Minimum Angle Of Resolution Research Articles

A Novel Artificial Endothelial Replacement Membrane for the Treatment of Chronic Corneal Edema.

The purpose of this study was to report the safety and efficacy results of an artificial lamellar implant for the treatment of chronic corneal edema. The EndoArt (EyeYon Medical, Ness Ziona, Israel), an artificial endothelial replacement membrane designed to treat corneal edema, was implanted in 24 eyes of 24 patients with low-to-normal visual potential. We present the safety and efficacy results from a prospective, open-label, single-arm, multicenter study conducted over a 12-month period. Twenty-four patients were enrolled, with no device-related serious adverse events reported. Seventeen patients completed 12-month follow-up, showing a reduction in average central corneal thickness from 759 ± 116 μm to 613 ± 135 μm. Best-corrected distance visual acuity improved from 1.88 ± 0.79 logarithmic minimum angle of resolution (logMAR) to 1.34 ± 0.57 logMAR. Sixty percent gained at least 3 early treatment diabetic retinopathy study (ETDRS) lines. The EndoArt was removed in 5 cases due to incomplete attachment and replaced by corneal transplants; 1 patient was lost to follow-up, and 1 had a procedure failure. No device-related long-term complications, infections, or inflammations were reported. The implants remained transparent throughout the study. The first-in-human results of EndoArt implantation demonstrated the device's potential to treat patients suffering from corneal edema with a favorable safety profile and effective edema reduction in most subjects, with no device-related serious adverse event. The EndoArt may offer a viable solution in regions facing a shortage of donor corneas, as well as for patients who have poor prognosis with human tissue.

Use of selective laser capsulotomy for mature white cataracts: Initial experience in Indian eyes.

To report the initial experience of performing capsulotomy in eyes with mature white cataracts using selective laser capsulotomy (SLC) in Indian eyes. This was a prospective, noncomparative, open-label study. All adults presenting to our institution with mature cataracts whose pupils dilated >6 mm and who were willing for phacoemulsification were invited to participate. During surgery, after staining the anterior capsule with a proprietary trypan blue, the CAPSULaser device (Excel-Lens Inc, Los Gatos, CA, USA) was used to create a capsulotomy of size ranging from 5 to 5.5 mm and phacoemulsification was carried out. The primary outcome was the size, centration, and continuity of the capsulotomy edge at the end of the surgery. Secondary outcomes were the surgical time for capsulotomy, capsulotomy centration on the intraocular lens (IOL) at 3 months, and adverse effects. Thirty eyes were studied of 30 patients who were recruited with a mean age of 66.4 ± 8.3 years, of which 17 (57%) were men. The intraoperative size of capsulotomy was the same as intended in all eyes and the edges were smooth. None of the eyes experienced any visible capsular tears or run out events; one had a capsular tag. The time for capsulotomy including capsular staining was 3 ± 0.23 min. All IOLs were well centered at 3 months with a capsulotomy size remaining the same. The endothelial cell count had dropped by 8% at 3 months post-op, and the vision improved significantly to 0.03 log of minimum angle of resolution. None of the eyes experienced any intraoperative complications or laser-induced adverse effects. SLC was a safe and effective technique providing precise, well-centered anterior capsulotomies in mature white cataracts.

Effects and safety of combined corneal collagen crosslinking and intrastromal corneal ring segment treatment in patients with keratoconus: a retrospective study

