Initial Visual Acuity Research Articles

SURGERY OUTCOMES OF GLAUCOMA DRAINAGE DEVICE IMPLANTATION IN REFRACTORY GLAUCOMA PATIENTS AT SARDJITO GENERAL HOSPITAL

Introduction: Glaucoma drainage device (GDD) implantation was an effective surgical procedure in treating uncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDD implants were classified into valved and non-valved in which its surgical outcomes in different types of device and various etiologies were not similar. This study aimed to evaluate the surgery outcomes of GDD implantation in patients with refractory glaucoma at Sardjito General Hospital. Methods: All 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at Sardjito General Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma, IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2 and 3. Type of GDD implants, postoperative glaucoma medications, complications and need for further glaucoma surgery were documented. Results: The mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreased after surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002) glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to 1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The most common early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated to ripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related to non-valved implant type (p=0.003). Conclusion: GDD implantation especially valved type appears to be safe and effective surgical option in treating refractory glaucoma patients Keywords: Glaucoma drainage device, refractory glaucoma, glaucoma surgery, intraocular pressure

Neuro-ophthalmologic Outcomes of Orbital Apex Syndrome Caused by Invasive Fungal Rhinosinusitis

Abstract Objectives Orbital apex syndrome (OAS) is characterized by visual loss, ophthalmoplegia, ptosis, and orbital pain. This study aims to analyze neuro-ophthalmologic outcomes of OAS resulting from invasive fungal rhinosinusitis (IFS). Methods This retrospective study analyzed 25 patients diagnosed with OAS resulting from IFS between January 2018 and July 2022. Patient's visual acuity, degree of ophthalmoplegia, ptosis, and orbital pain were analyzed. Poor and nonpoor visual acuity were classified based on 20/200. The study also investigated risk factors for the failure of vision restoration. Results Only 1 of 25 patients died from the progression of IFS. Among the 25 patients, 5 (20%) had initial visual acuity better than 20/200 before treatment and 20 (80%) had worse vision than 20/200. Four (80%) of five patients with better than 20/200 maintained visual acuity. Four (20%) of 20 patients with worse than 20/200 recovered to better than 20/200 but others remained or declined to worse vision after treatment. The presence of an infiltrative lesion in cavernous sinus on magnetic resonance image scans was significant in univariate but not multivariate analysis (odds ratio, 24.39; 95% confidence interval, 1.543–333.333; P-value = 0.023). Among the patients with worse than 20/200 vision, the patients whose treatment started less than 4 weeks achieved 33.3% (4/12 patients) vision recovery. In contrast, ophthalmoplegia, ptosis, and pain recovered more successfully than vision. Conclusions Although OAS caused by IFS has been reported as very rare, early pathological diagnosis and appropriate treatment can result in good survival and favorable neuro-ophthalmologic outcomes.

Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes.

To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.

Endogenous Candida endophthalmitis

Endogenous Candida endophthalmitis is arare but vision-threatening disease. In most cases, endogenous endophthalmitis caused by Candida species has abetter prognosis than endogenous endophthalmitis caused by other fungal species or bacteria but the prognosis still depends heavily on the time required for diagnosis and subsequent treatment as well as the initial visual acuity. Suggestions for treatment algorithms have already been made in the past but binding guidelines in ophthalmology only exist sporadically due to the rarity of the disease. This review discusses the current knowledge on endogenous Candida endophthalmitis and draws conclusions from the current study situation.

Influence of prior treatment protocol on intravitreal dexamethasone implant behavior in patients with diabetic macular edema in real-world practice

ABSTRACT Background and Objective Intravitreal dexamethasone implant (DEXI) has been placed as an effective option to treat diabetic macular edema (DME). However, there is no consensus on the best time to introduce it. We conducted a study to evaluate anatomical and functional behavior after the first DEXI according to previous treatment. Research design and methods This retrospective, real-world study between 2013 and 2020 investigated changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT at months 2 and 6 after the first DEXI in DME. Patients were divided into naive, early switch (≤3 anti-VEGF injections), or late switch (>3 anti-VEGF injections) groups. Results Among 112 consecutive eyes, mean BCVA and CMT improved significantly in all groups at month 2, with no difference between them. However, this improvement was not maintained at 6 months. The Naíve group presented better BCVA all over the study period. The previously treated groups, which started with worse initial visual acuity, showed more visual gain without reaching the BCVA of the naive group. CMT performance was similar between groups. Conclusions There was similar anatomical and functional behavior in all groups. Poorer visual acuity at baseline was associated with worse functional outcome despite good anatomic response.

