Visual Acuity Improvement Rate Research Articles

Visual outcomes after chemotherapy for optic pathway glioma in children with and without neurofibromatosis type 1: results of the International Society of Paediatric Oncology (SIOP) Low-Grade Glioma 2004 trial UK cohort

AimsTo report visual acuity (VA) outcomes following chemotherapy for optic pathway glioma (OPG) in children with or without neurofibromatosis type-1 (NF1) and to analyse associated risk factors.MethodsA prospective, multicentre, cohort...

Intravitreal ranibizumab injection combined with photodynamic therapy for polypoidal choroidal vasculopathy.

The aim of the present study was to evaluate the efficacy of combination treatment with intravitreal ranibizumab (IVR) injection and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). A total of 64 patients with PCV were included in the present study, which were divided into the IVR monotherapy group (Group A) and combination treatment groups (Groups B-D) with different treatment intervals. All subjects were followed-up at 1, 3, 6 and 12 months following treatment, and subjected to the detection of best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Compared with the monotherapy group, more significant BCVA improvement was observed for the combination treatment groups, with the most evident effect exhibited in Group C. At the end of the follow-up period, visual acuity improvement rates were markedly elevated in the combination treatment groups, as compared with the monotherapy group. According to optical coherence tomography, the CFT for the combination treatment groups was thinner than the monotherapy group. Among the combination groups, CFT improvement for Group C was superior to other groups. Fundus angiography demonstrated that, compared with monotherapy, combination treatment may significantly promote the regression and prevent the recurrence of polyps and BVN. The most efficient effectiveness was observed for Group C. In addition, combination treatment may significantly reduce the IVR injection numbers required to treat PCV. Patients receiving combination treatment with IVR injection and PDT have greater vision improvements, reduced macular degeneration and decreased injection numbers. Combination therapy may therefore, represent an effective and safe therapeutic strategy for PCV clinical treatment.

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis

ABSTRACTPurposes: The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)—an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes.Methods: Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990–2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis.Results: For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861–0.954) and for observation group patients, 0.368 (range, 0.236–0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610–0.849) and for observation group patients, 0.505 (range, 0.397–0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610–0.849).Conclusions: Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Endoscopic decompression of the optic canal for traumatic optic neuropathy

PurposeTraumatic optic neuropathy (TON) is a serious complication of head trauma with the incidence rate of 0.5%–5%. The aim of this study was to investigate the therapeutic efficacy of endoscopic decompression of the optic canal for optic nerve injuries. MethodsIn this study, 11 patients treated in our hospital from January 2009 to January 2015 with the visual loss resulting from TON were retrospectively reviewed for preoperative vision, visual evoked potential (VEP) scan, surgical approach, postoperative visual acuity, complications, and follow-up results. ResultsAll these patients received endoscopic decompression of the optic canal. At the 3-month follow-up, the visual acuity improvement rate of the 11 patients was 45.5%. The vision acuity of 2 cases improved from hand movement to 0.08 and 0.3 after operation. Another patient's vision acuity returned to 0.05 compared to light sensation preoperatively. Two cases had finger counting before surgery but they had a vision acuity of 0.4 and light sensation respectively after surgery. However, the other 6 cases' vision did not improve after surgery. ConclusionEndoscopic decompression of the optic canal is an effective way to cure TON. VEP could be used as an important reference for preoperative and prognosis evaluation. Operative time after trauma is only a relative condition that may affect the therapeutic effect of optic canal decompression. Poor results of this procedure may be related to the severity of the optic nerve injury.

A comparative study on visual acuity and stereopsis outcomes between perceptual learning based on cloud services and conventional therapy for amblyopia

