Improvement In Best-corrected Visual Acuity Research Articles

Comparison of Intraocular Tamponade in Patients with Peripheral Tear-Induced Retinal Detachment and Coexisting Macular Hole without High Myopia.

To introduce the surgical results and examine the effect of intraocular tamponades on surgical outcomes in patients with coexisting macular hole (MH) and rhegmatogenous retinal detachment (RRD) without high myopia. This retrospective, cross-sectional, two-center study was carried out with 29 eyes of 29 patients. The patients were divided into two groups according to the intraocular tamponade used in surgery: silicone oil (Group 1) and C3F8 gas (Group 2). In all patients, the internal limiting membrane was peeled during surgery. Exclusion criteria were determined as RRD with MH due to high myopia (≥ 6 D) without peripheral retinal tears and traumatic MH. In Group 1, the median preoperative best-corrected visual acuity (BCVA) was 3.0 (M ± SD: 2.85 ± 0.27) logMAR, while the median postoperative BCVA was 1.0 (M ± SD: 1.39 ± 0.83) logMAR (p < 0.001). In Group 2, the median preoperative BCVA was 3.0 (M ± SD: 2.37 ± 0.93) logMAR, while the median postoperative BCVA was 0.76 (M ± SD: 1.06 ± 0.86) logMAR (p = 0.008). The retinal attachment success rate was 15/17 (89.3%) in Group 1, and 11/12 (91.7%) in Group 2 (p = 0.64). The MH closure rate was 12/17 (71.6%) in Group 1, and 10/12 (78.1%) in Group 2 (p = 0.52). No difference was determined between the groups in terms of preoperative and postoperative BCVA, preoperative and postoperative intraocular pressure, and BCVA improvement. The study results showed no significant difference between using silicone oil or C3F8 gas as an intraocular tamponade after internal limiting membrane peeling in patients with RRD due to peripheral tear with coexisting MH.

Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation.

The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 (P < 0.001) after SLET and to logMAR 0.6 (P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.

Impact of intravitreal injection therapy on contrast sensitivity in patients with nAMD and DME

PurposeThe study aims to evaluate changes in contrast sensitivity (CS) during therapy with intravitreal vascular endothelial growth factor (VEGF) inhibitors in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME).MethodsProspective, uncontrolled, multicenter study on patients with neovascular AMD or DME who underwent intravitreal injection therapy with Ranibizumab, Aflibercept, or Bevacizumab was conducted. Best corrected visual acuity (BCVA) and CS measured by Mars Letter Contrast Sensitivity Test (MLCS) and Freiburg Visual Acuity and Contrast Test (FrACT) in logCS were evaluated before 3 consecutive VEGF inhibitor injections, which followed the pro renata regimen in treatment-naïve and pretreated eyes with a maximum of 9 injections. Correlation of MLCS and FrACT was calculated by the Spearman’s rank correlation coefficient.ResultsEighty eyes of 74 patients (mean age 72.7; SD ± 9.96) were included. BCVA improved significantly from 0.44 (SD ± 0.21) logMAR to 0.38 (SD ± 0.23) logMAR by 0.06 (SD ± 0.14) logMAR values (p < 0.001). CS measured by MLCS increased significantly from 1.27 (SD ± 0.25) logCS to 1.39 (SD ± 0.22) logCS (p < 0.001). CS measured by FrACT also improved significantly from 1.22 (SD ± 0.32) logCS to 1.30 (SD ± 0.29) logCS (p = 0.035). A positive correlation between MLCS and FrACT was found (r = 0.389; p < 0.001). Despite statistical significance, results for BCVA, MLCS, and FrACT failed clinical significance. Overall best test results were achieved with MLCS.ConclusionsIntravitreal injection therapy with VEGF inhibitors led to an improvement of BCVA and CS measured by MLCS and FrACT. MLCS was superior and more sensitive compared to FrACT and even BCVA to evaluate CS in elderly patients with macular pathology.

LIGHTSITE II Randomized Multicenter Trial: Evaluation of Multiwavelength Photobiomodulation in Non-exudative Age-Related Macular Degeneration.

