Minimum Angle Of Resolution Units Research Articles

PROLIFERATIVE VITREORETINOPATHY MAY BE A RISK FACTOR IN COMBINED MACULAR HOLE RETINAL DETACHMENT CASES

To review the incidence and closure rate of full-thickness macular holes (MH) in cases associated with concomitant rhegmatogenous retinal detachment (RRD). A retrospective consecutive case series was performed from patients undergoing surgical repair of RRD and simultaneous closure of MH. The presence of proliferative vitreoretinopathy (PVR), rates of hole closure and reattachment, and visual acuity outcomes were evaluated. There were a total of 607 RRDs during the study period. The incidence of concomitant MH in RRD cases was 2.3% (14 of 607), and the overall incidence of PVR was 15.8% (96 of 607). All eyes with a MH had a primary break that was distinct from the MH. Five patients did not meet the inclusion criteria for review of the postoperative outcomes. In the remaining 9 patients, the retinal reattachment rate was 100%, and MH closure was achieved in 8 of 9 (89%) eyes after a single surgery. At the time of primary repair, PVR was present in 6 of these 9 cases (66.7%). There was a significant association between the presence of PVR and a concomitant MH (P = 0.0027). The mean preoperative visual acuity was 2.59 ± 0.649 logarithm of the minimum angle of resolution units and significantly improved to 1.23 ± 1.01 logarithm of the minimum angle of resolution units (P = 0.00124). Overall, 88.8% of patients showed an improvement in visual acuity at the final postoperative visit, and a visual acuity of 20/125 or better was achieved in 66.7% of cases. Macular holes combined with a RRD are infrequent, and good anatomical results can be achieved after a simultaneous repair. Also, PVR may be more frequently encountered in this particular subset of RRDs.

Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty with the Microkeratome Double-Pass Technique: Two-Year Outcomes

To evaluate the outcomes and graft survival rates after ultrathin (UT) Descemet's stripping automated endothelial keratoplasty (DSAEK) using the microkeratome-assisted double-pass technique. Prospective, consecutive, interventional case series. Patients with endothelial decompensation of various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endotheliitis, or buphthalmus; n = 285 grafts). Donor preparation was performed using the microkeratome-assisted double-pass technique. Stripping of the Descemet's membrane was performed under air and the graft was delivered into the anterior chamber using the pull-through technique through a 3-mm clear-cornea incision using a modified Busin glide. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell density, and graft thickness (GT). Excluding all eyes with pre-existing ocular comorbidities, mean BSCVA at 3, 6, 12, and 24 months was 0.16, 0.11, 0.08, and 0.04 logarithm of the minimum angle of resolution units, respectively. The percentage of patients achieving BSCVA of 20/20 or better at 3, 6, 12, and 24 months was 12.3%, 26.3%, 39.5%, and 48.8%, respectively. A statistically significant (P < 0.0001) hyperopic shift of 0.78 ± 0.59 diopters (D; range, -0.75 to 1.75 D) was found at 1 year. The endothelial cell loss at 3, 6, 12, and 24 months was 29.8 ± 14.3%, 33 ± 15.5%, 35.6 ± 14.1%, and 36.6 ± 16.0%, respectively. The mean central GT recorded 3 months after surgery was 78.28 ± 28.89 μm. Complications included microkeratome failure to achieve perfect dissection in 21 donor tissues (7.2%), with 6 (2.1%) being discarded; total graft detachment in 11 cases (3.9%); primary failure in 4 cases (1.4%); and secondary failure in 4 additional cases (1.4%). Kaplan-Meier cumulative probability of a rejection episode at 3, 6, 12, and 24 months was 0%, 0.4%, 2.4%, and 3.3%, respectively. The visual outcomes of UT DSAEK are comparable with those published for Descemet's membrane endothelial keratoplasty and better than those reported after DSAEK in terms of both speed of visual recovery and percentage of patients with 20/20 final visual acuity. However, unlike with Descemet's membrane endothelial keratoplasty, preparation and delivery of donor tissue are neither difficult nor time consuming. Complications of UT DSAEK do not differ substantially from those recorded with standard DSAEK but are much less frequent than those reported after Descemet's membrane endothelial keratoplasty. Proprietary or commercial disclosure may be found after the references.

