Minimum Angle Of Resolution Units Research Articles

Retinal Nerve Fiber Layer Thickness in Children With Optic Pathway Gliomas

To determine the relationship of high-contrast visual acuity (VA) and low-contrast letter acuity with retinal nerve fiber layer (RNFL) thickness in children with optic pathway gliomas. Cross-sectional convenience sample, with prospective data collection, from a tertiary care children's hospital of patients with optic pathway gliomas associated with neurofibromatosis type 1, sporadic optic pathway gliomas, and neurofibromatosis type 1 without optic pathway gliomas. Patients underwent best-corrected VA testing using surrounded H, O, T, V optotypes and low-contrast letter acuity (5%, 2.5%, and 1.25% low-contrast Sloan letter charts). Mean RNFL thickness (micrometers) was measured by a Stratus optical coherence tomography device (Carl Zeiss Meditec) using the fast RNFL thickness protocol. Eyes were classified as having abnormal vision if they had high-contrast VA of more than 0.1 logarithm of the minimal angle of resolution units or visual field loss. The association of subject age, glioma location, and RNFL thickness with both VA and low-contrast letter acuity scores was evaluated by 1-way analysis of variance and linear regression, using the generalized estimating equation approach to account for within-patient intereye correlations. Eighty-nine eyes of patients with optic pathway gliomas were included, and 41 were classified as having abnormal VA or visual field loss. Reduced RNFL thickness was associated significantly with higher logarithm of the minimal angle of resolution scores for both VA (P < .001) and all low-contrast letter acuity charts (P < .001) when accounting for age and glioma location. Eyes of most children with optic pathway gliomas and decreased RNFL thickness had abnormal VA or visual field loss.

Development of Subretinal Fibrosis After Anti-VEGF Treatment in Neovascular Age-Related Macular Degeneration

to describe the development or progression of subfoveal fibrosis after anti-vascular endothelial growth factor (VEGF) therapy in the absence of significant subfoveal hemorrhage in neovascular age-related macular degeneration. retrospective case series. seven eyes of seven patients with neovascular age-related macular degeneration developed subfoveal fibrosis after anti-VEGF therapy in the absence of significant subfoveal hemorrhage. Five of seven patients experienced vision loss of 0.3 logarithm of the minimum angle of resolution units or greater. subfoveal fibrosis may develop or progress in neovascular age-related macular degeneration despite the absence of significant subfoveal hemorrhage and treatment with anti-VEGF. Development of anti-fibrotic therapeutics may be beneficial in reducing the incidence of subretinal fibrosis.

Randomized Trial of Intravitreal Clindamycin and Dexamethasone versus Pyrimethamine, Sulfadiazine, and Prednisolone in Treatment of Ocular Toxoplasmosis

To compare the efficacy of intravitreal injection of clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. Prospective, randomized single-masked clinical trial. A total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone (IVCD) group and 34 in the classic treatment (CT) group. The IVCD group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 μg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies (immunoglobulin [Ig] M and IgG) were measured using an enzyme-linked immunosorbent assay. Changes in retinochoroidal lesion size, measured by a computer program written in the MATLAB environment, 6 weeks after initiation of treatment. Visual acuity (VA) changes, vitreous inflammatory response, adverse drug reactions, and rate of recurrence were secondary outcome measures. The mean number of injections in the IVCD group was 1.6. The lesion size reduction was statistically significant after treatment in both IVCD and CT groups (P < 0.001 and P = 0.009, respectively). However, the difference in mean percentage of reduction at 6 weeks was not significant: 57.0 ± 27.8% in the IVCD group versus 58.4 ± 29.3% in the CT group (P = 0.569). In relation to the baseline, VA increased by 0.44 ± 0.24 and 0.29 ± 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively (P < 0.001); however, the difference of VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant (P = 0.002); this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was insignificant between the groups. Within 2 years, 4 eyes (2 in each group) had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to the classic treatment in ocular toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations.

