logMAR In Group Research Articles

Internal Limiting Membrane Peeling in Macula-off Retinal Detachment Complicated by Grade B Proliferative Vitreoretinopathy

To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR). Retrospective, interventional, comparative case series. Setting, study population, observationalprocedures and Main outcome measures. Institutional. Seventy-five consecutive patients who underwent vitrectomy for primary macula-off RD complicated by grade B PVR. Patients were divided into an ILM peeling (Group P) and a no ILM peeling group (Group NP). Anatomic success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6months. In all, 37 eyes with ILM peeling were included in Group P and 38 eyes without ILM peeling were included in Group NP. The anatomic success rate after single surgery was higher in Group P (89%) than in Group NP (66%, P= .03). Mean final visual acuity was 0.41 ± 0.40 logMAR in Group P vs 0.43 ± 0.22 logMAR in Group NP (P= .82). We found no epiretinal membrane (ERM) formation in Group P, whereas 5 cases of ERM (20%) were detected in Group NP (P= .012). The 2 groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage. ILM peeling during vitrectomy in macula-off RD complicated by grade B PVR reduces the need for a second surgery for redetachment or macular pucker.

The effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia.

To investigate the effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia (RAE). The records of pediatric cases with full RAE were reviewed; their first and last sensorial and motor findings were evaluated in two groups, classified as partial (Group 1) and full correction (Group 2) of refractive errors. The mean age at first admission was 5.84 ± 3.62years in Group 1 (n = 35) and 6.35 ± 3.26years in Group 2 (n = 46) (p = 0.335). Mean change in best corrected visual acuity (BCVA) was 0.24 ± 0.17 logarithm of the minimum angle of resolution (logMAR) in Group 1 and 0.13 ± 0.16 logMAR in Group 2 (p = 0.001). Duration of deviation, baseline refraction and amount of reduced refraction showed significant effects on change in BCVA (p < 0.05). Significant correlation was determined between binocular vision (BOV), duration of deviation and uncorrected baseline amount of deviation (p < 0.05). The baseline BOV rates were significantly high in fully corrected Group 2, and also were found to have increased in Group 1(p < 0.05). Change in refraction was - 0.09 ± 1.08 and + 0.35 ± 0.76 diopters in Groups 1 and 2, respectively (p = 0.005). Duration of deviation, baseline refraction and the amount of reduced refraction had significant effects on change in refraction (p < 0.05). Change in deviation without refractive correction was - 0.74 ± 7.22 prism diopters in Group 1 and - 3.24 ± 10.41 prism diopters in Group 2 (p = 0.472). Duration of follow-up and uncorrected baseline deviation showed significant effects on change in deviation (p < 0.05). Although the BOV rates and BCVA were initially high in fully corrected patients, they finally improved significantly in both the fully and partially corrected patients. Full hypermetropic correction may also cause an increase in the refractive error with a possible negative effect on emmetropization. The negative effect of the duration of deviation on BOV and BCVA demonstrates the significance of early treatment in RAE cases.

Influence of total intraocular lens diameter on efficacy and safety for in the bag cataract surgery.

CONTEXT:Intraocular lenses with variable total diameter are supposed to fit better in the capsular bag and lead to fewer complications.AIMS:This study aims to investigate the efficacy and the safety of an intraocular lens model with variable total diameter.SETTINGS AND DESIGN:Prospective randomized intraindividual study.SUBJECTS AND METHODS:Thirty-two eyes of sixteen patients with bilateral age-related cataract received standard cataract surgery with implantation of an intraocular lens with a standard diameter in one eye (Quatrix®, Group A) and with a variable total diameter in the fellow eye (Quatrix Evolutive®, Group B). Primary study endpoints included evaluation of refraction stability and posterior capsule opacification (PCO) over a follow-up period of 6 months.STATISTICAL ANALYSIS USED:SPSS (Version 19.0) was used for statistical analysis.RESULTS:Uncorrected and corrected distant visual acuity after 6 months were 0.24 and 0.1 LogMAR in Group A and 0.23 and 0.09 LogMAR in Group B, respectively. The objective and manifest spherical equivalent (OSE, MSE) 6 months postoperatively were + 0.65 D and + 0.62 D in Group A compared to + 0.33 D and + 0.33 D in Group B respectively (P = 0.665 for OSE, P = 0.208 for MSE). PCO-index increased statistically significant in both groups (P = 0.004 in Group A, P = 0.046 in Group B), but the difference of PCO-index between both groups was not statistically significant (P = 0.569).CONCLUSIONS:An intraocular lens with a variable total diameter shows good visual outcomes and safety performance as well as same outcomes concerning postoperative refractive stability and development of PCO compared to an intraocular lens with standard total diameter.

