Postoperative logMAR Best-corrected Visual Acuity Research Articles

Congenital Aniridia Variant: Minimally Abnormal Irides with Severe Limbal Stem Cell Deficiency

To clinically and molecularly characterize a group of patients with progressive limbal stem cell deficiency (LSCD) due to aniridic keratopathy (AK), but with minimally affected irides. Retrospective case series. A total of 12 eyes of 6 patients who underwent keratolimbal allograft (KLAL) for AK in the absence of the classic stigmata of aniridia at the Cincinnati Eye Institute/University of Cincinnati between 2000 and 2007. Retrospective chart review. Ocular surface stability after KLAL and change in visual acuity. Subjects' mean age was 32.57 years, 66% were female, and mean follow-up was 64.4 months (range, 20-115 months). All patients presented with a decline in their vision secondary to LSCD. Average preoperative best-corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) was 1.4 (range, 0.10-2.8). All patients had minimally affected irides with subtle abnormal findings, including ectropion uveae and stromal atrophy. All patients developed severe LSCD and required KLAL. Average postoperative logMAR BCVA was 0.35 (range, 0.00-1.00). All ocular surfaces remained stable throughout the follow-up period. Family history consistent with autosomal dominant inheritance was positive in 4 of 6 patients. PAX6 genetic testing identified 2 pathologic mutations and 1 possible disease-causing variant. Aniridic keratopathy may present in the absence of other classic stigmata of aniridia and be associated with minimally affected irides. A subset of these patients has definitive mutations in PAX6 and once identified can be counseled appropriately. These patients respond well to KLAL and may therefore benefit from early detection.

Effect of Vitrectomy for Epiretinal Membrane on Visual Function and Vision-Related Quality of Life

To evaluate the vision-related quality of life (VR-QOL) in patients undergoing vitrectomy for epiretinal membrane (ERM) removal and to investigate the relationship between VR-QOL and the severity of pre/postoperative metamorphopsia. Prospective, interventional, consecutive, comparative case series. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was self-administered by 28 patients (age, 66.7 +/- 8.5 years, mean +/- standard deviation) with ERM before and 3 months after vitrectomy. Preoperative and postoperative clinical data were collected, including logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA), letter contrast sensitivity, central macular thickness, and severity of metamorphopsia. The NEI VFQ-25 was also measured in 26 age-matched normal controls. The preoperative NEI VFQ-25 composite score was significantly lower in ERM patients than in normal controls (P < .0001). Vitrectomy significantly improved NEI VFQ-25 composite score as well as scores of 10 out of 12 subscales (P < .0001), except for general health and peripheral vision. The postoperative NEI VFQ-25 composite score in ERM patients, however, remained significantly lower than that in normal controls (P < .0001). The preoperative NEI VFQ-25 composite score significantly correlated with the severity of preoperative metamorphopsia (P < .05) but not with preoperative logMAR BCVA, letter contrast sensitivity, and central macular thickness. The postoperative NEI VFQ-25 composite score significantly correlated with the degree of postoperative metamorphopsia and logMAR BCVA (P < .05). The changes in NEI VFQ-25 composite score significantly correlated with changes in the severity of metamorphopsia (P < .05), but not with other parameters. VR-QOL is significantly impaired in patients with ERM, which is remarkably improved by vitrectomy. The severity of metamorphopsia strongly influences VR-QOL in patients with ERM.

25-Gauge Vitrectomy and Triamcinolone Acetonide–Assisted Internal Limiting Membrane Peeling for Chronic Cystoid Macular Edema Associated With Branch Retinal Vein Occlusion

To evaluate the efficacy of 25-gauge vitrectomy and triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling for chronic cystoid macular edema (CCME) in branch retinal vein occlusion (BRVO). Thirty-four patients (38 eyes) presenting with CCME in BRVO were treated prospectively by 25-gauge vitrectomy and ILM peeling. Change in best-corrected visual acuity (BCVA) and CCME status were evaluated preoperatively and postoperatively at 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, and 7 months. Mean postoperative logMAR BCVAs +/- SD were 0.69 +/- 0.42, 0.65 +/- 0.41, 0.59 +/- 0.32, 0.39 +/- 0.27, 0.35 +/- 0.31, 0.32 +/- 0.28, and 0.32 +/- 0.31 at the seven follow-up months, respectively. Mean foveal thicknesses +/- SD were 443 +/- 60 microm, 212 +/- 67 microm, 188 +/- 41 microm, 176 +/- 53 microm, 173 +/- 41 microm, 171 +/- 39 microm, and 170 +/- 41 microm at the 7 follow-up months, respectively. Compared with before surgery, BCVA improved, and CCME was absorbed significantly (P < 0.01, Dunnett test). Foveal thickness and logMAR BCVA 7 months after surgery had a significant negative linear correlation (r = -0.81, P < 0.01; Spearman rank correlation). Twenty-five-gauge vitrectomy with TA-assisted ILM peeling is generally effective in reducing macular edema and improving BCVA for CCME in BRVO for at least 7 months.

Vision-Related Quality of Life and Visual Function Following Vitrectomy for Proliferative Diabetic Retinopathy

To evaluate the vision-related quality of life (VR-QOL) and visual function following vitrectomy for proliferative diabetic retinopathy (PDR). Prospective, interventional, consecutive, comparative case series. The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by 51 patients with PDR before and three months after 20-gauge pars plana vitrectomy. Among the patients with PDR, 30 underwent combined cataract surgery and vitrectomy. Clinical data were collected, including logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA), letter contrast sensitivity, and metamorphopsia. The VFQ-25 was also administered to 46 age-matched normal controls. The preoperative VFQ-25 composite score was significantly lower in the PDR patients (56.3 +/- 18.8, mean +/- standard deviation) than in the normal controls (85.2 +/- 10.3; P < .0001). Vitrectomy significantly improved VFQ-25 composite score (P < .005) and eight of 12 subscales (P < .05). The preoperative VFQ-25 composite score significantly correlated with preoperative logMAR BCVA in the better-seeing eye (P < .001). The postoperative VFQ-25 composite score exhibited significant correlation with postoperative logMAR BCVA in the worse-seeing eye (P < .0001) as well as the better-seeing eye (P < .0001). Similar significant correlations were also observed between the VFQ-25 composite score and letter contrast sensitivity. Vitrectomy for PDR significantly improves VR-QOL. The current study quantitatively indicates that VR-QOL in PDR patients depends on visual acuity and contrast sensitivity in the better-seeing eye preoperatively and in both the better-seeing and worse-seeing eyes postoperatively.