Minimum Angle Of Resolution Units Research Articles

INTRAVITREAL METHOTREXATE INJECTION FOR THE TREATMENT AND PREVENTION OF PROLIFERATIVE VITREORETINOPATHY.

To report on our experience using intravitreal methotrexate (MTX) in patients with retinal detachment associated with proliferative vitreoretinopathy and/or open globe injury. This study performed a retrospective chart review of a consecutive series of 21 eyes of 21 patients who underwent serial intravitreal MTX injection for treatment and/or prevention of proliferative vitreoretinopathy from December 2021 to January 2024. Twenty-one patients underwent pars plana vitrectomy, membrane peeling, laser photocoagulation, silicone oil infusion, and intravitreal MTX injection. Postoperatively, all eyes received a series of intravitreal MTX (400 μg/0.1 mL) injections. Optimally, injections were administered weekly for 8 weeks and every 2 weeks for four weeks for a total of 13 injections, beginning intraoperatively at the conclusion of retinal reattachment surgery. Mean baseline preoperative and postoperative visual acuity was logarithm of the minimum angle of resolution 3.2 (approximately hand motions vision) and 2.5 (between CF and hand motions vision), respectively, yielding an average improvement in visual acuity of 0.7 logarithm of the minimum angle of resolution units (0 ETDRS lines/letters). These 21 patients received an average of 10.5 injections. With a single operation, detachments in 19 (90%) of 21 eyes were successfully reattached. Corneal epithelial defects were noted in 7 (33%) of 21 patients. Serial intravitreal MTX injection was associated with 90% single operation retinal reattachment rate in the setting of retinal detachment with proliferative vitreoretinopathy or retinal detachment at high risk of proliferative vitreoretinopathy.

Efficacy and Safety of Phaco-Goniosynechialysis in Advanced Primary Angle Closure Glaucoma With Severe Visual Field Loss.

Phacoemulsification with goniosynechialysis (phaco-GSL) demonstrates promise in safely and efficiently managing advanced primary angle closure glaucoma (PACG) cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations. To assess the efficacy and safety of phaco-GSL in patients with end-stage PACG exhibiting tubular vision or temporal field island. This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least 1 month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for antiglaucoma, and postoperative complications. The mean follow-up time was 9.11 ± 10.49 months. The mean preoperative visual field deviation and VA were -28.01 ± 3.30dB and 0.36 ± 0.37 log minimum angle of resolution unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65 ± 8.61 to 14.81 ± 3.54mm Hg. Glaucoma medication use also reduced from 1.46 ± 1.43 to 0.88 ± 1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in 5 of 6 wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion. Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.

Assessing the surgical competency of novice surgeons by using a three-dimensional heads-up display microscope.

To evaluate the surgical performance of novice surgeons operating on a three-dimensional (3D) heads-up display system compared to those using a traditional microscope (TM). Prospective study design in a private practice setting. Twenty novice surgeons with similar experiences in cataract surgery were selected. Each surgeon performed 20 phacoemulsification cataract surgeries: 10 surgeries on the 3D heads-up display microscope, and 10 surgeries using a TM system. Data were collected from a total of 400 patients operated on by 20 surgeons. Outcome measures were recorded and graded according to the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric-Phacoemulsification system. The main outcome measure was mean surgical competency scores. Overall, 400 data points were equally distributed between TM (200) and 3D (200) surgeries. The mean surgical competency scores were 60.19 (11.41) for TM surgeries and 62.99 (11.11) for 3D surgeries. 3D surgeries had significantly higher surgical competency scores than TM surgeries ( P = 0.013). The mean surgical duration for TM and 3D surgeries was 35.98 (6.02) min and 34.31 (7.12) min, respectively. 3D surgeries took significantly less time than TM surgeries ( P = 0.012). The overall mean best corrected visual acuity in the logarithm of the minimum angle of resolution units was 0.27 (0.42); in TM and 3D surgeries, it was 0.28 (0.43) units and 0.26 (0.41) units, respectively. The 3D heads-up display system enhances stereopsis in cataract surgery, making it a valuable training tool for novice surgeons in phacoemulsification procedures.

