Recovery Of Acuity Research Articles

Central Serous Chorioretinopathy after Application of Topical Corticosteroid

Central serous chorioretinopathy (CRSC) is a pathology of the retina and the choroid characterized by a vanishing point causing sub-retinal fluid accumulation and focal retinal detachment. We report a case of a 40-year-old male patient followed for 5 years in dermatology for psoriasis treated with topical corticosteroids who presented to the emergency department for a visual acuity at 3/10 in his right eye associated with a macular syndrome. Several cases of corticosteroid-induced CRSC were found in the literature, but only few cases were found after application of topical corticosteroid. Optical coherence tomography was performed urgently and revealed central serous chorioretinitis. Treatment with topical corticosteroids was discontinued. The patient was seen a week later, with visual acuity recovery from 3/10 to 10/10, with improvement in macular syndrome.

Incidence and risk factors of progressive nasal inner nuclear layer thickening after surgical peeling of epiretinal membrane

To assess incidence and risk factors of postoperative progressive nasal inner nuclear layer (INL) thickening after epiretinal membrane (ERM) surgery. Progressive nasal INL thickening was defined as 1.5-fold increase in thickness of nasal INL after ERM surgery compared to preoperative examination. Kaplan–Meier survival analysis was done to compare the cumulative risk ratio between groups stratified by presence of progressive nasal INL thickening. Logistic regression was performed to identify possible risk factors. Progressive nasal INL thickening occurred in 13.0% of ERM removal patients. Patients without progressive nasal INL thickening showed better visual acuity recovery compared to patients with nasal INL thickening (p = 0.029). Presence of cystoid space in inner retinal layer before surgery (odds ratio [OR] = 0.143, 95% confidence interval [CI] 0.028–0.736; p = 0.020), older age (OR = 0.896, 95% CI 0.817–0.982, p = 0.020), and thicker preoperative central macular thickness (OR = 0.994, 95% CI 0.988–1.000, p = 0.039) were correlated inversely with thickening of nasal INL. Correlation between nasal INL thickness and postoperative visual outcome was significant. Absence of cystoid space before ERM surgery, younger age, and thinner central macular thickness were risk factors for progressive postoperative nasal INL thickening. Progressive nasal INL thickening may serve as a new biomarker for worsened visual symptom after ERM surgery.

Multifocal Electroretinogram Photopic Negative Response: A Reliable Paradigm to Detect Localized Retinal Ganglion Cells' Impairment in Retrobulbar Optic Neuritis Due to Multiple Sclerosis as a Model of Retinal Neurodegeneration.

The measure of the full-field photopic negative response (ff-PhNR) of light-adapted full-field electroretinogram (ff-ERG) allows to evaluate the function of the innermost retinal layers (IRL) containing primarily retinal ganglion cells (RGCs) and other non-neuronal elements of the entire retina. The aim of this study was to acquire functional information of localized IRL by measuring the PhNR in response to multifocal stimuli (mfPhNR). In this case-control observational and retrospective study, we assessed mfPhNR responses from 25 healthy controls and from 20 patients with multiple sclerosis with previous history of optic neuritis (MS-ON), with full recovery of visual acuity, IRL morphological impairment, and absence of morpho-functional involvement of outer retinal layers (ORL). MfPhNR response amplitude densities (RADs) were measured from concentric rings (R) with increasing foveal eccentricity: 0–5° (R1), 5–10° (R2), 10–15° (R3), 15–20° (R4), and 20–25° (R5) from retinal sectors (superior-temporal (ST), superior-nasal (SN), inferior-nasal (IN), and inferior-temporal (IT)); between 5° and 20° and from retinal sectors (superior (S), temporal (T), inferior (I), and nasal (N)); and within 5° to 10° and within 10° and 20° from the fovea. The mfPhNR RAD values observed in all rings or sectors in MS-ON eyes were significantly reduced (p < 0.01) with respect to control ones. Our results suggest that mfPhNR recordings may detect localized IRL dysfunction in the pathologic condition of selective RGCs neurodegeneration.

Optical Coherence Tomography Combined with Fluorescein Fundus Angiography under Intelligent Algorithm to Evaluate the Clinical Efficacy of Ranibizumab Combined with Panretinal Photocoagulation in the Treatment of Macular Edema of Diabetic Retinopathy Patients.

