Positive Visual Outcomes Research Articles

Treatment of equine keratomycosis, part 1: selection of appropriate therapy based on clinical presentation and diagnostic testing improves clinical outcomes.

To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes. This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models. Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar. Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation. Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.

A single-center retrospective series of OCT and MRI findings in pediatric MOGAD optic neuritis patients

BackgroundWhether optical computed tomography (OCT) and magnetic resonance imaging (MRI) findings are associated with final visual acuity in children with myelin oligodendrocyte glycoprotein antibody disease (MOGAD) optic neuritis is unclear. MethodsWe retrospectively reviewed the charts of pediatric patients with MOGAD optic neuritis seen at St. Louis Children's Hospital/Barnes Jewish Hospital since 2016. ResultsIn the 12 patients in this study, presenting visual acuity was worse in the optic neuritis-affected eyes but significantly improved from presentation to follow-up, such that, at last follow-up, there was no longer a statistical difference between the affected and unaffected eyes. The number of affected eyes with nerve enhancement and the amount of optic nerve affected, as well as thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and macula, decreased from presentation to follow-up. Ultimately, none of these variables were associated with final visual acuity. ConclusionIn this cohort, pediatric MOGAD optic neuritis patients had positive visual outcomes despite significant RNFL thinning and involvement of the optic nerve on MRI, leading to a lack of correlation between follow-up visual acuity and OCT and MRI measures of disease severity, respectively.

Etiology of Congenital Cataract in a Tertiary Hospital, Lahore

Purpose: To identify the etiology of congenital cataracts in a tertiary care center of Lahore. Study Design: Cross-sectional. Sampling Technique: Non-probability purposive sampling. Place and Duration of Study: Department of pediatric ophthalmology The Children’s hospital and Institute of Child Health, Lahore from May 2018-October 2019. .Methods: Children one year and younger diagnosed with congenital cataract were included in the study. A detailed ocular examination was done including B-scan. Blood samples of all the infants were tested for presence of specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by the enzyme-linked immunosorbent assay (ELIZA). Specific blood tests were done to rule out any metabolic disorder. The children were referred to pediatrician for detailed systemic examination. Data were collected, and statistical analysis was done using Excel (Microsoft 2015, version 15.15) and Stata (version 13). Results: A total of 384 infants were included in the study. Mean age of the patients was 5.9 ± 5 months. No cause could be identified in 39.06% and familial pattern was seen in 28.12%. Consanguinity was seen in all familial cases. Rubella was found to be the causative agent in 17.7% participants of the study. Associated ocular problem was seen in 89 (23.17%) infants and microphthalmia being the most frequent. Developmental delay was seen in 126 (6.7%) children. Conclusion: Congenital cataract represents a complex and challenging ophthalmic condition that may result in significant visual impairment. Early identification and timely intervention are pivotal for achieving a positive visual outcome.

Intralenticular Metallic Foreign Body: A Case Report

Background: Intraocular foreign body (IOFB) injuries exhibit variations based on multiple factors, including size, composition, location, type, contamination, the extent of tissue damage, and potential complications that may arise. Case Presentation: This case study describes a 48-year-old male patient who presented to the outpatient clinic with a progressive decline in vision in the right eye lasting three weeks. The patient reported a history of redness in the affected eye, occurring for several days after performing maintenance work. Intraocular pressure measurements were normal for both eyes. The slit lamp examination revealed a corneal opacity near the limbus at the 2 o'clock position in the right eye, along with a small peripheral iris hole aligned with the corneal opacity. Additional diagnostic investigations, including a B-scan ultrasound and a CT scan of the orbit without contrast, were conducted. The B-scan ultrasound showed a clear vitreous and a flat retina, while the CT scan detected a metallic foreign body measuring 3x3 mm. The foreign body was found to be partially embedded in the lens and partially in the vitreous, as confirmed by the imaging. As a result, the patient was admitted to the hospital, and a comprehensive treatment plan was implemented. Topical antibiotics, steroids, cycloplegic, and nonsteroidal anti-inflammatory eye drops were prescribed. The patient underwent cataract surgery with sulcus intraocular lens implantation, combined with a pars plana vitrectomy to remove the foreign body. Additional procedures, such as 360 laser treatment, air-fluid exchange, and injection of SF6 gas, were performed. Conclusion: This case highlights the successful management of an intraocular foreign body injury, emphasizing the significance of prompt diagnosis and appropriate surgical intervention in achieving positive visual outcomes.

