Visual Improvement Research Articles

Prognostic model for improving the quality of vision after phacoemulsification

Background. Phacoemulsification is one of the most common and effective methods of cataract surgery, which allows patients to restore their vision and improve quality of life. Given the significant variability in outcomes, there is a growing need to develop prognostic models that help predict the quality of vision after surgery. Such models consider clinical, demographic, and biometric data of patients, which allows doctors to personalize approach to treatment and optimize outcomes. However, even with such effective technologies, the result may not always meet the expectations of patients, as it depends on many factors. The purpose of the study was to create a prognostic model to determine the treatment algorithm for a patient with age-related cataract. Materials and methods. A study was conducted of 160 patients (160 eyes), 80 women and 80 men aged 45–75 years who were diagnosed with age-related cataract. They were divided into two groups: experimental one (80 patients) — initial visual acuity 0.8–1.0; control group (80 patients) — initial visual acuity < 0.8. The assessment was performed in two stages: 1 day before surgery and 1 month after surgery. MedStat and EZR programs were used for statistical processing. Results. To calculate the ROC curve of the multivariate model for visual quality improvement in patients after phacoemulsification, the following factors were taken into account: visual acuity, spherical aberrations, contrast sensitivity using the Pelly-Robson chart and the Clinic CSF Contrast Sensitivity test. According to the calculations, the AUC was found to be 0.89 (95% CI 0.79–0.99), which is statistically significantly (p < 0.05) different from 0.5 and is evidence of the model adequacy. Calculation of the model by the formula showed a better result in the experimental group (87.8 %) than in controls (76.2 %). Thus, with surgical intervention, the prognosis for improving the quality of vision is more favorable in the experimental group. Therefore, it is necessary to carry out surgeries at early stages, when the patient’s visual acuity is 0.8–1.0, in order to achieve the maximum quality of vision, unlike the control group. Conclusions. The proposed prognostic model for predicting the improvement of visual quality after phacoemulsification showed high accuracy and practical value. It was found that phacoemulsification with intraocular lens implantation in patients from the experimental group is more effective in achieving higher quality of vision than in controls. Thus, to achieve the best visual quality, surgical intervention should be performed at early stages.

Effectiveness of vitrectomy with inverted internal limiting membrane flap in the treatment of macular hole retinal detachment in high myopia

PurposeThis study evaluates the effectiveness of the inverted internal limiting membrane (ILM) flap technique during vitrectomy for treating macular hole-induced retinal detachment (MHRD) in high myopia patients, a challenging complication for vitreoretinal surgeons due to its treatment complexity.MethodsWe conducted a prospective study analyzing 92 eyes diagnosed with MHRD, all undergoing vitrectomy using the inverted ILM flap technique between February 2022 and September 2024. Successful surgery was defined as achieving retinal reattachment, macular hole closure, and improvement in visual acuity by the 12-month postoperative follow-up. Microstructural recovery was assessed using spectral domain optical coherence tomography. Logistic regression analysis was performed to identify prognostic factors of surgical outcome.ResultsOf the 92 eyes, 94.6% achieved retinal reattachment, and 92.4% experienced macular hole closure. Visual acuity significantly improved in 91.3% of cases, with a mean improvement of 0.95 logarithm of the minimum angle of resolution. Recovery rates for the external limiting membrane, the ellipsoid zone, and the cone outer segment tip were 76.1%, 66.3%, and 66.3%, respectively. Larger retinal detachments and macular holes were important predictors of lower surgical success (p < 0.001; p = 0.015, respectively). There was a significant correlation between vision improvement and the recovery of structural integrity and foveal microstructures.ConclusionsThe ILM coverage technique represents a breakthrough in the treatment of MHRD, promoting both anatomical and functional recovery. This approach enhances the management of this complex condition, ultimately improving the quality of life for affected individuals.

Addition by Subtraction: Reversing Epikeratophakia and Stromal Scarring in a Patient With Myopia Magna.