Oral Docosahexaenoic Acid in the Prevention of Exudative Age-Related Macular Degeneration: The Nutritional AMD Treatment 2 Study

To evaluate the efficacy of docosahexaenoic acid (DHA)-enriched oral supplementation in preventing exudative age-related macular degeneration (AMD). The Nutritional AMD Treatment 2 study was a randomized, placebo-controlled, double-blind, parallel, comparative study. Two hundred sixty-three patients 55 years of age or older and younger than 85 years with early lesions of age-related maculopathy and visual acuity better than 0.4 logarithm of minimum angle of resolution units in the study eye and neovascular AMD in the fellow eye. Patients were assigned randomly to receive either 840 mg/day DHA and 270 mg/day eicosapentaenoic acid (EPA) from fish oil capsules or the placebo (olive oil capsules) for 3 years. The primary outcome measure was time to occurrence of choroidal neovascularization (CNV) in the study eye. Secondary outcome measures in the study eye were: incidence of CNV developing in patients, changes in visual acuity, occurrence and progression of drusen, and changes in EPA plus DHA level in red blood cell membrane (RBCM). Time to occurrence and incidence of CNV in the study eye were not significantly different between the DHA group (19.5±10.9 months and 28.4%, respectively) and the placebo group (18.7±10.6 months and 25.6%, respectively). In the DHA group, EPA plus DHA levels increased significantly in RBCM (+70%; P<0.001), suggesting that DHA easily penetrated cells, but this occurred unexpectedly also in the placebo group (+9%; P = 0.007). In the DHA-allocated group, patients steadily achieving the highest tertile of EPA plus DHA levels in RBCM had significantly lower risk (-68%; P = 0.047; hazard ratio, 0.32; 95% confidence interval, 0.10-0.99) of CNV developing over 3 years. No marked changes from baseline in best-corrected visual acuity, drusen progression, or geographic atrophy in the study eye were observed throughout the study in either group. In patients with unilateral exudative AMD, 3 years of oral DHA-enriched supplementation had the same effect on CNV incidence in the second eye as did the placebo. However, RBCM fatty acid measurements revealed that CNV incidence was significantly reduced in DHA-supplemented patients showing a steadily high EPA plus DHA index over 3 years. Proprietary or commercial disclosure may be found after the references.

Short-Term External Buckling With Pneumatic Retinopexy for Retinal Detachment With Inferior Retinal Breaks

To introduce a new approach for short-term external scleral buckling with pneumatic retinopexy for the management of rhegmatogenous retinal detachment with inferior retinal breaks. Retrospective, noncomparative, interventional case series. A review of 33 consecutive eyes of 31 patients who underwent external buckling with pneumatic retinopexy for uncomplicated rhegmatogenous retinal detachment with inferior retinal breaks from December 2006 through December 2010. An external buckle was made of a 505 sponge sutured along the blunt side of a 279 tyre (MIRA Inc). The buckle was inserted deeply into the inferior fornix without suture after pneumatic retinopexy and was kept in place for 3days. Primary and final anatomic outcomes, visual acuity, and adverse events were recorded. All patients tolerated the procedure. The mean follow-up period was 24.0months (range, 9 to 61months). Primary success, defined as successful retinal reattachment within 6months without further treatment, was achieved in 29 (87.9%) eyes. All patients attained final retinal reattachment (100%). Overall, the mean best-corrected visual acuity improved significantly at the end of follow-up (0.30 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/12), compared with the preoperative best-corrected visual acuity (0.82 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/38; P < .001). Short-term external buckling with pneumatic retinopexy is a novel and effective treatment for rhegmatogenous retinal detachment with inferior retinal breaks, with a comparable success rate with other treatment methods. This approach also can avoid complications of long-term buckle implantation. Further comparative cohort studies may be necessary to comparethe clinical efficacy with other conventional operations.