PurposeTo evaluate the safety and efficacy of different time-point combinations of intrastromal corneal ring segment (ICRS) implantation using femtosecond technology) and corneal collagen crosslinking (CXL) for the treatment of moderate-to-severe keratoconus (KCC).MethodsThis study included 69 eyes of 69 patients with keratoconus who underwent ICRS and CXL treatment at an Eye Hospital between March 2020 and March 2023. The patients were divided into two groups: Group 1 (n = 33 eyes of 33 patients), which received ICRS and CXL treatment in one session, and Group 2 (n = 36 eyes of 36 patients), which included treatment with ICRS for at least 6 months following CXL application. Preoperative and postoperative evaluations included visual acuity, autorefractometer refraction, corneal tomographic measurements using the Sirius (CSO) Scheimpflug camera and the TONOREF™ III device, and documentation of observed complications. Uncorrected visual acuity (UCVA) and best-corrected spectacle visual acuity (BCVA) were measured in each eye individually, and visual acuity was assessed using the logarithm of the minimum angle of resolution (logMAR).ResultsIn Group 1, mean UCVA improved from 0.81 ± 0.34 to 0.45 ± 0.25 (p < 0.01), and mean BCVA improved from 0.76 ± 0.35 to 0.38 ± 0.20 (p < 0.01). In Group 2, mean UCVA improved from 0.71 ± 0.32 to 0.43 ± 0.30 (p < 0.01), and mean BCVA improved from 0.65 ± 0.25 to 0.31 ± 0.23 (p < 0.01). Both groups showed significant reductions in manifest spherical and cylindrical refraction (p < 0.01). Group 1 exhibited greater reductions in maximum keratometry (Kmax), flat keratometry (K1), steep keratometry (K2) (p < 0.05), and astigmatic aberration compared with group 2 (p < 0.01). The use of simultaneous or separate CXL and ICRS does not significantly increase the incidence of complications.ConclusionsBoth combined and separate CXL and ICRS treatments resulted in significant improvement in UCVA and BCVA and reduced manifest refraction. Although improvements were observed in groups 1 and 2 in terms of K1, K2, and Kmax at 6 months, the improvements were more pronounced in Group 1. These results highlight the potential benefits of simultaneous ICRS + CXL treatment and underscore the importance of optimising the timing of CXL treatment to achieve the best visual outcomes.

Ten-Year Follow-Up After Descemet Membrane Endothelial Keratoplasty.

To examine clinical results up to 10 years after Descemet Membrane Endothelial Keratoplasty (DMEK) and Triple-DMEK. Prospective study including 201 eyes, of which 54 eyes [38 DMEKs and 16 Triple-DMEKs; Fuchs endothelial dystrophy (n = 45), pseudophakic bullous keratopathy (n = 9)] reached the minimum follow-up of 5 years and were followed up for up to 10 years. We evaluated best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]), endothelial cell density (ECD, cells/mm2), minimal central corneal thickness (CCT, μm), central retinal thickness (μm), rebubbling, graft survival and re-DMEK rate, chamber angle alterations, and incidence of glaucoma. Fifty-four eyes had a 5-year and 37 eyes an 8- to 10-year follow-up. Mean follow-up was 94.4 ± 12.1 months. Best-corrected visual acuity increased from 0.6 ± 0.3 logMAR to 0.1 ± 0.2 logMAR at 6 months (P ≤ 0.001) and was 539 ± 54 μm at long term. Endothelial cell density decreased from 2488 ± 320.9 (donor) to 980.1 ± 437 cells/mm2 with an average ECD loss/year of 4% and did not correlate with BCVA. Central corneal thickness decreased from 596.9 ± 82.2 μm to 498.6 ± 24.3 μm at 12 months (P ≤ 0.001) and remained stable (P = 1.000). Mean rebubbling rate was 0.3 ± 0.5/eye and did not correlate with BCVA. Eight eyes (14.8%) received at least 1 rebubbling. Primary graft failure/rejection rate was 1.5%/0% within the first postoperative year, and secondary graft failure rate was 12.4% at 7 years. Eight eyes (preoperative n = 3, de novo n = 5) had open-angle glaucoma without chamber angle changes (14.8%, P ≤ 0.001). Although ECD decreases continuously in the long-term follow-up, excellent visual acuity can be preserved 10 years after DMEK and Triple-DMEK. The final outcome can be estimated 6 months after surgery.

Simple Epithelial Transplantation for Ocular Surface Reconstruction After Severe Ocular Burn Injury.