Safety and Effectiveness of Interferon Alpha-2a in Treatment of Patients with Behçet's Uveitis Refractory to Conventional Treatments

To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. Open, nonrandomized, uncontrolled, interventional, prospective study. Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

INTRAVITREAL BEVACIZUMAB ALONE VERSUS COMBINED VERTEPORFIN PHOTODYNAMIC THERAPY AND INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION

The purpose of the study was to compare the mean change in visual acuity between bevacizumab and combined bevacizumab and photodynamic therapy for the treatment of choroidal neovascularization from age-related macular degeneration after 12 months of follow-up. This study included a retrospective cohort of patients with untreated choroidal neovascularization. The generalized estimating equation was used to account for the correlation between eyes and to construct multivariate models to control for confounding factors of visual acuity change. One hundred and thirty-nine eyes treated with bevacizumab were compared with 236 eyes that received bevacizumab and photodynamic therapy (combination treatment). The monotherapy eyes showed an improvement of 0.101 +/- 0.619 logarithm of minimum angle of resolution units (5.05 letters) after a mean follow-up of 409.6 days versus 0.096 +/- 0.611 (4.8 letters) after a mean follow-up of 416.7 days with combination therapy; there was no difference between the groups (P = 0.970). The monotherapy eyes received 3.32 +/- 1.71 injections versus 3.14 +/- 1.52 injections in the combination therapy group (P = 0.665). The multivariate analysis did not show any difference between groups at the end of the study period in terms of visual improvement, worsening, stabilization, or the number of bevacizumab injections used. Long-term visual outcomes for the treatment of choroidal neovascularization in age-related macular degeneration are not improved with the addition of photodynamic therapy to bevacizumab nor are fewer injections needed.

Primary Retinectomy in Proliferative Vitreoretinopathy

To describe the functional and anatomic results of retinectomy without scleral buckling for anterior proliferative vitreoretinopathy in eyes that did not undergo previous buckling surgery. Retrospective, nonrandomized, interventional case series. We reviewed the results of 123 consecutive cases of retinectomy for rhegmatogenous retinal detachment complicated by anterior proliferative vitreoretinopathy. The primary outcome measure was anatomic success, defined as complete retinal reattachment. Secondary outcome measures were final anatomic success, final visual acuity outcome, number of operations required for retinal reattachment, baseline extent of proliferative vitreoretinopathy, ocular pressure at final follow-up, extent of retinectomy, and occurrence of complications. The anatomic success rate was 77.2%. Final attachment rate was 95.9%, reached after 1 rhegmatogenous retinal detachment reoperation in 21 cases and after 2 rhegmatogenous retinal detachment reoperations in 4 cases. We had a low rate of postoperative hypotony (4.1%). Visual acuity was significantly improved from 2.10 to 1.44 logarithm of the minimal angle of resolution units (P < .001). Improvement was related significantly to retinectomy extent and primary anatomic success. Our results show that primary retinectomy without scleral buckling has good anatomic and functional results.

Functional and morphological changes of macula after subthreshold micropulse diode laser photocoagulation for diabetic macular oedema

To examine the early changes of retinal sensitivity by fundus-related microperimetry after subthreshold micropulse diode laser photocoagulation (SMDLP) for diabetic macular oedema (DMO). Twenty-eight eyes of 28 patients with diffuse DMO were treated with SMDLP. The mean retinal sensitivity within the central 10 degrees measured with a fundus-related microperimeter, MP1, best corrected visual acuity (BCVA) in logarithm of minimum angle of resolution units, and optical coherence tomography-determined foveal thickness (FT) were examined before and 3 months after SMDLP. The pretreatment values of the retinal sensitivity, FT, BCVA, and funduscopic findings were compared with the corresponding values at 3 months after SMDLP. At 3 months, the BCVA was significantly improved (P=0.03), and the FT was significantly reduced (P=0.0043). The mean retinal sensitivity within the central 10 degree, however, did not change significantly (P=0.70). The correlation between the changes in the retinal sensitivities and the decrease in the FT was not significant. The correlation between the changes in the retinal sensitivities and the BCVA was also not significant. Significant improvements in retinal sensitivities within the central 10 degrees were not observed even though the decrease in FT and the improvement of BCVA were significant. On account of this difference of changes in retinal sensitivity and BCVA, the combination of retinal sensitivity by MP1 and BCVA may be beneficial in assessing the visual function from various angles after SMDLP for eyes with DMO.

