Poor Visual Outcome Research Articles

A Clinical Study on the Incidence and Visual Outcome after Surgical Management of Lens-Induced Glaucoma

Aims and Objectives: To determine 1) the incidence of lens-induced glaucoma. 2) the more prevalent type of LIG. and 3) Visual outcome following surgical management of LIG. Material and Methods: 50 patients of lens-induced glaucoma, who presented in OPD of Regional Institute of Ophthalmology, were included in the study. All patients were admitted and managed in indoor wards. Informed and written consents were taken. A detailed history and a thorough ocular examination was done. Surgical correction was done by SICS or Phacoemulsification or triple procedures operations. Results: A standardized proforma was used to compile data and it was analyzed statistically using Chi-square test and Probability value. The incidence of LIG was found to be 0.174 among all OPD attendees. Phacomorphic glaucoma (58%) was found to be the highest followed by phacolytic glaucoma (32%). No significant association with respect to sex and age of the cases was found. The presenting symptoms varied in severity and were directly proportional to the degree of rise of IOP. 38% of cases in our study achieved best corrected visual acuity of 6/9 and 28% achieved 6/12 acuity at the end of 6 weeks. Visual outcome was found to be better for cases with early detection and treatment. Conclusion: The mainstay to prevent and treat LIG is early diagnosis and treatment of cataract. Delayed treatment of LIG may result in poor visual outcome. Keywords: LIG, IOP, Phacomorphic glaucoma, Phacolytic glaucoma, SICS, Phacoemulsification.

Profile of Microbial Keratitis.

Purpose: To study the demographic characteristics, predisposing factors, and latest trends of causative organisms and to analyze the prognostic factors of visual outcome in microbial keratitis.Methods: A retrospective study of patients diagnosed with microbial keratitis who required hospital admission in the period between January 2018 and December 2020 in Taiping Hospital, Perak, Malaysia.Results: A total of 75 eyes of 74 patients who were admitted to the hospital were studied. The male to female ratio was 13.8:1. Seventy percent of patients in this study were within the productive age group between 20 and 59 years old, with a mean age of 48 years old, and 51.4% of them were labourers. Cornea foreign bodies (42, 56%) were the most common predisposing factors and were associated with good visual outcomes (P<0.005). Other significant predictors for the final visual outcome were: presenting visual acuity, size of ulcer, duration of hospitalization, and duration of resolution. The mean duration of hospitalization was seven days. Corneal scrapings were done in all cases where 44 eyes (58.7%) were found to be positive for growth. Ten eyes (13.3%) that ended up with evisceration yielded a positive result. Gram-negative bacteria was the most prevalent causative organism of infective keratitis in the local/this region. Pseudomonas sp (20, 26.7%) being the most common bacterial isolate, was seen in all four contact lens-related cases and was associated with poor visual outcome and a high rate of evisceration. Patients who developed complications such as cornea melting (9, 12%), cornea perforation (11, 14.7%) and endophthalmitis (7, 9.3%) were associated with poor visual outcomes. Likewise, patients who required therapeutic interventions such as corneal gluing, tarsorrhaphy, and penetrating keratoplasty generally had poor visual outcomes (P<0.005; P=0.000008).Conclusion: Microbial keratitis is a major cause of ocular morbidity globally. Understanding the demographic and epidemiological characteristics of microbial keratitis of the region is important in the initial prompt treatment of the patients and may eventually improve the visual outcome.

Clinical profile, imaging features and short term visual outcomes of Indian optic neuritis patients with and without seromarkers for myelin oligodendrocyte glycoprotein and neuromyelitis optica

