Significant Change In Visual Acuity Research Articles

The influence of test illuminance on visual acuity in patients with primary open-angle glaucoma and age-related macular degeneration

PURPOSE. To study the influence of the illuminance level of test objects on the resolution of the visual analyzer in patients with primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD), and assess the possibility of using the obtained results for early diagnosis of these eye diseases.METHODS. Visual acuity (VA) under controlled illumination conditions (from 50 to 400 lx) of test objects was assessed using the developed device in three groups: in 50 healthy subjects aged 37.08±10.19 years without ophthalmic pathology (group A), in 50 patients with early (Ia and IIa) stages of POAG aged 47.16±8.28 years (group B) and 50 patients aged 46.08±4.56 years (group C) with dry form of AMD (initial stage).RESULTS. With an increase in the illumination of test objects (IT) from 50 to 400 lx, the VA of healthy individuals significantly increases on average by δ=0.32 (from 1.0±0.22 to 1.32±0.24, p<0.01), while in POAG the increase in VA with an increase in IT is much less pronounced, averaging δ=0.12 (from 0.9±0.20 to 1.02±0.26, p<0.05). At the same time, starting from IT 150 lx and above, the differences between the values of VA in the control group and in the group of patients with POAG of the initial stages become significant (p<0.05). VA of patients with AMD with increasing IT practically does not change, remaining at a stable level: δ=0.04 (from 0.76±0.20 to 0.80±0.26, t=0.66, p>0.5). At the same time, the VA values in this group of patients for each illumination level are significantly lower (p<0.05) than the corresponding VA values in the control group (group A).CONCLUSION. The revealed regularities can be used for early diagnosis of the pathological process: an increase in VA at the maximum level of IT relative to the initial value by less than δ≤0.2 indicates pathology of the optic nerve (POAG), and the absence of significant changes in VA with an increase in IT (minimum values of δ) is characteristic of the pathological process in the macula (AMD).

Prednisolone eye drops as a potential treatment in non-neovascular pachychoroid related diseases.

To investigate the functional and structural outcomes after treatment with prednisolone eye drops in the following pachychoroid related diseases: chronic central serous chorioretinopathy (cCSC), pachychoroid pigment epitheliopathy (PPE) and peripapillary pachychoroid syndrome (PPS). In this retrospective study, 54 eyes of 48 patients with pachychoroid related disease were treated with prednisolone acetate 1% eye drops for 3 times a day. Change in macular volume and retinal central subfield thickness on optical coherence tomography was measured. In addition, foveal or complete resolution of fluid and the change in visual acuity (VA) were studied. The follow-up visit was at a mean of 41.2 ± 14.5 days. In the 44 eyes with cCSC, a significant reduction in retinal central subfield thickness (p < 0.001) and macular volume (p < 0.001) was observed. Foveal intra- or subretinal fluid resolved completely in 22% of the eyes. In the 8 PPS eyes, a reduction in the nasal retinal thickness was observed (p = 0.025). One of the 2 PPE eyes showed structural improvement. No significant change in VA was observed in any of the pachychoroid spectrum diseases. In cCSC, PPS and PPE patients, anatomical improvement was observed after therapy with prednisolone eye drops. VA did not change significantly.

A Multicentric Cross-Sectional Observational Study to Analyze the Effects of Moderate High Altitude on Ocular Health.

Prolonged exposure to hypoxia at high altitudes can affect the eyes through various mechanisms, culminating in reduced vision. Multiple studies on this subject have focused on the ocular effects of high altitude on intraocular pressure (IOP), corneal thickness, and the retina. However, there is a lack of literature on the effects of 'moderate high altitude (2000-3000 m)' on the eyes. Hence, we designed our study to determine the impact of moderate high altitude on the eyes. We recruited two age and gender-matched groups of 250 research participants, each at moderate high altitude (Group A) and plains (Group B), respectively, to determine the effects of moderate high altitude on ocular health, if any. We found a statistically significant increase in dry eye in Group A. We also found four cases of central serous retinopathy and one case of central retinal vein occlusion in Group A. There was no statistically significant change in visual acuity, IOP, or central corneal thickness. There is a vast lacuna in the literature on this particular altitude range, and further studies are required to confirm our findings. It is also recommended that lubricant eye drops be advised as a standard prophylactic measure for all individuals traveling and staying at moderate high altitude.