Evaluation of Foveal Cone and Müller Cells in Epiretinal Membrane using Adaptive Optics OCT

To investigate cellular-level morphological alterations in the retinal neuroglia in eyes with epiretinal membrane (ERM). Prospective cross-sectional, observational study (November 2020-May 2022). We included 41 eyes with unilateral idiopathic ERM and 33 healthy eyes of healthy volunteers. We examined the foveal microstructures in all eyes using adaptive optics OCT (AO-OCT) with axial and lateral resolutions of 3.4 and 3.0 μm, respectively. Adaptive optics OCT images were acquired for a 2.5° (728μm) area at the foveal center. Foveal microstructures on AO-OCT images, best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution units, and associations between these parameters. Adaptive optics OCT imaging of healthy eyes and eyes with ERM revealed sharp hyperreflective lines of the external limiting membrane (ELM), accompanied by hyporeflective gaps, individual nuclei of the foveal cone photoreceptors, and Müller cell bodies. The arrangement of Müller cell bodies was more vertical in eyes with ERM than in normal eyes. Epiretinal membranes adhered to foveal Müller cells via the internal limiting membrane (ILM), exerting vertical traction that pulled the foveal cones anteriorly. Adaptive optics OCT also enabled visualization of outer segment (OS) discs. Hyperreflective changes in the OS discs were observed beneath the vertically thickened ellipsoid zone (EZ) in 15 eyes (36.6%) with ERM. For eyes with ERM, multiple regression analysis showed that the length from ILM to the inner border of the outer nuclear layer and the EZ thickness were significantly associated with BCVA (β=5.3×10-4 and 82.7×10-4, respectively), with associated 95% confidence intervals of 1.3×10-4 to 9.3×10-4 (P=0.011) and 39.0×10-4 to 126.5×10-4 (P<0.001), respectively. The EZ thickness was significantly and positively associated with the length from ELM to the retinal pigment epithelium (β=23.9×10-2, 95% confidence interval: 4.8×10-2 to 42.9×10-2; P=0.015). Cellular imaging of retinal neuroglia by AO-OCT may suggest possible mechanisms associated with visual impairment in patients with ERM, which could potentially contribute to the growing body of knowledge on its pathophysiology. However, these insights require further validation through extensive studies to fully ascertain their significance. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Impact of macular intraretinal hemorrhage and macular hole on the visual prognosis of submacular hemorrhage due to retinal arterial macroaneurysm rupture.

To compare the effects of macular intraretinal hemorrhage (IRH) and macular hole (MH) on best-corrected visual acuity (BCVA) after displacement of submacular hemorrhage (SMH) due to retinal arterial macroaneurysm (RAM) rupture. This multicenter retrospective study included 48 eyes with SMH due to RAM rupture. Cases underwent vitrectomy to displace SMH and were followed up for 6 months. We classified cases according to the presence of IRH and MH and compared the postoperative BCVA among the groups. We classified the eyes into IRH(+)MH(+) group (10 eyes), IRH(+)MH(-) group (23 eyes), and IRH(-)MH(-) group (15 eyes). The postoperative BCVA was significantly worse in the IRH(+)MH(+) and IRH(+)MH(-) than in the IRH(-)MH(-) (0.91 ± 0.41 in logarithm of the minimal angle of resolution units, Snellen equivalent 20/163, 0.87 ± 0.45, 20/148, and 0.18 ± 0.21, 20/30, respectively; P < 0.001). The postoperative CRT was significantly lower in the IRH(+) group (IRH(+)MH(+) and IRH(+)MH(-) groups combined) than in the IRH(-) group (IRH(-)MH(-) group) (121.4 ± 70.1 μm and 174.3 ± 32.9 μm, respectively, P = 0.008). The postoperative ELM and EZ continuities were significantly discontinuous in the IRH(+) group (P < 0.001, P = 0.001, respectively). The multiple linear regression analysis showed that both IRH(+)MH(+) and IRH(+)MH(-) were associated with the postoperative BCVA (regression coefficient, 0.799 and 0.711, respectively ; P < 0.001 for both). Both IRH and MH were poor prognostic indicators in cases with SMH due to RAM rupture.

Total and horizontal distances of the foveal stereotaxic displacement can be prognostic indicators for patients with idiopathic epiretinal membrane.

