract surgeries. Optical coherence tomography is an important method in detecting changes prior to clinical presentation.Aim: To assess macular thickness changes after uncomplicated phacoemulsification using spectral domain optical coherence tomography (SD-OCT).Setting: The study assessed healthy patients who had uneventful phacoemulsification and changes in macular thickness in Ibn Al Haitham Teaching Eye Hospital (tertiary eye center), Baghdad, Iraq.Methods: Macular thickness of 86 eyes with uncomplicated phacoemulsification were measured by using four OCT examinations: one preoperatively, which was used as a control, and three in the first week and first and second months. Incidence of macular thickness changes was evaluated in the central and para and perifoveal areas to detect which areas of the macular map will be affected more. Significance was tested by using paired t-test and p 0.05 was considered significant.Results: Significant increase in macular thickness postoperatively during the 2-month period reaching the maximum level in the second month; early significant changes were noticed in paracentral area in the first week whilst significant increase in the central and pericentral area was recorded in the first month. Cystoid macular oedema (CME) was detected in six eyes (7%) in the second month.Conclusion: Significant variation in macular thickness can occur after uneventful phacoemulsification surgery in healthy patients. Cystoid macular oedema was detected in 7% of our patients using SD-OCT. It is rare after uncomplicated phacoemulsification in healthy individuals but should be kept in mind in the follow-up period. A detailed fundus examination with OCT imaging is thus recommended in the first or second month postoperatively for the early detection and treatment of CME.

A retrospective study of the prevalence and management of complications of proliferative diabetic retinopathy and its visual outcome in patients in a tertiary care hospital

To provide the prevalence of complications of proliferative diabetic retinopathy (PDR) in patients visiting the retina clinic in Dr. B. R. Ambedkar Medical College and Hospital and to evaluate their visual acuity (VA) status. A retrospective study in which the chart review was done of the patients diagnosed with PDR, attending the retina clinic in Dr. B.R. Ambedkar Medical College and Hospital. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to at least 5 years were included. Evaluating the prevalence of the complications of PDR, presenting VA of people with PDR, short-term outcomes at 6 months and 5 years are the main outcomes of the study. The most common complication of PDR was diabetic macular edema (DME). Eyes receiving treatment early in the disease course (i.e. baseline VA 6/18 or better) had significantly better VA outcomes at 5 years versus eyes treated at a later stage (i.e. baseline VA &amp;#60;6/18 - ≥3/60). The treatment of patients with VA &amp;#60;3/60 can also lead to significant improvement in visual outcome. Our results suggest that early diagnosis and treatment of patients with PDR is of utmost importance in preventing severe vision loss due to advanced diabetic eye disease. People with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Vitreous microparticles contain apoptotic signals suggesting a diabetic vitreopathy

To evaluate differences in microparticle profiles in vitreous samples between diabetic and non-diabetic eyes undergoing vitrectomy. Un-masked cross-sectional series of 34 eyes undergoing vitrectomy. Vitreous specimens were collected and processed to evaluate for membrane integrity (DAPI), apoptosis (Annexin-V), and endothelial-cell origin (V-Cadherin). A BD LSR II flow cytometer was used for analysis and standardized sub-micron-sized beads were used for size comparison. Thirty-four specimens underwent analysis. Greater levels of Annexin-V were found on microparticles from specimens in which blood had entered the vitreous (n=12) compared to those without blood (n=22; 52.3%±30.7% vs 19.6%±27.2%, P=0.002). Patients with diabetes having surgery with hemorrhage (n=7) had greater expression of Annexin-V than those without hemorrhage (n=8; 62.1%±31.7% vs 18.9%±20.9%, P=0.009). However, in patients with non-diabetic vitreous hemorrhage, the level of Annexin-V expression was not significantly different compared to other disease processes (38.6%±25.7%, n=5 vs 20.0%±30.9%, n=14, P=0.087). Increased expression of the apoptotic marker, Annexin-V is detected on vitreous microparticles in diabetes-related vitreous hemorrhage. When evaluating vitreous hemorrhage in patients without diabetes, the apoptotic signal is not significantly different. Vitrectomy in patients with diabetes, and improvement in visual outcomes, may be related to the removal of a serum-derived, pro-apoptotic vitreous. Further investigation is warranted in order to identify the molecular characteristics of microparticles that regulate disease.