Efficacy and Safety of Processed Amniotic Fluid (pAF) Drops for the Treatment of Ocular Chronic Graft-Versus-Host Disease

Background: Ocular graft-versus-host disease (GVHD) affects more than 50% of patients with chronic GVHD and can lead to debilitating dry or painful eyes, impaired activities of daily living and poor quality of life. Management is mainly supportive, through control of surface inflammation, lubrication, and control of drainage and evaporation. Amniotic fluid (AF) is a rich source of nutrients, cytokines, and growth factors that has antimicrobial and immunomodulatory activities and may have reparative and regenerative roles in human disease. Investigators at the University of Utah developed protocols to collect AF from full-term pregnant women, process and sterile filter AF to separate cytokines and growth factors from residual cells and debris contained in the no-cellular fraction of AF, and treat patients with different conditions. We report the treatment effects and safety of processed AF (pAF) for the treatment of ocular GVHD. Methods: In this randomized, double-blinded, placebo-controlled phase II trial (NCT# 03298815), patients age ≥ 18 years diagnosed within 5 years after allogeneic hematopoietic transplant with ocular GVHD causing dry eye symptoms requiring lubricant drops &amp;gt;3x/day, punctal plugs, thermally cauterized puncta or special eyewear to relieve pain; or inability to work because of ocular symptoms; or loss of vision due to keratoconjunctivitis sicca were enrolled. Patients with any other chronic GVHD treated with &amp;gt;3 lines of therapy beyond corticosteroids with or without calcineurin inhibitors or sirolimus; or had a difference in dryness between both eyes of &amp;gt;2 points by the International Dry Eye WorkShop (DEWS) 2007 report; or were not willing to discontinue the use of medicated lubricant eye drops prior to randomization were excluded. Randomization was performed within participants, with one eye receiving one drop of pAF and the other eye saline treatment (placebo) twice daily for 30 days. In patients wearing scleral lenses, the eye drops were applied prior to lens insertion in the morning and after removal at night. Patients were allowed to resume their medicated eye drops after the 30-day treatment period. The primary objectives were to determine the day 30 overall response (complete and partial response) and safety of pAF. Response type to treatment is defined in Table 1. Key secondary objectives included longitudinal changes in visual acuity and the corneal surface, and patient-reported outcomes. Results: All fifteen patients' eyes were randomized to either pAF or saline treatment. The median age was 61 years (range, 35-72). At enrollment, six patients wore scleral lenses. The median baseline FACT-G score was 88 (range, 58-104). Baseline eye characteristics by treatment are shown in Table 2. Baseline NIH CC eye scores were similar between pAF and saline-treated eyes. The saline-treated group had more eyes with DEWS score 3 (n=7) compared to the pAF group (n=2). All 15 patients completed treatment. The overall response at day 30 in the pAF and saline-treated groups was 25% and 50%, respectively, p=0.38. All responding eyes had a partial response. No treatment-related serious ocular adverse events were observed. Two minor events occurred in the pAF treated eye group, including a change in eyelid position (n=1) and stinging after study drop application (n=1). There was no significant change in visual acuity and corneal surface staining between treatment groups at 30, 60, and 100 days. There was no significant change in the FACT-G score at 30, 60, and 100 days, and there was no significant difference in patient reported eye pain between pAF vs. saline-treated eyes over time (p=0.21). Conclusion: In this study, the primary endpoint of safety was met as there were few adverse events. One quarter of pAF-treated eyes responded. These findings justify evaluating pAF for ocular GVHD in a larger study. Limitations of this study included restricting patients to pAF application to twice a day and the study design of randomizing eyes within each subject as several patients had mild asymmetric disease between the two eyes. Other challenges included having delayed ocular assessments and/or altered perceptions of quality of life due to the COVID19 pandemic.

