logMAR Units Research Articles

Amblyopia therapy in children with penetrating corneal injuries.

BACKGROUND:The role of part-time occlusion therapy in children with penetrating ocular injuries has not been studied. The aim of the study is to analyze the role of part-time occlusion therapy in children with penetrating ocular trauma following surgical intervention.MATERIALS AND METHODS:This is a retrospective case series with a median follow-up of 17 months (range: 3–105 months). The study was carried out at a tertiary referral center. Consecutive children with penetrating corneal tear injury who underwent surgical intervention were included in the study. These patients were subjected to part-time occlusion, and those with good compliance and follow-up were included in the study. The role of part-time occlusion therapy in children with ocular trauma is studied.RESULTS:There were 26 patients included in the study of which 23 were male and 3 were female, with a median age at presentation of 5 years (range: 1–11 years). The vision following surgical intervention at 6 weeks was 0.85 logMAR units (range: 0.3–2.8). Final median visual acuity was 0.48 logMAR units (range: 0–2). Paired t-test done for improvement in visual outcome before and after amblyopia therapy was statistically significant (P = 0.007).CONCLUSION:Amblyopia therapy shows promising results for patients following penetrating intraocular injury despite corneal scar in the visual axis in our group. A study on larger population is indicated.

Anaesthesia outside operation room: Challenge for anaesthesiologists – Yttrium-aluminium-garnet capsulotomy

Introduction: Secondary capsular opacification is prevalent in children after cataract surgery, but for its treatment in children, few options exist. Poor cooperation precludes the use of neodymium yttrium-aluminium-garnet (Nd: YAG) capsulotomy in children. Surgery in the form of membranectomy is mostly resorted to, in case of a thick visually significant posterior capsular opacification (PCO). However, in case of thin PCO in the visual axis, Nd: YAG capsulotomy could act as a non-invasive alternative. Materials and Methods: Medical records of patients aged 1–16 years who underwent YAG capsulotomy under general anaesthesia between January 2007 and December 2016 were reviewed. Here, we present a case series of 18 eyes that underwent Nd: YAG capsulotomy under general anaesthesia at our centre. Eighteen eyes of 14 patients had undergone the laser procedure. All the patients were administered general anaesthesia in the laser room, and the procedure was performed in the sitting position on the slit-lamp laser delivery system. Results: The mean age at primary surgery for cataract was 2.15 ± 2.4 years. Of the 18 eyes, 1 (5.5%) was a traumatic cataract, all others being congenital cataracts. The mean age at Nd: YAG laser capsulotomy was 4.05 ± 2.38 years. The mean pre-procedural visual acuity was 0.654 ± 0.278 logMAR units and post-procedural visual acuity was significantly better at 0.502 ± 0.55 logMAR units, with P = 0.009. Conclusion: This, to our knowledge, is the largest reported series on patients who have undergone Nd: YAG laser capsulotomy under general anaesthesia. Although controversy exists on the positioning of patients during the procedure under general anaesthesia, we have successfully done 14 patients in the sitting position with no anaesthesia-related complications. Nd: YAG laser capsulotomy could be considered as a non-invasive alternative to membranectomy for PCO in children.

Clinical outcome after Descemet membrane endothelial keratoplasty in vitrectomized eyes

Purpose The aim of the present study was to evaluate the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous vitrectomy. Patients and methods This is a retrospective review of medical records and surgical videos of all DMEK cases in vitrectomized eyes (total or anterior vitrectomy) that were done at Alexandria Main University Hospital, Alexandria, Egypt, between January 2015 and November 2019. The primary outcome measure was the improvement in best-corrected visual acuity. Secondary outcome measures were unfolding time and technique, endothelial cell loss, and rebubbling rate. Results A total of 18 vitrectomized eyes of 18 patients with bullous keratopathy were included in this study. Follow-up duration ranged from 6 to 53 months, with a mean of 23.8±15.2 months. At the end of the follow-up, the best-corrected visual acuity improved from 1.9±0.5 log MAR units to 0.7±0.4 log MAR units. The mean endothelial cell density was 1136.6±204.4 cells/mm2, representing 53% loss of the mean preoperative donor endothelial cells (2388.3±114.8 cells/mm2). The mean graft unfolding time was 13.7±5.4 min. A total of 11 (61%) eyes needed rebubbling owing to postoperative Descemet membrane detachment. Conclusion DMEK is an effective surgical modality for treatment of bullous keratopathy in vitrectomized eyes. Restoration of corneal clarity and significant visual improvement were possible in all patients, despite the need for complex surgical steps, prolonged surgical time, and the increased rebubbling rate.