This study aimed to examine the foveal stereo deviations in the different ectopic inner foveal layer (EIFL) stages of idiopathic epiretinal membrane (iERM) and assess its predictive utility for the baseline and postoperative best-corrected visual acuity (BCVA). Based on the calculational combination of foveal displacements in the horizontal and vertical axial optical coherence tomography (OCT) images, the foveal stereotaxic displacement was estimated through the total distance (TD, the distance from the foveal bottom to the inner edge of displaced central foveal) and horizontal distance (HD, projection of the TD in the retinal plane). The preoperative TD, HD, and other OCT- and OCT angiography (OCTA)-related indicators were obtained. The correlations between structural parameters and baseline and postoperative BCVA were evaluated through correlation and multiple linear regression analyses. In patients with advanced EIFL stage, there was a significant increase in the HD, TD, baseline log of the minimum angle of resolution unit for BCVA, central macular thickness (CMT), acircularity index, and incidence of microcystic macular edema (MME; p < 0.05). Further, they showed a decreased foveal avascular zone (FAZ) area and perimeter (p < 0.001). HD, TD, CMT, MME, FAZ area, and FAZ perimeter were significantly correlated with the baseline and postoperative BCVA (p < 0.05). TD had the highest correlation indexic and was an individual predictor of the baseline and postoperative BCVA. Moreover, FD-300 and MME were individual predictors of postoperative BCVA. Stereoscopic foveal deviations significantly correlated with the baseline and postoperative visual acuity. TD may be used as an independent prognostic factor for BCVA.

Retinal and Choroidal Vasculature Before and After Patch Occlusion Treatment Using Optical Coherence Tomography Angiography in Patients with Amblyopia

This study aimed to investigate structural differences in the retinal and choroidal blood vessels before and after patch occlusion treatment in patients with amblyopia using optical coherence tomography angiography (OCTA) and to determine whether these differences are related to clinical improvement in patients. A total of 26 eyes of 17 patients with monocular or binocular amblyopia who underwent patch occlusion treatment for at least 1 month were retrospectively enrolled. The width of the foveal avascular zone, retinal blood vessel density, choroidal thickness, and choroidal vascularity index (CVI) measured by OCTA were compared before and after the treatment; the correlation with change in best-corrected visual acuity (BCVA) was analyzed for the data showing statistically significant differences. The mean BCVA of amblyopic eyes before and after patch occlusion treatment was 0.41 ± 0.23 and 0.25 ± 0.16 in logarithm of the minimum angle of resolution units, respectively. A decrease of about 2% in CVI was observed after the treatment (&lt;i&gt;p&lt;/i&gt; = 0.011). The correlation between the changes in CVI and the changes in BCVA were insignificant (Rs = 0.086, &lt;i&gt;p&lt;/i&gt; = 0.718). The results indicated that a decrease in CVI was observed after the patch occlusion treatment, but the relationship between CVI and BCVA could not be established. Patch occlusion treatment in amblyopia appears to affect the changes in the choroidal vessels and stroma.

Anatomical and functional outcomes of RETINOTOMY on primary inferior RHEGMATOGENOUS retinal detachment

AbstractPurpose: To analyse the anatomical and functional outcomes of pars plana vitrectomy combined with retinotomy alone in primary inferior rhegmatogenous retinal detachments (RD).Methods: Data from 139 patients who underwent vitreoretinal surgery for inferior RD in Centro Hospitalar Vila Nova de Gaia/Espinho, between 2012 and 2021 by the same surgeon, were analysed. Univariate and multivariate analysis were performed. Outcomes such as visual acuity (VA) and occurrence of complications were studied.Results: From the total 139 eyes analyse, 72 were subject to vitrectomy combined with retinotomy. Among them, 79% had macula‐off at the time of surgery and 94.4% had proliferative vitreoretinopathy (grade B or C). Functional success, with VA improvement or stabilization after surgery, was 75%. VA was significantly improved from 1.61 to 0.73 logarithm of the minimal angle of resolution units (p &lt; 0.001). The anatomic success rate was 95.8% in the first surgery.Conclusions: Inferior RD is a significant clinical and surgical challenge for vitreoretinal surgeons and the choice between the best surgical technique is still controversial. These cases frequently require some additional measures to vitreoretinal surgery due to its high recurrence rate. Our results show that vitrectomy with retinotomy alone on primary inferior RD has high anatomical and functional success rates.

Retropupillary Iris Fixation of an Artisan Myopia Lens for Intraocular Lens Dislocation and Aphakia in Eyes with Extremely High Myopia: A Case Series and a Literature Review.

