Prognosis Of Visual Acuity Research Articles

Treatment and management of orbital tumors

There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. This article gives asummary of the possible treatment options for the most common orbital tumors in childhood and adulthood. Aliterature search was carried out and the possible treatment pathways are presented. 1.Frequent orbital tumors in childhood: asystemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is apossible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2.Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is avery effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. There are now very effective conservative treatment options for many orbital tumors. In some cases asurgical procedure can be avoided and agood visual function can be retained.

Association Between the Types of Posterior Staphyloma and Their Risk Factors in Pathological Myopia.

PurposeThe purpose of this study was to investigate the relationship of posterior staphyloma (PS) types in pathological myopia (PM) with age, best-corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and myopic retinoschisis (MRS) using three-dimensional magnetic resonance imaging (3D-MRI) and optical coherence tomography (OCT).MethodsThis retrospective, cross-sectional study included 108 eyes of 59 patients with PM from the Henan Eye Institute, China. We classified the PS types based on current international classification criteria and analyzed the risk factors (age, AL, MRS, and BCVA).ResultsMost of the patients with bilateral PM had the same PS type (80.43%) in both eyes. Complex PS was more common in elderly patients than in younger patients (P < 0.05). Eyes with wide macular PS had a longer AL (P = 0.012) and worse BCVA (P = 0.049) than those with other PS types. MRS was always comorbid with PS (93.33%), and macular PS was the most common (82.14%).ConclusionsComplex PS is associated with patient age. PS is related to MRS, and these changes observed by 3D-MRI and OCT affect the prognosis of visual acuity. The 3D-MRI scans shows changes in the eye shape and PS efficiently.Translational RelevanceIn patients with PM, 3D-MRI can guide the planning of posterior scleral reinforcement.

Vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in eastern China

BackgroundTo evaluate the effect and prognostic factors of vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in Eastern China.MethodsWe retrospectively reviewed the medical records of patients who developed fungal endophthalmitis after penetrating ocular trauma at an ophthalmic center in Eastern China. All patients underwent vitrectomy and intravitreal injection of antifungal drugs.ResultsThirty-five patients (35 eyes) were included. Twelve eyes suffered plant trauma, 17 eyes metal trauma, and 6 eyes other trauma. The culture results for all 35 eyes showed filamentous fungi, including Aspergillus in 26 eyes (74.3%). Twenty-three eyes underwent vitrectomy once and 12 eyes were treated twice. Four eyes were iridectomized because of a fungal lesion behind the iris. Fungal endophthalmitis was effectively controlled in 33 eyes (94.3%), whereas 2 eyes were ultimately enucleated. Visual acuity was significantly better after treatment than before treatment (P = 0.0006). According to the preoperative vision, the affected eyes were divided into two groups: group 1A (light perception) and group 1B (better than light perception). The final visual acuity in group 1B was significantly better than that in group 1A (P = 0.0289).ConclusionsVitrectomy combined with intravitreal antifungal therapy is an effective treatment for posttraumatic fungal endophthalmitis. Preoperative visual acuity is a significant factor affecting the prognosis of visual acuity.

Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries.

To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 - 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.

Influence of CNV vascular morphology in exudative age-related macular degeneration on development of visual acuity and need for anti-VEGF therapy after 1 year