TWO-YEAR VISUAL OUTCOMES AFTER PHOTODYNAMIC THERAPY IN AGE-RELATED MACULAR DEGENERATION PATIENTS WITH OR WITHOUT POLYPOIDAL CHOROIDAL VASCULOPATHY LESIONS

To describe the visual outcomes 2 years after photodynamic therapy in Japanese patients with age-related macular degeneration (AMD) with or without polypoidal choroidal vasculopathy (PCV) lesions. Sixty-three eyes of 63 consecutive patients with AMD or AMD + PCV who underwent photodynamic therapy were included in this study. Fluorescein and indocyanine green angiography were performed to diagnose AMD and AMD + PCV. Change in mean visual acuity and recurrence of active lesion during the follow-up period up to 2 years were assessed. Patients with typical AMD maintained visual acuity for 2 years after photodynamic therapy. For patients with AMD + PCV, the visual acuity was maintained during the first year but started decreasing by 0.09 logarithm of the minimum angle of resolution units per 3 months (95% confidence intervals [CI], 0.06-0.14) after 1 year. Moreover, patients with AMD + PCV had 82% higher risk of a recurrence of active lesions for each increase in 3 months of follow-up time after 1 year; this suggested that the risk of recurrence had increased later in follow-up after 1 year. Recurrence of active PCV lesions and massive subretinal hemorrhages were the main reasons for the late worsening of visual acuity. The visual acuity after photodynamic therapy in AMD patients was maintained for 2 years after the initial treatment. Patients with AMD + PCV had stable visual outcome within 1 year but not after 1 year; there are risks of late recurrences and massive hemorrhages after 1 year in patients with AMD + PCV.

Visual Acuity and Contrast Sensitivity in Eyes Implanted with Aspheric and Spherical Intraocular Lenses

To compare visual acuity and contrast sensitivity (CS) in eyes implanted with aspheric and spherical intraocular lenses (IOLs) after cataract surgery. Randomized, prospective study. Five hundred twenty-four eyes from 262 cataract surgery patients implanted with 2 IOL models: the AcrySof IQ (262 eyes) and AcrySof SN60AT (262 eyes; Alcon Laboratories, Fort Worth, TX). High-contrast photopic best-corrected distance visual acuity (BCVA) and CS under photopic (85 cd/m(2)) and mesopic (6 cd/m(2)) conditions were measured. Pupil diameter was analyzed for distance vision under both lighting conditions. Follow-up was carried out for 6 months in all patients. Best-corrected distance visual acuity and photopic and mesopic CS after implantation under monocular and binocular conditions. No statistically significant differences in BCVA were found between either IOL (0.06+/-0.06 and 0.05+/-0.07 logarithm of the minimum angle of resolution units for AcrySof SN60AT and AcrySof IQ groups, respectively; P = 0.091). One hundred percent of patients achieved BCVA of 20/32 or better in both groups. The percentage of patients who achieved BCVA of 20/25 or better was 86.3%. The AcrySof IQ IOL group showed better monocular and binocular CS at 6, 12, and 18 cpd under photopic conditions and at 3, 6, 12, and 18 cpd under mesopic conditions (P<0.001). Eyes implanted with the aspheric AcrySof IQ IOL showed better photopic and mesopic CS at medium and high spatial frequencies than eyes implanted with the spherical AcrySof SN60AT IOL. High-contrast photopic BCVA was similar between both IOLs. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Long-term Efficacy and Safety of Low-dose Interferon Alpha2a Therapy in Severe Uveitis Associated With Behçet Disease