This study aimed at investigating the clinical effect of ranibizumab combined with panretinal photocoagulation in the treatment of macular edema in diabetic retinopathy (DR) patients. A parametric deformation model was constructed, and based on this, it was evaluated using optical coherence tomography (OCT) combined with fluorescein fundus angiography (FFA). 56 DR patients (80 eyes) who needed surgery were selected for OCT and FFA scanning, and 0.5 mg ranibizumab was administered intravitreal injection before surgery. It should observe the OCT and FFA image characteristics of patients. In addition, the vision correction status before the surgery, 1 month, 3 months, and 6 months after the surgery, the thickness of the macular retina, operation time, the number of intraoperative electrocoagulation, and complications of patients were recorded. It was found that 82.85% of patients had improved visual acuity after surgery. Compared with preoperative, the average logarithm of the minimum angle of resolution (logMAR) of patients at 6 months after surgery increased significantly (P < 0.01). With the increase of the grade of fibrosis and the grade of hemorrhage, the logMAR visual acuity recovery at 6 months after the surgery became worse; the macular retinal thickness at 6 months after the surgery decreased significantly (P < 0.01). With the increase of the grade of fibrous proliferation and the grade of bleeding, the operation time, the number of electrocoagulation, and the possibility of iatrogenic holes of patient would increase. It can be known that ranibizumab combined with panretinal photocoagulation surgery could not only reduce the macular edema but also effectively reduce the intraoperative bleeding, simplify the removal of proliferative membranes, decrease the number of electrocoagulation, and shorten the operation time, enhancing the visual function of patients.

Visual Perceptual Learning Induces Long-Lasting Recovery of Visual Acuity, Visual Depth Perception Abilities and Binocular Matching in Adult Amblyopic Rats.

An abnormal visual experience early in life, caused by strabismus, unequal refractive power of the eyes, or eye occlusion, is a major cause of amblyopia (lazy eye), a highly diffused neurodevelopmental disorder severely affecting visual acuity and stereopsis abilities. Current treatments for amblyopia, based on a penalization of the fellow eye, are only effective when applied during the juvenile critical period of primary visual cortex plasticity, resulting mostly ineffective at older ages. Here, we developed a new paradigm of operant visual perceptual learning performed under conditions of conventional (binocular) vision in adult amblyopic rats. We report that visual perceptual learning induced a marked and long-lasting recovery of visual acuity, visual depth perception abilities and binocular matching of orientation preference, and we provide a link between the last two parameters.

Protective Effect of a Water-Soluble Carotenoid-Rich Extract of Cordyceps militaris against Light-Evoked Functional Vision Deterioration in Mice.

Light-evoked retinal photodamage is considered an important factor contributing to functional vision deterioration and can even lead to light maculopathy or dry age-related macular degeneration. Loss of visual acuity (VA) and visual contrast sensitivity function (VCSF) are the major symptoms of retinal degenerative diseases. Cordyceps militaris is a carotenoid-rich Chinese medicinal fungus with antioxidant, anti-inflammatory, and immunomodulatory functions. C. militaris extract is a natural substance, and its bioactive constituents have been shown to confer health benefits, but their application in retinal tissue and functional vision protection in vivo remain incompletely understood. In the present study, we evaluated the influence of water-soluble, carotenoid-rich C. militaris extracts on the visual performance of light-damaged mouse retinas in vivo, using adult female CD-1® (ICR) albino mice. We showed that oral administration of this C. militaris extract (10 mg/kg, twice daily) protected the neural retina tissue against light-evoked photoreceptor cell death, reduced Müller cell hypertrophic gliosis, and elevated GSH levels and promoted the recovery of VA- and VCSF-thresholds, especially for high spatial frequency-characterized vision. These results suggest that, probably because of its water-soluble carotenoids, C. militaris extract has the potential to prevent or treat light-induced visual dysfunction.

Cytomegalovirus Retinitis in an Immunocompetent Patient

We report the case of a young immunocompetent patient with cytomegalovirus retinitis, received in the ophthalmological emergency room with a unilateral decrease in visual acuity due to macular localization. The clinico-tomographic follow-up was particularly satisfactory after 3 weeks on Ganciclovir with complete recovery of visual acuity after 2 months of treatment (interesting iconographic illustration).