Purpose:To analyze clinical profile, imaging features, and short-term visual outcomes of optic neuritis patients in Indian population with and without seromarkers for myelin oligodendrocyte glycoprotein (MOG)/neuromyelitis optica (NMO).Methods:Electronic medical records of 203 optic neuritis patients who presented between June 2018 and December 2019 to the Neuro-ophthalmology services of a tertiary care center in India were retrospectively analyzed.Results:Of 203 patients, 57 patients (28.08%) were positive for MOG-antibody and 20 patients (9.85%) were positive for NMO antibody. 114 patients (56.16%) were double-negative (negative for both antibodies) and 12 patients (5.91%) were diagnosed as multiple sclerosis (MS). None of the patients had both antibodies. Mean age of presentation was 31.29 ± 1.035 years. There was female preponderance in NMO-optic neuritis (NMO-ON) and MS-optic neuritis (MS-ON) groups (1:5). Mean vision on presentation was worse (logMAR 1.570 ± 0.863) in NMO-ON group. The mean visual acuity showed statistically significant recovery (logMAR 0.338 ± 0.639) in the final follow-up in MOG-optic neuritis (MOG-ON) group. Multivariate logistic regression analysis revealed poor visual outcome in patients presenting with retrobulbar neuritis, optic disc pallor, bilateral sequential optic nerve involvement, and with positive NMO antibody. Optic neuritis patients presenting with disc edema associated with pain and positive for MOG antibody were found to have a better visual outcome.Conclusion:In this Indian optic neuritis cohort, the prevalence of MOG-ON was higher than NMO-ON. MOG-ON had a better visual outcome than NMO-ON. The incidence of MS-ON was less compared to the western literature. A significant number of patients (114 patients, 56.16%) were double negative for both seromarkers and yet had presented with optic neuritis with no clinical or imaging features suggestive of MS/MOG associated disease (MOG AD)/NMO spectrum disorder (NMO SD).

Approach to Common Visual Complaints Presenting to the Outpatient Neurologist.

Visual complaints are commonly encountered by the practicing neurologist. We review assessment of vision loss, diplopia, and positive visual phenomena, all of which require a thoughtful evaluation to localize disease and refine management. While many causative entities are unlikely to cause poor visual outcomes, including dry eyes, migraine, and congenital strabismus, others may threaten vision, life, or both, such as posterior communicating artery aneurysms, pituitary apoplexy, or temporal arteritis. A systematic approach to vision loss and diplopia is reviewed along with focused differential diagnoses.

Choroidal hemangioma in Sturge Weber syndrome: Case series with confirmed tissue diagnosis.

IntroductionSturge-weber syndrome (SWS) is a rare condition that presents with a typical facial port-wine stain, neurological manifestations such as seizures, and ocular involvement by glaucoma and/or choroidal hemangioma. In this series we demonstrate the histopathological details of the primary ocular involvement as well as the late blinding secondary ocular changes.Presentation of casesSeven cases were included with the diagnosis of choroidal hemangioma in association with SWS (6 enucleations and one evisceration). Male to female ratio was 4:3. Age at enucleation/evisceration ranged from 25 to 68 years with a median of 42 years. Five cases had history of glaucoma (71.4%). Diffuse hemangioma was found in all (4 cavernous and 3 mixed cavernous/capillary type). Conjunctival and episcleral hemangiomas were found in 3/7. Iris neovascularization and retinal detachment were confirmed in 5/7 cases each (71%).DiscussionOur demographic and histopathological findings parallel what was previously concluded in the literature about the lack of gender predilection in SWS, and the most common ocular presentations of glaucoma and choroidal hemangioma, which is mostly diffuse in nature. The hemangioma type was found to be mostly cavernous followed by mixed capillary and cavernous. We demonstrated late associated ocular changes such as cataract, iris neovascularization, exudative retinal detachment, retinal pigment epithelium hyperplasia/metaplasia, and optic nerve atrophy, all of which aid in the poor visual outcome in these patients.ConclusionSturge-weber syndrome is a rare but visually disabling disease due to the associated ocular manifestations of glaucoma and choroidal hemangioma. Multidisciplinary approach because of the diverse presentation of this condition by pediatrician, neurologist, and ophthalmologist is essential with an attempt to preserve vision.

PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair

Background/aimsTo compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.MethodsAnalysis of the Primary Retinal detachment Outcomes (PRO)...

Clinical Characteristics and Outcomes of Fungal Keratitis in the United Kingdom 2011-2020: A 10-Year Study.