To describe a three-phase surgical approach for managing progressive visual decline in a patient with myopia magna and a history of epikeratophakia. A 55-year-old woman with previous epikeratophakia surgery in both eyes experienced progressive visual deterioration. The three-phase approach included: (1) removal of the epikeratophakia lenticule, (2) cataract extraction with intraocular lens implantation, and (3) transepithelial topography-guided photorefractive keratectomy (trans-PRK). Preoperative and postoperative refraction, corneal topography, and visual acuity were assessed. After trans-PRK, the right eye exhibited regularization of the corneal surface, with a final best spectacle-corrected acuity of 0.15 logMAR. A similar two-phase approach without lenticule removal was applied to the left eye, resulting in improved visual outcomes. A three-phase surgical approach combining lenticule removal, cataract surgery, and topography-guided PRK offers a potential pathway for visual improvement in patients with phakic postepikeratophakia.

Intravenous Tranexamic Acid Does Not Improve Visual Field Clarity During Hip Arthroscopy: A Double-Blind, Randomized, Placebo-Controlled Trial.

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS). This randomized, double-blind, parallel-design trial was conducted over a seven-month period between October 2023 and May 2024 at a single tertiary musculoskeletal hospital. Inclusion criteria included consecutive patients that were diagnosed with FAIS through clinical history, physical exam and advanced imaging and indicated for hip arthroscopy after having failed conservative management. This trial prospectively randomized 78 participants (n = 39 assigned to receive 1000mg of TXA in 100mL/0.9% normal saline (NS) bolus, n=39 assigned to receive 100mL/0.9% NS bolus only). Treatment intervention was administered within 15 minutes of incision. The primary outcome was arthroscopic VFC assessed on a Likert-style numeric rating scale (NRS) and graded by the surgeon at 15 minute intervals (1=poor visibility with active bleeding to the degree that vision was too poor to perform the operation; 2=fair visibility(mild bleeding that interfered with vision, but the surgery could still be performed), and 3=good visibility(clear vision without obvious blood). The percentage of good VFC (percent of surgeon-ratings equal to 3 on the NRS scale throughout the procedure) was quantified for each patient. No minimum follow-up was required as the primary endpoint was intraoperative. Baseline characteristics of the TXA cohort [mean age 37.3, 61.5% male, 76.9% Caucasian] were not significantly different than that of the placebo group ([mean age 33.6, 59% male, 86.8% Caucasian]; p>0.05 all). TXA was not associated with improved VFC compared with placebo at any intraoperative timepoint nor when considering composite overall VFC scores (TXA: 2.51±0.41 vs. placebo: 2.64±0.42;p=0.16). Furthermore, no significant difference was observed in the percentage of good VFC ratings between treatment groups (TXA:56.4%, placebo:66.4%, p=0.17). Multivariate regression analysis adjusted for demographic and intraoperative covariates did not demonstrate an association between TXA and VFC rating (ß =-0.14, p=0.14) nor percentage of good VFC ratings (ß =-11.6, p=0.15). No medical or intraoperative complications related to the treatment intervention were observed in either treatment arm. Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic VFC when compared with placebo. Therefore, these results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in arthroscopic visualization. 1, prospective randomized controlled trial.

Impact of Glaucoma Surgery on Corneal Graft Survival After Keratoplasty: A Systematic Review and Meta-Analysis.

