Poor Visual Outcome Research Articles

The association between personality disorders/traits and violent eye trauma.

To determine the prevalence of various personality disorders in patients with open globe injuries caused by violent eye trauma. One-hundred patients were divided equally to case and control groups. The case group was selected from admitted patients with open globe injury following a violent act. We considered open globe injuries not involved in violence as the control group. All patients interviewed using SCID-II questionnaire. The mean age was 30.7 ± 9.2 year and 34.4 ± 13.1 year for the case and control groups, respectively, (P > 0.05). The married population was more frequent in the control group (P = 0.027). Forty-three patients (86%) in the case group and 23 patients (46%) in the control group demonstrated some personality disorder (P < 0.001). In both groups, cluster B was most frequent. The antisocial personality disorder was more prevalent in the case group. (P = 0.046 and P = 0.006, respectively). The ocular trauma score (OTS) and the mean visual acuity was significantly worse in the case group (P = 0.028 and P = 0.044). Personality disorders are probably important factors in those who acquire an open eye injury during violent behavior. This group had a poor visual outcome. We suggest that this population merits appropriate psychiatric consultation for detection of personality disorders.

Three-dimensional analysis of morphologic changes and visual outcomes in diabetic macular edema.

To investigate the association of retinal fluid volume with the visual and anatomic outcomes of patients with diabetic macular edema (DME) after treatment with bevacizumab. Retrospective observational study. We retrospectively analyzed 65 eyes of 58 DME patients treated with bevacizumab. The volumes of the inner intraretinal fluid (IRF) in the inner nuclear layer (INL), outer IRF in the outer plexiform layer (OPL)/outer nuclear layer (ONL), and subretinal fluid (SRF) were calculated. The correlations between the baseline fluid volumes and best-corrected visual acuity (BCVA), area of disorganization of the retinal inner layers (DRIL), disrupted external limiting membrane (ELM), and disrupted ellipsoid zone (EZ) at 12 months after treatment were assessed. The baseline volume of the inner IRF correlated with poor BCVA at the final visit (r = 0.52, P < .001) whereas the baseline volume of the outer IRF and SRF volume did not show a significant correlation with BCVA at the final visit (P = .07 and P = .61, respectively). The improvement in BCVA correlated with the reduction in the baseline volume of the inner IRF and outer IRF (r = 0.25, P = .04 and r = 0.36, P = .003), but not with the SRF volume (P = .59). The baseline volume of the inner IRF correlated positively with the area of DRIL and the disrupted ELM at the final visit (r = 0.56, P < .001 and r = 0.25, P = .04, respectively). Such relationship remained in each quadrant of the macula (P < .005 for all quadrants). The baseline volume of the inner IRF correlated with a poor visual outcome, an increased DRIL area, and a more disrupted ELM area in patients with DME after treatment with bevacizumab.

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes.

Aim To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury. Methods Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses. Results The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P < 0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C3F8 gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P < 0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P < 0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029). Conclusions Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.

Ophthalmological manifestation in patients of tuberculous meningitis.

