Mean Best-corrected Visual Acuity Research Articles

Efficacy of a simple intravitreal perfluoropropane injection in treating unclosed idiopathic macular holes following vitrectomy

BackgroundThis study aimed to evaluate the efficacy of a simple intravitreal injection of perfluoropropane (C3F8) in treating unclosed idiopathic macular holes (IMHs) in patients who had previously undergone primary pars plana vitrectomy (PPV).MethodsThis study was a retrospective, observational clinical study. It included patients diagnosed with unclosed IMHs following primary PPV combined with internal limiting membrane peeling and air tamponade. Optical coherence tomography (OCT) performed 1 week after PPV revealed unclosed IMHs with the presence of the ‘cuff’ sign and intraretinal cysts. The following day, these patients received a simple intravitreal C3F8 injection. Comprehensive evaluations, including best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus photography, and OCT, were performed before PPV, 1 week after surgery, and at follow-up intervals of 1–3 months after the intravitreal gas injection.ResultsThe minimum linear diameter (MLD) of the macular holes (MHs) 1 week before C3F8 injection was 335.1 ± 74.3 μm. Following C3F8 tamponade, the closure rate of the MHs was 100%. The mean BCVA before C3F8 tamponade was 0.68 ± 0.17 logMAR (20/100) after primary PPV, which improved to 0.48 ± 0.19 logMAR (20/63) after C3F8 tamponade, showing a statistically significant difference (P = 0.01).ConclusionsFor patients with unclosed MHs after primary PPV, the presence of the ‘cuff’ sign on OCT suggests that retreatment can be effectively achieved through a simple intravitreal gas injection. This approach is straightforward, practical, and effective.

Predictive value of different baseline optical coherence tomography biomarkers for visual acuity changes in neovascular age-related macular degeneration

BackgroundTo evaluate baseline optical coherence tomography (OCT) biomarkers in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) and their correlation with visual acuity changes following intravitreal aflibercept injections.MethodsA retrospective analysis was conducted on treatment-naïve nAMD patients. Baseline OCT biomarkers, including shallow irregular pigment epithelial detachment (SIPED), subretinal hyperreflective material, subretinal fluid, intraretinal fluid (IRF), hyperreflective foci, and subretinal drusenoid deposits, were assessed. Patients received bimonthly aflibercept injections after three loading doses. Visual acuity changes were evaluated at 3 and 12 months. The maximum height and width of the largest pigment epithelial detachment (PED) were also measured.ResultsAmong 89 eyes with nAMD, mean best-corrected visual acuity (BCVA) improved by 6 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline to month 3, with sustained improvement through month 12. Baseline IRF was associated with poorer visual acuity improvement at month 12, with patients showing a mean improvement of 1.6 ± 18.2 ETDRS letters versus 11.1 ± 10 ETDRS letters in those without IRF (P = 0.002). Multivariable analysis indicated SIPED was linked to lower visual gains at month 3 (P = 0.025). The largest PED width correlated significantly with lower BCVA gains at months 3 (P = 0.021) and 12 (P = 0.043), suggesting its potential as a prognostic factor.ConclusionBaseline OCT biomarkers, including SIPED, IRF, and PED width, may predict visual acuity changes in nAMD patients treated with aflibercept, highlighting the need for individualized monitoring.Clinical trial numberNot applicable.

Proliferative Diabetic Retinopathy in Nigerians: Treatment Methods, Visual Outcomes, and Predictors of Poor Outcomes

Abstract Objective: To investigate demographics, treatment methods, pre- and post-treatment vision of proliferative diabetic retinopathy (PDR) patients, and predictors of poor visual outcomes. Materials and Methods: This is a multicentre chart review of consecutive PDR eyes, investigating vision, presence of vitreous haemorrhage (VH), tractional retinal detachment (TRD), diabetic macular edema (DME), and rubeosis. Rates of good vision (6/60+) and poor vision (< 6/60) and rates of worse, same, or improved vision were the primary outcomes. The secondary outcome was the number of eyes in each treatment category. Results: A total of 640 PDR eyes/473 patients were evaluated [334 bilateral eyes (52.2%)/167 patients (35.3%)]. Mean age: 58.9/SD 10.97 years (17–95). Mean symptom duration: 12.8 months. Rates of DME, TRD, VH, TRD with VH , and rubeosis were 12%, 3%, 25.6%, 2.5%, and 15%, respectively. The five treatment categories include intravitreal antivascular endothelial growth factor injections (IVI) alone (392 eyes/61.25%), IVI + retinal laser photocoagulation (86 eyes/13.45%), IVI + cataract surgery (CS) (24 eyes/3.76%), IVI + vitrectomy (V) (109 eyes/17.0%), and IVI + CS + vitrectomy (29 eyes/4.54%). IVI + CS had the highest mean number of intravitreal anti-VEGF use (2.96/SD 4.56) and highest rate of improved vision (62.5%). IVI + vitrectomy had the highest worse vision (29%). IVI alone and IVI + CS had the highest pre- and post-treatment best corrected visual acuity (BCVA). TRD, rubeosis, VH, and no DME eyes had poor mean pretreatment BCVA (< 6/60). Post-treatment mean BCVA improved significantly in VH and DME. Poor pretreatment BCVA, TRD, TRD with VH, and rubeosis were predictors of poor outcomes. Conclusion: PDR is a cause of poor vision and associated poor treatment outcomes in Nigerians. Systematic, effective DR screening and retinal laser treatment of high-risk eyes is urgently needed.