Outcomes of pars plana vitrectomy for the treatment of persistent diffuse diabetic macular edema

Aim The aim of this study was to evaluate surgical outcome of pars plana vitrectomy on patients with persistent diffuse diabetic macular edema (dDME) in the presence or absence of complete posterior vitreous detachment (PVD). Patients and methods Pars plana vitrectomy was performed on 37 eyes of 37 patients with dDME. They were divided into two groups: group I consisted of 21 eyes of 21 patients with dDME and attached posterior vitreous face. Group II consisted of 16 eyes of 16 patients with dDME and detached posterior vitreous face. Both visual acuity (VA) as logMAR values and central macular thickness using optical coherence tomography were measured before,1, 3, and 6 months postvitrectomy. Results The baseline VA was 0.8±0.17 and 0.7±0.39 logMAR in groups I and II, respectively. One month after vitrectomy, VA significantly improved to 0.5±0.23 (P=0.002) and to 0.5±0.24 (P=0.015) in groups I and II, respectively. The VA was 0.4±0.13 (P=0.001), 0.5±0.19 (P=0.003) 3 months postvitrectomy and was 0.4±0.25 (P=0.005) and 0.5± 0.22 (P=0.014) after 6 months in groups I and II, respectively. The mean foveal thickness before surgery was 598.6±105.4 and 520.87±103.15 µm in groups I and II, respectively. After 3 months it significantly improved to 235.25±110.2 µm (P=0.0001) and 280.23±112.3 µm (P=0.002), whereas after 6 months it was 220.13±98.15 and 270.62±85.15 µm in groups I and II, respectively. Conclusion Vitrectomy with removal of the posterior hyaloid face and the premacular vitreous pocket may achieve resolution of dDME and improve vision in some patients who failed to respond to conventional treatment. The visual and anatomical outcomes seem to be better in eyes with early stages of diabetic macular edema and good preoperative VA.

Comparison of Sulfur Hexafluoride (SF6) and Air Tamponade in Noniridectomized Descemet Membrane Endothelial Keratoplasty.

To compare the efficacy and safety of 20% sulfur hexafluoride gas (SF6) and air tamponade in patients who underwent noniridectomized Descemet membrane endothelial keratoplasty (DMEK). A retrospective chart review of patients who underwent DMEK with either air or SF6 tamponade: 41 eyes received air tamponade (group 1) and 41 received SF6 tamponade (group 2). Best spectacle-corrected visual acuity, endothelial cell density, and complications including graft detachment and elevated intraocular pressure were compared. The mean follow-up time was 8 ± 4 months in group 1 and 3 ± 2 months in group 2. Mean best spectacle-corrected visual acuity improved from 1.12 ± 0.88 to 0.64 ± 0.78 logarithm of the minimum angle of resolution (logMAR) in group 1 (P = 0.009) and from 1.00 ± 0.78 to 0.62 ± 0.53 logMAR in group 2 (P = 0.006). The graft detachment rate was 39% (16 eyes) in group 1 and 42% (17 eyes) in group 2 (P = 0.822). The rate of graft detachment larger than one third of the graft area was 17% in group 1 and 20% in group 2 (P = 0.775). Rebubbling was performed in 26.8% and 20% of eyes in group 1 and 2, respectively (P = 0.43). Average endothelial cell loss was 32% in group 1 and 33% in group 2 (P = 0.83). In the immediate postoperative period, elevated intraocular pressure was observed in 2 eyes (5%) in group 1 and in 4 eyes (10%) in group 2 (P = 0.4). There was 1 primary graft failure in each group. Use of air with it being readily available and short acting is a good method of Descemet membrane tamponade in noniridectomized DMEK.

