Median Presenting Visual Acuity Research Articles

Demographic profile and clinical characteristics of patients presenting with acute ocular burns.

To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.

Rapid treatment of endophthalmitis with intravitreal antibiotics is associated with better vision outcomes.

To discover whether the timing of intravitreal antibiotics, from the time of presentation to injection, affects the visual outcomes of patients with endophthalmitis from all causes. A retrospective study of consecutive patients managed at Auckland District Health Board between 1 January 2004 and 1 July 2021. The main outcome measure was final visual acuity at follow-up and the proportion of subjects with severe vision loss (≤6/60). Three hundred and seventy-four eyes were included in the study, with a median age of 69.7 years at presentation; 192 subjects (51.6%) were female. The median presenting visual acuity was hand movements and hypopyon was present in 194 subjects (51.9%). Cataract surgery was the most frequent aetiology in 115 subjects (30.7%), followed by intravitreal anti-vascular endothelial growth factor injections in 89 subjects (23.8%) and endogenous endophthalmitis in 54 subjects (14.4%). Median time to injection of intravitreal antibiotics was 3.5h (Interquartile range 2-6). On multivariate analysis, early treatment with intravitreal antibiotics was associated with better visual outcome, particularly for those treated within 2 h, while poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes. Rapid intravitreal antibiotic administration is associated with better final visual acuity outcomes, particularly for those receiving treatment within 2 h of presentation. Patients with severe vision loss on presentation, benefit the most with improved final visual acuity following expedited treatment.

Fungal Keratitis: Clinical Features, Risk Factors, Treatment, and Outcomes.

Fungal keratitis (FK) can be challenging to diagnose and treat. In this retrospective case series, FK cases presenting at the University of Pittsburgh Medical Center, Pennsylvania, USA, from 2015 to 2021 were reviewed for ocular risk factors, clinical presentation, management, and outcomes. Twenty-eight cases of FK were included. The median presenting age was 58.5 (18.5) years, and the median symptom duration prior to presentation was 10 (35.8) days. Predisposing ocular risk factors included contact lens use (67.9%), recent ocular trauma/abrasion (42.9%), and history of ocular surgery (42.9%). The median presenting visual acuity (VA) was 1.35 (1.72) LogMAR. About half presented with a central ulcer (42.9%), large infiltrate (6.7 (6.3) mm2), corneal thinning (50.0%), and hypopyon (32.1%). The majority of isolated fungal species were filamentous (75.0%). Most common antifungal medications included topical voriconazole (71.4%) and natamycin (53.6%) drops and oral voriconazole (64.3%). Surgical management was necessary in 32.1% of cases and enucleation in one case. Defect resolution occurred in 42.5 (47.0) days, and median final VA was 0.5 (1.84) LogMAR. Features associated with poor final visual outcomes included poor initial VA (p < 0.001) and larger defect size (p = 0.002). In conclusion, unlike prior studies in the northeast region of the USA, FK was commonly caused by filamentous fungi, and antifungal management most often consisted of topical and oral voriconazole.

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series.

Purpose:The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball.Methods:A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months.Results:Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001).Conclusion:Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

EDTA chelation for symptomatic band keratopathy: results and recurrence.