Suboptimal outcomes and treatment burden of anti-vascular endothelial growth factor treatment for diabetic macular oedema in phakic patients

ObjectivesIn England and Wales, treatment options were limited for patients with diabetic macular oedema (DMO) with phakic eyes that failed anti-vascular endothelial growth factor (anti-VEGF) treatment pre-2022. This study aimed to quantify the response to, and treatment burden of, anti-VEGF treatment in phakic eyes.MethodsRetrospective, cohort study using electronic patient record data from two UK centres between 2015 and 2020. Primary objective was proportion of phakic eyes with a suboptimal response after initial 6 months of anti-VEGF treatment. Data were available for 500 eyes from 399 patients.ResultsAt 6 months significantly more eyes had a suboptimal response to anti-VEGF treatment: 65.8% (95% CI 61.5–70.0%) vs 34.2% (95% CI 30.0–38.5%), p < 0.0001. Baseline visual acuity (VA) predicted VA outcome, however, despite greater gains in eyes with poorer VA, such eyes did not achieve the same VA levels as those who started treatment with better VA. Only 53.6% of eyes had more than three injections in the first 6 months indicating difficulties in delivering high volume/high frequency treatment. Treatment and review burden were similar over the following years regardless of response to anti-VEGF treatment.ConclusionsData confirm previous real world evidence around response to anti-VEGF treatment, importance of baseline VA and frequency of injections in predicting outcomes in a UK setting. Continuing treatment beyond 6 months in suboptimal responders imposes unnecessary treatment burden without significant change in VA. In suboptimal responders, consideration of early switch to longer acting steroid treatments may help to reduce treatment burden, whilst maintaining or improving vision.

Injectable Fluocinolone Implant for the Management of Chronic Postsurgical Cystoid Macular Edema in Vitrectomized Eyes.

Long-acting injectable steroids are changing the treatment paradigm for patients with chronic intraocular inflammation and cystoid macular edema (CME). We report the use of the fluocinolone implant (FAI) 0.18 mg in patients with chronic postsurgical CME following pars plana vitrectomy (PPV). This is a retrospective case series of 24 vitrectomized eyes which received FAI for the management postsurgical CME. Clinical outcomes and requirement for rescue therapy were studied. Median length of follow-up was 19.3 months (range 8.3-23.2 months). There was an improvement in median central subfield thickness from 412 μm (range 167-806 μm) to 311 μm (range 157-686 μm) following FAI (p < 0.001). The injection burden decreased significantly following study treatment (p < 0.001); however, there was no significant change in visual acuity (p = 0.334). Eighteen eyes had control of CME that did not require additional intravitreal therapy. Four eyes had initially controlled but recurrent CME requiring intravitreal steroid therapy at median of 7.8 months (range 7.6-15.4 months). One eye never attained sufficient inflammatory control despite rescue therapy. FAI can be an effective treatment in vitrectomized patients with chronic postsurgical CME and can help decrease the overall injection burden.

Goniotomy for Non-Infectious Uveitic Glaucoma in Children

Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26-34) mmHg with 4 (3-4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0-2), 1 (0-2), and 0 (0-2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma.

Topical Dexamethasone as an Adjuvant to Mineralocorticoid Receptor Antagonists for the Treatment of Recalcitrant Central Serous Chorioretinopathy

A previous report demonstrated efficacy of mineralocorticoid antagonist with adjuvant topical dexamethasone (MRA+DEX) in resolving subretinal fluid (SRF) in a chronic central serous chorioretinopathy (CSCR) patient. This pilot study investigates the use of MRA+DEX to treat recalcitrant, chronic CSCR patients. Retrospective review of chronic, recalcitrant CSCR patients unresponsive to MRA alone who were treated with MRA+DEX and followed for up to 3 months. Apical SRF thickness and visual acuity were measured. Ten eyes of eight chronic, recalcitrant patients were included with an average follow-up of 109 days. Mean percent reduction in apical fluid thickness at one month and at last follow-up after adding dexamethasone (DEX) was 33% and 52%, respectively. Five eyes (50%) achieved complete resolution of SRF. Three eyes (30%) showed partial response and two (20%) eyes had no response. There was no significant change in visual acuity. MRA+DEX decreased SRF in some recalcitrant, chronic CSCR patients. Large prospective studies are needed to evaluate the utility of MRA+DEX in these chronic CSCR patients. [Ophthalmic Surg Lasers Imaging Retina 2022;53:659-665.].

Short-Term Vision-Related Ocular Side Effects of Treatment with Dexmethylphenidate for Attention-Deficit/Hyperactivity Disorder.