IntroductionTo describe the outcomes of retropupillary iris fixation of an iris claw Artisan Myopia intraocular lens (IOL), and to review literature on retropupillary iris fixation of iris claw models for myopia for the correction of aphakia and IOL dislocation in eyes with extremely high myopia.MethodsSingle-center, retrospective case series. Three patients (three eyes) with pathological myopia underwent retropupillary iris fixation of the iris claw Artisan Myopia model 204 for the correction of aphakia and IOL dislocation. After IOL power calculation, we found that the Artisan Aphakia IOL was not available for these patients. One patient had a history of previous extracapsular cataract extraction and two patients exhibited IOL–bag complex dislocation. The target lens power was calculated using ultrasound biometry and the Sanders–Retzlaff–Kraff theoretical and T2 formulae, with an A-constant of 103.8. All surgeries were performed by a single surgeon. Visual outcomes were assessed at 12–48 months after surgery.ResultsThe mean axial length was 34.33 ± 0.21 mm. The power of the implanted Artisan IOLs ranged between − 4.00 and − 3.00 diopter. The corrected distance visual acuity, measured in logarithm of the minimum angle of resolution units, improved after surgery in all eyes, from 0.60 ± 0.36 logMAR before surgery to 0.40 ± 0.43 logMAR after surgery at 12 months postoperatively and remained stationary thereafter. There were no postoperative complications.ConclusionsRetropupillary iris fixation of Artisan Myopia IOLs may be a safe and effective surgical treatment option for the correction of aphakia and IOL dislocation in patients with extremely high myopia.

Phase 1 Clinical Trial of Elamipretide in Dry Age-Related Macular Degeneration and Noncentral Geographic Atrophy: ReCLAIM NCGA Study.

PurposeAssess the safety, tolerability, and feasibility of subcutaneous administration of the mitochondrial-targeted drug elamipretide in patients with dry age-related macular degeneration (AMD) and noncentral geographic atrophy (NCGA) and to perform exploratory analyses of change in visual function.DesignPhase 1, single-center, open-label, 24-week clinical trial with preplanned NCGA cohort.ParticipantsAdults ≥ 55 years of age with dry AMD and NCGA.MethodsParticipants received subcutaneous elamipretide 40-mg daily; safety and tolerability assessed throughout. Ocular assessments included normal-luminance best-corrected visual acuity (BCVA), low-luminance BCVA (LLBCVA), normal-luminance binocular reading acuity (NLBRA), low-luminance binocular reading acuity (LLBRA), spectral-domain OCT, fundus autofluorescence (FAF), and patient self-reported function by low-luminance questionnaire (LLQ).Main Outcome MeasuresPrimary end point was safety and tolerability. Prespecified exploratory end-points included changes in BCVA, LLBCVA, NLBRA, LLBRA, geographic atrophy (GA) area, and LLQ.ResultsSubcutaneous elamipretide was highly feasible. All participants (n = 19) experienced 1 or more nonocular adverse events (AEs), but all AEs were either mild (73.7%) or moderate (26.3%); no serious AEs were noted. Two participants exited the study because of AEs (conversion to neovascular AMD, n = 1; intolerable injection site reaction, n = 1), 1 participant discontinued because of self-perceived lack of efficacy, and 1 participant chose not to continue with study visits. Among participants completing the study (n = 15), mean ± standard deviation (SD) change in BCVA from baseline to week 24 was +4.6 (5.1) letters (P = 0.0032), while mean change (SD) in LLBCVA was +5.4 ± 7.9 letters (P = 0.0245). Although minimal change in NLBRA occurred, mean ± SD change in LLBCVA was –0.52 ± 0.75 logarithm of the minimum angle of resolution units (P = 0.005). Mean ± SD change in GA area (square root transformation) from baseline to week 24 was 0.14 ± 0.08 mm by FAF and 0.13 ± 0.14 mm by OCT. Improvement was observed in LLQ for dim light reading and general dim light vision.ConclusionsElamipretide seems to be well tolerated without serious AEs in patients with dry AMD and NCGA. Exploratory analyses demonstrated possible positive effect on visual function, particularly under low luminance. A Phase 2b trial is underway to evaluate elamipretide further in dry AMD and NCGA.

Clinical, Morphological, and Optical Correlates of Visual Function in Patients With Fuchs Endothelial Corneal Dystrophy.