Optic chiasm: Visualizing the visual pathway

Bilateral optic nerve confluence at the optic chiasm, anterior cerebral arteries, and anterior communicating artery during endoscopic endonasal resection of a craniopharyngioma compressing chiasm [Fig. 1]. Preoperative visual acuity was 1.4 logMAR units in right (OD) and 0.3 in the left eye with macular branch retinal vein occlusion in OD. Surgery performed using an image-guided protocol with intraoperative monitoring of visual evoked potentials as described by Miyagishima et al.[1] Complete tumor removal was achieved. There was no deterioration of visual function postoperatively.Figure 1: Intraoperative image of the bilateral optic nerves, their confluence at the optic chiasm and the anterior cerebral arteries along with the anterior communicating artery during endoscopic endonasal resection of a craniopharyngiomaswWe highlight the importance of a multidisciplinary approach and application of advanced intraoperative technology in the management of lesions affecting the visual pathway. 2.1 Financial support and sponsorship Nil. 2.2 Conflicts of interest There are no conflicts of interest.

Transepithelial Surface Ablation With Mitomycin C for the Treatment of Chronic Central Corneal Scars Following Adenoviral Keratoconjunctivitis

To assess visual and refractive outcomes and recurrence rates of subepithelial infiltrates after corneal surface ablation with mitomycin C (MMC) 0.02% for the treatment of chronic corneal scars following epidemic keratoconjunctivitis and to compare these results with a control group receiving only medical treatment. This was a retrospective case series enrolling patients with central corneal scars following epidemic keratoconjunctivitis. Patients were divided into two groups: (1) control with clinical follow-up and refractive correction with glasses or rigid gas-permeable contact lenses when necessary and (2) transepithelial phototherapeutic keratectomy (PTK) with MMC 0.02%, combined with photorefractive keratectomy (PRK) in selected cases (treatment group). Signs and symptoms, corrected distance visual acuity (CDVA) in logMAR units, manifest and cycloplegic refraction, and depth of the corneal opacities were assessed. Thirty-five eyes of 27 patients (11 men [40.7%] and 16 women [59.3%]) were enrolled, with a mean follow-up of 54.4 ± 19.7 and 27.5 ± 22.8 months in the control and treatment groups, respectively. Mean improvement in CDVA was 0.13 ± 0.17 logMAR (P = .007) in the control group and 0.29 ± 0.24 logMAR (P = .001) in the treatment group. Intergroup comparison showed a greater improvement in the treatment group (P = .041). Mean hyperopic shift induced in the treatment group was +0.46 ± 1.20 diopters. The recurrence rate of subepithelial infiltrates was 77.7% in the control group and 11.7% in the treatment group throughout the follow-up (54.4 ± 19.7 and 27.5 ± 22.8 months, respectively). Corneal surface ablation with MMC 0.02% was efficient in treating corneal scars following adenoviral epidemic keratoconjunctivitis, with greater visual improvement in comparison to clinical treatment and a decreased rate of infiltrate recurrence. [J Refract Surg. 2020;36(1):55-61.].

Evaluation of visual deficits in different types of amblyopia at rural tertiary setup