To investigate long-term responsiveness of patients with severe uveitis associated with Behçet disease to interferon alpha2a (IFN-alpha2a). Retrospective study. Thirty-two patients with sight-threatening uveitis associated with Behçet disease who relapsed despite corticosteroids and immunosuppressive agents were included. IFN-alpha2a was administered subcutaneously (three million units thrice a week). Ophthalmologic examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were visual acuity and recurrence of uveitis attacks before, during, and after initiation of IFN-alpha2a therapy. Control of inflammation was achieved in 28 of 32 patients (88%). Mean observation period of the 28 responder patients was 70.6 months (range, 30.3 to 129.2 months). Median visual acuity improved from 0.52 to 0.33 (logarithm of the minimum angle of resolution units; P = .005) two years after initiation of IFN-alpha2a therapy. The relapse rate decreased significantly during IFN-alpha2a treatment from 1.68 +/- 1.22 relapses/patient/year to 0.11 +/- 0.20 relapses/patient/year (P < .0001). IFN-alpha2a was discontinued in 19 of 28 patients (68%) after 32 months of treatment (range, 16 to 50 months). Mean follow-up after IFN-alpha2a discontinuation was 43 months (range, 11 to 84 months). After IFN-alpha2a discontinuation, the relapse rate increased from 0.08 +/- 0.21 relapse/person/year to 0.74 +/- 1.40 relapse/person/year (P = 0.04). IFN-alpha2a is efficient and safe for the long-term management of severe uveitis associated with Behçet disease. Meanwhile it seems to be a suspensive therapeutic strategy, even though long-term remission is possible in some patients.

Iris-fixated Posterior Chamber Intraocular Lenses in Children

To report the short-term outcomes and complications of iris-fixated posterior chamber intraocular lenses (PCIOL) in the pediatric population. Retrospective, observational case study. Twelve consecutive pediatric patients (17 eyes) underwent placement of foldable iris-sutured PCIOLs between September 1, 2004 and September 30, 2007 by two anterior segment surgeons at a single academic center. Outcome measures included change in visual acuity (VA) and complications. In our series, there was a higher rate of dislocation of iris-sutured IOLs in patients with a history of ectopia lentis resulting from Marfan syndrome or hereditary or idiopathic causes than in patients being treated for aphakia resulting from other causes (45% vs 0%). Mean final VA improved by 0.23 logarithm of the minimum angle of resolution units from preoperative baseline. One eye of a Marfan patient sustained a retinal detachment eight months after dislocation of the PCIOL, and one patient experienced iris capture of the IOL after surgery. Iris-fixated IOLs are reasonable alternative to transsclerally sutured IOLs to correct aphakia in pediatric patient. Dislocation of the IOLs can occur, however, and there is concern for suture degradation over time. The procedure should be considered with caution in pediatric patients.

Intravitreal Bevacizumab in Inflammatory Ocular Neovascularization

To assess the role of bevacizumab in inflammatory ocular neovascularization. Retrospective, multicenter, consecutive case series of inflammatory ocular neovascularization. Patients with inflammatory ocular neovascularization of varying causes for whom standard therapy failed were treated with intravitreal injection of bevacizumab. Main outcome measures included improvement of best-corrected visual acuity (BCVA) expressed in logarithm of minimum angle of resolution units, response of inflammatory ocular neovascularization by funduscopy and angiography, and decrease in central foveal thickness as measured by optical coherence tomography at the three-month follow-up. At the three-month follow-up, 84 eyes of 79 patients had been treated with a mean of 1.3 injections (range, one to three). Thirty-four eyes showed juxtafoveal choroidal neovascularization (CNV), 34 eyes showed subfoveal CNV, eight eyes showed peripapillary CNV, and 11 eyes showed neovascularization of the disc (NVD) or neovascularization elsewhere (NVE). BCVA improved 2.4 lines from 0.68 (6/28 or 20/94) to 0.44 (6/17 or 20/55) (P < .001). BCVA improved by one to three lines in 34.5% of the eyes, by four to six lines in 16.7% of the eyes, and by more than six lines in 14.2% of the eyes. Function was unchanged in 23.8% of the eyes. BCVA worsened in 10.7% (zero to three lines in 7.1%, more than four lines in 3.6%). Central foveal thickness decreased from baseline 346 to 252 microm (P < .001). For CNV, 32 eyes (43.2%) had complete regression after the injection, 27 (36.5%) had partial regression, five (6.8%) had no response, and 10 eyes (13.5%) were not evaluated by the contributors. For NVD or NVE, seven eyes (63.6%) had complete regression of new vessels and four eyes (36.4%) had partial regression after the injection. Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.