The purpose of this article was to study the clinical, optical, and morphological correlates of visual function in patients with Fuchs endothelial corneal dystrophy (FECD). The case records were analyzed for patients diagnosed with FECD between September 2019 and March 2020. The best-corrected visual acuity (BCVA) was recorded as decimal visual acuity and converted to the logarithm of the minimum angle of resolution units. Contrast sensitivity was measured with the Pelli-Robson contrast sensitivity test. Corneal alterations, including central corneal thickness, depression of the posterior cornea, and corneal densitometry values, were evaluated using Scheimpflug images. Corneal epithelial thickness was measured by spectral-domain optical coherence tomography. A total of 107 eyes of 61 patients (18 male and 43 female) with FECD were retrospectively investigated. The Spearman rank correlation coefficient showed moderate correlation between BCVA and contrast sensitivity (ρ = -0.66, P < 0.001), with some patients maintaining relatively good BCVA but having reduced contrast sensitivity. Logistic regression analysis demonstrated that age, central corneal thickness, depression of the posterior cornea, and epithelial thickening were negatively associated with contrast sensitivity but not with BCVA. Contrast sensitivity is a useful tool for assessing visual dysfunction and should be incorporated into the assessment protocol of patients with FECD. Alterations in the cornea, including central corneal thickness, depression of the posterior cornea, and epithelial thickening, might be objective parameters that can help the clinician in grading the severity of the disease and tracking its progression.

Glaucoma and Computer Use: Do Contrast and Color Enhancements Improve Visual Comfort in Patients?

To estimate the impact of glaucoma on computer use and to assess specific adaptations of the graphical interface to this form of visual impairment. Prospective, experimental cohort study. Forty-nine participants were recruited: 16 patients with primary open-angle glaucoma (mean ± SD, 62.7 ± 5.6 years of age), 17 age-matched participants (mean ± SD, 59.1 ± 8.3 years of age), and 16 young control participants (mean ± SD, 23.3 ± 2.1 years of age). An ophthalmologic examination before the study evaluated the level of visual loss (mean deviation), visual acuity (logarithm of the minimum angle of resolution units), and contrast sensitivity (CS) of the primary open-angle glaucoma patients. Each participant underwent the following measurements: an information technology (IT) experience questionnaire, a preference task monitored by eye tracking, and a feedback session. The experimental task was based on ecological computer scenes with 3 enhancement levels (low, medium, and high), determined by gradual modulation of contrast, luminance, and color. Participants were asked to select the most readable and comfortable stimulus among 4 images displayed on the screen: the original computer scene and 3 enhanced versions. Clinical, oculomotor, and subjective data were computed together in a multivariate model by using a principal component analysis (PCA). The PCA revealed 3 principal components accounting for 72% of the total variance of the data and showed a greater need for enhanced computer scenes in glaucoma patients, an equal preference for low and medium enhancement within the 3 groups, and significantly longer oculomotor behavior in the patient groups. Subjective reports of difficulty using IT because of vision were correlated with visual impairment and high enhancement preference. Contrast sensitivity was critical to explaining the main variations of the data. A reduced CS had a significant effect on the preference for enhanced computer scenes (r= -0.43; P < 0.002) and a less effective exploration velocity (r= 0.43; P < 0.002). Glaucoma alters the global exploration of computer scenes. High enhancement of the graphical interface could improve visual comfort during computer use. Subjective patients' reports underline the importance of including IT questions in visual-related quality-of-life questionnaires.

Combined versus Sequential Phacoemulsification and Pars Plana Vitrectomy: A Meta-Analysis

It is unclear whether differences exist in efficacy and safety between combined versus sequentially performed phacoemulsification and pars plana vitrectomy (phaco-PPV). This meta-analysis aimed to compare the efficacy and incidence of complications between these surgical methods. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched for articles reporting the efficacy and safety of combined versus sequential phaco-PPV for any indication. The primary outcomes were postoperative best-corrected visual acuity (BCVA) and mean absolute refractive error from target (RET). Secondary outcomes included efficacy outcomes and postoperative complications. Meta-analysis was conducted using a random effects model in all cases. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool for randomized trials and ROBINS-I tool for observational studies. Of the 5410 articles identified, 1 randomized controlled trial and 14 comparative studies were included, with 1407 and 951 eyes in the combined and sequential surgery groups, respectively. Mean age was 62.71 ± 6.16 years and 44% (range, 32.1%-70%) of eyes were from men. The mean baseline BCVA was 0.88±0.59 logarithm of the minimum angle of resolution units (Snellen equivalent, 20/152). The meta-analysis showed no significance between groups in postoperative mean BCVA (P= 0.76) and mean absolute RET (P= 0.46). The risks of synechiae formation (risk ratio [RR], 2.74; 95% confidence interval [CI], 1.83-4.11; P < 0.001), fibrin formation (RR, 2.81; 95% CI, 1.84-4.30; P < 0.001), and intraoperative or postoperative retinal detachment (RR, 2.65; 95% CI, 1.08-6.47; P= 0.03) were significantly higher after combined surgery. However, the risks of posterior capsular tear (RR, 0.43; 95% CI, 0.25-0.73; P= 0.002) and macular hole nonclosure or reopening (RR, 0.18; 95% CI, 0.03-0.93; P= 0.04) were significantly lower in the combined group. No significant differences were found in visual and refractive outcomes between combined and sequential phaco-PPV, whereas differences existed in certain safety outcomes. These conclusions remain preliminary, as most evidence is derived from low- to moderate-quality retrospective studies. Given the variability in outcome reporting and associated heterogeneity, future randomized controlled trials are needed.

