Lines Of Best-corrected Visual Acuity Research Articles

Long-term outcomes of anti-vascular endothelial growth factor therapy with and without posterior scleral reinforcement on myopic maculopathy in myopic choroidal neovascularization eyes

BackgroundAnti-vascular endothelial growth factor (anti-VEGF) therapy is used for myopic choroidal neovascularization (mCNV). Patchy chorioretinal atrophy (pCRA) enlargement has been reported in mCNV cases associated with vision loss. Our aim was to compare the long-term effectiveness of anti-VEGF therapy alone versus anti-VEGF followed by posterior scleral reinforcement (PSR) in controlling myopic maculopathy in mCNV eyes.MethodsWe performed a retrospective review of the medical records of 95 high myopia patients (refractive error ≥ 6.00 diopters, axial length ≥ 26.0 mm) with mCNV. Patients were treated with anti-VEGF alone (group A) or anti-VEGF followed by PSR (group B). The following data were collected: refractive error, best corrected visual acuity (BCVA), ophthalmic fundus examination, ocular coherence tomography and ocular biometry at 12 and 24 months pre- and postoperatively. The primary outcomes were changes in pCRA and BCVA.ResultsIn 26 eyes of 24 patients, the mean pCRA size significantly increased from baseline (0.88 ± 1.69 mm2) to 12 months (1.57 ± 2.32 mm2, t = 3.249, P = 0.003) and 24 months (2.17 ± 2.79 mm2, t = 3.965, P = 0.001) postoperatively. The increase in perilesional pCRA in group B (n = 12) was 98.2% and 94.2% smaller than that in group A (n = 14) at 12 and 24 months (Beta 0.57 [95% CI 0.01, 191 1.13], P = 0.048). In group B, 7 eyes (58.3%) gained more than 2 lines of BCVA compared with only 4 eyes (28.6%) in group A at 24 months.ConclusionAnti-VEGF therapy followed by PSR achieved better outcomes than anti-VEGF therapy alone in controlling the development of myopic maculopathy in mCNV and may constitute a better treatment option by securing a better long-term VA outcome.

Presentation of cases who underwent vitrectomy for the management of idiopathic epiretinal membranes (iERM)

Epiretinal membrane (ERM) is a term used to describe cellular avascular membranes that form on the inner retinal surface, causing distortion and a decrease in the best corrected visual acuity (BCVA). The prevalence of ERM ranges from 7% to 29% in the general population. Pre‐macular fibroplasia, macular pucker, cellophane maculopathy and pre‐macular fibrosis have also been used to describe this condition. The majority of ERM's have no associated ocular abnormality and are termed idiopathic while the secondary ERM's are associated with preexisting or coexisting conditions such as diabetic retinopathy, cataract surgery, retinal detachment and retinal detachment surgery.Patients with ERM are usually monitored by measuring BCVA and retinal morphology. Last decades a valuable tool in diagnosis, grading, follow up and post‐surgical evaluation of ERM is Optical Coherence Tomography (OCT). OCT can demonstrate the presence of ERM, degree of traction, the presence of cystoid macular edema and various biomarkers such us the disorganization of the inner retinal layers (DRIL).ERM may remain stationary with minimal effect on visual performance. However, some cases may progress with worsening of symptoms, increasing retinal thickness and traction. In those symptomatic cases, surgical peeling of ERM through pars plana vitrectomy (PPV) is the treatment of choice. Some surgeons prefer to peel the Internal limiting membrane (ILM) during primary vitrectomy. Previous studies showed that 40–83% of patients gain on average of 2 or more lines of BCVA after ERM surgery.We present three cases of successful surgical ERM repair. The first patient had a longstanding ERM with DRIL, his symptoms were metamorphopsia and low vision. One month following vitrectomy gained 5 lines. BCVA improved from CF pre‐op to 5/10 Snellen chart 1 month post‐op, with good macular anatomical restoration. The second patient, 1 month postoperatively, had also good anatomical result but presented an eccentric macular hole even though we did not perform an ILM peel. The third patient, 18 months after a successful vitrectomy for ERM peel in his only eye and BCVA 8/10 cc on Snellen chart the first 6 months, he experienced a decline in his vision and an OCT revealed a full thickness macular hole. Hence, a second operation was performed with ILM peel and good anatomical and functional restoration.

