Predictors Of Visual Outcome Research Articles

Association of Microvasculature Changes with Visual Outcomes in Idiopathic Epiretinal Membrane Surgery: A Clinical Trial.

Purpose: The purpose of this paper is to evaluate macular microvascular changes and their correlation with visual outcomes after idiopathic epiretinal membrane (iERM) surgery. Methods: Forty-seven eyes operated for iERM were included in this retrospective case series. The foveal avascular zone (FAZ) area, and the vessel density (VD) in the superficial and the deep capillary plexus (SCP and DCP) were evaluated using optical coherence tomography angiography (OCTA). The association between the OCTA parameters and best-corrected visual acuity (BCVA) was examined preoperatively and postoperatively. Regression analyses were conducted to determine the potential predictive factors for visual recovery. Results: At baseline, the FAZ area in iERM eyes was significantly smaller than that in the control eyes (p < 0.001). iERM eyes also had a lower macular VD in both the SCP and the DCP (p < 0.001). Preoperative BCVA was negatively correlated with the FAZ area (r = -0.499, p < 0.001) and macular VD in the DCP (r = -0.422, p = 0.003). A negative correlation was also found between postoperative BCVA and macular VD in both the SCP (r = -0.394, p = 0.006) and the DCP (r = -0.569, p < 0.001). In the bivariate analyses, age, preoperative BCVA, iERM stage, and baseline macular VD in the SCP were significantly associated with BCVA at 6 months post-surgery. Multivariate regression analysis revealed that the preoperative BCVA was the only predictor of visual outcomes in iERM eyes (p < 0.001). Conclusions: Idiopathic epiretinal membrane (iERM) causes microvascular changes, including foveal avascular zone (FAZ) contraction and decreased macular vessel density (VD) in both the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). These changes were significantly correlated with pre- and/or postoperative best-corrected visual acuity (BCVA). However, none of these alterations appeared to have prognostic value for visual outcomes in patients with iERM.

Prediction of Visual Outcome After Rhegmatogenous Retinal Detachment Surgery Using Artificial Intelligence Techniques.

This study aimed to develop artificial intelligence models for predicting postoperative functional outcomes in patients with rhegmatogenous retinal detachment (RRD). A retrospective review and data extraction were conducted on 184 patients diagnosed with RRD who underwent pars plana vitrectomy (PPV) and gas tamponade. The primary outcome was the best-corrected visual acuity (BCVA) at three months after the surgery. Those with a BCVA of less than 6/18 Snellen acuity were classified into a vision impairment group. A deep learning model was developed using presurgical predictors, including ultra-widefield fundus images, structural optical coherence tomography (OCT) images of the macular region, age, gender, and preoperative BCVA. A fusion method was used to capture the interaction between different modalities during model construction. Among the participants, 74 (40%) still had vision impairment after the treatment. There were significant differences in age, gender, presurgical BCVA, intraocular pressure, macular detachment, and extension of retinal detachment between the vision impairment and vision non-impairment groups. The multimodal fusion model achieved a mean area under the curve (AUC) of 0.91, with a mean accuracy of 0.86, sensitivity of 0.94, and specificity of 0.80. Heatmaps revealed that the macular involvement was the most active area, as observed in both the OCT and ultra-widefield images. This pilot study demonstrates that artificial intelligence techniques can achieve a high AUC for predicting functional outcomes after RRD surgery, even with a small sample size. Machine learning methods identified The macular region as the most active region. Multimodal fusion models have the potential to assist clinicians in predicting postoperative visual outcomes prior to undergoing PPV.

Quantitative Microvascular Change Analysis Using a Semi-Automated Algorithm in Macula-on Rhegmatogenous Retinal Detachment Assessed by Swept-Source Optical Coherence Tomography Angiography.