Two-Year Results of Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To report on the two-year visual outcomes of indocyanine green angiography-guided photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) patients. Retrospective case study. A retrospective analysis that examined the clinical and angiographic data related to 41 eyes of 38 PCV patients (25 males, 13 females; average age +/- standard deviation [SD], 72.9 +/- 7.4 years) with follow-up periods of 24 months or more. The average number of PDT treatments was 1.65. After the 12-month follow-up, 12 eyes required retreatment. Although the mean visual acuity (VA) +/- SD before PDT (0.55 +/- 0.38 logarithm of the minimum angle of resolution units) improved to 0.46 +/- 0.41 at 12 months after the initial PDT, at 24 months, it declined significantly to 0.59 +/- 0.44 (P = .0018). Although only seven of 41 eyes exhibited VA deterioration at the 12-month follow-up examination, a decreased VA was noted in 18 eyes during the period starting from the 12-month follow-up until the final examination. The cases were bilateral in 11 (61.1%) of the 18 eyes. At the final examination, the mean VA of the bilateral cases but not the unilateral cases was significantly lower than that observed for the initial VA. PDT is an effective treatment against PCV over the short-term for both unilateral and bilateral cases. However, the VA prognosis may not the same after 12 months, especially for those PCV patients who have exudative age-related macular degeneration in contralateral eye.

Lack of Concordance between Fixation Preference and HOTV Optotype Visual Acuity in Preschool Children: The Baltimore Pediatric Eye Disease Study

To compare the results of fixation preference testing and standardized visual acuity testing in white and black children aged 30 through 71 months. Cross-sectional study. The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 through 71 months in Baltimore, Maryland, United States. A total 1714 children 30 through 71 months of age were eligible for inclusion in this report, with 1435 (83.7%) testable by both fixation preference and Amblyopia Treatment Study (ATS) visual acuity testing protocol. The vision of all children 30 through 71 months of age was tested using both the ATS visual acuity testing protocol (using single HOTV symbols with surround bars) and fixation preference testing (FPT). The ability of fixation preference testing to identify children with clinically important interocular differences (IOD) in visual acuity (i.e., two or more logarithm of minimum angle of resolution units of difference or more). Fifty-three children had 2 or more lines of IOD in visual acuity. Seven of them were graded as having momentary or no fixation (sensitivity = 13.2%; 95% confidence interval [CI], 5.3-27.2]), whereas 45 were graded as normal by FPT. In all 7 of the cases of poor FPT, the better-seeing eye was preferred. Low sensitivity and high specificity for detecting an IOD of 2 lines or more with FPT were seen for both white (33.3% sensitivity; 95% CI, 9.5-57.2; 99.6% specificity; 95% CI, 98.7-100) and black (6.5% sensitivity; 95% CI, 0.6, 23.2; 99.3% specificity; 95% CI, 98.3-99.8) children. When assessing FPT performance for 3 or more lines of IOD, only 5 of the 20 children (sensitivity, 25%; 95% CI, 6.0-44.0) had FPT grades of momentary or no fixation. Fixation preference testing, when used as part of a population-based research project, does not identify accurately preschool children with 2 lines or more of IOD in presenting visual acuity. The clinical value of this test is poor and its use for diagnosis and monitoring interventions should be reconsidered.

Surgical outcomes of epiretinal membrane removal after successful pars plana vitrectomy for retinal diseases

To evaluate visual outcomes after a removal of an epiretinal membrane (ERM) secondary to rhegmatogenous retinal detachment (RRD), proliferative vitreoretinopathy (PVR), or proliferative diabetic retinopathy (PDR). The medical charts of 51 consecutive patients who underwent PPV to remove an ERM were reviewed in an institutional setting. The preoperative best-corrected visual acuity (BCVA) was evaluated to determine if it was a possible predictor of the postoperative BCVA. The visual outcomes in the RRD, PVR, and PDR groups were compared. Follow-up periods ranged from 13 to 90 months (mean, 40.9 months). After the ERM was removed, the postoperative BCVA improved significantly by 0.471 logarithm of the minimum angle of resolution units for all groups (t=8.99; P<0.001). The postoperative BCVA improved by two or more lines in 43 eyes (84.3%). Patient age and the preoperative BCVA significantly correlated with the visual improvement (P=0.0082 and P=0.035, respectively). The BCVA improves after removal of an ERM following PPV for eyes with RRD, PVR, or PDR. Patient age and preoperative BCVA correlated with the visual improvement after the ERM removal.