Use of Donors Predisposed by Corneal Collagen Cross-linking in Penetrating Keratoplasty for Treating Patients With Keratoconus

To investigate whether use of donors predisposed by corneal collagen cross-linking (CXL) reduced myopic refractive errors for keratoconic eyes after penetrating keratoplasty (PK). Randomized controlled trial. One hundred sixteen eyes of 116 patients with keratoconus from Zhongshan Ophthalmic Center were enrolled. Using stratified block randomization, we assigned eligible eyes to the CXL graft group (Group 1) or conventional graft group (Group 2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), and topographic data were compared 12, 24, and 36months after surgery. Group 1 had better UDVA and CDVA than Group 2 after 1 year follow-up. Also, Group 1 had a lesser degree of SE and lower manifest cylinder than Group 2. At 3 years follow-up, mean CDVA was 0.17 ± 0.10 logarithm of the minimum angle of resolution (logMAR) in Group 1 vs 0.23 ± 0.12 logMAR in Group 2 (P= .004). Mean SE was -3.50 ± 2.93 diopter (D) in Group 1 and-4.02 ± 2.57 D in Group 2 (P= .034). Mean manifest cylinder was-5.22 ± 2.64 D and-6.35 ± 2.80 D in Group 1 and Group 2, respectively (P= .013). At 3 years follow-up, simulated keratometry in the steepest meridian (Kmax) was 46.85 ± 2.85 D vs 49.37 ± 2.92 D (P= .036); corneal power was 44.41 ± 2.89 D vs 46.35 ± 2.87 D (P= .001); and keratometric astigmatism was 4.53 ± 1.06 D vs 5.98 ± 1.28 D (P < .001) in Group 1 and Group 2, respectively. Use of donors predisposed by CXL could reduce topographic readings after PK for the treatment of keratoconus, and consequently reduce myopic refractive errors and improve visual acuity.

Internal limiting membrane peeling in retinal detachment complicated by grade B proliferative vitreoretinopathy

PurposeTo specify the benefits of internal limiting membrane (ILM) peeling as a surgical adjunct in primary repair of retinal detachments (RD) complicated by grade B proliferative vitreoretinopathy (PVR).MethodsA retrospective comparative study included consecutive patients who underwent vitrectomy for primary RD complicated by grade B PVR between May 2010 and December 2015 at Nancy University Hospital (France). All patients were treated with SF6 or C2F6 gaz tamponade. The ILM was routinely peeled after staining from 2012. The best‐corrected visual acuity and spectral‐domain optical coherence tomography (SD‐OCT) were collected at 1 and 3 months postoperatively, looking for epiretinal membrane formation, macular oedema or photoreceptor damage.ResultsThirty seven eyes who underwent ILM peeling (group 1) and 38 eyes without ILM peeling (group 2) were included. At the end of follow‐up, anatomic success after single surgery was higher in group 1 (89%) than in group 2 (66%, p=0.03). Mean final visual acuity was 0.41 ±0.40 logMAR in group 1 versus 0.43 ±0.22 logMAR in group 2 (p=0.82). After 3 months follow up, we found no epiretinal membrane (ERM) formation on OCT scans in group 1 whereas 5 ERM (20%) were detected in group 2 (p=0.012). The 2 groups did not differ in terms of cystoid macular oedema occurence, macular thickness or photoreceptor damage.ConclusionsILM peeling at the macula during vitrectomy for the treatment of retinal detachment complicated by grade B PVR may prevent a second surgery for redetachment or macular pucker.