Photobiomodulation (PBM) represents a potential treatment for non-exudative age-related macular degeneration (AMD). PBM uses wavelengths of light to target components of the mitochondrial respiratory chain to improve cellular bioenergetic outputs. The aim of this study was to further investigate the effects of PBM on clinical, quality of life (QoL) and anatomical outcomes in subjects with intermediate stage non-exudative AMD. The multicenter LIGHTSITE II study was a randomized clinical trial evaluating safety and efficacy of PBM in intermediate non-exudative AMD. The LumiThera Valeda® Light Delivery System delivered multiwavelength PBM (590, 660 and 850nm) or sham treatment 3 × per week over 3-4weeks (9 treatments per series) with repeated treatments at baseline (BL), 4 and 8months. Subjects were enrolled with 20/32 to 20/100 best-corrected visual acuity (BCVA) and no central geographic atrophy (GA) within the central fovea (500μm). LIGHTSITE II enrolled 44 non-exudative AMD subjects (53 eyes). PBM-treated eyes showed statistically significant improvement in BCVA at 9months (n = 32 eyes, p = 0.02) with a 4-letter gain in the PBM-treated group versus a 0.5-letter gain in the sham-treated group (ns, p < 0.1) for patients that received all 27 PBM treatments (n = 29 eyes). Approximately 35.3% of PBM-treated eyes showed ≥ 5-letter improvement at 9months. Macular drusen volume was not increased over time in the PBM-treated group but did show increases in the sham-treated group. While PBM and sham groups both showed GA lesion growth in the trial period, there was 20% less growth in the PBM group over 10months, suggesting potential disease-modifying effects. No safety concerns or signs of phototoxicity were observed. These results confirm previous clinical testing of multiwavelength PBM and support treatment with Valeda as a novel therapy with a unique mechanism of action as a potential treatment for non-exudative AMD. Clinicaltrial.Gov Registration Identifier: NCT03878420.

Evaluating the safety and efficacy of epi-off corneal cross-linking in patients with thin corneas due to keratectasia.

Corneal cross-linking (CXL) is a safe and effective procedure for slowing keratectasia progression in eyes with a corneal thickness of at least 400 µm. Limited research has evaluated the safety and efficacy of epi-off CXL in corneas thinner than 400 µm. To evaluate the safety and efficacy of CXL to slow keratectasia progression in eyes with <400 µm preoperative corneal thickness. Retrospective chart review. This retrospective chart review included 37 eyes who underwent epi-off, iso-osmolar riboflavin corneal CXL with a preoperative thinnest point of the cornea <400 µm and had at least 6-12 months of follow-up. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity (BCVA), thinnest point of the cornea, flat keratometry, steep keratometry, maximum keratometry (Kmax), need for penetrating keratoplasty, and cases of endothelial failure were recorded. Data were collected at baseline and months 3, 6, 9, and 12 post-CXL. Following cross-linking, 18 eyes (47%) had improved BCVA, 13 (35%) had an unchanged BCVA, and 6 eyes (16%) had a worse BCVA (p = 0.05). The mean postoperative BCVA was 20/81 (0.61 LogMAR) compared to 20/121 (0.78 LogMAR) preoperatively (p = 0.06). Kmax decreased an average of 1.1 D at 3-month (p = 0.53) and 3.4 D at the furthest follow-up (p = 0.10). At the farthest follow-up, 22.7% of eyes had >1 D of Kmax steepening. No patients required keratoplasty and there were no cases of endothelial failure in the follow-up period. This research supports the safety and efficacy of epi-off, iso-osmolar CXL in eyes with <400 μm baseline corneal thickness with no patients requiring penetrating or endothelial keratoplasty, a trend toward improvement in BCVA, and Kmax flattening. In the future, prospective studies would be helpful to confirm these findings.

Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study

Introduction: Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. Methods: This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. Results: 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. Conclusion: Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.

Correlation between Anatomical and Functional Outcomes in Patients with Idiopathic Epiretinal Membrane after Vitrectomy.