Fungal keratitis (FK) is a serious ocular infection that often poses significant diagnostic and therapeutic dilemmas. This study aimed to examine the causes, clinical characteristics, outcomes, and prognostic factors of FK in the UK. All culture-positive and culture-negative presumed FK (with complete data) that presented to Queen’s Medical Centre, Nottingham, and the Queen Victoria Hospital, East Grinstead, between 2011 and 2020 were included. We included 117 patients (n = 117 eyes) with FK in this study. The mean age was 59.0 ± 19.6 years (range, 4–92 years) and 51.3% of patients were female. Fifty-three fungal isolates were identified from 52 (44.4%) culture-positive cases, with Candida spp. (33, 62.3%), Fusarium spp. (9, 17.0%), and Aspergillus spp. (5, 9.4%) being the most common organisms. Ocular surface disease (60, 51.3%), prior corneal surgery (44, 37.6%), and systemic immunosuppression (42, 35.9%) were the three most common risk factors. Hospitalisation for intensive treatment was required for 95 (81.2%) patients, with a duration of 18.9 ± 16.3 days. Sixty-six (56.4%) patients required additional surgical interventions for eradicating the infection. Emergency therapeutic/tectonic keratoplasty was performed in 29 (24.8%) cases, though 13 (44.8%) of them failed at final follow-up. The final corrected-distance-visual-acuity (CDVA) was 1.67 ± 1.08 logMAR. Multivariable logistic regression analyses demonstrated increased age, large infiltrate size (>3 mm), and poor presenting CDVA (<1.0 logMAR) as significant negative predictive factors for poor visual outcome (CDVA of <1.0 logMAR) and poor corneal healing (>60 days of healing time or occurrence of corneal perforation requiring emergency keratoplasty; all p < 0.05). In conclusion, FK represents a difficult-to-treat ocular infection that often results in poor visual outcomes, with a high need for surgical interventions. Innovative treatment strategies are urgently required to tackle this unmet need.

Mapping degeneration of the visual system in long-term follow-up after childhood hemispherectomy – A series of four cases

ObjectiveAlthough hemidisconnection surgery may eliminate or reduce seizure activity in patients with epilepsy, there are visual, cognitive and motor deficits which affect patients’ function post-operatively, with varying severity and according to pathology. Consequently, there is a need to map microstructural changes over long time periods and develop/apply methods that work with legacy data. MethodsIn this study, we applied the novel single shell 3-Tissue method to data from a cohort of 4 patients who were scanned 20-years following childhood hemidisconnection surgery and presented with variable clinical outcomes. We have successfully reconstructed tractography of the whole visual pathway from single shell diffusion data with reduced number of gradient directions. ResultsAll patients presented with degeneration of the visual system characterised by low fractional anisotropy and high mean diffusivity. There were no apparent microstructural differences between both optic nerves that could explain the different level of visual function across patients. However, we provide evidence suggesting an association between the level of visual function and DTI metrics within the remaining components of the visual system, particularly the optic tract, of the contralateral hemisphere post-surgery. SignificanceWe believe this study suggests that diffusion MRI can be used to monitor the integrity of the visual system following hemispherectomy and if extended to larger cohorts and a greater number of time-points, including pre-surgically, can provide a clearer picture of the natural history of visual system degeneration. This knowledge may in turn help to identify patients at greatest risk of poor visual outcomes that might benefit from rehabilitation therapies.

Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand.

Objective: To describe the epidemiology, clinical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to determine the risk factors for poor visual outcome.Methods: The medical records of patients aged younger than 15 years of age who were diagnosed with open globe injuries from January 2005 to December 2015 were retrospectively reviewed. The patients’ demographic data were collected, including age, sex, injury date, place of injury, mechanism of injury, cause of injury, and the activity related to the injury. Clinical data were recorded, including initial visual acuity (VA), wound size, wound location, associated ocular findings at presentation, and complications. The prognostic factors for a poor visual outcome were assessed.Results: In total, 46 pediatric patients were included in this study. The mean age was 6.8 years old. Most patients were male (65.2%). The most common type of injury was penetrating injury (60.9%) and mostly occurred during playing (60.9%). Household appliances/furniture and scissors/knives were common causes of injuries (17.4%, 15.2%, respectively). Poor final VA worse than 6/60 was found in 17 patients (37%). Wound location and retinal detachment (RD) at the time of presentation were significant prognostic factors for a poor visual outcome according to the univariate analysis (p = 0.008, <0.001). Only wound location at zone II and III was found to be significantly correlated with poor final VA in the multivariate analysis (adjusted risk ratio (RR) = 2.87, 95% confidence interval (CI), 1.26-6.55, p = 0.012). Traumatic cataract was the most common associated injury (45.7%).Conclusions: One-third of pediatric patients with open globe injuries had a poor visual outcome. Wound location at zone II and III significantly correlated with a poor visual outcome in pediatric open globe injuries. The parents and caregivers should be made aware of the seriousness of open globe injuries in order to prevent children from possible injuries.