Posterior chamber phakic intraocular lens implantation: comparative, multicentre study in 351 eyes with low-to-moderate or high myopia

AimTo compare the clinical outcomes of posterior chamber phakic intraocular lens implantation with a central hole (Hole Implantable Collamer Lens (ICL), STAAR Surgical) for low-to-moderate myopia and for high myopia.MethodsThis...

Greffes endothéliales par Descemet membrane endothelial keratoplasty (DMEK) : analyse d’une variante de découpe du greffon endothélio-descemétique

Descemet's membrane endothelial keratoplasty (DMEK) can replace just the corneal endothelium and respect the natural corneal anatomy. Currently, the technique of endothelial graft preparation remains manual and non-standardized. To report anatomic and functional results after DMEK, and compare two techniques of graft preparation. Single-center retrospective study, including 64 eyes of 64 patients undergoing DMEK, from September 2014 to February 2016 at Clermont-Ferrand University Medical Center. The "classic" preparation was used in 44 patients (group 1) and the "variant" preparation was used in 20 patients (group 2). An analysis of functional parameters (visual acuity), anatomy (pachymetry, corneal edema, endothelial cell count) and keratometry (sphere, cylinder, mean keratometry) was performed during the first postoperative year. The mean follow-up was 10.0±2.5 months. The average preparation time was 12.3±8.1minutes, with 14.4±8.8 in group 1 versus 7.8±3.0 in group 2 (P<0.001). At six months, the best corrected distance visual acuity was significantly better in group 1 with an acuity of 0.28±0.28 LogMAR in group 1 and 0.37±0.30 LogMAR in group 2 (P<0.01). The best corrected near visual acuity was also better in group 1 at 6 months, with an acuity of 0.29±0.24 LogMAR (P<0.001) in group 1 and 0.37±0.28 LogMAR in group 2 (P=0.02). Improvement in visual acuity was continuous for the 2 groups. At 6 months, endothelial cell loss was greater in group 1 than in group 2, but the difference was not significant (P=0.44). Central corneal thickness was similar between the 2 groups. Finally, no change in keratometry parameters was found between preoperative data and 6 months in each group or between the two groups. DMEK led to an improvement in all parameters as well as rapid visual rehabilitation. The new variation in preparation saved a considerable amount of time without decreasing graft survival or postoperative results.

The Effect of Combined Systemic Erythropoietin and Steroid on Non-arteritic Anterior Ischemic Optic Neuropathy: A Prospective Study

ABSTRACTBackground: To investigate the effect of combined intravenous (IV) erythropoietin (EPO) and corticosteroid as well as systemic steroid alone for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods: In this prospective interventional comparative case series, 113 consecutive patients diagnosed with recent onset (less than 14 days) NAION were included. Patients were categorized into three groups. 40 patients received systemic IV corticosteroid combined with recombinant human erythropoietin (rhEPO) (group 1), 43 patients received systemic corticosteroid alone (group 2), and 30 patients were enrolled as the control group (group 3). Functional and structural outcomes were analyzed 3 and 6 months after treatment. Best corrected visual acuity (BCVA) was the main outcome, and mean deviation (MD) and peripaillary retinal nerve fiber layer thickness (PRNFLT) were secondary outcome measures.Results: The mean BCVA at the time of presentation was 0.98 (±0.65), 0.96 (±0.67), and 1.02 (±0.63) log MAR in groups 1, 2, and 3, respectively (P = 0.95). At month 3, the corresponding values were 0.73 (±0.45), 0.76 (±0.49), and 0.8 (±0.45) log MAR (P = 0.80), and at the 6-month follow-up, they were 0.76 (±0.45), 0.71 (±0.4), and 0.71 (±0.46) log MAR, respectively (P = 0.87). There was no statistically significant difference in BCVA between months 3 and 6, which implies stabilization of the visual acuity by month 3. Considering the visual field, within 6 months of follow-up after disease onset, the MD index improved in all groups with no statistically significant differences between them (P = 0.82). PRNFLT at presentation was 178 (±60), 186 (±59), and 166 (±57) micrometers in groups 1, 2, and 3, respectively (P= 0.99), which decreased to 77 (±16), 83 (±22), and 73 (±11), respectively, at final visit (P = 0.14)Conclusion: We found no beneficial effect of either systemic steroid alone or combined with EPO in the visual outcome of NAION patients.

