Snellen Lines Of Visual Acuity Research Articles

Scleral sutured aniridia intraocular lens (Morcher®): indications and long-term outcomes.

To evaluate the outcomes of trans-scleral sutured posterior chamber black diaphragm intraocular lens (BDIOL) (Morcher®) implantations over 11 years. Retrospective case-series of patients, who underwent BDIOL implantation, identified from electronic patient records system from 2006 to 2016, Moorfields Eye Hospital. Demographics, pre/post-operative, final best-corrected visual acuity (BCVA), diagnosis, symptomatic improvement, intraoperative and postoperative complications immediate or late were collected and analysed to relate outcomes to surgical indication. Forty eyes of 38 patients (F:M 1:2.8) underwent BDIOL implantation with a mean surgical age of 46.6 years and follow-up of 44.5 months (range of 8-132 months). Indications included 23(57%) ocular trauma, 7(17%) congenital aniridia, 7(17%) iatrogenic lens and/or iris loss, and 3(7%) infectious keratitis. Mean preoperative BCVA was 1.64 logMAR and mean final postoperative BCVA was 0.94 logMAR with an average improvement in BCVA of 0.23 logMAR, equivalent to 1.5 lines of Snellen visual acuity. Visual results varied according to indications. Infectious cause patients had the greatest vision improvement (-0.7 logMAR), followed by trauma (-0.3 logMAR), and 25% of these achieved vision of 0.3 logMAR (6/12 in Snellen acuity) or better. Conversely, the aniridia group had the least improvement (worsened vision of 0.01 logMAR), 17 patients (42%) reported subjective improvement. BDIOLs achieve reasonably good visual outcomes in eyes with complex vision threatening pathology. No significant intra-operative complications are documented and most post-operative complications are related to the pre-existing pathology. Post - trauma and iatrogenic aniridia have better outcomes compared to congenital aniridia.

One Year Results of Faricimab for Aflibercept-Resistant Diabetic Macular Edema.

To assess the 12 month outcomes of intravitreal faricimab (IVF) in treatment-resistant diabetic macular edema (DME) recalcitrant to intravitreal aflibercept (IVA). This study was undertaken as a retrospective interventional case series of DME subjects receiving care at a single private practice facility. Subjects at baseline had undergone ≥8 IVA injections over the previous 12 months, ≥4 IVA injections over the previous 6 months, had an optical coherence tomography (OCT)-measured central macular thickness (CMT) of ≥320 microns, and had observable edema on OCT. The baseline visit for this study's purpose was considered the examination in which the subject was changed from IVA to IVF. Subjects were managed with a treat-and-extend (TAE) protocol and followed over 12 months from baseline. A total of 51 eyes of 51 subjects were analyzed. There were 39.2% (20/51) of patients who reached a treatment interval of ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT of the patient population reduced from 400.2 (385.3-415.3) microns at baseline to 340.6 (324.3-356.9) microns at 12 months (p<0.01). There were 21.6% (11/51) of patients who improved ≥3 lines of Snellen visual acuity at 12 months. The visual acuity of the overall study population improved from 0.60 (0.54-0.66) logMAR (Snellen 20/80) at baseline to 0.47 (0.41-0.53) logMAR (Snellen 20/59) at 12 months (p<0.01). A longer treatment interval and improved functional and anatomical outcomes at 12 months may be attained in a clinically significant minority of aflibercept-resistant DME patients after changing to IVF when a TAE protocol is employed. Specialists may consider IVF whenever resistance to IVA is experienced in this patient population.

One-Year Outcomes of Faricimab Treatment for Aflibercept-Resistant Neovascular Age-Related Macular Degeneration.