PurposeTo identify causes of symptomatic band keratopathy, and assess the results and long-term recurrence rates following chelation with topical ethylene-diamine-tetra-acetic acid (EDTA).Patients and methodsA retrospective review of surgical logbooks identified patients managed by EDTA chelation for symptomatic band keratopathy from 2009 to 2015.ResultsWe identified 108 cases; 89 case notes were available for analysis. Most cases of band keratopathy were idiopathic (36%). The most commonly identified underlying diagnosis was long-term topical glaucoma therapy (27%). Median presenting visual acuity was 6/18 (range 6/6-NPL) with the visual axis affected in 97.8% of cases. Treatment involved corneal epithelium removal, recurrent application of topical EDTA, and subsequent debridement. The mean duration of the operation was 20 min (range 10-45). Mean initial follow-up time was 40 days, and the visual axis was clear in 97.8%. Visual acuity was maintained or improved in 79.8%, with 13.5% improving by two lines or more. The mean length of follow-up was 581 days (median 374, maximum 2438). Twenty-five eyes (28.1%) showed localised recurrence of calcium with a mean time of 546 days (median 374), but only four cases required repeat EDTA chelation. The median time between operations was 430 days. Thirty-two per cent of the recurrence cases were associated with hypotony or chronic presence of silicone oil.ConclusionsChelation of calcium with topical EDTA is a safe and effective treatment for band keratopathy. Visual acuity improves in most eyes and while the rate of recurrence is moderate, the need for retreatment is low (4.5% overall).

Clinical outcomes and antibiotic susceptibilities of Staphylococcus aureus endophthalmitis.

To compare the antibiotic susceptibilities and visual acuity (VA) outcomes in endophthalmitis caused by methicillin-resistant (MRSA) versus methicillin-sensitive S. aureus (MSSA). The records of 34 cases of S. aureus endophthalmitis at The New York Eye and Ear Infirmary from Jan 1997 to June 2011 were reviewed. Antibiotic susceptibility profiles over time and VA at presentation and at 3, 6, and ≥12months were recorded. S. aureus isolates were grouped based on oxacillin resistance. Of the 34 cases, 15 (44%) were MRSA and 19 (56%) MSSA. Median presenting VA was hand motions (logMAR 4.0) in both the MRSA and MSSA groups. There was no statistically significant difference in VA between the MRSA and MSSA groups at 3, 6, or ≥12months. No MRSA isolates were resistant to vancomycin or gentamicin. While over 85% of MRSAisolates tested for fourth-generation fluoroquinolones were resistant, just 10 % MSSA isolates tested were resistant. There was a trend suggesting an increase in the proportion of MRSA isolates compared to MSSA isolates over the course of the study period. There was no statistical difference in short- or long-term VA outcomes between the MRSA and MSSA groups at any time point. Resistance to fourth-generation fluoroquinolones was present in over 85% of MRSA isolates, but just 10 % of MSSA isolates. An increasing proportion of MRSA amongst S. aureus isolates was noted over the course of the study period.

PARS PLANA VITRECTOMY IN THE MANAGEMENT OF PATIENTS DIAGNOSED WITH ENDOPHTHALMITIS FOLLOWING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION

To evaluate the possible benefit of pars plana vitrectomy in the treatment of patients with endophthalmitis following antivascular endothelial growth factor (VEGF) injection. The authors retrospectively reviewed the medical records of all patients in their practice with a diagnosis of endophthalmitis from January 1, 2007, through December 31, 2011. Only those with a clinical presentation consistent with endophthalmitis after intravitreal anti-VEGF injection were included. Clinical data that were collected and recorded included visual acuities and the method of initial and subsequent treatment of endophthalmitis following anti-VEGF injection: tap and injection of intravitreal antibiotics (TAP) and tap and inject with subsequent pars plana vitrectomy (VIT). The authors identified 23 patients meeting criteria. Nineteen patients had received bevacizumab and four patients had received ranibizumab. The median time from last injection to presentation was 4 days (range, 1-18 days) with a median follow-up of 15 months (range, 5-48 months) after being diagnosed of endophthalmitis. Nine patients had positive cultures. The median baseline visual acuity (preendophthalmitis) was 20/70 (range, 20/25 to counting fingers at 2 ft) with a median presenting visual acuity of counting fingers at 1 ft (range, 20/50 to light perception vision). Overall, 90% (9/10) of the patients in TAP only group regained visual acuity within 1 line or better of baseline versus 46% (6 of 13) in the TAP and VIT group. Only one of the patients treated with TAP alone suffered more than one line of visual acuity loss. Patients diagnosed with endophthalmitis after anti-VEGF intravitreal injection who underwent TAP regained baseline visual acuity more often than those who underwent TAP and VIT. This study did not support a benefit for VIT in all patients, rather only in those cases who warranted it because of worsening clinical course. The study suggests that TAP is a viable primary intervention for endophthalmitis after anti-VEGF injection.