Glaucoma surgery impacts corneal graft survival differently by procedure type, with GDDs being most effective at reducing intraocular pressure. However, graft survival rates are comparable across trabeculectomy, CPC, and GDDs. Trabeculectomy improves visual acuity best but often requires additional interventions. To investigate the impact of different glaucoma procedures on corneal graft survival and corneal endothelium health. We searched PubMed, Cochrane Library, Scopus, and Web of Science, to identify eligible studies. Studies were included based on predetermined criteria. The primary outcome was corneal graft survival, and secondary outcomes included intraocular pressure (IOP) control, visual acuity, antiglaucoma medications, additional glaucoma surgery, and postoperative complications. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed using the (I2) test. Our results included 27 studies involving 905 patients were analyzed. However, there were no randomized comparative studies. The overall proportion of corneal graft survival at last follow-up was 66.4%, with the three subgroups of trabeculectomy, cyclophotocoagulation (CPC), and Glaucoma drainage devices (GDD) showing similar survival rates of 66.6%, 64.8%, and 65.6%, respectively. Short term graft survival (6 months) was similar across groups, however 2-year survival favoured trabeculectomy. GDDs were the most effective in reducing IOP with an average reduction of 21.4mmHg compared to 18.9mmHg for trabeculectomy and 14.8mmHg for CPC. CPC yielded the best improvement in visual acuity reported as BCVA. GDD required the fewest postoperative antiglaucoma medications. Trabeculectomy had the highest proportion of patients needing additional surgery for glaucoma. The most common complications were hypotony, uveitis and tube obstruction. There were no significant differences in corneal graft survival rates among various glaucoma surgical techniques, but these findings must be interpreted with caution due to the limitations of primary research. GDDs effectively reduced IOP and minimized the need for antiglaucoma medications. Trabeculectomy may be associated with the greatest visual acuity improvement but may carry a higher likelihood of requiring further glaucoma surgery.

Clinical features, diagnosis, management, and prognosis of circumscribed choroidal hemangioma.

Because of its benign nature and rarity, circumscribed choroidal hemangioma (CCH) often receives limited attention, leading to a high rate of misdiagnosis and a lack of standardized treatment protocols. We provide a thorough clarification of the demographics, clinical features, diagnosis, management, and prognosis of CCH. We conducted a systematic search of the PubMed, EMBASE, and Ovid databases up to December, 2023, to identify relevant studies. The study included 106 studies encompassing 3,854 patients with CCH. The demographic profile revealed a male preponderance (62%, 95% CI 61%-64%) and a peak incidence in the working-age population (30-50 years, 48%, 95% CI 39%-57%), with the right eye being involved in 50% of cases (95% CI 48%-53%). Clinically, the most common symptom was decreased vision (90%, 95% CI 78%-99%), followed by blurred vision, visual field defect, and metamorphopsia. Fundus examination frequently revealed an orange-colored tumor (80%, 95% CI 58%-96%) located subfoveally (48%, 95% CI 42%-53%), often accompanied by subretinal fluid (SRF) (84%, 95% CI 78%-89%) and sometimes exudative retinal detachment (69%, 95% CI 51%-85%). The proportion of correctly diagnosed CCH upon first presentation was 13% (95% CI 3%-26%), with CCH commonly misdiagnosed as unspecified choroidal tumors, choroidal metastasis, and central serous chorioretinopathy. Photodynamic therapy (PDT) was the most widely researched treatment, taking up 18% (95% CI 8%-31%), followed by observation, transpupillary thermotherapy (TTT), and laser photocoagulation. When no treatment was applied, 33% of patients experienced visual acuity improvement, which increased to 76% (95% CI 58%-90%) with radiotherapy and 58% (95% CI 50%-67%) with PDT. In terms of tumor shrinkage, radiotherapy was most effective (100%), with PDT close behind (95% CI 96%-100%), and TTT at 63% (95% CI 45%-80%). PDT led to SRF resolution in 89% (95% CI 77%-97%) of patients and cystoid macular edema (CME) resolution in 73% (95% CI 38%-97%), while radiotherapy achieved the highest efficacy with 100% SRF resolution (95% CI: 99%-100%) and 100% CME resolution (95% CI: 83%-100%). Complication rates were highest with radiotherapy (14%, 95% CI 5%-25%) and PDT (9%, 95% CI 4%-16%). First-line treatment failure rates were highest for TTT (71%, 95% CI 44%-92%) and laser (70%, 95% CI 28%-99%), with radiotherapy showing the lowest rate (0%, 95% CI 0%-2%). Recurrence rates were highest for laser (68%, 95% CI 17%-100%) and TTT (62%, 95% CI 26%-93%), whereas radiotherapy had the lowest recurrence rate (0%, 95% CI 0%-1%). CCH predominantly affects the working-age male population, often leading to vision impairment and SRF. The diagnosis of CCH remains challenging, with low accuracy and frequent misdiagnoses. While PDT is the most widely researched treatment, radiotherapy offers superior outcomes in visual acuity, tumor shrinkage, and resolution of SRF and CME, though it carries higher complication rates. This study highlights the need for improved diagnostic accuracy and a balanced approach to treatment.