Visual and Anatomical Outcomes of a Single Intravitreal Dexamethasone in Diabetic Macular Edema: An 8 Year Real-World Study.

Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents. To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022. A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust. The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline. Intravitreal dexamethasone implant (700 µg). Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan-Meier models). From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months. Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.

Risk factors for infectious keratitis - a literature review

Introduction and purpose 
 Infectious keratitis represents the leading cause of corneal blindness worldwide, particularly in developing countries. Both risk factors and etiological patterns vary between economically developed and developing regions, with bacterial predominance in the former and fungal predominance in the latter. This review aims to provide an updated overview of the risk factors in relation to infectious keratitis.
 Description of the state of knowledge 
 Infectious keratitis is a painful and potentially vision-threatening ophthalmic condition characterized by decreased vision, photophobia and eye redness. In severe cases, it may require hospital admission for intensive medical treatment or surgical interventions. It can be caused by a wide array of organisms, including bacteria, fungi, viruses, parasites or polymicrobial infection. The most commonly observed predisposing factors for infectious keratitis include contact lens wear, trauma, ocular surface diseases, post-corneal surgery and systemic or local immunosuppression. Manual workers in construction or agricultural industry, exposed to vegetative matter, organic materials and animal products are particularly at risk. Higher rate of incidence is also observed in regions with poor environmental and personal hygiene, low level of education, poor access to sanitation and healthcare facility.
 Summary 
 Persistent prevalence of infectious keratitis in both developed and developing countries makes it a serious medical problem. Prevention, proper diagnosis and effective treatment are crucial for positive visual outcome.

Potential Prognostic Indicators for Patients With Retinal Vein Occlusion.

The second most prevalent cause of retinal vascular disease is retinal vein occlusion (RVO). RVO raises intravascular pressure in the capillary and veins, triggering vessel barrier collapse and subsequent leaking of blood or plasma components into the tissue (edema). Macular edema (ME) is a major complication of RVO that results in significant visual impairment. Laser therapy, intravitreal steroid injections, and vascular endothelial growth factor (VEGF) inhibitors are the major therapeutic techniques. Different therapies reduce ME of RVO and improve visual activity. However, some people have no impact on the resolution of ME, while others have a poor visual prognosis despite full ME cure. There are many investigators who studied the relationship between indicators of various instruments with visual activity. However, a summary of those findings is currently lacking. Therefore, we will focus on the predictive factors of different studies associated with positive visual activity outcomes, which would be very useful and important to help address both treatment expectations and methods for patients with RVO.

Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report

ObjectivePredicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2.Methods and analysisThis retrospective cohort study includes deidentified...

Insights From Survival Analyses During 12 Years of Anti–Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration

Although multiple imputation models for missing data and the use of mixed-effects models generally provide better outcome estimates than using only observed data or last observation carried forward in clinical trials, such approaches usually cannot be applied to visual outcomes from retrospective analyses of clinical practice settings, also called real-world outcomes. To explore the potential usefulness of survival analysis techniques for retrospective clinical practice visual outcomes. This retrospective cohort study covered a 12-year observation period at a tertiary eye center. Of 10 744 eyes with neovascular age-related macular degeneration receiving anti-vascular endothelial growth factor (VEGF) therapy between October 28, 2008, and February 1, 2020, 7802 eyes met study criteria (treatment-naive, first-treated eyes starting anti-VEGF therapy). Eyes were excluded from the analysis if they received photodynamic therapy or macular laser, any previous anti-VEGF therapy, treatment with anti-VEGF agents other than ranibizumab or aflibercept, or had an unknown date or visual acuity (VA) value at first injection. Kaplan-Meier estimates and Cox proportional hazards modeling were used to consider VA reaching an Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 70 (Snellen equivalent, 20/40) or better, duration of VA sustained at or better than 70 (20/40), and VA declining to 35 (20/200) or worse. A total of 7802 patients (mean [SD] age, 78.7 [8.8] years; 4776 women [61.2%]; and 4785 White [61.3%]) were included in the study. The median time to attaining a VA letter score greater than or equal to 70 (20/40) was 2.0 years (95% CI, 1.87-2.32) after the first anti-VEGF injection. Predictive features were baseline VA (hazard ratio [HR], 1.43 per 5 ETDRS letter score or 1 line; 95% CI, 1.40-1.46), baseline age (HR, 0.88 per 5 years; 95% CI, 0.86-0.90), and injection number (HR, 1.12; 95% CI, 1.10-1.15). Of the 4439 of 7802 patients (57%) attaining this outcome, median time sustained at an ETDRS letter score of 70 (20/40) or better was 1.1 years (95% CI, 1.1-1.2). In this cohort study, patients with neovascular age-related macular degeneration beginning anti-VEGF therapy were more likely to experience positive visual outcomes within the first 2.0 years after treatment, typically maintaining this outcome for 1.1 years but then deteriorating to poor vision within 8.7 years. These findings demonstrate the potential usefulness of the proposed analyses. This data set, combined with the statistical approach for retrospective analyses, may provide long-term prognostic information for patients newly diagnosed with this condition.