Congenital rubella syndrome and its postoperative visual outcome: A prospective longitudinal study in a tertiary care hospital in eastern India

BACKGROUND: Congenital rubella syndrome is a threatening consequence of rubella infection in pregnancy characterized by the triad of cardiac, ocular & hearing defects. The morbidity and financial load associated with congenital rubella syndrome have an adverse effect on the quality of life. AIMS and OBJECTIVES: To evaluate the postoperative visual outcome of congenital rubella cataract and assessment of the immediate postoperative complications.MATERIALS AND METHODS: Institution-based longitudinal prospective observational study was carried out among 21 patients aged 1 month to 6 years of both sex groups with congenital rubella cataract. A single surgeon performed phacoaspiration and anterior vitrectomy. Intraocular lens implantation was done in children aged >2 years where the rest were kept aphakic. Best-corrected visual acuity and immediate postoperative complications were assessed in all cases preoperatively and at 1 week, 4 weeks, and 6 months postoperatively.STATISTICAL ANALYSIS USED: Data were entered into Excel and analyzed by SPSS (version 25.0; SPSS Inc., Chicago, IL, USA) and Graph-Pad Prism version 5.RESULTS: The study evaluated 28 eyes of 21 patients. The mean age of the study population was 21.1 ± 20.27 months with male predominance (1.625:1). Among 28 eyes only 10 eyes (35.71%) single-piece acrylic hydrophilic intraocular lenses were implanted and the rest 64.29% were kept aphakic. Immediate postoperative complications were noted such as anterior uveitis(9 eyes), corneal edema(3 eyes), striate keratitis(6 eyes) with more predilection towards aphakic patients & rest had no significant complications. At 6 months follow-up, significant improvement of best-corrected visual acuity (≥6/60) was noted in 52.38% of eyes which was about 5.12% pre-operatively ('P' value <0.01).CONCLUSION: Significant improvement in visual outcome was noted with early diagnosis and intervention with acceptable rate of immediate postoperative complications.

Visual outcomes and quality of life before and after photorefractive keratectomy.

Purpose:To compare visual outcomes and vision-related quality of life (VRQoL) between subjects before and after photorefractive keratotomy (PRK) and controls. In addition, VRQoL was compared between subjects at different periods of PRK surgery.Methods:This was a cross-sectional study that included subjects with refractive errors aged 19–40 years and age-matched controls. Subjects were divided into three groups: pre-, post-PRK, and control. Subjects in the post-PRK group were divided into three subgroups (1-week, <6-month, and >6-month follow-up visits). Measurements including uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) of manifest refraction, and corneal topography were obtained for all participants. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire was administered to compare VRQOL between groups and between post-refractive surgery subgroups.Results:A total of 145 participants were included in this study. The mean age ± standard deviation (SD) of all participants was 26.29 ± 5.1 years. There was a significant difference (P < 0.001) in total QIRC scores between groups. The total QIRC score was better in the post-PRK group than in the pre-PRK and control groups. The scores of items included in the convenience, well-being, and health concern domains were significantly higher in the post-PRK group than in the pre-PRK and control groups. Within the post-PRK group, significant differences (P < 0.001) were found in UCVA and SE between the post-PRK subgroups. Uncorrected VA and SE were better in the post-PRK groups who were followed up in the < 6 and > 6 months subgroups than in the 1-week follow-up subgroup (P < 0.0001).Conclusion:A significant improvement in visual outcomes and VRQoL occurred after PRK surgery. Subjects enjoyed their VRQoL after refractive surgery.

Novel Association between Opioid Use and Increased Risk of Retinal Vein Occlusion Using the National Institutes of Health All of Us Research Program.