Anatomic and functional outcomes of 25-gauge vitrectomy for repair of eyes with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy

BackgroundThe purpose of this study was to evaluate the outcome of 25-gauge vitrectomy for repair of rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR).MethodsTwenty-seven eyes of 27 patients who had undergone 25-gauge vitrectomy for grade C PVR were investigated retrospectively. The surgical procedures, anatomic success, and best-corrected visual acuity were assessed.ResultsThe mean number of operations was 1.4 (range 1–4). During the 25-gauge vitrectomy, 20-gauge instruments were needed in eleven eyes (40.7%) to remove resilient fibrous preretinal membranes, to extract subretinal proliferations, or to remove or infuse silicone oil. The retina was reattached in 21 eyes (77.8%) after the initial vitrectomy and in 25 eyes (92.6%) at the final examination. The mean best-corrected visual acuity in logarithm of the minimal angle of resolution units was 1.36 ± 0.81 before vitrectomy and 0.79 ± 0.71 at one month, 0.73 ± 0.72 at 3 months, 0.73 ± 0.75 at 6 months, and 0.75 ± 0.78 at 12 months after vitrectomy. The best-corrected visual acuities were significantly improved compared with the preoperative ones at all postoperative assessments (P<0.001).ConclusionTwenty-five gauge vitrectomy is a relatively safe and efficacious method of treating RRD with PVR, although combined use of 20-gauge instruments may be needed for certain surgical procedures.

Characteristics of Peripapillary Choroidal Cavitation Detected by Optical Coherence Tomography

To evaluate the clinical features of peripapillary choroidal cavitation (PCC) detected by optical coherence tomography (OCT). Retrospective, observational case series. One hundred twenty-two eyes from 83 patients diagnosed with PCC by OCT database review were included in this study. Stereoscopic color fundus photographs from eyes with PCC were reviewed by 2 independent ophthalmologists. They were masked to the refractive error, axial length, and OCT findings. Chart review and data analysis included gender, age, best-corrected visual acuity (BCVA), refractive error, axial length, clinical appearance of the peripapillary area, and associated funduscopic abnormalities. One hundred twenty-two eyes with PCC from 83 patients were analyzed. Among the patients, 41.8% were men and 58.2% were women. The mean age was 48.2 ± 12.6 years and mean BCVA in logarithm of the minimum angle of resolution units was 0.23 ± 0.43. The mean refractive error in spherical equivalent was -9.03 ± 5.11 diopters (D) and mean axial length (AL) was 27.36 ± 2.09 mm. With respect to refractive error, 90 eyes (73.8%) were highly myopic (≥-6.00 D), 24 eyes (19.7%) had low myopia (<-6.00 D), 5 eyes (4.1%) were emmetropic (1.00 to -1.00 D), and 3 eyes (2.6%) were hyperopic (>1.00 D). Forty eyes (32.8%) with PCC had AL of less than 26.50 mm (mean, 25.11 ± 1.07 mm; range, 22.51-26.42 mm). Patients with eyes with PCC that had low myopia, were emmetropic, and were hyperopic also were significantly older than patients with highly myopic eyes (P<0.05). Stereoscopic fundus photographs demonstrated a yellow-orange, localized, well-circumscribed peripapillary lesion in 57 (46.7%) eyes with PCC. A PCC with opening was observed in 14 (26.4%) of 53 eyes with excavated myopic conus and in 5 (7.2%) of 69 eyes without excavated myopic conus (P<0.05). This study demonstrated that peripapillary choroidal cavitation is common and not exclusive to highly myopic eyes. The funduscopic finding of a yellow-orange peripapillary abnormality may not be evident in all eyes with demonstrable PCC by OCT. Although its pathogenesis and pathologic significance require further investigation, PCC may be a degenerative change in aging eyes.