Corneal perforation in ocular graft-versus-host disease

PurposeCorneal perforation is a rare, vision-threatening complication of ocular graft-versus-host disease (GVHD) and is not well understood. Our objective was to examine the clinical disease course and histopathologic correlation in patients who progressed to this outcome. MethodsThis study is a retrospective case series from four academic centers in the United States. All patients received a hematopoietic stem cell transplant (HSCT) prior to developing ocular GVHD. Variables of interest included patient demographics, time interval between HSCT and ocular events, visual acuity throughout clinical course, corticosteroid and infection prophylaxis regimens at time of corneal perforation, medical/surgical interventions, and histopathology. ResultsFourteen eyes from 14 patients were analyzed. Most patients were male (86%) and Caucasian (86%), and average age at time of hematopoietic stem cell transplant was 47 years. The mean interval between hematopoietic stem cell transplant and diagnosis of ocular graft-versus-host disease was 9.5 months, and between hematopoietic stem cell transplant and corneal perforation was 37 months. Initial best-corrected visual acuity was 20/40 or better in 9 eyes, and all eyes had moderate or poor visual outcomes despite aggressive management, including corneal gluing in all patients followed by keratoplasty in 8 patients. The mean follow-up after perforation was 34 months (range 2–140 months). Oral prednisone was used prior to perforation in 11 patients (79%). On histopathology, representative specimens in the acute phase demonstrated ulcerative keratitis with perforation but minimal inflammatory cells and no microorganisms, consistent with sterile corneal “melt” in the setting of immunosuppression; and in the healed phase, filling in of the perforation site with fibrous scar. ConclusionsIn these patients, an extended time interval was identified between the diagnosis of ocular graft-versus-host disease and corneal perforation. This represents a critical window to potentially prevent this devastating outcome. Further study is required to identify those patients at greatest risk as well as to optimize prevention strategies.

A Comparative Study between Occlusive and Non-occlusive Retinal Vasculitis: Data from a Referral Center in Tunisia, North Africa

ABSTRACT Purpose To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). Methods A retrospective comparative study Results 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10–3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10−3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p = .006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p = .006 and p ≤ 10–3, respectively), and retinal hemorrhages (p = .048) and optic atrophy (p = .040) in the ORV group. Conclusion Occlusive and non-occlusive RV have distinctive clinical and etiological profile.

Management of Allergic Fungal Rhinosinusitis Associated with Vision Loss During COVID-19 Era.

The ongoing COVID-19 pandemic has given rise to unique challenges related to healthcare management. The problems have arisen due to the direct effect of COVID 19 infection and treatment or as repercussions of administrative efforts being undertaken to check the rapid spread of the epidemic. The management of some of the diseases has been hampered with the implementation of the policies like lockdown and transportation difficulties. This paper presents a series of four patients (6 eyes with vision loss) of an otherwise benign entity, Allergic Fungal Rhinosinusitis (AFRS), causing visual deterioration, managed amid the pandemic. AFRS has been known to cause vision loss by pressure over the optic nerve or its blood supply; however, a timely surgical intervention in the form of functional endoscopic sinus surgery to remove the disease and decompress the optic nerve, results in favourable outcomes in most patients. A delay in diagnosis and treatment may result in irreparable damage with the resulting inability to salvage the vision. In our series, we observed that vision recovery could be achieved in 66.7% of the affected eyes (four out of six eyes), while a poor visual outcome was observed in two (33%). The poor visual outcome was observed for the eyes with a prolonged visual impairment (4–6 months) at the time of presentation. We would appeal to the physicians to be cognizant of the adverse outcomes associated with the delayed surgical intervention of AFRS in the current pandemic scenario.

Treatment outcomes on neovascularization after CRAO treated with hyperbaric oxygen

Central retinal artery occlusion (CRAO) is a condition that causes sudden vision loss due to obstruction of the retinal artery, typically from a thrombotic or embolic source. It is often associated with atherosclerotic risk factors, including cardiovascular disease, diabetes, hyperlipidemia, and a history of cerebrovascular disease. CRAO often leads to a poor visual outcome as well as neovascularization of the iris, retina, and optic disc, which can exacerbate vision loss and cause pain. While there are several treatment modalities for CRAO, few have been proven to be effective in decreasing the effects of neovascularization. The use of hyperbaric oxygen (HBO2) therapy is often used in the treatment of CRAO due to its ease of use and relatively benign side effect profile. This study aims to assess the degree of improvement in visual acuity (VA) and neovascularization following HBO2. Our data ultimately shows that 20% of patients developed neovascularization after HBO2 compared to 29.8% of those who did not undergo HBO2 (p&lt;.05). Our findings suggest that HBO2 has a statistically significant protective effect against neovascularization and may improve long-term visual acuity.