To manage ocular surface complications and recover conjunctival and corneal epithelia after unilateral severe chemical burn. We performed simple conjunctival epithelial transplantation (SCET) to obtain renewal of fornix and bulbar-tarsal conjunctiva epithelium, followed by simple limbal epithelial transplantation (SLET) to recover limbal function and epithelial corneal surface. Slit-lamp examination, fluorescein staining, in vivo confocal microscopy, Kheirkhah grading system for symblepharon severity, Wong-Baker FACES Pain Rating Scale, and best-corrected visual acuity were assessed before surgery, at 1 to 3 months after SCET and SLET, and thereafter at 6 to 12 to 36 months. Two patients with unilateral burn injuries underwent surgery. Eye mobility and fornix reconstruction were promptly achieved, and conjunctival epithelium with goblet cells was observed on the bulbar and tarsal conjunctiva 3 months after SCET. After SLET, corneal epithelium and cornea-conjunctiva transition zone were observed at 3 and 6 months, respectively. From before surgery to 6 months after SLET, symblepharon improved from grade IVa2 and IIIb2 to Ic0 and Ib0, the Wong-Baker FACES Pain Rating Scale changed from grade 6 and 4 to 0, and best-corrected visual acuity upgraded from 1.40 and 1.10 logarithm of the minimum angle of resolution to 0.5 logarithm of the minimum angle of resolution, in patient 1 and 2, respectively. After 3 years, results remained stable. SCET effectively healed the bare conjunctival area relieving subjective symptoms and discomfort. Sequential SCET and SLET showed to be feasible in restoring a normal ocular surface with long-lasting results suggesting the aim in patients with severe ocular burn is not merely corneal epithelium renewal but also the regeneration of ocular surface homeostasis.

Off-Centered DMEK Grafts: Impact and Resolution.

The aim of this study was to assess the outcomes of off-centered Descemet membrane endothelial keratoplasty (DMEK) grafts compared to descemetorhexis. This is a retrospective case series of DMEK procedures conducted between June 2022 and July 2023 with postoperative graft decentration, characterized by a gap between the graft and descemetorhexis edge. Eight eyes of 8 patients met the inclusion criteria. The average gap between the descemetorhexis edge and DMEK graft was 911.2 μm (range 306-1468). The resulting focal peripheral edema overlying the gap resolved in all cases, with a median time of 3 months. Best-corrected visual acuity improved from 0.49 (±0.26) logarithm of the minimum angle of resolution to 0.01 (±0.02) logarithm of the minimum angle of resolution at 12 months (P = 0.003). Central corneal thickness decreased from 646.5 (±177.8) μm to 473.7 (±29.6) μm at 12 months (P = 0.05). One eye, in the overlapped area of host-donor Descemet membranes, had small peripheral partial graft detachment less than one-third of graft surface area. No eyes required graft rebubbling. A larger descemetorhexis to DMEK gap showed a trend toward longer resolution times (P = 0.06). Focal edema in the inferonasal periphery took longer to recover compared with the nasal position (P = 0.01). Larger descemetorhexis to DMEK gaps did not significantly influence the longitudinal visual acuity trend (P = 0.75). Decentered DMEK, characterized by a gap between the graft and descemetorhexis edge, leads to focal stromal edema that diminishes over time, with no impact on final visual acuity.

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Evaluation of Medically Reversible Limbal Stem Cell Deficiency.