Introduction: Amblyopia is defined as unilateral or bilateral dimness of vision caused by form vision deprivation and/or abnormal binocular interaction, is the most common cause of preventable monocular blindness and nearly all-amblyopic visual loss is reversible with timely detection and appropriate intervention. The conditions leading to functional amblyopia are well known and include strabismus, anisometropia, astigmatism, hypermetropia, cataract, and other forms of stimulus deprivation. Material &Method: The present hospital based cross sectional study has been carried out in Department of Ophthalmology at Acharya Vinoba Bhave Rural Hospital attached to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, a constituent of Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur during the period from September 2012 to August 2014. 100 eyes of 91 patients having Amblyopia or amblyogenic factor (strabismus or anisometropia) in outdoor and indoor patients were selected for the study.All patients were enrolled in the study after due consideration of various exclusion criteria for selection. Results: The mean age of the study population was 15.00 ± 5.74 years, range 6-30 year. The present study found amblyopia to be more common in males than females. All the patients included in this study had one of the diagnoses from strabismic amblyopia, anisometropic amblyopia, isometropic amblyopia and stimulus deprivation amblyopia. Out of these maximum number of eyes was found to have anisometropic amblyopia (37%) and strabismic amblyopia (36%). Maximum numbers of eyes were seen with0.9-1.0 visual acuity (in LogMAR units).It was found to be highly significant in almost all except between strabismic and stimulus deprivation amblyopia; and between anisometropic and isometropic amblyopia.The present study found colour vision to be normal in all the various types of amblyopia. Most eyes were found to have hyperopic astigmatism/hyperopia (56%) followed by myopic astigmatism/myopia (31%) while mixed astigmatism was least common (13%). Maximum numbers of eyes were seen with 0.00 – 0.15 contrast sensitivity. 43% had normal while 57% had abnormal stereopsis. Conclusion: Amblyopia and associated strabismus can have devastating psychosocial and economic fallouts. Knowledge about the sub-types of amblyopia is important because the clinical presentations, management and outcomes of these different types are different. The data in the present study could be used to enhance screening efforts in an organized manner in those health-care groups which come in regular contact with infants and young children.

Clinical outcomes of a novel presbyopia-correcting soft contact lens with a small aperture

PurposeTo investigate the efficacy and safety of a newly developed pinhole soft contact lens (Eyelike Pinhole II; Koryo Eyetech Co. Ltd.) for presbyopia correction. MethodsThis prospective clinical study enrolled 29 patients with presbyopia between October 2018 and December 2018. All participants wore the Eyelike Pinhole II in the non-dominant eye for >3 h/day for a period of 1 week. Binocular and monocular uncorrected near visual acuities, distance-corrected near visual acuity (DCNVA), uncorrected distance visual acuity, and corrected distance visual acuity (CDVA) were measured before and after the intervention. All visual acuities were measured in logarithm of the minimal angle of resolution (logMAR) units. In addition, binocular defocus curves were generated, and contrast sensitivity values were obtained under photopic and mesopic conditions before and after lens wear. ResultsThe mean DCNVA of the treated eye and the mean binocular DCNVA improved from 0.34 ± 0.12 to 0.15 ± 0.14 (P < 0.001) and 0.31 ± 0.13 to 0.11 ± 0.10 (P < 0.001) logMAR, respectively, after pinhole contact lens wear. Although the mean CDVA of the treated eye deteriorated from −0.04 ± 0.05 to 0.02 ± 0.11 logMAR (P = 0.015), there was no significant change in the mean binocular CDVA (P = 0.79). The binocular defocus curve showed a significant improvement from −5.0 dioptres (D) to −1.0 D after pinhole contact lens wear. ConclusionsThe newly developed Eyelike Pinhole II soft contact lens showed safe and effective outcomes; thus, it could be a promising option for the treatment of presbyopia.

The effectiveness and safety of posterior scleral reinforcement with vitrectomy for myopic foveoschisis treatment: a systematic review and meta-analysis.

