Predictors Of Good Visual Outcome Research Articles

Clinical profile and treatment outcomes of Fusarium keratitis.

Purpose:To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis.Methods:A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019.Results:The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis.Conclusion:Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

Identification of microvascular and morphological alterations in eyes with central retinal non-perfusion.

PurposeTo evaluate the characteristics and morphological alterations in central retinal ischemia caused by diabetic retinopathy (DR) or retinal vein occlusion (RVO) as seen in optical coherence tomography angiography (OCTA) and their relationship to visual acuity.MethodsSwept-source optical coherence tomography (SSOCT) and OCTA (Topcon, Triton) data of patients with central involving retinal ischemia were analyzed in this cross-sectional study. The following parameters were evaluated: vessel parameters, foveal avascular zone (FAZ), intraretinal cysts (IRC), microaneurysms (MA), vascular collaterals in the superficial (SCP) and deep plexuses (DCP), hyperreflective foci (HRF), epiretinal membrane (ERM), external limiting membrane (ELM) and ellipsoid zone (EZ) disruption, as well as the disorganization of retinal inner layers (DRIL). Best-corrected visual acuity (BCVA), age, gender, disease duration and ocular history were also recorded.Results44 eyes of 44 patients (22 with RVO, 22 with DR) were analyzed. The mean age was 60.55 ± 11.38 years and mean BCVA 0.86 ± 0.36 (Snellen, 6m). No significant difference was found between DR subgroups (non proliferative vs. proliferative). Between RVO subgroups (CRVO vs. BRVO) a significant difference was found in term of collateral vessel of the DCP (p = 0.014). A pooled DR and RVO group were created and compared. Significantly more MAs (p = 0.007) and ERM (p = 0.007) were found in the DR group. Statistically significant negative correlation was demonstrated between FAZ and BCVA (p = 0.45) when analyzing all patients with retinal ischemia.ConclusionThis study has shown that the best predictor of visual outcome in center involved ischemic diseases is the size of FAZ. Besides the presence of MAs and ERM, all other OCT and OCTA parameters were present in a similar extent in DR and RVO group despite the completely different disease origins. Our results suggest that as soon as retinal ischemia in the macular region is present, it has a similar appearance and visual outcome independently of the underlying disease.

Vision improvement in severe acute isolated optic neuritis after plasma exchange treatment in Chinese population: a prospective case series study.

Background:Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment.Methods:Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit.Results:This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6–53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively (p < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 (p < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, p = 0.044], serum AQP4 antibody-positive status (OR = 0.004, p = 0.001), bilaterality (OR = 0.042, p = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, p = 0.002).Conclusion:This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.

Pediatric open-globe injury in a university-based tertiary hospital.

To investigate epidemiology, etiology, and outcomes after repair of pediatric open-globe injury. We retrospectively reviewed medical records of patients ⩽18 years who underwent primary open-globe repair. A total of 213 patients were identified. Male-female ratio was 1.44:1. Type of injury was penetration in 157 (74.4%) cases, rupture in 52 (24.4%) cases, and perforation in 2 (0.9%) cases. Knife injuries were the most common cause, affecting 38/196 (19.4%), followed by metallic object in 37/196 (18.9%) patients, glass in 26/196 (13.3%) patients, and pen or pencil in 24/196 (12.8%). Predictors of good visual outcome defined as (⩾20/40) were good initial visual acuity (⩾20/40; p < 0.0001), time from injury to arrival at the emergency room >24 h (p = 0.038), size of wound less than 10 mm (p < 0.0001), absence of iris prolapse (p < 0.0001), deep anterior chamber at presentation (p < 0.0001), absence of hyphema (p = 0.043), intact lens (p < 0.0001), and no retinal detachment during follow-up (p < 0.0001). A total of 27 (12.7%) cases were documented to have retinal detachment at any time during follow-up period. Predictors of retinal detachment were perforation and rupture (p < 0.0001), whereas penetration was not associated with development of retinal detachment, size of the wound ⩾10 mm (p < 0.0001), initial visual acuity ⩽20/200 (p < 0.0001), lens injury (p < 0.0001), and development of endophthalmitis (p < 0.027). Eight (3.7%) eyes had the clinical diagnosis of posttraumatic endophthalmitis. The most common type of injury was penetration and the most common tool was knife. Visual outcome was affected by the initial presentation. Retinal detachment was a significant predictor of a worse final visual outcome.