Staphylococcus aureus Endophthalmitis: Antibiotic Susceptibilities, Methicillin Resistance, and Clinical Outcomes

To investigate the antibiotic susceptibility and clinical outcomes of endophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA) versus methicillin-resistant (MRSA) S. aureus. Retrospective, consecutive case series. Charts of 32 patients with culture-proven S. aureus endophthalmitis seen at the Bascom Palmer Eye Institute from January 1, 1995, through January 1, 2008, were reviewed. Antibiotic susceptibility profiles, identified using standard microbiologic protocols, and visual acuity at 1 and 3 months were the main outcome measures. MSSA was recovered from 19 (59%) of 32 patients and MRSA was recovered from 13 (41%) of 32 patients. Causes included cataract surgery in 18 (56%) of 32 patients, endogenous in 5 (16%) of 32 patients, bleb association in 4 (13%) of 32 patients, pars plana vitrectomy and ganciclovir implantation in 3 (9%) of 32 patients, and trauma in 2 (6%) of 32 patients. All isolates were sensitive to vancomycin. MSSA isolates were sensitive to all tested antibiotics, except one that exhibited fluoroquinolone resistance. In the MRSA group, frequent resistance occurred with the fourth-generation fluoroquinolones (moxifloxacin, 5 of 13 patients [38%]; gatifloxacin, 5 of 13 patients [38%]). The median presenting visual acuity was approximately hand movements for both MSSA and MRSA eyes. All eyes received intravitreal antibiotics. Pars plana vitrectomy was performed on 47% of MSSA and 61% of MRSA patients. A final visual acuity of 20/400 or better at 3 months was achieved in 59% of MSSA and 36% of MRSA patients (P = .5). Although all MSSA and MRSA isolates were sensitive to vancomycin, fewer than half of MRSA isolates were sensitive to the fourth-generation fluoroquinolones. Visual acuity outcomes between MRSA and MSSA eyes were not significantly different.

Perforating Globe Injuries during Operation Iraqi Freedom

To report the injury patterns associated with perforating (through-and-through) injuries of the globe and the visual impact of these injuries on patients with combat ocular trauma (COT) seen at Walter Reed Army Medical Center (WRAMC) from March 2003 through October 2006. Retrospective, noncomparative, interventional case series. Sixty-five eyes of 61 United States military soldiers deployed during Operation Iraqi Freedom sustaining perforating globe injuries and treated subsequently at WRAMC. Principal procedures included enucleation and 20-gauge 3-port pars plana vitrectomy with or without intraocular foreign body removal. Final visual acuity and rates of proliferative vitreoretinopathy, enucleation, and endophthalmitis. Average patient age was 29 years, with an average of 200 days of postinjury follow-up (median, 97 days; range, 4-1023 days). Nineteen patients confirmed the use of eye protection at the time of injury, whereas 25 patients did not use eye protection. The median presenting visual acuity at WRAMC was no light perception (range, no light perception to hand movements). Twenty-five patients underwent primary enucleation, 1 was eviscerated, and 12 patients underwent secondary enucleation within 2 weeks of surgery. Of 19 patients undergoing pars plana vitrectomy, median visual acuity at presentation was light perception and the median final visual acuity was counting fingers, whereas 4 eyes (21%) achieved final visual acuity of better than 20/200, and in 11 (61%) of 17, proliferative vitreoretinopathy developed over a follow-up of at least 6 months. There were no cases of endophthalmitis or sympathetic ophthalmia. Neither mechanism of injury nor timing of surgery correlated with favorable outcomes. However, entry and exit wounds localized to the anterior half of the globe were associated with favorable anatomic outcome (P<0.005, Fisher exact test, 2-tailed) and visual outcome (P = 0.041, Fisher exact test, 2-tailed). Perforating globe injuries associated with COT generally result in poor visual and anatomic outcomes despite surgical intervention. Prophylactic measures, such as eye protection, are helpful in reducing the likelihood of perforating injuries; however, novel surgical and pharmacologic therapies will be required to improve the functional and anatomic outcomes of these devastating injuries.