The aim of this pilot study was to investigate vascular morphological characteristics of choroidal neovascularization (CNV) at the time of the initial diagnosis of exudative age-related macular degeneration (nAMD), which enable a prognosis for the development of visual acuity and the necessity for treatment in the first year. In 57patients with the initial diagnosis of nAMD, CNV was detected by optical coherence tomography angiography (OCT-A) and an automated quantitative vessel analysis was performed with respect to area, total vessel length, flow value and average vessel caliber of the CNV. After 12months patients were divided into 2 groups based on visual acuity (visual loss vs. visual gain) and necessity of anti-VEGF therapy (<7 intravitreal injections, IVOM vs. ≥7 IVOM). The mean CNV area was 0.95 mm2 ± 1.07 mm2 (group visual loss 1.56 mm2 ± 1.54 mm2; group visual gain 0.65 mm2 ± 0.53 mm2; p = 0.002/<7 IVOM 1.05 mm2 ± 1.40 mm2; ≥7 IVOM 0.98 mm2 ± 0.94 mm2, p = 0.60). The average total vessel length of the CNV was 9.84 mm ± 11.35 mm (visual loss 16.00 mm ± 16.58 mm; visual gain 6.74 mm ± 5.42 mm; p < 0.003/<7 IVOM 11.21 mm ± 15.10; ≥7 IVOM 9.90 mm ± 9.68 mm; p = 0.68). The mean flow value of the CNV was 0.40 ± 0.06 (visual loss 0.37 ± 0.04; visual gain 0.41 ± 0.07; p = 0.004/<7 IVOM 0.42 ± 0.08; ≥7 IVOM 0.38 ± 0.06; p = 0.02). The average vessel caliber was 28.86 µm ± 2.93 µm (visual loss 28.39 µm ± 2.97 mm; visual gain 29.32 µm ± 3.05 µm; p = 0.24/<7 IVOM 30.26 µm ± 3.49 µm; ≥7 IVOM 28.23 µm ± 2.25 µm; p = 0.02). The results show that amathematical quantification of the CNV in nAMD is possible using OCT‑A. This analysis confirmed again that the size of the CNV (area and total vessel length) is decisive for the prognosis of visual acuity. It also shows that alarger flow value as asign of awell-differentiated CNV is associated with abetter functional prognosis. The number of IVOMs required, however, depends primarily on the composition of the CNV (flow value and vascular caliber). More precise imaging and larger examination cohorts could possibly reveal further relevant biomarkers.

Correlation of Baseline Visual Acuity with Outcomes of Treatment with Anti-VEGF in Neovascular Age-Related Macular Degeneration.

PurposeNeovascular age-related macular degeneration (nv-AMD) is the leading cause of blindness in individuals 55 years and older. The advent of anti-vascular endothelial growth factor (anti-VEGF) therapy has greatly altered the visual acuity (VA) prognosis in these patients. While many studies have described treatment outcomes, few have explored the impact of early detection on VA outcomes.Patients and MethodsThis retrospective cohort study consisted of treatment-naïve eyes with nv-AMD (ICD9 diagnosis code 362.52) that were treated with bevacizumab, ranibizumab, and aflibercept by four physician investigators in a large urban tertiary center from March 2008 to October 2015. Eyes were categorized by baseline VA into good (20/50 or better), intermediate (20/50–20/200), and poor (20/200 or worse) initial VA. VA and optical coherence tomography (OCT) findings were evaluated throughout the treatment period.Results224 eyes were evaluated. Of eyes with good, intermediate, and poor initial VA, 14.1%, 37.2%, and 58.3% showed an increase in 2 or more lines of vision on LogMAR, respectively [p < 0.001], while 71.8%, 40.7%, and 16.7% of eyes had a final VA of 20/50 or better, respectively [p < 0.001]. Average final Snellen VA in eyes with good, intermediate, and poor initial VA was 20/47, 20/96, and 20/277, respectively. Change in VA for good, intermediate, and poor initial VA groups was ΔLogMAR of +0.117, +0.041, and −0.230, respectively. Of eyes with good, intermediate, and poor baseline VA, 42.3%, 20.9%, and 20.0%, respectively, showed resolution of fluid on OCT [p = 0.003].ConclusionPatients with good initial VA were more likely to maintain good vision and show resolution of fluid on OCT through follow-up. Patients with poor initial VA tended to gain more vision, however, had poorer final VA. This underscores the importance of early detection and treatment of nv-AMD in maintaining superior outcomes.

Analysis of Prognostic Factors for the Indirect Traumatic Optic Neuropathy Underwent Endoscopic Transnasal Optic Canal Decompression.

