Improvement In BCVA Research Articles

Macular Pigment Changes and Visual Recovery Following Successful Full-Thickness Macular Hole Closure Using the Inverted Flap Technique.

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings.

Efficacy and safety of non‐penetrating surgery versus trabeculectomy in open‐angle glaucoma: A systematic review and meta‐analysis

Aims/Purpose: Whilst trabeculectomies (TE) remain the gold‐standard treatment for open‐angle glaucoma (OAG), non‐penetrating surgery (NPS) are rising in popularity as an alternative. This systematic review and meta‐analysis compared the efficacy and safety of trabeculectomy and NPS for OAG.Methods: The following databases of PubMed, Embase, Medline, Scopus and Cochrane Library were searched for original studies comparing TE to NPS (from inception to 23/01/2024). The primary outcome was IOP reduction, with secondary outcomes including success rate, medication score, visual acuity (BCVA) and complications. A random‐effects model on ReviewManager (RevMan) was used for the meta‐analysis. Sub‐group analyses for concomitant mitomycin C and hyaluronate were performed, unlike current existing reviews.Results: Initially 529 papers were identified. Of these, 20 studies containing 1422 participants (1565 eyes) were included. 16 studies reported higher complete success rates with TE. Meta‐analysis showed that although the IOP reduction was larger in TE, this was not statistically significant (mean difference = ‐1.31, 95% CI: ‐3.12 to 0.50). There was no significant difference in reduction of medications but there was significant improvement in BCVA at 12 months with NPS (unweighted average: TE = 0.078, NPS = ‐0.015, p &lt; 0.00652). The relative risk of complications (hypotony, choroidal detachment, cataract, shallow anterior chamber and hyphaema) were higher in TE than all NPS (RR: 2.80, 95% CI: 2.13 to 3.68, p &lt; 0.0001). However, hyphaema was less likely to occur in TE compared to canaloplasty (NPS) (RR: 0.14, 95% CI: 0.03 to 0.62, p &lt; 0.0090).Conclusions: Findings show trabeculectomy and NPS appear to reduce IOP comparably, a finding not found in previous reviews. However, complication risks increased in trabeculectomy, potentially favouring the use of NPS. However, the training requirement for NPS may limit its universal uptake.

Intravitreal anti‐vegf agents and combination treatment in proliferative diabetic retinopathy

Proliferative diabetic retinopathy (PDR) poses as a significant threat to patient's vision if untreated or treated insufficiently. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. The advent of anti‐VEGF therapy provided an additional option for the management of this condition. The aim of the presentation is to present the effects of anti VEGF treatment in PDR with special emphasis on the combination: PRP with anti‐VEGF therapy. Results of treatment with these modalities, especially regression of neovascularization, together with the incidence of potential complications will be discussed. Additional aspects of such therapy, such as BCVA improvement and central retinal thickness reduction will also be presented. Potential indications for such treatment will be outlined as well as possible treatment schedules for such management.

Severe Microbial Keratitis in Virgin and Transplanted Cornea-Probability of Visual Acuity Improvement.

Purpose: To evaluate visual acuity improvement and identify contributing factors in patients with severe keratitis affecting both virgin and transplanted corneas, treated at a hospital. Methods: A retrospective analysis was conducted on 497 patients with unilateral corneal ulcers treated at a tertiary referral center between 2008 and 2023. Data included distance (BCVA) and near best-corrected visual acuity at initial presentation and at discharge, treatments before hospital admission, demographic details, risk factors, clinical signs and symptoms, ancillary test results, and management strategies. Patients were categorized into two groups: Group A (naïve corneal ulcers, 379 patients) and Group B (post-keratoplasty infectious keratitis, 118 patients). Additional analysis focused on patients with presenting visual acuity of at least 1.0 logMAR (≤5/50 Snellen charts = legal blindness) to predict final visual outcomes. Results: The median BCVA at presentation for the entire cohort was 1.9 logMAR, advancing to 1.5 logMAR at discharge (p < 0.001). At least one line improvement in BCVA was observed in 47% of patients (52% of naïve cornea and 33% of transplanted cornea patients). Significantly worse results were observed in Group B were observed for BCVA at presentation, BCVA improvement, and distance and near vision improvement. Among patients with legal blindness at presentation, vision status improved for 52/379 (14%) in Group A and 6/118 (5%) in Group B during hospital admission (p < 0.001), while 67% of the cohort was discharged with VA equal or worse than 5/50. The average hospital stay was 9 days. Near visual acuity got better in 23% of patients (27% in Group A vs. 9% in Group B). A multivariate regression model showed that older age and worse distance BCVA on admission were independent negative predictors of improvement (p < 0.001, p < 0.001, respectively) while midperiphery ulcers were associated with better visual outcomes. Conclusions: Hospital admission leads to BCVA improvement in 47% of the patients with severe corneal ulcer, though the prognosis is significantly worse for those with post-keratoplasty microbial keratitis. At discharge, 67% of patients remained at the legal blindness level. Older age and lower BCVA at first presentation are associated with worse prognosis, while ulcers located in the corneal midperiphery are linked to better visual outcomes.

