Lines Of Acuity Research Articles

Características clínicas, manejo y resultados de los pacientes con endoftalmitis estéril asociados con la inyección intravítrea de factores de crecimiento endotelial antivascular

PurposeAnalyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. MethodsObservational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. ResultsSeven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n=5 and ranibizumab n=2). These patients have some active neovascular condition: age related macular degeneration (n=4), myopic choroidal neovascularization (n=1) or macular edema: diabetic macular edema (n=1), branch retinal vein occlusion (n=1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. ConclusionDifferentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment.

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.

Optimization of the Light Sword Lens for Presbyopia Correction.

PurposeWe propose and evaluate the modifications of a light sword lens (LSL) to obtain better performance for distance vision while maintaining good operation for near and intermediate vision.MethodsThe modifications consisted of assigning angular or circular windows for distance vision while rescaling the LSL profile in the remaining area of the element. The objective performance of the redesigned LSLs was verified numerically by the Strehl ratio and experimentally using correlation coefficients and Michelson contrast. Subjective assessments were provided by monocular visual acuity (VA) and contrast sensitivity (CS) through-focus curves for six patients with paralyzed accommodation. The tested object vergence range was [–4.0, 0.0] diopters (D). All experiments were conducted in a custom-made monocular visual simulator.ResultsComputational simulations and objective experiments confirmed the better performance of the modified LSL for the imaging of distant objects. The proposed angular and radial modulations resulted in flat VA and CS through-focus curves, indicating more uniform quality of vision with clearly improved distance vision. The VA provided by the modified LSL profiles showed a maximal improvement of 1.5 lines of acuity with respect to the VA provided by the conventional LSL at distance vision.ConclusionsOptimized LSLs provide better imaging of distant objects while maintaining a large depth of focus. This results in comparable and acceptable quality for distance, intermediate, and near vision. Therefore, the modified LSLs appear to be promising presbyopia correctors.Translational RelevanceThe new design of LSL reveals an improved performance for all ranges of vision and becomes a promissory element for a real presbyopia correction in clinical applications.

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.

Real-world Outcomes among Eyes with Center-Involving Diabetic Macular Edema and Good Visual Acuity

ABSTRACT Purpose We aimed to determine long-term visual and anatomical outcomes among patients with center involving-diabetic macular edema and good vision and evaluate factors associated with visual and anatomic outcomes. Materials and Methods In this retrospective study, all patients with type 2 diabetes aged ≥18 years had seen at the Wilmer Eye Institute between March 2015-June 2018 and with diabetic macular edema confirmed on spectral-domain optical coherence tomography imaging were included, provided they had visual acuity of 20/30 or better in ≥1 eye and a follow-up duration of ≥3 clinic visits. Change in logMAR visual acuity and central 1 mm foveal thickness from baseline, lines of visual acuity gained/lost for overall cohort stratified by treatment were analyzed. Results Among 197 (243 eyes) participants, mean (± standard deviation) age was 63.4 ± 11.2 years, and half were males. Average duration of follow-up was 1.7 ± 0.7 years. One hundred and forty-six eyes (60%) received anti-vascular endothelial growth factor injections, at an average of 3.7 ± 2.9 injections/eye/year. Mean logMAR visual acuity at baseline was 0.1 ± 0.1 [Snellen 20/25] in both treatment and observation (no anti-vascular endothelial growth factor treatment received during and 3 months prior to the study inclusion period) groups. Final logMAR visual acuity was 0.2 ± 0.2 in the treatment group [Snellen 20/32] versus 0.1 ± 0.3 in observation group [Snellen 20/25]; (p = .23). Mean central foveal thickness changed from 333 ± 66 to 308 ± 45 microns in treatment group and 319 ± 41 to 308 ± 65 microns in observation group. Conclusions After an average of 1.7 years of follow-up, there were no significant differences in final vision or central foveal thickness irrespective of whether patients received or did not receive treatment with anti-vascular endothelial growth factor injections.