This study aimed to investigate the clinical outcomes of endoscopic transnasal optic canal decompression (ETOCD) for patients with indirect traumatic optic neuropathy (TON) and identify the relevant prognostic factors. Seventy-two indirect TON patients who underwent ETOCD surgery from August 2017 to May 2019 were analyzed retrospectively. The paired t-test was used to compare the visual acuity (VA) before and after ETOCD, and multiple linear regression analysis was used to distinguish the potential prognostic factors. Among the patients analyzed, postoperative VA (-2.87 ± 0.19) was significantly higher than the preoperative VA (-3.92 ± 0.13) (P < 0.05). Multiple linear regression analysis models showed that poor initial VA and longer time to surgery were independent risk factors for VA prognosis (P < 0.05), but surgical time alone was significantly associated with the improvement degree of visual acuity (IDVA) (P < 0.05). Optic canal fracture, orbital fracture, and hemorrhage within the ethmoid and/or sphenoid sinus were not significantly correlated with IDVA and VA prognosis (P > 0.05). ETOCD surgery could salvage VA impairment in patients with indirect TON. A better initial VA indicates better final VA outcomes after surgery. Additionally, shorter time to surgery implies better VA prognosis and higher IDVA.

Clinical analysis of pediatric ocular trauma

Objective To analyze the clinical characteristics of pediatric ocular trauma. Methods A retrospective study. Clinical data of 165 eyes of 164 cases with ocular trauma aged 0-14 years in the Second Affiliated Hospital of Chongqing Medical University from Apr. 2009 to Apr. 2019 were analyzed. All patients were compared according to age, sex, time of injury, population distribution, causes, types of trauma, complications and efficacy of treatment. Results The incidence of pediatric ocular trauma in boys was higher than that in girls and the incidence was higher in rural areas than that in cities. The ocular trauma was more common in children aged 3-8 years. Penetrating injury was the most common type, and traumatic cataract often occurred in ocular trauma. The following types were ocular contusion and ocular adnexal trauma. There were varieties of vulnerant, and the most injury were caused by implements, including knives, sticks, broken bowl, glass, pebble and so on. The visual acuity were improved to different extent after timely treatment. Conclusion The focus of prevention and treatment of pediatric ocular trauma in different age groups are different. Early treatment will improve the prognosis of visual acuity. Key words: Trauma, ocular, pediatric; Complications; Prevention; Treatment

The clinical analysis of the ocular trauma caused by wood

Objective To analyze the clinical features and treatment of the ocular trauma caused by wood. Methods A total of 25 eyes of 25 cases with ocular trauma caused by wood from Aug. 2018 to Dec. 2018 in Affiliated Hospital of Weifang Medical University were retrospectively analyzed. Results There were 15 cases with closed ocular trauma, the complications included hyphema, lens injury and cyclodialysis cleft. There were 2 cases with 3 kinds of complications, 2 cases with 2 kinds of complications and 11 cases with only 1 kind of complication. All the 15 cases underwent lens surgery, and among them 4 cases received cilliary suture and 10 cases received vitrectomy combined with lens surgery. Among 10 cases with open ocular trauma, the range of injury in zone Ⅰ was 7 cases, 2 cases in zone Ⅱ and 1 case in zone Ⅲ. The 10 cases underwent one stage debridement and suturing, which combined with lens surgery in 4 cases, 2 cases with vitrectomy and 10 cases with vitrectomy and lens surgery. The difference was statistically significant between types of complications in group A and visual acuity impairment (P<0.05). The difference was statistically significant between locations of trauma and visual acuity impairment in group B (P<0.05). The difference in postoperative visual acuity was statistically significant between two groups. Conclusion With the increase of complications in closed ocular trauma, the visual impariment is obviously influenced. The range of injury is a significant factor affecting visual prognosis in open ocular trauma. The visual acuity of patient with injury in zoneⅠis better than that in zone Ⅱ and zoneⅢ. Open ocular trauma has a worse prognosis of visual acuity than that of closed ocular trauma. Key words: Trauma, ocular, wood; Severity, injury; Method, surgery