The purpose of this study was to objectively evaluate the longitudinal changes observed in the retinal capillaries in eyes with macula-on rhegmatogenous retinal detachment (RRD), assessed with optical coherence tomography angiography (OCTA), and to assess the role of these microvascular measures as potential biomarkers of postoperative visual outcomes. This was a prospective, longitudinal study conducted on consecutive patients who underwent 25 G pars plana vitrectomy for primary RRD. The vessel area density (VAD), vessel skeleton density (VSD), and vessel diameter index (VDI) were assessed in the superficial (SCP) and deep (DCP) capillary plexuses. Twenty-three eyes with macula-on RRD were included in the study. The mean preoperative VDI, VAD, and VSD of the RRD eye were 18.6 ± 1.1, 0.43 ± 0.02, and 0.17 ± 0.01 in the SCP; and 18.6 ± 0.6, 0.38 ± 0.03, and 0.15 ± 0.01 in the DCP, respectively. At month 6, eight (34.8%) eyes achieved a best-corrected visual acuity (BCVA) gain ≥ 0.1 LogMAR. A preoperative VDI > 17.80, VSD > 0.170, and VDI-change > -0.395 in the SCP; and VDI > 18.11 and VDI change > -0.039 in the DCP were predictors of achieving a BCVA-gain ≥ 0.1 LogMAR. The preoperative VDI in SCP and DCP, the preoperative VSD in SCP, and their changes from preoperative values were predictors of visual outcomes. A quantitative OCTA analysis of capillary density and morphology may represent a potential predictive tool for surgical outcomes in RRD. The results reported in this study suggest that OCTA is a useful ancillary test for clinical disease management.

Peripapillary Retinal Nerve Fiber Layer Thickness as a Predictor of Visual Outcomes in Patients with Acute Nonarteritic Anterior Ischemic Optic Neuropathy.

To evaluate the utility of peripapillary retinal nerve fiber layer thickness (pRNFLT) for the prediction of visual outcomes, including visual acuity (VA) and visual field (VF), in subjects with acute nonarteritic anterior ischemic optic neuropathy (NAION). We performed a retrospective study of data relating to 60 eyes of 60 subjects with acute NAION. Of these, reliable VF values were obtained at both the initial and at 6-month follow-up visits for 30 eyes, which were included in the VF analysis. The pRNFLT was measured globally and separately in all four quadrants (superior, inferior, nasal, and temporal) using optical coherence tomography at the initial visit. Multivariate analysis and the area under the curve (AUC) were used to evaluate the utility of pRNFLT for the prediction of visual outcomes, including favorable VA (VA better than or equal to 20/25) and favorable VF (visual field index (VFI) ≥90%), at the 6-month follow-up visit. The median VA and mean VFI at the initial visit were 0.40 (interquartile range (IQR): 0.40, 0.54; logarithm of the minimum angle of resolution (logMAR)) and 73.07% ± 6.73%, respectively. The median VA and mean VFI at the 6-month follow-up visit were 0.30 (IQR: 0.00, 0.70) logMAR and 69.27% ± 28.94%, respectively. Thinner temporal-quadrant pRNFLT was associated with favorable VA (odds ratio 0.98; p = 0.042) with a cut-off value of 128 µm (AUC 0.839, 95% CI: 0.732-0.947, sensitivity 77.27%, specificity 84.21%). Thinner nasal-quadrant pRNFLT was associated with favorable VF (odds ratio 0.97; p = 0.047) with a cut-off value of 105 µm (AUC 0.780, 95% CI: 0.612-0.948, sensitivity 90.00%, specificity 70.00%). The pRNFLT is clinically useful for the prediction of visual outcomes in patients with acute NAION. A temporal-quadrant pRNFLT ≤128 µm and a nasal-quadrant pRNFLT ≤105 µm predict favorable VA and VF at the 6-month follow-up visit, respectively.