Outcome simultaneous replacement of stromal donor lenticul in cornea with ectasia during Smile surgery

AbstractPurposeLenticule implantation can be used to correct vision problems. The aim of the present study was to investigate the feasibility and effects of Simultaneous replacement of stromal donor lenticul in cornea with ectasia during Smile surgeryMethodsSix patients with decreased visual acuity due to corneal ectasia were included in this prospective pilot study. These lenticules were extracted during SMILE procedures using the VisuMax femtosecond laser (Carl Zeiss Meditec) on 6 donors with myopia and Simultaneous replacement of stromal donor lenticul in cornea with ectasia. Pre‐ and postoperative (1 or 3 days, 1 month, and 6 months) slit lamp microscopy, corneal topography, anterior segment optical coherence tomography, and in vivo confocal microscopy were performed.ResultsThe surgeries and postoperative follow‐up examinations were uneventful and no complications were noted over 6 months of follow‐up. At the last measurement, the corrected distance visual acu‐ity of all recipient eyes gained at least two lines. Two eyes (33.3%) gained at least two lines of uncorrected distance visual acuity compared to their preoperative levels.Mean keratometric power increased by 5.97 ± 3.73 diopters and central corneal thickness increased by 55.25 ± 36.38 μm. Anterior segment optical coherence tomography observation showed the lenticule was transparent with a visible demarcation line during the follow‐up examination.ConclusionsThis technique seems to be feasible and safe for increasing corneal stromal thickness and changing corneal refractive power, which may provide a useful method for treatment of keratoectasia, presbyopia, and hyperopia.

LONG-TERM VISUAL OUTCOMES AND CLINICAL FEATURES AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION-RELATED ENDOPHTHALMITIS.

To determine long-term visual outcomes in patients who developed endophthalmitis after intravitreal anti-vascular endothelial growth factor injections and to correlate visual outcomes with clinical features. This is a retrospective, multicenter, consecutive case series of patients diagnosed with anti-vascular endothelial growth factor injection-related endophthalmitis who were treated at Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, PA, and the University of Southern California Roski Eye Institute, Los Angeles, CA. Patients were included if they had at least 1 year of follow-up. Primary outcome was to evaluate long-term visual outcomes up to 5 years of follow-up. The secondary outcome was to determine clinical features (e.g., culture results) that may predict long-term visual acuity outcomes. A total of 56 cases of endophthalmitis from 168,247 anti-vascular endothelial growth factor injections were identified (0.033%, 1/3,004 injections), from which 51 eyes met inclusion criteria. Mean follow-up period was 3.3 years (median 4 years; range 1-5 years). A total of 24 patients (47%) reached a maximum final follow-up of 5 years. Mean Snellen visual acuity at the causative injection visit was 20/102 and decreased to counting fingers at diagnosis (P < 0.001). At 6-month follow-up, mean visual acuity improved to 20/644 (P < 0.001) and remained stable up to 5 years (20/480, P = 0.003) follow-up compared with diagnosis. At the final follow-up, 20 eyes had visual acuity that returned to within one line of baseline visual acuity (visual recovery group), whereas 31 patients' visual acuity was at least one line worse than initial visual acuity (visual deterioration group). The cultures for the visual recovery group were more likely to grow coagulase-negative Staphylococcus, whereas the visual deterioration group primarily grew Streptococcus species, Staphylococcus aureus, and Enterococcus faecalis (P = 0.002, comparing organisms isolated in the visual recovery and deterioration group). Visual outcomes after anti-vascular endothelial growth factor injection-related endophthalmitis seem to reach peak improvement by 6 months and remain stable up to a median of 4-year follow-up. Patients who develop culture-negative endophthalmitis or endophthalmitis secondary to coagulase-negative Staphylococcus are more likely to regain baseline visual acuity compared with cases secondary to Streptococcus species.

SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY TO DETERMINE THE RECOVERY OF RETINAL LAYERS AFTER INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE: Correlation With Visual Acuity Improvement.

To analyze the recovery of retinal lines using swept-source optical coherence tomography after inverted internal limiting membrane flap technique to treat full-thickness macular hole, and the relationship between best-corrected visual acuity and retinal line repair. Thirty-eight eyes were evaluated for recovery of the external limiting membrane, photoreceptor inner segment/outer segment junction line, and cone outer segment tips (COST) line. Correlation between the recovery of retinal lines and best-corrected visual acuity improvement was analyzed 6 months after surgery. The closure rate of full-thickness macular hole was 97%. The best recovery rates were associated with external limiting membrane line recovery (25 eyes, 65.8%), followed by inner segment/outer segment line recovery (22 eyes, 57.9%), and less frequently, COST line recovery (9 eyes, 23.7%); moreover, recovery of the COST line was apparent only in eyes with recovered external limiting membrane and inner segment/outer segment lines. Mean postoperative visual acuity in the COST line recovery group (COST+) was 20/42 (0.48, 0.33 logarithm of the minimum angle of resolution), compared with 20/95 (0.21, 0.68 logarithm of the minimum angle of resolution) without COST line recovery (COST-). Final visual acuity was significantly better in the COST+ group compared with the COST- group (P = 0.002). Cone outer segment tips line recovery is correlated with best-corrected visual acuity improvement for eyes treated with inverted internal limiting membrane flap technique for full-thickness macular hole.

