Light Perception Vision Research Articles

Bilateral Endogenous Streptococcus mitis Endophthalmitis Following Dental Implant: A Case Report and Literature Review.

Endogenous endophthalmitis is an intraocular inflammation caused by the hematogenous spread of microorganisms from distant foci. Streptococcus mitis is a low-virulence organism that inhabits the oral cavity; however, it has rarely been reported to cause endogenous endophthalmitis. In this case report, we present a 63-year-old woman with bilateral asymmetrical endogenous endophthalmitis and a severely affected right eye, with light perception vision, hypotony, and severe anterior and posterior segment inflammation. The left eye exhibited intraretinal infectious infiltrates and minimal vitritis. However, the cause of the S. mitis bacteremia was unclear. Considering the patient's recent dental implant procedure, we hypothesized that the bacteria may have entered the bloodstream through the oral cavity. The patient received intravitreal and systemic antibiotics and underwent pars plana vitrectomy for the right eye. In conclusion, we present a case of endogenous endophthalmitis, presumed following a dental implant procedure. S. mitis may invade the bloodstream following an uncomplicated dental procedure, leading to bilateral endogenous endophthalmitis. Early detection, prompt management with systemic and intravitreal antibiotics, and early vitrectomy may potentially preserve the patient's globe and vision.

Comparison of treatment outcomes between slow coagulation transscleral cyclophotocoagulation and micropulse transscleral laser treatment

This study compared treatment outcomes of slow coagulation transscleral cyclophotocoagulation (SC-CPC, 65 eyes) and micropulse transscleral laser treatment (MPL, 134 eyes) in patients with medically uncontrolled glaucoma. Success was defined as achieving an intraocular pressure (IOP) of 6–21 mmHg with a ≥ 20% reduction from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Visual acuity, number of glaucoma medication, corneal endothelial cell count, aqueous flare values, and complications were analyzed. At 12 months, mean IOP decreased from 32.2 ± 13.4 to 17.9 ± 8.3 mmHg in the SC-CPC group and from 26.4 ± 10.8 to 16.5 ± 6.8 mmHg in the MPL group. No significant changes were observed in visual acuity, medication count, or corneal endothelial cell count. Aqueous flare values increased immediately after the procedure and gradually decreased in both groups, with greater changes at 1 week significantly associated with greater IOP reduction (p < 0.05). Pupillary abnormalities were found in 5 eyes (4.5%) of the MPL group, with no severe complications. The 12-month success rates were 50.1% for SC-CPC and 38.2% for MPL (p = 0.131). Both SC-CPC and MPL effectively controlled IOP, with early postoperative aqueous flare values predicting treatment outcomes.

Long-term outcomes of ocular and visual preservation after carbon-ion radiotherapy for choroidal malignant melanoma.

This study aimed to evaluate the long-term results of carbon ion radiotherapy (CIRT) for choroidal malignant melanoma (CMM), especially regarding the preservation of the eye and visual acuity (VA). A total of 250 patients with intraocularly localized CMM treated with CIRT between January 2003 and September 2021 were included. The dose prescription included 60-85 Gy/4-5 fr, with only 68 Gy/4 fr used from 2018 onwards. The rotating gantry system with scanning beams was introduced in April 2018. Adverse events (AEs) were graded according to the Common Terminology Criteria for AEs (version 5.0.) For secondary glaucoma, tumor-related visual field defects were excluded from the evaluation. For VA, 245 patients with VA≥ light perception (LP) were followed up. Effective VA (EV: ≥ 20/200, Snellen equivalent), counting fingers (CF) and LP were used as indicators. The median age was 55 (15-86) years. The T- categories 1, 2, 3, and 4 were observed in 16 (6.4%), 41 (16.4%), 189 (75.6%), and 4 (1.6%) patients, respectively. With a median follow-up of 72.5 months, the 5- and 8-year overall survival rates were 87.5% and 84.2%, respectively; the 5- and 8-year local control rates were 94.4% and 92.9%, respectively. At the last follow-up, 19 of 250 patients (7.6%) underwent enucleation, 15 due to local recurrence and 4 due to AEs. Secondary glaucoma grades 1, 2, and 3-4 were observed in 22 (8.8%), 49 (19.6%), and 5 patients (2.0%), respectively. At the last follow-up, ≥ EV, ≥ CF, and ≥ LP were maintained in 80 (33%), 120 (49%), and 154 (63%) patients, respectively. Preservation rate of ≥LP vision at 5 and 8 years after CIRT was 65.7% and 55.3%, respectively. CIRT for CMM is a promising treatment for both tumor control and preservation of the eye and VA.