RETINAL SURFACE WRINKLING AS AN INDICATOR FOR INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR RETINAL DETACHMENT.

To assess the validity of retinal surface wrinkling (RSW) as an indicator to select patients relevant for internal limiting membrane peeling during vitrectomy for rhegmatogenous retinal detachment, to prevent postoperative visual decline due to epiretinal membrane growth. This was a prospective, interventional case series of 78 consecutive eyes that underwent initial vitrectomy to repair rhegmatogenous retinal detachments and were followed for 6 months. The presence/absence of RSW was evaluated presurgically on en face optical coherence tomographic images. The internal limiting membrane was peeled if RSW was identified. The main outcome measure was the prevalence of postsurgical epiretinal membrane growth that caused a visual decline of 0.2 or more in logarithm of the minimum angle of resolution unit. The internal limiting membrane was peeled for RSW appearance in 22 eyes (28.2%). Mild epiretinal membranes developed in 8 of the 56 internal limiting membrane-unpeeled eyes (10.3% of total, 6 eyes at stage 1 in the classification of Govetto); however, visual decline occurred in none of them with the mean visual acuity of these 8 eyes maintained at -0.08 ± 0.11 in logarithm of the minimum angle of resolution (≈20/16). Visual decline due to epiretinal membrane growth after rhegmatogenous retinal detachment repair was entirely prevented by peeling the internal limiting membrane in about 30% of cases selected for the presence of RSW.

English

BACKGROUND Peripheral ulcerative keratitis (PUK) is a destructive inflammatory disease of the juxta-limbal corneal stroma that is caused by various infectious and non-infectious ocular and systemic diseases. Certain morphologic and immunologic characteristics of peripheral cornea make it more vulnerable to inflammatory reactions and necrosis. Early diagnosis and prompt treatment prevent blindness due to this devastating inflammatory condition. We wanted to study the aetiology, clinical features and outcome of various treatment modalities of peripheral ulcerative keratitis of non-infective aetiology. METHODS 54 eyes of 40 patients with peripheral ulcerative keratitis of non-infective aetiology were evaluated and treated with either medical or surgical therapy or both in a tertiary care centre and were followed up. The total study duration was 12 months. RESULTS 60 percent of cases were males (24 / 40). The most common age group affected was 60 - 70 years (32.5 %) and the mean age in our study group was 57.7 ± 18.33 years. 65 % were unilateral (26 / 40). In our study 15 eyes (27.77 %) had meibomitis. 13 % of eyes had mild involvement, 40.8 % eyes had moderate involvement, 46.2 % eyes had severe involvement. Severe involvement was the most common presentation. The incidence of perforated PUK in the study group was 20.37 % (11 / 54 eyes). 45 % were found to have unknown aetiology. Of the remaining, the most common aetiology was Mooren's ulcer (32.5 %) followed by rheumatoid arthritis (20 %) and Systemic Lupus Erythematosus (2.5 %). Among 54 eyes, the resolution of signs of active PUK was seen in 50 eyes (92.59 %) after treatment. Visual acuity improvement noted on comparison of mean of pretreatment visual acuity 0.90 with standard deviation 0.39 and the mean of post treatment visual acuity 0.62 with standard deviation 0.37 logarithm of minimum angle of resolution units with P value is &lt; 0.001 which is significant. For perforated peripheral ulcerative keratitis eyes, patch graft was found to be successful in 87.5 %. Peritomy was successful in 100 % and peritomy with amniotic membrane graft was successful in 70 %. CONCLUSIONS In our study, male patients were more than female and the commonest presentation was unilateral. Most common aetiology was idiopathic followed by Mooren's ulcer, rheumatoid arthritis and systemic lupus erythematosus. Mild to moderate cases respond well to medical management. Severe cases need immunosuppressants. Perforated cases needs surgical intervention especially patch graft which is better in achieving good anatomical integrity and enhanced visual acuity. Early referral of patients with peripheral ulcerative keratitis to a tertiary care centre helps in early treatment which is beneficial in avoiding blindness. KEYWORDS Peripheral Ulcerative Keratitis, Non Infective, Immunosuppressants, Patch Graft