Adjunctive intravitreal dexamethasone in the treatment of acute endophthalmitis following cataract surgery

Controversy exists regarding the use of intravitreal dexamethasone (IVD) as an anti-inflammatory adjunct to intravitreal antibiotics in patients with acute endophthalmitis following cataract surgery. The purpose of this project was to evaluate our experience regarding the effect of adjunctive IVD use on visual outcomes in such patients. Retrospective, comparative case series. Patients treated for acute endophthalmitis following cataract surgery from 1995-2004. In addition to standard intravitreal antibiotic treatment, some patients also received a single adjunctive injection of IVD. Median visual acuity at last follow-up and percentage of patients achieving a >/=3-line improvement in visual acuity. Inflammatory index scoring, including amount of cell and flare, height of hypopyon, and presence of fibrin as a function of time after treatment. Twenty-six eyes were treated with and 38 eyes without adjunctive IVD. Median presenting visual acuity was Hand Motion in both groups. Median visual acuity at last follow-up measured 20/40 in the IVD group and 20/50 in the No-IVD group (p = 0.75). Seventy-three percent of patients in the IVD group and 82% of patients in the No-IVD group achieved a >/=3-line improvement in visual acuity (p = 0.42). No significant difference was detected between the IVD and No-IVD groups for any of the three measures of inflammation. The use of IVD did not significantly improve the final median visual acuity, the chance of achieving a >/=3-line improvement in visual acuity, or the amount of intraocular inflammation. Based on these findings, and the possible detrimental effect of IVD on visual outcomes previously reported in the literature, the use of IVD does not appear to be warranted as a routine adjunctive treatment in postoperative endophthalmitis.

Presumed Sterile Endophthalmitis Following Intravitreal Triamcinolone Acetonide Injection

&lt;div class="ftSection"&gt;&lt;span class="ftInlineSubsectionTitle"&gt;BACKGROUND AND OBJECTIVE:&lt;/span&gt;&lt;p&gt; To report acute postoperative, presumed sterile endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA).&lt;/p&gt;&lt;/div&gt;&lt;div class="ftSection"&gt;&lt;span class="ftInlineSubsectionTitle"&gt;PATIENTS AND METHODS:&lt;/span&gt;&lt;p&gt; Retrospective, interventional, multicenter study of patients with acute sterile endophthalmitis following IVTA injection.&lt;/p&gt;&lt;/div&gt;&lt;div class="ftSection"&gt;&lt;span class="ftInlineSubsectionTitle"&gt;RESULTS:&lt;/span&gt;&lt;p&gt;A total of 922 IVTA injections were performed. Eight eyes of 8 patients with presumed sterile endophthalmitis were identified. The incidence of endophthalmitis was 0.87% (95% confidence interval, 0.38% to 1.70%). Median time to presentation was 1.5 days (range, 1 to 7 days). Median presenting visual acuity was 20/563 (range, 20/80 to light perception). Initial treatment included vitreous tap and injection of antibiotics (n = 4), pars plana vitrectomy and injection of intravitreal antibiotics (n = 2), or systemic treatment alone with oral levofloxacin (n = 2). Six of 6 intraocular cultures were sterile. Median follow-up was 5.9 months (range, 4 to 9 months) with a median visual acuity at last follow-up of 20/75 (range, 20/40 to counting fingers).&lt;/p&gt;&lt;/div&gt;&lt;div class="ftSection"&gt;&lt;span class="ftInlineSubsectionTitle"&gt;CONCLUSIONS:&lt;/span&gt;&lt;p&gt;Acute presumed sterile endophthalmitis following IVTA injection presents early in the postoperative period. Visual outcomes are generally good.&lt;/p&gt;&lt;p&gt;&lt;b&gt;[Ophthalmic Surg Lasers Imaging 2005;36:24–29.]&lt;/b&gt;&lt;/p&gt;&lt;/div&gt;