To evaluate the clinical characteristics and treatment strategies of limbal stem cell deficiency (LSCD) patients managed with medical therapy. The study included 29 eyes of 21 patients with LSCD who were managed medically at Ege University Faculty of Medicine, Department of Ophthalmology between May 2013 and May 2023. LSCD stages before and after medical treatment were recorded according to the LSCD staging system published by the International LSCD Working Group. The medical records of patients showing improvement in LSCD stage with medical treatment without surgical intervention were evaluated. The mean age was 35.5±23.8 years (range, 5-71 years) with a male-to-female ratio of 6:15. The primary etiology of LSCD was ocular rosacea in 12 patients (57.1%), marginal keratitis in the setting of blepharitis in 8 patients (38.1%), and topical medication toxicity in 1 patient (4.8%). The mean baseline best corrected visual acuity (BCVA) was 0.25±0.26 logarithm of the minimum angle of resolution (logMAR) (range, 0-1 logMAR). Pre-treatment LSCD stage was stage 1A in 5 eyes (17.2%), stage 1B in 12 eyes (41.4%), stage 1C in 4 eyes (13.8%), stage 2A in 4 eyes (13.8%), and stage 2B in 4 eyes (13.8%). Complete regression of LSCD was achieved in 6 eyes (20.7%) with medical treatment addressing the primary etiology. In the remaining eyes, after medical treatment, the severity of LSCD decreased below the surgical threshold, which is considered stage 2B. The mean final BCVA was 0.07±0.1 logMAR (range, 0-0.4 logMAR). This study highlights that LSCD can be completely or partially reversible with appropriate management, especially in cases with underlying limbal niche dysfunction, where inflammation plays a significant role. Although limbal stem cell transplantation is considered the main treatment approach for LSCD, localized and early-stage LSCD can be effectively managed medically without the need for surgical intervention.

Multilayered Inverted Internal Limiting Membrane Flap Technique in Optic Disc Pit Maculopathy.

To evaluate the anatomical and visual outcomes of the multilayered inverted internal limiting membrane (ML-ILM) flap technique in the treatment of optic disc pit maculopathy (ODPM). In this retrospective interventional case series, medical records and macular spectral-domain optical coherence tomography images of patients who underwent combined pars plana vitrectomy with ML-ILM flap surgery for ODPM were analyzed. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) at postoperative 6 months were compared with baseline findings. Intraoperative and postoperative complications, fluid resolution time, and recurrence during follow-up were recorded. Five eyes of 5 patients with ODPM were included in the study. According to the preoperative macular fluid characteristics, 2 patients had only intraretinal fluid, while 3 patients had intraretinal and subretinal fluid. The preoperative median BCVA was 1.0 logarithm of the minimum angle of resolution (logMAR) (range, 1.0-1.3 logMAR), and the CMT was 560 μm (range, 452-667 μm). At the 6-month postoperative follow-up, the median BCVA was 0.40 logMAR (range, 0.1-0.7 logMAR), and CMT was 315 μm (range, 265-326 μm) (p=0.042 and p=0.043, respectively). During the 6-month follow-up period, no recurrence or full-thickness macular hole formation was observed. The ML-ILM flap technique is a preferable surgical option to achieve both high anatomical and functional success and flap stabilization.

Effects of pregnancy on the clinical course and treatment outcomes of Vogt-Koyanagi-Harada disease.

To describe the clinical course and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease during pregnancy. This retrospective study compares the clinical course and outcomes in pregnant and nonpregnant women with VKH. All VKH patients who were pregnant at presentation or on follow up and age-matched nonpregnant female controls during the study period (2013-2022) were included. Their best-corrected visual acuity (BCVA), clinical presentations, and treatment outcomes were analyzed. Among the 532 female VKH patients, nine (1.7%) were included. Thirty nonpregnant patients were included as control. At presentation, the mean age in the study group was 26 years ± 6.48 standard deviation (SD) compared to the control group (mean 25.1 years ± 3.04). The mean BCVA was comparable between the two groups at presentation (study group 1.35 logarithm of the minimum angle of resolution [logMAR] vs. control group 0.76 logMAR; P = 0.05) and the final follow-up (study group 0.65 logMAR vs. control group 0.35 logMAR; P = 0.15). Participants with anterior segment inflammation (study group 77.7% vs. control group 70%; P = 0.65), the disease stage (early-stage VKH: study group 88.8% vs. control group 73.3%; P = 0.33), and disease exacerbation (study group 33.3% vs. control group 26.6%; P = 0.69) were all comparable between the study and control groups. Following treatment, 66.6% and 46.6% of the study and control groups, respectively, had sunset glow fundus (P = 0.29). At the last follow-up, 44.4% and 26.6% of the study and control groups, respectively, had subretinal fibrosis (P = 0.31). Though pregnancy is an immunomodulatory state, the clinical course of VKH in pregnant patients can be similar to that of nonpregnant women and needs close monitoring and follow-up.