Idiopathic epiretinal membrane (iERM) is a common disorder of the vitreomacular interface characterized by decreased visual acuity and metamorphopsia. This study aimed to analyze the association between the anatomical change of the retina and functional outcomes in iERM patients so as to derive the prognostic factors of visual acuity (VA) and metamorphopsia. Forty-five patients (one eye per patient; 45 eyes in total) who underwent pars plana vitrectomy and membrane peeling for iERM by a single surgeon were enrolled in this retrospective study. The results on best-corrected visual acuity (BCVA) and metamorphopsia as well as retinal images were obtained before the surgery and 1, 3, 6 months after the surgery. The BCVA and retinal microstructure, including central retinal thickness (CRT), ganglion cell layer (GCL) thickness, inner nuclear layer (INL) and outer nuclear layer + outer plexiform layer (ONL+OPL), and continuity of photoreceptor inner/outer segment (IS/OS) junction before and after iERM surgery were compared using paired samples t-test (continuous variables) or Chi-square test (categorical variables). Multiple regression analysis was carried out to explore the association among BCVA, M-score, and the parameters derived from optical coherence tomography. Compared with preoperative data, a significant improvement in BCVA was observed 1, 3, and 6 months postoperatively (t = 5.37, p < 0.0001; t = 7.29, p < 0.0001; t = 6.44, p < 0.0001 for 1, 3, and 6 months postoperatively, respectively), whereas the M-score only decreased significantly 3 and 6 months after the surgery (t = 2.36, p = 0.02; t = 5.00, p < 0.0001, respectively). In comparison with the baseline, the CRT, INL, and ONL+OPL thickness showed a significant decrease at each postoperative follow-up time, and GCL thickness (t = 3.86, p = 0.0002) and IS/OS disruption ratio (χ2 = 4.86, p = 0.027) were markedly reduced only 6 months postoperatively. Six-month postoperative BCVA was considerably associated with preoperative CRT and ONL+OPL thickness, as well as postoperative CRT, ONL+OPL thickness, and severity of IS/OS disruption. Moreover, the M-score after surgery was markedly correlated with both the preoperative and postoperative INL and CRT thickness. Both VA and M-score in iERM patients were significantly improved after vitrectomy. Pre- and post-operative CRT was significantly associated with both postoperative BCVA and M-score. Besides, pre- and post-operative INL thickness was correlated to postoperative metamorphopsia, and postoperative BCVA was associated with postoperative ONL+OPL thickness and IS/OS integrity.

Efficacy of Single-site versus Two-site Phacotrabeculectomy in Primary Open-angle Glaucoma: A Prospective Cohort Study

Introduction: The prevalence of co-existing cataract and glaucoma is increasing in the adult population. Combined surgeries have become more popular. However, there is a conflict over which technique provides the best Intraocular Pressure (IOP) control with good postoperative outcomes. Aim: To compare the efficacy of single-site versus two-site phacotrabeculectomy with mitomycin-C in patients with Primary Open-angle Glaucoma (POAG) and cataract. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology, S.V. Medical College, Tirupati, Andhra Pradesh, India, over a period of one year from January 2019 to January 2020. A total of 50 cases of POAG coexisting with cataract were analysed in the present study. Twentyfive cases were included in each group (Group-1 and Group-2). Phacoemulsification and trabeculectomy were both performed through a superior scleral tunnel in the single-site approach. The two-site method combines a superior trabeculectomy with a temporal clear corneal phacoemulsification. A concentration of 0.2 mg/mL of MMC was applied in both groups for three minutes. Patients were followed-up for three months after surgery to evaluate Intraocular Pressure (IOP), the need for antiglaucoma medication, and postoperative best-corrected Visual Acuity (VA). Comparative analysis was done using the Student’s t-test, and a p-value &lt;0.05 was considered statistically significant. Results: Throughout the three-month duration, the patients were monitored. In the single-site group, the average preoperative IOP was 21.880±8.4079 mmHg, which significantly decreased to 11.16±9.95 mmHg after three months (p&lt;0.001). In the twosite group, the corresponding figures were 22.640±6.3040 and 10.8±1.19 mmHg, respectively (p&lt;0.001), with no discernible statistical distinction between the two groups (p=0.486). At the final follow-up, the number of antiglaucoma medications was 0.24±0.5 in the single-site group compared to 0.16±0.24 in the two-site group. The mean postoperative Best Corrected Visual Acuity (BCVA) did not exhibit any significant variation between the two groups. Furthermore, there was no disparity in the occurrence rate of complications between the two groups. Conclusion: Both single and two-site phacotrabeculectomy led to a significant reduction in IOP and improvement in BCVA. The final IOP was similar in the two procedures, although the twosite group needed less glaucoma medication. As both surgical procedures are equally effective, the choice of procedure remains at the discretion of the surgeon.