To investigate the effectiveness and safety of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis (MF) treatment. We conducted a systematic review and meta-analysis. We evaluated the improvement of best-corrected visual acuity (BCVA) in logMAR unit, the percentage of patients with improved or stabled BCVA, benefit on axial length (AL), the retinal reattachment rate, the macular hole (MH) closure rate, as well as the complication rate. Fourteen studies (311 eyes) were included. Overall, patients' BCVA improved - 0.46 (95% confidence interval [CI] - 0.52, - 0.40) logMAR unit, with 80% (95%CI 74%, 85%) benefiting from BCVA improvement and 6% (95%CI 3%, 10%) suffering from BCVA loss. Patients' AL was shortened by - 1.74 (95%CI - 2.92, - 0.57) mm, and for patients whose AL was ≥ 30mm, the average benefit reached - 3.68 (95%CI - 4.59, - 2.77) mm. Ninety-three percent (95%CI 89%, 96%) of the patients achieved retinal reattachment, and 65% (95%CI 47%, 80%) of the MH was closed. Patients' central foveal thickness decreased; the MD was - 187.32 (95%CI - 206.25, - 168.40) mm. The pooled complication rate was 9% (95%CI 8%, 19%), with extrusion, choroidal atrophy, and choroidal neovascularization being the most common complications. Subgroup analysis indicated no statistical difference in BCVA improvement, AL change, retinal reattachment rate, and complication rate between patients with or without MH. Subgroup analysis indicated no statistical difference in the above four outcomes between the primary and the recurrent patients either. There was no statistical difference in the above four outcomes no matter ILM peeling was combined or not. PSR combined with vitrectomy helps improve 80% MF patients' BCVA; the average benefit on BCVA is - 0.46 logMAR unit. The average change in AL is - 1.74mm; patients with AL ≥ 30mm benefit much more than the patients with AL < 30mm. The retinal reattachment rate is up to 93%; the MH closure rate is 65%. About 9% patients will suffer from extrusion, choroidal atrophy, choroidal neovascularization, and other complications. The outcomes were not influenced by presence of MH, disease recurrence, or ILM peeling.

Improvements of retinal sensitivity, visual acuity, and central retinal thickness after intravitreal injection of aflibercept in patients with wet age‐related macular degeneration

AbstractPurposeTo determine the retinal sensitivity, best‐corrected visual acuity (BCVA), and central retinal thickness (CRT) in patients with wet age‐related macular degeneration (wAMD) after intravitreal aflibercept (IVA).MethodsAn observational study conducted at the Chiba University Hospital between October 2016 and March 2019. All patients were treatment‐naïve with wet AMD and received three monthly (induction phase) and bimonthly (maintenance phase) of IVA for 12 months. Each patient underwent spectral‐domain OCT, fundus autofluorescence, indocyanine green angiography, and microperimetry. The primary outcome was the change in the retinal sensitivity from the baseline at 6 months (6 M). The retinal sensitivity was determined by the average of 13 points within the central 2 degrees and measured by Macular Integrity Assessment (MAIA, CenterVue, Italy). The secondary outcomes were the changes in the BCVA, CRT, presence of subretinal exudations, and greatest linear dimension (GLD) at 12 M relative to the baseline.ResultsThirty‐seven eyes of 37 patients were studied. The mean age was 72.8 ± 7.4 years (mean ± SD), and there were 26 men (72.2%). There were 18 eyes (49%) with typical wAMD and 19 eyes with PCV (51%). The mean retinal sensitivity was significantly improved from 15.4 ± 4.2 dB at the baseline to 19.9 ± 5.0 dB at 3M, 20.3 ± 4.5 dB at 6M, and 20.9 ± 4.6 dB at 12M (all p &lt; 0.0001 relative to baseline). The mean BCVA at the baseline was 0.35 ± 0.23 logMAR units which improved to 0.22 ± 0.28 logMAR units at 12 months (p = 0.001). The BCVA was improved or maintained at 12M in 71% of the patients. The mean CRT and GLD were significantly reduced at 12M (p &lt; 0.001). Twenty‐two eyes (71%) had a dry macula at 12M.ConclusionsThese results indicate that IVA applied with this protocol will improve not only the morphology (CRT) but also the physiology (BCVA, retinal sensitivity) of the retina at 12M.