Unilateral Myelinated Retinal Nerve Fibers Associated with Ipsilateral Myopia, Amblyopia and Exotropia

This report describes a case of unilateral myelinated retinal nerve fibers associated with ipsilateral myopia, amblyopia and exotropia. A 3-year-old boy presented with the complaint of diminished vision in his right eye. Visual acuity testing with a picture at a distance of 2.5 m revealed 1.5 in the left eye, but right visual acuity was not available. Near visual acuity with dot cards was 0.2 in the right eye and 0.6 in the left eye. The refractive error was -7.25D and +1.50D in the right and left eyes, respectively. Fundus examination revealed extensive myelinated retinal nerve fibers in the right eye, but no abnormal findings in the left eye. The axial length was 24.10 mm and 22.90 mm in the right and left eyes, respectively. Cycloplegic retinoscopy revealed a refractive error of a −7.00D in the right eye and plane in the left eye. Glasses with full optical correction were prescribed, and the patient was evaluated one month later, presenting a best-corrected visual acuity of 0.6 in the right eye and 2.0 in the left eye with a picture at a distance of 2.5 m. Three months later, his visual acuity was 0.7 in the right eye. At this point, amblyopia treatment was started with two hours daily of left eye occlusion. One year following the initial presentation, his visual acuity improved 0.8 in the right eye. The type of fixation, the initial visual acuity, the high myopia and the high anisometropia indicated a most likely bad prognosis. However, the age of diagnosis and wearing status of glasses were advantage for treatment effect in this case. Even though this condition is associated with poor visual prognosis, intensive occlusion therapy should always be attempted, along with the prescription of a cycloplegic refraction, due to unexpected and variable responses to treatment.

Endophthalmitis after cataract surgery

Aims/Purpose: Retrospective review in 164 patients with endophthalmitis after cataract surgery, and intended to figure out the factors which affect clinical features, bacteria identification and final visual acuity (VA).Methods: We followed the guideline of EVS for operative treatment. In the case of initial LP, vitrectomy was conducted. HM or better, either IOAI (intraocular antibiotics injection, 1.0 mg/0.1 mL of vancomycin and 2.25 mg/0.1 mL of ceftazidime) or vitrectomy was optionally conducted. After initial treatment, we conducted reintervention within 48 h where the decrease of vitreous opacity and hypopyon, and pain relief did not show up. We obtained A/C fluid and vitreous specimen for figure out the bacteria identification.Results: 25 patients had initial VA below LP, the cases of HM were 86 and 53 patients had better than FC. 81 patients were observed where it took 3 days until the symptoms of post‐operative endophthalmitis occurred. Where final VA improved by 0.5 or better, the case that vitrectomy was conducted with early treatment was not statistically much different from the case of sole IOAI. The influential factors in final VA was where it took more than 3 days for endophthalmitis to occur after cataract surgery, initial VA was HM or better, and the result of bacteria identification was Gram(+) and those 3 cases affected the positive outcomes.Conclusions: Good initial VA means the diagnosis of endophthalmitis was relatively prompt. It can be said that intraocular tissues were less damaged, the virulent would be infected by less bacteria and then those affect positive prognosis. In addition, endophthalmitis diagnosed 3 days later after surgery, prognosis was good. It seems that this is because damage of intraocular tissues occurs slowly as pathogenicity did not progress quickly with light clinical features where it is infected by weak bacteria. And it can be considered that the period until post‐operative endophthalmitis occurs affects prognosis.

Intravitreal bevacizumab in choroidal neovascularisation in Vogt‐Koyanagi‐Harada disease in a child: A review of literature