Optical coherence tomography predictors of the outcomes of occlusion therapy in anisometropic amblyopia.

(1) To compare optical coherence tomography (OCT) parameters between amblyopic eyes and fellow eyes in patients presenting with anisometropic amblyopia. (2) To find OCT factors predicting the outcomes of occlusion therapy. This prospective study was conducted in a tertiary eye care center for a period of 20 months. Fifty-four children diagnosed with anisometropic amblyopic were included in the study. After complete ophthalmic and OCT examination, patients were advised to undergo occlusion therapy with large spectacle patch. Patients were reviewed after 6 months to record improvement in visual acuity and analyze their OCT parameters. Statistical tests used were paired "t" test and independent "t" test. The mean age of 54 study patients was 9.24 ± 2.82 years. For comparison of OCT parameters, they were classified as myopic (22 patients), hypermetropic (24 patients), and astigmatic (8 patients) groups. In the anisomyopic amblyopia group, the mean inner macular thickness was significantly increased in fellow eyes (304.09 ± 11.06 μm) compared to amblyopic eyes (297.59 ± 14.16 μm). In the anisohyperopic amblyopia group, the outer macular thickness significantly increased in amblyopic eyes (286.43 ± 18.63 μm) when compared to fellow eyes (272.62 ± 14.90 μm). In the follow-up visit, 28 patients showed improvement and 6 patients did not show improvement in final best-corrected visual acuity, and the OCT parameters in amblyopic eyes of these two groups did not differ significantly. Abnormal experience in early life does not affect the maturation process of retinal layers as evident by OCT parameters, and these parameters cannot predict the outcomes of occlusion therapy.

Evaluation of retinal function and morphology in isoametropic amblyopia.

To observe the photoreceptor anomalies in cases of ametropic amblyopia. A prospective study with 25 isoametropic amblyopic children in the age group of 5-14 years and 25 age-matched controls was done. Examination included refraction, best-corrected visual acuity (BCVA), and color vision. Adaptive optics (AO) and multifocal electroretinogram (mf-ERG) were done to assess the anatomy and function of photoreceptors. The subgroup analysis of the improved and non-improved groups was done. The mean cone density in cases and control in the superior, temporal, and nasal quadrants was respectively as follows (21640 ± 5713, 24040 ± 3386, P = 0.01) (19755 ± 6282, 21832 ± 2911, P = 0.03) (19897 ± 5418, 22171 ± 3660, P = 0.01) (20768 ± 4799, 22819 ± 3241, P = 0.01). The amplitude of N1 wave and P1 wave in cases was significantly low compared to the controls. Cases with subnormal color vision had reduced BCVA (0.55 ± 0.018) in comparison to the children with normal response (0.350 ± 0.014). Cone density was also significantly reduced in children with subnormal color vision. Sixteen out of 25 cases showed BCVA improvement with spectacles. Baseline cone density was found to be significantly higher in the improved group. There was no correlation between BCVA and AO parameters. Patients with ametropic amblyopia show subnormal photoreceptor properties than controls. Low cone density may be associated with defective color vision and poor prognosis in these cases.