Evaluation of the efficacy of surgical treatment of cataracts in patients with neovascular age-related macular degeneration

Purpose. To study of the effectiveness of cataract surgery based on the results of a comprehensive evaluation, including the patient's opinion about the state of visual functions, when assessed using a questionnaire before and after surgery.Material and methods. 117 patients (117 eyes) diagnosed with nAMD and cataract (LOCS I — 56 patients, 47.9 %; LOCS II — 57 patients, 48.7 %, LOCS III — 4 patients, 3.4 %), mean age 76.2 ± 5.7 years were included in the study. All patients received angiogenesis inhibitor therapy (aflibercept 2 mg), in Treat&amp;Extend regimen. Cataract surgery was performed if disease activity is controlled. A questionnaire including 10 questions was developed to interview patients, 9 of which were assessed before, 1 and 6 months after cataract surgery, and a 10th question on patient satisfaction with the results of surgery — 1 and 6 months after cataract surgery.Results. There was a significant improvement in functional (increase in BCVA by 0.31 units from the baseline) and anatomical parameters (significant decrease in CRT, height of neuro- and pigment epithelium detachment), as well as in patients' assessment of vision-related quality of life. The most compromised aspect before surgery was the ability to read text in newspapers, books, and magazines. After surgery there was a significant improvement of the indicators characterizing the patient's adaptation to navigation and outside activities. There were minimal changes in central vision loss and metamorphopsia as assessed by patients (on average, by 0.02 b. and 1.21 b.). 99 patients (84.0 %) reported satisfaction with the results of the surgery. The strongest correlations (r = 0.94 and 0.81, p &lt; 0.05) characterized the relationship between patients' evaluation of the effect of surgery and the presence of central vision spotting/loss of central vision, double vision.Conclusion. The results of surgery significantly contribute to the patient's assessment of his/her daily activities requiring clearer vision, primarily in the middle and far distances. Cataract surgery does not worsen the course of nAMD and, on the contrary, cataract surgery and continuation of antiangiogenic therapy contribute to a significant improvement in BCVA and anatomical improvement.

Effect of Therapeutic Pars Plana Vitrectomy on Total Immunosuppression Load in Patients with Non-Infectious Uveitis

ABSTRACT Purpose The anti-inflammatory effect of therapeutic pars plana vitrectomy (PPV) in the management of posterior segment uveitis is incompletely quantified. In this study, we evaluated the change in total immunosuppression load (TIL) following PPV for the eyes of patients with non-infectious uveitis. Methods Retrospective chart review of patients with non-infectious posterior segment uveitis on continuous anti-inflammatory therapy (systemic corticosteroids ± immunomodulatory therapy [IMT]) ±3 months, who received therapeutic PPV for non-resolving inflammation. The TIL scores were calculated by adding the total daily dose of prednisolone graded on a scale of 0–9, and of the IMT graded between 0 and 3, and calculating the mean values for the pre-operative and post-operative visits, respectively. Results Sixty-five eyes of 65 patients were included. Mean follow-up was 19.1 ± 14.6 months pre-operatively and 9.4 ± 7.1 months post-operatively. Mean TIL scores for the post-operative visits (2.6 ± 1.9) were significantly lower than the pre-operative (4.4 ± 1.7) visits (p < 0.001). Mean logMAR BCVA was four lines better 1 month post-operatively (0.5 ± 0.4) than the immediate pre-operative vision (0.9 ± 0.6, p < 0.001). On multivariate regression analyses, the reduction in mean TIL scores post-operatively was more with longer durations of pre-operative treatment (adjusted risk ratio [aRR] = -0.04, p = 0.04), while the improvement in one-month post-operative BCVA was more if pre-operative vitreous haze was ≥2+ (aRR = −0.25, p = 0.02). Post-operative adverse outcomes included new-onset cystoid macular edema (n = 6), raised intraocular pressure (n = 5), and intra-operative retinal break (n = 1). Eleven (16.9%) patients were off all immunosuppression during the final follow-up. Conclusions Therapeutic PPV allowed control of intraocular inflammation on less intensive systemic anti-inflammatory therapy. Post-operative adverse outcomes observed were manageable.