Vision impairment, blindness in particular is a devastating complication in patients with tuberculous meningitis. However, information regarding ophthalmological manifestation and its impact on vision is sparse in the literature. This study evaluated the spectrum of ophthalmological manifestations in tuberculous meningitis, including retinal nerve fiber layer thickness assessment by optic coherence tomography and its correlation with visual and clinical outcome. This was a prospective observational study done from October 2015 to March 2017. Consecutive patients of tuberculous meningitis, diagnosed as per consensus case definition were included in the study. The patients were divided into two categories: uncomplicated and complicated tuberculous meningitis. Clinical evaluation, cerebrospinal fluid examination and contrast enhanced MRI of brain was done. Detailed ophthalmological evaluation including optic coherence tomography was done in all patients. All the patients were followed for 6 months. The primary outcome was blindness or low vision after 6 months. The secondary outcome was death or severe disability after 6 months. It was defined as modified Barthel index (MBI) ≤ 12 at 6 months (including disability plus death). Appropriate statistical analysis was done. Out of 101 patients of tuberculous meningitis, 47 patients of TBM belonged to uncomplicated category, while 54 patients were of complicated group. The visual impairment was present in 24 out of 101 (23.76%) patients out of which 20 (19.8%) patients had low vision while 4 (3.96%) had blindness. The visual impairment was more evident in complicated group, low vision 0.03 (1.2-31.5). The most common abnormality on fundus examination was papilledema (22.8%). The complicated group had more incidence <0.0001 (19.6-48). Optic atrophy was found in three patients while choroid tubercles were found in eight patients (all complicated TBM group). RNFL thinning was noted in 10 patients in both the eyes. On univariate analysis, presence of diplopia at baseline, impairment of color vision at baseline, visual impairment at baseline, cranial nerve VIth involvement, optic atrophy and papilledema at baseline, RNFL thinning, abnormal VEP and baseline MBI were associated with poor visual outcome. On multivariate analysis, none of the factors were found to be independently associated with poor visual outcome. On univariate analysis, many factors including baseline MRC staging, altered sensorium, seizure, hemiparesis, basal exudates, infarcts, optochiasmaticarachnoiditis, visual impairment at baseline were found to be associated with poor clinical outcome at 6 months. On multivariate analysis, presence of seizure (P = 0.047, odds ratio = 78.59, 95% confidence interval (1.07-578.72)) was the only factor found to be independently associated with poor outcome. Wide spectrum of ophthalmological manifestation was observed in patients of tuberculous meningitis. The visual impairment was more evident in complicated tuberculous meningitis. Ophthalmological findings like optic atrophy, papilledema and RNFL thinning were associated with poor visual outcome on univariate but not multivariate analysis. Visual impairment at baseline, among other factors was associated with poor clinical outcome on univariate analysis, whereas seizure was the only factor independently associated with poor outcome on multivariate analysis.

Clinical and microbiological characteristics of Moraxella keratitis

Background/aimsTo describe the risk factors, clinical features, bacterial subspecies characteristics and treatment outcomes of Moraxella keratitis in a single centre.MethodsA retrospective review of all patients diagnosed with Moraxella keratitis between...

Prognostic Factors and Visual Outcomes of Pyogenic Liver Abscess-Related Endogenous Klebsiella pneumoniae Endophthalmitis: A 20-year retrospective review

Endogenous K. pneumoniae endophthalmitis (EKE) has a higher incidence among East Asians, and the most common infectious source of EKE is pyogenic liver abscess (PLA). We investigate the risk factors for poor visual outcomes in patients with PLA-related EKE. The retrospective medical records of 104 patients (120 eyes) diagnosed with PLA-related EKE between 1996 and 2015. In univariate logistic regression analysis, the risk factors for poor visual outcomes were initial visual acuity (VA) worse than counting fingers (CF) (p < 0.001), eye pain (p = 0.013), hypopyon (p = 0.003), ocular hypertension (p = 0.003), positive intraocular fluids cultures (p < 0.001), subretinal abscess (p = 0.025), unilateral involvement (p = 0.017), delayed ophthalmologic visit (p = 0.022), initially presented with ocular symptoms ahead of systemic symptoms (p < 0.001), and corneal edema (p < 0.001). Intravitreal dexamethasone reduced the requirement of enucleation or evisceration (p = 0.01). The multivariate logistic regression revealed that poor initial VA worse than CF (p = 0.004) and initially presented with ocular symptoms ahead of systemic symptoms (p = 0.007) were the significant independent factors for poor visual outcomes. Early diagnosis and prompt treatment may salvage useful vision in some eyes.

Predictors of visual impairment in primary and secondary glaucoma in a tertiary institute in North India.