Special Commentary: Reporting Clinical Endpoints in Studies of Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery (MIGS) refers to a group of procedures generally characterized by an ab interno approach, minimal trauma to ocular tissue, moderate efficacy, an excellent safety profile, and rapid recovery. The number of MIGS procedures continues to increase, and their use has become widespread among glaucoma and cataract specialists. Standardization of the methodology and reporting of clinical endpoints in MIGS investigations enhances interpretation and comparison across different studies. The assessment of surgical interventions not only should consider statistical significance, but also whether the outcome is meaningful to patients. Minimal clinically important difference (MCID) is defined as the smallest change in a treatment outcome that is considered beneficial for an individual patient and prompts a change in their clinical management. Expert consensus is an accepted approach to determine the MCID. The American Academy of Ophthalmology's Glaucoma Preferred Practice Pattern® Committee is an expert panel that develops guidelines identifying characteristics and components of quality eye care. The Committee recommends that the cumulative probability of surgical success at 2 years with Kaplan-Meier survival analysis be used as the primary efficacy endpoint in MIGS studies. The Committee suggests that surgical success for standalone MIGS be defined as intraocular pressure (IOP) of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The proposed MCID for the cumulative probability of success of standalone MIGS at 2 years is 50%. The panel recommends that surgical success for MIGS combined with cataract extraction with intraocular lens implantation (CE-IOL) be defined as a decrease in glaucoma medical therapy of 1 medication or more from baseline without an increase in IOP or IOP of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The suggested MCID for the cumulative probability of success for MIGS combined with CE-IOL at 2 years is 65%. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

COVID-19-associated rhino-orbito-cerebral mucormycosis: a single center prospective study of 264 patients

ABSTRACT Purpose Outbreaks of mucormycosis were reported worldwide throughout the COVID-19 pandemic. We report clinical outcomes of a treatment protocol for COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM). Methods Patients with biopsy-proven mucormycosis and COVID-19 were included. All received intravenous amphotericin B deoxycholate 1 mg/kg and surgical endoscopic sinus debridement (FESS). Those with rhino-orbital or cerebral disease limited to the cavernous sinus were eligible for transcutaneous retrobulbar amphotericin B (TRAMB). Patients were followed with weekly imaging, endoscopic examinations, and serial debridement as necessary. Patients were discharged on oral posaconazole for 6 months. Results In total, 264 patients were followed for a mean of 2.5 months. On presentation, 163 patients (174 eyes) had eye involvement. Of these, 141 eyes (81.0%) had light perception or worse vision. By the last follow-up, 163 patients (176 eyes) were affected, and of these, 96 eyes (54.5%) had no light perception. Twenty-one patients (8%) died and 3 orbits (0.5%) were exenterated. There was no change in mortality (p = 0.38) or exenteration (p = 0.38) in the 55 patients who received TRAMB compared to patients with rhino-orbital or cerebral disease limited to the cavernous sinus who did not. Asymptomatic COVID-19 was associated with higher mortality than symptomatic COVID-19 (p = 0.025). Uncontrolled diabetes was a risk factor for death (p = 0.022). New diabetes was associated with increased mortality versus pre-existing diabetes (p = 0.005). Conclusion A multidisciplinary approach is crucial to manage COVID-19-ROCM. In our cohort, TRAMB therapy did not increase mortality or exenteration rates. While poor vision on presentation was profound, some vision recovery was noted with treatment. COVID-19 immune dysregulation may predispose patients to ROCM, particularly those with asymptomatic disease.

Do Treatment Patterns for Endophthalmitis after Cataract Surgery Follow the Endophthalmitis Vitrectomy Study Recommendations?: An Academy IRIS® Registry Analysis