Equine ulcerative keratitis with furrow: A review of the outcomes of 72 cases from 1987 to 2015.

Ulcerative keratitis with peripheral furrow formation is a poorly-described condition which has been associated with a grave prognosis due to rapid necrosis of the cornea. To describe the infectious aetiologies associated with furrow-forming ulcerative keratitis, its overall clinical course and the efficacy of medical and surgical intervention in horses. Retrospective clinical case series. Medical records of 72 horses which presented with furrow-forming ulcerative keratitis at the University of Florida between 1987 and 2015 were reviewed. Seventy-two horses (72 eyes) with furrow-forming ulcerative keratitis were treated at the University of Florida between 1987 and 2015. Of these, a definitive aetiologic diagnosis was available for 37 eyes. Ten of 37 eyes (27%) were diagnosed with fungal keratitis based on cytology of corneal scraping, culture, histopathology and/or fungal PCR. Fourteen of 37 eyes (38%) were diagnosed with a mixed fungal and bacterial keratitis. Thirteen of 37 eyes (35%) were diagnosed with bacterial keratitis. Overall, 26 of 72 total eyes were treated with medical therapy alone (36%). Forty-six of 72 eyes were treated medically and surgically (64%). Of the 26 eyes which received medical therapy, 20 healed with a positive visual outcome (77%) and 6 eyes were non-visual (23%). Of the 46 eyes which received surgical intervention, 40 healed with a positive visual outcome (87%), while six eyes were non-visual (13%). Altogether, 60 of 72 eyes healed with a positive visual outcome following medical or surgical treatment of furrow-forming ulcerative keratitis (83%). Twelve of 72 eyes failed treatment (17%), with six eyes requiring enucleation and six globes becoming phthisical after treatment. Inconsistencies in available medical record data due to the large span of time (1987-2015) are inherent in this retrospective study, along with gradual evolution of corneal surgical techniques and medical therapies over the decades. Furrow-forming ulcerative keratitis was associated with a positive visual outcome in 83% of horses treated at the University of Florida between the years 1987 and 2015. Furrow formation may be associated with either fungal or bacterial infection.

Aflibercept: A review of its effect on the treatment of exudative age-related macular degeneration.

Considerable improvement has been achieved in the way in which exudative age-related macular degeneration is conventionally treated and in the associated visual outcomes and prognosis, thanks to the agents with effects against vascular endothelial growth factor (anti-VEGF). By comparison to earlier treatment approaches that involved the use of lasers, the anti-VEGF agents have made it possible to accomplish more positive visual and anatomical outcomes in cases of exudative age-related macular degeneration. Indeed, owing to their positive effects, anti-VEGF agents have quickly come to be considered the gold standard for the treatment of wet age-related macular degeneration. Aflibercept, the most recently approved intravitreally administered anti-VEGF, seems to mark another milestone in the treatment of wet age-related macular degeneration. This anti-VEGF agent presents a series of singular pharmacodynamic and pharmacokinetic attributes that provide it a number of biological benefits in relation to the treatment of choroidal neovascularization compared to other agents. These attributes include high level of affinity for the VEGF-A factor, an intravitreal half-life of great length, as well as the ability to serve as an antagonist for other growth factors besides VEGF. The impact of Aflibercept on the manner in which exudative age-related macular degeneration is managed was demonstrated by thoroughly reviewing the related literature. The present review article highlights the pharmacology, pharmacokinetics, safety and effectiveness of this anti-VEGF agent as well as the landmark clinical studies that have been carried out to establish this drug as a gold standard in the therapy of neovascular age-related macular degeneration. In addition, studies regarding the outcomes and effectiveness of the various dosage regimens, either as monotherapy or in combination with other agents, are also reviewed.

