Visual Improvement In Patients Research Articles

Efficacy of visual rehabilitation of patients with pellucid marginal degeneration fitted with SPOT® scleral contact lenses

To assess visual improvement in patients with pellucid marginal degeneration (PMD) after fitting with SPOT® scleral contact lenses (Scleral Protection & Ocular Treatment, Laboratoires d'Appareillage Oculaire, Amphion-Les-Bains, France). We report a case series of 5 patients with PMD and unsatisfactory refractive correction managed at Clermont-Ferrand university hospital from January to December 2018 fitted with customized SPOT scleral lenses. We assessed the best-corrected visual acuity (BCVA) before and after fitting with SPOT, keratometric data and tolerability of the scleral lenses. Nine eyes of 5 patients aged 51.8±8.47 years were fitted. The BCVA was significantly improved from 0.51 logMAR (±0.39) to 0.04 logMAR (±0.07) (P<0.001). Sixty-six percent of the patients recovered optimal BCVA. No serious adverse event was reported. The presence of whitish deposits and an inordinate amount of manipulation required were the main disadvantages of the lenses. Nevertheless, all the patients considered them to be comfortable. Fitting PMD patients who have failed conventional optical devices with SPOT scleral lenses significantly improves BCVA, without serious adverse events, allowing surgery to be deferred even when it appears to be unavoidable.

Clinical outcomes after intracorneal ring segment implantation for keratoconus management in corneas with apical haze

AbstractPurposeIntracorneal ring segment implantation represents a safe and effective treatment option for visual improvement in patients with keratoconus. The presence of corneal scarring is considered to be an exclusion criterion for the use of intracorneal ring segments. The aim of this retrospective cohort study was to evaluate the clinical outcomes after intracorneal ring segment implantation for keratoconus in patients with corneal apical haze.MethodsSix eyes from 6 patients with keratoconus and corneal apical haze, who underwent femtosecond laser‐assisted Keraring implantation for keratoconus, were included in this study. All patients have had corneal crosslinking in the past. Uncorrected visual acuity (UCVA), corrected visual acuity (CDVA), Kmax, Kmean and thinnest corneal pachymetry have been evaluated preoperatively and 6 months after the Keraring implantation. Wilcoxon test was applied for statistical analysis with calculation of median value (lowest value – highest value). P values less than 0.05 were considered statistically significant.ResultsSix eyes of 6 patients (4 males and 2 females) were included in the study. Median age (years) was 33 (28 ‐ 38). UCVA (logMAR) and CDVA (logMAR) improved significantly from 1.05 and 0.75 preoperatively to 0.9 and 0.4 at 6 months postoperatively, respectively (p=0.03). Kmax (diopters) and Kmean (diopters) decreased from 54.5 and 47.85 preoperatively to 53.45 and 46.42 postoperatively, respectively (p=0.3). Changes in thinnest corneal pachymetry were not statistically significant (p=1.0). No complications occurred peri‐ or postoperatively.ConclusionOur study showed significant keratometric amelioration and visual improvement after intracorneal ring segment implantation for in patients with keratoconus and mild corneal apical haze at 6 months postoperatively. No complications occurred. These results suggest that the presence of mild corneal apical haze should not necessarily exclude the use of intracorneal ring segments in patients with keratoconus.

Intracorneal Ring Segment Implantation in the Management of Keratoconus: An Evidence-Based Approach.

Intracorneal ring segment (ICRS) implantation represents a modern, minimally invasive, surgical option for visual improvement in patients with keratoconus. ICRS modify the corneal geometry in a manner that enhances its refractive properties and thereby, they improve visual acuity. It is well-documented that implantation of ICRS decreases the keratometric readings, spherical equivalent and cylinder, reduces high-order aberrations and improves uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCDVA) in patients with keratoconus. Success rate after ICRS implantation is high, depending on appropriate patient selection and adherence to suitable implantation nomograms, and most important, the overall complication rate is very low. This review is summarizing current indications/contra-indications for ICRS implantation, implantation techniques, clinical outcomes and potential complications, shedding light on myths and realities related to this innovative surgical option.

Intravenous Prostaglandin E1 Infusion for Acute Central Retinal Artery Occlusion.