Рефракционная замена хрусталика при рефракционной амблиопии: «лечение» или диагностика?

Relevance. Refractive amblyopia is one of conditions that reduce best corrected visual acuity (BCVA) in patients. With the advent of new methods of refractive surgery, we note new features of the course of refractive amblyopia in adult patients after refractive surgery. Purpose. Determination of changes in uncorrected visual acuity and BCVA as well as changes in the degree of amblyopia in patients with high-grade refractive errors after implantation of toricIOLs during refractive lens replacement (RLL). Materials and methods. Retrospective evaluation of functional outcomes in 20 patients over 18 years (28 eyes) who received surgical treatment in the form of refractive lens replacement for myopic and hypermetropic astigmatism in the presence of high-grade ametropia with amblyopia. Results. In 35.3% of patients with myopic refraction, the diagnosis of amblyopia was removed. In 41.2%, we saw reducing the degree of amblyopia, 23.5% added 1 line of BCVA without changing the degree of amblyopia. When comparing the BCVA of patients with myopic refraction before and after surgical treatment, significant differences were obtained. In all eyes with hypermetropic refraction, there was no change in the degree of amblyopia after surgery, 22% of operated ones received an increase in BCVA by 1 line. There were no significant differences of BCVA a week after surgery in patients with hyperopic refraction. Conclusion. The revealed change in the degree of amblyopia in patients in early stages after RLL makes us clarify diagnosis and doubt sufficiency of standard methods for diagnosing amblyopia and determining its degree. In amblyopic patients with high myopia, in comparison with patients with hyperopia, refractive replacement of the transparent lens in most cases leads to an increase in BCVA in a short time after. Refractive lensectomy, is a amblyopia treatment, and is an important tool to exclude the diagnosis of amblyopia or reduce its degree. Key words: amblyopia, lens, refractive surgery, myopia, hypermetropia

Predictive potential of optical coherence tomography parameters for the prognosis of decreased visual acuity after trabeculectomy in open-angle glaucoma patients with good vision

BackgroundTrabeculectomy (trab) is the most effective surgical procedure for lowering IOP and preventing glaucoma progression. However, decline in best-corrected visual acuity (BCVA) is one of the most serious postoperative complications of trab. Here, we investigated methods to predict decreased BCVA after trab in glaucoma patients with good preoperative BCVA.MethodsThis study included 35 eyes of 35 open-angle glaucoma (OAG) patients (male / female: 21 / 14, age: 64.0 ± 9.7 years old, preoperative intraocular pressure: 15.9 ± 5.4 mmHg, mean deviation: -18.1 ± 5.6 dB) with preoperative BCVA of 0.7 or better who underwent trab and were observed for more than 12 months. As a preoperative analysis, we measured temporal quadrant circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and ganglion cell complex thickness in a central strip between the disc and fovea (csGCCT), an area that corresponds to the location of the papillomacular bundle (PMB) in swept-source optical coherence tomography (OCT). We defined BCVA decline as a loss of more than 3 lines of BCVA after 12 months. Measurement parameters were compared between the BCVA-decline group and the non-BCVA-decline group.ResultsBCVA decline was detected in 11 cases (31.4%) 12 months after trab. There was a statistically significant difference in axial length (P = 0.049). A single logistic analysis showed that the BCVA-decline group had significantly lower cpRNFLT than the non-BCVA-decline group (27.7 ± 8.0 μm vs. 45.1 ± 5.3 μm, P < 0.001, cut-off value: 33.4 μm), as well as lower csGCCT (72.4 ± 7.7 μm vs. 87.5 ± 5.1 μm, P = 0.002, cut-off value: 82.3 μm). Multivariable logistic analysis showed that the BCVA-decline group had significantly lower temporal quadrant cpRNFLT (P < 0.001) and lower middle csGCCT (P < 0.001) compared to the non-BCVA-decline group.ConclusionsLower temporal quadrant cpRNFLT and middle csGCCT, OCT scan areas that correspond to the location of the PMB, might be biomarkers that predict BCVA decline after trab in OAG patients with good vision.