Outcomes in eyes with retained lens fragments undergoing pars plana lensectomy and scleral-fixated intraocular lens insertion.

To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL). Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery. 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion. In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

A telemedicine-enabled intravenous thrombolytic treatment pathway for patients with hyperacute non-arteritic central retinal artery occlusion

PurposeTo describe the visual acuity (VA) outcomes from a telemedicine-enabled pathway allowing for rapid diagnosis and administration of intravenous (IV) thrombolytic treatment for non-arteritic central retinal artery occlusion (naCRAO) within 4.5 hours (4.5 h) of visual loss. DesignRetrospective observational case series. MethodsSetting: A large managed healthcare consortium.Patient Population: Eighty-five patients with naCRAO and vision loss for less than 4.5 h presenting between 2021 and 2023. Thirty-five patients received IV thrombolytic therapy and 50 patients were closely observed.Intervention: A collaborative telemedicine-enabled pathway employing fundus photography was previously established by Ophthalmology, Emergency Medicine, and Stroke services to rapidly evaluate and manage patients presenting with acute painless monocular vision loss and allow for administration of IV tenecteplase (0.25 mg/kg) for eligible consenting patients diagnosed with naCRAO within 4.5 h. Retrospective chart review was conducted to collect data on demographics, vascular risk factors, clinical features, VA outcomes, and adverse events. Comparison was made between patients who received intravenous thrombolysis and those who were observed.Main Outcome Measures: Improvement in VA of at least 0.3 logarithm of the minimum angle of resolution (logMAR) and/or from 20/200 or worse to 20/100 or better. ResultsA greater percentage of patients in the treated group had VA improvement of ≥0.3 logMAR (54.3 % vs 28 %, p = .014), and a greater percentage of patients in the untreated group had VA worsening of ≥0.3 logMAR (30 % vs 5.7 %, p = .006). Twice the percentage of treated versus untreated patients had improved VA from 20/200 or worse to 20/100 or better, but this difference was not statistically significant (20 % vs 10 %, p = .192). There was a significantly shorter mean time to treatment for those patients who had VA improvement from 20/200 or worse to 20/100 or better compared to those who did not (118 versus 171 min, p = .031). Two patients experienced intracranial bleeding after IV thrombolysis. ConclusionsThe evaluation and treatment of hyperacute naCRAO is possible on a large scale via an integrated telemedicine-enabled approach utilizing fundus photography. The use of IV thrombolytic was associated with better VA outcomes compared to observation alone. Prospective randomized controlled trials are needed to confirm these findings and determine optimal management.

Artificial Intelligence-Enhanced OCT Biomarkers Analysis in Macula-off Rhegmatogenous Retinal Detachment Patients.