To assess the 12-month outcomes of intravitreal faricimab (IVF) in treatment-resistant neovascular age-related macular degeneration (nAMD) subjects recalcitrant to intravitreal aflibercept (IVA). This study was conducted as a retrospective interventional case series of nAMD patients receiving treatment at a single private practice institution. All included patients at baseline had undergone six or more IVA injections over the previous 12 months, four or more IVA injections over the previous 6 months, had a central macular thickness (CMT) ≥320 µm on optical coherence tomography (OCT), and were observed to have intraretinal and/or subretinal fluid on OCT assessment. The baseline exam for the purpose of this study was considered the visit in which the patient was switched from IVA to IVF. Patients were managed with a real-world treat-and-extend protocol and followed over a 12-month study period. A total of 54 eyes of 54 subjects were analyzed. Overall, 31.5% (17/54) of subjects attained a treatment interval ≥8 weeks and had a fluid-free macula on OCT at 12 months. The CMT on OCT decreased from 395.4 (383.5-407.3) µm at baseline to 350.0 (335.1-364.8) µm at the end of the 12-month study interval (p<0.01). There were 16.7% (9/54) of subjects who gained three or more lines of Snellen visual acuity at the end of the study. Visual acuity improved from 0.72 (0.67-0.77) logMAR (Snellen 20/105) at baseline to 0.59 (0.55-0.64) logMAR (Snellen 20/78) at the end of the study (p<0.01). A clinically significant minority of aflibercept-resistant nAMD subjects may attain longer treatment intervals and improved outcomes at 12 months after switching to IVF when a treat-and-extend treatment protocol is utilized. IVF use may be considered whenever resistance to IVA is encountered in this patient population.

Explantation of KAMRA Corneal Inlay: 10-Year Occurrence and Visual Outcome Analysis.

PurposeTo evaluate 10 years of KAMRA corneal inlay explantation and associated visual outcomes.Patients and MethodsSingle-site retrospective chart review of 22 cases of AcuFocus KAMRA Inlay (ACI7000PDT) explantation (range 1 week–1 year). Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and manifest refraction at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year post-explantation were reviewed.ResultsThe explantation rate was 8.2% across 10 years. All patients underwent KAMRA explantation due to dissatisfaction with their vision including blurry near vision, impaired night vision, decreased vision in dim lighting, streaks or halos, haze, and double vision. Mean UDVA pre-implant was −0.01±0.13 logMAR (logarithm of the minimal angle of resolution), 0.30±0.22 logMAR pre-explant, and 0.16±0.15 logMAR post-explant (n=20). Mean UNVA pre-implant was 0.37±0.09 logMAR, 0.38±0.13 logMAR pre-explant, and 0.42±0.21 logMAR post-explant (n=20). Mean CDVA pre-implant was −0.01±0.04 logMAR and 0.05±0.11 logMAR post-explant (n=17). Mean CDVA pre-explant was 0.04±0.07 logMAR and 0.04±0.11 logMAR post-explant (n=19). Significant differences were observed between pre-implant and post-explant UDVA (p=0.009), and between pre-explant and post-explant UDVA (p=0.02). All patients (100%) had 20/20 or better CDVA pre-implant but decreased to 73.7% post-explant. Sixty percent (12/20) of the patients lost UDVA Snellen acuity lines post-explant. MRSE was −0.31±0.29 D pre-implant and +0.26±0.77 D post-explant (p=0.007) with note of a hyperopic shift. The hyperopic shift in 31.6% (6/19) of patients did not resolve after explantation. Post-explant residual corneal haze occurred in 72.7% (16/22) of patients.ConclusionAlthough the KAMRA corneal inlay is a removable device, patients may experience residual corneal haze, hyperopic shift, and deficits in UDVA after explantation compared to pre-implantation UDVA.

The outcomes of trans-scleral cyclophotocoagulation in pediatric glaucoma secondary to Sturge-Weber syndrome

To report the outcomes of trans-scleral cyclophotocoagulation (TSCPC) in pediatric glaucoma secondary to Sturge-Weber syndrome (SWS). The medical records of all SWS glaucoma cases in the pediatric age group (<18 years of age) that underwent TSCPC at our institute from January 2000 to September2017. A total of 22 eyes of 22 patients were included. Mean age at the time of TSCPC was 5.9 ± 5 years (range, 0-16 years). Mean postoperative follow-up was 32.2 ± 16.6 months (range, 6-54 months). Intraocular pressure (IOP) was reduced from a preoperative mean of 28 ± 4.5 mm Hg to 20.3 ± 3.7 mm Hg at 36 months (P = 0.02). The mean number of glaucoma medications used was 3.5 ± 0.7 preoperatively and 3.1 ± 1.4 at 36 months (P = 0.70). The overall success rate (complete and qualified) was 72.7% at 12 months, 62.3% at 24 months, and 54.5% at 36 months. One eye developed hypotony and choroidal effusion, which resolved with medical therapy. Of the patients for whom visual acuity was recorded preoperatively, no one experienced a loss of more than 2 lines of Snellen visual acuity. In our study cohort, TSCPC resulted in mild reduction in IOP, with minimal complications.