AAV2-Mediated Gene Therapy for Choroideremia: 5-Year Results and Alternate Anti-sense Oligonucleotide Therapy

To assess the long-term safety and efficacy of AAV2-REP1 in choroideremia (CHM) patients, and to test a potential antisense oligonucleotide therapy for CHM. Extended, prospective phase 1/2 clinical trial and laboratory investigation. Five patients who received a single subfoveal injection of AAV2-REP1 were studied. The long-term safety was evaluated by ophthalmic examination, spectral domain optical coherence tomography, and fundus autofluorescence (FAF) for up to 5 years. Functional and structural changes were determined by different test modalities. Four antisense oligonucleotides (ASOs) were designed to treat the CHM c.1245-521A>G mutation, which was present in 2 patients within this trial. Subject P3 experienced a localized intraretinal immune response that resulted in a significant loss of preserved retinal pigment epithelium (RPE). P4 experienced an exacerbation of peripheral retinoschisis. P2 had a constant ≥15-letter best-corrected visual acuity (BCVA) gain in the treated eye, whereas P5 had ≥15-letter BCVA improvement once in the untreated eye. The preserved FAF areas declined more rapidly in the treated eyes compared to the untreated eyes (P=.043). A customized 25-mer ASO recovered 83.2% to 95.0% of the normal RNA and 57.5% of the normal protein in fibroblasts from 2 trial patients. Intraretinal inflammation triggered by AAV2-REP1 subretinal injection stabilized after 2 years but resulted in permanent damage to the retinal structure. Long-term progression of the disease was seen in both treated and untreated eyes, casting doubt as to the effectiveness of this approach in late-stage CHM. Alternative approaches such as ASO may have a therapeutic effect in a subgroup of CHM patients.

Antithrombotic treatment for retinal vein occlusion: a systematic review and meta-analysis

BackgroundRetinal vein occlusion (RVO) represents a common thrombotic disorder. ObjectivesIn this meta-analysis, we evaluated the efficacy and safety of anticoagulant and antiplatelet therapy in RVO. MethodsMEDLINE and EMBASE were searched up to December 2021 for observational studies and randomized controlled trials including patients with RVO. Efficacy outcomes were best-corrected visual acuity improvement, recurrent RVO, fluorescein angiography improvement, cardiovascular events, and safety outcomes were major bleeding and intraocular bleeding. ResultsA total of 1422 patients (15 studies) were included. Antiplatelet therapy was administered to 477 patients (13 studies), anticoagulant therapy to 312 patients (12 studies), and 609 (7 studies) patients received no antithrombotic treatment. The treatment duration ranged between 0.5 and 3 months. The median follow-up duration was 12 months. Best-corrected visual acuity improvement was reported in 58% of the patients (95% confidence interval [CI], 45%-69%) overall, 64% (95% CI, 58%-71%) in those on anticoagulant therapy, and 33% (95% CI, 21%-47%) in those on antiplatelet therapy. The rates of recurrent RVO was 11% (95% CI, 7%-17%), 7% (95% CI, 2%-19%), and 15% (95% CI, 8%-28%), respectively. The rate of recurrent RVO in untreated patients was 9% (95% CI, 6%-14%). The rate of major bleeding was 5% (95% CI, 3%-9%) overall, 4% (95% CI, 2%-9%) in those on anticoagulant therapy, and 7% (95% CI, 2%-23%) in those on antiplatelet therapy. ConclusionAnticoagulant therapy was associated with higher visual acuity improvement and fewer recurrent RVO events than antiplatelet therapy, at the cost of an acceptable proportion of bleeding complications.

Displacement of submacular hemorrhage secondary to age-related macular degeneration with subretinal injection of air and tissue plasminogen activator