Therapeutic Options in Keratoconus

A recent epidemiology study revealed that prevalence of keratoconus was much higher than previously assumed. Therefore, it is no longer deemed an "orphan disease", as it has a relevant socioeconomic impact on the healthcare system. One of the most important risk factors for developing keratoconus is chronic eye rubbing which, apart from other known risk factors such as atopy or Down's syndrome, is the only modifiable factor. Informing the patient and offering behavior modifying therapies seems to be essential. Further therapeutic options regarding improvement of visual function include the wearing of glasses and the fitting of rigid gas permeable contact lenses and implantation of intrastromal corneal ring segments or phakic intraocular lenses. Corneal crosslinking (CXL) has been proven to be a highly effective and safe procedure in keratoconus cases showing disease progression. Significantly fewer corneal transplants were performed in this indication following the introduction of CXL. Recent studies reevaluated a combination of photorefractive keratectomy, which has been contraindicated until recently for patients with primary corneal ectasia with CXL, reporting a positive visual refractive outcome and stability of keratoconus. Still, penetrating keratoplasty is the gold standard of surgical treatment for end-stage keratoconus, whereas recently lamellar procedures have gained higher importance.

Psychological impact of anti-VEGF treatments for wet macular degeneration-a review.

PurposeTo review the current literature on the psychological impact of anti-VEGF treatments for wet age-related macular degeneration (wAMD), in terms of patients’ experiences of receiving these treatments, and the impact of these treatments for patients’ mental health and quality of life.MethodsWe critically analyzed current literature evaluating psychological impact of anti-VEGF treatments for wAMD. Primary searches of PubMed, Science Direct, and Web of Science were conducted in July and August of 2015. We reviewed all papers on the topic published until August 5, 2015.ResultsOur literature search found 14 papers addressing the psychological impact of anti-VEGF treatments for wAMD. Results highlighted potential anxieties and experiences of pain caused by receiving regular intravitreal injections. A positive visual outcome of anti-VEGF therapy is associated with positive vision-related QOL outcomes, although such association seems to be dependent on improvements on visual acuity. In the literature reviewed, patients receiving anti-VEGF treatments showed a prevalence rate of depression between 20 and 26 %.ConclusionsAlthough anti-VEGF treatments can cause some anxiety and being experienced as a stressful event, especially in the beginning of the treatment, preliminary findings suggest a potential benefit for long-term vision-related quality of life. Further longitudinal and qualitative research should bring more evidence on the positive and negative effects of these treatments on patients’ long-term mental health.

VISUAL OUTCOME IN DIABETIC MACULAR EDEMA AFTER GRID LASER TREATMENT

Regarding the causes of blindness, Diabetic retinopathy is a one the majorcause of blindness in all types persons from both industrialized and developing countries.Due to inadequate eating habits, prevalence of diabetic retinopathy is increasing. Both focaland diffuse leakage from retinal capillaries can cause Diabetic macular edema. Varioustreatment modalities for macular photocoagulation are focal laser, Grid laser and modified gridused in patients having diabetic macular edema Study Design: Prospective, interventional,noncompetitive case series. Setting: Department of Ophthalmology, Allied Hospital andDepartment of Ophthalmology, Divisional Headquarter Hospital Faisalabad. Period: One yearfrom April 2012 to April 2013. Materials and Methods: A total of 200 eyes of 200 patientswith clinical significant macular edema that met the inclusion criteria were enrolled. Results: Inthis study, 200 patients with diabetic macular edema were studied. Of these 121 (60.5%) weremales and 79 (39.5%) females with mean age of 38.52 years (SD 7.512, Range 25-50 years).All patients had diffuse, clinically significant macular edema at baseline for which they hadreceived grid laser photocoagulation. Discussion: In recent past number of diabetic patientsall over the world has increased that has caused increase incident of diabetic retinopathy .Soin patients having diabetic retinopathy, macular edema can cause deterioration in visual acuityduring any stage of diabetic retinopathy. The pathogenesis of Diabetic macular edema (DME)is the disruption of inner blood – retinal barrier that is known to be associated with metabolicalteration affecting the retinal pigment epithelium or retinal vascular endothelium. Focal and/orgrid laser photocoagulation is being considered as the treatment of DME. Conclusion: Macularphotocoagulation was found to be an effective method of treatment for CSME among diabeticpatients, which has resulted in a positive visual outcome in 87% of the patients (stable andimproved vision).