Micropulse Cyclophotocoagulation: A Multicenter Study of Efficacy, Safety, and Factors Associated With Increased Risk of Complications.

The purpose of this study was to evaluate the efficacy and complications of MPCP in a large series of patients with all stages of glaucoma. Multicenter, retrospective chart review of patients from 3 clinical sites. One hundred sixty-seven eyes of 143 patients. MPCP was performed with 2000 mW energy, 31.3% duty cycle and 2 to 4 180-degree applications of 80 seconds duration each per treatment. The procedure was considered a failure if any of the following occurred: additional IOP lowering intervention, <20% IOP reduction from baseline at the last follow-up (with or without medication), or severe complications. Mean age was 71 years, 53% were female, and 53% were Asian. 60% of eyes had POAG, 63% were pseudophakic, 38% had prior glaucoma surgery, and 51% had Snellen visual acuity (VA) of 20/40 or better. Mean follow-up time was 11.9±7.8 months. Mean IOP was 21.9±8.4 mm Hg before intervention, and 17.4±7.2 mm Hg at last follow-up (P<0.0001). There was no change in mean logMAR VA (P=0.0565) but 15% lost ≥3 Snellen lines of VA. The success rate was 36.5% (61/167 eyes) at last follow-up. The probability of survival by Kaplan-Meier analysis was 82%, 71%, and 57% at 3, 6, and 12 months after the procedure, respectively. The reasons for failure were additional intervention in 47%, inadequate IOP reduction in 14%, and severe complication in 1.8%. In a multivariable Cox proportional hazard model, female sex was associated with a 56% decrease in failure rate compared with males (P<0.0001), while a unit increase in baseline IOP corresponded with a 5.7% increase in failure rate (P<0.0001). If repeat MPCP was allowed then success rate increased to 58%. There were no complications in 73% (122/167) but 11% (18/167) had persistent complications at the last follow-up and half of these 18 eyes had decrease in VA of 1 to 6 Snellen lines. Asian race (odds ratio 13.5, P=0.0131) and phakic status (odds ratio 3.1, P=0.0386) were associated with higher odds of developing mydriasis, which was the most common complication. MPCP lowered IOP in the short-term but nearly half required additional IOP lowering intervention. Potential complications should be discussed in detail especially when the procedure is being considered for those with good VA and early stage disease.

Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for Visual Rehabilitation in Limbal Stem Cell Deficiency

To evaluate the clinical outcomes of patients with limbal stem cell deficiency (LSCD) who were fitted with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral device. In this retrospective, interventional case series, we reviewed the charts of 31 eyes of 19 consecutive patients clinically diagnosed with LSCD who were evaluated for the PROSE device. Clinical data were reviewed before PROSE evaluation and at the last available follow-up. The main outcomes measures were best-corrected distance visual acuity (CDVA) and modified ocular involvement score (OIS), graded using a previously described system for corneal findings. Corrected distance visual acuity improved from 0.86±0.50 logarithm of the minimal angle of resolution (Snellen equivalent, 20/145) at baseline to 0.46±0.44 (Snellen equivalent, 20/58) with PROSE at the last follow-up (mean, 25.1±18.0 months; P<0.0001). In 27 eyes (87.1%) CDVA improved, with 22 eyes (71.0%) gaining 2 or more lines of Snellen acuity. When categorized by disease severity, CDVA improved in less severe eyes (stage 1) and more severe eyes (stage 2 or 3; P=0.049 and P=0.00009, respectively). Total OIS was not significantly different between baseline and last follow-up (P=0.754); however the epithelial defect score was significantly less (P=0.034). Twenty-four of 31 eyes (77.4%) continued wearing the PROSE device, with a mean daily wearing time of 10.0±4.6 hrs. In patients with LSCD, vision improved and the OIS remained stable with PROSE, suggesting that the device could be considered for visual rehabilitation in this population.