Delayed closure of highly myopic macular holes combined with retinoschisis after inverted internal limiting membrane flap.

To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS). Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RTNAS and RTTEM), peri-HMMH nasal and temporal O-RS height (O-RSNAS and O-RSTEM). The ratios O-RSNAS/ RTNAS and O-RSTEM/RTTEM were defined as %O-RSNAS and %O-RSTEM. Postoperatively, we distinguished classic HMMH closure (n = 14) from a newly described "delayed" closure pattern (n = 5). Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up (p = 0.009 and p = 0.001, respectively). At every follow-up, "classic" vs. "delayed closure" did not influence BCVA (all p > 0.05). Baseline O-RSNAS (p = 0.026), O-RSTEM (p = 0.04), %O-RSNAS (p = 0.04) and %O-RSTEM (0.004), were significantly associated with the "flap closure" pattern, differently from MLD and BD. In the "delayed closure" subgroup we reported a 100% closure rate, but 65.8 ± 64.4days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RSNAS and O-RSTEM progressively reduced until HMMH closure. Inverted flap is useful to close HMMH with O-RS. In case of "delayed closure" pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA. What is known Inverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is new HMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or "delayed closure" pattern. In cases of delayed closure, it took a variable range of 30-179days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing "delayed" and "classic" closure subgroups.

Optic disc pit maculopathy: Covering or filling technique with human amniotic membrane patch to treat the optic disc pit maculopathy?

To describe two patients affected by optic disk pit-maculopathy ODP-M surgically treated with pars-plana vitrectomy (PPV) and the apposition of a human Amniotic Membrane (hAM) patch. Patients underwent a PPV with the apposition of a hAM patch to cover the ODP. In case 1, a 2nd surgery was necessary to push the hAM patch inside the pit, whereas in case 2 the patch was pulled inside the pit following the pressure gradient when infusion was turned on. After surgery the hAM patch filled the ODP and in both cases, during follow-up, there was a progressive reduction of macular OCT changes and a concomitant BCVA improvement. Our experience seems to support the idea that the dynamic fluctuation of pressure between intra-ocular and intra-cranial spaces can direct the movement of fluid through the anomalous communication created by the ODP. In this perspective, our cases seem to support the idea that the primary goal of any surgery should be to create a permanent barrier to fluid migration through the ODP to the intra-ocular space, and that hAM can be successfully used to fill the OPD and to create that permanent barrier to achieve the resolution of ODP-M.

Опыт применения математического моделирования для прогноза результата лечения прогрессирующего кератоконуса