To evaluate the efficacy of systemic prostaglandin E1 (PGE1) infusion within the first 24 hours of acute central retinal artery occlusion (CRAO). Best corrected visual acuity (BCVA) was analyzed in a case series of six eyes from six patients (mean age: 69.33 years) with acute CRAO who were treated with twice-daily intravenous infusion of 40 μg PGE1. Therapy continued until the patient no longer experienced visual acuity improvements for 24 hours. Average time to presentation was 8.33 hours (range: 2 to 12 hours). The logMAR BCVA at presentation was 2.73. BCVA at the final visit 1 month after initial presentation was 1.48 (P = .025). All patients experienced vision improvement. No systemic adverse events were experienced. Intravenous PGE1 infusion resulted in significant visual improvement in patients presenting with acute CRAO and is well tolerated with few adverse effects. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S5-S8.].

Dose-response analysis of ranibizumab as-needed regimens for visual improvement in patients with diabetic macular edema using a modelling approach

BackgroundRanibizumab and aflibercept are anti-vascular endothelial growth factor therapies for diabetic macular edema (DME) but have only been directly compared in one study: the Protocol T study, a 24-month randomized controlled trial which compared the safety and efficacy of three anti-VEGF agents (ranibizumab 0.3 mg, aflibercept 2.0 mg and bevacizumab 1.25 mg). The ranibizumab dose used in Protocol T is not licensed for use outside of the US, where a higher ranibizumab dose of 0.5 mg is approved. Therefore, the relevance of the head-to-head Protocol T study findings to healthcare providers in Europe is limited. The purpose of this research was to predict the visual outcomes that may have been achieved in Protocol T with ranibizumab 0.5 mg. MethodsA simplified dose-response model was constructed to describe the relationship between average monthly dose and one-year best corrected visual acuity (BCVA) change from baseline. A linear mixed effects model was evaluated and Bayesian Monte-Carlo Markov chains method was used to estimate the model parameters. ResultsIf ranibizumab 0.5 mg PRN had been studied in Protocol T, it would have resulted in a BCVA gain of 14–15 early treatment diabetic retinopathy study (ETDRS) letters; 3–4 letters more than the actual BCVA gain reported with ranibizumab 0.3 mg PRN. In Protocol T patients with poor baseline BCVA (<69 letters), a similar additional letter gain would have been achieved. ConclusionThe relevance of the Protocol T study findings are limited due to the use of ranibizumab 0.3 mg PRN which, based on the modelling approach reported herein, resulted in sub-optimal visual gains.

Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema.

This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME). Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment. After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6LogMAR and 478.2 ± 107.8µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4LogMAR (p = 0.005) and 313.8 ± 62.7µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5LogMAR and 298.4 ± 71.5µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively). Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.

Visual and keratometric outcomes of keratoconus patients after sequential corneal crosslinking and topography-guided surface ablation: Early United States experience

To evaluate a sequential treatment algorithm for visual and keratometric improvement in keratoconus patients after corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK). Ophthalmic Consultants of Long Island, Garden City, New York, USA. Retrospective case series. This study reviewed patients with keratoconus who had CXL followed by custom topography-guided PRK between April 2016 and December 2016. The following data were collected at baseline, the time of CXL, and 3months and 6months after PRK: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, keratometric astigmatism, spherical equivalent, maximum and mean keratometry readings, and corneal thickness at the cone apex. Demographic data, age at time of CXL and PRK, and time elapsed between CXL and PRK were analyzed for significance and a correlation with visual and astigmatic outcomes. The study comprised 56 patients (62 eyes), 34 who had both topographic and refractive treatment and 28 patients who had treatment of topographic irregularities only. The mean age was 38.08years±13.07 (SD) at CXL and 40.33±13.44years at topography-guided PRK. Six months after PRK, there was a significant improvement in UDVA and CDVA in the refractive group (20/60 and 20/30, respectively) versus the nonrefractive group (20/100 and 20/40, respectively). Ninety-three percent of eyes that had refractive treatment had 20/40 or better CDVA. There were no significant adverse events in any case. The data support the use of refractive treatment in addition to topographic treatment for visual improvement in patients with keratoconus having CXL and PRK.