To find out and compare various predictors of glaucoma-related visual impairments in primary and secondary glaucoma. A prospective observational study of patients, who were above 30 years of age. They were diagnosed as primary/secondary glaucoma with visual acuity <20/200 Snellen's/visual field showing less than 20° isopter in at least one eye, with a minimum follow-up of one year at a tertiary center. Patients were classified into advanced and end-stage glaucoma and outcome was assessed according to visual acuity and visual fields to see predictors of visual impairments. There were 169 (99 primary/70 secondary) glaucoma patients with mean age of 62.67 ± 11.9 and 54.65 ± 15.26 years, respectively. Trauma (21.4%), complicated cataract surgery (15.7%), and silicon oil tamponade (14.3%) were common causes of secondary glaucoma. There was significant delay in diagnosis in primary compared to secondary glaucoma (57.57% vs 32.85%) and non-compliance was significantly higher in primary glaucoma (34.3% vs 17.1%, p = 0.01). In univariate analysis, literacy, income status, locality, and delayed or missed diagnosis were found to be significant (p < 0.05) according to visual acuity criteria. Out of the 33 patients who had undergone glaucoma filtration surgery, 18 (54.5%) were in the end-stage group. While 105 (77.2%) of 136 patients who were not subjected to any glaucoma filtration surgery reached end-stage glaucoma as per visual fields criteria (p = 0.011). Lack of awareness, delayed diagnosis, low literacy, and income were associated with poor visual outcome. Patients who underwent glaucoma filtration surgery had significantly better visual outcome in comparison to patients managed medically.

Clinical characteristics and prognostic factors of posterior segment intraocular foreign body in a tertiary hospital

BackgroundTo identify the clinical characteristics, prognostic factors and visual outcomes in posterior segment IOFBs patients managed by PPV in a tertiary hospital.MethodsA retrospective chart review was performed for 56 patients, who had PPV for IOFBs removal between November 2013 and November 2015. The mechanisms of injury, the nature of the IOFBs, the BCVA before and after the surgery, the penetrating site and the complications of the surgery were all collected. Univariate analyses were conducted to evaluate the prognostic factors.ResultsThe mean age of the patients was 36.4 years. The nature of IOFBs was mainly metal. Most injuries were commonly caused by hammering the metal. The mean preoperative VA was 2.30 logMAR, and mean final VA was 0.92 logMAR. From univariate analysis, good visual outcome was correlated with the good visual acuity before surgery and poor visual outcome was correlated with the macular break and multiple surgeries.ConclusionsIn a tertiary hospital of eastern China, most cases of IOFBs were work-related. The prognosis of the patients was really well in the patients with good presenting visual acuity. Nevertheless the prognosis was not good for those patients who had macular injury or underwent several surgeries because of retinal detachment, epiretinal membrane or proliferative vitreous retinopathy. Good facilities for eye protection are urgently in demand for the workers indeed.

Take a look at the eyes in Systemic Lupus Erythematosus: A novel point of view.

Systemic Lupus Erythematosus (SLE) is a connective tissue disease that involves multiple organs. Ocular structures and visual pathways can be affected in SLE because of disease-related eye involvement or drug toxicity. All the part of the eye may be interested with an external, anterior involvement, responsible of the dry eye disease, or posterior (retina) and neuro-ophtalmic manifestations. Retinopathy in SLE is suggestive of high disease activity being a marker of poor visual outcome and prognosis for survival. The early diagnosis is thus the key to a better management and successful treatment. Antimalarial drugs are the cornerstone of SLE treatment and recently the American Academy of Ophthalmology updated the recommendations for hydroxychloroquine retinal toxicity screening which includes the standard automated visual fields and the spectral domain optical coherent tomography. More recently new imaging techniques have been investigated to assess retinal function and reveal subclinical eye involvement. In this review we focalize on the evidence of eye manifestations in SLE, the eye drug toxicity related to antimalarial agents and steroids, and the methods employed for the eye screening. Moreover, the future perspectives on new techniques, such as the optical coherence tomography angiography, are dissected giving new insights on evaluation of microvasculature of the retina and choroid in SLE.

Usefulness of MOG-antibody titres at first episode to predict the future clinical course in adults.