Prognostic factors for visual acuity improvement after treatment of submacular hemorrhage secondary to exudative age-related macular degeneration.

To recognize prognostic factors for better final visual acuity (VA) in patients presenting with submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration. This retrospective study included patients who presented to a tertiary ophthalmology department between 2012 and 2019 with SMH and were treated by pars plana vitrectomy (PPV) or injection of tissue plasminogen activator (tPA) with pneumatic displacement. Baseline characteristics included demographic data, VA and optical coherence tomography (OCT) characteristics of the SMH. Patients were divided into groups by improvement of at least 2 lines in BCVA (best corrected visual acuity), and by having a final BCVA better than 20/200. Forty-three eyes of 43 patients were included. Mean age was 86.72 ± 7.18. Prognostic factors for final VA better than 20/200 included better VA at presentation (1.25 vs 1.90 logMAR, p < 0.001), smaller area of SMH in the infra-red image (19.47 mm2 vs 38.45 mm2, p = 0.024), and lower height of SMH as measured by OCT (713.5 µm vs 962.5 µm, p = 0.03). Third of the patients improved in ≥2 lines from presentation, all in the group of the pneumatic and TPA displacement. Smaller SMHs with good VA at presentation have a better chance for improvement and result in a better final VA. These patients may benefit the most from pneumatic displacement of the SMH with intravitreal tPA and gas.

Comparison of antivascular endothelial growth factor treatment for myopia choroidal neovascularisation: a systematic review and meta-analysis of randomised controlled trials

ObjectivesTo evaluate the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapy for myopia choroidal neovascularisation (CNV), and to compare the efficacy of two different anti-VEGF retreatment criteria.Data sourcesPubMed,...

Visual outcome of implantable phakic contact lens

Aim To evaluate the visual outcome of implantable phakic contact lens (IPCL) in high myopia. Setting Al-Mashreq Eye Center, Cairo, Egypt. Patients and methods Thirty eyes of 17 patients underwent surgery to correct high myopia using IPCL (Care Group-India) with a central hole (V2.0). Visual acuity, spherical equivalent, and intraocular pressure (IOP) were evaluated 6 months postoperatively. Anterior chamber parameters Anterior chamber volume (ACV), Anterior chamber depth (ACD), Anterior chamber angle width (ACAW) were measured using Pentacam. Results After 6 months, spherical equivalent decreased from −14.19±4.2 to −0.18±0.66 D, all cases were within ±1.00 D of intended correction. Best corrected visual acuity (BCVA) remained unchanged in 13% of cases, 13% gained one line, and 74% gained two or more lines. ACV, ACD, and ACAW decreased from 189.77±20.19 mm3, 3.15±0.27 mm, and 37.31±5.63° to 131.4±14.01 mm3, 3.05±0.29 mm, and 23.94±4.81°, respectively. Changes in IOP between preoperative and 6 months postoperatively were statistically insignificant. Conclusion IPCL is a safe, effective, and predictable surgery to correct high myopia. Most cases gained one or more lines of BCVA. Reduction of ACV did not induce IOP rise during 6 months of follow-up.

Comparison of clinical outcome of small-incision lenticule intrastromal keratoplasty and FS-LASIK for correction of moderate and high hyperopia.