ObjectiveEvaluate whether treatment patterns for endophthalmitis after cataract surgery in American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients are in line with evidence-based guidelines established by the 1995 Endophthalmitis Vitrectomy Treatment Study (EVS), which showed that patients who present with light perception vision (LP) have better visual outcomes with immediate vitrectomy (VIT) compared with vitreous tap with antibiotic injection (TAP). DesignRetrospective cohort study SubjectsIRIS Registry patients undergoing cataract surgery between 2014 and 2022 (identified by CPT codes), presenting with endophthalmitis (identified by ICD 10 codes) within 42 days post-cataract surgery, and having a record of being treated with VIT or TAP on the same or one day following endophthalmitis diagnosis were identified. MethodsPotential covariates of age, sex, race, ethnicity, geographic region, insurance status, and visual acuity on the day of endophthalmitis diagnosis were evaluated using multivariable logistic regression. Main Outcome MeasureTreatment with VIT or TAP ResultsOf the 2425 patients who met the inclusion criteria, 14% (345) underwent VIT and 86% (2080) underwent TAP. 80% of patients (1946) presented with endophthalmitis within 14 days from cataract surgery (median = 6 days). Notably, 66% (173/263) of the patients presenting with LP vision underwent TAP instead of VIT. In a multivariable logistic regression model, receiving VIT instead of TAP was positively associated with poor vision at endophthalmitis presentation (LP – OR, 5.3 [CI: 2.9-10.5]; Counting Fingers, Hand Motion – OR 1.8 [CI: 1.0-3.6]) vs. [20/20-20/40] vision; Asian vs. White race (OR, 2.6 [CI: 1.2-5.1]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.9 [CI, 1.0-3.2]); living in the West (OR, 1.5 [CI, 1.1-2.2]) and Midwest (OR- 1.4 [CI, 1.0-2.0]) (vs. South), but not with age, sex, and insurance coverage (P>0.05). ConclusionsIn the IRIS Registry, treatment patterns for post-cataract surgery endophthalmitis did not match evidence-based recommendations of the EVS, a randomized controlled clinical trial. More work is needed to evaluate whether the current treatment patterns are optimal for patients with post-cataract surgery endophthalmitis.

Aggregatibacter Aphrophilus as a Rare Cause of Endogenous Endophthalmitis

Purpose: To describe a rare case of endogenous endophthalmitis caused by Aggregatibacter aphrophilus (A. aphrophilus) in context of all previously reported cases of endophthalmitis caused by this organism. Methods: A 59-year-old male with no history of ocular trauma or surgery presented with a red, painful right eye with light perception vision. Examination showed a hypopyon, dense fibrin reaction, and cells in the anterior chamber. B-scan ultrasound showed evidence of vitritis. Broad investigations were initiated for both inflammatory and infectious etiologies. Results: The patient was diagnosed with presumed endogenous bacterial endophthalmitis as the blood cultures was positive for A. aphrophilus and vitreous cultures were negative for growth. The patient was promptly treated with intravitreal and systemic antibiotics and later underwent pars plana vitrectomy. The final visual acuity was 20/50. The patient had a prosthetic aortic valve and careful investigations had ruled out endocarditis. Conclusions: This case emphasizes the importance of early recognition, investigation, and intervention for A. aphrophilus endophthalmitis including the role of therapeutic vitrectomy. While early presentation can mimic ocular inflammatory diseases, infection from under-recognized causative organisms like A. aphrophilus, should be ruled out. Systemic and intraocular antibiotics should be started promptly in order to provide the best visual prognosis.

A Retrospective Comparison of Phaco-tube vs. Phaco-trabeculectomy in Glaucoma Patients

PurposeTo compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery. DesignSingle-center, retrospective, comparative case series. ParticipantsA total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group. MethodsEligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed. Main Outcome MeasuresThe primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on two consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those that used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications. ResultsThe cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P= 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4 to 10.4 months). IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P= 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P= 0.015). LogMAR VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P= 0.82) and VFMD was -18.3 ± 9.0 dB in the phaco-tube group and -14.1 ± 7.0 dB in the phaco-trab group (P= 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P= 0.28). ConclusionsPhaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success.

Septic Cavernous Sinus Thrombosis: Clinical Characteristics, Management, and Outcomes.