Background Amblyopia is a developmental disorder of spatial vision that results in both monocular and binocular deficits.Conventional therapy for amblyopia which focuses on monocular training can improve visual acuity.However, how to improve the binocular function, especially stereopsis is rarely studied. Objective This study was to evaluate the outcome of perceptual learning based on cloud services of improving stereopsis and visual acuity for amblyopia. Methods A randomized-controlled clinical study was performed.One hundred and seven amblyopic patients (178 eyes) with the age of 5—18 years old were recruited in The Second Affiliated Hospital of Anhui Medical University from July 2013 to March 2014.The patients were randomized into the perceptual learning group and the conventional therapy group.A perceptual learning based on cloud services with computer under the best corrected visual acuity was carried out in the perceptual learning group with 30-day duration as a course for 5—6 cycles, and training feedback data was obtained after each cycle for the regulation of following treatment.The dominant eye was covered during the training process.In the conventional therapy group, a training regimen of health eye covering that combined with eyesight training of amblyopic eye was performed.The stereopsis and visual acuity of the patients were estimated after training.Written informed consent was obtained from the parents or custodians of the children before entering the cohort. Results The total effective rate of visual acuity improvement is significantly higher in the perceptual learning group than that in the conventional therapy group after training (Z=6.368, P=0.012). The mean stereopsis value of the amblyopic eyes in the perceptual learning group and the conventional therapy group was (127±53)″ and (174±67)″ after training, which was significantly higher than (273±95)″ and (311±103)″ before training, respectively, and the increasing range of the mean stereopsis was considerably larger in the perceptual learning group than that in the conventional therapy group(t=12.329, 9.557, 15.649; all at P<0.05). In the perceptual learning group, the improving range of mean stereopsis was larger in the severe or moderate amblyopic eyes than that in the mild amblyopic eyes, and the improving range of mean stereopsis in ametropic amblyopia was larger than that in anisometropic amblyopia (all at P<0.05). Conclusions Both perceptual learning based on cloud services and conventional therapy can improve stereopsis and visual acuity in amblyopic eyes.However, perceptual learning based on cloud services can improve the treating compliance of children. Key words: Amblyopia/physiopathology; Vision, binocular/physiology; Visual acuity/physiology; Amblyopia/therapy; Children; Randomized controlled trials; Cloud services; Perceptual learning

The Outcome of Endoscopic Transethmosphenoid Optic Canal Decompression for Indirect Traumatic Optic Neuropathy with No-Light-Perception.

Purpose. To present the safety and effect of endoscopic transethmosphenoid optic canal decompression (ETOCD) for indirect traumatic optic neuropathy (ITON) patients with no-light-perception (NLP). Methods. A retrospective study performed on 96 patients (96 eyes) with NLP after ITON between June 1, 2010, and June 1, 2015, who underwent ETOCD, was reviewed. Visual outcome before and after treatment was taken into comparison. Results. The overall visual acuity improvement rate after surgery was 46.9%. The improvement rates of visual acuity of patients who received treatment within 3 days of injury, 3–7 days after injury, and later than 7 days were 63.6%, 42.9%, and 35.7%, respectively. Statistically significant difference was detected between the effective rates of within-3-day group and later-than-7-day group (χ 2 = 5.772, P = 0.016). The effective rate of atrophy group and nonatrophy group was 25.0% and 51.3%, respectively. The effective rate was significantly higher in nonatrophy group (χ 2 = 4.417, P = 0.036). Conclusion. For patients suffering from ITON with NLP, time to medical treatment within 3 days is an influential factor for visual prognosis. Optic nerve atrophy is an important predictor for visual prognosis. Treatment should still be recommended even for cases of delayed presentation to hospital.

Visual Recovery in Treated Bacterial Keratitis

Bacterial keratitis is a leading cause of visual impairment worldwide. However, the natural history of treated bacterial keratitis has not been well characterized. We performed a secondary analysis of the Steroids for Corneal Ulcers Trial (SCUT; clinicaltrials.gov #NCT00324168) to better characterize the rate of visual acuity improvement after successful antimicrobial treatment.