To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty (sLIKE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of moderate and high hyperopia. A case-controlled clinical study was performed. Twenty right eyes of 20 moderate and high hyperopia patients underwent sLIKE (sLIKE group) and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK (FS-LASIK group) were enrolled in this study from October 2015 to October 2017. Visual acuity, refractive error, corneal thickness, and keratometry were compared between the groups before and 1y postoperatively. The postoperative uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity (UDVA) were improved in the two groups. The UNVA reached J1 in 15 eyes (75.0%) in the sLIKE group and 5 eyes (22.7%) in the FS-LASIK group 1y after surgery (χ 2=11.476, P=0.001). The UDVA was equal or better than the preoperative CDVA in 16 eyes (80.0%) in the sLIKE group and 8 eyes (36.4%) in the FS-LASIK group, respectively (χ 2=8.145, P=0.004). No eyes lost any line of best-corrected visual acuity (BCVA) in either group. The amount of postoperative residual hyperopia in the sLIKE group was significantly less than in the FS-LASIK group (Z=-2.841, P=0.004). The postoperative keratometry and corneal thickness were significantly higher in the sLIKE group than in the FS-LASIK group (t=4.411, 10.279, P<0.001). The SRI and SAI of the sLIKE group were significantly higher than that in the FS-LASIK group. There was no statistically significant difference in mean decentration between the two groups. sLIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.

Surgical outcome of retropupillary iris-claw lens implantation: a retrospective review

Introduction: Intraocular lens (IOL) selection, especially in cases with insufficient capsular and/or zonular support has increasingly become a challenge to surgeons. Retropupillary iris-claw IOLs (RP-ICIOL) have gained popularity in recent years.Purpose: This study aimed to review the outcomes of RP-ICIOL implantation in two tertiary eye centres.Study design: Retrospective review.Methods: This is a retrospective study of 14 eyes of 14 patients who underwent Artisan RP-ICIOL implantation between November 2018 and December 2020 in two tertiary eye centres in Malaysia.Results: The mean age of patients was 51.5 ± 17.4 years with the range between 18 and 77 years old. There were ten (71.4%) males and four (28.6%) females. The IOL was implanted primarily in three eyes (21.43%) and as a secondary procedure in eleven eyes (78.6%). Mean preoperative best-corrected visual acuity (BCVA) was logMAR 1.32 ± 0.82, while mean postoperative BCVA was logMAR 0.56 ± 0.42 (p = 0.010). Visual improvement of two or more lines in BCVA was observed in nine eyes (64.3%), no improvement in two eyes (14.3%), and worsening in three eyes (21.4%). There were no complications observed during the surgery. All our patients had a well-centred IOL at the 1-month postoperative follow-up. Mean preoperative intraocular pressure was 16.8 ± 2.0 mmHg and postoperative intraocular pressure was 15.7 ± 5.1 mmHg (p = 0.430).Conclusion: RP-ICIOL implantation is safe and provides the optical advantage of a more biologically appropriate retropupillary position, ensuring a favourable functional visual outcome with low risk of complications.

Visual function assessment of posterior-chamber phakic implantable collamer lenses with a central port.

BackgroundTo investigate the short-term visual function of the V4c implantable collamer lens (ICL) for myopia using a Binoptometer 4P.MethodsEighty eyes from 40 patients (age, 28.75±6.57 years) who underwent ICL V4c implantation at Shenzhen Eye Hospital from August 2020 to June 2021 were enrolled. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), subjective manifest refraction, intraocular pressure (IOP), and corneal endothelial cell density (ECD) were evaluated 1 month after surgery. Corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA), contrast sensitivity (CS), near stereoacuity (NSA), twilight vision, and glare sensitivity were measured using a Binoptometer 4P.ResultsThe average logMAR (logarithmic minimum angle of resolution) UCVA postoperative was 0.07±0.13, which was significantly better than the preoperative BCVA (P=0.028). At 1 month postoperatively, the mean safety and efficacy indexes were 1.14±0.24 and 0.98±0.16, respectively. The mean spherical equivalent (SE) of all eyes was −8.98±3.20 D preoperatively, and −0.16±0.48 D postoperatively. None of the patients lost one or more lines of BCVA, 62.1% remained unchanged, 10.6% gained one line, and 27.3% gained two or more lines. CDVA, CNVA, CS, and NSA of both eyes were measured using a Binoptometer 4P, which were significantly better than the preoperative values. In addition, some patients had subjective symptoms in the early postoperative period, such as halo, glare, etc.ConclusionsICL V4c implantation is a safe, effective, and predictable solution for myopia. We found that the short-term visual function of patients was improved significantly. The Binoptometer 4P is an effective and convenient visual testing device for assessing postoperative visual function after ICL V4c implantation.