Resurgence of ocular syphilis in British Columbia between 2013–2016: a retrospective chart review

ObjectiveTo characterize the trends and explore the demographics, ophthalmic manifestations, and outcomes of ocular syphilis cases in British Columbia. DesignRetrospective chart review. ParticipantsOcular syphilis cases reported to the British Columbia Centre for Disease Control (BCCDC) between January 2013 and December 2016. MethodsThe demographic and clinical data were extracted from the BCCDC's centralized sexually transmitted infection database and the ophthalmologists’ clinical charts. ResultsThere was a steady increase in the rate of syphilis infection per 100 000 population, from 3.4 in 2010 to 18.4 in 2018. There were 39 ocular syphilis cases identified from January 2013 to December 2016. The median age was 50 years (interquartile range: 40–59.5 years); 82.1% were male and 51.3% were HIV positive. The clinical charts belonging to 32 patients were available for review, 14 of which (43.8%) presented with bilateral ocular complaints (46 affected eyes). The most commonly noted ocular presentations were uveitis (93.5%), including retinal vasculitis in 54.3%, and optic nerve involvement in 65.2% (which included papillitis, optic nerve swelling, or pallor). Panuveitis was the most frequent type of uveitis (52.2% of all eyes); 77.8% of affected eyes with best-corrected visual acuity (BCVA) ≤20/50 on presentation had an improvement of 2 or more Snellen lines of visual acuity at their final assessment. At presentation, 37.0% of eyes had BCVA ≤20/200, which decreased to 17.1% at final assessment. ConclusionOcular syphilis, although rare, is on the rise globally and can result in serious ocular sequelae. A high index of suspicion is required for proper diagnosis and treatment.

COMPARISON OF VISUAL AND ANATOMICAL OUTCOMES OF EYES UNDERGOING TYPE I BOSTON KERATOPROSTHESIS WITH COMBINATION PARS PLANA VITRECTOMY WITH EYES WITHOUT COMBINATION VITRECTOMY.

To determine whether 1-year visual and anatomical results after surgery combining pars plana vitrectomy, Boston keratoprosthesis, and a glaucoma drainage device as needed are similar, better, or worse than Boston keratoprosthesis initial implantation alone. We performed a retrospective review of adult patients undergoing Boston keratoprosthesis at our institution. Visual acuity outcomes, anatomical results, and complication rates of patients undergoing combination surgery (including pars plana vitrectomy and a posterior glaucoma drainage device) were compared with those undergoing keratoprosthesis placement alone. There were 70 eyes in the keratoprosthesis alone group and 55 eyes in the keratoprosthesis with pars plana vitrectomy group. Mean follow-up durations were 54.67 months in the keratoprosthesis alone group and 48.41 months in the combination group. Baseline mean Snellen equivalent visual acuities were worse for the combination group compared with the keratoprosthesis alone group (P = 0.027). Visual acuities improved postoperatively by 1 month after keratoprosthesis implantation for both groups and improved three or more lines of Snellen acuity in the majority of eyes for both groups (≥72% by 12 months). Eyes undergoing pars plana vitrectomy had lower rates of de novo (P = 0.015) and significantly lower rates of secondary procedures (P = 0.002) at 1 year. One year complications rates for retroprosthetic membrane formation, retinal detachment, hypotony, cystoid macular edema, epiretinal membrane formation, endophthalmitis, and corneal melting were similar for both groups. Compared with keratoprosthesis alone, combining keratoprosthesis with pars plana vitrectomy and a glaucoma drainage device as needed, resulted in lower rates of de novo glaucoma, lower rates of additional surgical procedures, similar visual acuity outcomes at 1 year, and did not result in higher complication rates.

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria

ImportanceTo investigate the safety, effectiveness and follow‐up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria.BackgroundThere is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor.DesignProspective case series.ParticipantsNew glaucoma patients where surgical intervention was recommended.MethodsA diode 810 nm laser G‐probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits.Main Outcome MeasuresIOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications.Results201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re‐treated. Mean pre‐treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7–45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months.Conclusions and RelevanceTransscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short‐term preservation of vision and minimal complications. Poor follow‐up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow‐up is less critical.

Stem Cell Ophthalmology Treatment Study: bone marrow derived stem cells in the treatment of Retinitis Pigmentosa.