Visual Outcomes in Eyes With Neovascular Glaucoma and Anterior Segment Neovascularization Without Glaucoma

To find predictive factors of neovascular glaucoma (NVG) development in eyes with anterior segment neovascularization without glaucoma (ASNVWG), and poor visual outcomes in eyes that have already developed NVG. Retrospective, clinical cohort studies. A retrospective chart review was performed on 106 eyes of 94 patients with ASNVWG and 245 eyes of 225 patients with NVG. Measured outcomes included the development of NVG at any time point of the disease for the ASNVWG arm, and a visual acuity of ≤20/200 at 6 months after initial presentation for the NVG arm. Overall, 25% of ASNVWG eyes progressed to NVG. Progression was associated with retinal vein occlusion (RVO) (P < .01), lower median presenting BCVA (P < .01), and concurrent traction retinal detachments (TRDs) (P=.025). Sixty-eight percent of NVG eyes had a BCVA of ≤20/200 by 6-month follow-up, which was associated with RVO (P=.005), vitreous hemorrhage on presentation (P=.001), and no panretinal photocoagulation (PRP) treatments (P < .001). BCVA >20/200 at 6 months was associated with ≥1 PRP or intravitreal bevacizumab (IVB) treatment within 1 week of presentation or ≥3 PRP or IVB treatments overall (P < .001). RVO, presenting visual acuity, and concurrent TRD are risk factors for NVG in eyes with ASNVWG. In eyes with NVG, RVO and concurrent vitreous hemorrhage are risk factors for ≤20/200 vision at 6 months, whereas treatment with ≥1 PRP or IVB within 1 week of presentation, or ≥3 treatments of PRP or IVB within 6 months are protective.

Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes.

Purpose To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) (p=0.001 and p=0.047). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI (p=0.171). Conclusions The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.

Management of Rhegmatogenous Retinal Detachment during COVID-19 Pandemic

Patients with primary Rhuegmatougenous Retinal detachment during COVID-19 pandemic were more likely to present late, have macula involving disease secondary and to show poor visual outcomes. Pneumatic Retinopexy (PR) is a procedure that eliminates the need for admission and limits the duration of contact with patients. Hence, more feasible during periods of shortage in hospital beds and medical personnel in the pandemic. In our experience, we successfully performed pneumatic retinopexy on two confirmed COVID-19 cases with favourable visual outcomes. We would recommend retina surgeons be familiar with such procedure as it may be a good alternative to conventional treatment while minimizing the risk of transmitting COVID-19.

Outcomes of manual small incision cataract surgery and phacoemulsification in eyes with chorioretinal coloboma.

To evaluate outcomes of manual small-incision cataract surgery (MSICS) and phacoemulsification in eyes with chorioretinal coloboma. Tertiary eye center, South India. Retrospective study. Electronic medical records of 71 patients with chorioretinal coloboma undergoing cataract surgery from January 2017 to December 2019 were evaluated. Demographics, corrected distance visual acuity (CDVA), slitlamp biomicroscopy findings, grade of cataract, type of coloboma and associated posterior segment pathology, outcomes of different surgical techniques and risk factors for poor visual outcomes, and intraoperative complications were analyzed. Among the 78 eyes studied, 53.9% eyes achieved visual outcome of 20/40 or greater and 20.5% eyes achieved CDVA less than 20/200. For the MSICS group, the median preoperative CDVA was 1.78 (interquartile range [IQR] 1.08 to 2.60) logMAR), which improved to 0.60 (IQR 0.30-1.08) logMAR postoperatively. In phacoemulsification group, the CDVA improved from 0.78 (IQR 0.60-1.00) logMAR to 0.18 (IQR 0.18-0.30) logMAR. Statistically significant visual improvement was noticed in both groups (P < .001 in both). However, eyes that underwent phacoemulsification showed better visual recovery (P < .001). The mean age at presentation was 49.7 ± 10.8 years. MSICS was the most commonly performed surgery (61.54%), and 62 eyes had uneventful cataract surgery. Twelve eyes in MSICS group and 4 eyes in phacoemulsification group had intraoperative complications. Poor visual outcome was associated with male sex, microcornea, hard cataracts, and macular involvement of coloboma. MSICS is an alternative to phacoemulsification in colobomatous eyes with advanced cataract. Hard cataract and microcornea were risk factors for intraoperative complications. Significant postoperative improvement in CDVA was noticed in both macula involved and macula not involved groups.