The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes.

PurposeTo evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome.MethodsPatient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. >0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors.ResultsTwo hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes.ConclusionsAlthough Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.

Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up.

Phakic intraocular lens (pIOL) models have indicated an association between cataract formation and inadequate vaulting. In this study, the efficacy and safety of low-vault posterior chamber pIOLs in the correction of myopia were examined over 3years. From 316 patients undergoing surgery, 14 eyes with a low vault (≤ 150μm) were examined from 14 patients. After implanting the Visian Implantable Collamer pIOL for the correction of myopia (moderate and high), the pIOL vault, endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), and detrimental events were examined over 3years. Based on the findings, the mean spherical equivalent reduced from - 8.15 ± 3.29 before surgery to - 1.02 ± 0.75 diopters 3years after the surgery. In terms of visual outcomes, the mean UDVA (Log MAR) significantly increased from 0.95 ± 037 to 0.27 ± 0.28, and the mean CDVA also increased from 0.99 ± 0.11 to 0.06 ± 0.08 (P < 0.05). The mean indices of safety and efficacy were respectively 1.075 and 0.748. The eyes lost not more than two visual acuity lines. Based on the findings, 82% achieved 0.80 or better CDVA, while the total endothelial cell loss was 7.96% during 3years. Overall, vision-threatening conditions were not reported. The introduced pIOL can be considered a safe and efficient method for myopia at moderate to high levels.

Visual and refractive outcomes of 100 small incision lenticule extractions (SMILE) in moderate and high myopia: a 24-month follow-up study.

We aimed to present the visual results obtained in 100 small incision lenticule extraction (SMILE) refractive surgeries, demonstrate whether the technique is effective in the treatment of moderate and high myopia, and observe the follow-up of these patients over 24-month period. One hundred eyes of 50 consecutive patients were treated with SMILE. The preoperative spherical equivalent refraction was - 5.64 ± 1.23 D. During the postoperative period, patients were examined at 3, 6, 12, and 24months. We analysed the efficacy, safety, predictability, and stability of the technique. The Snellen visual acuity of 99% of the patients was 20/20 or better after 24months of follow-up. Two eyes had a loss of two lines of visual acuity; 1% of the patients had a loss of one line of visual acuity. The postoperative spherical refraction was - 0.04 ± 0.35 D (- 1.00 to 0.50 D). The postoperative spherical equivalent refraction was - 0.19 ± 0.38 D (- 1.25 to 0.50 D). Eighty-three percent of the eyes were within ± 0.50 D, and 87% obtained a residual astigmatism of 0.50 D or less. The SMILE technique was demonstrated to be an effective, predictable, safe, and stable technique in the treatment of moderate-to-severe myopia during the 24-month follow-up. Long-term follow-up should be undertaken to observe possible refractive regressions.

Lensectomy after radial keratotomy: 1-year follow-up.

To report visual and refractive results in radial keratotomy (RK) patients that underwent a cataract surgery with a monofocal intraocular lens (IOL) implantation with 1year of follow-up. Twenty-eight eyes of 15 patients with cataract and the previous RK were included. All eyes underwent phacoemulsification and monofocal IOL implantation. IOL power calculation was done using the Double-K formula of Aramberri. The preoperative versus postoperative corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA) values were used to assess the efficacy and safety of the surgery; meanwhile, the achieved versus the expected refractive outcomes postoperatively were used to assess the predictability. Phacoemulsification and IOL implantation was performed successfully in all eyes, and no intra- and postoperative problems occurred. The mean logMAR UDVA significantly improved from 0.7 ± 0.3 to 0.4 ± 0.2 at 6months, and 0.3 ± 0.2 at 12months postoperatively. By the end of the follow-up period, about 60% of the eyes achieved 20/25 or better CDVA, 25% of the eyes gained three or more lines of visual acuity, and two eyes had lost one or more lines of visual acuity. The mean spherical equivalent improved from - 1 ± 6.00 to - 0.75 ± 1.1D by the end of the follow-up, and about 60% of the eyes were within ± 1D at 12months after the surgery. No intra- and postoperative problems occurred. Pseudophakic monofocal IOL implantation offers good visual acuity recovery and acceptable refractive correction in RK patients after 1-year follow-up.