The Spectrum of Functional, Structural and Patient-Reported Outcomes in Intermediate Age-Related Macular Degeneration – A MACUSTAR Study Report

Introduction: There is an unmet medical need for therapies in intermediate age-related macular degeneration (iAMD). The prospective European multi-center cohort study MACUSTAR validates structural, functional and patient-reported iAMD endpoints for use in future trials. The multiplicity of assessments allows characterizing iAMD in more dimensions than previously available. We describe the heterogeneity of assessments in the iAMD baseline cohort of the MACUSTAR study. Methods: A wide range of assessments were administered across 20 European study sites in accordance with established guidelines. These assessments encompassed multiple structural evaluations, such as color fundus photography, fundus autofluorescence, and optical coherence tomography. Additionally, functional tests were conducted, including assessments of best-corrected and low-luminance visual acuity (VA), Moorfields acuity, contrast sensitivity, reading speed, mesopic and scotopic microperimetry, and dark adaptometry. Moreover, patient-reported outcome assessments, specifically the Vision Impairment in Low Luminance questionnaire, were also incorporated into the evaluation process. Associations between variables were investigated using Phi coefficients, Pearson correlation coefficients and age-corrected regression models. Results: Five-hundred eighty-five individuals with iAMD (66% women; mean (standard deviation) age: 72±7 years) were included in the MACUSTAR study. Forty-nine percent had pigmentary abnormalities, 27% had reticular pseudodrusen; 10% and 9% had incomplete and complete retinal pigment epithelium and outer retinal atrophy at baseline, respectively. Mean best-corrected VA, low-luminance VA and mesopic average threshold on microperimetry at baseline were 0.03±0.11 logMAR, 0.24±0.16 logMAR and 23.3±3.7 dB. Mean VILL subscale scores at baseline were 2±2 to 2±3 logits. Phi coefficients between structural assessments ranged between 0.17 and 0.22 (median 0.21); correlation coefficients between function tests ranged between 0.07 and 0.69 (median 0.34) and between VILL scores ranged between 0.21 and 0.68 (median 0.23). Conclusion: The findings from this broad and comprehensive spectrum of assessments of structure, function, and patient-reported outcomes in iAMD suggest that the disease spectrum is diverse and heterogeneous and that further efforts are necessary to fully understand and characterize iAMD in all its complexities. A further in-depth characterization will enable novel enrichment strategies for clinical trials in iAMD. Trial registration: ClinicalTrials.gov, NCT03349801. Registered on November 22, 2017

Prevalence of HSV Genomic Signatures Among Acanthamoeba Hosts and Contaminated Lens Cases: A Molecular and Clinical Study.

To document the presence of herpes simplex virus (HSV) genomic signatures among Acanthamoeba hosts recovered from patients with Acanthamoeba keratitis (AK) and in contaminated lens cases. We used a combination of PCR sequencing and shotgun metagenomics to detect and confirm the presence of HSV genomic signatures in Acanthamoeba hosts and lens cases. Clinical outcomes were correlated with the prevalence of host HSV signatures. HSV genomic signatures were detected in 26% (n = 6) of Acanthamoeba hosts recovered from patients with culture confirmed AK. HSV-1 and HSV-2 or both were identified in 33%, 50%, and 17% of isolates, respectively. Fifty-two percent of patients (12/23) were misdiagnosed initially as presenting with HSV keratitis. Patients with HSV-positive Acanthamoeba isolates had a mean best-corrected visual acuity of 1.43 LogMAR at diagnosis and 0.53 LogMAR at follow-up, compared with 1.85 and 0.92 LogMAR, respectively, in HSV-negative cases. Contact lens use was identified as a risk factor in 83% of 18 patients. We detected 46,597 viral signatures in 5 of 14 contaminated lens cases (35.7%). Distribution included 33% bacteriophages, 8.2% giant viruses, 4.1% nonhuman Herpesviridae, and 0.39% human Herpesviridae. Among the 184 human Herpesviridae genomic signatures, HSV types 1 or 2 or both were documented in 5.7%, VZV in 39.7%, HHV7 in 38.6%, HHV6 in 15.0%, and Epstein-Barr virus in 0.5%. This study is the first to identify HSV-positive genomic signatures in clinical AK isolates and/or contact lens cases. Taken together, the high prevalence of HSV genomic signatures in both amebic hosts and lens cases, might signal an unrecognized Acanthamoeba-HSV association and the need for reassessing current management.