Aims/Purpose: Interest of bevacizumab in children in the treatment of choroidal neoplasms in Vogt Koyanagi Harada syndrome.Methods: In this work we report the case of an extra‐foveal choroidal neovascularization in a child followed for VKH syndrome with a good response to intravitreal injections of bevacizumab.Results: We report the case of a 12‐year‐old child who initially presented to the hospital in 2020 for bilateral decreased visual acuity and headache. There was no history of systemic disease. Initial visual acuity was 1/10 in both eyes. Biomicroscopic examination revealed granulomatous retrodescemetic precipitates, 2× anterior chamber tyndall, 1× vitreous tyndall, and bilateral exudative retinal detachment associated with bilateral papilledema in both eyes. Based on these findings, a diagnosis of Vogt‐Koyanagi‐Harada syndrome was made, and treatment was initiated with intravenous, oral, and topical corticosteroids. Visual acuity improved to 6/10 OD and 7/10 OS the following month. The patient was then followed up at the university hospital regularly. After controlling the inflammation, steroids were decreased over a period of 2 years but the patient relapsed at high dose to declare cortico‐dependence. Anti‐TNF alpha was started to control the inflammation and visual acuity remained stable until July 2022. Choroidal neovascularization then developed, reducing the patient's visual acuity to 3/10 in both eyes within 1 month. Fluorescein angiography and macular OCT confirmed the diagnosis of extrafoveolar choroidal neovascularization in both eyes. After obtaining informed consent, intravitreal bevacizumab was injected 3 times at 6 week intervals in each eye. After the 6th injection, the patient's best‐corrected visual acuity improved to 8/10 in the right eye and 10/10 in the left eye. The fundus photograph illustrates the regression of the choroidal neovessels. Fluorescein angiography confirmed the reduction in leakage. Choroidal neovascular membranes can cause severe visual impairment and are a major challenge in the management of patients.Conclusions: This case illustrates that intravitreal bevacizumab has a possible role in the treatment of the disease, with regression of neovascular lesions in the eye.

Epidemiological profil of post contusive hyphaema experience of the paediatric ophthalmology department of Casablanca

Aims/Purpose: Hyphaema is defined as the presence of blood in the anterior chamber. It occurs after a contusive or perforating ocular trauma or in the aftermath of ocular surgery. The aim of our work is to analyse the clinical, therapeutic and evolutionary profile of post‐contusive hyphaema.Methods: A retrospective study was conducted on 66 children (33 eyes) admitted to the ophthalmologic emergency room for post‐contusive hyphaema followed and treated in the paediatric ophthalmology department of the 20 August hospital in Casablanca between January 2015 and January 2023.Results: There was a male predominance with 67% of boys affected. The average age was 9.5 years. The main cause of consultation was visual acuity (VA) loss in 49%. On examination, the initial VA was <1/10 in 38% of cases, the ocular tone was >20 in 30% of cases. Hyphaema was classified as stage I in 26.4%, stage II in 52%, stage III in 15.2%, stage IV in 6.4%. Post‐traumatic cataract was present in 50% of the cases, lens dislocation in 22% of the cases, angle recession in 6%. Intravitreal haemorrhage was present in 2 patients, berlin oedema in 3 patients. The treatment prescribed in all patients was strict rest, abundant drinks, oral and local corticotherapy and dilatation with atropine. In addition, a hypotonizing treatment was prescribed for the patients who presented an ocular hypertonia. The evolution was marked by the total resorption of the hyphaema in 90% of the cases. Surgical treatment (hyphaema lavage) in 10% of cases. The final VA was >6/10 in 60% of cases. The most serious complication was haematocornea in 6% of cases.Conclusions: Frequent and serious condition in children that can jeopardize the functional prognosis of the eye. When the diagnosis is made, the management must be early in order to avoid complications.

Evaluating the effectiveness of inflammatory markers in pediatric open globe injury using a modified pediatric ocular trauma score.

This study aims to assess pediatric patients with Open Globe Injury (OGI) using the Modified Pediatric Ocular Trauma Score (MPOTS) and to investigate the correlation between Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lympho-cyte ratio (PLR) parameters with the prognosis determined by MPOTS. In this retrospective study, we included pediatric patients with OGI. Recorded data encompassed demographic details, injury type, duration from injury to surgery, complete ophthalmological examinations, initial and final visual acuities, anterior segment and fundus findings, and NLR and PLR values. Patients were categorized into three groups based on their MPOTS scores: Grade I (≤30 points), indicating high risk; Grade II (35-65 points), moderate risk; and Grade III (≥70 points), low risk. Differences between categories were statistically evaluated. The study comprised 22 patients. In Category I, the duration from injury to surgery was longer (p=0.018). The most common injury type in this category was globe rupture, occurring in four (50%) patients, with a significant difference noted between the groups (p=0.041). Category I exhibited lower final visual acuity and higher NLR and PLR values compared to the other categories (p<0.050 for all values). Both NLR and PLR demonstrated significant negative correlations with MPOTS (respectively, r=-0.869, p<0.001; r=-0.809, p<0.001). The Modified Pediatric Ocular Trauma Score is an effective and practical method for assessing the prognosis of pediatric patients with Open Globe Injury (OGI). Furthermore, there is evidence indicating a negative correlation between MPOTS and the increase in NLR and PLR values that often follows OGI in this patient population.