Correlation between disease duration and retinal sensitivity and structure in patients with neuromyelitis optica spectrum disorder with no history of optic neuritis

AbstractPurposeTo determine whether there is a significant correlation between the disease duration and the sensitivity and structure of the retina in patients with neuromyelitis optica spectrum disorder (NMOSD) with no history of optic neuritis (ON).MethodsFifteen eyes of 15 patients with NMOSD (2 men, 13 women; mean age 50.2 ± 11.2 years) who had no history of ON were studied. The retinal sensitivity of the central 10º was determined by macular integrity assessment (MAIA), a microperimetric method, and the retinal structure by spectral‐domain optical coherence tomography (SD‐OCT). For MAIA, the retina was stimulated with a scanning laser ophthalmoscope at 37 loci covering 10° of the central retina. For the retinal structures, the mean thickness of the ganglion cell complex (GCC) thickness and outer nuclear layer (ONL) thickness were measured in the SD‐OCT images. The correlations between the disease duration and the sensitivity and the GCC thickness or the ONL thickness were determined by the Spearman’s rank‐correlation coefficients.ResultsThe mean best‐corrected visual acuity(BCVA) was 0.05 ± 0.03 logMAR units. The mean disease duration was 42.4 ± 37.4 months with a range of 1 to 103 months. The mean retinal sensitivity of the central 10º was 27.6 ± 1.78 dB. The mean GCC thickness was 95.0 ± 8.99 μm, and the mean ONL thickness was 53.8 ± 5.43 μm. There was a significant correlation between the disease duration and the sensitivity of the central 10º (r = 0.48, p = 0.034; Spearman’s rank‐correlation coefficients) and the ONL thickness (r = 0.60, p = 0.016; Spearman’s rank‐correlation coefficients). However, there was not a significant correlation between disease duration and GCC thickness (p &gt; 0.05; Spearman’s rank‐correlation coefficients).ConclusionsThese results indicate that the visual function is impaired even before the development of the ON in patients with NMOSD. We recommend that microperimetry and OCT be used in eyes with NMOSD because subclinical optic neuritis may be present.

Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

Objectives:To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyesMaterials and Methods:Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded.Results:Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 µm at baseline to 310, 368±34 and 375 µm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections.Conclusion:Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

Vision-related quality of life in Japanese patients with wet age-related macular degeneration treated with intravitreal aflibercept in a real-world setting.

To evaluate vision-related quality of life (QoL) in wet age-related macular degeneration (wAMD) patients receiving intravitreal aflibercept (IVT-AFL). Prospective, observational Japanese postmarketing surveillance study. All decisions were made by the treating physician. QoL was assessed using the 25-item National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ-25) composite score administered at baseline, 6 months, and 12 months (primary assessment). Secondary assessments included NEI-VFQ-25 subscale scores, resource use, and best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]). In total, 576 patients (baseline), 555 patients (6 months), and 446 patients (12 months) were included. The mean (SD) number of IVT-AFL injections was 3.5 (1.2) at 6 months and 4.6 (2.2) at 12 months. The mean (SD) improvement from baseline in the NEI-VFQ-25 composite score was 3.1 (11.1) at 6 months and 2.7 (12.3) at 12 months (P < .0001). For the NEI-VFQ-25 subscale scores, the mean change was ≥ 4 (minimally important difference) for general vision, near vision, and mental health at 6 months, and for general vision and mental health at 12 months (all P < .0001). A significant improvement from baseline was found in mean BCVA (logMAR) at 6 months (-0.1) and 12 months (-0.1) (P < .0001). The mean change from baseline in the NEI-VFQ-25 scores was greatest in patients with improved BCVA (gain of ≤ -0.3 logMAR units or ≥ 15 letters) after treatment. IVT-AFL was associated with significant improvements in QoL and visual acuity in Japanese patients with wAMD in a real-world setting.

Papillary Vessel Density Changes After Intravitreal Anti-VEGF Injections in Hypertensive Patients with Central Retinal Vein Occlusion: An Angio-OCT Study.

Purpose: To investigate papillary microvascular changes in patients affected by macular edema due to Central Retinal Vein Occlusions (CRVO) after anti-Vascular Endothelial Growth Factor (VEGF) therapy. Methods: Prospective analysis of papillary and peripapillary vessel density (VD) changes in 18 eyes of 18 hypertensive patients affected by CRVO before and after the loading-phase of intravitreal Ranibizumab (IVR) injections. Data were quantitatively measured by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) before as well as 1 month and 4 months after injections. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA was assessed. Results: 18 eyes of 18 consecutive patients with a known history of arterial hypertension and affected by an acute CRVO episode were enrolled. Central macular thickness (CMT) was significantly reduced after IVR injections (p < 0.001), while mean BCVA improved from 0.70 ± 0.26 logarithm of the minimal angle of resolution (logMAR) units at baseline to 0.25 ± 0.18 logMAR units after 4 months (p < 0.001). VD inside disc and peripapillary significantly increased (p < 0.001 and p = 0.01, respectively) after treatment. Conclusions: OCTA showed VD increase in the papillary area in patients affected by CRVO after anti-VEGF therapy. This area could represent a new region of interest to study microvasculature changes concomitant with severe macular edema.