To analyze whether myelin oligodendrocyte glycoprotein antibody (MOG-Ab) titres at onset of the disease were different according to the clinical phenotype at presentation, and to investigate whether the titres were associated with risk of further relapses or predicted clinical outcome in adult patients. Finally, we assessed an alternative method to the classical measurement of MOG-Ab levels by serial dilutions. This is a retrospective study including 79 MOG-Ab-positive adult patients, whose samples were obtained at first episode. MOG-Ab were tested by cell-based assay. HEK293 cells were transfected (tHEK293) with human-MOG plasmid. Non-tHEK293 cells were used as negative controls. Assessment of antibody titres was performed by serial dilution, and delta mean fluorescence intensity ratio signal (MOG-ratio ΔMFI) by flow cytometry. MOG-ratio ΔMFI was calculated as follows: (MFI tHEK293cells- MFI non-tHEK293cells)/MFI non-tHEK293cells. MOG-ratio ΔMFI was calculated from the first serum dilution at 1:320. The association between MOG-Ab titres and risk of relapse was analyzed by Cox regression. The association between MOG-Ab titres and visual or motor disability at last follow-up was performed by binary logistic regression. Poor visual outcome was defined when patients displayed some degree of visual disability (visual acuity [VA] < 20/20) and poor motor outcome when patients displayed some degree of motor disability (Disability Status Scale [DSS] > 1). We also investigated correlations between MOG-Ab titres and MOG-ratio ΔMFI. MOG-Ab titres were higher in Caucasians than in those with other ethnicities, and in patients with a more severe VA (VA ≤ 20/100) or motor disability (DSS ≥ 3.0) at onset (p = 0.006, 0.034, and 0.058, respectively). MOG-Ab titres were not associated with risk of relapses or with the final clinical outcome. MOG-ratio ΔMFI correlated with MOG-Ab titres in the whole cohort (ρ = 0.90; p < 0.001), and when stratified by initial clinical phenotype. High MOG-Ab titres at onset are associated with a more severe presentation, but do not predict the future disease course. MOG-ratio ΔMFI is an alternative and straightforward method to determine MOG-Ab levels.

Ocular outcomes and comorbidities in preterm infants enrolled for retinopathy of prematurity screening: A cohort study from western India

BACKGROUND:Retinopathy of prematurity (ROP) is emerging as an important cause of childhood blindness in middle-income countries such as India. Although blindness can be prevented in most cases with timely screening and treatment, certain ocular comorbidities can lead to visual impairment. We evaluated and compared 1-year visual, refractive, and structural outcomes and comorbidities in three subsets of preterm infants enrolled for screening of ROP.SUBJECTS AND METHODS:Preterm children enrolled in the hospital's ROP screening program and with diagnosis of no ROP, mild ROP, or severe ROP were followed at 1 year of age to evaluate and compare visual, refractive, and structural outcomes as well as the presence of ocular comorbidities. Risk of poor outcome was calculated in children with mild and severe ROP reference population being children without ROP.RESULTS:Eyes with severe ROP were at highest risk of poor visual (risk ratio [RR]: 3.5, P < 0.001), refractive (RR: 45, P < 0.001), and structural (RR: 11, P = 0.006) outcome as well as ocular comorbidities (RR 11, P < 0.001). Eyes with mild ROP were at higher risk of myopia (RR: 11, P = 0.06) and ocular comorbidities (RR: 4, P = 0.04). Sixteen (16%) of the eyes without ROP developed poor visual outcome.CONCLUSION:Eyes with severe ROP are at highest risk of poor ocular outcomes and comorbidities and need a long-term follow-up. Eyes which do not develop ROP can have poor visual outcome and need to be assessed within the 1st year of life.

Submacular Hemorrhage: Visual Outcomes and Prognostic Factors.

To describe causes, visual outcomes, and prognostic factors in patients with submacular hemorrhage (SMH). Retrospective case review. We performed a retrospective review of SMH with a size of at least 1 disc diameter. SMH causes were classified into 3 groups: 1) neovascular age-related macular degeneration (nAMD), 2) polypoidal choroidal vasculopathy (PCV), and 3) other miscellaneous causes. Ninety-eight eyes of 98 patients were included. Based on clinical presentation and indocyanine green angiography (ICGA), the diagnoses of PCV (59%), nAMD (31%), and miscellaneous other causes (10%) were made. PCV patients were younger (P = 0.005) and had larger SMH size than nAMD patients (P = 0.008). Poor visual outcome [>1.0 logarithm of the minimum angle of resolution (logMAR)] at 6 months was associated with low initial visual acuity (VA; >1.0 logMAR; P = 0.002) and with the diagnosis of nAMD (P = 0.02). In addition, limited visual outcomes were noted for patients older than 65 years and those with persistent SMH for at least 2 months. PCV was the most common cause of SMH in Thailand. ICGA represented a valuable tool for the diagnosis. Visual outcomes were limited for patients with nAMD and for patients who presented with poor initial VA.