Five-year outcomes after intravitreal bevacizumab of treatment-naive eyes with macular edema secondary to CRVO in routine clinical practice: Results of the Pan-American Collaborative Retina Study (PACORES) group.

The purpose of this study was to report the 5-year outcomes of treatment-naive eyes with cystoid macular edema secondary to central retinal vein occlusion treated with intravitreal bevacizumab in routine clinical practice. We conducted multicenter retrospective non-comparative case series of 102 eyes. The main outcome measured was the change in best-corrected visual acuity (BCVA) at 5years. Secondary outcomes included the number of injections and the change in CMT at 5years. At 5years, the mean BCVA improved from 1.22 ± 0.58 (Snellen 20/428) at baseline to 1.00 ± 0.68 logMAR (Snellen 20/200; p < 0.0001). At 5 years, 48 (47%) eyes had a gain of ≥ 3 lines, 41 (40.2%) eyes remained within 3 lines and 13 (12.7%) eyes had a loss of ≥ 3 lines of BCVA. The CMT improved from 740 ± 243 to 322 ± 179µm (p < 0.0001). At 5 years, 59 (57.8%) eyes had a completely dry SD-OCT. Patients received a total of 10.6 ± 6.1 (range 6-27) injections. Baseline BCVA (p < 0.0001) and the duration of symptoms prior to initial anti-VEGF injection (p = 0.0274) were the only predictive factors for BCVA at 5years. After 5years with an average of 10.6 injections, there was a mean gain of 0.22 logMAR. In addition, more eyes achieved a BCVA of ≥ 20/40, gained ≥ 3 lines and less patients had a BCVA ≤ 20/200. Eyes with a better baseline BCVA and a shorter duration of symptoms were more likely to achieve better BCVA at 5years.

Effectiveness of Difluprednate for the Treatment of Anterior Scleritis

To describe the effectiveness and side effect profile of difluprednate therapy in a series of patients with anterior scleritis. Retrospective, interventional case series. Data collected from all patients with anterior scleritis who used difluprednate as a single treatment agent from January 1, 2018, to January 1, 2020, including demographics, scleritis type, presence of nodules or necrosis, changes in scleritis activity, intraocular pressure (IOP), number of difluprednate drops used, best-corrected visual acuity (BCVA), and lens status. The primary outcome was clinical resolution of scleritis. Secondary outcomes included BCVA loss ≥2 lines, change in lens status or cataract surgery, and IOP ≥24 mm Hg. Twenty-five patients (35 eyes) were analyzed. The median age was 60 years (range 13-78); 60% were female; 64% were White. Forty percent had bilateral disease, and 44% of patients had an associated systemic disease. The majority of eyes (66%) had diffuse anterior scleritis. Eighty-three percent of eyes achieved resolution of scleritis, with a median time of resolution of 6 weeks. Eyes treated with an initial dose of ≥4 times daily were more likely to achieve disease resolution (hazard ratio [HR]=3.43, 95% confidence interval [CI] 1.19, 9.88, P=.02). Nine eyes had IOP elevation. Four eyes lost ≥2 lines of BCVA, and 1 due to cataract progression. One eye underwent cataract surgery. Difluprednate alone may effectively treat non-infectious anterior scleritis with a tolerable side effect profile.