Indocyanine Green-Assisted Internal Limiting Membrane Peeling in Macular Hole Surgery: A Meta-Analysis

BackgroundThe opinion of application of indocyanine green (ICG) in the macular hole surgery was contradictory. Here we conducted a meta-analysis to evaluate the effect of in internal limiting membrane (ILM) peeling for macular hole surgery.Methods and FindingsWe searched electronic databases for comparative studies published before July 2012 of ILM peeling with and without ICG. Twenty-two studies including 1585 eyes were included. Visual acuity (VA) improvement, including the postoperative rate of ≥20/40 VA gained (OR, 0.65; 95% CI, 0.43 to 0.97; P = 0.033) and increased LogMAR (WMD, −0.09; 95% CI, −0.16 to −0.02; P = 0.011), was less in the ICG group. The risk of visual field defects was greater in the ICG group than in the non-ICG group. There was no significant difference in the rate of anatomical outcomes between ILM peeling procedures performed with and without ICG. RPE changes and other postoperative complications were not significantly different between the ICG and non-ICG groups. An additional analysis showed that the VA improvement of the ICG group was less than the non-ICG group only within the first year of follow up. A subgroup analysis showed that the rate of VA improvement was lower in the ICG group than in other adjuncts group. A higher rate of secondary closure and less VA improvement were observed in a high proportion (>0.1%) of the ICG group. A sensitivity analysis after the randomized-controlled trials were excluded from the meta-analysis demonstrated no differences compared with the overall results.ConclusionsThis meta-analysis demonstrated that there is no evidence of clinical superiority in outcomes for ICG-assisted ILM peeling procedure over the non-ICG one. The toxicity of ICG should be considered when choosing the various staining methods.

Pars plana vitrectomy for myopic traction maculopathy

Objective To observe the therapeutic effect of pars plana vitrectomy (PPV) on myopic traction maculopathy (MTM). Methods The clinical data of 31 eyes of 29 patients with MTM diagnosed by time domain optical coherence tomography (TD-OCT) and slit-lamp ophthalmoscopy were retrospectively analyzed. The cases were divided into 2 groups according to the stage of MTM: 12 eyes of 10 patients at the early stage of MTM were in group 1 ; 19 eyes of patients at the most Advanced stage of MTM were in group 2. All of these eyes had undergone PPV with 10%-15% inert gas filling. The patients were followed post-operatively for 6 to 12 months with the average of 8 months, and the bes corrected visual acuity, reattachment of macular and retina was examined. Results The improvement rate of visual acuity after surgery for 6 months was 100% in group 1, and 63.2% in group 2 had (12/19); the visual acuity in group 1 was apparently better than that in group 2 (Z=-5. 477, P=0.000). The macular hole disappeared without exposure of the pigment epithelium in all eyes of Group 1, but only 3 eyes in Group 2. For Group 2 patients, 3 eyes had reattached retina with macular holes, and 3 eyes had detached retina with macular holes. The recovery of macular configuration in Group 1 was obviously better than that in Group 2 (Z= -4.318, P=0.000). Conclusion The surgical intervention of MTM before the formation of macular hole and retinal detachment may prevent the formation of macular holes. Key words: Myopia; degenerative/complications; Retina diseases/surgery; Vitrectomy

Cost-effectiveness sequential modeling of ranibizumab versus usual care in age-related macular degeneration

To assess effectiveness, cost, and cost-effectiveness of ranibizumab versus the current medical practices of treating age-related macular degeneration in France. A simulation decision framework over 1 year compared ranibizumab versus the usual care using two effectiveness criteria: the "visual acuity improvement rate" (greater than 15 letters on the ETDRS scale) and the "rate of legal blindness avoided". Two decision trees included various sequences of current treatments, with or without ranibizumab. Ranibizumab appeared significantly more effective than the usual care (p < 0.001), providing greater treatment success rate of visual acuity improvement (48.8% versus 33.9%). The cost of the ranibizumab strategy was higher (9,123 euros over 1 year for ranibizumab versus 7,604 euros for the usual care) but the average cost-effectiveness was lower--18,721 euros/success for ranibizumab versus 22,543 euros/success for usual care (p < 0.001). Considering the "legal blindness avoided" success criterion, the ranibizumab strategy appeared significantly more effective (p < 0.001), providing greater treatment success rate for of legal blindness avoided than usual care (99.7% versus 93.1%) although it was more expensive (9,196 euros over 1 year for ranibizumab versus 5,713 euros for the usual care). Ranibizumab significantly improved the rate of visual acuity improvement and reduced the rate of legal blindness. Ranibizumab appeared significantly more cost-effective than the usual treatments in terms of visual acuity improvement.