Objective: To evaluate the short-term effect of dexmethylphenidate (D-MPH) on visual acuity (VA), pupil size, anterior chamber depth, and accommodation-convergence reflex in children treated with D-MPH for attention-deficit/hyperactivity disorder (ADHD). Method: Prospective cohort study including 15 patients aged 8-16 (11.58 ± 2.39) treated with D-MPH for ADHD. Patients were questioned for subjective complaints such as blurred vision and photosensitivity. An ophthalmic evaluation was performed twice; before and 1.5 hours after D-MPH administration. The examination included evaluation of best corrected visual acuity at distance and near, accommodation range, convergence range, 3D vision test (stereopsis), and anterior segment optical coherence tomography. Results: A significant association between change in pupil diameter and D-MPH treatment dose was demonstrated (p = 0.01). In addition, a positive correlation between complaints about blurred vision and pupil's size change was found (p < 0.05). There were no significant changes in VA, convergence range, stereopsis, accommodation range, or anterior chamber measures. Conclusions: Our findings provide support for the effect of stimulants on pupil diameter in a dose-dependent manner. No clinically significant differences in visual functions were found 1.5 hours after consumption of D-MPH. Institutional review board clinical trial refference no. 0122-17-TLV.

Efficacy of a Student-Run Ophthalmology Service in Managing Diabetic Retinopathy: A Five-Year Retrospective Review

Background:&#x0D; Diabetic retinopathy is one of the leading causes of blindness in the world, and its development and progression can be prevented with appropriate glycemic control. The Health Outreach Partnership of EVMS Students (HOPES) Student-Run Free Clinic at Eastern Virginia Medical School (Norfolk, VA) provides both primary care and ophthalmology care to patients from underserved backgrounds. The purpose of this retrospective chart review is to assess whether a student-run free clinic’s primary care and ophthalmology services are effective in preventing the development and progression of diabetic retinopathy.&#x0D; Methods:&#x0D; Inclusion criteria were a diagnosis of Type 2 Diabetes Mellitus (T2DM), two or more HOPES Ophthalmology Clinic appointments separated by at least 4 months between January 2015 and July 2019, and medical management of T2DM by the HOPES Primary Care Clinic. Objective patient data collected were HbA1c, visual acuity, and documented dilated fundus examination findings.&#x0D; Results:&#x0D; There were 174 HOPES Ophthalmology visits and 66 diabetic eye exam appointments in this five-year time period. The average HbA1c for patients at the initial appointment with the Ophthalmology Clinic was 7.77% ± 1.65% and the average HbA1c at the most recent appointment was 7.4% ± 2.28%. Among all patients, there was no statistically significant change in visual acuity in either eye from baseline to the most recent visit. There was no change in fundus examination findings in any of the patients from their initial visit to their most recent visit.&#x0D; Conclusions:&#x0D; The HOPES Clinic has been effective in preventing the development and progression of diabetic retinopathy in its patients who regularly follow up with both the primary care and ophthalmology clinics. This study highlights that a student-run free clinic is capable of making an impact in the community by preventing the development of a potentially blinding disease, but that further strategies to enable consistent patient follow-up are needed.

Virtual reality training improves accommodative facility and accommodative range.

To evaluate the effects of virtual reality (VR) training on different parameters of vision. Sixty individuals ranged 18-60 years old with asthenopia were randomly divided into short-term (n=40) and long-term (n=20) treatment groups. They were given a specially designed VR training device only once for 15min or 3-4 times a day for 15min each time for 1mo. The visual acuity, spherical equivalent, accommodative range, accommodative facility, pupil size, and visual fatigue were evaluated before (control) and after VR training. The visual acuity, accommodative range, and accommodative facility increased in subjects of the short-term treatment group, whereas their pupil size contracted significantly. No significant changes in spherical equivalent and visual fatigue were observed. The changes in distant vision and corrected visual acuity were positively correlated with those in pupil size, but not with spherical equivalent. The accommodative range and accommodative facility improved significantly in subjects of the long-term treatment group. No significant changes in visual acuity, spherical equivalent, pupil size, and visual fatigue were noted. VR training can improve the accommodative range and accommodative facility of human eyes. Although short-term VR training can transiently improve vision, which probably due to bright light adaptation, there is no evidence that it can improve myopia.

SHORT-TERM OUTCOMES AFTER INTERIM TREATMENT WITH BROLUCIZUMAB: A Retrospective Case Series of a Single Center Experience.