Purpose:To assess for risk factors for retinal vein occlusion (RVO) among participants in the National Institutes of Health All of Us database, particularly social risk factors that have not been well studied, including substance use.Design:Retrospective, case-control study.Participants:Data were extracted for 380 adult participants with branch retinal vein occlusion (BRVO), 311 adult participants with central retinal vein occlusion (CRVO), and 1520 controls sampled among 311 640 adult participants in the All of Us database.Methods:Data were extracted regarding demographics, comorbidities, income, housing, insurance, and substance use. Opioid use was defined by relevant diagnosis and prescription codes, with prescription use > 30 days. Controls were sampled at a 4:1 control to case ratio from a pool of individuals aged > 18 years without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. Multivariable logistic regression identified medical and social determinants significantly associated with BRVO or CRVO. Statistical significance was defined as P < 0.05.Main Outcome Measure:Development of BRVO or CRVO based on diagnosis codes.Results:Among patients with BRVO, the mean (standard deviation) age was 70.1 (10.5) years. The majority (53.7%) were female. Cases were diverse; 23.7% identified as Black, and 18.4% identified as Hispanic or Latino. Medical risk factors including glaucoma (odds ratio [OR], 3.29; 95% confidence interval [CI], 2.22–4.90; P < 0.001), hypertension (OR, 2.15; 95% CI, 1.49–3.11; P < 0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18–2.38; P = 0.004) were re-demonstrated to be associated with BRVO. Black race (OR, 2.64; 95% CI, 1.22–6.05; P = 0.017) was found to be associated with increased risk of BRVO. Past marijuana use (OR, 0.68; 95% CI, 0.50–0.92; P = 0.013) was associated with decreased risk of BRVO; however, opioid use (OR, 1.98; 95% CI, 1.41–2.78; P < 0.001) was associated with a significantly increased risk of BRVO. Similar associations were found for CRVO.Conclusions:Understanding RVO risk factors is important for primary prevention and improvement in visual outcomes. This study capitalizes on the diversity and scale of a novel nationwide database to elucidate a previously uncharacterized association between RVO and opioid use.

Early Residual Fluid-Free Status and Long-Term BCVA Outcomes: A Treatment Agnostic, Post Hoc Analysis of Pooled HAWK and HARRIER Data

The aim of this study was to determine associations between early residual fluid (ERF)-free status and improved long-term visual outcomes. This was a retrospective clinical cohort study from a post hoc analysis of 2 phase III clinical trials' data. Independent of treatment allocation, patients from the multicenter, prospective, randomized, double-masked HAWK and HARRIER trials who received either brolucizumab 6 mg or aflibercept 2 mg were split into 2 cohorts depending on the presence or absence of ERF at week 12. In addition, similar analyses were performed on the presence or absence of early residual intraretinal fluid (IRF) and subretinal fluid (SRF) at week 12. The 2 groups, ERF-free (n=1051) and ERF (n=366) patients were compared. Changes from baseline in best corrected visual acuity (BCVA) and central subfield thickness (CST) were determined. From week 12 to 96, patients who were ERF free had greater least squares (LS) mean increases from baseline for BCVA and CST compared to ERF patients. Greater LS mean differences in BCVA from week 12 to 96 were noted between ERF-free and ERF patients. A greater proportion of patients in the ERF-free cohort reported a ≥5, ≥10, or ≥15 letter improvement, and a higher proportion reported BCVA ≥70 letters from baseline to week 96 compared to patients with fluid. Improvements in visual outcomes in ERF-free patients were greater than in ERF patients occurring as early as 4 weeks (week 12) after the last loading dose and continued to week 96. Therefore, ERF status may be a useful indicator of anti-vascular endothelial growth factor treatment response.

Voretigene Neparvovec Gene Therapy in Clinical Practice: Treatment of the First Two Italian Pediatric Patients.