Intermediate-Term Outcomes and Complications of Ahmed Glaucoma Valve in Type 1 Keratoprostheses.

To evaluate intermediate-term outcomes and complications associated with Ahmed glaucoma valve (AGV) implantation in eyes with type 1 keratoprosthesis (KPro). We retrospectively reviewed records of 43 eyes of 43 Indian patients with type 1 KPro and AGV from 2009 to 2021 with a minimum of 6-months of follow-up. Five eyes that had AGV before KPro were excluded, leaving 38 eyes for analysis. Primary outcome measure was postoperative complications. Secondary outcome measure was stability of glaucoma, assessed by Humphrey visual fields, intraocular pressure, and best-corrected visual acuity (BCVA). Sight-threatening complications, implant removal, or repeat glaucoma surgery was considered failure. Median age (interquartile range) at AGV implantation was 36.5 (23-49) years, with median post-AGV follow-up of 30.5 (6.5-53) months. Preoperative logarithm of minimal angle of resolution median BCVA was 0.6 (0.4-1). Post-AGV, median intraocular pressure as measured by scleral Schiotz reduced significantly from 30.4 (20.6-30.4) to 13.5(12.2-14.8) mm Hg (P < 0.0001), and the mean number of antiglaucoma medications significantly decreased from 3.4 to 1.7 (P < 0.0001). Mean BCVA (P = 0.24) remained stable. Humphrey visual fields mean deviation progressed from -13.5 dB (-25, -9) to -26 dB (-30, -13) at final follow-up (P = 0.05) and progression occurred in 10 eyes. Seven eyes (18.4%) had postoperative complications needing surgical intervention, including tube block [5 eyes (13.1%)] and tube exposure [2 eyes (5%)]. One failed AGV needed additional glaucoma surgery after 8 years. None had implant extrusion/explanation or endophthalmitis. Ahmed glaucoma valve implantation offered promising results in managing glaucoma in eyes with type 1 KPro, particularly in relatively young Indian population. However, close monitoring for tube-related complications and glaucoma progression is warranted.

Salivary steroids in acute central serous chorioretinopathy.

To analyze levels of salivary steroids, including 17-OH-progesterone (17-OHP), androstenedione, dehydroepiandrosterone, cortisol, cortisone, progesterone, testosterone, and estradiol, in patients with acute central serous chorioretinopathy (CSCR) patients. Acute CSCR patients and healthy individuals were included in this observational case-control study. Levels of salivary steroids were determined by high-performance liquid chromatography with tandem mass spectrometry detection. Clinical characteristics of CSCR patients were assessed based on multimodal imaging. Seventeen CSCR patients (40.1 ± 4.6years) and fourteen age-matched healthy controls (40.6 ± 3.8years) were included. Mean central retinal thickness and subfoveal choroidal thickness in affected eye of CSCR patients were 436.2 ± 131.1µm and 464.6 ± 132.6µm, respectively. Mean best-corrected visual acuity was 0.09 ± 0.11 LogMAR. Mean symptoms duration before saliva collection was 0.9 ± 0.6months. 17-OHP was decreased compared to the normal limits established in healthy controls in 10 out of 17 patients (59%), androstenedione in 15 out of 17 patients(88%), dehydroepiandrosterone in 10 out of 17 patients (59%), cortisol in 6 out of 17 patients(35%), cortisone in 12 out of 17 patients (83%), progesterone in 9 out of 17 patients(53%), testosterone in 10 out of 17 patients (59%), and estradiol in 5 out of 17 patients(29%). In total, among CSCR patients lower level in saliva was found for all studied hormones (p < 0.05), except progesterone and estradiol. Salivary steroids are decreased in acute CSCR male patients compared with age-matched controls. This may indicate inhibition of steroidogenesis caused by chronic stress and personal reactivity preceding manifestation of CSCR.

Drainage from intentional extramacular holes after internal limiting membrane insertion to treat macular hole retinal detachment in highly myopic eyes.