Near Complete Recovery of Visual Acuity After Calcium Hydroxylapatite Injection–Related Vision Loss

Injection of fillers has gained popularity over the past decades in aesthetic treatments. Calcium hydroxylapatite (CaHA; Radiesse) was introduced in the year 2003 and received approval from the Food and Drug Administration in 2006 for the treatment of moderate-to-severe wrinkles. The properties of CaHA include biostimulation, neocollagenesis, and stability over a long period. However, similar to other fillers, CaHA is associated with the risk of complications such as ecchymosis, inflammation, local infection, skin necrosis, and vascular occlusion. Iatrogenic vision loss remains the most devastating complication related to vascular occlusion. Development of vision impairment is associated with a relatively high risk of permanent damage to vision acuity and poor prognosis. The current report presents a case of a patient who suffered from skin necrosis, vision impairment, and ophthalmoplegia after the injection of CaHA into the nasal dorsum. Significant improvement in visual acuity was observed during hospitalization after the treatment. The patient recovered to near-normal visual acuity and completely recovered from ophthalmoplegia. We aimed to discuss the current treatment employed and review the literature on CaHA-related vision loss.

Prognostic factors for visual acuity in patients with Leber's hereditary optic neuropathy after rAAV2-ND4 gene therapy.

ImportanceFactors affecting visual acuity prognosis after gene therapy in Leber's hereditary optic neuropathy (LHON) patients with mutation at site 11 778 are unknown.BackgroundTo analyse correlations between visual acuity prognosis and baseline characteristics of LHON after rAAV2‐ND4 gene therapy.DesignRetrospective study.ParticipantsFifty‐three LHON patients with a mutation at site 11 778.MethodsSingle‐eye intravitreal injection of rAAV2‐ND4.Main Outcome MeasuresSex, onset age, duration of disease, best‐corrected visual acuity (BCVA), visual field index (VFI) and mean deviation (MD) were recorded for all patients at baseline. BCVA was recorded at 1‐ and 3‐month follow‐up visits after gene therapy. Correlations between BCVA prognosis and baseline characteristics were analysed by univariate analysis. Logistic regression analysis was performed on independent factors affecting BCVA prognosis.ResultsUnivariate analysis showed significant differences in the VFI and MD of the injected eye between BCVA improvement and non‐improvement groups after 3 months of treatment, with greater VFI and smaller absolute MD in the BCVA improvement group. Logistic regression showed that VFI and baseline BCVA were independent prognostic factors for visual acuity. The correlation between VFI and MD was statistically significant.Conclusions and RelevanceVFI and baseline BCVA were correlated with the visual acuity prognosis of LHON patients receiving gene therapy, with greater baseline VFI and better baseline BCVA predicting better visual acuity prognosis. MD was strongly correlated with VFI and might be correlated with gene therapy prognosis. This finding may form a basis for predicting the efficacy of gene therapy in these patients and guiding subsequent treatment.

Long-term visual acuity in patients with optic pathway glioma treated during childhood with up-front BB-SFOP chemotherapy-Analysis of a French pediatric historical cohort.