A Preliminary Report of Predisposing Factors and Predominant Microbiological Diagnosis of Corneal Ulcers Seen at the Federal Teaching Hospital Abakaliki, Nigeria

Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives: To determine the predisposing factors and predominant microbiological diagnosis of corneal ulcers seen at the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Materials and Methods: This is a preliminary report of an on-going longitudinal descriptive study of all consenting corneal ulcer patients managed at the FETHA eye clinic over a 4-month period. Information obtained were socio-demographic data, presenting complaints, duration of symptoms prior to presentation, history of preceding trauma, medications used before presentation, presenting and final visual acuity and microbiological diagnosis. Results: A diagnosis of corneal ulcer was made in 8 out of the 852 outpatients seen over the study period giving a hospital prevalence rate of 0.59%. Five patients (62.50%) were males, five (62.50%) were farmers and 4 patients (50%) were above 60 years of age. The microbial diagnoses were bacterial keratitis 37.5% (Staphylococcus aureus), fungal keratitis 25% (Fusarium spp. and aspergillus) and acanthamoeba (25%). None of the patients ever used contact lenses. There was a history of eye trauma in 50% of the patients. All the eyes presented blind after a period of failed attempts to treat by self or quacks. Mean duration before presentation was two weeks. Treatment improved the visual acuity in 37.5% of patients. Conclusion: Bacteria, fungi and acanthamoeba organisms were the microbiological isolates from the scrapings of corneal ulcer patients seen in the eye clinic of FETHA; with bacterial organisms being the most common. Farming activities, preceding eye trauma, delayed presentation, self-medication and use of traditional eye medications (TEM) were common findings among the patients. A future larger study is recommended to confirm the findings of this study. Eye health education campaigns should be directed at farmers to encourage early presentation to hospitals.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature.

Background and PurposeThe aim of this study is to report the relative incidence of arteritic anterior ischemic optic neuropathy (AAION) associated with giant-cell arteritis (GCA) in a single-center and evaluate the clinical features of AAION in Korean patients.MethodsThe medical records of patients with presumed AION who visited our hospital from January 2013 to August 2018 were examined retrospectively. The patients were divided into two groups: AAION associated with GCA, and non AION (NAION). We additionally reviewed the literature and identified all cases of AAION in Korean and Caucasian patients. We evaluated the clinical data including the initial and final best-corrected visual acuities, fundus photographs, visual field tests, fluorescein angiography, and contrast-enhanced MRI, and compared the data with those for Caucasian patients in the literature.ResultsOf the 142 patients with presumed AION, 3 (2.1%) were diagnosed with AAION and 139 (97.9%) were diagnosed with NAION. Seven Korean patients with AAION associated with GCA were identified in our data and the literature review. We found no difference in any clinical features other than laterality: four of the seven Korean patients had bilateral involvement. Moreover, the optic nerve sheath was enhanced in two of our Korean patients.ConclusionsAAION associated with GCA is a very rare condition compared to NAION in Korea. However, GCA should be considered in all cases of ischemic optic neuropathy because AAION is associated with poor visual outcome, and sometimes presents bilaterally.

23MODELING A GENETIC RISK FOR SCHIZOPHRENIA: PHENOTYPIC DIFFERENCES IN HUMAN NEURAL PRECURSORS AND CEREBRAL ORGANOIDS FROM PATIENTS WITH CHR16P13.11 MICRODUPLICATIONS