Submacular hemorrhage (SMH) can lead to devastating visual loss in patients with age-related macular degeneration. We retrospectively evaluated the surgical outcomes of vitrectomy with subretinal injection of tissue plasminogen activator, bevacizumab, and air in 13 cases. Visual prognosis, anatomical results obtained with optical coherence tomography (OCT), and their correlations were investigated. We analyzed OCT parameters including SMH height, pigment epithelial detachment (PED) height and width, and status of ellipsoid zone (EZ) line. Complete displacement of SMH was achieved in 12 eyes. At 3 months post-surgery, best-corrected visual acuity (BCVA) and SMH height exhibited significant improvements (P < 0.01). In eyes with preoperative SMH height < 300 µm and a detectable EZ line, BCVA was significantly improved at as early as 1 month, whereas the remaining eyes exhibited visual improvements only at 3 months. Postoperative BCVA positively correlated with preoperative BCVA (r = 0.86, P < 0.005), and negatively correlated with SMH size (r = 0.69, P < 0.01) and PED height (r = 0.58, P < 0.05) and width (r = 0.67, P < 0.05). Multivariate analyses confirmed preoperative BCVA as the predominant factor associated with postoperative BCVA (β = 1.093, P < 0.05). In conclusion, significant improvements in BCVA and anatomical findings can be achieved with our reported surgical technique. Preoperative OCT findings may influence the duration required for visual improvements.

Clinical utility of cytokine analysis in the diagnosis and efficacy monitoring of vitreoretinal lymphoma.

To investigate the value of cytokine analysis in aqueous humor (AH) for discriminating vitreoretinal lymphoma (VRL) from uveitis and for evaluating the efficacy of intravitreal methotrexate (MTX) injections. This retrospective study was done on 28 VRL patients between 2013 and 2019. AH interleukin (IL)-10, IL-6, IL-8, vascular endothelial growth factor (VEGF), and vascular cell adhesion molecules (VCAM) were measured in 28 VRL patients and 38 uveitis patients. As to the respective examinations for distinguishing VRL from uveitis, the diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. The response to treatment was monitored by observing changes in best-corrected visual acuity (BCVA), ocular manifestation, and AH cytokine levels in 21 patients with VRL who had undergo multiple intravitreal injections of MTX. Compared with uveitis patients, VRL patients had higher IL-10 level (P<0.001) and IL-10/IL-6 ratio (P<0.001), whereas patients with uveitis had significantly higher IL-6 level than those with VRL (P=0.003). An ROC analysis was used to identify the diagnostic threshold values for VRL, and it was found that optimal sensitivity and specificity improved to 94.1% and 100%, respectively, for IL-10/IL-6>1.55 and 88.2% and 81.1%, respectively, for IL-10>76.7 pg/mL. In 21 patients who had undergo repeated injections, improvements in BCVA, clinical remission of VRL and continuous decrease in cytokine levels over time were observed. In those patients, the BCVA correlated with the aqueous levels of IL-10 and IL-6 during the course of disease treatment. The combination of the aqueous cytokine profiles can be instrumental for conventional diagnostic methods and for progression monitoring and treatment response.

Perforating scleral vessels adjacent to myopic choroidal neovascularization achieved a poor outcome after intravitreal anti-VEGF therapy.

This study aimed to summarize the features of perforating scleral vessels (PSVs) in patients with myopic choroidal neovascularization (CNV) (mCNV) using optical coherence tomography angiography (OCTA) and to identify the associations with the response after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. A consecutive series of naïve patients who had mCNV and received intravitreal anti-VEGF therapy with a follow-up duration of 12 months or more were enrolled. The prevalence, location, and branches of PSVs were analyzed. Projection-resolved OCTA (PR-OCTA) was used to analyze the neovascular signals between CNV and PSVs. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured. The proportion of CMT change relative to baseline was used to assess therapeutic response. A total of 44 eyes from 42 patients with mCNV were enrolled. PSVs were identified in 41 out of 44 eyes. Branches were identified in the PSVs of 24 eyes (57.14%), and 20 eyes did not have PSV branches (47.62%). In eight eyes (18.18%), PSVs were adjacent to mCNV, and in 36 eyes (81.82%), PSVs were not adjacent to mCNV. After anti-VEGF therapy for mCNV, BCVA increased (F = 6.119, p < 0.001) and CMT decreased (F = 7.664, p < 0.001). In the eyes where PSVs were adjacent to mCNV, BCVA improvements (F = 7.649, p = 0.009) were poor, and changes in CMT were small. The eyes with PSVs adjacent to mCNV showed poor therapeutic responses after intravitreal anti-VEGF therapy.