Study of OCT based biomarkers as a predictor of visual outcome in diabetic macular edema

To determine the association between optical coherence tomography (SD-OCT) based biomarkers and visual acuity (VA) in diabetic macular edema (DME). This cross-sectional study was conducted at a tertiary care teaching hospitalbetweenJanuary 2021 and July 2022.The study included 54 eyes (30 patients) with DME. Based on the early treatment diabetic retinopathy study (ETDRS) grading system, these were classified as mild (n=1), moderate (n=31), severe (n=14), and very severe (n=8) non-proliferative diabetic retinopathy (NPDR). The demographics, VA recorded using ETDRS chart and ETDRS scoring system, slit lamp biomicroscopy findings, colour fundus pictures and biomarkers determined using macular scans on SD-OCT were noted. Six eyes with proliferative diabetic retinopathy (n-4) and considerable media opacity (n-2) were excluded. The data was entered into Microsoft Excel spreadsheet 2021and IBM's SPSS 26 statistical program was used to calculate the results.VA and biomarkers, which included central macular thickness, disorganisation of retinal inner layers (DRIL), ellipsoid zone disruption (EZD), choroidal thickness were measured on SD-OCT.: The mean age was 59.4±9.4 years, and male to female ratio was 1.3:1. Mean uncorrected and best corrected VA were 46 and 61 letters, 55.12±1.76 and 67.25±10.05 letters for moderate NPDR, 43.07±3.95 and 52.14±17.83 letters for severe NPDR, and 26.50±16.53 and 36±16.38 letters for very severe NPDR, respectively. VA deteriorated with increasing disease severity. Poorer VA was associated with increased average foveal and macular thickness and increased mean horizontal disruption of the inner retinal layers (DRIL). Average choroidal thickness positively correlated with increasing DR severity. : Poorer VA was associated with increasing DR severity, increased central retinal thickness, increased mean horizontal DRIL and increased average foveal choroidal thickness. We found no statistically significant correlation between VA and ellipsoid zone disruption.

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

Retinal Detachments after Open-Globe Injury: Risk Factors and Outcomes

To identify risk factors for retinal detachment (RD) after open-globe injury (OGI) and evaluate outcomes of RD repair after OGI. Case-control study. Overall, 769 patients presented with 786 OGIs, which were surgically managed with ≥ 30 days of follow-up. Of the 786 eyes, 223 developed RD, the other 551 served as controls, and RD status of 12 eyes was unknown. A retrospective chart review was performed of all OGIs presented to the University of Michigan between 2000 and 2022. Multivariable regression identified risk factors for RD after OGI and predictors of poor vision after RD repair. Kaplan-Meier analysis estimated time from OGI to RD. Predictors of visual outcome after RD repair after OGI. After OGI, 223 (28.4%) of 786 eyes were diagnosed with RD, with > 73% diagnosed within a month. Predictors of RD include posterior injury (zone II vs. I odds ratio [OR], 1.60 [95% confidence interval {CI}, 1.04-2.46]; P= 0.0331; zone III vs. I OR, 2.29 [1.53-3.41]; P < 0.0001), vitreous hemorrhage (OR, 2.29 [1.54-3.1]; P < 0.0001), and presenting acuity worse than count fingers (CFs) (OR, 2.65 [1.69 - 4.16]; P < 0.0001). Retinal detachment repair took place in 142 of 223 eyes. The mean logarithm of minimal angle of resolution visual acuity (VA) improved from 2.3 ± 0.8 to 1.7 ± 0.9 after RD repair at 6-month follow-up, with 51.2% of eyes achieving CF or better vision. Single surgery anatomic success rate was 69.7% and final anatomic success was 88%. Predictors of vision worse than CF include history of ocular surgery (OR, 0.32 [0.11-0.94]; P= 0.039), proliferative vitreoretinopathy (PVR; OR, 0.39 [0.16 - 0.92]; P= 0.032), aphakia (OR, 0.25 [0.08 - 0.77]; P= 0.016), and redetachment (OR, 0.26 [0.1 - 0.63]; P= 0.003). Most RD occur within the first month after OGI. Patients with posterior injuries, vitreous hemorrhage, or poor presenting VA were more likely to develop RD after OGI. Anatomic success was achieved in the majority, as was final VA of CF vision or better. History of ocular surgery, PVR at time of repair, aphakia, and redetachment were risk factors for a poor outcome. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical Outcomes of 27-Gauge Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment Repair.