Abstract Original article Experience in the application of mathematical modeling for predicting the outcome of treatment of progressive keratoconus E.G. Solodkova, S.B. Izmailova, B.E. Malyugin, I.N. Zakharov, V.P. Fokin, S.V. Balalin, E.V. Lobanov, V.A. Sivolobov, V.H. Le S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd branch, Volgograd, Russian Federation S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Volgograd State Technical University, Volgograd, Russian Federation Purpose. To analyze the results of applying mathematical modeling to plan, predict and control the effects of ultraviolet corneal crosslinking (UVCXL), to develop a customized method of local crosslinking and to evaluate its safety and effectiveness in comparison with a standard UVCXL method. Material and methods. COMSOL Multiphysics® was used for modeling of corneal biomechanics in eyes with keratoconus under external diagnostic exposure. 3D-images of stress and strain distribution in reliance to finite elements calculation were obtained. Their correlation with topographic and tomographic maps from Pentacam AXL and Corvis ST allowed defining localization and dimensions of the weakened cornea and elaborating a modified technique of UVCXL with its subsequent application in treatment of 30 persons (30 eyes) with 1st and 2nd stage keratoconus (by Amsler – Krumeich classification). Effectiveness and safety of the proposed approach were evaluated in comparison with a reference group (20 patients, 20 eyes with keratoconus of the 1st and 2nd degree, standard UVCXL). Results. This study represents application of corneal «digital double» for selection of optimal treatment option. Improvement of UCVA and BCVA was observed in all the patients within 6–12 months follow-up (p&lt;0,01). Decrease of maximum keratometric value Kmax along with increase of biomechanical resistance with a reliable improvement of corneal rigidity SP-A1 were achieved in all the cases within 6–12 months follow-up (p&lt;0,01). A credible amelioration of UCVA, BCVA and SP-A1 along with a decrease of an average Kmax were registered one month postoperatively after the standard UVCXL. Effectiveness of the proposed UVCXL technique was confirmed by incurrence of demarcation line in site of UVCXL application at the depth of 242,37±46,27 µm. Conclusion. The proposed personalized topographically and tomographically reliable method of UVCXL provides an evident stabilizing action due to improvement of corneal biomechanical resistance. Key words: corneal biomechanical properties, keratoconus, ultraviolet crosslinking of corneal collagen

A New Ray of Hope in the Treatment of Seasonal Hyperacute Panuveitis: Could Intravitreal Triple Combination Therapy of an Antibiotic with Dual Steroids Play a Pivotal Role?

ABSTRACT Introduction Seasonal Hyperacute Panuveitis (SHAPU) is a blinding disease in Nepal with unknown aetiology. Henceforth, we proposed to study the treatment outcome of a triple intravitreal combination therapy of dual steroids triamcinolone (long-acting steroid) and dexamethasone (short-acting steroid) along with antibiotic moxifloxacin for patients with severe stage of SHAPU. Methods A prospective study was conducted among the SHAPU patients presenting in severe stages during the September to December 2023 outbreak. Intravitreal injection of 4-mg preservative-free triamcinolone acetonide (4 mg/0.1 ml) with intravitreal dexamethasone injection (0.4 mg/0.1 ml) and 0.5 mg/0.1 ml of moxifloxacin was given in the operating theatre. Best corrected visual acuity, intraocular pressure measurements, vitreous haze and fundus evaluation, were assessed to determine the treatment outcome on examination on day 7 and day 30 following intravitreal combination therapy. Result A total of 6 patients (2 female and 4 male) were enrolled. At presentation, the mean BCVA was 2.40 ± 0.30 logMAR, mean intraocular pressure was 12.8 mmHg and vitreous haze was 4+ haze in all cases. The evaluation on the 7th day and 30th after injection showed significant improvement in BCVA (p value = 0.039; p value = 0.040, respectively). The change in the IOP at day 7 (p value = 0.85) was insignificant. However, the IOP change was significant at day 30 (p value = 0.5). Similarly, there was a marked reduction in the vitreous haze with better fundus visibility after treatment. Conclusion This study depicted that steroids prevent the dreaded complication of hypotony due to ciliary shutdown by combating severe inflammation, thus adding new hope to the armamentarium of SHAPU management.

Efficacy and safety of treat-and-extend intravitreal brolucizumab in naive and switched patients with macular neovascularization: one-year follow-up study

Backgroundto analyze, at one year, the efficacy and safety of treat-and-extend (T&E) intravitreal (IV) Brolucizumab in patients affected by macular neovascularization (MNV). Both naïve and previously treated (i.e., switched) patients were included, and the data from the two groups were compared.Methodsanatomical (i.e., central subfoveal thickness, CST; presence of fluid), functional (i.e., best corrected visual acuity, BCVA) and treatment-related (i.e., number of IV injections within the study period; number of patients reaching a 12-weeks interval between treatments) data from 41 eyes of 41 subjects (20 naïve and 21 switched) were analyzed. Patients were treated with 3 monthly IV injections followed by a T&E regimen based on a disease activity assessment performed at each scheduled IV treatment.Resultssignificant CST reduction (from 412.1 ± 115.8 to 273.2 ± 61.6; p < 0.05) and BCVA (mean; p) improvement were observed in the naïve group, while in the switched cohort, both parameters were almost stable. In the naïve and switched groups, 55% and 33.5% of patients, respectively, reached a 12-week IV interval at one year, with a mean of 6.55 ± 1 and 7.43 ± 0.68 IV treatments, respectively. One patient with mild anterior uveitis without sequelae was recorded.ConclusionIn patients with MNV, IV Brolucizumab injections following a T&E regimen demonstrated great efficacy and a good safety profile, with greater anatomical and functional results in naïve patients.Trial registrationThis study was approved by the Local Ethics Committee (protocol number 155/2020, general registry number n°11486, InterHospital Ethics Committee, San Luigi Gonzaga Hospital, Orbassano, Italy).