Post-clear corneal phacoemulsification endophthalmitis: profile and management outcomes at a tertiary eye care center in western India.

BackgroundInfectious endophthalmitis is a serious sight threatening intraocular inflammation that results from exogenous or endogenous spread of organisms into the eye.A retrospective case series to study the profile of endophthalmitis following clear corneal phacoemulsification in western India between years 2008 and 2014 was held in the National Institute of Ophthalmology, Pune, India. Cases of endophthalmitis post-clear corneal phacoemulsification were reviewed pertaining to demography, clinical history, surgeon experience, surgical complications, time of onset following surgery, duration between onset of symptoms and presentation to the center, presenting visual acuity and at follow-ups, slit-lamp examination and ultrasound findings, vitreous tap culture results, treatment, and final functional and anatomical outcomes.ResultsOf 60 cases, 34 were operated in the tertiary center and 26 were referred. The incidence of endophthalmitis post clear corneal phacoemulsification performed at the tertiary center was 0.17%. Mean time delay between onset of symptoms and presentation to the tertiary care center was 2.6 days. Fifty percent cases were culture +ve, of which 80% were Gram +ve and 20% were Gram −ve, no fungal isolates. Coagulase –ve staphylococcus was the most common causative organism; rare isolates included Sphingomonas paucimobilis and Streptococcus mitis. Twenty-six eyes underwent primary vitrectomy. Mean presenting visual acuity was 2.14 ± 0.07 logMAR units which improved to logMAR 0.98 ± 0.12 at final follow-up. Presenting VA was >20/200 in 13.3% and <HM in 60% cases. 66.7% of eyes had visual improvement; 26.7% cases achieved VA 20/40 at final follow-up. Gram +ve and culture –ve cases, better presenting VA, and less time delay between onset and presentation had a favorable visual outcome.ConclusionsThe shift of the clinico-microbiological spectrum of endophthalmitis could be due to change in surgical technique to clear corneal phacoemulsification. Predictors of good visual outcome include good presenting visual acuity, early presentation to the center, culture negativity, and coagulase negative organisms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12348-016-0115-y) contains supplementary material, which is available to authorized users.

Visual outcome in open globe injuries

To determine the factors affecting the visual outcome in patients with open globe injuries of eye. In a prospective interventional study of consecutive patients with open globe injuries, the age, gender, place of injury, object causing injury and safety precautions taken were recorded. A detailed examination of the eye was done with a slit-lamp. X-rays of the orbits were taken in order to determine the presence of a foreign body. The injuries were classified as simple or complicated depending on the involvement of the pupil/iris, lens and retina. Finally, post operative best-corrected visual acuity at last follow up was noted. Fifty-two patients (52 eyes) were included in the study. The mean age of patients was 27.25±12.62 years (range 9-73 years). The majority of injuries occurred in the workplace (36.5%); nail (15.4%) and glass (15.4%) were the most common objects causing injury. Of those with good initial visual acuity, 90% maintained good visual outcome. Patients with corneal lacerations of less than 5 mm had significant good visual outcome. The number of corneal lacerations and visual axis involvement did not affect the visual outcome. Those with corneoscleral lacerations had significantly poor visual outcomes compared to those with corneal or scleral lacerations alone. Predictors of good visual outcome are good initial visual acuity, a corneal laceration wound of less than 5mm, a deep anterior chamber, and simple lacerations. Age, gender, place of injury, object causing injury, presence of hyphema or intraocular foreign body, and the use of safety precautions did not affect the visual outcome.