The prevalence of amblyopia in 7–9-year-old schoolchildren in Mashhad

Background: To determine the prevalence of amblyopia in schoolchildren aged 7–9 years old in Mashhad, Iran.&#x0D; Methods: This was a cross-sectional, community-based study with schoolchildren aged 7–9 years old. We randomly selected 20 of 189 elementary schools (three schools per district; 10 male-segregated and 10 female-segregated schools) from a proportional combination of public schools across Mashhad. Basic vision exams were performed. If amblyopia was suspected, children underwent supplementary vision exams. The diagnostic criterion for amblyopia was a best corrected visual acuity (BCVA) in one or both eyes equal to or worse than 20/40 or an interocular difference of more than two lines in BCVA without any significant organic pathology.&#x0D; Results: A total of 2831 children were included in the study. All children were examined comprehensively by an optometrist, and amblyopia was detected in 49/2831 (1.7% [95% CI, 1.22?2.18]). Of the 49 children with amblyopia, 20 (40.8%) were amblyopic in the right eye, 9 (18.4%) in the left eye, and 20 (40.8%) in both eyes. Twenty-four (49%) were first graders, 15 (30.6%) were second graders, and 10 (20.4%) were third graders. The most prevalent subtype of amblyopia was anisometropic amblyopia (57.1%, [95% CI, 43.24?70.96]). &#x0D; Conclusions: Considering the prevalence of amblyopia among schoolchildren aged 7–9 years old (1.7%), timely detection of amblyopia through preschool screening programs is essential for early treatment or prevention of further visual impairment during childhood.&#x0D; &#x0D; How to cite this article: Shahpary S, Ramin S, Azimi A, Heyrani M. The prevalence of amblyopia in 7-9-year-old schoolchildren in Mashhad. Med Hypothesis Discov Innov Optom.2021 Spring; 2(1): 18-23. DOI: https://doi.org/10.51329/mehdioptometry121&#x0D;

Efficacy and Safety of Infliximab in HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy.

PurposeTo determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy.MethodsThis was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart.ResultsTwenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6–24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients (n = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients.ConclusionInfliximab might induce and maintain the steroid-free remission in HLA-B27-associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.

Therapeutic HL-Contact Lens versus Standard Bandage Contact Lens for Corneal Edema: A Prospective, Multicenter, Randomized, Crossover Study.

Introduction To compare the safety and efficacy of the Therapeutic Hyper-CL™ lens versus a standard bandage contact lens (PureVision B&L) for chronic corneal edema. Methods Prospective, multicenter, randomized, crossover study. Chronic corneal edema patients were randomized to one of two arms. The first arm was fitted with the Therapeutic Hyper-CL™ lens while the second arm was fitted with a standard soft bandage contact lens. Both arms were treated with 5% sodium chloride 6 times a day. After a 7-day treatment period, there was a 7-day washout period, after which the arms were crossed over. Patients were evaluated at days 0 (baseline), 7 (following first treatment allocation), 14 (following washout), and 21 (following second treatment allocation). The primary outcomes were 3 lines of BCVA (best corrected visual acuity) improvement. Results In total, 49 patients were enrolled. There was significantly greater BCVA improvement rate >3 lines (30.4% versus 17.4%, P=0.04) in the Therapeutic Hyper-CL™ lens group. The mean change in BCVA lines was significantly greater for the Therapeutic Hyper-CL™ lens (3.4 ± 6.7 versus 0.9 ± 2.3, P=0.02). Conclusions The Therapeutic Hyper-CL™ lens was associated with a higher chance for significant visual acuity improvement when compared to a standard bandage contact lens combined with 5% sodium chloride. This trial is registered with NCT02660151.

Radiotherapy for neovascular age-related macular degeneration.