Surgical Outcomes in Childhood Uveitic Glaucoma

To evaluate surgical outcomes and to describe a strategy for pediatric uveitic glaucoma. Retrospective case series. The clinical practice of a single surgeon identified 36 patients with juvenile uveitic glaucoma (diagnosed before 18 years of age) who underwent 1 or more intraocular pressure (IOP)-lowering surgical procedures. The first eye operated on was included in the analysis. The main indication for success was IOP of less than 21mm Hg with controlled inflammation, without further IOP-lowering surgery or devastating complication. Patients with uveitic glaucoma associated with juvenile idiopathic arthritis (n= 20), idiopathic uveitis (n= 9), other (n= 6) were included. Mean age± standard deviation at initial glaucoma surgery was 11.1 ± 4.4 years with a follow-up of 5.6 ± 4.8 years (range, 0.2 to 16.4 years). Goniotomy was the initial surgical procedure in 31 (86%) eyes. Fifteen eyes did not require further IOP-lowering surgery. Sixteen eyes had additional IOP-lowering surgery: second goniotomy (n= 9), glaucoma drainage device (n= 6), and trabeculectomy (n=1). By Kaplan-Meier survival analysis, the first versus the first or second goniotomy were successful at 10 years in 48% (95% confidence interval, 28% to 65%) versus 69% (95% confidence interval, 47% to 84%). Goniotomy failure was noncorrelative with phakic status or presence of preoperative synechiae. Five eyes (14%) had initial glaucoma drainage device implantation because of closed angles. Visual acuity was similar between initial and final examinations (0.37 ± 0.48 logarithm of the minimal angle of resolution units [Snellen 20/47] vs 0.28 ± 0.34 logarithm of the minimal angle of resolution units [Snellen 20/38]). IOP was reduced (33.0 ± 8.0mm Hg vs 12.6 ± 4.5mm Hg; P< .0001), as was number of glaucoma medications (3.2 ± 1.1 vs 1.2 ± 1.3; P < .0001). Eyes undergoing cataract removal after successful glaucoma surgery maintained IOP control. Glaucoma was controlled and vision was preserved in 33 (92%) eyes. Refractory juvenile uveitic glaucoma was managed successfully by goniosurgery and glaucoma drainage device implantation. Cataract removal can be accomplished successfully, provided IOP and uveitis are well controlled before surgery.

Design and Evaluation of a Customized Reading Rehabilitation Program for Patients with Age-related Macular Degeneration

To evaluate the efficacy of a reading rehabilitation program (RRP) specifically designed for patients with impaired central vision from age-related macular degeneration (AMD) and the impact of the program on the quality of life (QoL) and to determine any predictable reading performance improvements between visits. Prospective case series. Forty-one patients with AMD who attended to the Institute of Applied Ophthalmobiology Eye Institute. An ad hoc-created RRP comprising 4 customized in-office training and in-home training visits over 6 weeks was undertaken by AMD patients. The RRP was based on the principle of stepwise progressive goal achievement: the difficulty of training tasks increased depending on the success obtained when performing previous easier ones. Reading performance was evaluated during each in-office training visit, and the individual's perception of his or her QoL was assessed before and after the RRP. Reading performance parameters were assessed to evaluate RRP effectiveness. Best-corrected visual acuity (BCVA), reading speed, reading duration, near visual acuity (VA), font size, and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire scores. The effect sizes (mean differences and standard deviations) also were calculated. The mean distance BCVA was 0.81±0.29 logarithm of the minimum angle of resolution units. The mean near VA with the appropriate low-vision aid was 0.91±0.18 (M notation) at baseline. The mean near magnification was 4.32±1.15 at the last in-office visit. The mean reading speed, reading duration, and font size improvement after the reading rehabilitation program were 48.31±22.06 words per minute (P<0.001), 35.46±15.68 minutes (P<0.001), and -4.08±2.19 font points (P<0.001), respectively. The effect sizes of reading speed, reading duration, and font size after the last visit were 2.19, 2.26, and -1.86, respectively. The final score of each WHOQOL-BREF domain improved significantly (P≤0.004) after the RRP. The increased ability to read a smaller font size was correlated with improvement in the physical health domain score of the WHOQOL-BREF (r=0.35; P=0.04). This customized RRP significantly enhanced reading performance and perceived QoL in patients with AMD. The improvement between visits seemed to be consistent. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Rotational Autokeratoplasty in Pediatric Patients for Nonprogressive Paracentral Corneal Scars