The Effect of Initial Visual Acuity on Visual Prognosis in Low Vision Aid and Rehabilitation Cases

Low Vision Aid (LVA) devices which are used to enable patients to use their remaining sight in the most efficient way in low vision aid and rehabilitation and to reintroduce them to society as independent individuals, provide vision improvement in patients whose sight cannot be improved through standard procedures.

Ranibizumab combined with photodynamic therapy for the treatment of advanced-stage exudative age-related macular degeneration: Study protocol for a self-controlled trial and preliminary results

Background and objectives: The lack of visual field in the visual center of older adults with age-related macular degeneration (AMD) has a serious impact on daily activities. AMD is subdivided into atrophic and exudative AMD according to pathology. Patients with advanced stage exudative AMD develop aged-related degeneration in the macular area. Ranibizumab combined with photodynamic therapy is mainly used for the treatment of early exudative AMD; however, treatment outcomes in advanced stage exudative AMD are not well documented. Therefore, we attempt to analyze vision recovery, retinal thickness, and leakage of choroidal neovascular lesions in patients with advanced stage exudative AMD after treatment with ranibizumab plus photodynamic therapy. We also further explore the therapeutic efficacy of the combined therapy. Design: A prospective self-controlled trial. Methods: The trial will be undertaken in the Department of Ophthalmology, Affiliated Hospital of Qinghai University, China. The study population will comprise 113 patients with advanced exudative AMD who are eligible for inclusion. Photodynamic therapy combined with intravitreal injection of ranibizumab will be given as the interventional therapy. Outcome measures and preliminary results: The primary outcome measure of the trial is visual improvement in patients 12 months after treatment. Secondary outcome measures include logarithmic visual acuity chart scores, retinal thickness, and leakage of choroidal neovascular lesions assessed monthly at 1-12 months after treatment. Adverse events are also recorded during follow-up. Pre-test results showed that at 12 months after treatment, visual acuity in 43 affected eyes was increased by ≥ 2 lines, and the average retinal thickness decreased by 111.21 μm compared with before treatment. Leakage of choroidal neovascular lesions in most affected eyes stopped or the lesions were contracted. Discussion: Findings from the trial are expected to provide reliable data on the efficacy of ranibizumab combined with photodynamic therapy in the treatment of advanced exudative AMD. This will provide a basis for the rational use of this combined therapy in the treatment of advanced exudative AMD. Ethics and dissemination: The study was designed in December 2017, and approved by the Ethics Committee of the Affiliated Hospital of Qinghai University (approval No. QHY001Y) in January 2018. The trial was registered with the Chinese Clinical Trial Registry in March 28, 2018. Participant recruitment was initialized in March 2018, and data analysis will be completed in December 2020. The results of this study will be disseminated by publications in peer-reviewed journals. Trial registration: This trial was registered in the Chinese Clinical Trial Registry with registration No. ChiCTR1800015410 (protocol version 1.0).

Clinical Outcomes after Keraring Implantation for Keratoconus Management in Patients Older Than 40 Years: A Retrospective, Interventional, Cohort Study

BackgroundIntracorneal ring segment implantation is an effective and safe method of visual improvement in patients with keratoconus. The aim of our study was to evaluate the long-term clinical outcomes after Keraring implantation for keratoconus in patients older than 40 years.MethodsEleven eyes from 11 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. The uncorrected visual acuity (UCVA), corrected visual acuity, keratometric readings, central corneal thickness and thinnest corneal pachymetry were evaluated preoperatively and 6 months after the Keraring implantation.ResultsUCVA, BCVA and keratometric readings improved at 6 months postoperatively.ConclusionOur data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients older than 40 years at 6 months postoperatively.

Effect of cataract surgery in patients with neovascular age-related macular degeneration: further evidence from disciform scars.