Purpose: To analyze the clinical outcomes of 27-gauge pars plana vitrectomy (PPV) repair of diabetic tractional retinal detachment (TRD) of various severities. Methods: This retrospective case series examined the outcomes of 27-gauge PPV to repair diabetic TRD from 2016 to 2020. The effect of medical and ophthalmologic history parameters and baseline detachment characteristics on visual acuity (VA) and retinal reattachment was analyzed. A grading system was established to stage the severity of the baseline vitreoretinal traction or detachment and compare the visual and anatomic outcomes between stages. Results: The study comprised 79 eyes (79 patients). The overall redetachment rate was 10.1% (8/79). The proportion of eyes with severe visual impairment (worse than 20/200) decreased from 81.0% (64/79) preoperatively to 56.9% (37/65) 6 months postoperatively (P < .001). Worse preoperative logMAR VA was associated with greater odds of redetachment (P = .017) and worse postoperative VA (P < .001). Insulin dependence was associated with better VA at 6 months (P = .017). A shorter known duration of diabetes (P = .026) and evidence of neovascularization of the iris (NVI) or angle (P = .004) were associated with worse visual outcomes. Eyes with detachment involving the posterior pole extending beyond the equator had worse VA at 6 months (P = .048). Conclusions: The primary reattachment rate after 27-gauge PPV was 89.9%. There was significant VA improvement, with a roughly 40% reduction in the number of eyes with severe visual impairment by the final follow-up. Insulin dependence, duration of diabetes, presence of NVI before surgery, and baseline posterior pole detachment extending beyond the equator were predictors of visual outcomes.

Real-Life Experience and Predictors of Visual Outcomes with Intravitreal Brolucizumab Switch for Treatment of Neovascular Age-Related Macular Degeneration

Introduction: To analyze visual and anatomical outcomes after switch to intravitreal brolucizumab therapy in eyes affected by neovascular age-related macular degeneration (nAMD) previously treated with other intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents. Methods: Retrospective study of eyes with nAMD that underwent intravitreal brolucizumab at San Raffaele Hospital (Milan, Italy) or San Rocco Clinical Institute (Ome, Italy) between January 2021 and July 2022. All study eyes had persistent residual retinal fluid after receiving at least 3 intravitreal injections of other anti-VEGF agents prior to switch to brolucizumab. Results: Among 66 eyes from 60 patients (35 males; mean age 76.5 ± 7.4 years) with nAMD, 43 (65.2%) eyes received a complete loading dose of 3 brolucizumab injections, while 15 (22.7%) and 8 (12.1%) eyes were treated with 2 or 1 brolucizumab injections, respectively. The average number of brolucizumab injections was 2.5 during 4.0 ± 2.0 months (mean interval between two injections of 51.2 days). Lower letter gains (<5 letter improvement from baseline) were found in eyes that did not complete a loading dose, after a greater number of previous anti-VEGF injections, after a longer duration of disease, and in eyes with a greater rate of macular atrophy at baseline. No serious ocular or systemic adverse events were found after switch to brolucizumab. Conclusion: nAMD eyes with persistent residual retinal fluid despite frequent anti-VEGF treatment can still gain functional and anatomical improvements after switch to brolucizumab therapy. Despite a relevant heterogeneity in patients’ response to brolucizumab, we identified potential biomarkers for functional and anatomical improvement.