To report the outcomes of ipsilateral rotational autokeratoplasty (RAK) for nonprogressive paracentral corneal opacities in children <16 years of age. Retrospective, consecutive, interventional case series. Thirty-three eyes of 33 children aged <16 years undergoing RAK for nonprogressive paracentral scars. Medical records were retrospectively reviewed for the primary etiology of corneal opacity, time of onset, duration of opacity, preoperative visual acuity, formula used for calculation of trephine size, size of the trephine used, and duration of follow-up. Any intraoperative and early and late postoperative complications were noted for all patients. Postoperative visual acuity and astigmatism were noted. Visual acuity was converted to logarithm of the minimum angle of resolution units for analysis. Primary outcome was postoperative visual acuity. Graft clarity and complications were analyzed as secondary outcomes. The mean age at surgery was 7.2 ± 3 .9 months. The mean follow-up duration was 27 ± 37 months. The commonest etiology of corneal opacity was trauma (62.5%), followed by resolved microbial keratitis (21.9%). Postoperative visual acuity (1.25 ± 0.84) was significantly better (P<0.001) than preoperative visual acuity (2.05 ± 0.96). The mean astigmatism at last visit was 4.04 ± 2.21 diopters. Postoperative visual acuity was better in older children (β = -0.01; P = 0.03) and had a shorter delay in presentation (β = 0.02; P = 0.05). At the last follow-up, the graft was clear in 27 cases (81.25%). The cumulative probability of graft survival was 85% at 2 years and 65% at 5 years. Complications included wound leak in 4 eyes, secondary glaucoma in 2 eyes, graft infiltrate and traumatic dehiscence in 1 eye each. Rotational is a autokeratoplasty viable alternative surgical option to allogenic keratoplasty. Graft survival at 2 years seems to be better than allogenic keratoplasty. Younger age and delay in presentation contribute to poorer visual outcomes after surgery. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Subfoveal Choroidal Thickness after Ranibizumab Therapy for Neovascular Age-related Macular Degeneration: 12-Month Results

To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). Prospective, consecutive, interventional case series. Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months (P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 μm at baseline to 234±66 μm at 1 month (P = 0.013), 226±68 μm at 3 months (P<0.001), 229±67 μm at 6 months (P = 0.002), and 226±66 μm at 12 months (P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 μm at baseline to 238±83 μm at 12 months (P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid.

TWO-YEAR OUTCOMES OF INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN JAPANESE PATIENTS WITH PATHOLOGIC MYOPIA

To determine the 2-year results of intravitreal bevacizumab in highly myopic eyes with choroidal neovascularization (CNV). An open-label, consecutive, interventional case series. Seventy-five eyes of 69 consecutive Japanese patients with either subfoveal or nonsubfoveal myopic CNVs were studied. The eyes were treated with intravitreal bevacizumab and followed-up for at least 2 years. The best-corrected visual acuities at the baseline in eyes with subfoveal CNV were compared with that in eyes with nonsubfoveal CNV at 2 years after the intravitreal bevacizumab. The difference between the mean best-corrected visual acuity at the baseline and that at 2 years in eyes with a subfoveal CNV was not significant. However, the mean best-corrected visual acuity in eyes with nonsubfoveal CNV was significantly improved from 0.53 ± 0.36 logarithm of the minimal angle of resolution units (Snellen 20/66) before intravitreal bevacizumab to 0.29 ± 0.36 logMAR units (Snellen 20/40) (P < 0.001) 2 years after intravitreal bevacizumab. The incidence of chorioretinal atrophy after 2 years was 3 of 49 (6.1%) in eyes with nonsubfoveal CNV and 21 of 26 (80.8%) in eyes with which subfoveal CNV (P < 0.001). Furthermore, the chorioretinal atrophy area with nonsubfoveal CNV was 0.05 ± 0.21 mm, which was also significantly smaller than that of subfoveal CNV at 1.76 ± 1.60 mm (P < 0.001). Intravitreal bevacizumab is a good treatment for eyes with nonsubfoveal CNV; however, another treatment is necessary for eyes with a subfoveally located CNV.

Severity of Pediatric Blepharokeratoconjunctivitis in Asian Eyes

To describe and evaluate the severity of pediatric blepharokeratoconjunctivitis in Asia. Retrospective case series. Clinical records of patients diagnosed with pediatric blepharokeratoconjunctivitis at a tertiary referral center in Singapore from 1991 through 2010 were reviewed. Patients were graded as having mild (corneal involvement without scarring), moderate (corneal scarring), or severe (corneal scarring with thinning or perforation) disease based on recorded clinical findings. Fifty-one patients were diagnosed with pediatric blepharokeratoconjunctivitis. The mean age at presentation was 10.2 ± 3.6 years, most patients were female (80.4%), and the mean duration of follow-up was 58.9 ± 44.0 months. Chinese (56.9%) subjects made up most of the cases. Most subjects had moderate (56.9%), followed by severe (37.4%) and mild (5.9%), disease. Four patients (7.9%) had an associated dermatologic disease. All patients were treated with topical antibiotics, and 98% were treated with topical steroids. Nineteen (37.3%) patients received systemic antibiotic therapy, and 1 received systemic steroid therapy. Three patients required deep lamellar keratoplasty (2 tectonic and 1 optical), and 2 underwent cornea gluing alone; all 5 of them were Chinese. Patients graded as having severe disease were more likely to undergo surgical intervention (26.3%) than patients who were graded as having moderate (0%) and mild (0%) disease (P < .05). The main complication of treatment was raised intraocular pressure in 7 (13.7%) patients requiring medical therapy. Overall, best-corrected visual acuity improved by 0.10 logarithm of the minimal angle of resolution units (P < .001) after appropriate medical and surgical intervention. Pediatric blepharokeratoconjunctivitis patients in Asia seem to have a more severe clinical presentation and course. Early and adequate management can arrest the disease process and can minimize visual morbidity.