Seventeen patients with bilateral visual loss due to Retinitis Pigmentosa (RP) underwent autologous bone marrow derived stem cell (BMSC) treatment within the Stem Cell Ophthalmology Treatment Study (SCOTS and SCOTS 2). Both are National Institutes of Health (NIH) and Office of Human Research Protection (OHRP) compliant Institutional Review Board (IRB) approved clinical studies utilizing using autologous BMSC in the treatment of retinal and optic nerve diseases that meet inclusion criteria. The average age of the patients treated was 48.8 years. The average duration of disease prior to treatment was 27.6 years and ranged from 4 to approximately 60 years. Affected eyes were treated with either retrobulbar, subtenons and intravenous BMSC or retrobulbar, subtenons, intravitreal and intravenous. Follow up was provided a minimum of 6 months. The primary outcome was visual acuity as measured by Snellen or converted to LogMAR. Following therapy in SCOTS or SCOTS 2, 11 patients (64.7%) showed improved binocular vision averaging 10.23 lines of Snellen acuity per eye over pre-treatment acuity; 8 patients (35.3%) remaining stable over the follow up period; no patients experiencing loss of overall acuity. In 33 treated eyes, 15 eyes (45.5%) improved an average of 7.9 lines of Snellen acuity, 15 eyes (45.5%) remained stable, and 3 eyes (9%) worsened by an average of 1.7 lines of Snellen acuity. Improvements ranged from 1 to 27 lines of vision. Using the LogMAR Scale and calculating delta as a ratio to pre-treatment vision in improved eyes, acuity improvement ranged from 23% to 90% with an average of 40.9% visual acuity improvement over baseline vision. Evaluation of all patients and eyes capable of LogMAR vision showed an average of 31% improvement in vision over baseline. Findings were of statistical significance (P=0.016). There were no surgical complications. The BMSC protocols of the SCOTS achieved meaningful visual acuity improvements or stability in RP that were of statistical significance. Duration of disease did not appear to affect the ability of eyes to respond. Safety was confirmed. Possible mechanisms by which improvement occurred may include transdifferentiation of BMSC into Neuronal Nuclei (NeuN) positive cells, BMSC paracrine secretions or neurotrophic factors and hormones, transfer of mitochondria, release of messenger RNA or other compounds via exosomes or microvesicles. Given the successful outcome in this otherwise progressive condition, consideration should be given to providing this treatment option.

Femtosecond assisted intracorneal segments implantation for mild to moderate keratoconus: long term results

PurposeTo describe the 2 year results of femtosecond assisted intracorneal segments implantation for the treatment of mild to moderate keratoconus with the use of a femtosecond laser.MethodsProspective case series including 4 eyes of 4 consecutive patients with keratoconus. Patients where implanted with KC Solutions intrastromal segments (IS). Patients’ assessment included visual acuity measurement, manifest refraction, clinical examination and corneal topography and tomography. IS implantation was scheduled in patients with unsatisfying corrected visual acuity (CDVA) and contact lens intolerance. Planning of the operation was done based on the topography and refraction based on nomogram provided by the IS manufacturer. IS were implanted in intracorneal pocket created with the FS200 femtosecond laser. Comparisons were made between pre‐ to postoperative values with the Wilcoxon signed‐rank test.ResultsPreoperative average steep keratometry was 48.45D (range 45.6 to 51.6), whereas at 2 years postoperatively it was 46.73 (44.8 to 48.7), (p&lt;0.05). Preoperatively corneal astigmatism on average was 4.95D (2 to 9.1) and refractive astigmatism was 3.94D (2 to 9), whereas postoperatively average corneal and refractive astigmatism was 2.75 (1.2 to 6) and 1.87 (range 0,5 to 5) (p&lt;0.05 in both comparisons). CDVA improved in all cases by 1 to 2 lines of Snellen visual acuity. Average spherical equivalent refraction was ‐3.22 (‐1.87 to ‐4.5) preoperatively, and postoperatively it was reduced to ‐1,81 (‐0.50 to ‐3,5) (p&lt;0.05). No statistically significant differences were found between the last and 6th month follow up results.ConclusionsAccording to our pilot long term study, Implantation of KC Solutions intrastromal segments with the aid of a femtosecond laser improved all patients’ topographic and refractive astigmatism, visual acuity and refraction.