English

Regarding the causes of blindness, Diabetic retinopathy is a one the major cause of blindness in all types persons from both industrialized and developing countries. Due to inadequate eating habits, prevalence of diabetic retinopathy is increasing. Both focal and diffuse leakage from retinal capillaries can cause Diabetic macular edema. Various treatment modalities for macular photocoagulation are focal laser, Grid laser and modified grid used in patients having diabetic macular edema Study Design: Prospective, interventional, noncompetitive case series. Setting: Department of Ophthalmology, Allied Hospital and Department of Ophthalmology, Divisional Headquarter Hospital Faisalabad. Period: One year from April 2012 to April 2013. Materials and Methods: A total of 200 eyes of 200 patients with clinical significant macular edema that met the inclusion criteria were enrolled. Results: In this study, 200 patients with diabetic macular edema were studied. Of these 121 (60.5%) were males and 79 (39.5%) females with mean age of 38.52 years (SD 7.512, Range 25-50 years). All patients had diffuse, clinically significant macular edema at baseline for which they had received grid laser photocoagulation. Discussion: In recent past number of diabetic patients all over the world has increased that has caused increase incident of diabetic retinopathy .So in patients having diabetic retinopathy, macular edema can cause deterioration in visual acuity during any stage of diabetic retinopathy. The pathogenesis of Diabetic macular edema (DME) is the disruption of inner blood – retinal barrier that is known to be associated with metabolic alteration affecting the retinal pigment epithelium or retinal vascular endothelium. Focal and/or grid laser photocoagulation is being considered as the treatment of DME. Conclusion: Macular photocoagulation was found to be an effective method of treatment for CSME among diabetic patients, which has resulted in a positive visual outcome in 87% of the patients (stable and improved vision).

Current state of therapeutic strategies with ranibizumab in neovascular age-related macular degeneration.

To summarize the current dosing strategies in the management of neovascular age-related macular degeneration with intravitreal injections of ranibizumab. A variety of therapeutic strategies has been recently described as an alternative to the monthly fixed treatment. The efficacy and local and systemic safety results of each approach is relevant in order to make a clinical decision and to provide patients an accurate information. The proposed therapeutic strategies achieve positive visual outcomes when compared with monthly fixed regimen in the clinical trials. However, the real-life practice does not reflect these results. The main cause of this difference is the incapability to adopt any of the different strategies as the clinics are completely booked and this turns into a delay in the diagnostic and treatment visits.

Incidence and Outcomes of Anterior Chamber Gas Bubble during Femtosecond Flap Creation for Laser-Assisted In Situ Keratomileusis.

Purpose. To report the incidence and outcomes of anterior chamber gas bubble formation during femtosecond laser flap creation for laser-assisted in situ keratomileusis (LASIK). Methods. The charts of 2,886 consecutive eyes that underwent femtosecond LASIK from May 2011 through August 2014 were retrospectively reviewed. The incidence, preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed in subjects developing anterior chamber gas bubble formation during the procedure. Results. A total of 4 cases (0.14%) developed anterior chamber gas bubble formation during femtosecond laser flap creation. In all four cases, the excimer laser was unable to successfully track the pupil immediately following the anterior chamber bubble formation, temporarily postponing the completion of the procedure. There was an ethnicity predilection of anterior chamber gas formation toward Asians (p = 0.0055). An uncorrected visual acuity of 20/20 was ultimately achieved in all four cases without further complications. Conclusions. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK is an uncommon event that typically results in a delay in treatment completion; nevertheless, it does influence final positive visual outcome.

Clinical evaluation of two multifocal intraocular lens implantation patterns.

To evaluate the visual outcomes and patient satisfaction of two multifocal intraocular lens implantation patterns, with the decision between the two patterns being guided by the patients' choice of visual zones that best suited their lifestyle, or lifestyle zones. This is a prospective non-randomized comparative study. The lifestyle zones of 32 consecutive age-related cataract patients (64 eyes) were investigated individually to guide the surgical decision between two multifocal intraocular lens implantation patterns. The first group (MIX) received a combined implantation of a ReZoom NXG1 lens in the dominant eye and a Tecnis ZM900 lens in the other eye. The second group (MATCH) received bilateral ReZoom NXG1 lenses. One year postoperatively, the patients were assessed for binocular uncorrected visual acuity, reading visual acuity, reading speed and depth of focus under different luminance and were surveyed for visual disturbances, satisfaction and complete spectacle independence. According to the determination of lifestyle zones, 18 and 14 patients were included in the MIX and MATCH groups, respectively. One year postoperatively, each of the patients exhibited positive visual outcomes and lifestyle satisfaction, although there were still some differences between the two groups. Generally, patients in the MATCH group had better distance visual acuity than those in the MIX group. In contrast, patients in the MIX group had better near visual acuity, better reading acuity and better reading speed than those in the MATCH group. Between the two groups, there was no clear difference in intermediate visual acuity, and the depths of focus between the two groups were approximately equal. The results of the mean NEI-RQL-42 questionnaire score, overall satisfaction, and complete spectacle independence did not differ between the two groups. Different multifocal intraocular lenses implantation patterns can have differing advantages and disadvantages; however, the best results with respect to visual outcome and patient satisfaction can be achieved by taking individual lifestyle zones into account.