To identify optical coherence tomography (OCT) biomarkers for macula-off rhegmatogenous retinal detachment (RRD) with artificial intelligence (AI) and to correlate these biomarkers with functional outcomes. Patients with macula-off RRD treated with single vitrectomy and gas tamponade were included. OCT volumes, taken at 4 to 6 weeks and 1 year postoperative, were uploaded on an AI-derived platform (Discovery OCT Biomarker Detector; RetinAI AG, Bern, Switzerland), measuring different retinal layer thicknesses, including outer nuclear layer (ONL), photoreceptor and retinal pigmented epithelium (PR + RPE), intraretinal fluid (IRF), subretinal fluid, and biomarker probability detection, including hyperreflective foci (HF). A random forest model assessed the predictive factors for final best-corrected visual acuity (BCVA). Fifty-nine patients (42 male, 17 female) were enrolled. Baseline BCVA was 0.5 logarithmic minimum angle of resolution (logMAR) ± 0.1, significantly improving to 0.3 ± 0.1 logMAR at the final visit (P < 0.001). Average thickness analysis indicated a significant increase after the last follow-up visit for ONL (from 95.16 ± 5.47µm to 100.8 ± 5.27µm, P = 0.0007) and PR + RPE thicknesses (60.9 ± 2.6µm to 66.2 ± 1.8µm, P=0.0001). Average occurrence rate of HF was 0.12 ± 0.06 at initial visit and 0.08 ± 0.05 at last follow-up visit (P=0.0093). Random forest model revealed baseline BCVA as the most critical predictor for final BCVA, followed by ONL thickness, HF, and IRF presence at the initial visit. Increased ONL and PR-RPE thickness associate with better outcomes, while HF presence indicates poorer results, with initial BCVA remaining a primary visual predictor. The study underscores the role of novel biomarkers like HF in understanding visual function in macula-off RRD.

Substance P- and insulin-like growth factor 1-derived tetrapeptides for neurotrophic keratopathy related to leprosy: a clinical trial

PurposeNeurotrophic keratopathy is part of the leprosy sequelae and causes progressive deterioration of visual acuity. Although leprosy is bacteriologically curable, there is currently no efficient treatment. Eye drops containing tetrapeptides, Phenylalanine-Glycine-Leucine-Methionine-amide (FGLM-NH2) and Serine-Serine-Serine-Arginine (SSSR), derived from substance P and insulin-like growth factor 1 (IGF-1), are clinically efficacious in the treatment of corneal epithelial disorders caused by neurotrophic keratopathy. To further investigate the effect of this treatment on leprosy sequalae, we evaluated the clinical efficacy of FGLM-NH2+SSSR eye drops for treating neurotrophic keratopathy. DesignClinical trial: Interventional, multicenter, exploratory, single-arm, before and after comparison. ParticipantsThe eyes (12) of 11 patients, aged >60 years, were studied from two leprosy sanatoriums in Japan. MethodsPatients with neurotrophic keratopathy in leprosy sanatorium, specifically those with corneal perception of <40 mm, assessed by the Cochet-Bonnet corneal esthesiometer, and persistent corneal epithelial defects (PEDs) and/or corneal stromal thinning were included in this study. Those treated for infection in the acute phase were excluded from the study. Eye drops containing FGLM-NH2 0.05% and SSSR 5x10-6% were administered four times daily for up to 3 months. Fluorescein staining and optical corneal sections were photographed using a slit-lamp microscope at protocol-set intervals. Where possible, anterior segment optical coherence tomography was performed before and after the intervention. Main outcome measuresThe primary outcome measured was improvement in neurotrophic keratopathy. The patient was judged to have improved when one or more of the following criteria were met: 1) healing epithelial defects or 2) increased thickness in the thin area of the cornea. Secondary endpoints were visual acuity, subjective findings, and time to complete healing for a PED. ResultsNeurotrophic keratopathy on epithelial defects or stromal thickness improved in 83.3% of the patients (90% confidence interval 56.2%–97.0%, P<0.00001). The mean value of corrected visual acuity increased -0.16 by logarithm of the minimum angle of resolution. There were no adverse events reported in association with the treatment. ConclusionsWe confirmed that FGLM-NH2+SSSR eye drops are effective for neurotrophic keratopathy without any adverse reaction in leprosy. These results should be disseminated to any parties who could need this information.

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.

Prospective Evaluation of Clinical and Patient-Reported Outcomes Following Contralateral Implantation of an Extended Depth of Focus (EDOF) and Hybrid EDOF-Multifocal IOL.