A novel predictor of persistent ocular hypotony after pars plana vitrectomy for rhegmatogenous retinal detachment: The initial intraocular pressure difference between the eye with RRD and the fellow eye.

To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients' demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal.

The outcome of cataract surgery in paediatric uveitis

Aims/Purpose: Cataract is a frequent complication of chronic uveitis. It can be a consequence of intraocular inflammation or the use of corticosteroids. In children, uveitic cataract is a source of amblyopia, hence the interest in surgery. Our work aims to study the therapeutic particularities, the peri and post‐operative complications and the visual and functional results of these cataracts.Methods: We performed a retrospective study of 14 patients (18 eyes) with uveitis; involving children under 15 years of age; who underwent cataract surgery between January 2011 and November 2022.Results: The average age of the operated children was 9.5 years (4–14 years) with a female predominance of 70%. Uveitis was bilateral in 8 children. The aetiology of the uveitis was found in 9 patients. It was juvenile idiopathic arthritis (JIA) in 6 cases, ocular toxoplasmosis in 1 case, tuberculosis in 1 case and Eales disease in 1 case. The aetiology of the uveitis was not found in 5 patients. The initial visual acuity varied between light perception and 2/10. Total white cataract was found in 44% of cases, posterior subcapsular in 39% of cases, anterior subcapsular in 5.5% of cases and corticonuclear and posterior subcapsular in 11% of cases. Phacoemulsification was performed with implantation in the lens bag in 17 eyes, only 1 patient in our series was not implanted. Post‐operative visual acuity was greater than 7/10 in 68% of cases, between 7/10 and 3/10 in 16% of cases and less than 3/10 in 16% of patients. Post‐operative complications were dominated by the inflammatory reaction of the anterior segment, which was controlled by corticosteroid treatment in 40% of cases, macular oedema occurred in 2 patients in our series post‐operatively and Elsching's beads in 6 eyes (34%). Immunosuppressive treatment was maintained in 75% of cases.Conclusions: Cataract surgery in uveitic children requires careful management to ensure successful outcomes. The control of peri‐operative inflammation in the surgery of paediatric uveitic cataracts is the key to obtaining good visual outcomes and preventing amblyopia.ReferencesAlAmeer AM, Al Shamrani M. Outcome of cataract surgery in pediatric uveitis (experience at King Khalid Eye Hospital). Oman J Ophthalmol. 2022 Mar 2;15(1):43–48.

Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury.

To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome. This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome. Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05). Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI.

Современные подходы к хирургии катаракт с высокой остротой зрения на основании анализа волнового фронта

Relevance. Until recently, visual acuity was the main criterion for determining the timing of surgery, but already in the early stages of cataract development, patients may suffer from reduced image quality, which affects the quality of life (“night” myopia, light scattering, blurring). Deterioration in visual function in these patients may be explained by refractive errors. Analysis of internal higher-order aberrations resulting from slight opacification of the lens is important for determining the effect of media opacity on wavefront aberrations (WF) and for determining the indications and timing of surgical treatment, especially in patients with high visual acuity. Purpose. Evaluate the optical system of the eye with initial cataracts and high visual acuity. Evaluate the wavefront and its aberrations, contrast sensitivity and Shtrel coefficient. Material and methods. The study included 111 eyes with cataracts and 42 eyes without signs of cataracts (control group). Patients aged on average 57±5.3 years. Wavefront analysis was performed using an iTrace ray tracing aberrometer (Tracey Tech., USA) in a dark room under maximum drug-induced mydriasis. In each group, total, corneal, and internal wavefront aberrations were measured at a pupil diameter of 6.0 mm. Higher order aberrations were analyzed using Zernike polynomials (3rd to 5th order). The modulation transfer function (MTF) at different spatial frequencies (0–30 c/deg) and the Strehl coefficient in patients in the study groups were also assessed. Results. Total and internal higher-order wavefront aberrations were significant in different cataract groups compared with control patients, while higher-order corneal aberrations were not statistically different. We noted a higher level of total and internal aberrations in the group of patients with posterior subcapsular cataract. In this regard, patients with posterior subcapsular cataract require surgical treatment at an earlier stage, despite high visual acuity. Conclusion. We recommend assessing the optical quality of vision and wavefront aberrations when observing early cataracts in order to decide whether to perform surgery at an earlier date. Key words: initial cataract, quality of vision, higher order aberrations, internal wavefront aberrations