Orbital apex syndrome secondary to herpes zoster ophthalmicus: Clinical features and outcomes case report and systematic review

BackgroundThis study aimed to describe the clinical features of patients with orbital apex syndrome (OAS) as a complication of herpes zoster ophthalmicus (HZO) and to identify factors associated with poor visual acuity outcomes. MethodsWe performed a systematic review and retrospective analysis of the clinical characteristics and outcomes of patients with OAS secondary to HZO reported in the literature over 42 years (1978–2020). ResultsWe analysed 21 cases, 20 of which were identified in the literature, together with our patient. Their median age was 65 years, with equal involvement in both sexes. The median onset of OAS due to HZO was 10 days (range 1–28 days). The median time of treatment initiation was five days (range 1–21 days). All patients presented with reduced visual acuity, complete ophthalmoplegia, and ptosis. Most patients (17/21, 80.95%) were treated with systemic antiviral and corticosteroid therapy. Three (3/21, 14.29%) patients were immunocompromised. Recovery for ophthalmoplegia (19/21, 90.48%) and ptosis (16/21, 76.19%) was good. Half of the patients (9/18, 50%) showed poor vision recovery. Starting treatment more than 72 h after HZO onset (p = 0.045) was more likely to cause poor vision recovery. ConclusionOAS is a rare, serious, and potentially late complication of HZO and continued observation up to and perhaps beyond four weeks is justifiable, if not encouraged. Early initiation of treatment with systemic antiviral and/or corticosteroids within 72 h of onset of HZO appears beneficial for the recovery of visual acuity.

Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study

BackgroundRhegmatogenous retinal detachment (RRD) is a common, potentially blinding ocular pathology that is considered a surgical emergency. Macular involvement has been identified as a major negative prognostic indicator for visual recovery after RRD correction. It is not currently clear whether early intervention improves visual outcomes, and in practice, there are potential disadvantages to performing early surgery for fovea-involving RRD. Such disadvantages include inadequate assessment of coexisting comorbidities, increased rate of complications related to poorly trained staff or tired surgeons, and anesthetic risk.MethodsA single-center, retrospective, cohort study of patients who underwent repair of macula-involving rhegmatogenous retinal detachment at the University of Virginia was performed. Variables collected included patient demographics, ocular history, clinical characteristics, and post-operative complications. Patients were excluded if they had a history of congenital or acquired pathology with an effect on visual function, bilateral or repeat rhegmatogenous detachment, age less than 18 years, follow up duration less than 6 months, or if they were repaired using scleral buckle, pneumatic retinopexy, 25- or 27-gauge pars plana vitrectomy, or any combination of these techniques. A multivariate regression model was used to compare overall outcomes such as post-operative visual acuity, intra-ocular pressure, retina attachment status, and complications among patients of differing timing of surgical repair. These analyses were adjusted for clinical factors known or considered to be associated with worse prognosis in rhegmatogenous retinal detachment.ResultsA total of 104 patients undergoing 23-gauge vitrectomy for repair of macula involving rhegmatogenous retinal detachments were included in this study with mean follow up period 17.9 ± 14.1 months. Early surgical repair (< 48 h) was pursued in 26 patients, moderately delayed surgical repair (3–7 days), was performed in 29 patients and late surgical repair (> 7 days) in 49 patients. Our analysis showed no difference in post-operative visual acuity between patients with detachments undergoing early versus moderately delayed repair of RRD. However, mean visual acuity differed between patients undergoing early versus late repair at 3, 6, and 12 months. No significant difference was observed in post-operative complications between the three surgical timepoints including cataract formation, development of glaucoma and re-detachment rate. Use of 360 laser was found to be protective against re-detachment overall (OR 6.70 95% CI 1.93–23.2).ConclusionsThese findings indicate that a moderate delay of 3–7 days from symptom onset for repair of macula-involving retinal detachment may be a safe approach as there are no differences in terms of visual acuity or post-operative complications compared to early repair within 48 h. Delaying surgery for > 7 days however is not recommended due to the loss of recovery of visual acuity observed in this study. Use of 360 laser may prevent risk of re-detachment after primary repair.