Assessment of the effect of Posterior Sub-capsular cataract on the refractive status of the eye at the outpatient department of Hayatabad Medical Complex, Peshawar

Introduction: Cataract-induced refractive change is the refraction change caused by a cataract. It can reach multiple diopters (D). It modifies expected refraction errors during cataract surgery by modifying axial length measurement.&#x0D; Objective: To find the effect of the Posterior subcapsular Cataracts on the refractive status of the eye.&#x0D; Methodology: A cross-sectional study was progressed in Eye OPD in Hayatabad Medical Complex, Peshawar. 102 patients having Posterior Subcapsular Cataracts were part of this study. The anterior segment was examined with a slit lamp for evaluation of the posterior subcapsular cataract. The refractive status of an eye having a posterior subcapsular cataract was determined using Retinoscopy and subjective refraction techniques. The axial length of the eye was measured using A-Scan. Keratometric reading was measured using Keratometer.&#x0D; Results: A total of 102 patients were included in this study. Of these, 27 were males and 75 were females. The mean age was 60.5 years with 5.8SD. Results from the study showed refractive error due to Posterior Subcapsular Cataracts were mainly myopic astigmatism and spherical myopia with 0.16SD. Patients with PSCs had myopic astigmatism with a mean value of (1.7diopters, 15.7%) with 0.93SD and spherical myopia with a mean value of (0.1D, 2.9%) with 0.67SD. &#x0D; Conclusion: The most common refractive error found in PSCs was Astigmatism followed by Myopia. These results may help to clarify the types of refractive errors in patients with PSCs and the prediction of visual outcomes with spectacles.

Epidemiology and Predictors of Visual Outcome in Patients with Occupational Eye InjuriesA Prospective Observational Study

Introduction: Work Related Eye Injuries (WREI) constitute majority of eye injuries affecting younger age group. Trauma mainly affects people from lower socioeconomic background. People having workplace related eye injuries have an added financial burden. Challenges with respect to workplace related eye injuries include lack of occupational safety and health cover, lack of related information about pattern and exact incidence and management protocols. Aim: To study epidemiological profile, risk factors and predictors of visual outcome in occupational eye injury patients. Materials and Methods: This prospective observational/cohort study was conducted in Department of Ophthalmology, at Rajiv Gandhi Medical college and CSM Hospital, Kalva, Thane between October 2020 to February 2022. Study population included 42 patients having occupational eye injuries. After obtaining written informed consent, detailed history regarding their occupation, mode of injury and awareness and history of use of any Protective Eye Device (PED) at the time of injury was noted. Best Corrected Visual Acuity (BCVA), detailed anterior segment examination and fundus examination was done. Ocular injury was classified as Open Globe Injury (OGI) or Closed Globe Injury (CGI) and ocular trauma scale was calculated. Patients were treated medically or surgically as indicated and followedup next day and subsequently BCVA was noted and progress at each follow-up till six months was recorded. Factors related to good visual outcome (better or equal to 6/24) and bad visual outcome (visual acuity worse than 6/24) were identified. Continuous variables were described as the mean and variation of each observation from the mean value (Standard deviation) represented as mean±SD (analysed using independent t-test). Univariate analysis was done for identifying factors associated with bad visual outcome and p-value of &lt;0.05 was considered significant. Results: Forty-two patients were included in study (40 males and 2 females). There were 21 patients each in OGI and CGI. Most commonly affected were construction workers- 15 (35.72%). A total of 45% workers had access to PED at workplace but none of them used them. Univariate analysis showed open-globe injury, Zone-1 injury, presence of iris prolapse, traumatic cataract, vitreous prolapse/RD were related to bad visual outcome (&lt;6/24). At six months, the median logMAR BCVA improved significantly from logMAR 0.8 to 0.18 (0-1.3) (p=0.0002). Conclusion: Occupational ocular trauma is commonly seen in younger males. Poorer visual outcomes are associated with OGI and Zone-1 injuries, presence of iris prolapse, traumatic cataract, vitreous prolapse/retinal detachment. Lack of use of protective eye gear was universally noted along with its unavailability in many places. Conducting regular educational programs on ocular safety at workplaces, sensitising the workers and their employees regarding the hazards of ocular trauma and strict implementation of mandatory use of eye protective devices is recommended.