: Radiotherapy has been proposed as a treatment to prevent new vessel growth in people with neovascular age-related macular degeneration (AMD). : The aim of this review was to examine the effects of radiotherapy on neovascular AMD. : We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library Issue 2, 2004, MEDLINE (1966 to May 2004), EMBASE (1980 to June 2004) and LILACS (Latin American and Caribbean Health Sciences Literature Database) (May 2004). We also wrote to investigators of trials included in the review to ask if they were aware of any other studies. : We included all randomised controlled trials in which radiotherapy was compared to another treatment, sham treatment, low dosage irradiation or no treatment in people with subfoveal choroidal neovascularisation secondary to AMD. : Two reviewers independently extracted the data. Relative risks were combined using a random effects model. The percentage of the variability in effect estimates that was due to heterogeneity, rather than sampling error, was estimated using I2. : Eleven trials randomising a total of 1078 people were included in this review. All trials used a similar method of delivering the radiotherapy treatment (external beam). Dosage ranged from 7.5 to 24 Gy. Most trials found effects (not always significant) that favoured treatment. However, there was considerable inconsistency in the results between trials (I2 > 50%). As only 11 trials were included in the review and only some of these trials provided data for each outcome our ability to determine the causes of the heterogeneity between trials was limited. Subgroup analyses did not reveal any statistically significant interactions although with small numbers of trials in each subgroup (range two to four) this was not surprising. There was some indication that trials with no sham irradiation reported a greater effect of treatment as did trials with a greater percentage of participants with classic choroidal neovascularisation. : This review currently does not provide evidence that external beam radiotherapy is an effective treatment for neovascular AMD. If further trials are to be considered to evaluate radiotherapy in AMD then adequate masking of the control group must be considered. Given the recent evidence that most lesions are amenable to treatment with photodynamic therapy if identified at a small lesion size, trials evaluating radiotherapy against photodynamic therapy are warranted.

Clinical study on topography-guided laser ablation combined with accelerated corneal collagen cross-linking for early keratoconus

Objective: To study the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in treatment of early keratoconus. Methods: Ninteen patients(20 eyes) (13 males 14 eyes, and 6 females 6 eyes), aged 12 to 44 years (24.7±8.0) were diagnosed as keratoconus by three-dimensional corneal topography and tomography, clinical history and examinations, and classified as KC1~KC3. Based on the classical excimer laser subepithelial keratomileusis (LASEK) method, topography guided laser ablation was performed with an excimer laser system (WaveLight EX500). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes, and then was irradiated by ultraviolet light (Avedro KXL) at 30 mW/cm(2) for 4 minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best corrected visual acuity (BSCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV) and other indicators were observed. For normal distribution variables, Dunnett-t test was used before and after operation, and Wilcoxon test was used for variables with abnormal distribution. And the complications were recorded. Results: There was no loss of BSCVA at 12 months postoperatively, 20% of the eyes had no change of BSCVA, and 15% of the eyes gained 1 line of BSCVA, 15% of the eyes gained 2 lines of BSCVA, 50% of the eyes gained 3 lines and more of BSCVA. There was no significant difference in UCVA, BSCVA, manifest refractive spherical equivalent (MRSE) and the cylinder at 3 months postoperatively (P>0.05). The BSCVA were significantly improved at 6 and 12 months postoperatively compared with those before operation (t=3.095, 3.079, <0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at 6 and 12 months postoperatively (t=-2.890, -2.435, P<0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of central cornea decreased significantly (Z=-2.903, P<0.01; Z=-2.667, P<0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9±31.1) μm to post-operational (416.6±27.0) μm (Z=-3.059, P<0.01), the cornea became regular with keratometric asymmetry index of anterior corneal surface decreased (Z=-2.667, P<0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX and CV at 12 months postoperatively (P>0.05). Twelve months after operation, grade 0, 0.5, 1 and 2 haze were seen on 20%, 55%, 20% and 5% corneas respectively. Conclusions: The topography guided excimer laser ablation combined with accelerated corneal collagen cross linking is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, so as to improve the best corrected visual acuity postoperatively. (Chin J Ophthalmol, 2019, 55: 904-910).

Corneal Refractive Surgery in Patients with History of Optic Neuritis.