Septic cavernous sinus thrombosis (CST) is a rare condition traditionally associated with high morbidity and mortality. More recent case series report more favorable outcomes, including full functional recovery. A comprehensive assessment of the clinical characteristics and prognostic factors of visual and survival outcomes in septic CST is warranted to contemporize current understanding and help guide management. A multicentered retrospective cohort study was conducted at 2 tertiary care centers using an electronic medical record search of the term, "thrombosis of cavernous venous sinus" between January 1, 2000, and December 31, 2021. Inclusion criteria consisted of active infection and radiographic evidence of associated CST. Demographic and clinical data extracted included age at presentation, sex, infection type and extent, and ophthalmic examination findings at presentation-best-corrected visual acuity (BCVA), presence of relative afferent pupillary defect (RAPD), intraocular pressure (IOP), and extraocular motility (EOM) limitation. Management data collected consisted of type and length of antimicrobial therapy, type and length of anticoagulation administration, and surgical intervention. Primary outcomes assessed were ophthalmic examination findings at final evaluation and same-hospitalization mortality. A total of 27 patients with imaging-confirmed septic CST were identified at 2 tertiary care centers. At presentation, 2 (8.7%) patients had no light perception (NLP) vision, 8 (29.6%) patients had RAPD, 17 (73.9%) patients had EOM limitation, and 13 (54.2%) had IOP >21 mm Hg. All patients received antimicrobial therapy, with vancomycin being the most common agent. Fifteen patients (55.6%) received anticoagulation, and 21 (81.5%) patients underwent surgical intervention. Same-hospitalization mortality was 3 (11.1%). Among the 21 patients with ophthalmic data at follow-up, 3 (16.7%) had NLP vision, 5 (23.8%) had a persistent RAPD, 7 (31.8%) had persistent EOM limitation, and no patients had IOP elevated above 21 mm Hg. Patients with RAPD at presentation had significantly worse BCVA at final evaluation (logMAR BCVA 1.43 higher on average, P = 0.01) and a significantly higher mortality rate (37.5% vs. 0.0%, P < 0.01) than non-RAPD patients. Demographic features, BCVA at presentation, EOM limitation at presentation, elevated IOP at presentation, and comorbid orbital cellulitis were not associated with worse visual or mortality outcomes. Septic CST may result in permanent ophthalmic functional deficit in almost one-third of cases and mortality in approximately 11% of patients under contemporary management. New RAPD at presentation may indicate higher risk of poor visual and survival outcomes.

Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision

Objective or PurposeTo identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGI) and presenting with no light perception (NLP) vision. DesignRetrospective chart review. Subjects, Participants, and/or ControlsAll patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022. Methods, Intervention, or TestingManual data extraction to collect patient demographic characteristics, pre-operative, intraoperative, and post-operative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with more than one week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age less than 10 years. Multivariable regression was performed. Main OutcomesVA recovery defined as light perception or better in patients with OGI and initial NLP vision. Results147 eyes with NLP vision after OGI were included. 25 (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n=15, 60%) followed by 20/500 or better (n=5, 20%), hand motion (n=3, 12%), and count fingers (n=2, 8%). Most injuries were zone III (n=102, 69%) and presented with rupture (n=127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (OR=0.170, 95%CI: 0.042-0.681, P=0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement. ConclusionRecovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery.

Three-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma.

In our case series, the 3-year failure for Paul Glaucoma Implant (PGI) implantation was 14.6%. At 3 years postoperatively, there was a significant reduction in mean intraocular pressure (IOP) and the number of glaucoma medications used. To determine the 3-year efficacy and safety of the PGI, a novel glaucoma tube shunt in patients with glaucoma. Retrospective review of all patients who had undergone PGI implantation in a single tertiary institution in Singapore between May 1, 2017 and January 1, 2022. Data were extracted from electronic health records (Computerized Patient Support System 2 and Epic). The primary outcome measure was failure, defined as IOP >18 mm Hg or <6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant, or loss of light perception vision. Complete success was defined as the absence of failure without medications at 36 months, and qualified success similarly, but with medications. Postoperative mean IOP, mean number of IOP-lowering medications used, and visual acuity were also assessed. Forty-eight eyes in 48 patients were identified. Thirty-one patients (64.6%) had primary open angle and angle closure glaucoma, and 18 (37.5%) had previous existing tube implants or trabeculectomy. At 3 years postoperatively, 7 cases (14.6%) fulfilled the criteria for failure and 36 (75%) met the criteria for complete success. The mean IOP at 36 months was 14.9 ± 4.11 mm Hg, from the mean preoperative IOP of 20.6 ± 6.13 mm Hg ( P < 0.001). The mean number of IOP-lowering medications used was reduced from 3.13 ± 0.959 preoperatively to 0.167 ± 0.476 at 36 months ( P < 0.001). The most common postoperative complication was hypotony (n = 17, 35.4%), of which the majority were self-limiting, followed by hyphema (n = 5, 10.4%) and tube exposure (n = 4, 8.3%). The PGI demonstrated sustained IOP reduction and a reduction of medication burden at 3 years postoperatively.