PurposeTo present visual outcomes of the first two Italian patients with RPE65-related inherited retinal dystrophy (RPE65-IRD) treated with voretigene neparvovec (VN).MethodsTwo pediatric patients with RPE65-IRD were treated with VN in both eyes. Patients were evaluated by best-corrected visual acuity (BCVA), full-field stimulus threshold (FST) test, semiautomated kinetic visual field (SKVF), microperimetry, and chromatic pupillometry over 6 months.ResultsNo complications occurred in the first patient, whereas in the second a subretinal hemorrhage was observed in the first treated eye, and excessive resistance to drug injection occurred during treatment of the second eye. BCVA improved by at least one Early Treatment Diabetic Retinopathy Study line in all treated eyes. The FST test and SKVF showed clinically significant improvements in all eyes (i.e., change of light sensitivity > 10 decibels; area enlargement of at least 20%). Moreover, microperimetry showed better fixation stability. Finally, chromatic pupillometry showed increases in pupillary constriction that ranged from 10% to 20%. All visual changes remained stable during follow-up.ConclusionsThe first VN treatments in two pediatric Italian patients in clinical practice showed significant improvements in visual outcomes, even in the case of surgical complications, which spontaneously recovered without sequelae.Translational RelevanceThese findings with VN in patients with RPE65-IRD confirm the results of clinical trials.

Pluripotent stem cell therapy for retinal diseases.

Pluripotent stem cells (PSCs), which include human embryonic stem cells (hESCs) and induced pluripotent stem cell (iPSC), have been used to study development of disease processes, and as potential therapies in multiple organ systems. In recent years, there has been increasing interest in the use of PSC-based transplantation to treat disorders of the retina in which retinal cells have been functionally damaged or lost through degeneration. The retina, which consists of neuronal tissue, provides an excellent system to test the therapeutic utility of PSC-based transplantation due to its accessibility and the availability of high-resolution imaging technology to evaluate effects. Preclinical trials in animal models of retinal diseases have shown improvement in visual outcomes following subretinal transplantation of PSC-derived photoreceptors or retinal pigment epithelium (RPE) cells. This review focuses on preclinical studies and clinical trials exploring the use of PSCs for retinal diseases. To date, several phase I/II clinical trials in patients with age-related macular degeneration (AMD) and Stargardt disease (STGD1) have demonstrated the safety and feasibility of PSC-derived RPE transplantation. Additional phase I/II clinical trials using PSC-derived RPE or photoreceptor cells for the treatment of AMD, STGD1, and also retinitis pigmentosa (RP) are currently in the pipeline. As this field continues to evolve, additional technologies may enhance PSC-derived cell transplantation through gene-editing of autologous cells, transplantation of more complex cellular structures such as organoids, and monitoring of transplanted cells through novel imaging technologies.

Vitreoretinal Complications in Boston Keratoprosthesis Type 1

To evaluate the incidence of vitreoretinal complications, treatment modalities, and the visual outcomes in a large cohort of eyes that underwent Boston Keratoprosthesis (KPro) implantation. Retrospective, interventional case series. 132 eyes of 114 patients who underwent KPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1 year follow-up. Charts were reviewed and data was collected, including demographics, initial corneal indication for surgery, posterior segment complications, preoperative and postoperative visual acuity. Mean follow-up was 68.2 months and 61.4% of eyes developed postoperative vitreoretinal complications (VRC). The most common VRC was RPM formation (38.6%, n=51) followed by RD (15.2%, n=20), CME (12.1%, n=16), ERM (9.8%, n=13), endophthalmitis (9.1%, n=12), sterile vitritis (7.6%, n=10), vitreous hemorrhage (6.8%, n=9), choroidal detachment (3.0%, n=4) and central retinal vein occlusion (0.7%, n=1). BCVA improved in the no VRC group from 1.74 ± 0.33 logMAR to 1.33±0.83 logMAR and in the VRC group from 1.74±0.36 logMAR to 1.52±0.83 logMAR, without any statistically significant intergroup differences (p=0.231). RD was the only significant complication associated with poorer visual outcomes (p=0.001). Potentially blinding secondary complications occur in the majority of patients and frequent monitoring is necessary, specifically in the early and intermediate postoperative periods. This study evidenced significant improvements in visual outcomes of KPro eyes, including those that developed postoperative vitreoretinal complications.

Ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe and often life-threatening reactions of the skin and mucous membranes. They are considered as asingle disease entity with different expressions of severity and are summarized under the term epidermal necrolysis (EN). There is ahigh risk of ocular involvement, which can lead to long-lasting eye problems and even blindness without immediate ophthalmological treatment. The acute occurrence, the unpredictable course and extreme variation in the manifestation of complications require an interdisciplinary approach. A rapid diagnosis of eye involvement and initiation of an intensive lubricating and anti-inflammatory surface treatment is of utmost importance for the long-term outcome. This article should help ophthalmologists to have a better understanding of this condition and therefore lead to substantial improvement in visual outcome and the quality of life of patients.