The purpose is to evaluate the effect of drainage from intentional extramacular holes after internal limiting membrane insertion to treat macular hole retinal detachment (MHRD) in highly myopic eyes. This study is a retrospective, observational, and comparative case series that included 25 consecutive highly myopic eyes with MHRD. All eyes underwent standard 23-gauge vitrectomy, inverted internal limiting membrane insertion into the macular hole, subretinal fluid drainage from an intentionally created extramacular retinal hole, and tamponade with either silicone oil (SO group, n = 13) or perfluoropropane (C3F8 group, n = 12). A facedown position was maintained for 1week postoperatively. The anatomic and functional outcomes were compared between two groups at the endpoint. There was no significant difference in the retinal reattachment rate between the SO and C3F8 groups (100% and 91.67%, P = 0.48). The macular hole closure rates were 92.31% in the SO group and 100% in the C3F8 group (P = 0.52). The mean best-corrected visual acuity (BCVA) improved from 2.18 ± 0.60 logarithm of the minimum angle of resolution(logMAR) preoperatively to 1.11 ± 0.36 logMAR (P < 0.01) in the SO group and from 2.20 ± 0.61 to 1.29 ± 0.50 (P < 0.01) in the C3F8 group at the endpoint. There was no significant difference in BCVA improvement between the two groups (P = 0.37). The drainage technique from intentional extramacular holes after internal limiting membrane insertion is an effective treatment for MHRD in highly myopic eyes, regardless of whether silicone oil or gas is used as a tamponade.

Surgical outcomes after trabeculotomy for primary congenital glaucoma.

To investigate outcomes after trabeculotomy in Japanese patients with primary congenital glaucoma (PCG), and to identify risk factors for multiple glaucoma surgery procedures. Retrospective observational study. Surgical outcomes were investigated in Japanese patients with PCG who underwent their first glaucoma surgery at Hiroshima University Hospital between January, 2006, and December, 2021. The data included in this study were divided into single- and multiple-surgery groups, and risk factors for requiring multiple surgery procedures were evaluated using multivariate analysis. Twenty eyes of 20 patients were included. All eyes underwent ab externo trabeculotomy as the first surgery. The mean follow-up period was 75.7 ± 44.8 months. The cumulative success rate for up to 3 trabeculotomies at 5 years after the first surgery was 89.7%. The glaucoma in 11 eyes (55.0%) was controllable with just one surgery, whereas 9 eyes (45.0%) required 2 or more glaucoma surgical procedures. The single-surgery group had a significantly better mean best-corrected visual acuity at the last visit than the multiple-surgery group (0.1 ± 0.1 versus 0.9 ± 1.1, respectively, p = 0.001) and a smaller mean cylindrical power (- 0.8 ± 0.8 versus - 2.2 ± 1.0, respectively, p = 0.01). In multivariate logistic analysis, a 1-mm increase in corneal diameter was associated with a 16-fold increase in the risk of multiple glaucoma surgical procedures (p = 0.047). The glaucoma in most PCG eyes can be controlled with up to three trabeculotomies. Corneal-diameter enlargement was a significant risk factor for multiple surgical procedures.

An analysis of heavy silicone oil treatment for inferior proliferative vitreoretinopathy

PurposeProliferative vitreoretinopathy (PVR) is a complication of retinal detachment which requires multiple vitreoretinal surgical interventions and frequent use of oil endotamponade. In this study, we conducted an in-depth analysis of complications associated with the use of heavy silicone oil in the management of inferior PVR.MethodsA retrospective cohort study of 20 eyes that underwent vitrectomy for inferior PVR with use of heavy silicone oil (Densiron 68) between March 2021 and October 2022 at Oxford Eye Hospital. Complications were classified into major categories relating to intraocular pressure, inflammation, lens, and oil emulsification/migration. Visual outcomes and surgical success rate were also evaluated.ResultsFill-induced pressure spikes (> 30 mmHg) within 14 days post-surgery were common after Densiron tamponade, especially in patients previously on glaucoma drops. The number of glaucoma drugs were increased in 45% of patients during Densiron tamponade. In 20% of cases, an increased medication was continued long-term after Densiron removal. Significant cataract progression occurred in all phakic patients. In 25% of pseudophakic cases, posterior capsule opacification was noted. Inflammatory complications, such as anterior uveitis, were rare and any cystoid macular oedema was transient. No unexplained acute loss of vision following Densiron removal was encountered. The anatomical success rate at 30 days after Densiron removal was 70%. The mean (± SD) best-corrected visual acuities were 1.04 (± 0.79), 0.85 (± 0.62) and 0.50 (± 0.51) logMAR prior, during and after Densiron tamponade, respectively.ConclusionThe outcomes in this cohort treated with Densiron 68 were comparable to previously reported anatomical and functional results in cases with inferior PVR. IOP and lens-related complications require additional treatment during or after Densiron tamponade. Inflammatory complications rarely occurred over tamponade durations of around three months.Trial registrationAnalyses were conducted as an internal quality improvement audit and as such did not require external IRB review.

Outcomes and safety of Descemet's membrane endothelial keratoplasty (DMEK) as a surgical treatment for corneal endothelial dysfunction: A multicenter study.