Clinical Effect of Laser Treatment Combined with Compound Xueshuantong Capsule in the Treatment of Diabetic Retinopathy

Objective: To determine the clinical value of compound Xueshuantong capsule in the treatment of diabetic retinopathy on the basis of laser treatment. Methods: Data were collected from 98 patients with diabetic retinopathy from February 2021 to February 2022. They were divided into two groups by drawing lots. The experimental group was treated with compound Xueshuantong capsule and laser treatment, whereas the control group was treated with laser treatment alone. Results: The absorption of exudation, resolution of retinal edema, and absorption of bleeding took longer in the control group; the incidence of visual acuity recovery to more than 0.5 and the patients’ blood glucose levels were better in the experimental group, p &lt; 0.05. Conclusion: For patients with diabetic retinopathy, laser treatment combined with compound Xueshuantong capsule can effectively improve the visual function and rehabilitation efficiency of patients with diabetic retinopathy as well as stabilize their blood sugar levels. It has high clinical application value.

Characterization of Poor Visual Outcomes of Diabetic Macular Edema: The Fight Retinal Blindness! Project

To investigate the incidence, characteristics, and baseline predictors of poor visual outcomes in eyes with diabetic macular edema (DME) receiving intravitreal therapy in routine clinical practice. Observational study. Treatment-naïve eyes starting intravitreal therapy for DME between 2014 and 2018 tracked in the Fight Retinal Blindness! registry. We examined 2 groups with poor visual outcomes: (1) those with sustained vision loss of > 10 letters from baseline without recovery of visual acuity (VA); and (2) those with a VA of < 55 letters at 2 years. Respective controls were eyes that did not experience poor visual outcomes. Kaplan-Meier curves analyzed the proportion of eyes that experienced poor outcomes. Cox proportional hazards models evaluated the potential baseline predictors of poor outcomes. The proportion of eyes that experienced poor visual outcomes within 2 years of treatment initiation and its baseline predictors. The proportion of eyes with sustained VA of ≥ 10 letter loss was 14% at 2 years; 16% of eyes had VA of ≤ 55 letters 2 years after starting intravitreal therapy. Initial treatment with intravitreal corticosteroid was independently associated with a higher incidence of ≥ 10 letter loss (hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.60-6.44; P < 0.01). No improvement in the VA at 3 months after starting treatment was associated with ≥ 10 letter loss (HR, 6.81; 95% CI, 4.11-11.27; P < 0.01) and VA of ≤ 55 letters at 2 years (HR, 4.28; 95% CI, 2.66-6.89; P < 0.01). The other factors related to higher risk of VA of ≤ 55 letters were older age (HR, 1.02 per year; 95% CI, 1-1.04; P = 0.04) and poor baseline VA (HR, 0.68 per 5 letters; 95% CI, 0.65-0.72, P < 0.001). Fourteen percent of eyes managed with intravitreal therapy in routine clinical care experienced ≥ 10 letter loss and 16% had VA of ≤55 letters 2 years after starting the treatment for DME. The identification of the incidence and predictors of poor outcomes provides a more accurate assessment of the potential benefit from intravitreal therapy.

Impact of unintended initial dissection of the posterior plane during SMILE surgery on surgery time and visual outcomes

BackgroundTo study the impact of unintended initial dissection of the posterior plane (UIDPP) on operation time and surgical outcomes during small incision lenticule extraction (SMILE) surgery.MethodsThis was a retrospective study. Based on the SMILE procedure video, the operating eyes were assigned to the normal and UIDPP groups according to the presence or absence of UIDPP signals during surgery. The UIDPP group was further separated into early and late detection based on whether the complete dissection of the lenticule posterior plane or not. Patient's demographic data, preoperative evaluation data, operation time and postoperative outcomes were collected.ResultsSixty-six patients (66 eyes) who underwent SMILE were included, with 24 eyes with UIDPP (13 in the early detection group and 11 in the late group). The optical zone was smaller (median 6.5 vs. 6.6, P = 0.007), and the operation time was longer (median, 189.5 vs. 91.0 s, P < 0.001) in the UIDPP group compared with normal group. There were significant differences in operation time between the late detection group and early detection group (median, 489.0 vs. 139.0 s, P < 0.05) and between the late detection group and normal group (median 489.0 vs. 91.0 s, P < 0.05), while the optical zone was different only between the late detection and normal groups (median, 6.5 vs. 6.6, P < 0.05). At the one-year follow-up, UDVA was better than or equal to 20/20 in 87.5% of eyes, and 75% of eyes were within ± 0.5 D of the intended refractive target. One eye lost one Snellen line.ConclusionThe occurrence of UIDPP will significantly prolong the operation time, but not affect the recovery of long-term visual acuity after surgery. Detecting UIDPP earlier could help shorten the operation time.