The effect of high-dose steroids, and normobaric oxygen therapy, on recent onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial.

To evaluate the effect of high-dose intravenous steroids, as well as normobaric oxygen therapy, in the management of recent onset non-arteritic anterior ischemic optic neuropathy (NAION). Ninety eyes of 90 patients diagnosed with NAION within 14days of onset were included in this single masked randomized clinical trial. Thirty patients were randomized into each set as group 1 (control), group 2 (steroids), and group 3 (oxygen). Controls received placebo; group 2 received methylprednisolone 500mg twice a day for 3days followed by 2weeks of oral prednisolone 1mg/kg/day; group 3 received 100% normobaric oxygen with mask, at a flow rate of 5 liters per minute for 1hour twice a day for two weeks. Functional and structural outcomes were analyzed at 1 and 6months following treatment. Best corrected visual acuity (BCVA) was the main outcome measure, and mean deviation (MD) of visual field (VF) test and peripaillary retinal nerve fiber layer thickness (PRNFLT) were secondary outcome measures. The mean BCVA at the time of presentation was 1.02 ± 0.63, 1.05 ± 0.7, and 0.76 ± 0.5 LogMAR in groups 1, 2, and 3, respectively (p = 0.293); corresponding values were 0.8 ± 0.45, 0.84 ± 0.45, and 0.58 ± 0.4 at month 1 (p = 0.127, 0.19, and 0.168, respectively). BCVA improved to 0.71 ± 0.46, 0.73 ± 0.36, and 0.59 ± 0.41 LogMAR at the 6-month follow-up point (p = 0.039, 0.048, and 0.195, respectively). The mean deviation (MD) at the time of presentation was 19.26 ± 7.02, 20.51 ± 4.68, and 19.3 ± 7.17 in the control, steroid, and oxygen groups, respectively (p = 0.65). Corresponding values at month 1 were 20.26 ± 8.52, 19.52 ± 7.08, and 18.3 ± 7.45, (p = 0.656); and at month 6 were 18.42 ± 8.17, 17.66 ± 6.44 and 16.53 ± 6.32, respectively (p = 0.635). PRNFLT at presentation was 166 ± 57, 184 ± 57, and 193 ± 65 micrometer in the control, steroid, and oxygen groups, respectively (p = 0.265); which decreased to 73 ± 11, 87 ± 26, and 79 ± 19 at the final foll-w up (all p < 0.001). There were no statistically significant differences between the three groups in terms of final visual function and structure. The lack of demonstrable improvement in the structural and functional outcomes of NAION with high-dose IV steroids, or normobaric oxygen, in this randomized controlled trial calls into question the administering of systemic steroid or normobaric oxygen in this condition.

Measuring recovery of visual function in children with papilledema using sweep visual evoked potentials

To assess visual function in children with papilledema using sweep visual evoked potentials (VEP) to determine whether vision function improved following treatment. Contrast sensitivity and grating acuity were prospectively measured by using sweep visual evoked potential testing in children with mild or moderate acute papilledema. A subset of children were tested longitudinally before and after treatment. Subject data was compared with that of age-matched controls using the Wilcoxon-Mann-Whitney test. A total of 9 subjects (age range, 9-16years) and 11 controls were included; 5 subjects were studied longitudinally. The control group's logMAR grating acuity (mean, 0.09; range, -0.13 to 0.36) was better than that of the papilledema group (mean, 0.36; range 0.15-0.59). Four patients showed recovery of contrast sensitivity following treatment of their raised intracranial pressure between first and last visit. In our study cohort, sweep VEP was able to detect early improvement in contrast sensitivity despite absence of apparent clinical change in disk edema in children undergoing treatment for raised intracranial pressure.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons.