BackgroundVisual outcome is one of the main issues in the treatment of optic pathway glioma in childhood. Although the prognostic factors of low vision have been discussed extensively, no reliable indicators for visual loss exist. Therefore, we aimed to define initial and evolving factors associated with long-term vision loss.MethodsWe conducted a multicenter historical cohort study of children treated in France with up-front BB-SFOP chemotherapy between 1990 and 2004. Visual acuity performed at the long-term follow-up visit or within 6 months prior was analyzed. Logistic regression analysis was used to estimate the effects of clinical and radiological factors on long-term visual outcome.FindingsOf the 180 patients in the cohort, long-term visual acuity data were available for 132 (73.3%) patients (median follow-up: 14.2 years; range: 6.1–25.6). At the last follow-up, 61/132 patients (46.2%) had impaired vision, and 35 of these patients (57.3%) were partially sighted or blind. Multivariate analysis showed that factors associated with a worse prognosis for long-term visual acuity were an age at diagnosis of < 1 year (OR 3.5 [95% CI: 1.1–11.2], p = 0.04), tumor extent (OR 4.7 [95% CI: 1.2–19.9], p = 0.03), intracranial hypertension requiring one or more surgical procedures (OR 5.6 [95% CI: 1.8–18.4], p = 0.003), and the need for additional treatment after initial BB-SFOP chemotherapy (OR 3.5 [95% CI: 1.1–11.9], p = 0.04). NF1 status did not appear as a prognostic factor, but in non-NF1 patients, a decrease in tumor volume with contrast enhancement after BB-SFOP chemotherapy was directly associated with a better visual prognosis (OR 0.8 [95% CI: 0.8–0.9], p = 0.04).InterpretationOur study confirms that a large proportion of children with optic pathway glioma have poor long-term outcomes of visual acuity. These data suggest new prognostic factors for visual acuity, but these results need to be confirmed further by large- and international-scale studies.

Results of pars plana vitrectomy with peeling of the inner limiting membrane in patients with laser-induced macular hole

Objective: To evaluate the results of pars plana vitrectomy (PPV) with peeling of the inner limiting membrane (ILM) in patients with laser-induced macular hole. Methods: The clinical data of 11 patients (12 eyes) with decreased visual acuity due to laser-induced macular hole from January 2014 to December 2017 were retrospectively studied.All patients underwent routine examination, fundus photography and optical coherence tomography (OCT). Patients were observed every two weeks. PPV with ILM peeling was performed when macular hole was enlarged. Closure of macular hole, pre- and post-operation visual acuity were observed. Results: A total of 11 male patients (12 eyes)aged (18±4) years were included in the study.Laser instruments which lead to macular hole consisted of laser toy (3 eye), laser pen (4 eye), laser torch (1 eye) and cosmetic laser instrument (4 eyes). All patients were followed up every two weeks and evaluated by OCT. None of the macular hole was spontaneously closed in this study. All Macular holes were enlarged in 1-3 months of follow-up and underwent PPV with ILM peeling immediately. All of the macular hole with PPV and ILM peeling were completely closed. During follow-up, the best-corrected visual acuity(BCVA) of 10 eyes (10/12) were found to increase above 3 lines and BCVA of 7 eyes(7/12) were found to be more than 0.5. Only 1 eye maintained the same visual acuity after the surgery which might be due to long course, large macular hole diameter (850 μm) and serious retinal pigment epithelium (RPE) damage. Conclusion: Early PPV with ILM peeling for laser induced macular hole might benefit for the closure rate of macular hole and better visual acuity prognosis.

Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy.

To investigate a possible correlation between visual acuity (VA) prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy (ITON). From July 1st, 2012 to July 1st, 2015, 224 adults diagnosed with ITON who underwent endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) were reviewed. Visual outcome before and after treatment were taken into comparison. Accompanied older in age, longer time to medical treatment and existence of optic canal fracture (OCF) were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity (IDVA), while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF (t=2.272, P<0.05). Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.

The relationship between optical coherence tomography performance and visual acuity of acute retinal necrosis