Magnetic Oculomotor Prosthetics for Acquired Nystagmus

PurposeAcquired nystagmus, a highly symptomatic consequence of damage to the substrates of oculomotor control, often is resistant to pharmacotherapy. Although heterogeneous in its neural cause, its expression is unified at the effector—the eye muscles themselves—where physical damping of the oscillation offers an alternative approach. Because direct surgical fixation would immobilize the globe, action at a distance is required to damp the oscillation at the point of fixation, allowing unhindered gaze shifts at other times. Implementing this idea magnetically, herein we describe the successful implantation of a novel magnetic oculomotor prosthesis in a patient.DesignCase report of a pilot, experimental intervention.ParticipantA 49-year-old man with longstanding, medication-resistant, upbeat nystagmus resulting from a paraneoplastic syndrome caused by stage 2A, grade I, nodular sclerosing Hodgkin's lymphoma.MethodsWe designed a 2-part, titanium-encased, rare-earth magnet oculomotor prosthesis, powered to damp nystagmus without interfering with the larger forces involved in saccades. Its damping effects were confirmed when applied externally. We proceeded to implant the device in the patient, comparing visual functions and high-resolution oculography before and after implantation and monitoring the patient for more than 4 years after surgery.Main Outcome MeasuresWe recorded Snellen visual acuity before and after intervention, as well as the amplitude, drift velocity, frequency, and intensity of the nystagmus in each eye.ResultsThe patient reported a clinically significant improvement of 1 line of Snellen acuity (from 6/9 bilaterally to 6/6 on the left and 6/5–2 on the right), reflecting an objectively measured reduction in the amplitude, drift velocity, frequency, and intensity of the nystagmus. These improvements were maintained throughout a follow-up of 4 years and enabled him to return to paid employment.ConclusionsThis work opens a new field of implantable therapeutic devices—oculomotor prosthetics—designed to modify eye movements dynamically by physical means in cases where a purely neural approach is ineffective. Applied to acquired nystagmus refractory to all other interventions, it is shown successfully to damp pathologic eye oscillations while allowing normal saccadic shifts of gaze.

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome.

PurposeTo determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period.MethodsPatients with deterioration in vision in at least one eye of 3 lines of Snellen acuity or 15 letters on ETDRS chart or deterioration in visual field deviation of 3 decibels due to health service initiated delay in review or care were ascertained through the BOSU using prospective active surveillance involving all UK consultant ophthalmologists. Demographic details, diagnosis, cause and length of delay, and vision loss were then sought by questionnaire.Results238 cases reported between March 2015 and February 2016. 197/238 questionnaires were returned (83%). Twenty-eight reports were out of the study period or did not meet the case definition. Median age was 76 years (range: 1 to 98 years). Median delay was 22 weeks (range: 2 days to 5½ years). Seventy two per cent experienced permanent reduction in visual acuity, 23% permanent deterioration in visual field. Main diagnoses were Glaucoma 42%, Age-related Macular Degeneration (AMD) 23%, and Diabetic Retinopathy (DR) 16%. Eighteen patients were eligible for Severely Sight Impaired (SSI) or Sight Impaired (SI) registration. Main causes were delayed follow-up (76%), lost referral (7%), and delayed treatment (8%).ConclusionPatients are suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This is occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.

Vision Loss and Recovery after Baerveldt Aqueous Tube Shunt Implantation.

This study aims to determine the course of vision loss after Baerveldt aqueous tube shunt placement and identify risk factors associated with unexplained severe long-term vision loss, or snuff-out. We retrospectively reviewed 247 eyes of 222 patients who underwent Baerveldt implantations at one of two academic institutions. Postoperative vision loss at 6 months following surgery was categorized as mild-to-moderate versus severe and long-term versus transient. Long-term vision loss, defined as 3 or more lines of Snellen visual acuity (VA) loss compared with preoperative VA, occurred in 63 of 247 eyes (25.5%), and 39 had mild-to-moderate and 24 had severe loss. Of these 63 eyes, 18 had no identifiable cause of vision loss. On multivariate analysis, poorer Snellen VA on postoperative day 1 (POD1) was found to be a significant risk factor for long-term vision loss (p = 0.005). In addition, the negative change in preoperative versus POD1 Snellen VA (p = 0.021) and the presence of split fixation involving the inferonasal quadrant on preoperative Humphrey visual field (p = 0.044) were significant risk factors for snuff-out. Transient vision loss occurred in 76 of 242 eyes (30.8%). In conclusion, vision loss is not uncommon after Baerveldt surgery, with snuff-out occurring in 2.4% of cases in this study.