To evaluate clinical outcomes following contralateral implantation of a diffractive extended depth of focus (EDOF) and a hybrid EDOF-multifocal intraocular lens (IOL) with a violet filter in a U.S.-based population. In this prospective, non-comparative study, 60 eyes of 30 patients aged 40 years and older underwent bilateral cataract surgery and implantation of a DXR00V IOL (Tecnis Symfony OptiBlue) in the dominant eye and a DFR00V (Tecnis Synergy) IOL in the non-dominant eye. Outcome measures included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, distance-corrected intermediate (DCIVA, 66 cm), near and very near visual acuity (DCNVA, 40 and 33 cm), and patient-reported outcomes. At 6 months postoperatively, binocular mean UDVA and CDVA were -0.10 ± 0.07 and -0.11 ± 0.05 logarithm of the minimum angle of resolution (logMAR), respectively. The mean DCIVA was 0.26 ± 0.08 logMAR in the DXR00V eyes and 0.23 ± 0.06 logMAR in the DFR00V eyes. The mean DCNVA at 40 and 33 cm were 0.28 ± 0.12 and 0.30 ± 0.15 logMAR, respectively, in the DXR00V eyes and 0.07 ± 0.08 and 0.07 ± 0.10 logMAR, respectively, in the DFR00V eyes. The mean binocular DCIVA and DCNVA at 33 and 40 cm were 0.18 ± 0.05, 0.06 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. The percentages of patients achieving spectacle independence at far, intermediate, and near distances were 100%, 100%, and 81%, respectively. Contralateral implantation of the diffractive EDOF and a hybrid EDOF-multifocal IOL yielded excellent binocular visual acuity at all distances, as well as high patient satisfaction and functional performance on visual tasks. [J Refract Surg. 2024;40(10):e699-e705.].

Comparison Between Monofocal and Aspheric Monofocal Intraocular Lens With Higher Order Aspheric Optic in Pediatric Patients: Early Outcomes.

To retrospectively compare the visual acuity outcomes for far, intermediate, and near vision of an aspheric monofocal intraocular lens (IOL) with higher order aspheric optic with a monofocal IOL in pediatric patients. Thirty-eight eyes of 38 patients (mean age: 9.0 ± 2.3 years) affected by monolateral infantile cataract were evaluated 6 months after surgery performed with simultaneous IOL implantation. The Tecnis Eyhance ICB00 aspheric monofocal IOL (Johnson & Johnson Vision) was implanted in 17 eyes (Tecnis Eyhance group, mean age: 8.9 ± 2.5 years) and the Tecnis PCB00 monofocal IOL (Johnson & Johnson Vision) was implanted in 21 eyes (control group, mean age: 9.1 ± 2.2 years). Corrected visual acuity expressed in logarithm of the minimum angle of resolution (logMAR) was assessed for distance (CDVA) and, expressed in Jaeger standard, for intermediate (DCIVA) and near vision (CNVA). DCIVA was measured with distance correction and without addition. The Mann-Whitney test for two independent samples was performed, and a P value less than .05 was considered statistically significant. Six months postoperatively, mean CDVA was 0.20 ± 0.2 logMAR and mean DCIVA and CNVA were 5 ± 1 and 2 ± 1 Jaeger, respectively, in the Tecnis Eyhance group. In the control group, mean CDVA was 0.21 ± 0.2 logMAR and mean DCIVA and CNVA were 8 ± 1 and 3 ± 1 Jaeger, respectively. Only DCIVA showed a significant statistical difference between groups (P < .0001). In pediatric patients, the aspheric monofocal IOL with higher order aspheric optic seems to provide better intermediate distance visual acuity than a monofocal one, whereas no significant difference was observed for CDVA and CNVA. [J Refract Surg. 2024;40(10):e724-e727.].

Clinical Performance of an Extended Range of Vision Intraocular Lens After LASIK.