To analyze the outcomes and frequency of complications after Descemet's membrane endothelial keratoplasty (DMEK) and evaluate the parameters associated with the occurrence of these complications. A multicenter retrospective study of 143 DMEK procedures performed consecutively by five surgeons between June 2018 and March 2021 was performed. Surgeon-specific surgical and graft characteristics were also assessed. Data on best-corrected visual acuity (BCVA), central pachymetry, and endothelial cell density (ECD) were collected at one, three, six, and 12months. Postoperative complications and secondary procedures (rebubbling and regrafting) were also recorded. The mean BCVA at one year was 0.17 logMAR (±0.19). There was a mean hyperopic shift at one year of +0.26 diopters. The mean pachymetry at one year was 526μm (±53). The mean ECD at one year was 1164cells/mm2 (±479). Graft detachment occurred in 51% of the procedures and was significantly associated with the performance of an intraoperative iridotomy (OR=2.8) [95% CI: 1.2-6.6]. Rebubbling occurred in 34% of the procedures, and a new graft was performed in 21% of cases. Performing a peripheral iridotomy during DMEK is a significant risk factor for graft detachment. DMEK significantly improves patients' vision and restores normal pachymetry.

Twelve-Month Outcomes and Optical Coherence Tomography (OCT) Biomarkers After Intravitreal Dexamethasone Implantation in Pseudophakic Eyes with Post-Vitrectomy Cystoid Macular Edema (CME)-Refractory to Medical Therapy.

Background: In this study, we evaluated the incidence of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for different retinal pathologies and assessed the role of optical coherence tomography (OCT) biomarkers in guiding treatment decisions in post-surgical CME patients who were refractory to medical therapy over a follow-up period of 12 months. Methods: Medical records of consecutive pseudophakic patients, who underwent PPV for different retinal pathologies, were retrospectively evaluated in this single-center, uncontrolled study. The incidence of post-PPV CME was assessed. Eyes with post-PPV CME in the first 2 months after surgery, with available clinical and OCT data for 12 months after surgery, were included in the evaluation. The mean best-corrected visual acuity (BCVA; logMAR), mean central macular thickness (CMT; μm) change, and response to different treatments [medical therapy and intravitreal dexamethasone (DEX) implant] were evaluated 1, 3, 6, 9, and 12 months after PPV. The impact of OCT biomarkers on the exposure to DEX implants was assessed. Adverse events, potentially related to the treatment, were investigated as well. Results: Of the 346 pseudophakic patients (352 eyes) who participated in this study, 54 (54 eyes) developed CME within the first 2 months after PPV (incidence of 15.3%). Among them, 48 patients were deemed eligible for the 12-month analysis. Preoperative mean BCVA (1.44 ± 0.99 logMAR) significantly improved to 0.32 ± 0.37 logMAR after 12 months (p < 0.001). The mean baseline CMT of 347 (±123.5) μm significantly decreased to 290 μm (±80.4; p = 0.003) by the end of the follow-up. Twenty-five eyes (52%) required one or more DEX implants for CME, due to being refractory to topical therapy. Significant correlations were found between the mean CMT values at various time points. Additionally, patients who required DEX implants at months 3 and 9 were more likely to present intraretinal fluid (IRF), disorganization of inner retinal layers (DRIL), disorganization of outer retinal layers (DROL), and hyper-reflective foci (HRF) at 1-month OCT. Five patients experienced a slight increase in intraocular pressure (IOP), which was successfully managed with topical medication. Conclusions: Topical therapy alone can be a valuable option for post-PPV CME in approximately 50% of patients. Significant visual recovery and macular thickness reduction at 12 months demonstrated that DEX implants can be a safe and effective second-line treatment for pseudophakic patients with post-PPV CME and who are refractory to medical therapy. Early post-surgical OCT biomarkers may indicate a more severe CME that might benefit from the steroid implant.

Keratoconus in children in Tunisia: Epidemiological, clinical and therapeutic features.

To report the clinical and therapeutic particularities of pediatric keratoconus (KC). Retrospective study focusing on patients aged less than 18 years, presenting with KC and followed in a tertiary reference center in Sfax, Tunisia. Our study involved 38 eyes of 20 children. We found a mean age of 12.8 years, a family history of keratoconus for 25% of cases and an atopic background in 30% of children. The mean best-corrected visual acuity was 5.3/10, the mean myopia was -6.3D and the mean total astigmatism was -4.9D. The average maximum simulated keratometry (Kmax) was 54.6 D. The visual acuity decrease was correlated with the presence of corneal opacities, with all keratometric indices except Skewed Radial Axes (SRAX) at 3 and 5 mm, with all elevation parameters and those of pachymetry except the delocalization of the thinnest point. 71.1% of eyes were classified as clinical KC and 47% of eyes were classified as Amlser-Krumeich stage 4. 42.1% of eyes were fitted with glasses and 57.9% with contact lenses. Six patients (10 eyes) underwent cross-linking (CXL). We noted an evolution of the KC for 64.29% of eyes not treated with CXL and a stabilization of 80% of eyes treated with CXL. The difference in follow-up parameters between the two groups was significant. Pediatric KC is a severe disease, often diagnosed at a late stage. CXL is a safe and effective way to stop the disease.