Prognostic Factors After Repair of Open Globe Injuries

Background: To identify prognostic factors for visual acuity and anatomic outcomes after repair of open globe injuries. Methods: We retrospectively reviewed the medical records of 443 patients with open globe injuries admitted to King Abdulaziz University Hospital between May 1996 and January 2008. Results: Predictors of good visual outcome (20/200 or better) were age of 18 years or younger, good initial visual acuity of counting fingers or better, sharp mechanism of injury, wound length of 10 mm or less, wounds limited to the cornea, absence of associated ocular injuries at presentation including lens injury, vitreous hemorrhage, vitreous prolapse and retinal detachment, absence of endophthalmitis, vitrectomy not performed, and findings at final evaluation including clear vitreous, attached retina, and absence of hypotony. Predictors of persistent retinal detachment at final evaluation were poor initial visual acuity of hand motions or worse, posterior wound location, and performance of vitrectomy. Predictors of hypotony at final evaluation were poor initial visual acuity of hand motions or worse, dirty wound, presence of vitreous hemorrhage, and vitreous prolapse at presentation, development of culture-positive endophthalmitis, performance of vitrectomy, and persistent retinal detachment at final follow-up. Conclusions: Prognosis after repair of an open globe injury is influenced by age, initial visual acuity, mechanism of injury, location and extent of initial damage, and development of endophthalmitis.

Outcomes of Bilateral Cataract Surgery in Tanzanian Children

To investigate outcomes of bilateral pediatric cataract surgery in east Africa. Retrospective interventional case series. Two hundred forty-three children who underwent bilateral cataract surgery at the Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital between 2001 and 2004. Demographic, surgical, preoperative, and postoperative clinical characteristics obtained from patient records were entered into a database (Microsoft Excel; Microsoft, Redmond, WA), and statistical analysis was conducted using SPSS software for Windows (SPSS, Inc., Chicago, IL). Postoperative visual acuities and factors affecting them and postoperative refraction results. Intraocular lenses were inserted in the first eyes of 232 children (149 Alcon AcrySof [Alcon Laboratories, Fort Worth, TX], 83 polymethyl methacrylate [PMMA]). Fifty-eight (62%) of 94 patients with final follow-up acuities recorded in both eyes achieved 20/60 or better in their better eye and 13 (13%) of 94 patients were blind. Of the various predictors of good visual outcome identified for children or eyes, only absence of preoperative blindness (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.0-18.0; P<0.0005) remained significant in a multivariate logistic regression model. One hundred nine (51%) of 212 refracted first eyes had early postoperative refractive error spherical equivalent magnitudes of 2 diopters (D) or more. Ninety-nine (47%) of 212 eyes had initial postoperative cylinders of 3 D or more, dropping to 30 (18%) of 164 of those who had later follow-up refraction. Presence of biometric data was not associated with smaller postoperative refractive errors. Eyes with AcrySof lenses were less likely (OR, 2.5; 95% CI, 1.04-6.06) to have more than 3 D of astigmatism at latest follow-up. AcrySof lenses also were more likely (OR, 2.1; 95% CI, 1.2-3.7) to be fixated in the bag than PMMA lenses. Acute fibrinous uveitis occurred in 30 cases (12%), and transient corneal haze occurred in 20 cases (8%). Twenty-seven (11%) had chronic complications, 69 (28%) underwent a further general anesthetic procedure, and 9 (4%) underwent yytrium-aluminum-garnet capsulotomy. Preoperative blindness was the strongest predictor of poor postoperative visual outcome; the use of AcrySof lenses as opposed to PMMA lenses made in-the-bag fixation more likely and also reduced postoperative astigmatism.

Visual Outcome and Prognostic Factors after Vitrectomy for Posterior Segment Foreign Bodies

To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis. After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.

Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases

AIMSTo evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet.METHODSThe...

Multivariate Analysis of Prognostic Factors in Penetrating Ocular Injuries

We used a multivariate statistical analysis to identify factors predicting visual outcome in 281 eyes that underwent primary repair of a penetrating ocular injury. Visual acuity of 20/800 or better on initial examination was the most important factor, with these eyes 28 times more likely to have a final visual acuity of 20/800 or better than eyes with initial visual acuities worse than 20/800. The effect of other factors differed depending on the initial visual acuity. In patients with initial visual acuities of 20/800 or better, youth (less than or equal to 18 years) was a significant predictor of final visual acuities of 20/50 or better. In patients with initial visual acuities worse than 20/800, a laceration limited to the cornea was the best predictor of good visual outcome. Absence of an expelled or subluxed lens and lacerations limited to a location anterior to the rectus muscle insertions were also important predictors of good visual outcome. When an intraocular foreign body was present these factors were no longer significant and older age (greater than 18 years) was the most important predictor of good visual outcome.