Topography-guided, patterned, customized corneal crosslinking for non-invasive astigmatism correction.

To propose and evaluate a novel, non-invasive approach for enduring corneal astigmatism correction based on topography-guided, patterned, customized riboflavin-ultraviolet A corneal collagen crosslinking (CXL). Astigmatism was modelled on both eyes of rabbits. A randomly selected eye of each rabbit was treated by the proposed CXL procedure with another eye as control. The proposed procedure was performed by a self-built intelligent platform through delivering ultraviolet A lattice in a refined and patterned manner, based on pre-operative corneal topography. The long-term effectiveness, stability, and safety were investigated for 180 days, with topographic measurements, anterior segment optical coherence tomography (AS-OCT), and in vivo corneal confocal microscopy (IVCM). Spatially selective demarcation lines in AS-OCT images and trabecular patterned hyperdense structure with abundant needle-like processes in IVCM images were detected in the CXL eyes, revealing spatially selective crosslinking. Reductions of astigmatic magnitude (in the steep axis: 0.46 ± 0.28 vs. 2.15 ± 0.58 dioptres, P < 0.001) and high order aberration (0.38 ± 0.18 vs. 0.59 ± 0.19, P = 0.009) with increase of visual strehl ratio (0.21 ± 0.06 vs. 0.13 ± 0.03, P < 0.001) were found in the CXL eyes after CXL and maintained for 180 days, compared to inconspicuous changes in the control eyes. No obvious opacity and inflammation were observed in the CXL eyes, and transient loss of endothelial cells in the treated area was recovered in the subsequent visit. The proposed novel, non-invasive approach safely fulfilled corneal astigmatism correction with visual quality improvement as well as a decrease in high-order aberration.

Treatment of vision-threatening branch retinal artery occlusion following coronary angioplasty with surgical displacement of embolus.

To report a successful case of vision restoration and macular reperfusion following branch retinal artery occlusion (BRAO) using pars plana vitrectomy with undermining the artery off the retinal bed. This case report involves a 75-year-old patient who was diagnosed immediately with BRAO following cardiac catheterization procedure. An embolus at the superior retinal artery bifurcation was noted. Initial treatments were ineffective, leading to a pars plana vitrectomy and mechanical elevation of the artery, performed six hours post-occlusion. The surgical intervention successfully dislodged the embolus, resulting in significant visual improvement. Post-operative day 1, 4, and 14 assessments showed visual acuity improvement to counting fingers at 2 meters, 20/40, and 20/20, respectively. Fundoscopic examination and OCT angiography confirmed improved macular perfusion and normalization of the flow signal in the affected artery. This case highlights the efficacy of pars plana vitrectomy and mechanical elevation of the artery for BRAO where the embolus can be visualized. Prompt identification and referral for surgical intervention in BRAO cases with poor prognosis are crucial for favorable visual outcomes. Further research is needed to assess the efficacy of this surgical technique and other interventions for managing BRAO.