Comparison between sulcus-implanted three-piece hydrophobic intraocular lens and bagal-implanted single-piece intraocular lens in combined diabetic phacoemulsification and pars plana vitrectomy

Background Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. In advanced stages of DR, vitreoretinal surgery frequently becomes necessary to preserve or restore vision. Patients with vitreoretinal diseases often present with preexisting lens opacification. In addition, cataract formation is a common complication of pars plana vitrectomy. Thus, combining vitrectomy with cataract removal has recently become a common practice. Still, limited studies exist on the efficacy of placing the intraocular lens (IOL) in the ciliary sulcus and its potential to reduce the complications associated with the IOL implanted in the bag. Objective The current study aimed to compare the sulcus-implanted three-piece hydrophobic IOL and the bagal-implanted single-piece hydrophobic IOL in combined diabetic phacoemulsification with pars plana vitrectomy in diabetic eyes. Patients and methods This is a prospective interventional comparative study of the eyes for which phaco-vitrectomy was performed for the complications of DR. The eyes were equally randomized according to the indication for surgery and the severity of the disease into two groups, group 1: phaco-vitrectomy with hydrophobic acrylic three-piece sulcus IOL (60 eyes of 35 patients) and group 2: phaco-vitrectomy with hydrophobic acrylic one-piece in the bag IOL (57 eyes of 38 patients). We excluded eyes with other concomitant pathologies. All study participants were evaluated by visual acuity assessment, intraocular pressure (IOP) measurement, optical or ultrasound biometry, and optical coherence tomography. The cases were followed up for 3 months or more postoperatively. Results The study included 117 eyes of 73 patients, of whom 58.9% were females with a mean age of 47.71±15.37 years. The two groups were comparable in terms of preoperative assessment. Compared to group 2, group 1 was associated with significantly better mean best-corrected visual acuity (0.4 vs. 0.6 LogMAR, P&lt;0.001) and lower mean IOP (19.0 vs. 23.6 mmHg, P&lt;0.001). Regarding the postoperative complications, group 1 had significantly lower rates of posterior synechia at a single site than group 2 (3.3 vs. 24.6%, respectively, P=0.002) and posterior synechia at more than a single site (0 vs. 14%, respectively, P=0.008). Ring synechia was observed in four cases, all of whom were in group 2 (7%, P=0.11). Given the safer and better outcome of group 1, this group was less commonly prescribed antiglaucoma drugs, and none of them required iridotomy (P&lt;0.05). Conclusion The three-piece sulcus IOL proved to be superior over the single-piece IOL in the capsular bag technique in terms of visual acuity, IOP, improved visual outcome, and fewer postoperative complications.

Efficacy, durability and safety of faricimab for patients with neovascular age-related macular degeneration: 48-week results from the phase 3 LUCERNE China subpopulation.

To evaluate the efficacy, durability and safety of intravitreal faricimab versus aflibercept over 48 weeks in patients with neovascular age-related macular degeneration (nAMD) from the LUCERNE China subpopulation. LUCERNE (NCT03823300) was a phase 3 global, double-masked, active comparator-controlled trial. The China subpopulation comprised patients from mainland China, Taiwan and Hong Kong. Treatment-naïve patients aged ≥50 years with nAMD were randomized 1:1 to receive faricimab 6.0mg up to every 16 weeks (Q16W) based on prespecified disease criteria after four initial Q4W doses or aflibercept 2.0mg Q8W after three initial Q4W doses. The primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) averaged over weeks 40 to 48. Anatomical, durability and safety outcomes were also evaluated. The China subpopulation comprised 119 patients (faricimab: n = 59, aflibercept: n = 60). At weeks 40 to 48, adjusted mean (95% confidence interval [CI]) BCVA letter gains from baseline were +9.7 (7.4 to 12.0) and +9.8 (7.5 to 12.1) with faricimab and aflibercept, respectively. Central subfield thickness was reduced from baseline by weeks 40 to 48 in both arms, with an adjusted mean (95% CI) change of -145.4µm (-156.2 to -134.6) and -156.5µm (-167.3 to -145.7) for faricimab and aflibercept, respectively. By week 48, 87.3% of the patients were on extended ≥Q12W faricimab dosing. Faricimab was well tolerated with no new safety signals. Faricimab up to Q16W showed durable efficacy in the LUCERNE China subpopulation, consistent with global findings. Faricimab may reduce treatment burden for patients with nAMD in China, without compromising efficacy.