Validation of an Affordable Handheld Wavefront Autorefractor.

There is a critical need for tools that increase the accessibility of eye care to address the most common cause of vision impairment: uncorrected refractive errors. This work assesses the performance of an affordable autorefractor, which could help reduce the burden of this health care problem in low-resource communities. The purpose of this study was to validate the commercial version of a portable wavefront autorefractor for measuring refractive errors. Refraction was performed without cycloplegia using (1) a standard clinical procedure consisting of an objective measurement with a desktop autorefractor followed by subjective refraction (SR) and (2) with the handheld autorefractor. Agreement between both methods was evaluated using Bland-Altman analysis and by comparing the visual acuity (VA) with trial frames set to the resulting measurements. The study was conducted on 54 patients (33.9 ± 14.1 years of age) with a spherical equivalent (M) refraction determined by SR ranging from -7.25 to 4.25 D (mean ± SD, -0.93 ± 1.95 D). Mean differences between the portable autorefractor and SR were 0.09 ± 0.39, -0.06 ± 0.13, and 0.02 ± 0.12 D for M, J0, and J45, respectively. The device agreed within 0.5 D of SR in 87% of the eyes for spherical equivalent power. The average VAs achieved from trial lenses set to the wavefront autorefractor and SR results were 0.02 ± 0.015 and 0.015 ± 0.042 logMAR units, respectively. Visual acuity resulting from correction based on the device was the same as or better than that achieved by SR in 87% of the eyes. This study found excellent agreement between the measurements obtained with the portable autorefractor and the prescriptions based on SR and only small differences between the VA achieved by either method.

Refractive outcomes of implantation of an implantable phakic copolymer lens with peripheral holes in the intraocular posterior chamber in moderate to high myopia patients: a single-surgeon series.

PurposeTo assess the safety and efficacy of implanting implantable phakic copolymer lenses (IPCLs) with peripheral optic holes in the intraocular posterior chamber in Indian patients with moderate to high myopia.MethodsSeventy-five eyes of 50 patients who underwent IPCL implantation were retrospectively analyzed. Preoperative parameters, such as subjective refraction, anterior chamber depth (measured using a pentacam), and white-to-white diameter were measured. A custom-made IPCL using the aforementioned parameters was then implanted in the sulcus to correct moderate to high myopia. All patients had undergone neodymium-doped yttrium aluminum garnet peripheral iridotomy.ResultsClinical outcome data were collated retrospectively from the medical case records of the patients. The mean age was 25.36 years (standard deviation [SD]: 3.60 years), and 55.55% of the patients were men. The mean preoperative best-corrected visual acuity (BCVA) was 0.367 logmar units (SD: 0.266, max: 0.0 and min: 1.2). The post-IPCL implantation mean uncorrected visual acuity was 0.225 logmar units (SD: 0.172, max: 0 and min: 0.7), which was significantly superior to the preoperative BCVA (P=<0.0001). Forty-three patients (86%; satisfaction scores of ≥4; scale 1–5) were “highly satisfied” to “extremely satisfied” with the outcome. The mean follow-up period was 1.8 years.ConclusionImplantation of the IPCL with peripheral holes in the intraocular posterior chamber resulted in a clinically significant improvement in unaided visual acuity. Long-term follow-up showed optimum stability of vision.

Phenotypical Characteristics of POC1B-Associated Retinopathy in Japanese Cohort: Cone Dystrophy With Normal Funduscopic Appearance.