Role of visual evoked potential (VEP) in indirect traumatic optic nerve (ITON) injuries and assessment of the visual outcome

To demonstrate the critical function of Visually Evoked Potential (VEP) in the prompt detection of indirect optic neuropathy. 60 patients suspected of having traumatic optic nerve injury underwent VEP testing in &amp;#60; eight hours of traumatic experience. Baseline visual acuity was revealed to be the most imperative prognosticator of eventual visual outcome. The VEP was instrumental in the primary detection as well as validation of ITON. Additionally, VEP aided in predicting prognosis and follow-up for patients with IITON. Visual recovery is impossible in the absence of recordable VEP waves. The manifestation of orbital fractures wasn't associated with a preliminary or ultimate visual perception decrease. Patients who present &amp;#60; 8 hours following ITON with normal initial visual acuity, VEP alterations, and lower RAPD grades may have a greater chance of recovering final visual perception when treated with an instantaneous high steroid dosage. The above-mentioned prognostic markers in patients with ITON may be beneficial in predicting visual prognosis and determining the need for surgical therapy in patients who experience vision loss following head trauma.

The role of optical coherence tomography angiography in dome-shaped maculopathy

Purpose: To demonstrate the role of optical coherence tomography angiography (OCT-A) in the management of dome-shaped maculopathy (DSM). Methods: Retrospective case review. Results: A 52-year-old woman was referred to our retina service for potential bilateral choroidal neovascular membrane (CNVM) and blurry vision bilaterally. Initial spectacle-corrected visual acuity (VA) was 20/30-2 in the right eye (RE) and 20/30+2 in the left eye (LE). DSM was diagnosed on OCT. In both eyes, OCT B-scan passing through the fovea showed shallow, irregular RPE elevation (SIRE) suspicious of occult (type 1) CNVM. The outer retina and choriocapillaris angiograms showed a zone of nonexudative CNVM in the RE and exudative CNVM in the LE. Given the persistent SRF with CNVM in the LE, we elected to perform intravitreal injections of ranibizumab 0.5 mg on a treat and extend regimen. Upon the most recent follow-up, the best corrected VA improved to 20/20 in the LE with no persisting SRF. Conclusion: We present a case where assessing disease progression, the development of CNVM and evaluating the efficiency of therapies were realized through the application of novel OCT-A technology. This diagnostic tool may be used to guide clinicians in their management of DSM, as demonstrated through our experience. OCT-A can also make it possible to visualize nonexudative CNVM lesions that may be missed on traditional imaging assessments.

Assessing the Correlation Between Visual Acuity and Critical Fusion Frequency in Acute Optic Neuritis Before and After Steroid Therapy.

Background Optic nerve diseases include inflammatory optic nerve diseases such as vasculitis, metabolic optic neuropathy, ischemic optic neuropathy, and optic neuritis. In this study, patients with acute optic neuritis are classified with better and poor visual acuity based on visual acuity after one month of steroid pulse therapy. To determine prognosis, initial visual acuity and critical fusion frequency (CFF) values will be compared with those recorded one month after treatment and at the last visit. Methods Visual acuity and CFF were evaluated one month after the start of treatment in patients diagnosed with acute optic neuritis, and follow-up was available for at least three months at Hiroshima University Hospital. Results All patients received steroid pulse therapy as initial treatment. After one month of treatment, visual acuity and CFF at the last visit were significantly improved in the group with improved visual acuity compared to the group with impaired visual acuity. Conclusions Visual acuity at the initial visit did not affect treatment outcome, and final visual acuity and CFF after one month of treatment for acute optic neuritis were better in patients with better visual acuity. Therefore, visual acuity values one month after treatment initiation may affect treatment outcomes.

Impact of First Healthcare Provider on Acanthamoeba Keratitis Course: How to Overcome Poor Prognosis in Acanthamoeba Keratitis Treatment? A Single Tertiary Center, Observational Study.