Retinal Angiomatosis and Cystoid Macular Oedema in Cogan's Syndrome

To describe clinical features and visual and therapeutic outcomes in a patient affected by Cogan's syndrome with retinal angiomatosis and cystoid macular edema (CMO). A 46-year-old Caucasian man reported frequent episodes of eye redness and pain, conjunctivitis, xerophthalmia, photophobia, and progressive worsening of visual acuity. Slitlamp examination revealed interstitial keratitis. Pan-fundus fluorescein and indocyanine green angiographies revealed the presence of CMO, optic disc edema, and a peripheral angiomatous-like lesion in OS. The audiogram revealed bilateral sensorineural deafness. Blood cultures and genetic counseling and tumor screening tests were negative; antibodies against both CD148/DEP1 and Cogan peptide were positive. Intravitreal injection of bevacizumab did not induce either CMO reduction or improvements in visual acuity. Oral administration of corticosteroids reduced CMO and improved visual acuity and hearing, whereas the peripheral angiomatosis still showed leakage. Cryotherapy of the lesion was successfully carried out to avoid consequent exudative retinal detachment. A close follow-up was scheduled to rule out a possible recurrence of CMO and/or angiomatosis. This case described Cogan's syndrome with peripheral retinal angiomatosis and CMO. It highlights the variability of manifestations of this rare syndrome. Delay in diagnosis is common and can lead to visual and auditory disability. Corticosteroids are the first line of treatment and early administration may aid recovery. Early diagnosis and treatment of peripheral retinal angiomatosis lead to positive visual outcomes.

Anatomic and functional outcome after surgical removal of idiopathic macular epiretinal membrane

The purpose of this study is to investigate the functional and structural outcomes of surgical treatment of eyes with idiopathic macular epiretinal membrane (ERM). Clinical records of 21 patients (22 eyes) who underwent macular ERM removal with at least 6 months of postoperative follow-up period were reviewed retrospectively. All patients were treated with pars plana vitrectomy and ERM peeling surgery. Fourteen patients also underwent cataract surgery at the same time. Pre- and postoperative visual acuity (VA), intraocular pressure (IOP), and macular thickness along with postoperative adverse events were all recorded. The mean follow-up was 8.5 ± 3.2 months. Three eyes were pseudophakic and 19 eyes were phakic preoperatively. Five phakic eyes undergoing simple ERM peeling surgery had worsened cataracts, and vision was recovered after subsequent cataract extraction surgery. Mean preoperative IOP was 13.1 ± 4.2 mmHg, which did not differ significantly postoperatively ( p = 0.228). One patient had increased IOP postoperatively and needed topical antiglaucoma treatment. Thirteen eyes showed visual improvement, and six eyes became worse during the follow-up. Mean preoperative best-corrected VA was 0.36 decimal equivalent, which was then converted to logarithm of the minimum angle of resolution (logMAR 0.502 ± 0.259) for statistical analysis; this had improved to a mean of 0.536 decimal equivalent (logMAR 0.38 ± 0.35) at the final follow-up. Mean central macular thickness (CMT) also significantly declined ( p < 0.0001). From an analysis of dividing patients into two subgroups according to clinical severity [macular pucker (MP) and cellophane maculopathy (CM)], measured mean CMT of both groups demonstrated significant reduction at final follow-up (MP, p < 0.0001; CM, p = 0.005). Mean final best-corrected VA also reached significant improvement in MP group ( p = 0.008). However, in the CM group, no significant change in VA was observed ( p = 0.52). Besides, VA measurements in the MP group had improved significantly to that of CM ( p = 0.037). The measured CMTs of the MP group had also reduced significantly ( p = 0.046) compared with those of the CM group. In conclusion, membrane peeling surgery can lead to a significant reduction of macular edema in patients with idiopathic macular ERM. The advantages of combined peeling and cataract surgery will achieve maximum positive visual outcome.