To evaluate the clinical and patient-reported outcomes (PROMs) of cataract surgery with implantation of a wavefront-shaping extended depth of focus (EDOF) intraocular lens (IOL) in eyes with previous laser in situ keratomileusis (LASIK) for myopia correction. This prospective observational study enrolled 50 eyes with previous LASIK from 25 patients (age: 46 to 70 years) who underwent cataract surgery with implantation of the AcrySof IQ Vivity IOL (Alcon Laboratories, Inc). Visual and refractive outcomes were evaluated during a 3-month follow-up. PROMs were evaluated with the Intraocular Lens Satisfaction (IOLSAT; Alcon Vision, LLC) (general satisfaction), Catquest-9SF (difficulty in doing vision-related activities), and Questionnaire for Visual Disturbances (QUVID; Alcon Vision, LLC) (photic phenomena) questionnaires. Mean 3-month postoperative binocular uncorrected distance, intermediate, and near visual acuities were 0.02 ± 0.11, -0.02 ± 0.09, and 0.14 ± 0.13 logarithm of the minimum angle of resolution (logMAR), respectively. Mean binocular distance-corrected intermediate and near visual acuities were 0.05 ± 0.11 and 0.32 ± 0.14 logMAR, respectively. All eyes had a postoperative spherical equivalent within ±0.75 diopters (D). The mean defocus curve showed visual acuity values better than 0.20 logMAR for defocus levels from +0.50 to -1.50 D. Most patients (92.0%) confirmed that they had no vision-related difficulties limiting their normal daily life. Perception of starbursts, halos, glare, hazy vision, blurry vision, and double vision was referred by 24%, 24%, 28%, 28%, 8%, and 4% of patients, respectively. Most of symptoms were described as mild and not or a little bothersome. The wavefront-shaping EDOF IOL evaluated provides efficacious distance, intermediate, and near visual restoration in eyes with previous LASIK, with minimal photic phenomena associated. [J Refract Surg. 2024;40(10):e742-e753.].

Three-point transscleral suture fixation of a foldable three-looped haptics one-piece posterior chamber intraocular lens implantation

A 73-year-old male patient was suffering from aphakia due to ocular trauma. Capsular implantation of a posterior chamber intraocular lens (PCIOL) was impossible in the absence of capsular support. Three-point transscleral suture fixation was used. The technique was performed under retrobulbar anesthesia. A three-looped haptics one-piece foldable PCIOL was suspended in the eye with one haptic at 6 o’clock and tied by a cow-hitch knot, and the haptics at 2 o’clock and 10 o’clock were threaded by another suture. The patient was followed up for 6 months postoperatively, and the postoperative logarithm of the minimum angle of resolution at the final follow-up was 0.3. The intraocular lens remained well positioned and stable. No complications, such as suture loosening, hypotony, chronic inflammation, or retinal detachment, were observed during the postsurgery follow-up period.

Age, Sex, and Clinical Characteristics of Juvenile Open-Angle Glaucoma Patients in a Saudi Tertiary Hospital: A Retrospective Study of Surgical and Non-Surgical Outcomes.

Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes in JOAG patients. Methods: We carried out a retrospective study at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, from 2015 to 2022. We extracted data from the medical records. Visual acuity data were converted to the logarithm of the minimum angle resolution (LogMAR) for standardized analysis. The CARL ZEISS Humphrey 745i Field Analyzer/HFA II-i Visual Field Analyzer was used to perform visual field examinations under the 24-2 program SITA standard. Results: The study involved 45 JOAG patients (87 affected eyes) with a mean age of 26.91 years. Myopia was the prevailing trait (93%), and a family history of glaucoma was found in 51.1% of cases. Most of the patients presented with severe visual field defects in both eyes (right-57.1%, left-44.4%). Regarding visual acuity, we found that the majority of affected categories belonged to either mild or moderate in both eyes. Initial and final Intraocular pressure (IOP) measurements together showed a significant reduction (p < 0.001) and clearly demonstrated the need for IOP control. Surgical and non-surgical treatments significantly reduced IOP, with no gender or eye differences Conclusions: This research offers important data concerning JOAG demographics (age and gender), clinical picture, and treatment results. Though early-onset presents challenges, multidimensional therapeutic methods have great potential to get JOAG under control and maintain visual function. Additional research is needed to study the genetic causes of JOAG and assess the long-term treatment outcomes.