Subfoveal choroidal thickness following pars plana vitrectomy in tractional diabetic macular edema.

To evaluate changes in subfoveal choroidal thickness (SCT) in cases of tractional diabetic macular edema (DME) after pars plana vitrectomy (PPV). This prospective study included 31 eyes of 31 patients who underwent PPV for the management of tractional DME. Best-corrected visual acuity (BCVA), SCT, and central macular thickness (CMT) were measured before the operation, as well as one, three, and six months following the surgery in the operated eyes and at baseline, as well as six months in the fellow eyes. The SCT decline in eyes with tractional DME was statistically significant six months postoperatively (P = 0.009). A statistically significant decline was observed in the CMT values one, three, and six months postoperatively in eyes with tractional DME (P = 0.02, P < 0.001, and P < 0.001, respectively). There was a statistically significant improvement in the visual acuity of the affected eyes three (P = 0.047) and six months (P = 0.017) postoperatively. After PPV for the treatment of tractional DME, a statistically significant decrease in the CMT values is detectable from the first month after surgery, followed by the improvement of BCVA from the third month. It is worth mentioning that a decrease was found in the SCT six months postoperatively.

Choroidal neovascularization (CNV) due to non‐age‐related macular degeneration (AMD) causes: Multimodal imaging and treatment outcome in a retrospective case series

AbstractPurpose: To present the management (clinical evaluation, fundus imaging and treatment outcome) of patients with non‐AMD related CNV.Methods: We retrospectively reviewed the medical records of a case series with non‐AMD related CNV patients that were referred to our clinic since January 2021 and treated with intravitreal injections of anti‐VEGF (ranibizumab or aflibercept). The following data were retrieved: demographic data, best‐corrected visual acuity (BCVA) at the initial and final visit, number of injections and side‐effects, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT‐angiography imaging results.Results: We included nine eyes of nine patients (seven females and two males, median age: 59 years, range 19–72): five myopic, three with idiopathic CNV, one with angioid streaks (AS). Median BCVA at presentation was 0.7 (range 0.1–0.8). FFA revealed a classic CNV in all cases (subfoveal: eight cases, extrafoveal: one case). OCT‐angiography confirmed the presence of an active CNV in six out of nine cases. In OCT, there was minimal fluid (five out of nine cases), subretinal fluid (two cases) or both subretinal and intraretinal fluid (two cases). The median number of injections was three (range 1–14) with no reported adverse events. An improvement in BCVA was documented in all cases after treatment. On the final recorded visit, OCT showed minimal/no fluid in all patients while in OCT‐angiography the CNV showed signs of inactivity in the majority cases.Conclusions: Multimodal imaging is useful in the diagnosis, follow‐up and management of cases with non‐AMD related CNV. Most of them demonstrated minimal signs of exudative disease and required less number of anti‐VEGF injections compared to neovascular AMD cases.

The phase 3 REFLECT trial: Efficacy and safety of bilateral gene therapy for Leber hereditary optic neuropathy (LHON)

AbstractPurpose: To evaluate the efficacy and safety of a bilateral injection of lenadogene nolparvovec in patients with Leber Hereditary Optic Neuropathy (LHON) carrying the m.11778G &gt; A mutation.Methods: REFLECT is a randomized, placebo‐controlled, phase 3 study that included 98 patients with vision loss ≤1 year at enrolment. Patients received a single intravitreal injection of lenadogene nolparvovec (9E10 viral genomes per eye) in their first‐affected eye. The second‐affected eye was randomized to a second injection of gene therapy or placebo.Results: A total of 48 patients were treated bilaterally and 50 unilaterally. At 1.5 years, the change from baseline in best‐corrected visual acuity (BCVA) of the second‐affected eyes was not statistically different between the two arms (primary endpoint). Two years after injection, a statistically significant improvement in BCVA was reported from baseline in treated eyes. Mean BCVA showed an absolute difference between the arms of +6 ETDRS letters in favour of bilaterally treated patients. The improvement from nadir was +20 and +17 letters for the first‐ and second‐affected eyes treated bilaterally, and +19 and +14 letters for first‐ and second‐affected eyes treated unilaterally (all p &lt; 0.0001). Clinically meaningful improvement from nadir ≥ +15 letters was found in the majority of bilaterally and unilaterally treated patients (73% and 66%, respectively). The main ocular adverse event related to gene therapy was intraocular inflammation, which was mostly mild and responsive to conventional treatment. Overall, the safety profile was favourable and comparable in patients treated unilaterally and bilaterally.Conclusions: The 2‐year data confirm the results observed 1.5 years after treatment: bilaterally treated patients have better improvement of BCVA than unilaterally treated patients with a favourable safety profile. Placebo eyes showed a contralateral therapeutic effect as previously observed in the RESCUE and REVERSE trials.