To evaluate fine motor ability in children treated for unilateral congenital or infantile cataract.Twenty-three children 3-13 years of age who were treated for unilateral congenital or infantile cataract and 38 age-similar control children were enrolled. Children completed five fine motor skills tasks (unimanual dexterity, bimanual dexterity, drawing trail, aiming, catching) from the Movement Assessment Battery for Children-2. Raw scores were converted into standardized scores, with higher scores indicating better performance.Compared with controls, children treated for unilateral cataract scored lower on drawing trail (P = 0.009), aiming (P = 0.009), and catching (P < 0.001) but not on unimanual (P = 0.77) or bimanual dexterity (P = 0.31). Poorer affected eye visual acuity was moderately related to poorer performance for unimanual dexterity (r = −0.47; P = 0.025), bimanual dexterity (r = −0.50; P = 0.014), and catching (r = −0.41; P = 0.051). Those with a poor visual outcome (>0.6 logMAR) had worse performance than those with a good visual outcome (≤0.6 logMAR) for all tasks (all P values, 0.008-0.09) except aiming. Cataract type (congenital, 9; infantile, 14) and sensory fusion by Worth 4-Dot testing at 33 cm (pass, 10; fail, 13) had no effect on fine motor performance (all P values, 0.12-0.98).In our study cohort, fine motor deficits were found in children treated for congenital or infantile unilateral cataract.

Clinical characteristics of posterior segment penetrating eye injuries treated in tertiary referral hospital in Serbia

Background/Aim. Ocular trauma is a significant cause of visual impairment worldwide. The aim of the study was to analyze clinical characteristics of patients with penetrating eye injuries with retained intraocular foreign body (IOFB) in posterior segment of the eye. Methods. The retrospective study enrolled medical records of consecutive patients hospitalized in a five year period (2012?2016) in a tertiary referral center in Serbia. Surgical repair included pars plana vitrectomy and IOFB removal. Postoperative results were evaluated using the best corrected visual acuity (BCVA). Results. Out of 130 patients who suffered penetrating eye injury with retained IOFB, 72 had IOFB in posterior segment of the eye (43 in retina, 25 in vitreous, 3 in ciliary body, 1 on the optic nerve). Patients were predominantly young adults (aged 44.3 ? 14.9 years, 97.2% men). Average BCVA at admission was poor (0.27 ? 0.38, measured by Snellen chart), and 52.8% of patients had BCVA of counting fingers at 1 meter or less. The majority of patients had corneal wound (70.8%), medium sized IOFB (48.6%), iris injury (61.1%) and traumatic cataract (69.4%). Complications included retinal detachment (16.7%) and endophthalmitis (15.3%). Two patients had the eye enucleated due to severe endophthalmitis, which could not be otherwise controlled. Significant risk factors for postoperative outcome were: initial BCVA (p &lt; 0.001), ocular hypotony (p = 0.013), medium size of IOFB (p = 0.037), presence of traumatic cataract (p = 0.036), retinal detachment (p = 0.032) and endophthalmitis (p = 0.045). Conclusion. Treatment of posterior segment penetrating eye injuries remains a challenge due to high frequency of low initial visual acuity, retinal detachment and endophthalmitis, all of which are risk factors for poor visual outcome. Patients with better initial BCVA, normal intraocular pressure and small IOFB have better postoperative results.

Initial misdiagnosis of Vogt-Koyanagi-Harada disease

PurposeTo report the initial misdiagnosis of patients with Vogt–Koyanagi–Harada (VKH) disease. MethodsThe medical records of 76 consecutive patients diagnosed with VKH disease were reviewed retrospectively at The Eye Center, Riyadh, Saudi Arabia. Patients were referred to The Eye Center from Saudi Arabia and other Middle Eastern countries. The initial diagnosis was made by an ophthalmologist or neurologist. The main outcome measure was to evaluate cases with VKH disease who were initially misdiagnosed. ResultsIn 7 (9.2%) out of the 76 patients the initial diagnosis was incorrect. Patients were initially misdiagnosed as optic neuritis (1.3%), intracranial hypertension (1.3%), brain tumor (1.3%), Susac disease (1.3%), migraine (1.3%), rhegmatogenous retinal detachment (1.3%) or anterior granulomatous uveitis of unknown etiology (1.3%). Patients underwent unnecessary tests including MRI and invasive procedures including CSF analysis and anterior chamber paracentesis. ConclusionThe initial diagnosis of patients with VKH disease was incorrect in 9 % of the cases. Delay in the diagnosis of VKH disease may lead to delay in management and may cause irreversible damage to the photoreceptors with poor visual outcome.