Abrupt visual loss during anti-vascular endothelial growth factor treatment for type 3 neovascularization

To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.

Three-year follow-up of intrastromal corneal ring segment implantation in central keratoconus with regular astigmatism: 'Bow-tie' shape.

To assess the outcomes of implanting Ferrara-type intrastromal corneal ring segments in central 'bow-tie'-shaped keratoconus over 3 years of follow-up. A total of 20 eyes with central 'bow-tie'-shaped keratoconus were evaluated before and after implanting Ferrara-type intrastromal corneal ring segments (AJL Ophthalmic, Spain). LogMAR uncorrected distance visual acuity and best corrected distance visual acuity and residual refractive errors analysed using vector analysis were recorded preoperatively, at 6 months, 1 year, and 3 years postoperatively. The mean uncorrected distance visual acuity (LogMAR scale) rose from a preoperative 0.75 ± 0.28 to a 6-month postoperative 0.38 ± 0.28 (p < 0.0001). The corrected distance visual acuity, in turn, improved from 0.07 ± 0.06 to 0.05 ± 0.06 (p = 0.0008). Both the uncorrected distance visual acuity and corrected distance visual acuity were stable over the postoperative period in both groups (p > 0.05). None of the eyes lost uncorrected distance visual acuity and corrected distance visual acuity lines over the postoperative follow-up period. The spherical equivalent and the refractive cylinder declined steeply after intrastromal corneal ring segments implantation (p < 0.0001). Both the spherical equivalent and refractive cylinder were stable over the postoperative period. None of the eyes had an increase in maximum or minimum keratometry greater than 0.75D over the postoperative period. The planning for intrastromal corneal ring segments insertion proposed in this study reduces the spherical equivalent and refractive cylinder in this type of keratoconus, while improving post-surgery uncorrected distance visual acuity and corrected distance visual acuity. These results remain stable over 3 years of follow-up. Therefore, this procedure could be considered as an effective therapeutic alternative in patients affected by this type of keratoconus.

Evaluation of Aircrew Low-Intensity Threat Laser Eye Protection

Prototype low-intensity threat laser eye protection (LIT-LEP) spectacles were evaluated for US Coast Guard (USCG) cockpits and night vision goggle compatibility. The impetus for interest in aviation LIT-LEP is driven in part by the fact that easily accessible 0.5-2.0 W high-power laser pointers exceed safety standards for direct on-axis viewing. A repeated-measures experimental design was used to assess LIT-LEP performance relative to a no-LEP control for the following tasks: Near- and far contrast acuity, night vision goggle far-contrast acuity, emissive and non-emissive light source color-vision screening, and USCG multifunctional display color symbol discrimination reaction time and accuracy. Near- and far-contrast acuity results demonstrated good LIT-LEP performance for typical in- and out-of-cockpit lighting conditions. Night vision goggle performance suffered marginally at only one contrast level (85%; 20/30 acuity line). Color vision test results showed good color balance in that S-, M-, and L-cone performance did not demonstrate a clinical diagnostic color defect for emissive or non-emissive light sources when wearing LIT-LEP. Color symbol discrimination reaction-time-task results based on inverse efficiency scores revealed that some non-primary flight display colors exhibited a combination of slower speed and decreased accuracy. The findings will contribute to an acquisition decision as well as guide future LEP designs.

Ophthalmic Findings and Their Effect on Visual Function in Persons with Albinism in Southern Nigeria

Aim: To determine the pattern of ocular disorders in persons with albinism and how they affect visual function.&#x0D; Methods: This was a descriptive cross-sectional study conducted over a five-month period on persons living with albinism in Southern Nigeria. The study participants were randomly selected during the monthly meetings of a support group known as The Albinism Foundation (TAF).Visual acuity and contrast sensitivity were assessed using the ETDRS visual acuity chart and Pelli Robson contrast sensitivity test chart. A comprehensive eye examination including dilated fundoscopy was also carried out to determine other ocular disorders. Data was analyzed using SPSS version 22 and statistical significance was set at a p-value ≤ 0.05.&#x0D; Results: A total of 116 PWA (232 eyes) were examined. There were 44 (37.9%) males and 72 (62.1%) females. The age of the study subjects ranged from 5 to 56 years. Most eyes were visually impaired for both distance (n=228; 98.3%) and near vision (n= 224; 96.6%). Contrast sensitivity in most eyes (n=138; 59.5%) was subnormal. With refraction and Low Vision Aid (LVA), there was significant improvement of the mean VA by 2-3 acuity lines and 6 acuity lines respectively (p=0.000). All the examined eyes had fundus hypo-pigmentation, 91.4% (n=212) had iris trans-illumination, 86.2% (n=200) had nystagmus, and 34.4% (n=80) had strabismus. Nystagmus, strabismus and iris trans-illumination significantly (p=0.00) reduced visual acuity and contrast sensitivity.&#x0D; Conclusion: Most study participants had reduced distance visual acuity and contrast sensitivity but with correction there was a significant improvement in vision. The presence of nystagmus, strabismus and iris trans-illumination were observed to contribute to the poor vision experienced by most persons living with albinism. Hence, early optical intervention and counselling is important in improving the quality of living of persons with albinism.