OUTCOMES OF 20-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY

To assess the effectiveness and safety of the 20-gauge transconjunctival sutureless vitrectomy system in vitreoretinal surgeries. The charts of 102 consecutive patients who underwent 20-gauge transconjunctival sutureless vitrectomy by 1 surgeon were retrospectively reviewed. The main outcome measures were intraoperative and postoperative complications and postoperative intraocular pressure and Snellen visual acuity relative to preoperative values. Patients were evaluated before surgery and 1 day, 1 week, 1 month, and 3 months postoperatively. No trocar-related intraoperative complications were recorded. Two patients (2%) each required suturing of 1 sclerotomy because of leakage at completion of surgery. Mean preoperative visual acuity (in logarithm of the minimum angle of resolution units) was 1.1 ± 0.6. By 3 months after surgery, the mean visual acuity had improved to 0.8 ± 0.5 (P < 0.001). Mean preoperative intraocular pressure was 14.7 ± 5.1 mmHg. Mean postoperative intraocular pressure was 14.2 ± 5.5 mmHg (P = 0.48) at Day 1 and 14.6 ± 4.3 mmHg (P = 0.82) at Day 7 after surgery. Hypotony was present in 3 patients (3%) on the first postoperative day, but their intraocular pressure normalized spontaneously within 1 week. None of the patients developed postoperative endophthalmitis or retinal detachment. Twenty-gauge transconjunctival sutureless vitrectomy is a safe and effective technique for the surgical treatment of a variety of vitreoretinal pathologies.

Predictive factors of resolved retinal fluid after intravitreal ranibizumab for polypoidal choroidal vasculopathy

Background/aimsTo investigate the predictive factors for the resolution of retinal fluid after intravitreal injections of ranibizumab (IVRs) for polypoidal choroidal vasculopathy (PCV).MethodsForty-seven eyes of 45 patients with symptomatic PCV received...

PERSISTENT SUBFOVEAL FLUID AND INCREASED PREOPERATIVE FOVEAL THICKNESS IMPAIR VISUAL OUTCOME AFTER MACULA-OFF RETINAL DETACHMENT REPAIR

To investigate the influence of subfoveal fluid and foveal thickness on visual outcome in patients who underwent reattachment surgery for rhegmatogenous retinal detachment (RRD). This prospective study included 53 patients who were undergoing successful scleral buckling surgery for primary RRD. A thorough ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography scanning was performed preoperatively and during all subsequent follow-up visits at 1, 3, 6, 9, 12, and 24 months postoperatively. Preoperative foveal thickness was significantly higher in the macula-off group (n = 38) compared with the macula-on group (n = 15) (P < 0.0001), whereas postoperative measurements were normal in both the groups. Linear mixed-model analysis revealed that persistent subfoveal fluid (P = 0.0004) was an independent predictor of a worse visual outcome after scleral buckling surgery for primary macula-off RRD, although the effect on visual outcome was small (0.1 logarithm of the minimal angle of resolution units). Moreover, increased preoperative foveal thickness was associated with a worse visual prognosis in macula-off RRD (P = 0.010). Persistent subfoveal fluid and increased preoperative foveal thickness were associated with a worse visual prognosis in macula-off RRD patients, albeit the effect of persistent subfoveal fluid was small and temporary.