Time to steroids impacts visual outcome of optic neuritis in MOGAD

BackgroundTo characterise the response to treatment of inaugural optic neuritis (ON) in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).MethodsWe searched the French MOGAD database for adults with inaugural ON...

Commentary: Indistinct retinal outer layers in the walls of idiopathic full thickness macular hole - A potential predictive biomarker for surgical outcomes.

Commentary: Indistinct retinal outer layers in the walls of idiopathic full thickness macular hole - A potential predictive biomarker for surgical outcomes.

Prognostic Factors for Visual Outcomes in Acute Anterior Optic Neuritis Using Optical Coherence Tomography

Purpose: To identify the clinical characteristics and predictors of visual outcomes in acute anterior optic neuritis patients treated with high-dose steroid pulse therapy using spectral domain optical coherence tomography (SD-OCT).Methods: In this study, the medical records of 34 acute anterior optic neuritis patients treated with intravenous high-dose steroid pulse therapy and followed-up for at least 3 months were retrospectively reviewed. The patients were divided into two groups based on the final best-corrected visual acuity (BCVA); group 1 (n = 23) had a final BCVA ≥20/32, while group 2 (n = 11) had a final BCVA &lt;20/32. Clinical characteristics and optical parameters obtained using SD-OCT were evaluated to identify factors influencing the final visual outcome.Results: There were no statistically significant differences in clinical or demographic data between the two groups. Peripapillary retinal nerve fiber layer (pRNFL) swelling at initial presentation was less common (p = 0.015), and the time to pRNFL thickness stabilization was longer (p = 0.016), in group 1. Multivariate logistic regression demonstrated better final visual acuity for patients in whom pRNFL thickness stabilization took longer, as well as in those with a smaller reduction in macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and those without recurrence (p = 0.002, 0.016, and 0.035, respectively).Conclusions: Intravenous high-dose steroid pulse therapy much improved long-term visual outcomes in acute anterior optic neuritis patients with delayed pRNFL thickness stabilization, a smaller mGCIPL thickness reduction, and no recurrence. This suggests that inner retinal layer thickness and recurrence after stabilization may serve as biomarkers for final visual acuity after intravenous steroid treatment in acute anterior optic neuritis.

Outcome of Cataract Surgery in Patients With Retinitis Pigmentosa

To assess the visual outcome of cataract surgery in patients with retinitis pigmentosa (RP). Retrospective, noncomparative clinical study. Preoperative, intraoperative, and postoperative data of patients with RP who were undergoing cataract surgery were collected from several expertise centers across Europe. In total, 295 eyes of 225 patients were included in the study. The mean age at surgery of the first eye was 56.1 ± 17.9 years. Following surgery, best-corrected visual acuity (BCVA) improved significantly from 1.03 to 0.81 logMAR (ie, 20/214 to 20/129 Snellen) in the first treated eye (-0.22 logMAR; 95% CI=-0.31 to -0.13; P < .001) and from 0.80 to 0.56 logMAR (ie, 20/126 to 20/73 Snellen) in the second treated eye (-0.24 logMAR; 95% CI=-0.32 to -0.15; P < .001). Marked BCVA improvements (postoperative change in BCVA of ≥0.3 logMAR) were observed in 87 of 226 patients (39%). Greater odds for marked visual improvements were observed in patients with moderate visual impairment or worse. The most common complications were zonular dialysis (n=15; 5%) and (exacerbation of) cystoid macular edema (n=14; 5%), respectively. Postoperative posterior capsular opacifications were present in 111 of 295 eyes (38%). Significant improvements in BCVA are observed in most patients with RP following cataract surgery. Baseline BCVA is a predictor of visual outcome. Preoperative evaluation should include the assessment of potential zonular insufficiency and the presence of CME, as they are relatively common and may increase the risk of complications.

Prediction of Visual Outcomes After Diabetic Vitrectomy Using Clinical Factors From Common Data Warehouse.