Cone/cone-rod dystrophy is a large group of retinal disorders with both phonotypic and genetic heterogeneity. The purpose of this study was to characterize the phenotype of eight patients from seven families harboring POC1B mutations in a cohort of the Japan Eye Genetics Consortium (JEGC). Whole-exome sequencing with targeted analyses identified homozygous or compound heterozygous mutations of the POC1B gene in 7 of 548 families in the JEGC database. Ophthalmologic examinations including the best-corrected visual acuity, perimetry, fundus photography, fundus autofluorescence imaging, optical coherence tomography, and full-field and multifocal electroretinography (ERGs) were performed. There were four men and four women whose median age at the onset of symptoms was 15.6 years (range, 6-23 years) and that at the time of examination was 40.3 years (range, 22-67 years). The best-corrected visual acuity ranged from -0.08 to 1.52 logMAR units. The funduscopic appearance was normal in all the cases except in one case with faint mottling in the fovea. Optical coherence tomography revealed an absence of the interdigitation zone and blurred ellipsoid zone in the posterior pole, but the foveal structures were preserved in three cases. The full-field photopic ERGs were reduced or extinguished with normal scotopic responses. The central responses of the multifocal ERGs were preserved in two cases. The diagnosis was either generalized cone dystrophy in five cases or cone dystrophy with foveal sparing in three cases. Generalized or peripheral cone dystrophy with normal funduscopic appearance is the representative phenotype of POC1B-associated retinopathy in our cohort.

Anti-VEGF versus dexamethasone implant (Ozurdex) for the management of Centre involved Diabetic Macular Edema (CiDME): a randomized study.

To compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection versus dexamethasone implant (Ozurdex) for the treatment of center-involved DME (CiDME). This prospective randomized comparative study included 40 eyes (38 patients) of CiDME. They were randomized into two groups. Patients in group A received the intravitreal anti-VEGF injection (bevacizumab 1.25mg or ranibizumab 0.5mg) and those in group B received dexamethasone implant (0.7mg) pro-re-nata after 4weeks and 3months, respectively. The primary outcome was measured at 3months from the baseline that included improvement in BCVA, reduction in CFT, and adverse effects during the follow-up period. Mean best-corrected visual acuity (BCVA) improved from 0.51 ± 0.275 LogMAR units (20/63) to 0.20 ± 0.185 LogMAR units (20/32) in group A and from 0.56 ± 0.213 LogMAR units (20/80) to 0.141 ± 0.177 LogMAR units (20/32) in group B at 3months. There was no significant difference in mean BCVA between both the groups (p = .27). The mean central foveal thickness (CFT) improved from 443.55 ± 131.536µ to 277.66 ± 76.184µ and from 460.95 ± 125.462µ to 233.25 ± 37.552µ at 3months in group B (p = .02). Both the groups had the similar visual outcome. However, the superior anatomical result was observed in dexamethasone implant group during this short follow-up.

Clinical and genetic characteristics of 14 patients from 13 Japanese families with RPGR-associated retinal disorder: report of eight novel variants

Variants in the retinitis pigmentosa GTPase regulator (RPGR) gene are a major cause of X-linked inherited retinal disorder (IRD). We herein describe the clinical and genetic features of 14 patients from 13 Japanese families harboring RPGR variants in a nationwide cohort. Comprehensive ophthalmological examinations were performed to classify the patients into one of the phenotype subgroups: retinitis pigmentosa (RP) and cone rod dystrophy (CORD). The mean age of onset/at examination was 13.8/38.1 years (range, 0–50/11–72), respectively. The mean visual acuity in the right/left eye was 0.43/0.43 (range, 0.1–1.7/−0.08–1.52) LogMAR unit. Eight patients had RP, and six had CORD. Whole-exome sequencing with target analyses identified 13 RPGR variants in 730 families with IRD, including 8 novel variants. An association between the phenotype subgroup and the position of variants (cutoff of amino acid 950) was revealed. To conclude, the clinical and genetic spectrum of RPGR-associated retinal disorder was first illustrated in a Japanese population, with a high proportion of novel variants. These results suggest the distinct genetic background of RPGR in the Japanese population, in which the genotype–phenotype association was affirmed. This evidence should be helpful monitoring and counseling patients and in selecting patients for future therapeutic trials.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery.

To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists' National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017. Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England. The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access. We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.

Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.