Disparities in Retinal Vein Occlusion Presentation and Initiation of Anti-VEGF Therapy: An Academy IRIS® Registry Analysis

Investigate disparities in retinal vein occlusion (RVO) presentation and initiation of anti-VEGF treatment. Retrospective cohort study. Patients in the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry database (2015-2021) with branch or central RVO and macular edema (ME). The association of demographic characteristics and presenting visual acuity (VA) with anti-VEGF treatment initiation were quantified using multivariable logistic regression. Treatment with ≥ 1 anti-VEGF injection within 12 months after RVO diagnosis. A total of 304 558 eligible patients with RVO and ME were identified. Age at presentation varied by race, ethnicity, sex, and RVO type (all P values < 0.001). Within the first year after RVO presentation, 192 602 (63.2%) patients received ≥ 1 anti-VEGF injection. In a multivariable regression model adjusting for relevant covariates, female (vs. male) patients had lower odds of receiving injections (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.93-0.96; P < 0.0001) as did Black/African American (vs. White) patients (OR, 0.90; 95% CI, 0.88-0.92; P < 0.0001) and Asian (vs. White) patients (OR, 0.95; 95% CI, 0.91-0.99; P= 0.02), whereas older patients (vs. patients aged < 51 years) had higher odds (61-70 years: OR, 1.20; 95% CI, 1.16-1.24; 71-80 years: OR, 1.20; 95% CI, 1.16-1.24; > 80 years: OR, 1.15; 95% CI, 1.11-1.18; all P values < 0.0001). Hispanic (vs. non-Hispanic) patients had a small increased odds of treatment initiation (OR, 1.08; 95% CI, 1.04-1.11; P < 0.0001). Results were similar in the subset of 226 143 patients with VA data. In this subset, patients with presenting VA < 20/40 to 20/200 were most frequently treated in the first year after diagnosis (∼ 70%) and patients with light perception/no light perception (LP-NLP) vision or VA of 20/20 or better were treated least frequently (36.9% and 41.9%, respectively). In this large national clinical registry, 37% of RVO patients with ME had no anti-VEGF treatment documented in the first year after diagnosis. Black/African American, Asian, and female patients and patients with VA of LP-NLP were least likely to receive treatment. Awareness of this undertreatment and these disparities highlight the need for initiatives to ensure all RVO patients receive timely anti-VEGF injections for optimized visual outcomes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Recurrent ocular surface squamous neoplasia treated with orbital exenteration

Ocular surface squamous neoplasia (OSSN) consists of an array of dysplastic, pre-invasive and malignant squamous lesions that impair the ocular surface. We report a case of a 61-year-old female with recurrent OSSN and had chronic hepatitis B. She was managed surgically, excision of the lesion and cryotherapy with amniotic membrane grafting with topical Mitomycin C 0.02% was performed. She came back with recurrence after 8 months and was managed with 6 cycles of Mitomycin C. After 9 months she reported back with recurrence with light perception vision and underwent orbital exenteration.

Surgical Outcomes of Children with Unilateral Congenital Cataract and Persistent Fetal Vasculature.

To delineate the characteristics, surgical interventions, and visual outcomes among children diagnosed with congenital cataract and persistent fetal vasculature (PFV). Retrospective observational single-center study was conducted between January 1, 2009, and December 31, 2019, at Helsinki University Hospital. The national cohort encompassed 82 children aged from birth to 15 years who underwent lensectomy, 3-port vitrectomy, or a combined procedure, with the objective of achieving visual rehabilitation. Among the surgical cohort, paediatric cases with International Classification of Disease (ICD-10) codes Q14.0 for PFV and Q12.0 for congenital cataract were identified and analyzed. Data were collected through a comprehensive review of medical records, encompassing clinical history (birth weight), gender distribution, ocular parameters (laterality, intraocular pressure [IOP], visual acuity [VA]), details of cataract and vitreoretinal surgical interventions, indications for surgery, postoperative ophthalmic complications, as well as evaluations of functional and anatomical outcomes. The cohort consisted of 11 children, ranging in age from 6 months to 12 years. Surgical intervention resulted in the attainment of at least light perception vision in nine of the operated eyes, representing 81.8% of cases. Among these, two eyes (18.2%) achieved hand motion vision, while 5 eyes (55.6%) achieved vision of finger counting or better. Additionally, two eyes (18.2%) achieved visual acuity measurable on the Snellen chart. However, one eye (9.1%) experienced complete vision loss, while the contralateral eye developed sympathetic ophthalmia. Congenital cataract with PHV without anterior segment pathology associated with best postoperative VA, while eyes with anterior segment pathology or a complex posterior segment pathology had poor visual prognosis. Case selection for surgery is considered of great importance, since sympathetic ophthalmia may occur postoperatively. Understanding more deeply pathogenesis of PFV is warranted.