To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first healthcare provider (HCP) seen. Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and Acanthamoeba subspecies. Forty-one patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4-14 days), while mean time to the correct diagnosis of AK was 15 days (IQR 7-29 days). Patients saw an optician, optometrist or ophthalmologists significantly earlier than GPs (median 4 days, vs 15 or 5 days, respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the ophthalmologists' group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36). AK patients often seek ocular help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP seen, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.

Factors predictive of poor visual outcome in indirect traumatic optic neuropathy: A retrospective cohort study

IntroductionThe gold standard treatment for indirect traumatic optic neuropathy (ITON) has not yet been conclusively established, and it is essential to gain an understanding of visual prognosis and to counsel patients regarding the predictive risk factors of poor visual outcomes. Currently, there is limited information regarding ITON in Thai populations; therefore, this study aimed to determine the risk factors of poor visual outcome in patients with this condition. MethodsA retrospective review was conducted of all ITON cases diagnosed at Rajavithi Hospital and Sawanpracharak Hospital between January 2016 and December 2022 in order to determine clinical characteristics and evaluate associated risk factors of poor visual prognosis using binary logistic regression analysis. ResultsThe mean age of this cohort of 101 patients was 36.17 years, with a male predominance of 73.3 %. Motor vehicle accidents were the most common cause of ITON, with a statistically significant 79.2 % of cases. The patients were categorized into an “improved group” of 29 patients and an “unimproved group” of 72. The unimproved group had a significantly older mean age and poorer initial visual acuity of 20/200 (p-values 0.001 and p < 0.001 respectively). There was no significant difference between Computed Tomography (CT) findings in the two groups. The improved group had significantly better visual acuity (VA) at 1-month and final follow-up visit than the unimproved group (both p < 0.001). Differences between gender, Glasgow coma score, associated underlying diseases, and duration from trauma to intravenous glucocorticoids therapy in the two groups were not statistically significant. Multivariable logistic regression analysis identified patient age of 40 years or more (Odds ratio (OR) 3.447, 95 % CI, 1.085–10.955, p = 0.036) and poor baseline VA (OR 6.628, 95 % Confidence Interval (CI), 2.308–19.036, p < 0.001) as significant risk factors for poor visual outcome in ITON patients. ConclusionsNo clear benefit was found of intravenous glucocorticoids in treatment of ITON. Patients aged 40 years or more and/or with poor baseline visual status should be advised that they are at increased risk of poor final visual outcomes.

Factors affecting the total occlusion time in eyes with hyperopic anisometropic amblyopia

BackgroundAmblyopia treatment by occluding the healthy eye is known to be effective during a sensitive critical period. This study aims to clarify the factors for the total occlusion time (TOT) required for the amblyopic eye to achieve a normal visual acuity (VA) level of 1.0 (0.0 logMAR equivalent). This could contribute to an efficient treatment plan for eyes with hyperopic anisometropic amblyopia.MethodsSubjects were 58 patients (26 boys and 32 girls; age range, 3.6-9.2, average, 5.8 ± 1.3 years) with hyperopic anisometropic amblyopia. All the subjects had initially visited and completed occlusion therapy with improved VA of 1.0 or better in the amblyopic eye at Kindai University Hospital between January 2007 and March 2017. Using the subjects’ medical records, we retrospectively investigated five factors for the TOT: the age at treatment, the initial VA of the amblyopic eye, refraction of the amblyopic eye, anisometropic disparity, and the presence of microstrabismus. Patient’s VA improvement at one month after treatment was also evaluated to confirm the effect of the occlusion therapy.ResultsThe initial VA of the amblyopic eye ranged from 0.1 to 0.9 (median, 0.4). The TOT ranged from 140 to 1795 (median, 598) hours with an average daily occlusion time of 7 hours. The initial VA of the amblyopic eye and presence of microstrabismus were the significant factors for the TOT (p < 0.01). To achieve VA of 1.0 or better, patients with an initial VA of ≤ 0.3 in the amblyopic eye required a longer TOT. Moreover, patients with concomitant microstrabismus required a 1.7-fold longer TOT compared to those without microstrabismus.ConclusionLonger daily occlusion hours and early start of the treatment will be necessary for patients with poor initial VA or microstrabismus to complete occlusion therapy within the sensitive critical period.