PurposeThe purpose of this study was to evaluate the risk of recurrence of optic neuritis after corneal refractive surgery in patients with a history of optic neuritis and to examine the safety and efficacy of the procedure in this population.MethodsThis was a retrospective chart review of patients with a history of optic neuritis who underwent laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) at a single tertiary center from June 1996 to December 2014. Fifteen eyes of 14 patients were included in this study. Visual acuity before and after the surgery was recorded. Patients were followed-up for over five years postoperatively for the recurrence of optic neuritis.ResultsThe average LogMAR best corrected visual acuity (BCVA) preoperatively was 0.12 0.19 (–0.10 to 0.60) and postoperatively was 0.06 0.10 (–0.10 to 0.30). No eyes lost lines of BCVA. The average LogMAR uncorrected distance visual acuity (UDVA) after surgery was 0.12 0.13 (0.00 to 0.48). Twenty-eight percent of patients reached a UDVA of 20/20 or better after refractive surgery. Optic neuritis recurred in 3/15 (20%) eyes and 3/14 patients (21%).ConclusionWhile corneal refractive procedures appear safe in patients with a history of optic neuritis, our data suggest that their efficacy may be reduced.

Optical Coherence Tomography Assessment of Risk Factors for Visual Acuity Decline After Trabeculectomy in Patients With Advanced Open-Angle Glaucoma.

To identify structural parameters that could predict VA decline after trabeculectomy in patients with advanced open-angle glaucoma. Retrospective review of 74 eyes of 74 patients with advanced glaucoma (defined as mean deviation -12 dB or worse) and best-corrected VA (BCVA) of ≥40/200. All patients underwent trabeculectomy between 2013 and 2016. Measurements included intraocular pressure, BCVA, visual field parameters, and optical coherence tomography-derived parameters [(in both the overall macula and within the papillomacular bundle (PMB)], including mRNFL thickness (mRNFLT), ganglion cell layer/inner plexiform layer thickness, and ganglion cell complex thickness. Measurements were obtained before and after surgery, and follow-up was at least 6 months. We grouped the patients according to whether they underwent VA decline of >3 lines of BCVA after 6 months. We then compared the VA-decline group and the stable-VA group and performed a receiver operating characteristic analysis to determine optimal cut-off values for predicting VA decline. The VA-decline group comprised 7 eyes (9.5%) and had lower preoperative mean deviation (P=0.021) and thinner mRNFL, ganglion cell layer/inner plexiform layer, and ganglion cell complex in the PMB (P=0.003, 0.135, and 0.023, respectively) than the stable-VA group. The cut-off values for predicting VA decline were 9.5 μm for mRNFLT in the PMB. This study found that thin mRNFLT in the PMB were risk factors for VA decline after trabeculectomy.

Comparison between patching and interactive binocular treatment in amblyopia: A randomized clinical trial

PurposeTo compare the effect of amblyopia therapy on cases who received interactive binocular treatment (I-BiT™) with those who received standard patching of the dominant eye with placebo I-BiT™. MethodsIn this randomized clinical trial, 38 unilateral amblyopic children (3–10 years old) were studied. All unilateral amblyopic children who had best corrected visual acuity (BCVA) worse than 0.30 logMAR or a difference of two Snellen lines of BCVA between their two eyes were included, and children who did not complete at least 75% of amblyopia treatment were excluded from this study. Eventually, a total of 19 and 21 subjects were included in case and control groups, respectively. Cases played I-BiT™ games, while controls had standard patch therapy and played with placebo I-BiT™ games, both for one month. All subjects were examined at baseline and after one-month therapy. ResultsBCVA improved significantly in both groups after one-month treatment (case: P = 0.003, control: P < 0.001), while in comparison with each other, there was not any difference between them (P = 0.52). Although stereopsis improved in the case (P < 0.001) and control (P < 0.001), there was no significant difference between them pre and post-therapy. Our children played games for about 6 h total during one month in both groups, and their compliance was 87.5% and 76% in cases and controls, respectively. Two children were excluded due to their lower compliance of playing I-BiT™ games (n = 38). ConclusionsI-BiT™ game and patching with placebo game had similar BCVA improvement in amblyopic children after one-month treatment. It is suggested to conduct further randomized clinical trials with a larger sample size and longer duration of study and assessment of its recurrence.