NASAL CROWDING AND NASAL TILTING OF THE MACULA AFTER EPIRETINAL MEMBRANE SURGERY.

To identify postoperative macula deviation after epiretinal membrane surgery and to investigate its clinical effects. Patients who underwent idiopathic epiretinal membrane removal and followed up for >12 months were enrolled. Macular deviation was evaluated using disk margin-to-fovea distance, foveal angle, and horizontal and vertical asymmetry of retinal thickness and volume. Horizontal or vertical asymmetry was defined as percentile asymmetry between nasal and temporal quadrants or between superior and inferior quadrants, respectively. The association between macular deviation parameters and best-corrected visual acuity and metamorphopsia were evaluated. Baseline and postoperative parameters were compared depending on epiretinal membrane severity. Data from 102 eyes with a mean follow-up of 21.14 months were analyzed. Disk margin-to-fovea distance and foveal angle decreased with time and horizontal asymmetry of thickness and volume increased with time, showing nasal crowding and nasal tilting. Postoperative changes of disk margin-to-fovea distance and horizontal asymmetry were associated with best-corrected visual acuity. Severe epiretinal membrane eyes showed greater postoperative nasal deviation than mild epiretinal membrane eyes. Postoperative nasal crowding and tilting was quantitatively identified. The causative layers for nasal deviation might be the inner retinal layers, as the foveal angle decreased with time. Postoperative disk margin-to-fovea distance shortening and nasal-deviated horizontal asymmetry were correlated with best-corrected visual acuity improvement.

TREATMENT OF PERSISTENT MACULAR HOLES WITH HEAVY SILICONE OIL.

To determine anatomical success and best-corrected visual acuity after secondary surgery with heavy silicone oil tamponade in patients with persistent full-thickness macular holes. In this retrospective study, 63 eyes with persistent full-thickness macular holes after primary pars plana vitrectomy and internal limiting membrane peeling underwent secondary surgery with heavy silicone oil tamponade. Macular spectral domain optical coherence tomography and best-corrected visual acuity measurements were performed during the follow-up. Fifty of 63 eyes (79.4%) achieved anatomical success. In eyes achieving anatomical success, best-corrected visual acuity before primary vitreoretinal surgery was significantly better (0.77 [∼20/125 Snellen] ± 0.24 [1.3-0.3] logarithm of the minimum angle of resolution) compared with eyes not achieving anatomical success (0.88 [∼20/160 Snellen] ± 0.17 [1.1-0.6] logarithm of the minimum angle of resolution, P = 0.044). Minimum linear diameter of full-thickness macular holes was significantly smaller in eyes achieving anatomical success, both before primary (403.4 ± 128.7 [199.0-707.0] µ m vs. 568.1 ± 209.1 [307.0-953.0] µ m, P = 0.009) and secondary surgery (464.1 ± 215.0 [178.0-1,521.0] µ m vs. 663.3 ± 228.5 [451.0-1,301.0] µ m, P = 0.010). Patients remaining phakic during all three surgeries did not benefit from best-corrected visual acuity improvement, although anatomical success was achieved. Heavy silicone oil tamponade in secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. Best-corrected visual acuity and minimum linear diameter before surgery may be indicators for anatomical success.