Ayurvedic management of age-related macular degeneration – A Case Report

Age-related macular degeneration (ARMD) is a progressive degenerative retinal disease in which there is a gradual progressive decrease in central vision. ARMD is the most common cause of blindness in developed countries mainly affecting the elderly, with a high prevalence among the age group more than 60 years. There are two forms of macular degeneration, dry/nonexudative and wet/exudative, and these differ in fundal findings and treatment options. Dry macular degeneration is due to accumulation of drusen between the retinal pigment epithelium and Bruch’s membrane and eventually progresses to geographic atrophy. The exudative or wet form represents the most severe form with rapid progression despite therapeutic progress. It is characterized by the development of choroidal neovascularization, crossing the retinal pigment epithelium and developing below the macular area. A diagnosed case of Dry ARMD with complaints of diminished vision in both eyes approached Salakyatantra department of Government Ayurveda Medical College, Tripunithura, and after in-patient treatment significant improvement in vision obtained. Ayurveda treatment seems to have contributed substantially to improved vision and it has an important role in the prevention and further progression of the disease. So, it is necessary to report this case for identification of treatment strategies for the prevention of progression of ARMD.

Midterm Outcomes of the Endoscopic Endonasal Approach for Treating Tuberculum Sellae Meningiomas: The Impact of Malleable Forceps and Predictors of Surgical Success

Abstract Objective To evaluate the midterm surgical outcomes and factors associated with the extent of resection (EOR), postoperative visual improvement, and risk factors for postoperative cerebrospinal fluid (CSF) leaks in cases of the endoscopic endonasal approach (EEA) for tuberculum sellae meningiomas (TSMs), including cases utilizing the malleable forceps. Design Retrospective clinical study. Setting Single-center tertiary referral hospital. Participants Twenty-two patients who underwent the EEA for TSMs between November 2013 and April 2024. Main Outcome Measures Patient characteristics, intraoperative findings, and postoperative outcomes were evaluated. Predictors of the EOR, postoperative visual improvement, and postoperative CSF leaks were investigated. Results The median age was 58 years, with 77.2% being women. The median follow-up was 70.5 months, and the mean tumor size was 23.5 mm. Gross total resection (GTR) was achieved in 18 patients (81.8%), with no recurrence. Adhesion to the optic nerve was significantly associated with the EOR (p = 0.001). The malleable forceps were used in 14 out of 22 cases, and the GTR rate increased to 92.8% (13 out of 14 cases) with this instrument._Postoperative visual improvement was achieved in 16 of 19 patients (84.2%) and was significantly associated with tumor size (p = 0.02) and the duration of preoperative visual disturbances (p = 0.002). Two patients (9.0%) experienced postoperative CSF leaks, significantly associated with sex (p = 0.04) and Simpson grade (p = 0.032). Conclusion The EEA yielded favorable outcomes and significant postoperative visual improvement for TSMs, supporting early intervention for symptomatic TSMs and radical treatment for GTR. The malleable forceps can enhance the management of complex procedures.

Optimizing outcomes in phacoemulsification: Addressing intraoperative and postoperative complications in a case series from Iraq

Background Phacoemulsification is still considered the most performed surgery in the field of cataract extraction, boasting one of the highest successes of all surgical procedures. However, complications of posterior capsular rupture (PCR) and increased intra-ocular pressure (IOP) bear the potential for great risk, especially in patients with comorbidities such as diabetes or advanced age. Methods A retrospective analysis of 31 cases regarding patients undergoing phacoemulsification in a private ophthalmology clinic in Baghdad was done by noting intraoperative and postoperative complications. A systematic review is also carried out so that findings could be contextualized; studies have been sourced from both PubMed and Scopus databases. Our review covered studies that researched complications such as PCR, increased IOP, and corneal edema, chronicling developments in surgical techniques and patient management. Results The case series resulted in a postoperative best-corrected visual acuity of 6/6 in 35.5% of the patients in the right eye and 29% in the left eye. This series was associated with PCR and raised IOP; however, appropriate management ensured good improvement in vision for the majority of cases. The systematic review supports these findings, pointing out that contemporary surgical procedures and personalized attention can reduce complications substantially, even among high-risk patients. Conclusion Case series and systematic review bring forth the importance of meticulous surgical techniques combined with early recognition of risk factors and personalized postoperative management in attempting to minimize complications. These findings point to the implication of an ideal strategy in handling complications from phacoemulsification, but also have shown that continuing improvement in the surgical and postoperative protocols could further improve patient outcomes, especially those very highly at-risk.

Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study

Background Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the “Discover” (understanding of current gaps) and “Define” (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the “Develop” phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final “Deliver” phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results A new digital tool, Healthy Kai (Food) Checker—a searchable database of packaged food and drink products that classifies items according to the Policy’s nutritional criteria—was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool’s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool’s utility.

The VaMa (Vatavuk and Marić) Artificial Intraocular Lens Capsule: A Novel Device and Method for Reversible Secondary Intraocular Lens Implantation in Patients with Aphakia Without Efficient Capsular Support.

We describe a novel experimental device, the VaMa (Vatavuk and Marić) artificial intraocular lens (IOL) capsule, and a method that enables all IOL types to be implanted in the bag. We present the application of the device and the procedure in patients with aphakia and native capsule damage and without efficient capsular support. The VaMa device and the method facilitate IOL exchange due to refractive errors and, in the case of their invention, the implementation of superior IOLs in the future. The postoperative results after the implantation of the VaMa capsule along with IOLs in three patients are promising, with significant visual improvement and without adverse events 7 to 10 months postoperatively.

A combination regimen of Intravitreal clindamycin with dexamethasone, systemic co-trimoxazole and steroids for macular Toxoplasma retinochoroiditis in immunocompetent cases.

To study the role of intravitreal clindamycin with dexamethasone as an adjuvant to systemic co-trimoxazole and steroids in macular Toxoplasma retinochoroiditis. Retrospective study of Toxoplasma retinochoroiditis cases from January 2014 to December 2021 treated with a combination of oral and intravitreal therapy in immunocompetent patients. 39 eyes of 39 patients were included in this study after meeting the inclusion criteria with the mean age of presentation being 25.25 years (± 9.30; range 4-52 years). Male preponderance with 61.53 % of males (n = 24) and 38.47% of females (n = 15) was observed. Active retinitis was unilateral in all eyes (20 right eyes; 19 left eyes). Five lines of improvement in vision acuity on ETDRS chart were noted at final visit. The location of retinitis was either foveal (n=24) or extrafoveal (n=15). The mean size of retinitis was 1.24 ± 0.70-disc diameter. The mean number of injections given was 1.79 with a mean interval of 1.39 weeks. Intravitreal clindamycin with dexamethasone when used as an adjunct to systemic therapy showed resolution of retinitis in all cases with visual improvement.

Supramolecular Engineering of Nanoceria for Management and Amelioration of Age-Related Macular Degeneration via the Two-Level Blocking of Oxidative Stress and Inflammation.

Age-related macular degeneration (AMD), characterized by choroidal neovascularization (CNV), is the global leading cause of irreversible blindness. Current first-line therapeutics, vascular endothelial growth factor (VEGF) antagonists, often yield incomplete and suboptimal vision improvement, necessitating the exploration of novel and efficacious therapeutic approaches. Herein, a supramolecular engineering strategy to construct moringin (MOR) loaded α-cyclodextrin (α-CD) coated nanoceria (M@CCNP) is constructed, where the hydroxy and newly formed carbonyl groups of α-CD interact with the nanoceria surface via O─Ce conjunction and the isothiocyanate group of MOR inserts deeply into the α-CD cavity via host-guest interaction. By exploiting the recycling reactive oxygen species (ROS) scavenging capability of nanoceria and the anti-inflammation properties of MOR, the two-level strike during AMD pathogenesis can be precisely blocked by M@CCNP. Remarkably, excellent therapeutic efficacy to CNV is observed in vivo, achieving over 80% reduction in neovascularization and over 60% reduction in leakage area. In summary, the supramolecular engineered nanoceria provides an efficient approach for amelioration of AMD by blocking the two-level strike, and presents significant potential as an exceptional drug delivery platform, particularly for ROS-related diseases.

Outcomes of Endoscopic versus Microscopic Ossicular Chain Reconstruction-A Systematic Review and Meta-analysis.