Optic Disk Pit Maculopathy Treatment Using a Human Amniotic Membrane Patch: One-Year Results

To report the 1-year results of human amniotic membrane patch implantation for optic disc pit maculopathy. A prospective, consecutive, interventional study. Eleven eyes of 11 patients affected by optic disc pit maculopathy associated with subretinal/intraretinal fluid were included in this single-institution study. A 25-gauge pars plana vitrectomy was performed in all cases, with an implant of a human amniotic membrane patch into the optic disc pit and air was injected as endotamponade. The primary study outcome was the subretinal and intraretinal fluid reabsorption. Secondary outcomes were visual acuity improvement and postoperative complications. Mean central retinal thickness gradually diminished from 512 ± 137 µm to 243 ± 19 µm, at the 12-month follow-up. The mean visual acuity improved from 20/80 at baseline to 20/32 at the 12-month follow-up. Complete fluid resorption occurred in 9 of 11 (81.8%) eyes and there was partial resorption in 2 eyes (18%). No subretinal fluid recurrence was observed during the 12-month follow-up. No intraoperative or postoperative complications were reported during the follow-ups. The amniotic membrane patch remained detectable inside the pit for the entire follow-up time. An amniotic membrane plug may be effective for improving optic disc pit maculopathy. All cases had an anatomical improvement and encouraging visual acuity recovery.

Invited Session III: Reawakening plasticity in visual cortex: Lifting brakes on visual cortical plasticity

Enduring amblyopia after early imbalanced binocular input is a classic example of critical period biology across species. Recovery of visual acuity is typically poor in adulthood due to both the extensive loss of connections and declining neuroplasticity in primary sensory areas. The discovery that rewiring is actively limited in adulthood rather than passively lost with age inspires novel therapeutic approaches to lift such brakes on plasticity. Notably, these mechanisms converge on pivotal inhibitory circuits in primary visual cortex. This talk will overview insights from rodent models of acuity recovery which may augment that of humans endowed with higher visual areas exhibiting prolonged plasticity.

Световая чувствительность зрительной системы как функциональный биомаркер нейрональных повреждений при рассеянном склерозе у пациентов с перенесенным острым ретробульбарным оптическим невритом и без него

Цель исследования — оценка контрастно-цветовой чувствительности в центральной области поля зрения, контрастно-частотной чувствительности и динамической остроты зрения у здоровых испытуемых, в больных и здоровых глазах при рассеянном склерозе (РС) у пациентов с перенесенным ретробульбарным оптическим невритом (РБН) и без него. Материал и методы. Исследование зрительных функций проведено в 150 глазах 114 здоровых испытуемых, 49 глазах 36 пациентов с РС, перенесших острый РБН, и 43 глазах 29 пациентов с РС без перенесенного РБН. У всех испытуемых перед исследованием показателей световой чувствительности проводились определение статической остроты зрения, рефракции и офтальмоскопия глазного дна. Результаты и заключение. На основании анализа показателей контрастно-цветовой чувствительности, контрастно-частотной чувствительности и динамической остроты зрения проведена оценка изменений световой чувствительности больных и здоровых глаз у пациентов с РС с перенесенным РБН и без него. Выявлено, что световая чувствительность снижена во вторых — здоровых глазах при РС с перенесенным монокулярным РБН и что снижение световой чувствительности в глазах при РС с перенесенным РБН более глубокое. Световая чувствительность остается сниженной, несмотря на восстановление статической остроты зрения после перенесенного РБН. Различия показателей cветовой чувствительности зрительной системы используются для обсуждения связи острой демиелинизирующей оптической нейропатии с нейрональными повреждениями и характером течения рассеянного склероза. Обсуждается также возможность использования данных о снижении световой чувствительности для ранней диагностики и оценки нейрональных нарушений в зрительной системе при РС.

Characteristics of macular microvasculature before and after idiopathic macular hole surgery.