Clinical outcomes of silicon oil tamponade in patients with chronic exudative retinal detachments in effective with conservative treatment

Aims/Purpose: To investigate the surgical treatment outcomes and complications of pars plana vitrectomy and silicone oil tamponade in patients with chronic exudative retinal detachment that did not respond to conservative treatment.Methods: This retrospective study included 81 eyes of 81 patients diagnosed with chronic exudative retinal detachment who underwent pars plana vitrectomy and silicone oil tamponade after failing to respond to conservative treatment with oral steroids and intravitreal or sub‐Tenon's triamcinolone injections between February 2002 and September 2023. The best‐corrected visual acuity (BCVA) before and after surgery, postoperative complications, and recurrence rates were analyzed.Results: The mean duration of silicone oil tamponade was 17.98 ± 3.16 months. Successful retinal reattachment was achieved in 68 eyes (83.95%) after the initial surgery. Of the 51 eyes that had the silicone oil removed, 14 (27.45%) experienced retinal re‐detachment and required additional silicone oil injection. After final silicone oil removal, 39 eyes (48.15%) maintained stable retinal attachment. The mean BCVA improved significantly from logMAR 1.54 ± 0.134 preoperatively to logMAR 1.155 ± 0.139 after silicone oil removal (p = 0.029). Postoperative complications included cataract (n = 30), secondary glaucoma (n = 20), epiretinal membrane and macular edema (n = 8), and emulsified silicone oil (n = 4).Conclusions: Silicone oil tamponade is an effective surgical treatment that can improve visual outcomes in patients with chronic exudative retinal detachment refractory to conservative management. Although complications can occur, they are manageable, making this approach a reasonable option when conservative treatments fail.

Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Lamellar Macular Hole: Long-Term Follow-Up

Background: To investigate functional and anatomical outcomes after pars plana vitrectomy (PPV) for lamellar macular hole (LMH) with a long-term follow-up. Methods: An interventional study on 14 patients (16 eyes) with LMH was conducted. The inclusion criteria included a minimum 36-month follow-up after PPV. The preoperative and postoperative best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography parameters were examined. Results: Preoperatively, the mean BCVA was 0.46 ± 0.22 LogMAR. Epiretinal proliferation (ERP) was visible in 81.25% of eyes. Outer retinal disruption was present in 31.25% of LMH cases. The average central foveal thickness (CFT) measured 183.68 ± 61.73 microns. The mean BCVA improved at each follow-up time point: it was 0.24 ± 0.16 LogMAR at 1 month, 0.18 ± 0.15 LogMAR at 6 months, and 0.09 ± 0.11 LogMAR at the last follow-up. There was a statistically significant improvement between BCVA at 1 month and BCVA at 6 months and between BCVA at 6 months and BCVA at the last follow-up (p &lt; 0.001). BCVA improved in all eyes, with 87.5% achieving at least 0.3 LogMAR improvement. The mean CFT at the 1-month follow-up was 211.45 ± 43.55 microns, increased to 248.81 ± 48.51 microns at 6 months, and further increased to 278.37 ± 45.50 microns at the last follow-up. Foveal contour restoration was achieved in all eyes, and those with preoperative ellipsoid zone alterations demonstrated a complete repair of the external retinal layers. No intra or postoperative complications were recorded. Conclusions: In our series, PPV had a high success rate and was associated with a substantial functional improvement in LMH treatment, and this result was maintained and kept increasing until the last follow-up. Long-term follow-up is crucial for a comprehensive evaluation of the healing process and to assess the benefits of the surgical intervention.

Five-Year Outcomes of Lenadogene Nolparvovec Gene Therapy in Leber Hereditary Optic Neuropathy

Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON). To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration. The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from 2018 to 2022, is the 5-year follow-up study of the 2 phase 3 clinical studies RESCUE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss Up to 6 Months From Onset in LHON Due to the MT-ND4 Mutation) and REVERSE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the MT-ND4 Mutation). At the end of each study, ie, 2 years after gene therapy administration, patients were offered enrollment in the RESTORE trial, a multinational, multicenter, prospective study, for an additional 3 years of follow-up. Patients with LHON due to the MT-ND4 gene variant received lenadogene nolparvovec in 1 eye and a sham injection in the other eye. Lenadogene nolparvovec was administered as a single intravitreal injection in the RESCUE/REVERSE studies. Measures included best-corrected visual acuity (BCVA), quality of life using the National Eye Institute visual functioning questionnaire 25 (NEI VFQ-25), and adverse events. Among the 76 patients who received gene therapy in the RESCUE (n = 39) and REVERSE (n = 37) studies, 72 (94.7%) completed these studies; 62 patients (81.6%) participated in the RESTORE trial, and 55 patients (72.4%) completed the 5-year follow-up. Participants were mostly male (49 [79.0%]) with a mean (SD) age of 35.9 (15.3) years at treatment. At baseline, the mean (SD) BCVA was 1.5 (0.5) logMAR (20/600 Snellen) in eyes to be treated with lenadogene nolparvovec and 1.4 (0.5) logMAR (20/500) in sham eyes. At the end of the RESCUE/REVERSE trials, ie, 2 years after treatment, eyes treated with lenadogene nolparvovec and eyes treated with sham reached a mean BCVA value of 1.4 (0.6) logMAR (20/500). The mean (SD) change from baseline to year 2 was -0.05 (0.6) logMAR (+1 line) and 0.01 (0.6) logMAR (-0 line) in gene therapy-treated and sham eyes, respectively (difference, -0.03; 95% CI, -0.16 to 0.09; P = .60). Five years after treatment, the bilateral improvement from nadir was similar to that observed at 2 years, with a mean (SD) change in BCVA of -0.4 (0.5) logMAR (more than +4 lines) for eyes treated with lenadogene nolparvovec and -0.4 (0.4) logMAR (+4 lines) for eyes treated with sham (difference, -0.05; 95% CI, -0.15 to 0.04; P = .27). An improvement of at least -0.3 logMAR (+3 lines) from the nadir in at least 1 eye was observed in 66.1% of participants (41 of 62). Between 2 and 5 years, intraocular inflammation was noted in 4 participants with 8 events in eyes treated with lenadogene nolparvovec and 1 event in an eye treated with sham. In this analysis of the RESTORE trial, follow-up of patients with LHON due to the MT-ND4 gene variant unilaterally treated with lenadogene nolparvovec demonstrated a sustained bilateral improvement in BCVA and a good safety profile up to 5 years after treatment. This evidence of persistent benefit over time is promising for the use of gene therapy in these patients. ClinicalTrials.gov Identifier: NCT03406104.

Clinical characteristics and intravitreal aflibercept outcomes in patients aged 90 years and older with neovascular age-related macular degeneration

BackgroundAge-related macular degeneration (AMD) stands as the primary cause of visual impairment and blindness among the elderly population. Patients over 90 years comprise a unique demographic that may necessitate particular attention. The aim of this study was to examine the clinical characteristics and treatment outcomes in patients aged 90 years or older diagnosed with neovascular age-related macular degeneration (nAMD).MethodsThe medical records of treatment-naive patients aged ≥ 90 years diagnosed with nAMD have been retrospectively reviewed in our clinic. The complete ophthalmic examination findings of the patients, along with optical coherence tomography and fundus fluorescein angiography records, as well as their adherence to treatment, and reasons for treatment discontinuation were noted. Clinical data following intravitreal injection loading dose and during the 1st and 2nd years of treatment were evaluated.ResultsThe average age of the 45 participants (25 females, 20 males) included in the study was 93.55 ± 5.2 years (range; 90–101). The mean best-corrected visual acuity at diagnosis, at the 4th month of treatment, and during the 1st and 2nd years were LogMAR 0.8, 0.5, 0.7 and 1.0, respectively. The most common reasons for missing appointments and completely discontinuing treatment were death and inability to attend appointments due to additional comorbidities.ConclusionIn the very elderly patient group, nAMD can lead to severe damage in the macula, and a decrease in visual acuity despite treatment is not uncommon. Close monitoring and support for treatment adherence are necessary for this group of patients.

Does microperimetry have a role in monitoring visual function in patients with Behçet uveitis?

BackgroundTo evaluate the change in time in visual acuity, central macular thickness (CMT), and microperimetry (MP) findings in Behçet uveitis (BU) patients who were in remission with maintenance therapy.MethodsThis single center, retrospective, observational cohort study included twenty-five eyes of 25 patients with BU who were in remission during maintenance therapy. Best corrected visual acuity (BCVA), CMT, macular integrity index, average threshold, and fixation stabilities (P1 and P2) evaluated at six-month intervals were recorded. The changes in time were statistically analyzed. Paired samples t-test was used for normally distributed data and Wilcoxon rank test was performed for non-normally distributed data.ResultsThe mean BCVA and CMT showed no significant changes after six months. Although the mean macular integrity index decreased and the mean fixation stabilities increased after six months, these findings were not statistically significant. The mean average threshold was 16.8 dB at baseline and it increased significantly to 19.3 dB in the sixth month (p < 0.001).ConclusionsThe results of our study suggest that although visual acuity and CMT showed no change in patients with Behçet uveitis receiving maintenance therapy, MP could detect an improvement in macular function.