A study of evaluation of anterior segment changes in eyes with pseudo exfoliation syndrome including anterior chamber depth status of lens anterior chamber angle preoperatively

Background: Pseudoexfoliation syndrome is an important ocular manifestation of a systemic disease, found to be common in cataract patients as well as in 50% of glaucoma patients. Present study was intended to assess the profile of Pseudoexfoliation syndrome and evaluate the surgical outcome of Manual Small Incision Cataract Surgery in Pseudoexfoliative eyes. Material and Methods: Present study was prospective, observational, hospital-based study, conducted in patients with age more than 50 years, with Pseudoexfoliation, admitted for cataract surgery, posted for Manual Small incision cataract surgery(MSICS). All patients underwent a manual small incision cataract surgery, and visual outcomes of the procedures were recorded on the first postoperative day. Results: In present study, maximum numbers of patients were from the age group of 70-79 years (62.5%) and 56 (70%) patients were males and 24 (30%) were females. In this study of 80 patients with Pseudoexfoliation Syndrome, 60 patients had Bilateral Pseudoexfoliation i.e. 120 eyes (85.71%) while 20 patients had Unilateral Pseudoexfoliation i.e. 20 eyes (14.29%). In majority of the eyes 111 (79.29%) had involvement of lens with Pseudoexfoliation while 109 (77.86%) had pupillary involvement. Mean Anterior Chamber Depth in Pseudoexfoliative eyes was 2.50±0.22 mm. Majority of the eyes i.e. 74 (52.9%) were having IOP between 16 – 20 mm Hg. 61 eyes (43.6%) had IOP between 11 – 15 mm Hg. 80 eyes of 80 patients underwent MSICS, 17 (21.25%) patients developed Intraoperative Complications. Conclusion: There is significant association between Pseudoexfoliation syndrome and age, male preponderance and bilateral involvement of eyes. MSICS provides significant improvement in visual outcome in patients with Pseudoexfoliation syndrome with cataract.

A 12-month, prospective, observational study of ranibizumab in treatment-na\xefve Taiwanese patients with neovascular age-related macular degeneration: the RACER study

BackgroundThe current National Health Insurance scheme in Taiwan reimburses 3 initial plus 4 additional injections of ranibizumab 0.5 mg for eligible patients with neovascular age-related macular degeneration (nAMD). The Ranibizumab AMD Clinical Efficacy in Real-world practice (RACER) study aimed to observe the effectiveness of ranibizumab injections under this reimbursement system.MethodsRACER was a 12-month, prospective, observational study conducted in treatment-naïve, adult Taiwanese patients with nAMD. Patients received intravitreal ranibizumab 0.5 mg injections in adherence with local prescribing information.ResultsOf 161 patients enrolled, 114 (70.8%) completed the 12-month study. Overall, patients received a mean (standard deviation [SD]) of 4.3 (1.7) ranibizumab injections. The mean (SD, [95% confidence interval], P value) gain in best-corrected visual acuity (BCVA) from baseline at Month 3 was 5.2 (12.2, [3.1, 7.3] letters, P < 0.0001) and at Month 12 was 3.4 (15.4, [0.2–6.6] letters, P = 0.0352). Mean central retinal thickness also decreased from baseline at Months 3 and 12 (both P < 0.001). In subgroup analyses, better treatment outcomes at Months 3 and 12 were observed among patients who received a loading dose and those who had a shorter duration of nAMD at baseline. Adverse events were reported in 58.4% of patients; most (94.4%) were mild-to-moderate in severity and 98.8% were deemed unrelated to study treatment.ConclusionsTreatment with ranibizumab 0.5 mg resulted in significant improvements in visual outcomes among treatment-naïve Taiwanese patients with nAMD. Early treatment and frequent dosing in the real-world setting may be the key to achieving better outcomes.