To evaluate the effect of cataract surgery on disease activation and visual outcomes in neovascular age-related macular degeneration (AMD). In this retrospective case-control study, study arm consisted of neovascular AMD patients, who underwent phacoemulsification surgery. Patients did not have any disease activation at least 6months before the inclusion, and all had at least 12-month follow-up thereafter. Control group consisted of phakic patients, who did not undergo eye surgery during the study period. Primary outcomes were the presence of the disease activation and the change in best-corrected visual acuity (BCVA). A total of 114 neovascular AMD patients [55 (48%) in exudative group and 59 (52%) in disciform group] were included. Preoperative logMAR BCVA was significantly improved after cataract surgery [0.8 (0.6-1.0) vs. 0.4 (0.4-0.7), P<0.001 in exudative AMD; 1.85 (1.1-1.9) vs. 1.09 (0.8-1.9), P=0.001 in disciform scar], but this improvement was not maintained during the study period in patients with both exudative AMD and disciform scar [0.6 (0.3-1.1), P=0.313 in exudative AMD; 1.30 (1-1.9), P=0.03 in disciform scar]. The incidence of disease activation was not statistically significant between surgery and control groups in patients with exudative AMD [5 (25%) patients in surgery group and 8 (22%) patients in the control group, P=0.886, Cox proportional hazards regression analysis]. In disciform scar, disease activation was observed in 4 (17%) patients in the surgery group; however, no patient in the control group had disease activation (P=0.009, HRs could not be estimated, 95% CI 0.001-43.49, Cox proportional hazards regression analysis). Cataract surgery has benefit on early postoperative visual improvement in patients with neovascular AMD. The incidence of disease activation was not affected after surgery in exudative AMD.

Tissue plasminogen activator-assisted vitrectomy for submacular hemorrhage due to age-related macular degeneration.

Purpose:The purpose of this study was to evaluate the treatment efficacy of vitrectomy combined with subretinal recombinant tissue plasminogen activator (r-tPA) and factors affecting visual improvement in patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (nAMD).Materials and Methods:Medical records of 17 consecutive patients diagnosed with SMH secondary to nAMD were retrospectively reviewed. The initial surgical procedure involved a 23-gauge transconjunctival vitrectomy, subretinal r-tPA application through a self-sealing inferior retinotomy, and sulfur hexafluoride gas for tamponade in all patients. The duration, size, and thickness of the hemorrhage and the pre- and post-operative visual acuity (VA) using a Snellen chart were recorded. VA was converted to logMAR for statistical analysis.Results:The average duration and size of the SMH were 12.8 ± 18.2 days and 8.6 ± 5.3 disc areas, respectively. The mean follow-up time was 16.9 ± 4.7 months. A statistically significant visual improvement was found when comparing initial VA with postoperative best-corrected VA (BCVA) and final BCVA (Wilcoxon rank test, P ≤ 0.01). There was no significant correlation between the size of the hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). There was no statistically significant correlation between the initial VA and postoperative BCVA and final BCVA (Spearman's rho test). There was no significant correlation between the duration of hemorrhage and postoperative BCVA and final BCVA (Spearman's rho test). The preoperative thickness of hemorrhage (747.5 ± 30 μm) was not correlated with postoperative BCVA or final BCVA (Pearson's test).Conclusions:Vitrectomy combined with subretinal r-tPA injection and gas tamponade is an effective surgical intervention to preserve VA in selected patients with apparent SMH.

Perceptual learning leads to long lasting visual improvement in patients with central vision loss.

Macular Degeneration (MD), a visual disease that produces central vision loss, is one of the main causes of visual disability in western countries. Patients with MD are forced to use a peripheral retinal locus (PRL) as a substitute of the fovea. However, the poor sensitivity of this region renders basic everyday tasks very hard for MD patients. We investigated whether perceptual learning (PL) with lateral masking in the PRL of MD patients, improved their residual visual functions. Observers were trained with two distinct contrast detection tasks: (i) a Yes/No task with no feedback (MD: N = 3; controls: N = 3), and (ii) a temporal two-alternative forced choice task with feedback on incorrect trials (i.e., temporal-2AFC; MD: N = 4; controls: N = 3). Observers had to detect a Gabor patch (target) flanked above and below by two high contrast patches (i.e., lateral masking). Stimulus presentation was monocular with durations varying between 133 and 250 ms. Participants underwent 24- 27 training sessions in total. Both PL procedures produced significant improvements in the trained task and learning transferred to visual acuity. Besides, the amount of transfer was greater for the temporal-2AFC task that induced a significant improvement of the contrast sensitivity for untrained spatial frequencies. Most importantly, follow-up tests on MD patients trained with the temporal-2AFC task showed that PL effects were retained between four and six months, suggesting long-term neural plasticity changes in the visual cortex. The results show for the first time that PL with a lateral masking configuration has strong, non-invasive and long lasting rehabilitative potential to improve residual vision in the PRL of patients with central vision loss.