Regenerative Surgery of the Corneal Stroma for Advanced Keratoconus: 1-Year Outcomes

This study evaluated 1-year safety and efficacy outcomes of corneal stroma cell therapy. Therapy consisted of implanting autologous adipose-derived adult stem cells (ADASc) with or without sheets of decellularized donor human corneal stroma within the stroma of patients with advanced keratoconus. This was a prospective interventional non-randomized series of cases. Fourteen consecutive patients were selected and divided into 3 experimental groups. Group A patients underwent implantation of autologous ADASc alone (3× 106 cells/1mL) (n= 5). Group B patients received decellularized donor 120-μm-thick corneal stroma lamina alone (n= 5). Group C patients had implantation of recellularized donor lamina with 1× 106 autologous ADASc plus another 1× 106 cells/1mL at the time of the surgery (n= 4). Autologous ADASc were obtained by elective liposuction. Implantation was performed in the corneal stroma through a femtosecond-assisted 9.5-mm diameter lamellar dissection with the patient under topical anesthesia. Twelve months of follow-up data are presented. No complications were observed during the 1-year follow-up, and full corneal transparency was recovered within 3months in all patients. No patient lost lines of visual acuity. Corrected distance visual acuity improved 0.231, 0.264, and 0.094 Snellen lines in groups 1, 2, and 3, respectively. In group 1, refractive parameters showed an overall stability, whereas in groups 2 and 3, sphere improved 2.35 diopter (D) and 0.625 D, respectively. Anterior keratometry remained stable (group 1) and improved in groups 2 and 3 (mean improvement of 2D). Corneal aberrometry improved significantly. In optical coherence tomography scans, corneal thickness showed a mean improvement of 14.5μm (group 1) and 116.4μm (groups 2 and 3) in the central thickness, and new collagen production was observed at the surgical plane (group 1). Confocal biomicroscopy confirmed the host recellularization of the implanted laminas. Intrastromal implantation of autologous ADASc and decellularized human corneal stroma did not show complications at 1 year of follow-up and were moderately effective for the treatment of advanced keratoconus. NOTE: Publication of this article is sponsored bythe American Ophthalmological Society.

Micropulse Transscleral Cyclophotocoagulation: A Look at Long-Term Effectiveness and Outcomes

To investigate the long-term effectiveness of intraocular pressure (IOP) and medication reduction in patients who have undergone micropulse transscleral cyclophotocoagulation (mTS-CPC). Retrospective chart review. A total of 73 eyes of 62 patients treated no more than 1 time with mTS-CPC in a practice in New York City with at least 1 year of follow-up. Treatment was 100 seconds of mTS-CPC with energy titrated on the basis of visual acuity. Paired t test and multivariable analysis were performed with SAS (SAS Institute Inc, Cary, NC). Visual acuity, IOP, medication burden, phthisis, and development of macular edema were followed. Average initial IOP was 25.5±9.4, and average number of initial medications was 3.1±1.1. At 1 year, average IOP was 13.8±7.0 (46% reduction) and average number of medications was 2.5±1.0 (19% reduction). A total of 11 of 15 patients (73.3%) initially taking an oral carbonic anhydrase inhibitor before CPC did not require the oral carbonic anhydrase inhibitor 1 year after treatment. Seventy-six percent of patients obtained at least 20% IOP reduction. Multivariate analysis found IOP reduction was associated with power used and preoperative IOP, whereas medication reduction was associated with initial medication burden. Notably, there was a 57% reduction in IOP at 2500 mW power and a 30% reduction at 2000 mW power. No patients developed macular edema or phthisis from the procedure. Some 18.8% of patients with 20/400 vision or better experienced persistent vision loss of ≥2 lines after the procedure, and 10% of patients with light perception to count finger vision progressed to no light perception (NLP) after the procedure. Of patients with 20/400 vision or better, 12.5% gained ≥2 lines of visual acuity on the Snellen chart at the postoperative year 1 visit. In addition, 15.4% of patients with count fingers to NLP vision improved at the postoperative year 1 visit after treatment. One of 6 patients (16.7%) with NLP gained vision at the postoperative year 1 visit. This study provides evidence that mTS-CPC is a clinically useful procedure associated with good long-term medication burden reduction and IOP reduction that follows a dose-response pattern related to power used.