Fluorescein angiographic findings and Behcet's disease ocular attack score 24 (BOS24) as prognostic factors for visual outcome in patients with ocular Behcet's disease

PurposeTo determine the application of fluorescein angiographic (FA) findings and Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcome in patients with ocular Behcet’s disease.Study designRetrospective cohort study.MethodsWe included 73 eyes of 38 patients with ocular Behcet’s disease who underwent FA and reviewed FA images, anterior chamber cells, vitreous opacity, retinal and optic disc lesions, which are parameters in BOS24. The correlation between FA findings, BOS24, and visual acuity was assessed.ResultsOptic disc hyperfluoresence (74%), diffuse posterior pole leakage (52%) and diffuse peripheral leakage (52%) were the three most common findings. Common complications were peripheral capillary nonperfusion (29%), arterial narrowing (22%), and macular ischemia (19%). BOS24 scores of ≥ 6 (p < 0.0001), arterial narrowing (p < 0.0001), and severe posterior pole leakage (p = 0.004) were significantly associated with poor visual outcome. Combining significant FA findings: arterial narrowing and severe posterior pole leakage, to BOS24 ≥ 6 results in an increased relative risk of developing poor visual acuity from 7.30 to 10.43 and 1.89 to 2.02 respectively.ConclusionFluorescein angiography is an important investigation for predicting poor visual outcome. BOS24 may be a useful alternative when fluorescein angiographic is unavailable.

Anterior Segment Organ Culture Platform for Tracking Open Globe Injuries and Therapeutic Performance.

Open globe injuries have poor visual outcomes, often resulting in permanent loss of vision. This is partly due to an extended delay between injury and medical intervention in rural environments and military medicine applications where ophthalmic care is not readily available. Untreated injuries are susceptible to infection after the eye has lost its watertight seal, as well as loss of tissue viability due to intraocular hypotension. Therapeutics to temporarily seal open globe injuries, if properly developed, may be able to restore intraocular pressure and prevent infection until proper ophthalmic care is possible. To facilitate product development, detailed here is the use of an anterior segment organ culture open globe injury platform for tracking therapeutic performance for at least 72 h post-injury. Porcine anterior segment tissue can be maintained in custom-designed organ culture dishes and held at physiological intraocular pressure. Puncture injuries can be created with a pneumatic-powered system capable of generating injury sizes up to 4.5 mm in diameter, similar to military-relevant injury sizes. Loss of intraocular pressure can be observed for 72 h post-injury confirming proper injury induction and loss of the eye's watertight seal. Therapeutic performance can be tracked by application to the eye after injury induction and then tracking intraocular pressure for multiple days. Further, the anterior segment injury model is applicable to widely used methods for functionally and biologically tracking anterior segment physiology, such as assessing transparency, ocular mechanics, corneal epithelium health, and tissue viability. Overall, the method described here is a necessary next step toward developing biomaterial therapeutics for temporarily sealing open globe injuries when ophthalmic care is not readily available.

Chirurgie de cataracte seule chez le patient porteur d’une dystrophie endothéliale de Fuchs

While endothelial keratoplasty has become the standard treatment for Fuchs dystrophy, the strategy for first-line surgery in patients with associated cataract is still debated. The purpose of this study was to evaluate the surgical outcomes of eyes with Fuchs endothelial corneal dystrophy (FECD) undergoing phacoemulsification alone, to ascertain preoperative factors that predict the need for endothelial keratoplasty (EK). Single-center retrospective study. Cataract surgery alone was performed in 64 eyes of 50 patients with FECD. This decision was made if the patient did not have morning blur, the central corneal thickness (CCT) was below 630 microns, and endothelial cells were visible in the periphery. Mean follow-up was 21 months (range 5-55 months). The mean preoperative CCT was 571±43μm. 6 months after surgery, it was 584±52μm (P=0.12). During follow-up, 14 eyes (22%) required an EK because of poor visual outcome after cataract surgery alone. Mean pre-operative CCT of these eyes (595±23μm) was significantly higher than eyes that did not require EK during follow-up (564±45μm, P=0.022). Over 570 microns, 34% of eyes required an endothelial keratoplasty after the cataract surgery alone. CCT below 630μm associated with the absence of morning blur are preoperative criteria allowing 78.1% eyes with FECD to obtain good visual outcomes after cataract surgery alone. In these eyes, EK can therefore be avoided while ensuring good results.