Objective: To analyze the relationship between optical coherence tomography(OCT) performance and visual acuity of patients with acute retinal necrosis (ARN). Methods: Retrospective analysis was performed on the patients diagnosed with ARN at the ophthalmology department of Peking union hospital during October 2011 and May 2016. Fourteen patients (15 eyes), 9 males and 5 females, whose anterior and posterior inflammation disappeared and the retinal necrosis lesion in the fundus of the eye subsided were included. The mean age was (41.6±12.2) years. All patients underwent careful examinations including best corrected visual acuity (BCVA), slit-lamp microscope, indirect ophthalmoscope, color fundus picture, fundus fluorescein angiography (FFA) and OCT (results of their last consultations). Results: BCVA: 8 eyes were increased, 2 eyes were unchanged and 5 eyes were decreased at the last visit; light perception (LP) 1 eye, finger count (FC) 1 eye, 3 eyes of 0.01 to 0.1, 6 eyes of 0.15 to 0.25. The inflammatory reaction in the anterior segment of 14 eyes disappeared, while the inflammatory reaction of the remaining 1 eye was relieved. The fundus lesions of all 15 eyes disappeared. According to OCT results: five eyes (5/15) exhibited normal macula area, among the 5 eyes, 4 eyes are of 0.15 to 0.25 visual acuity, and 1 eye is of 0.5 visual acuity;macular epiretinal membrane is present in three eyes (3/15), of which the visual acuity is 0.02, 0.25 and 0.3 respectively macula edema is present in three eyes (3/15), among the 3 eyes, 1 eye (visual acuity of 0.01)showed thickening of neurosensory retina, cystoid change of fovea and several fluid dark areas, the other 2 eyes (visual acuity of 0.02 and 0.5 respectively) showed small diffuse fluid dark area in the neurosensory retina;atrophy of neurosensory retina and absence of IS/OS was found in four eyes (4/15), among the 4 eyes, the visual acuity of 3 is below 0.01, and the other 1 eye is of 0.08 visual acuity. Conclusions: The OCT performance of stationary phase of ARN tends to be positively correlated with the visual acuity of patients. The prognosis of visual acuity of the patients whose OCT results showed atrophy of neurosensory retina and absence of IS/OS is poor. (Chin J Ophthalmol, 2018, 54: 369-374).

Clinical characteristics and surgical efficacy of endogenous endophthalmitis

Objective To evaluate the efficacy of vitrectomy for the treatment of endogenous endophthalmitis. Methods The data of 12 eyes of 12 cases with endogenous endophthalmitis from Aug. 2014 to Aug. 2017 were collected.The clinical characteristics, surgery treatment and its efficacy were retrospectively analyzed. Results The age of 12 patients ranged from 32 to 75 years, average (53.67±3.09) years.There were 8 (66.67%) males and 4 (33.3%) females.Eight cases (66.67%) were right eyes and 4 cases (33.33%) were left eyes.Endogenous endophthalmitis with systemic disease was in 9 patients (75.00%), positive culture outcome happened in 5 cases (41.67%), 2 eyes were misinterpreted as non-infectious uveitis at first visit.All cases underwent pars plana vitrectomy(PPV) combined with silicone oil tamponade. The infection was controlled after surgery in 10 eyes (83.33%) and 2 eyes (16.67%) received evisceration of eyeball due to recurrent infection.After surgery, visual acuity was from counting fingure to 0.3 in 7 eyes.One eyes infected by Candida got the best vision acuity. Conclusion The patients with endogenous endophthalmitis generally have systemic predisposing factors. There is no specific clinical feature and the prognosis of visual acuity is poor.Antibiotic therapy and vitrectomy combined with silicone oil tamponade can control infection effectively and achieve better efficacy. Key words: Endophthalmitis, endogenous; Vitrectomy; Silicone oil; Efficacy