The Association between Foveal Floor Measurements and Macular Hole Size

Determining which factors influence idiopathic macular hole (MH) size is important because it is a major prognostic indicator of treatment success. Foveal pit morphologic features are highly symmetrical within individuals and may influence idiopathic MH size. Using a series of patients with unilateral idiopathic MHs, we examined the foveal floor size of the fellow eye to evaluate its relationship with idiopathic MH size and postoperative outcomes. Retrospective observational study. Two hundred forty-one participants with a unilateral idiopathic MH treated with surgery and a fellow eye with no ocular pathologic features. Both eyes underwent spectral-domain (SD) OCT imaging at the time of surgery. Minimum linear diameter (MLD) and base diameter (BD) defined idiopathic MH size. Foveal floor width (FFW) and minimal foveal thickness defined foveal pit morphologic features of the fellow eye. Baseline characteristics, SD OCT measurements, and preoperative variables were compared to determine their relationship with idiopathic MH size and postoperative visual acuity (VA) in logarithm of the minimum angle of resolution units. Foveal floor width was correlated with MLD (r= 0.36; P ≤ 0.001) and BD (r= 0.30; P ≤ 0.001), but not postoperative VA. Minimum linear diameter correlated with preoperative VA (r= 0.49; P ≤ 0.0001) and postoperative VA (r= 0.54; P ≤ 0.0001). A 2-stage regression model was developed to predict postoperative VA (r2= 0.28): preoperative VA (β= 0.36; P= 0.002) explained 13% of variability and MLD (β= 0.29; P= 0.002), and idiopathic MH duration (β= 0.23; P= 0.004) explained a further 16%. Foveal floor width of the fellow eye in patients with a unilateral idiopathic MH was correlated significantly with idiopathic MH size and may explain some of the variability in idiopathic MH size observed between individuals. However, FFW could not predict postoperative vision.

RP2-associated retinal disorder in a Japanese cohort: Report of novel variants and a literature review, identifying a genotype-phenotype association.

The retinitis pigmentosa 2 (RP2) gene is one of the causative genes for X-linked inherited retinal disorder. We characterized the clinical/genetic features of four patients with RP2-associated retinal disorder (RP2-RD) from four Japanese families in a nationwide cohort. A systematic review of RP2-RD in the Japanese population was also performed. All four patients were clinically diagnosed with retinitis pigmentosa (RP). The mean age at examination was 36.5 (10-47) years, and the mean visual acuity in the right/left eye was 1.40 (0.52-2.0)/1.10 (0.52-1.7) in the logarithm of the minimum angle of resolution unit, respectively. Three patients showed extensive retinal atrophy with macular involvement, and one had central retinal atrophy. Four RP2 variants were identified, including two novel missense (p.Ser6Phe, p.Leu189Pro) and two previously reported truncating variants (p.Arg120Ter, p.Glu269CysfsTer3). The phenotypes of two patients with truncating variants were more severe than the phenotypes of two patients with missense variants. A systematic review revealed additional 11 variants, including three missense and eight deleterious (null) variants, and a statistically significant association between phenotype severity and genotype severity was revealed. The clinical and genetic spectrum of RP2-RD was illustrated in the Japanese population, identifying the characteristic features of a severe form of RP with early macular involvement.

Clinical and genetic characteristics of Stargardt disease in a large Western China cohort: Report 1.