The efficacy of the transcanal endoscopic approach in tympanoplasty, cholesteatoma removal, and stapedotomy is detailed. This study reviews evidence on the feasibility of endoscopic ossiculoplasty as a suitable alternative to traditional microscopic ossiculoplasty. PubMed, Embase, and Cochrane Library were searched from inception to 19 June 2024 for articles comparing endoscopic and microscopic ossicular chain reconstruction. This systematic review was conducted in accordance with PRISMA guidelines. The primary outcomes assessed include air bone gap closure, pre-operative and post-operative air bone gap, pure tone audiometry, and word recognition scores. The secondary outcomes include operation time, surgical success, and surgical complications. These outcomes between microscopic and endoscopic techniques were pooled and compared as mean differences using a random-effects model. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) scale were adopted to assess for study bias in observational studies and randomized controlled trials, respectively. This study included five studies comprising 504 patients. While endoscopic ossiculoplasty had shorter operating durations (95% CI -42.97 to -1.57), it conferred comparable air bone gap closure (95% CI -0.34 to 3.76), post-operative pure tone audiogram (95% CI 10.97-18.77), and surgical success. Additional qualitative strengths identified in endoscopic ear surgery include improvements in visualization, decreased need for supplemental incisions, excellent ergonomics, and reduced post-operative pain. Overall, endoscopic ossiculoplasty may confer comparable audiological outcomes to microscopic ossiculoplasty and may serve as a reasonable alternative surgical approach. Laryngoscope, 2025.

Optic Nerve Sheath Meningiomas: A Retrospective Cohort Study Comparing Outcomes in Treated Versus Observed Patients.

The rarity of optic nerve sheath meningiomas (ONSMs) complicates the guidelines surrounding optimal treatment strategies and prognostic factors. There are limited data on the visual outcomes of those treated with radiotherapy versus those observed without treatment. This study aimed to characterize the clinical and radiographic presentations of patients diagnosed with ONSMs and to identify factors predicting improvement in visual function after treatment. This is a retrospective case series of 26 patients who presented to 2 tertiary neuro-ophthalmology practices for 10 years with the presumptive diagnosis of ONSM. Demographic, clinical, investigative, radiologic, treatment, and outcome data were collected. Visual improvement was defined as improvement in visual acuity (VA) by ≥2 Snellen lines or visual field (VF) mean deviation (MD) improvement by ≥2 dB. Statistical analyses were performed to compare patients who experienced improvement in visual function with those who did not poststereotactic radiotherapy to identify pretreatment predictors of visual recovery. Seventeen patients underwent radiotherapy (16 received 54 Gy in 30 fractions and 1 received 50 Gy in 25 fractions) and 4 elected observation. Five were lost to follow-up. Visual function improvement was seen in 10 patients who underwent radiotherapy. Pretreatment VA (logMAR 0.492 vs 1.42, P = 0.025), tumor size (8.50 vs 18.3 mm, P = 0.028), and a decrease in tumor size postradiotherapy (P = 0.009 for VA and 0.035 for VF MD improvement) were significantly associated with objective visual improvement. Pretreatment VA and tumor size may predict improvement in visual function in patients with ONSMs treated with radiotherapy. Future larger scale studies that include these data may be able to draw more definite conclusions.

Choroidal Remodeling After Subthreshold Micropulse Laser in Chronic Central Serous Chorioretinopathy: Short-Term Outcomes.