PurposeTo determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.Patients and methodsEighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.ResultsOut of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.ConclusionB-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Long-term outcomes of combination photodynamic therapy with ranibizumab or bevacizumab for treatment of wet age-related macular degeneration.

Aim:To evaluate and compare the efficacy of combination of ranibizumab or bevacizumab with photodynamic therapy (PDT) in treating choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD) on long-term follow-up.Materials and Methods:Of 42 eyes, 18 were treated with bevacizumab (Group A) and 24 with ranibizumab (Group B) in combination with verteporfin PDT. Treatment was initiated after informed consent. Complete ophthalmic examination including optical coherence tomography (OCT) was performed at presentation, 1 month, 3 months, and subsequent follow-up visits. OCT measures used were lesion thickness (LT) of the CNV, retinal thickness above the lesion (RT), and central macular thickness (CMT). Mean follow-up period was 33 months (median 18, range 1-84). Additional treatment on follow-up was left at treating surgeon's discretion.Results:Visual acuity improved significantly from baseline by 0.3 LogMAR in Group A and 0.26 LogMAR in Group B. LT decreased significantly from 1st month onward and remained significant at all the subsequent visits, in both the groups. CMT and RT showed a decreasing trend in both the groups. No difference was seen in visual acuity (VA), LT, CMT, and RT between Group A and Group B at any of the visits. The mean number of additional anti-vascular endothelial growth factor injections given postcombination therapy were 1.5 (median 1, range 0-7) injections per eye.Conclusions:PDT in combination with either ranibizumab or bevacizumab was equally effective in preventing vision loss in eyes with wet-Age-related macular degeneration (ARMD). Such combination also reduces the economic burden of the treatment.

Comparison of Sulfur Hexafluoride 20% versus Air Tamponade in Descemet Membrane Endothelial Keratoplasty

To compare clinical outcomes using 20% sulfur hexafluoride (SF6) versus 100% air as a tamponade for graft attachment in Descemet membrane endothelial keratoplasty (DMEK). Retrospective, comparative, interventional case series. Pseudophakic patients with Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy that underwent DMEK using either 20% SF6 (group 1; 42 eyes) or 100% air (group 2; 39 eyes) tamponade between April 2010 and August 2011. A bimanual infusion technique was used to introduce and position the donor endothelium-Descemet membrane graft tissue. Outcome measures were analyzed at the following time points: before surgery, 3 and 6 months after surgery, and at yearly intervals up to at least 3 years. Corrected distance visual acuity (CDVA), manifest refraction, pachymetry, central endothelial cell count (cECC), complications, and rebubbling rates. Three years after surgery, mean CDVA improved from 0.48±0.45 logarithm of the minimum angle of resolution (logMAR) to 0.04±0.23 in group 1 (P < 0.001) and from 0.67±0.45 logMAR to 0.09±0.13 logMAR in group 2 (P < 0.001). The percentage of eyes with CDVA of 20/25 or more was 85.71% (36/42 eyes) in group 1 and 82.05% (32/39 eyes) in group 2 (P = 0.43). Mean preoperative cECCs and at last follow-up were: group 1, 2525±338 cells/mm(2) and 1758 ± 398 cells/mm(2) (mean cell loss, 30±11%; P = 0.008); and group 2, 2492±204 cells/mm(2) and 1678±373 cells/mm(2) (mean cell loss, 32±13%; P = 0.008). Endothelial cell loss was similar in both groups (P = 0.65). Intracameral air reinjection was needed in 1 patient in group 1 (2.38%) and in 5 patients in group 2 (12.8%). The rebubbling rate was significantly higher in group 2 (P = 0.004). No episodes of immunologic graft rejection were documented. Although clinical outcomes and corneal endothelial cell loss were similar in both groups, tamponade with 20% SF6 yielded a significantly lower incidence of graft detachments that may warrant its routine use in DMEK. Longer-term, randomized studies are needed to recommend this approach fully.