PurposeWe sought to analyze the visual outcome and systemic prognostic factors for diabetic vitrectomy and predicted outcomes using these factors.MethodsThis was a multicenter electronic medical records (EMRs) review study of 1504 eyes with type 2 diabetes that underwent vitrectomy for proliferative diabetic retinopathy at 6 university hospitals. Demographics, laboratory results, intra-operative findings, and visual acuity (VA) values were analyzed and correlated with visual outcomes at 1 year after the vitrectomy. Prediction models for visual outcomes were obtained using machine learning.ResultsAt 1 year, VA was 1.0 logarithm of minimal angle resolution (logMAR) or greater (poor visual outcome group) in 456 eyes (30%). Baseline visual acuity, duration of diabetes treatment, tractional membrane, silicone oil tamponade, smoking, and vitreous hemorrhage correlated with logMAR VA at 1 year (r = 0.450, −0.159, 0.221, 0.280, 0.067, and −0.105; all P ≤ 0.036). An ensemble decision tree model trained using all variables generated accuracy, specificity, F1 score (the harmonic means of which precision and sensitivity), and receiver-operating characteristic curve area under curve values of 0.77, 0.66, 0.85, and 0.84 for the prediction of poor visual outcomes at 1 year after vitrectomy.ConclusionsVisual outcome after diabetic vitrectomy is associated with pre- and intra-operative findings and systemic factors. Poor visual outcome after diabetic vitrectomy was predictable using clinical factors. Intensive care in patients who are predicted to result in poor vision may limit vision loss resulting from type 2 diabetes.Translational RelevanceThis study demonstrates that a real world EMR big data could predict outcome after diabetic vitrectomy using clinical factors.

Cataract Surgery in Uveitis: Risk Factors, Outcomes, and Complications

To determine the outcomes of cataract surgery in eyes with uveitis, including the rates of intraoperative and postoperative complications, as well as predictors of visual outcomes. Retrospective observational cohort study. Setting: Tertiary public hospital setting in Auckland, New Zealand, between 2008 and 2020. Patients who underwent cataract surgery following a diagnosis of uveitis.Main observation Procedures: Additional intraoperative procedures, intraoperative and postoperative complications, and postoperative visual outcomes and complications. 471 eyes of 371 subjects were included. Median duration of uveitis prior to cataract surgery was 3.0 years (interquartile range [IQR] 5.2) and median period of quiescence prior to surgery was 1.0 years (IQR 1.5). Additional procedures (posterior synechiae peel [32.3%] and vision blue [18.1%]) were common. Intraoperative complications occurred in 32 eyes (6.8%). Consultants were the primary surgeons in the majority (82.5%) of operations. By 12 months, visual acuity was 20/50 or better in 248 eyes (79.7%). The most common postoperative complication was uveitis flare, occurring in 56.5%. On Cox proportional hazards analysis, time quiescent was associated with reduced risk of flare (HR 0.794, P=.003). Postoperative cystoid macular edema (CME) developed in 45 eyes (9.6%), with no significant predictors identified on multivariate analysis. Cataract surgery in uveitis is complex. In the hands of the surgically experienced, rates of intraoperative complications are low. The primary challenge is managing postoperative care as we report a high rate of uveitis relapse and CME. Careful monitoring is important as complications can be unpredictable and occur later than expected.

A modified pediatric ocular trauma score for predicting visual outcome post open globe injury.