To evaluate the macular microvasculature before and after surgery for idiopathic macular hole (MH) and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration. Twenty eyes from 20 patients with idiopathic MH were enrolled. Optical coherence tomography angiography (OCTA) images were obtained before, 2wk, 1, and 3mo after vitrectomy with internal limiting membrane peeling. Preoperative foveal avascular zone (FAZ) area and perimeter and regional vessel density (VD) in both layers were compared according to the 3-month best-corrected visual acuity (BCVA). The BCVA improved from 0.98±0.59 (logMAR, Snellen 20/200) preoperatively to 0.30±0.25 (Snellen 20/40) at 3mo postoperatively. The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group (all P<0.05). A significant reduction was observed in FAZ parameters and all VDs 2wk postoperatively. Except for deep perifoveal VD, all VDs recovered only to their preoperative values. The postoperative FAZ parameters were lower during follow-up. Decreases in preoperative deep VDs were correlated with worse postoperative BCVA (Pearson's r=-0.667 and -0.619, respectively). A larger FAZ perimeter (Spearman's r=-0.524) and a lower deep perifoveal VD preoperatively (Pearson's r=0.486) were associated with lower healing stage. The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH. Except for the deep perifoveal region, VD recovers only to preoperative levels.

Contrast Sensitivity and Stereoacuity in Successfully Treated Refractive Amblyopia.

PurposeTo assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia.MethodsA retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues.ResultsStatistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test.ConclusionsFull recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.

Predictors of early visual outcome after endoscopic trans sphenoidal excision of pituitary adenomas

BACKGROUND: Endoscopic transsphenoidal excision has revolutionized the surgical management of pituitary macroadenoma. There had been several retrospective studies on the factors determining the visual outcome after surgical excision of pituitary adenoma, but very few prospective studies were published in this context. This is a prospective study of the factors predicting visual outcome following endoscopic transsphenoidal excision of pituitary adenoma. Various factors like age, duration of visual symptoms, the volume of the tumour, suprasellar extension, parasellar extension, type of adenoma, pituitary apoplexy, completion of excision, fundoscopic changes, and preoperative visual deficits were studied. METHODS: Single centre prospective observational study done between November 2016 to December 2018. Thirty patients with pituitary macroadenoma who underwent trans nasal endoscopic excision were studied with preoperative and postoperative visual impairment score (VIS) and the visual outcome was categorized as a good outcome if there was more than 5% improvement in VIS and as worse otherwise. Various predictors that may influence the outcome were statistically compared. RESULTS: 83.3% of patients (n=25) showed improvement in their vision at 6months follow-up. Overall visual outcome (considering both parameters visual acuity and visual field together) was dependent on suprasellar extension (P=0.01), completion of excision (P=0.004), and primary optic atrophy (P=0.018). On subgroup analysis recovery in visual acuity was significantly determined by the preoperative tumour volume(P=0.041), suprasellar extension (P=0.006), completion of excision(P=0.003), and primary optic atrophy (P=0.013). The improvement in the field of vision depended on the severity of preoperative field defects (P=0.04) and completion of excision (P=0.01). CONCLUSIONS: The factors predicting the early visual outcome were the suprasellar extension, completion of excision, preoperative field deficits, and primary optic atrophy. This study highlights the importance of early and proper intervention in pituitary adenomas managed surgically to procure the desired result.

A Case of Invasive Fungal Sinusitis in the Onodi Cell with Recovery of Visual Acuity Despite Two Weeks Delay from Onset to Treatment

A Case of Invasive Fungal Sinusitis in the Onodi Cell with Recovery of Visual Acuity Despite Two Weeks Delay from Onset to Treatment

Advanced Coats' disease: Treating the effect before the cause

An 8-year-old child with Stage 3A Coats' disease and severe submacular lipid exudation was initially treated with intravitreal injections of bevacizumab followed by triamcinolone. The exudative retinal detachment was then treated by scleral buckling, cryotherapy of persistent telangiectasia, and subretinal fluid drainage. The residual telangiectasia on the reattached retina was finally ablated by photocoagulation. The patient had a near-total resolution of submacular hard exudates without macular fibrosis. The peripheral telangiectasia and exudative detachment also regressed, with the sustained recovery of excellent visual acuity.