Visual acuity improvement in adult amblyopic eyes with an iris-fixated phakic intraocular lens: Long-term results

To evaluate the effect of implantation of iris-fixated phakic intraocular lenses (pIOLs) (Artisan) in adult amblyopic eyes. Optical Express, London, United Kingdom. Retrospective case series. The study analyzed data from 5 years of follow-up of amblyopic eyes that were implanted with iris-fixated pIOLs and had a preoperative corrected distance visual acuity (CDVA) of 6/15 or worse. Visual acuity, refraction, endothelial cell count, and complications were assessed. Data for 103 eyes were analyzed as 2 groups. Group 1 comprised 82 eyes with myopia or myopic astigmatism, and Group 2 contained 21 eyes with hyperopia or hyperopic astigmatism. The mean preoperative sphere in Group 1 was -13.42 diopters (D) ± 5.62 (SD) with a mean cylinder of -2.35 ± 1.75 D. In Group 2, the mean sphere and cylinder were +6.77 ± 1.91 D and -2.63 ± 2.43 D, respectively. The mean CDVA improved from 0.51 ± 0.15 logMAR to 0.34 ± 0.16 logMAR (P<.001) in Group 1 and from 0.54 ± 0.17 logMAR to 0.46 ± 0.14 logMAR in Group 2 (P<.005). The safety index was 1.48 in Group 1 and 1.19 in Group 2. The efficacy index was 1.21 in Group 1 and 1.00 in Group 2. The mean gain in CDVA was statistically significantly greater in Group 1 (0.17 ± 0.14 logMAR) than in Group 2 (0.08 ± 0.11 logMAR). Two or more lines of CDVA were gained by 48.8% of eyes in Group 1 and by 19.0% of eyes in Group2. The iris-fixated pIOL was a safe and effective option for improving visual acuity in adult amblyopic eyes. Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Comparison of ultrathin manual and automated stripping of the endothelium in Fuchs endothelial dystrophy

AbstractPurpose This study compares two techniques of preparation of the endothelial graft: the DSAEK (Descemet Stripping Automated Endothelial Keratoplasty) and an ultrathin endothelial graft manually prepared.Methods A randomised prospective study is being conducted at the Hospital of Rouen, France. Patients presenting a Fuchs dystrophy are included in two groups. Patients from Group A receive an ultrathin manually prepared endothelial graft and patients from Group B receive a DSAEK. In order to improve the power of our study, one patient from each group is grafted on the same day, with a corneal endothelium coming from the same donor. Improvement of visual acuity is the main outcome measure. Vitality of the graft, refractive modifications induced by surgery and complications are also studied.Results Currently, 22 patients with a follow up of 6 months have been included. At inclusion, patients from Group A and B were not statistically different. Six months after surgery, mean best corrected visual acuity has significantly improved in both groups but is statistically better in Group A (0,18 logMar in Group A versus 0,31 logMar in Group B (p&lt;0,05)). Mean endothelial cell density is 1686 cells in Group A statistically more than in Group B (1260 cells) p&lt;0,05. There were no refractive modifications in either group. There was no episode of graft rejection.Conclusion Ultrathin endothelial graft seems to give better results than DSAEK in Fuchs dystrophy in terms of visual acuity and endothelial cell density. It could be a good alternative to DMEK (Descemet membrane endothelial keratoplasty) because it is easier to prepare and inject than DMEK and should then be favoured when DMEK is not possible.

The Comparison of Astigmatic Outcomes after Cataract Surgery of Inferior versus Superior Clear Corneal Incision