Clinical and functional outcomes of correcting low to moderate myopia with FemtoLASIK performed with Russian and Swiss femtolaser platforms

To compare the effectiveness, safety, predictability and stability of FemtoLASIK procedure in low to moderate myopia using Femto Visum and Femto LDV Z6 femtosecond laser platforms and to evaluate the effect of these procedures on corneal higher-order aberrations. Russian femtolaser platform (1 MHz) was used to form the corneal flap in the main group consisting of 98 patients (98 eyes) with mean spherical equivalent (SE) of -3.73±1.42 D. Swiss femtolaser platform (5 MHz) was used in the control group (94 patients, 94 eyes; mean SE -3.81±1.44 D). Excimer laser ablation was performed using the Russian platform (500 Hz) in both groups. All patients underwent complete ophthalmological examination. The follow-up period was 12 months. Twelve month postoperatively, in the '1 MHz' group uncorrected visual acuity (UCVA) of 1.0 or better was achieved in 91.8% of patients, and in the '5 MHz' group - in 90.4% (p>0.05). There were no registered losses of 2 or more lines of best-corrected visual acuity (BCVA) in either group. In the '1 MHz' group, predictability of targeted refraction within ±0.5 D was achieved in 91.8% of patients, within ±1.0 D - in 99.0%; in the '5 MHz' group - in 91.5% and 98.9% of patients, respectively (p>0.05). Root-mean-square (RMS) deviation of corneal higher-order aberrations in the 6-mm optical zone was increased by 0.072 μm (by 1.21 times) and by 0.077 μm (by 1.22 times) in the '1 MHz' and '5 MHz' groups (p>0.05), respectively. The FemtoLASIK procedures performed using Russian (1 MHz) and Swiss (5 MHz) femtosecond laser platforms are effective, safe, predictable, have stable postoperative visual and refractive outcomes, and lead to increase in RMS of corneal higher-order aberrations using both platforms in patients with low to moderate myopia. There were no statistically significant differences between the two femtolaser platforms (p>0.05) for all examined parameters.

Lasik as a Solution for High Hypermetropia.

Aim:To evaluate safety and efficacy of Laser in situ Keratomileusis (LASIK) procedure for the correction of high hypermetropia.Methods:Retrospective study of 160 patients (266 eyes) who underwent LASIK procedure for the correction of hypermetropia between +3.00 and +7.00 diopters(D) and cylinder up to 2.00D from January 2013 and August 2015. All ablations were performed with Wavelight Allegretto Eye-Q400Hzexcimer laser (Alcon, Forth Worth, TX, USA) with aberration free module and were centered on a corneal vertex. All flaps were made with Moria M2 (Moria, Antony, France) mechanical microkeratome (90μm head). Preoperative and postoperative uncorrected and corrected distant visual acuity (UDVA, CDVA), spherical equivalent (SE) and a berrometry for 5mm pupil were measured. Measurements were taken at 1 week, 1,3,6 and 12 months after the surgery. Wilcoxon Signed Ranks Test was used for statistical analysis.Results:Postoperative UDVA was lower than preoperative CDVA at 1 week(p=0.001), at 1 month there was no difference (p=0.099), and at 3,6 and 12 months UDVA was better (p<0.0001). Preoperative SE was 4.69±1.20D (+3.75 to +7.50D). At 1 week SE was 0.03±0.67D (-0.50 to +0.63D), while at 1 year regressed to 0.58±0.56D (+0.25 to +0.88D). Sphere shifted from negative values targeted in treatment planning to compensate for regression to positive values. There was significant difference in SE at every time point (p<0.0005). There was a significant increase in coma (p<0.0001), trefoil (p<0.0001, p=0.0006) and spherical aberration (p=0.022, p=0.0052) at 1 week and 1 month postoperatively, without change throughout the rest of follow up.Conclusion:LASIK for high hypermetropia showed satisfactory results in postoperative refraction with reasonable regression without significant loss of lines of visual acuity. However, more test are necessary to asses optical quality.