児童・思春期における機能性視覚障害について : 眼球運動検査と視力・視野の短期予後検査の結果を中心に

児童・思春期における機能性視覚障害について : 眼球運動検査と視力・視野の短期予後検査の結果を中心に

Langzeitprognose der Peters-Anomalie

Peters anomaly normally presents in early childhood. Common features are central corneal opacities and dysgeneses of the anterior eye segment. Early surgery is commonly warranted to prevent deep amblyopia or because of severe glaucoma. We herein present the clinical outcomes of all patients treated in the Eye Center of the Albert Ludwigs University of Freiburg since 2005. Emphasis is placed on the Peters subtype. Data were collected retrospectively by means of chart review. Kaplan-Meier analyses were used to estimate visual prognosis, the indication for keratoplasty, and the incidence of retinal detachment. Atotal of 23patients were identified. Subtype distribution was 40% type1, 50% type2, and 10% Peters plus syndrome. Ten patients were female (45%). Mean age at first presentation was 5years; mean follow-up period censored in terms of eyeball preservation was 2years (0months-8years). At mean follow-up, 40.5% of all patients had undergone at least one keratoplasty (up to six per eye); 43% had undergone glaucoma surgery (cylophotocoagulation, trabeculectomy, implants) at this time. Important complications were retinal detachment (31%) and phthisis bulbi (15%). After 4years, visual acuity in the better eye was at most 0.05 in every second patient. Prognosis of visual acuity in Peters anomaly is poor. It is generally not possible to restore visual function in the long run, i. e., reading-grade visual acuity is rarely achieved. Surgical interventions are associated with a high risk of severe complications. Therefore, the young patients should be connected to institutions for visually impaired persons at an early stage.

Retinal Vein Occlusion - Which Treatment When?

According to the latest findings, macular oedema due to retinal vein occlusion is best treated safely and effectively with near-term intravitreal anti-VEGF therapy (aflibercept, bevacizumab [off label], ranibizumab). After an initial upload of 3monthly injections of anti-VEGF, the decision on re-injection should be based on OCT (rather than on visual acuity). After initial monthly injections, the "pro-re-nata" (PRN) and the "treat-and-extend" regimens have been predominantly used in the further course of therapy. Taking into account the side effect spectrum (in particular cataract progression, increased intraocular pressure), intravitreal therapy with a dexamethasone implant may be a reasonable alternative. The prognosis for visual acuity and the decline in macular oedema depend on starting treatment early and continuing it consistently. Before starting treatment, as well as during treatment, fluorescein angiography is necessary to detect ischemic retinal areas. There is evidence that early targeted laser coagulation of ischemic retina may reduce the frequency of necessary injections and improve the response of the oedema to therapy. Significant retinal ischemia may lead to proliferations, rubeosis iridis and secondary glaucoma and therefore requires laser treatment.

Sonderformen choroidaler Neovaskularisationsmembranen

Choroidal neovascularisation (CNV) in the context of exsudative age-related macular degeneration (nAMD) can be divided into type 1 (occult) and type 2 (classical) membranes. Retinal angiomatous proliferation (RAP) or polypoidal choroidal vasculopathy (PCV) are "rare subtypes" of chorioretinal neovascularisation and are distinguished by their distinct morphology and the sometimes worse response to therapy. Chorioretinal anastomosis, severe exsudates with serosanguinous pigment epithelial detachment and, in PCV, orange-red lesions in the papillomacular bundle can be diagnostic. Indocyanine green angiography (ICGA) is considered the gold standard for diagnosis of PCV and delivers important information for RAP too. Typical characteristics of PCV include foci of hyperfluoresence, with pulsatile filling in the early phase. This characterises choroidal polypoidal lesions, often in connection with an abnormal choroidal vascular network. In RAP, typical retino-retinal anastomosis can be identified, in particular in areas with pigment epithelial detachment. Optical coherence tomography (OCT) can complement diagnostic testing. In cases of RAP, early therapy initiation with intravitreal anti-VEGF is crucial for the prognosis of visual acuity. PCV can exhibit spontaneous regression. In active disease, photodynamic therapy (PDT) is efficient in the closure of PCV polyps. In association with CNV, it makes sense to combine PDT and intravitreal anti-VEGF medication. In spite of the initial increase in visual acuity, this state is normally "only" stabilised in the long term. In patients with idiopathic secondary CNV membranes (high myopia, post-inflammatory, post-traumatic changes or in hereditary connective tissue diseases), small "classical" type 2 membranes are mostly involved. Hence, these are strictly speaking not directly rare subtypes. Nevertheless, these patients are mostly younger, with less protracted illness and limited available regeneration ability of the retinal pigment epithelium (RPE): they may therefore differ favourably from the courses with nAMD, with earlier inactivation and with fewer required anti-VEGF injections. CNV with angioid streaks are a special case in this group. Unfortunately, these lesions have a recurrent, protracted and, in the end, mostly frustrating course.