Purpose: To analyze the difference in astigmatism and the mean change in total astigmatism between inferior clear corneal incision and superior clear corneal incision following cataract surgery in surgically-induced astigmatism (SIA). Methods: Fifty-five eyes of 55 patients with with-the-rule astigmatism >0.5 diopters were evaluated. Patients were divided into two groups according to incision location (Group 1, 26 eyes with an inferior incision; Group 2, 29 eyes with a superior incision). Patients were evaluatied one month postoperatively. Uncorrected visual acuity (UCVA, log MAR), best-corrected visual acuity (BCVA, log MAR), SIA and mean change in corneal astigmatism were measured in both groups. Results: One month postoperatively, mean UCVA was 0.15 ± 0.17 log MAR in Group 1 and 0.23 ± 0.24 log MAR in Group 2 (p = 0.253). Mean BCVA was 0.08 ± 0.13 and 0.08 ± 0.12 log MAR in Groups 1 and 2, respectively (p = 0.926). The SIA was 0.50 ± 0.17 diopter and 0.57 ± 0.34 diopter (p = 0.253) and mean change in total astigmatism was 0.50 ± 0.96 diopter and 0.38 ± 0.86 diopter in Groups 1 and 2, respectively (p = 0.426). Conclusions: There was no statistically significant difference between the two groups. Thus, corneal incision on the inferior side in patients of with-the-rule astigmatism can reduce the SIA and mean change in corneal astigmatism for patients with glaucoma, hard upper eyelid tension or sunken eye. J Korean Ophthalmol Soc 2014;55(10):1470-1475

Efficacy of Microperimetric Biofeedback after Retinal Detachment

Background: To evaluate visual recovery after rehabilitation with microperimetric biofeedback in patients submitted to surgery for retinal detachment. Methods: We have randomly divided 44 eyes of 44 patients after surgery for retinal detachment into two group: group A, 23 eyes, submitted to biofeedback training with microperimetry MP-1, 10 training sessions, once a week, ten minutes for each eye; group B (control group), 21 eyes, treated with common care strategy. We have compared best correct visual acuity (BCVA) of two groups at baseline, 6, 12 and 18 weeks with Student’s t test. Results: At baseline the mean BCVA was 0.6 ± 0.43 logMAR in group A and 0.66 ± 0.67 logMAR in group B (p=0.74). At 6 weeks after training the mean BCVA of group A was 0.27 ± 0.29 logMAR significantly better (p=0.02) than group B (0.67 ± 0.67 logMAR). At 12 weeks the mean BCVA was 0.18 ± 0.25 logMAR in group A better than the control group in which the mean BCVA was 0.60 ± 0.66 logMAR (p=0.01). At 18 weeks visual performances were still better in biofeedback group than in group B (p=0.01) in which the mean BCVA was 0.58 ± 0.68 logMAR. Conclusions: Microperimetric biofeedback allowed a better and faster visual recovery after surgery for retinal detachment than normal condition.

Effect of ranibizumab on serous and vascular pigment epithelial detachments associated with exudative age-related macular degeneration

PurposeTo report the effect of intravitreal ranibizumab therapy for serous and vascular pigment epithelial detachments (PED) associated with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD).MethodsIn a prospective study, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were collected for 62 eyes of 62 patients, with serous or vascular PED associated with CNV secondary to AMD. Intravitreal ranibizumab 0.5 mg was administered with a loading phase of three consecutive monthly injections, followed by monthly review with further treatment, as indicated according to the retreatment criteria of the PrONTO study. The change in visual acuity and PED height from baseline to month 12 after the first injection was determined.ResultsSixty-one eyes of 61 patients (one of the patients developed retinal pigment epithelial tear and was excluded from the study) were assessed at the 12-month follow-up examination. There were two types of PED, including vascular PED in 32 patients (Group A) and serous PED (Group B) in 29 patients. The mean improvement of mean BCVA from baseline to 12 months was 0.09 logMAR (Logarithm of the Minimum Angle of Resolution) in Group A and 0.13 logMAR in Group B. Both groups showed significant improvement of the mean BCVA 12 months after the first injection compared with the baseline value (P < 0.05). In relation to the PED height, the mean decrease of mean PED height from baseline to 12 months was 135 μm in Group A and 180 μm in Group B. Both groups showed significant reduction of the PED height during the follow-up period (P < 0.01). The PED anatomical response to ranibizumab was not correlated with the BCVA improvement in any of the groups. Apart from one patient who developed pigment epithelial tear no other complications were documented.ConclusionRanibizumab is an effective and safe treatment for improving vision in patients with serous and vascular PED, although the anatomical response of the PED to ranibizumab may not correlate directly with the visual outcome.