Ahmed ClearPath vs. Baerveldt Glaucoma Implant: A Retrospective Noninferiority Comparative Study

To compare the efficacy and safety of two non-valved glaucoma drainage devices (GDDs): Ahmed ClearPath (ACP) vs. Baerveldt glaucoma implant (BGI). Single-center, retrospective, comparative study. Consecutive patients who underwent ACP or BGI surgery for glaucoma (250 mm2 or 350 mm2 models), and had ≥6 months of follow-up and no prior GDD implantation. Chart review of ACP or BGI surgery in patients with glaucoma at Wills Eye Hospital (2020-2023). The primary outcome measure was surgical failure at the end of follow-up, defined as intraocular pressure (IOP) >21 or <6 mmHg at 2 consecutive visits, progression to no light perception (NLP) vision, glaucoma reoperation, or implant removal. Secondary outcome measures included the rate of postoperative complications and changes in best corrected visual acuity (BCVA), IOP, and glaucoma medications. A total of 128 eyes of 113 patients (63 ACP, 65 BGI) with similar baseline characteristics and a mean follow-up duration of 19.6±10.8 (median 20.5) months were included. Surgical failure occurred in 12 eyes (9.4%) with no significant difference between ACP and BGI eyes (9.5% vs. 9.2%, respectively; P=0.810). Reasons for failure included IOP >21 mmHg (3/12, 25.0%), glaucoma reoperation (5/12, 41.7%), and tube removal (4/12, 33.3%). No eyes progressed to NLP vision. Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure in both groups (P=0.871). Both groups achieved significant IOP and medication reduction compared to their baseline. Final IOP, BCVA, and complication rate was similar in both groups, but medication number was significantly lower in the ACP group (P=0.012). Both the 250 mm2 and 350 mm2 models had similar outcomes, but diplopia was significantly associated with the 350 mm2 model of either implant (P=0.012). Univariate logistic regression analysis did not identify either tube type or plate size as predictors of surgical failure. To our knowledge, this is the first study to compare the recently approved ACP vs. the BGI. Both implants had similar surgical failure and complication rate. Final IOP was similar in both groups, but ACP achieved lower medication number. Diplopia was significantly associated with the use of 350 mm2 model of either implant. Neither tube type nor plate size were significant predictors of surgical failure.

Surgical Outcome in Patients with Traumatic and Atraumatic Optic Neuropathy Following Endoscopic Optic Nerve Decompression.

Endoscopic optic nerve decompression is a highly effective and reliable approach for patients with select cases of optic neuropathy. It reduces the hydrostatic pressure and helps in relieving the compressive forces within the intracanalicular portion of the optic nerve consequently preserving and arresting the deterioration of vision. The advantages of the endoscopic approach over other procedures include preservation of olfaction, quick recovery, lack of external scars and less morbidity. The objective of the study isto assess the surgical outcome of endoscopic optic nerve decompression in patients with traumatic and atraumatic optic neuropathy. The case records of consequent patients attending ENT department with defective vision due to traumatic and atraumatic causes were reviewed. The outcome was measured in terms of improvement in visual acuity by log MAR scale. Among the 14 patients studied, 57% were females and the median age of presentation was 33 years. As compared to preoperative baseline visual acuity, the overall improvement was achieved in 11 patients, with an effective rate of 78.5% postoperatively. Patients presenting with no light perception and residual vision had significant improvement in visual acuity after surgery. Trans-nasal endoscopic surgery helps in decompressing the optic nerve with proper exposure of the orbital apex and optic canal without any intracranial or intra-orbital complications. Further, being a minimally invasive procedure has great advantage in cases of optic neuropathy.

CENTRAL RETINAL ARTERY OCCLUSION AS PRESENTATION OF BARTONELLA ENDOCARDITIS.