Vancomycin in infusion during vitrectomy in surgical treatment of acute postoperative and posttraumatic endophthalmitis.

BackgroundEndophthalmitis is potentially devastating intraocular inflammation following eye trauma or surgery. We describe the visual outcomes and causative pathogens in acute bacterial postoperative and posttraumatic endophthalmitis treated with immediate pars plana vitrectomy (PPV) with Vancomycin dissolved in the infusion fluid.MethodsClinical records of consecutive 30 patients with postoperative endophthalmitis and 15 patients with posttraumatic endophthalmitis were evaluated. Vancomycin was administered constantly in the infusion fluid at the time of complete PPV. Cultures were prepared from anterior chamber paracentesis. The mean follow-up period was 13 months.ResultsThe visual acuities were improved in 38 cases (84 %) and remained stable in seven cases (16 %). Median post-PPV visual acuity was 1.0 logMAR in a group with postoperative endophthalmitis and 1.3 logMAR in a group with posttraumatic endophthalmitis (p < 0.05). Twenty cases (44 %) were culture-positive (Staphylococcus, Streptococcus, Enterococcus and Bacillus spp).ConclusionsEarly PPV with Vanomycin in infusion leads to vision improvement in patients with both posttraumatic and postoperative endophthalmitis. In our series of 45 cases culture was positive only in half of the cases.

Plasma exchange response in 34 patients with severe optic neuritis

Optic neuritis could lead to severe visual impairment despite corticosteroids. Our aim was to evaluate the rate of visual improvement in patients treated with plasma exchange (PLEX) for severe steroid unresponsive optic neuritis and to identify predictive factors of outcome. Thirty-four patients (41 optic nerves damaged) with remaining visual acuity of 0.1 or less despite steroid pulse therapy were treated with PLEX from September 2010 to May 2015. Demographic and clinical neuro-ophthalmic findings, and spectral domain-optical coherence tomography data before PLEX treatment were analyzed. The mean symptom duration before PLEX was 34.6 days (median 28days; range 6-92 days). After PLEX, the median final visual acuity was 0.8 and in 56% of cases, final acuity was 0.5 or better. Past history of ipsilateral optic neuritis was associated significantly with poor outcome defined as final acuity less than 0.5. No significant difference in the visual outcome after PLEX was found between multiple sclerosis and neuromyelitis optica. In conclusion, this observational study showed that PLEX as second-line therapy led to a functionally important visual recovery in more than half patients with severe optic neuritis.

Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

Purpose: To report the anatomic and functional outcome in patients with severe visual loss after acute massive submacular hemorrhage secondary to retinal arterial macroaneurysm submitted to vitrectomy and subretinal recombinant tissue plasminogen activator injection. Methods: Retrospective, observational, case-series of 4 eyes of 4 patients submitted to pars plana posterior vitrectomy (ppV) combined with internal limiting membrane (ILM) removal and subretinal recombinant tissue plasminogen activator (rtPA-12.5 mg/0.1 ml) injection with dilute (20%) sulfur hexafluoride (SF6) gas in the vitreous cavity of eyes with recent onset (≤7 days) massive macular hemorrhage due to retinal arterial macroaneurysm (RAMA). Optical coherence tomography (OCT) was obtained both at presentation and during follow up. Results: Patients ranged in age from 63 to 78 years and all had systemic arterial hypertension. Visual acuity at presentation ranged from hand motions to count fingers at 50 cm. All eyes showed extensive retinal hemorrhage involving more than two-thirds of macular area. The time between the onset of symptoms and the surgery ranged from 3 to 7 days. After a mean postoperative follow-up of 15.5 ± 5.19 months (range, 10-22 months), all eyes showed visual acuity improvement and final visual acuity ranged from 20/30 to 20/80. All had complete displacement of the subretinal hemorrhage from the fovea after the surgery. OCT images showed neurosensory retina thinning and disruption of the reflective line that represents the junction between inner and outer photoreceptors segments (IS/OS line) beneath the macular area and absence of the external limiting membrane (ELM). Conclusions: ppV associated with subretinal rtPA injection with intravitreal gas seems to be a safe and effective technique to promote visual improvement in patients with multilevel macular hemorrhage secondary to RAMA. Despite functional improvement, OCT images demonstrate that submacular hemorrhage leads to permanent structural damage to the neurosensory retina, especially to the outer photoreceptors layers.