Characterization of Poor Visual Outcomes of Neovascular Age-related Macular Degeneration Treated with Anti–Vascular Endothelial Growth Factor Agents

To investigate the incidence, characteristics, and baseline predictors of poor visual outcomes in eyes with neovascular age-related macular degeneration (nAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in daily clinical practice. Observational study. Treatment-naive eyes starting anti-VEGF therapy for nAMD between 2007 and 2012 tracked in the Fight Retinal Blindness! registry. Eyes had sustained ≥15 letters of loss from baseline without recovery of visual acuity (VA) at final end point. A subgroup analysis included eyes that sustained ≥30 letters of loss. Controls had not sustained ≥15 letters of loss. Kaplan-Meier curves estimated time to first development of loss of ≥15 letters. Cox proportional hazards models evaluated predictors of loss of ≥15 letters. The proportion of eyes with sustained VA loss within 5 years, the time to development of sustained VA loss, and baseline predictors of sustained VA loss. There were 1760 eyes in total and 856 eyes that completed 5 years follow-up. The proportion of eyes with sustained VA loss of ≥15 letters at 5 years was 22.9% (95% confidence interval [CI], 20.7%-25.1%) and VA loss of ≥30 letters was 10.8% (95% CI, 9.1%-12.5%). Factors independently associated with higher incidence of sustained ≥15-letter loss included age >80 years (odds ratio [OR], 1.33 for patients >80 years vs. ≤80 years; 95% CI, 1.05-1.69; P= 0.02), fewer injections (OR, 0.97 per injection; 95% CI, 0.96-0.98; P=0.0005), and more visits at which the choroidal neovascularization was graded as active (OR, 1.97 for eyes in upper quartile of active visits vs. eyes in lowest quartile of active visits; 95% CI, 1.39-2.79; P= 0.0001). Baseline VA ≥70 letters was associated with reduced risk of sustained ≥30-letter loss (OR, 0.61; 95% CI, 0.38-0.98; P=0.04). Baseline angiographic lesion criteria were not significantly associated with sustained VA loss. Twenty-three percent of eyes with nAMD developed sustained VA loss of ≥15 letters over 5 years of anti-VEGF therapy. Baseline predictors of poor outcomes provide more accurate assessment of the potential benefit from anti-VEGF therapy.

Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study.

Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India. One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.

Early Predictors of Long-term Outcomes in Childhood Glaucoma.

A data-based staging system for childhood glaucoma is likely to improve the prediction of visual acuity and intraocular pressure (IOP) control outcomes. We investigated early clinical factors associated with poor long-term visual, and IOP control outcomes in early-onset glaucoma as the initial steps to constructing a severity staging system. Statistical modeling of retrospective case series data. Glaucoma patients younger than 3 years of age who presented to Bascom Palmer Eye Institute between 1990 and 2010 with at least 5 years of follow up. Statistical modeling of retrospective case series data from first, second, third, 3-year, 5-year, and final visits. Association of early clinical characteristics to final IOP-control outcomes and visual acuities. A total of 26 eyes of 15 children were included. Nine of 15 (60%) of patients were male. Mean age at initial presentation: 9.98±10.55 months. Mean duration between initial and final visits: 11.13±3.55 years. By the third visit (mean 6.69 mo after presentation), presence of nystagmus, anterior segment dysgenesis (ASD) or having failed angle surgery increased the final LogMAR visual acuity by 0.76 (P=0.0516), 0.64 (P=0.0618), and 0.58 (P=0.0159), respectively. At year 3, failed amblyopia therapy, failed angle surgery, nystagmus, media opacity (MO), or ASD increased the final LogMAR by 1.30, 1.34, 1.21, 0.85, 0.64, respectively (all P<0.02). Failed angle surgery or MO increased the chance of uncontrolled IOP at the final visit (proportional odds ratio of 6.77 and 12.88, respectively). In this pilot study of a modest size cohort, the presence of nystagmus, ASD or failed angle surgery early in the course of infantile-onset glaucoma management predicted poor final visual outcome, whereas failed angle surgery and presence of MO predicted poor final IOP control. These predictors of poor outcomes will serve as the initial steps in constructing a severity staging system.