To describe a rare ocular presentation of a systemic illness and the important lifesaving diagnosis made by a complete eye examination. The patient was evaluated with a comprehensive ophthalmic examination and followed closely in the outpatient setting with optical coherence tomography, fluorescein angiography, and color fundus photos. A 66-year-old man presented with acute vision loss of the left eye. A complete eye examination revealed that he had a central retinal artery occlusion. Systemic workup revealed that he had a mitral valve vegetation and blood cultures grew Bartonella henselae. His kidney biopsy showed membranoproliferative glomerulonephritis, which is often seen with septic emboli. Furthermore, the patient lacked any ocular inflammatory signs. This constellation of findings was diagnostic for a thromboembolic etiology causing his central retinal artery occlusion. At follow-up, the optical coherence tomography demonstrated inner retinal hyperreflectivity and the fluorescein angiogram showed segmented flow and no neovascularization. On follow-up, the patient had a stable examination with light perception vision and completed antibiotic therapy for bartonella endocarditis. The detection of a fatal systemic illness was made promptly with a thorough ocular examination. We highlight the importance of a multidisciplinary approach in making a lifesaving diagnosis.

Long-term outcomes of Baerveldt glaucoma implant surgery in Japanese patients

This study evaluated the long-term surgical outcomes of Baerveldt glaucoma implant (BGI) surgery in patients with refractory glaucoma (204 eyes/204 patients). Surgical failure was defined by: < 20% reduction in preoperative intraocular pressure (IOP), or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Reoperation, loss of light perception vision, or hypotony also denoted failure. The probability of success at 5 years postoperatively using criteria A, B, and C was 72.4%, 49.7%, and 24.4%, respectively. The mean IOP decreased significantly from 32.7 ± 9.7 mmHg preoperatively to 13.1 ± 3.9 mmHg at 5 years; the mean number of glaucoma medications also decreased from 3.7 ± 1.2 to 1.8 ± 1.9 (both P < 0.01). The number of previous intraocular surgeries was significantly associated with failure in the multivariable analysis for criterion B (hazard ratio 1.30; P < 0.01) and criterion C (hazard ratio 1.19; P = 0.031). Early and late postoperative complications occurred in 82 (40.2%) and 28 (13.7%) eyes, respectively. Postoperative interventions were performed in 44 eyes (21.6%). BGI surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. BGI surgery is effective for refractory glaucoma. However, postoperative interventions due to complications are required in numerous cases.

Determinants of Clinical Outcomes After Infectious Scleritis.

The aims of this study were to describe the clinical course of microbial infectious scleritis and identify factors associated with poor visual outcomes. Data from 26 eyes of 26 patients with culture-proven bacterial or fungal scleritis presenting at a single tertiary center from January 1, 2007, to July 1, 2021, were reviewed. Thirty-six variables were analyzed for associations with poor vision [best-corrected visual acuity (BCVA) <20/200] or loss of vision (no light perception vision or requirement for enucleation or evisceration) at final visit. The mean age at initial presentation was 67.1 ± 14.0 (range: 34-92) years with a mean follow-up of 2.1 ± 2.2 (0.05-8.45) years. The mean presenting logarithm of minimal angle of resolution (logMAR) BCVA was 1.3 ± 1.0 (∼20/400) and mean final logMAR BCVA was 1.6 ± 1.2 (∼20/800). Fourteen eyes (53.8%) exhibited poor vision and 7 (26.9%) had loss of vision at final follow-up. History of necrotizing scleritis and poor presenting vision were associated with poor final vision (OR = 19.1; P = 0.017 and OR = 7.5; P = 0.047, respectively), whereas fungal scleritis was associated with loss of vision (odds ratio [OR] = 30.3, P = 0.013). Subconjunctival antimicrobial treatment was inversely associated with loss of vision (OR = 0.06, P = 0.023). There was no difference in vision between medical and combined medical-surgical management, although infection resolution time was shorter for combined intervention (16.8 ± 10.6 vs. 53.7 ± 33.8 days; P = 0.005). Infectious scleritis is often successfully treated, but loss of vision or eye removal is common. Poor baseline vision, history of necrotizing scleritis, and fungal etiology were prognostic for worse clinical outcomes. Surgical intervention was associated with quicker resolution compared with medical treatment alone.

Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma.

To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase. Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM). A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups. Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term. Ramesh S, Shalaby WS, Myers JS, et al. Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma. J Curr Glaucoma Pract 2023;17(2):91-97.