Stargardt disease 1 (STGD1) is the most prevalent retinal dystrophy caused by pathogenic biallelic ABCA4 variants. Forty-two unrelated patients mostly originating from Western China were recruited. Comprehensive ophthalmological examinations, including visual acuity measurements (subjective function), fundus autofluorescence (retinal imaging), and full-field electroretinography (objective function), were performed. Next-generation sequencing (target/whole exome) and direct sequencing were conducted. Genotype grouping was performed based on the presence of deleterious variants. The median age of onset/age was 10.0 (5-52)/29.5 (12-72) years, and the median visual acuity in the right/left eye was 1.30 (0.15-2.28)/1.30 (0.15-2.28) in the logarithm of the minimum angle of resolution unit. Ten patients (10/38, 27.0%) showed confined macular dysfunction, and 27 (27/37, 73.7%) had generalized retinal dysfunction. Fifty-eight pathogenic/likely pathogenic ABCA4 variants, including 14 novel variants, were identified. Eight patients (8/35, 22.8%) harbored multiple deleterious variants, and 17 (17/35, 48.6%) had a single deleterious variant. Significant associations were revealed between subjective functional, retinal imaging, and objective functional groups, identifying a significant genotype-phenotype association. This study illustrates a large phenotypic/genotypic spectrum in a large well-characterized STGD1 cohort. A distinct genetic background of the Chinese population from the Caucasian population was identified; meanwhile, a genotype-phenotype association was similarly represented.

Combined Intrastromal Voriconazole and Amphotericin B Treatment for Persistent Fungal Keratitis.

To evaluate the clinical outcomes of combined intrastromal voriconazole and intrastromal amphotericin B for the treatment of persistent fungal keratitis. Patients who received combined corneal intrastromal voriconazole (0.05 mg/0.1 mL) and intrastromal liposomal amphotericin B (0.01 mg/0.1 mL) injections in addition to topical therapy for treatment of persistent fungal keratitis were included in the study. Persistence was described as no improvement or progression in the clinical findings despite treatment with combined topical voriconazole (1 mg/0.1 mL) and topical amphotericin B drops (0.15 mg/0.1 mL) hourly for at least 10 days. The healing of keratitis was considered as the complete closure of epithelial defect with complete resolution of a corneal infiltrate. Thirty-two eyes of 32 patients who met the inclusion criteria were included in this study. Predominant organisms in fungal isolates were Aspergillus species. Combination therapy of intrastromal amphotericin B and intrastromal voriconazole in addition to topical therapy resulted in complete resolution of persistent fungal keratitis in 28 (87.5%) patients. The mean number of intrastromal injections was 9.3±6.4 and ranged from 1 to 18. The mean best-corrected visual acuity values improved from 2.17±0.43 to 1.76±0.77 logarithm of the minimum angle of resolution units (P=0.003). The mean duration of complete epithelial closure was 45.3±16.3 days. Four patients required therapeutic penetrating keratoplasty because of persistence of fungal keratitis (3 patients) and progression of keratitis (1 patient). There was no need for evisceration. Combination therapy with intrastromal voriconazole and intrastromal amphotericin B may be an effective adjunct treatment for persistent fungal keratitis.

ADVERSE EFFECT OF MACULAR INTRARETINAL HEMORRHAGE ON THE PROGNOSIS OF SUBMACULAR HEMORRHAGE DUE TO RETINAL ARTERIAL MACROANEURYSM RUPTURE.

To investigate the clinical course of submacular hemorrhage associated with ruptured retinal arterial macroaneurysm using swept-source optical coherence tomography. This study included 23 eyes of 23 consecutive patients diagnosed with submacular hemorrhage associated with ruptured retinal arterial macroaneurysm. Cases underwent displacement of submacular hemorrhage (vitrectomy + subretinal injection of tissue plasminogen activator + air tamponade) and were followed up for 6 months after surgery. Localization of the preoperative hemorrhage and its effect on preoperative and postoperative best-corrected visual acuity, central retinal thickness, and continuity of the ellipsoid zone were measured. Macular intraretinal hemorrhage (IRH) was observed in 17 eyes (73.9%, IRH [+] group) and was not observed in 6 eyes (26.1%, IRH [-] group). The IRH (+) group showed worse postoperative best-corrected visual acuity values compared with the IRH (-) group (0.89 ± 0.47 in logarithm of the minimal angle of resolution units, Snellen equivalent 20/155 and 0.16 ± 0.23, 20/29, respectively; P < 0.01), smaller central retinal thickness values (97.7 ± 53.5 μm, 173.0 ± 32.3 μm, respectively; P < 0.01), and a higher rate of ellipsoid zone disruption (100%, 33.3%, respectively; P < 0.01). Patients with preoperative macular IRH showed lower postoperative visual acuity and worse macular contour after submacular hemorrhage displacement compared with patients without macular IRH.