Treatment of Serpiginous Choroiditis with Chlorambucil: A Report of 17 Patients

ABSTRACTPurpose: To evaluate the efficacy of chlorambucil in the treatment of serpiginous choroiditis.Methods: Patient records from the Massachusetts Eye Research and Surgery Institution (MERSI) were reviewed from over the past 10 years. In total, 17 patients with the diagnosis of serpiginous choroiditis treated with chlorambucil were identified. QuantiFERON gold was negative in all of them. Chlorambucil was started at 0.15 mg/kg and dosage was titrated up using weekly white blood cell (WBC) count to achieve a target cell number of 3.0–4.5 × 109 cells/L. The goal of therapy was to maintain this value for at least 6–9 months. Adverse effects, recurrence, rate of new choroidal neovascularization (CNVM), and visual acuity before and after treatment were recorded.Results: The mean age of the 17 patients with the diagnosis of serpiginous choroiditis treated with chlorambucil was 46 years, and six patients (35%) were male. The mean duration of treatment for chlorambucil was 8.4 months. None of them developed cancer or persistent side-effects, with a mean follow-up of 53 months. Of the patients, 12 (71%) achieved an average of 45 (5–120) months drug-free remission in their last follow-up. Visual acuity of 33 treated eyes remained within two lines of Snellen acuity in 27 eyes (82%), improved in one eye (3%), and deteriorated in five eyes (15%). Leukopenia was the most common side-effect, which was reversible in all cases.Conclusions: Chlorambucil in a relatively short duration of time, with an escalating dose guided by weekly WBC was well tolerated, as well as effective in preventing recurrence and maintaining vision in patients with serpiginous choroiditis.

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

AimsTo investigate the effect of intravitreal dexamethasone implant (IVD) on central foveal thickness (CFT), choroidal thickness (CT) and its correlation with visual acuity in eyes with refractory diabetic macular oedema (DMO).MethodsThis was a retrospective interventional case-series. Thirty-five eyes of 35 patients were treated with a single injection of IVD because of refractory DMO with CFT over 300 μm, and persistent intraretinal and subretinal fluid despite of multiple intravitreal bevacizumab injections. Patients were followed-up for 6 months for the evaluation of CFT and subfoveal CT by spectral-domain optical coherence tomography.ResultsAll eyes (mean age: 59.4±12.35 years; 18 males, 17 females) had been previously treated with multiple bevacizumab injections and showed persistent DMO (mean number of injections 4.08±2.98) The preoperative logMAR BCVA was 0.49±0.24, which gradually improved to 0.46±0.32 at 6 months (P=0.652) and 26% gained two or more lines of Snellen visual acuity. At baseline, the mean CFT was 526.29±123.48 μm, which significantly improved to 316.15±100.09 μm at 3 months (P<0.001). However, CFT deteriorated to 457.07±136.53 μm at 6 months (P=0.051). Similarly, the mean preoperative subfoveal CT was 288.91±36.47 μm and it decreased to 266.85±30.93 μm at 3 months (P<0.01), but increased to 278.63±32.55 μm at 6 months (P=0.137). The reduction of CFT from baseline showed significant correlation with that of subfoveal CT at 3 months (P=0.041) and at 6 months (P=0.008).ConclusionsIn DMO refractory to multiple bevacizumab injections, IVD significantly reduced CFT and subfoveal CT, with BCVA improvement in one-fourth of the patients. The reduction of CFT showed significant correlation with reduction of subfoveal CT.

Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone

To compare the results of corneal collagen cross-linking (CXL) alone with combined simultaneous topography-guided photorefractive keratectomy plus CXL (tPRK-CXL) for progressive keratoconus for a 3-year interval. Prospective, comparative interventional case series. Forty-eight patients (60 eyes) with progressive keratoconus. Thirty eyes underwent combined tPRK with a solid-state laser (maximum ablation depth, 50 μm) followed by CXL, and 30 eyes underwent CXL alone. Groups were matched in terms of age and keratoconus stage. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), keratometry, and corneal confocal microscopy. Mean follow up was 39±11 months. Mean age at operation was 28±5.82 years. Before surgery, average CDVA in the tPRK-CXL group was 0.26±0.17 logarithm of the minimum angle of resolution (logMAR), and in the CXL group was 0.24±0.18 logMAR (P= 0.58). At last follow-up, CDVA was 0.09±0.10 logMAR in the tPRK-CXL group and 0.15±0.12 logMAR in the CXL group (P < 0.05). In both groups, no patient lost more than 2 lines of Snellen visual acuity, whereas 19 eyes and 8 eyes in the tPRK-CXL group and in the CXL group, respectively, gained 2 or more lines of CDVA. Before surgery, average UDVA was 0.83±0.54 logMAR in the tPRK-CXL group and 0.86±0.62 logMAR in the CXL group (P= 0.79). At last follow-up, UDVA was 0.27±0.25 logMAR in the tPRK-CXL group and 0.69±0.58 logMAR in the CXL group (P < 0.001). Before surgery, steep and flat keratometry had no significant differences between groups, and at last follow-up, both steep and flat keratometry readings were significantly flatter in the tPRK-CXL group compared with the CXL group. Depth of CXL treatment, as evaluated by confocal microscopy, was 269.8±31.8 μm in the CXL group and 299.7±29.8 μm in the tPRK-CXL group (P<0.001). No differences were found in endothelial cell density. Simultaneous tPRK followed by CXL in this series of keratoconus patients offered significantly improved vision to treated patients in comparison with CXL alone, and similar results regarding postoperative stability. Safety concerns regarding corneal thickness were taken into account in treatment planning.