Meta-Analysis Study for the Best Surgical Techniques for Secondary Intraocular Lens Implantation in Complicated Cataract Surgeries

Abstract Background The most appropriate location to implant intraocular lenses (IOL) is the interior of the capsular bag, but in complicated cataract surgeries, procedures of secondary IOL implantation are associated with insufficiency or absence of this anatomic structure. In these cases, the IOL must be fixated at alternative sites of the eye globe, e.g., the iris or the sclera. Aim of the Work to compare different surgical IOL implantation techniques for best correction of aphakia, postoperative visual acuity, acquired astigmatism and least complications as corneal decompensation, glaucoma and angle support. Methodology This systematic review included a discussion of all available studies meeting the eligible criteria including: well conducted descriptive studies, cohort, articles, accepted manuscripts, clinical trials, analytic studies and the literature of reviews, technical notes. An extensive search of electronic literature located 291 studies; 160 duplicates were removed and 131 of which were eliminated after the title and abstract were reviewed. Results This study demonstrated a statistically significant change in the mean BCVA improvement in all techniques when comparing the baseline to one and three month follow up after operation, though with no statistically difference between the three techniques as A final corrected distance visual acuity of 6/12 or better was achieved in (65%) implanted with an AC-IFIOL, in (44.3%) with anRP-IFIOL, and (18.1%) with an SF-PCIOL(two studies only taken in consideration). At six month follow up all groups showed no significant difference in the BCVA compared to the baseline and along the follow up periods. There is no significant loss in mean ECD in all groups. Regarding IOP elevation it was more in scleral fixated and anterior chamber IOL than that in retropupillary IOL, and glaucoma was the second most common complication in secondary IOL implantation after anterior chamber reaction. Conclusion AC-IFIOL, RP-IFIOL, and SF-IFIOL were similar in visual efficacy and mean corneal endothelial cell loss. Although IOP elevation was significantly higher in the SF- PCIOL group than in the other groups, other rates of complications were similar between the groups.

Intraoperative closure of large full thickness macular holes with perfluorocarbon liquid.

To report the role of perfluorocarbon liquid (PFCL) and passive extrusion for management of large full thickness macular holes (FTMHs). A standard pars plana vitrectomy with induction of posterior vitreous detachment was performed for all patients. After internal limiting membrane (ILM) peel, a bubble of perfluorocarbon liquid (PFCL) was injected over the posterior pole and passive extrusion of fluid was performed with a backflush instrument below the PFCL bubble, without touching the FTMH edges, until the FTMH centre was reached. Intraoperative optical coherence tomography (OCT) showed formation of an inner retina roof in all cases and confirmed intraoperative FTMH closure. Complete PFCL removal was performed after fluid-air exchange and gas tamponade was utilised in all cases. Preoperative FTMH mean aperture size was 761um and standard deviation (SD) 100um (range 682-918um). FTMH closure was achieved in all eyes and visualised intraoperatively with OCT. After an average follow-up of 2 months, there was improvement in the mean BCVA and central scotoma. FTMH closure can be achieved intraoperatively with the use of PFCL and passive extrusion. The described surgical technique could be a valid alternative for repair of large FTMHs.

Use of a silicone shield to protect the optical cylinder following osteo- and osteo-odonto-keratoprosthesis (O/OKP) procedures.