Clinical Course of Younger Patients With Central Retinal Vein Occlusion

To describe the clinical course of patients 55 years and younger with central retinal vein occlusion (CRVO). Retrospective, noncomparative case series. Medical records of 67 patients were reviewed for demographic, photographic, clinical, and visual acuity (VA) data. Data from 57 patients with at least 6 months of follow-up (mean, 29.2 months) were analyzed statistically. Best-corrected visual acuity and incidence of intraocular neovascularization. Of 67 consecutive patients (55% men; mean age, 45 years), the median presenting VA was 20/50. Forty-five patients (67%) were found to have at least 1 systemic disease. In 57 patients with at least 6 months of follow-up, the final VA was 20/40 or better in 42%, 20/50 to 20/100 in 18%, and 20/200 or worse in 40%. Visual decline was most common within 3 to 6 months of CRVO onset. Visual improvement was uncommon after 12 months. Of the 22 patients with a presenting VA of 20/40 or better, 36% declined to 20/400 or worse at the most recent examination. Of the 10 patients with a presenting VA of 20/200 to 20/400, 8 improved to 20/60 or better. None of the 6 patients with a presenting VA of counting fingers or worse improved. Intraocular neovascularization was diagnosed at 1 to 9 months following CRVO in 10 patients (18%). Neovascularization of the anterior segment developed in 6 patients (11%), including neovascular glaucoma in 3 (5%). The occurrence of neovascularization appeared to be unrelated to sex, age, presence of associated disease, duration of symptoms, or presenting VA. Younger patients with CRVO have a variable clinical course. Presenting VA does not appear to be predictive of visual or anatomic outcome. As a significant number of patients with good vision at presentation develop legal blindness, therapeutic intervention during periods of visual decline may be considered in these patients.

Acute endophthalmitis following intravitreal triamcinolone acetonide injection

Purpose To report the clinical features, causative organisms, management, and visual acuity outcomes of eight eyes of eight patients who developed acute postoperative endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA). Design Retrospective, multicenter, interventional, case series. Methods A retrospective, interventional, case series of all patients with acute postoperative endophthalmitis following IVTA at seven academic clinical centers between March 2001 and July 2002. Results A total of 922 IVTAs were performed. Eight eyes of eight patients with acute postoperative endophthalmitis were identified in the 6 weeks following IVTA for an incidence of 0.87% (95% confidence interval of 0.38% to 1.70%). The median time to presentation was 7.5 days (range, 1–15 days) after IVTA. The most common clinical findings were iritis (n = 8), vitritis (n = 8), hypopyon (n = 8), pain (n = 7), red eye (n = 6), and decreased vision (n = 5). The median presenting visual acuity was 20/1127 (range, 20/60 to light perception). Initial treatment consisted of vitreous tap and injection of antibiotics (n = 6) or pars plana vitrectomy and injection of intravitreal antibiotics (n = 2). Intraocular cultures yielded identification in seven patients. One demonstrated intracellular gram-positive cocci in chains with numerous polymorphonuclear cells on gram stain. The median postinfection vision was 20/400 (range, 20/40 to no light perception). Three patients ended up with no light perception visual acuity, including enucleation (n = 1) and phthisis (n = 1). Conclusions Acute postoperative endophthalmitis following IVTA occurs rapidly and can result in severe loss of vision.