Objectives: To evaluate the effects of subthreshold micropulse laser treatment (SMLT) on choroidal architecture in chronic central serous chorioretinopathy (CSC) and their correlations with functional outcomes. Methods: This retrospective study included 48 eyes with chronic CSC that were treated with 577 nm SMLT. The choroidal thickness (CT); Sattler's layer and choriocapillaris complex thickness (SLCCT); Haller's layer thickness (HLT); subretinal fluid (SRF); and best-corrected visual acuity (BCVA) were assessed at baseline and at 2 months post treatment. Results: At 2 months, the SLCCT increased from 185.92 ± 80.89 μm to 214.17 ± 83.36 μm (p = 0.023), and the total CT increased from 444.46 ± 80.43 μm to 484.33 ± 93.19 μm (p = 0.002). The SRF height decreased from 140.38 ± 95.89 μm to 57.58 ± 63.54 μm (p < 0.001), with complete resolution in 79.2% of cases. The BCVA improved from 0.41 ± 0.48 to 0.22 ± 0.30 logMAR (p < 0.001). Changes in the SLCCT correlated negatively with BCVA changes (r = -0.48, p = 0.025) and positively with total CT changes (r = 0.687, p < 0.001). Conclusions: SMLT induces significant choroidal remodeling in chronic CSC, particularly affecting the Sattler-Bruch layer complex. The increase in the SLCCT correlates with visual improvement, challenging the conventional understanding of choroidal thinning in CSC treatment.

Postoperative evaluation of visual and cognitive functions following cataract surgery in patients with age-related cataracts: a prospective longitudinal study.

Cataracts are associated with a decline in both cognitive and visual functions. This study examines postoperative changes in cognitive and visual functions in patients with age-related cataracts, focusing on the differential effects of unilateral and bilateral cataract surgeries on these functions. Additionally, the study evaluates changes in cognitive function following cataract surgery in individuals with mild cognitive impairment (MCI). A cohort of patients (n = 35, 59 eyes) aged 60 years and older (69.9 ± 7.0 years) with age-related cataracts who underwent unilateral or bilateral cataract surgery between May and June 2024 was selected. Cognitive and visual functions were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Visual function was assessed using a binocular visual function testing system based on virtual reality (VR) technology, which evaluated low spatial frequency suppression, simultaneous vision, stereopsis, and perceptual eye position under 3D viewing conditions without glasses. Based on preoperative MoCA scores, patients were classified into cognitively normal and mild cognitive impairment (MCI) groups. Patients with age-related cataracts demonstrated significant improvements in both cognitive and visual functions at 1 week, 1 month, and 3 months postoperatively, compared to preoperative assessments (p < 0.05). Specifically, both the bilateral surgery group and the MCI group exhibited substantial improvements in cognitive function at these time points (p < 0.05). Additionally, the bilateral surgery group outperformed the unilateral surgery group in cognitive function throughout the follow-up period (p < 0.05). In terms of visual function, the bilateral surgery group showed significant improvements in low spatial frequency suppression, simultaneous vision, and stereopsis at 1 week, 1 month, and 3 months postoperatively, compared to preoperative measurements (p < 0.05). Both cognitive and visual functions significantly improved after cataract surgery. Bilateral cataract surgery is more effective in increasing the cognitive functions than unilateral surgery. Additionally, cataract surgery plays a critical role in facilitating cognitive recovery in patients with mild cognitive impairment (MCI).

Real-World Treatment Outcomes of an Artificial Tear Containing Arabinogalactan, Hyaluronic Acid and Trehalose Among Subjects with Dry Eye.

To assess the efficacy, adherence, and tolerability of a new artificial tear based on arabinogalactan, hyaluronic acid, and trehalose in a population with dry eye disease (DED). A retrospective, real-world, post-marketing study identified 96 adult patients (aged 18-80 years) with signs and symptoms of dry eye. These patients received fixed combination therapy with eye drops containing arabinogalactan, hyaluronic acid, and trehalose at various dosing schedules. The data for this study were collected from April 2022 to June 2023. Patients underwent evaluation at baseline (T0) and after a follow-up period of two-three months (T1) using a patient-reported questionnaire. In 96 adult patients (71 women and 25 men) with dry eye due to various conditions, the results indicated a 98% positive response to therapy. This response included improvements in vision (13%), comfort (39%), redness (13%), itching (16%), photophobia (4%), and tearing (14%). Additionally, 61% of the patients experienced 1-2hours of comfort following instillation. This real-life post-marketing study demonstrated clinical improvement of signs and symptoms in patients with dry eye disease using a new artificial tear medical device based on arabinogalactan, hyaluronic acid, and trehalose.