To describe the placement of a silicone shield to protect the optical cylinder following osteo-keratoprosthesis or osteo-odonto-keratoprosthesis (O/OKP) procedures in four patients. In this retrospective observational study, we reviewed all patients who underwent O/OKP in our tertiary medical centre. We found four patients in whom a protective cellphone silicone shield (VisionGuard+, Zagg, Utah, USA) was cut with a 3 mm dermal punch and placed on the polymethyl methacrylate (PMMA) optical cylinder of an O/OKP 3-4 months after implantation to either correct or prevent abrasions. The first patient presented with a severely abraded OOKP optic that reduced BCVA from 6/6 to 6/20. The shield smoothed the optical surface and filled minor scratches, leading to BCVA improvement to 6/9. In the subsequent three patients, the optic was relatively clear, and the shield was used as a preventive measure. In two patients, the shield fell off after a few weeks and was replaced. Placing a protective silicone shield on the optical cylinder of an O/OKP can prevent permanent abrasions and, in an already scratched polymethyl methacrylate (PMMA) optic cylinder, improve vision by smoothing the surface. This intervention can be clinically significant, considering that the optical cylinder cannot be removed after implantation.

Outcomes of sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty

BackgroundThe purpose of the study was to assess visual outcomes, complications, intraocular lens (IOL) stability, and corneal status after sutured scleral-fixated intraocular lens implantation combined with penetrating keratoplasty (PKP).MethodsThis retrospective single-arm cohort study included patients who underwent PKP and sutured scleral-fixated intraocular lens implantation between 2013 and 2018 at the Dhahran Eye Specialty Hospital. The eyes were examined postoperatively at 1, 3, 6, 12, and 24 months. Corneal status, complications, and IOL status were also evaluated periodically, and the number of eyes with a BCVA of > 20/200 was recorded.ResultsTwenty-two eyes from 22 patients were included. The median duration of follow-up was 3 (IQR 1.8; 4.4) years. Reasons for surgery were traumatic globe rupture (six eyes, 27.3%), bullous keratopathy (nine eyes, 40.1%), failed previous graft (five eyes, 22.7%), and corneal scarring (two eyes, 9.1%). Twelve (54.5%) eyes showed a BCVA of > 20/200 (non-blind) at 12 months after surgery and only five (22.7%) before surgery. Twelve months after surgery, 13 patients showed an improvement in BCVA in two lines (59.1%), seven remained the same (31.8%), and 2 deteriorated (9.1%). The indication for surgery (p = 0.2) and the stability of the sutured-scleral fixated IOL (p = 0.8) were not associated with an improvement in BCVA at the final follow-up. The corneal graft remained clear in nine eyes (40.9%) at a median duration of 3 years. The overall average survival period for all corneal grafts was 42.9 months.ConclusionsThe combination of sutured scleral-fixated intraocular lens implants and PKP is an effective intervention for preserving visual acuity in patients with complex cases. However, the risk of graft failure and then need for repeat transplantation should be taken into consideration.

Efficacy and Safety of Efdamrofusp Alfa versus Aflibercept in Participants with Neovascular Age-Related Macular Degeneration: A Randomized, Double-Masked, Active-Controlled, Noninferiority, Phase II Trial

PurposeTo evaluate efficacy and safety of efdamrofusp alfa compared with aflibercept in neovascular age-related macular degeneration (nAMD). DesignRandomized, double-masked, multicenter, active-controlled, non-inferiority phase 2 study ParticipantsA total of 231 treatment-naïve and previously treated participants with active choroidal neovascularization secondary to nAMD were enrolled. MethodsEligible participants were randomized (1:1:1) to 2 mg efdamrofusp alfa, 4 mg efdamrofusp alfa or 2 mg aflibercept groups. Participants in all groups received three initial monthly loading doses, followed by treatment every 8 weeks with assessment every 4 weeks up to week 52. Main outcome measuresThe primary endpoint was the mean BCVA change from baseline to week 36. The pre-specified noninferiority margin was set as –5 letters (80% CI). ResultsEach treatment group included 77 participants. The mean BCVA changes from baseline to week 36 for 2 mg efdamrofusp alfa, 4 mg efdamrofusp alfa and aflibercept groups were +10.6, +11.4, +12.0 letters, respectively; Least Squares (LS) mean difference were –1.4 (80% CI: –3.5 to 0.7) between 2 mg efdamrofusp alfa and aflibercept, and –0.6 (80% CI: –2.7 to 1.6) between 4 mg efdamrofusp alfa and aflibercept. Mean central retinal thickness changes were consistent across groups. Adverse event rate was comparable among the groups. ConclusionsEfdamrofusp alfa demonstrated noninferiority to aflibercept in BCVA improvement, accompanied by a similar safety profile.