Lamellar Keratoplasty and Keratolimbal Allograft for Mustard Gas Keratitis

To report the clinical outcomes of lamellar keratoplasty (LKP) in patients with delayed-onset mustard gas keratitis and to compare visual acuity and graft survival rates between subgroups with simultaneous or sequential keratolimbal allograft and LKP. Retrospective, comparative, interventional case series. Fifty-two eyes of 37 male survivors of chemical warfare with mustard gas keratitis who underwent LKP were included. The results were evaluated with respect to best spectacle-corrected visual acuity (BSCVA), refractive error and keratometry readings, and graft clarity. Thirty-two eyes required stem cell transplantation (keratolimbal allograft), which was performed before or concomitant with LKP. The groups with sequential and concomitant intervention were compared regarding BSCVA, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates. The mean patient age at the time of surgery was 43.4 ± 8.2 years, and the mean follow-up period was 41.4 ± 19.6 months. The mean preoperative BSCVA was 0.51 ± 0.48 logarithm of the minimal angle of resolution units, which increased to 0.33 ± 0.18 logarithm of the minimal angle of resolution units (P = .03). The mean preoperative spherical equivalent refractive error was -2.40 ± 1.5 diopters, which remained unchanged after surgery (-1.52 ± 3.7 diopters; P = .77). No significant difference between the sequential and simultaneous subgroups was found with regard to postoperative BSCVA, refraction, keratometry readings, or corneal graft survival (90.3% and 89.9%, respectively; P = .68). However, the latter group had statistically better stem cell graft survival (40.0% vs 100% at month 41, respectively; P = .02). LKP is an effective method of corneal transplantation in mustard gas victims. When stem cell and corneal transplantation are indicated, the simultaneous approach can yield better results than staged intervention.

ROLE OF INTRAVITREAL BEVACIZUMAB IN EALES DISEASE WITH DENSE VITREOUS HEMORRHAGE

To investigate the role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage. This is a prospective randomized control trial. Twenty eyes of 20 patients with dense vitreous hemorrhage because of Eales disease were randomly distributed in Group 1 (n = 10) and Group 2 (n = 10). Group 1 eyes received intravitreal injection of bevacizumab (1.25 mg/0.05 mL) every 4 weeks, and Group 2 eyes were observed. Patients of both groups were followed-up every 2 weeks. Vitrectomy was performed in case of nonresolving vitreous hemorrhage Grade 2 or more after 3 months of enrollment or immediately if retinal detachment was detected. Intraoperative difficulties while performing surgery and excessive bleeding were noted. The primary outcome measures were reduction in the grade of vitreous hemorrhage and the need for vitrectomy. Only 1 eye from Group 1 and 2 eyes from Group 2 showed decrease in vitreous hemorrhage to Grade 2 (P = 0.531, 95% confidence interval). But all three eyes required vitrectomy because of persisting poor vision. Postoperative mean vision ± SD in Group 1 was 1.2 ± 0.57 in logarithm of the minimum angle of resolution units, and in Group 2, it was 0.78 ± 0.41 in logarithm of the minimum angle of resolution units (P = 0.086, 95% confidence interval). Three eyes (30%) in Group 1 had tractional retinal detachment after a single bevacizumab injection, while none of the Group 2 eyes had tractional retinal detachment (P = 0.060, 95% confidence interval). Vitrectomy was performed in all three eyes and had poor visual outcome after surgery. No intraoperative difficulties were noted in either group. Our study showed that repeated intravitreal bevacizumab in patients with Eales disease with dense vitreous hemorrhage may not hasten the resolution of vitreous hemorrhage or reduce the need for vitrectomy. Moreover, tractional retinal detachment may be a serious complication of therapy and hence should be closely monitored because it entails a poor visual prognosis.

FACTORS PREDICTIVE OF VISUAL ACUITY OUTCOMES 1 YEAR AFTER PHOTODYNAMIC THERAPY IN JAPANESE PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY

The purpose of this study was to determine the factors predictive of visual acuity (VA) outcomes 1 year after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy. We prospectively studied 220 eyes of 210 Japanese patients with polypoidal choroidal vasculopathy treated with primary application of PDT. A stepwise logistic regression model was used to estimate the independent factors predictive of better VA and improvement of VA 1 year after the primary PDT. Visual acuities at the various follow-up evaluations improved significantly compared with baseline (P = 0.001 for all comparisons). The VA improved and decreased more than 0.3 logarithm of minimum angle of resolution unit 1 year after the primary PDT in 55 (25%) and 21 (10%) eyes, respectively. Stepwise logistic regression analysis showed that younger age, smaller greatest linear dimension, better baseline VA, and less baseline hemorrhage were significant and independent factors predictive of better VA 1 year after PDT, and younger age, smaller greatest linear dimension, better baseline VA, less hemorrhaging, and the presence of a serous macular detachment at baseline were significant and independent factors predictive of VA improvement. Photodynamic therapy stabilized eyes anatomically and functionally. Clinical characteristics at baseline were predictors of favorable VA outcomes after PDT. These findings may help establish the strategy of treatment for polypoidal choroidal vasculopathy.