Intravitreal Bevacizumab for Myopic Choroidal Neovascularization

To evaluate the effect of intravitreal bevacizumab on visual acuity in patients with myopic choroidal neovascularization. The retrospective case series study included 13 patients with myopic choroidal neovascularization who received three intravitreal injections of 1.5 mg of bevacizumab. At 1, 3, and 6 months after the first injection, mean visual acuity improved significantly from 0.63 +/- 0.41 logarithm of the minimum angle of resolution units (LogMAR) to 0.39 +/- 0.22 (P< .001), 0.47 +/- 0.49 (P= .002), and 0.52 +/- 0.49 LogMAR (P = 0.009), respectively. The increase in visual acuity was correlated with a significant decrease in central retinal thickness (P = .003) as measured by optical coherence tomography. Mean intraocular pressure did not change significantly (P> .05) during follow-up. Intravitreal injections of bevacizumab may be a therapeutic option for exudative myopic macular degeneration.

Long-term Safety and Functional Outcome of Combined Pars Plana Vitrectomy and Scleral-Fixated Sutured Posterior Chamber Lens Implantation

To investigate the complication profile and the long-term functional outcome of combined pars plana vitrectomy and scleral-fixated sutured posterior chamber lens (PC IOL) implantation. Retrospective, consecutive, interventional case series. The records of 63 patients (mean age, 67.5 years) were reviewed retrospectively (follow-up, 12 to 132 months; mean, 43.5 months). The underlying ocular pathologic features; the intraoperative, early (within two weeks after surgery), and late complications (more than two weeks after surgery); final best-corrected visual acuity (BCVA); and the refractive outcome were recorded. Fifty-nine of 63 procedures (93.7%) were performed without complications. Intraoperative complications included vitreous hemorrhage (n = 2), a retinal tear (n = 1), and a rupture of the iris base (n = 1). Early complications included transient raise of intraocular pressure (IOP; n = 19), transient vitreous hemorrhage (n = 2), scleral tunnel insufficiency (n = 5), pupillary capture of intraocular lens [IOL] (n = 6), persistent vitreous (n = 3), and choroidal hemorrhage (n = 1). Late complications occurred in 12 patients: rhegmatogenous retinal detachment (n = 4), proliferative vitreoretinopathy retinal detachment secondary to the underlying ocular pathologic features (n = 2), choroidal hemorrhage (n = 1), macular pucker (n = 1), and IOL dislocation (n = 4), including two cases of suture break. Mean BCVA in logarithm of the minimum angle of resolution units improved significantly from 1.025 (standard deviation [SD], 0.654) to 0.766 (SD, 0.750; P = .03). Mean cylindric equivalent significantly changed from 0.92 diopters (D; SD, 1.075) to 1.76 D (SD, 1.344; P = .005). The surgical procedures were performed safely in approximately 94% of patients. Most postoperative complications were minor: significant ones occurred in approximately 20%, whereas suture breaks were observed rarely. The only moderate long-term functional improvement in this case series was mainly determined by the underlying ocular pathologic features.

Interferon-α as an Effective Treatment for Noninfectious Posterior Uveitis and Panuveitis

Several studies have shown the capacity of interferon-alpha (IFN-alpha) to control ocular Behçet disease. The authors aimed to determine whether IFN-alpha was effective in treating patients with severe, refractory sight-threatening intraocular inflammation (uveitis) from a wider range of causes, including Behçet disease. Prospective, interventional case series. Twelve patients with sight-threatening uveitis that failed to respond to one or more immunosuppressive regimens were enrolled to this study. Recombinant human IFN-alpha-2b was administered subcutaneously daily, and the dose was adjusted according to the clinical response. Main outcome measures were visual acuity, clinical activity of uveitis (including binocular indirect ophthalmoscopy [BIO] score and presence or absence of macular edema), and adverse effects of the treatment. The mean observation period was 11 months (range, one to 29 months). A positive clinical response was observed in 83% of patients. Median visual acuity improved from 0.54 to 0.2 (logarithm of the minimum angle of resolution units; P < .001) and median BIO score decreased from 1.0 to 0.5 (P < .05) within one month of treatment. Macular edema, if present, resolved in all patients within days of treatment. The main adverse events were tiredness, lymphopenia, flu-like symptoms, and transient increase of liver enzymes. Weight loss occurred in four patients. Four patients experienced depression, one of them attempting suicide. Three patients experienced typical features of IFN-alpha-associated retinopathy, which resolved on reducing the dose. IFN-alpha seems to have significant potential in treatment of severe, sight-threatening refractory uveitis from a variety of causes. A range of adverse events, including IFN-alpha-associated retinopathy, may occur and could limit the use of this immunomodulatory drug.