Exudative Age-Related Macular Degeneration: Association between Treatment Efficacy and Single-Nucleotide Variants in RAD51B, TRIB1, COL8A1, COL10A1, IL-9, IL-10, and VEGFA Genes.

Age-related macular degeneration (AMD) is a progressive neurodegenerative condition leading to vision loss and eventual blindness, with exudative AMD posing a heightened risk due to choroidal neovascularization and localized edema. Therapies targeting the VEGF pathway aim to address this mechanism for treatment effectiveness. Our study aimed to evaluate associations between specific genetic variants (RAD51B rs8017304, rs2588809; TRIB1 rs6987702, rs4351379; COL8A1 rs13095226; COL10A1 rs1064583; IL-9 rs1859430, rs2069870, rs11741137, rs2069885, rs2069884; IL-10 rs1800871, rs1800872, rs1800896; VEGFA rs1570360, rs699947, rs3025033, rs2146323) and the response to anti-VEGF treatment for exudative AMD. We enrolled 119 patients with exudative AMD categorized as responders or non-responders based on their response to anti-VEGF treatment. Statistical analysis revealed that RAD51B rs8017304 heterozygous and homozygous minor allele carriers had increased CMT before treatment compared to wild-type genotype carriers (p = 0.004). Additionally, TRIB1 rs4351379 heterozygous and homozygous minor allele carriers exhibited a greater decrease in central macular thickness (CMT) after 6 months of treatment than wild-type genotype carriers (p = 0.030). IL-9 rs1859430, rs2069870, and rs2069884 heterozygous and homozygous minor allele carriers had worse BCVA before treatment than wild-type genotype carriers (p = 0.018, p = 0.012, p = 0.041, respectively). Conversely, IL-9 rs2069885 heterozygous and homozygous minor allele carriers showed greater improvement in BCVA after 6 months compared to wild-type genotype carriers (p = 0.032). Furthermore, VEGFA rs699947 heterozygous and homozygous minor allele carriers had better BCVA before treatment and after 3 and 6 months of treatment than wild-type genotype carriers (p = 0.003, p = 0.022, respectively), with these carriers also exhibiting higher CMT after 6 months of anti-VEGF treatment (p = 0.032). Not all results remained statistically significant under this stringent correction for multiple comparisons. The comparisons of the serum concentrations of IL-10, VEGF-A, and VEGF-R2/KDR between non-responders and responders did not yield statistically significant differences. Our study identified significant associations between genetic variants, including RAD51B rs8017304, TRIB1 rs4351379, IL-9 rs1859430, rs2069870, rs2069884, rs2069885, and VEGFA rs699947, and parameters related to the efficacy of exudative AMD treatment, such as BCVA and CMT.

Prognostic factors for intravitreal conbercept in the treatment of choroidal neovascularization secondary to pathological myopia.

To identify risk factors influencing visual outcomes in patients with pathological myopia-associated choroidal neovascularization (PM-CNV) following intravitreal injections of conbercept. A total of 86 eyes from 86 patients received intravitreal conbercept in a 1 + PRN regimen. After the initial injection, patients were followed for 12months. They were categorized into two groups based on their 12-month visual acuity change: those who achieved greater than a one-line improvement in BCVA (improved group; n = 65) and those who experienced a one-line or lesser improvement or a decrease in BCVA (non-improved group; n = 21). Over the 12-month period, the mean BCVA in the improved group significantly improved from 0.82 to 0.41 LogMAR. In the non-improved group, BCVA changed from 1.24 to 1.09 LogMAR. Similarly, the mean CRT decreased from 426.21μm at baseline to 251.56μm at 12months in the improved group, and from 452.47 to 382.45μm in the non-improved group. Multivariable logistic regression analyses revealed that older age (OR 1.287; 95% CI 1.019-1.625; P = 0.034), poorer baseline BCVA (OR 6.422; 95% CI 1.625-25.384; P = 0.008), the presence of subfoveal CNV (OR 4.817; 95% CI 1.242-18.681; P = 0.023), and organized interlacing patterns of CNV morphology (OR 5.593; 95% CI 1.397-22.392; P = 0.015) emerged as independent risk factors correlated with worsened visual prognosis following intravitreal conbercept injections. Conbercept demonstrates significant efficacy and safety in treating PM-CNV. Key factors influencing visual recovery post-treatment include older age, poorer baseline BCVA, the presence of subfoveal CNV, and organized interlacing patterns of CNV morphology.