PHOTODYNAMIC THERAPY, RANIBIZUMAB, AND RANIBIZUMAB WITH PHOTODYNAMIC THERAPY FOR THE TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY

The purpose of this study was to compare photodynamic therapy (PDT), ranibizumab, and ranibizumab with PDT in polypoidal choroidal vasculopathy. In this retrospective comparative study, 30 eyes of 30 patients with polypoidal choroidal vasculopathy were assigned to 1 of the 3 groups. The patients in Group 1 (n = 11) received 1 session of PDT. The patients in Group 2 (n = 10) received 3 monthly intravitreal injections of 0.5 mg ranibizumab, and the patients in Group 3 (n = 9) received 1 session of PDT and 3 injections of 0.5 mg ranibizumab. Retreatment, with the same therapeutic scheme in each group, was considered in case of leaking polyps on the indocyanine green angiography in Groups 1 and 3 and persistence or recurrence of subretinal fluid, intraretinal fluid, and/or hemorrhages in Group 2. All the patients completed 12 months of follow-up. The visual acuity in the patients of Group 1 improved by 0.25 logarithm of the minimum angle of resolution units (P < 0.001), whereas the differences in the visual acuity in the other 2 groups were not statistically significant (0.04 logarithm of the minimum angle of resolution, P = 0.8118 in Group 2 and 0.18 logarithm of the minimum angle of resolution, P > 0.05 in Group 3). Of the patients in Group 1, 45.45% gained more than 3 lines (P = 0.0056), whereas no patient in Groups 2 and 3 experienced such a difference. No patient in Group 1 and 11.1% (n = 1) in Group 3 had angiographically evident polyps at 12 months, whereas 90% (n = 9) of the patients in Group 2 had persistent leakage. No extensive submacular hemorrhage or other complications were noted during the follow-up period. Photodynamic therapy resulted in a significantly better outcome at the end of the follow-up, whereas the patients who received ranibizumab or PDT and ranibizumab experienced a stabilization of the disease.

Long-term Anatomic and Visual Outcomes of Initially Closed Macular Holes

To evaluate the anatomic and visual outcomes in patients with initially closed macular holes after vitreoretinal surgery and with 1 to 7 years of follow-up. Retrospective, noncomparative, consecutive case series. Eighty-seven consecutive eyes of 79 patients with previous closure of the macular holes and with at least 1 year of follow-up were reviewed in this retrospective clinical study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. The mean age of enrolled patients was 63.1 ± 6.2 years (range, 49 to 74 years); the mean duration of macular hole was 5.6 ± 9.7 months (range, 0.25 to 60 months); and the mean follow-up interval was 38.4 ± 19.7 months (range, 12 to 86 months). All eyes underwent internal limiting membrane peeling during the vitrectomy, and 64 (73.6%) of 87 eyes underwent cataract extraction. No reopening of initially closed macular holes was observed in any eyes. Slight perifoveal epiretinal membranes were observed by optical coherence tomography in 32.2% of cases (28/87). The final best-corrected visual acuity improved to 0.47 ± 0.39 logarithm of the minimal angle of resolution units, which was significantly higher than preoperative visual acuity of 1.01 ± 0.36 logarithm of the minimal angle of resolution units (t = -12.532; P = .000). Multiple linear regression analysis demonstrated that the final best-corrected visual acuity was affected by the macular hole stage, preoperative best-corrected visual acuity, and cataract exaction (F = 19.858; P = .000). The stable closure of macular holes is achieved after vitrectomy with internal limiting membrane peeling. Phacoemulsification cataract surgery with intraocular lens implantation for improvement of visual function is not responsible for the reopening of previously closed macular holes.