Functional Macular Mapping in Patients with Vitreomacular Pathologic Features Before and After Surgery

To evaluate the potential benefit of microperimetry and preferential hyperacuity perimeter (PHP) to document visual performance objectively in patients with macular hole and macular pucker undergoing macular surgery. Observational case series. In 19 patients with macular hole and 18 with macular pucker, best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution units), central retinal sensitivity, and presence and extent of metamorphopsia were documented before and four and 12 weeks after surgery. Macular sensitivity (mean sensitivity decibel [dB], stability of fixation) was determined using MP1 microperimetry (Nidek, Padova, Italy). The PreView-PHP (Carl Zeiss Meditec, Dublin, California, USA) was used to quantify metamorphopsia. Before surgery, mean BCVA was 0.68 +/- 0.25 (macular holes) and 0.58 +/- 0.25 (macular pucker). Microperimetry demonstrated a mean retinal sensitivity of 11.3 +/- 2.5 dB (macular holes) and 10.7 +/- 2.8 dB (macular pucker). Twelve weeks after surgery, mean BCVA improved to 0.53 +/- 0.26 (macular holes) and 0.33 +/- 0.26 (macular pucker; P = .042 and P = .004). Accordingly, retinal sensitivity increased significantly with 12.8 +/- 1.9 dB (macular holes) and 12.7 +/- 2.5 dB (macular pucker; P = .04 and P = .02) as well as stability of fixation. At 12 weeks, 47.3% of macular hole eyes and 66.7% of macular pucker eyes improved in BCVA, but a significantly higher number (68.4% [macular holes] and 77.8% [macular pucker]) demonstrated improvement in microperimetry results. PHP results showed no significant change of scotomas, patient reliability, or presence of metamorphopsia at any interval. A higher number of patients improved in microperimetry than in visual acuity testing. Therefore, microperimetry highlights the value of functional macular mapping for these patients and indicates that BCVA may underestimate functional benefit of surgery.

Evaluation of Intravitreal Kenalog Toxicity in Humans

To evaluate possible functional toxicity of intravitreal Kenalog (commercial triamcinolone acetonide) in patients' retinas. Observational case series. Thirty-two phakic eyes of 16 patients who had nonproliferative diabetic retinopathy and bilateral macular edema refractory to laser therapy, which had no other eye disorder and no previous ophthalmic operation. Kenalog (4 mg/0.1 ml) was injected intravitreally to one eye, whereas the second eye served as the control. The experimental eye was chosen as the eye with worse visual acuity (VA). Deterioration of electroretinogram parameters of the study eye measured at 3 months of follow-up when compared with the electroretinogram responses of the fellow, control eye and when compared with electroretinogram responses obtained before injection. Visual acuity, intraocular pressure (IOP), and eventual complications were assessed. No improvement or deterioration of VA or any increase in IOP was regarded as a secondary outcome. Average maximal response amplitude ratios of the dark-adapted b-wave (treated/control eyes) of the electroretinogram were 0.93 before (P = 0.221) and 0.94 (P = 0.387) 3 months after Kenalog injection. Average ratios of the light-adapted b-wave amplitude (treated/control eyes) of the electroretinogram were 1.04 (P = 0.702) before and 0.86 (P = 0.138) 3 months after Kenalog injection. No significant differences (P>0.05) were found between the electroretinogram parameters obtained from all eyes before and 3 months after Kenalog injection. Average VAs in the treated eyes were 1.08, 0.8, and 1.0 logarithm of the minimum angle of resolution units before and 2 and 4 months after injection, respectively. Temporary elevation of IOP was found in 4 treated eyes of 4 patients (25%). No electroretinographic evidence of a retinotoxic effect of intravitreal Kenalog was found in our patients.