Aspheric Ablation Depth as the Target Depth for Enhanced Wavefront-Guided Myopic Retreatments After Laser-Assisted In Situ Keratomileusis.

To propose a new adjustment method and present the clinical result of wavefront-guided myopic laser-assisted in situ keratomileusis (LASIK) retreatment with an aspheric program-targeted central ablation depth to avoid refractive overcorrection. Thirty-two eyes (of 20 consecutive patients) that underwent wavefront-guided LASIK myopic retreatment between January 2009 and February 2012 after primary wavefront-guided LASIK for myopia were included. Wavefront-guided retreatments were performed using the Bausch and Lomb Technolas 217z100 excimer laser system. Wavefront-guided retreatments were adjusted by setting the ablation depth corresponding to the ablation depth determined by the aspheric program. The refractive outcome, visual outcome, and outcome of high-order aberrations (HOAs) were analyzed. Linear mixed models were also used to evaluate the predicting factors for retreatment offset. Mean age was 29.5 ± 3.1 years. Spherical equivalent (SE) before retreatment was -1.0 ± 0.44 diopters (D) (range, -2.25 to -0.5). Twelve months postoperatively, SE was -0.03 ± 0.12 D, and 31 of 32 eyes had an uncorrected visual acuity 20/20 or better. All eyes were within ±0.5 D. None of the eyes had lost >2 lines of Snellen visual acuity. Safety and efficacy indices were 1.03 and 1.00, respectively. Total HOA, coma, and trefoil were reduced significantly (P = 0.028, P = 0.036, P = 0.034, respectively). Predictive factors for the amount of offset required are significantly related to preoperative SE (P = 0.006) and spherical aberration (P = 0.03, adjusted by SE). Setting the target ablation depth using the aspheric program provided high refractive predictability with a satisfactory visual outcome, significant reduction of HOAs, and no overcorrections.

Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty.

To evaluate the efficacy, refractive outcomes, and complications of supplementary intraocular lens (IOL) implantation in pseudophakic eyes after keratoplasty. This is a retrospective review of pseudophakic postkeratoplasty eyes after implantation of a custom-designed, sulcus-fixated, supplementary "piggyback" IOL to correct refractive errors. The outcome measures included preoperative and postoperative uncorrected distance visual acuity (UDVA), spectacle-corrected distance visual acuity (CDVA), refractive correction, and complications. This study evaluated 10 eyes (10 patients) with previous penetrating or deep anterior lamellar keratoplasty with a mean follow-up period of 12.2 ± 10.7 months (range, 2-33 months). All eyes showed improved UDVA postoperatively with 70% achieving ≥20/40. Median UDVA (logarithm of the minimum angle of resolution) improved from 1.2 (20/280, range 20/70-20/2000) preoperatively to 0.3 (20/40, range 20/20-20/60) postoperatively at the latest follow-up visit (P < 0.01). Five eyes (50%) had improvement in CDVA by at least 1 line of Snellen acuity with all eyes achieving ≥20/40 and 70% achieving ≥20/25. Median CDVA (logarithm of the minimum angle of resolution) was 0.2 (20/30, range 20/20-20/50) preoperatively compared with 0.1 (20/25, range 20/20-20/40) postoperatively (P = 0.03). In 8 eyes that received toric secondary IOLs, the mean refractive astigmatism decreased by 84% from 5.7 diopters (D) (range, 4-9 D) to 0.9 D (range, 0.2-3.0 D) (P = 0.01). Postoperative refractive astigmatism was ±1 D of predicted astigmatism for 7 of 8 eyes. No eyes lost any lines of UDVA or CDVA, and there were no keratoplasty rejection/failure events. Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.