Quantitative Microvascular Change Analysis Using a Semi-Automated Software in Macula-off Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

Objective: To analyze the performance of custom semi-automated software for quantitative analysis of retinal capillaries in eyes with macula-off rhegmatogenous retinal detachment (RRD) and the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. Methods: A prospective, observational, and single-center study was conducted on consecutive patients who underwent 25G pars-plana vitrectomy for primary uncomplicated macula-off RRD. Optical coherence tomography angiography (OCTA) was performed in the fellow and RRD eyes before surgery and in months 1, 3, and 6 after surgery. The preoperative values of the fellow eyes were used as surrogates of macula-off ones. The primary endpoints were the mean vessel diameter index (VDI); vessel area density (VAD); and vessel skeleton density (VSD) at month 6. Results: Forty-four eyes (44 patients) were included in the study. Considering the fellow eyes as a surrogate of preoperative values of macula-off eyes, VDI in superficial (SCP) and deep (DCP) capillary plexuses was significantly reduced at month 6 (p = 0.0087 and p = 0.0402, respectively); whereas VSD in SCP increased significantly from preoperative values (p = 0.0278). OCTA built-in software parameters were significantly reduced from month 1 to month 6 in both SCP and DCP (p values ranged between 0.0235 and <0.0001). At month 6, 25 (56.8%) eyes achieved a best-corrected visual acuity BCVA ≥ 0.3 (LogMAR). The greater the preoperative BCVA, the greater the probability of achieving good visual outcomes (Odds ratio: 11.06; p = 0.0037). However, none of the OCTA parameters were associated with the probability of achieving a BCVA improvement ≥ 0.3. Conclusions: Quantitative evaluation of capillary density and morphology through OCTA and semi-automated software represents a valuable tool for clinical assessment and managing the disease comprehensively.

Non-Neovascular Subretinal Fluid with Serous Retinal Pigment Epithelial Detachment: Wait or Treat

Introduction: To describe the course of subretinal fluid (SRF) in eye with serous pigment epithelial detachment (serous PED) in the absence of macular neovascularization (non-neovascular AMD). Method: This is a retrospective case study included one eye with non-neovascular SRF associated with serous PED. Swept source optical coherence tomography (SS-OCT) and optical coherence angiography (OCTA) were obtained at baseline and follow up with qualitative and quantitative analysis of macula, pigment epithelial detachment (PED), subretinal fluid (SRF) and the presence or absence of macular neovascular membrane (MNV) in addition to other multimodal imaging modalities like fluorescein angiography (FA) and fundus auto fluorescence (FAF). Results: Our 66-year-old female has presented with left serous (PED) with apical (SRF) and no MNV on OCTA with baseline best corrected vision (BCVA) in Log MAR = 0.5. The SS-OCT, OCTA, and BCVA were stable over the initial five-month follow-up observation period with no MNV (non-neovascular SRF). One month later, the patient received an intravitreal anti-VEGF injection outside our clinic. 1-month post-outside clinic anti-VEGF injection, SS-OCT showed a small RPE tear with flattening of RPE detachment and preservation of BCVA =0.5. In the 3rd month post-outside clinic anti-VEGF injection, the SS-OCT showed slight flattening of RPE detachment with an obvious increase in SRF, still negative MNV on the OCTA associated with a drop in BCVA to 0.3. The decision was made to give the patient an initial three loading doses of aflibercept injections .The SS-OCT post 2nd aflibercept injection showed complete resolution and drying out of SRF, with an improvement of BCVA to 0.5. we continue completing the loading phase and then the patient was placed on treat and extend regimen (T&amp;E). After the fifth aflibercept injection, the PED was completely flattened with appearance of MNV on OCTA after resolution of SRF. Conclusion: Many published studies provide preliminary data about non-neovascular AMD with SRF. SRF could be present in the absence of MNV due to RPE decompensation or RPE pump failure. However, the non-neovascular SRF could be transformed with time into a neovascular one with the presence of MNV. Multimodal imaging approach is essential in differentiating non-neovascular versus neovascular SRF and avoiding unnecessary antiVEGF injections.