To construct a new pediatric ocular trauma score for predicting visual outcome after open globe injuries (OGI) and to compare it to the ocular trauma score (OTS) and pediatric ocular trauma score (POTS). This is a retrospective chart review study. For each case, the following data were collected: demographics, mechanism of the injury, initial ophthalmologic findings, presented and last follow-up visual acuity (VA), ocular treatments, and final ocular findings. We then analyzed the risk factors for the poor visual outcome (VA ≤ 20/200), and a modified pediatric ocular trauma score (MPOTS) was constructed accordingly and compared to the OTS and POTS for predicting poor outcome. Finally, a different cohort of pediatric OGIs was used for score validation. Forty-five cases were included, significant predicting factors for poor visual outcome were initial VA ≤ 20/200, zone 2-3 locations of injury, presence of retinal detachment, vitreous hemorrhage, hyphema, and iris prolapse at initial presentation. The calculated Spearman correlation coefficients between each system score and poor visual outcome were OTS 0.56, POTS 0.57, and MPOTS 0.64 (P < 0.001 for all). A total of 71 new cases were used as validation cohort, and calculated Spearman correlation coefficients between each system score and poor visual outcome were: OTS 0.50, POTS 0.51, and MPOTS 0.53 (P < 0.001 for all). We suggest a new scoring system for predicting poor final visual outcomes after OGI's in children, which is simpler and more clinically suitable for this study population. It was found to be a better predictor of visual outcome in this scenario compared with existing scoring systems.

Optical coherence tomography angiography as predictor of visual outcomes in retinal vein occlusion treated with antiangiogenic therapy.

Evaluate optical coherence tomography angiography (OCT-A) features in retinal vein occlusions (RVO) associated with visual outcomes after anti-VEGF. Analytical observational study performed in eyes with macular edema secondary to RVO treated with anti-VEGF, with at least 6 months of follow-up. Bradley et al. classification of macular ischemia was used. Logistic regression analysis was used to investigate associations between final best-corrected visual acuity (BCVA) and OCT-A. A total of 62 eyes, 61 subjects, mean age of 70 ± 12,6 years were included. Median follow up time 21,2 months (IQR 24.8), 53,2% had central retinal vein occlusion (CRVO) and 46,8% branch retinal vein occlusion (BRVO). Median BCVA pre-treatment was 0,84 logMAR (IQR 0,83) and post-treatment 0,47 logMAR (IQR 0,52). BCVA improved at the end of follow-up (p = 0,01), as well as central retinal thickness (CRT) (p = 0,02). Regarding capillary densities (CD), there was a decrease for both plexus, Superficial CD (p = 0,01) and Deep CD (p = 0,01), being more involved the superficial plexus. The lower the capillary density in both plexus, the worse BCVA, Superficial CD (r - 0,27, p = 0,03) and Deep CD (r - 0,29, p = 0,02). Media FAZ pre-treatment was 0,30 mm2 (IQR 0,23), with enlargement to 0,37 mm2 (IQR 0,32) (p = 0,01) post-treatment. Preservation of External Limiting Membrane/ Ellipsoid Zone (ELM/EZ) was seen in 60% of subjects (n = 37). The majority had grade 3 macular ischemia. Variables that best explain visual results were, baseline visual acuity (p = 0,01), pre-treatment CRT (p = 0,02) and pretreatment foveal superficial CD (p = 0,02). Variables that best explain final vision after anti-VEGF were baseline visual acuity, CRT and foveal superficial CD.

Endogenous endophthalmitis among people with diabetes; a review

Although endogenous endophthalmitis (EE) among diabetic individuals (DEE) is uncommon, the prevalence of the condition has recently increased due to better intensive healthcare services available and increased longevity of critically ill patients with systemic infections. The existing literature was critically reviewed on DEE and its present incidence, risk factors, causative organisms, management, outcomes, and proposed measures to improve its public health approach. This review is of critical importance, as the COVID-19 pandemic has increased the risk of EE for diabetic patients as a result of a systemic infection. Aggressive glycemic control is concurrent with patient care for DEE management, which requires lifelong maintenance. Early detection and standard management are crucial for patients&amp;apos; visual recovery. Still, a guarded prognosis is given to patients and relatives as outcomes are not always predictable. There is a need for the teamwork of ophthalmologists with other health professionals and patients throughout the management. The causative organisms, early pharmacotherapy suitable for the identified organisms, and pars plana vitrectomy are predictors of visual outcomes. DEE patients need lifelong eye care.