Perceptual learning improves vision in patients with macular degeneration

Perceptual learning improves vision in patients with macular degeneration

Comparison of visual outcomes between intravitreal ranibizumab injection combined with or without photodynamic therapy for polypoidal choroidal vasculopathy

Objective To compare the visual outcomes of treatment with intravitreal ranibizumab alone or in combination with photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).Methods In this retrospective and comparative study,36 eyes of 36 patients with PCV were enrolled.Eighteen eyes received 0.5 mg (0.05 ml) ranibizumab injection only (simple injection group) and the other 18 eyes underwent combination therapy of ranibizumab injection and PDT (combination treatment group).Intravitreal ranibizumab was given at the third day after PDT.Re-treatment was considered in clinic examination.The minimum re-treatment interval was 3 months for combination therapy and 1 month for ranibizumab.Best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) at baseline and each follow-up visit at 1,3,6,12 month was measured as a primary outcome,and complications also observed in every follow-up.Results No complications occurred in these 36 patients during the treatment or follow-up,such as retinal detachment,sustained high intraocular pressure,retinal holes,intraocular inflammation,and systemic adverse reactions.The average times of ranibizumab injections of simple injection group and combined treatment group were (3.00 ± 0.84) and (1.89±0.68) times respective,and the difference was significant (t=4.370,P=0.000).The logMAR BCVA of the first and third month after initial treatment between two groups were significant different (t=0.668,0.940; P＞0.05).However,there was no significant difference between them at the 6th and 12th month (t=2.188,2.547; P＜0.05).In the last follow-up,the logMAR BCVA were improved in simple injection group and combination treatment group compared to the pre-treatment values (t =3.351,9.408; P=0.012,0.000).In simple injection group,visual acuity was improved in 3 eyes (16.7％),stable in 13 eyes (72.2％) and decreased in 2 eyes (11.1％).In combination treatment group,visual acuity was improved in 4 eyes (22.2％),stable in 13 eyes (72.2％) and decreased in 1 eyes (5.6％).Conclusions Intravitreal ranibizumab injection and combined with PDT are both effective to improve vision in patients with PCV.Visual acuity was the same between the two treatments in 3 months after initial treatment; however 6 to 12 months after first treatment,patients received PDT combined with intravitreal ranibizumab injection had better visual acuity than those received the intravitreal ranibizumab injection only. Key words: Choroid diseases/therapy; Photochemotherapy; Antibodies, monoclonal; Comparative effectiveness research

Traumatic Optic Neuropathy and Second Optic Nerve Injuries

Current controversy about the primary treatment of traumatic optic neuropathy (TON) has anchored on final vision following injury, but, to our knowledge, no study has examined the effect of different treatments on regaining and protecting optic nerve reserve or on the outcome of second optic nerve injuries. To assess vision improvement in patients treated by various methods who have a second incidence of TON. Retrospective medical record review of 12 patients with a second TON seen in an 18-year period (mean follow-up, 11.3 months) at a single tertiary care oculoplastic practice. Observation, high-dose corticosteroids, optic nerve decompression, or high-dose corticosteroids plus optic nerve decompression. Change in vision on the Snellen eye chart. RESULTS All second TON events involved the same-side optic nerve as initially injured, and with observation alone, corticosteroids, or corticosteroids and partial optic canal decompression, all patients had vision improvement after their initial injury (P = .004). However, following the second optic nerve injury, most patients' vision fell to the pretreatment level of the first injury, and subsequent management of the second injury with corticosteroids and/or optic canal decompression provided little or no vision return (P = .05). In contrast, optic canal decompressions performed for 91 primary TON injuries resulted in 82.4% having some degree of vision improvement. Patients with TON may have a second optic nerve insult, and vision recovery from the second event may be limited regardless of primary treatment choice.

Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C3 F8) for retinal detachment.

Purpose:To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD).Materials and Methods:A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C3F8) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded.Results:Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better.Conclusions:PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.