To examine outcomes of eyes with neovascular age-related macular degeneration that were switched to brolucizumab because of an unsatisfactory response to bevacizumab, ranibizumab, and/or aflibercept and then switched back because of the presence or risk of intraocular inflammation. Retrospective case series of 51 eyes. Visual acuity and retinal anatomy on optical coherence tomography were recorded at the first brolucizumab injection (T1), the final brolucizumab injection (T2), and 6 months following the final brolucizumab injection (T3). At T2, 41 eyes (41/51%, 80%) had decreased subretinal fluid (31 eyes), intraretinal fluid (12 eyes), or pigment epithelial detachment height (12 eyes). At T3, decreased subretinal fluid was sustained in 17 eyes (17/31%, 55%), decreased intraretinal fluid was sustained in eight eyes (8/12%, 67%), and decreased pigment epithelial detachment height was sustained in eight eyes (8/12%, 67%). Mean logarithm of the minimum angle of resolution visual acuity at T1, T2, and T3 was 0.396 (∼20/50), 0.441 (∼20/55), and 0.468 (∼20/59), respectively. During the brolucizumab treatment period, 11 eyes (11/51%, 22%) developed intraocular inflammation, including one case of retinal vasculitis. Interim treatment with brolucizumab resulted in anatomical improvements in 41 eyes (41/51%, 80%) that were maintained in 22 of these eyes (22/41%, 54%) for at least 6 months after switching back to the original anti-vascular endothelial growth factor therapeutic. There were no corresponding significant changes in visual acuity.

Impact of Taping The Upper Mask Edge On Ocular Surface Stability and Dry Eye Symptoms

To evaluate the impact of taping the upper mask edge on ocular surface stability, dry eye symptomology, and tear osmolarity in N95 mask users. Prospective interventional before-and-after study. Fifty eyes of 50 health care workers regularly using N95 masks were included. Preintervention, ocular surface parameters, subjective dry eye score, and visual acuity were assessed at the end of an 8-hour shift when the subjects used an N95 face mask without taping the upper edge. Next day, the upper edge of the N95 mask was taped to the nasal bridge in all subjects at the beginning of the 8-hour shift, and postintervention assessment was performed after the shift. The primary outcome measure was change in noninvasive tear break-up time (NIBUT). Secondary outcome measures were change in the symptom score, tear lipid layer thickness (LLT), tear break-up time (TBUT), Schirmer I test, tear meniscus height (TMH), osmolarity, and visual acuity. Mean age of the cohort was 26.7 ± 3.67 years. Post-taping, significantly better ocular surface stability was observed in terms of NIBUT (P < .001), TBUT (P < .001), LLT (P < .001), TMH (P=.01), corneal staining score (P=.001), and tear osmolarity (P=.04). There was no significant change in visual acuity, Schirmer I, and Ocular Surface Disease Index score (P > .05). Symptom improvement was reported by 68% patients (SANDE version 2), which correlated well with change in NIBUT (r=0.38; P=.005), TMH (r=0.37; P=.007), LLT (r=0.35; P=.01), and TBUT (r=0.28; P=.04). Taping of the upper mask edge resulted in significantly better ocular surface stability, which correlated well with decrease in dry eye symptoms.

Expansion of patient eligibility for virtual glaucoma clinics: a long-term strategy to increase the capacity of high-quality glaucoma care

AimsThe virtual glaucoma clinic (VGC) is a well-established diagnostic pathway for delivery of glaucoma care. Current UK national guidance recommends VGCs for patients with ocular hypertension, glaucoma suspects or early...

Visual Adaptation to Scattering in Myopes

Myopes exhibit a larger capability of adaptation to defocus. Adaptation produces a boost in visual performance that can be characterized through different metrics. The ability of myopes to adapt to other sources of blur, such as diffusion, has not been studied so far. In this work, a group of 20 myopes with normal vision underwent high-contrast visual acuity (VA) measurements under different viewing conditions, wearing their refractive correction with or without a diffuser (Bangerter filter, BF). VA decreased immediately after wearing the BF of density 0.6, showing a significant relationship with the ocular refraction. After 40 minutes of binocular vision through the BF, a statistically significant increase (p = 0.02) in VA from 0.54 to 0.62 in decimal scale (from 0.3 to 0.2 logMAR) was obtained. No correlation with the refraction was observed. After removing the diffuser, VA returned to baseline. A control group (17 subjects) underwent the same experimental protocol but without diffuser filters. No significant changes in VA were found in this group. We describe a new type of contrast adaptation to blur in myopes caused by scattering, rather than by defocus. The effects of low scattering levels in vision might be relevant in the analysis of early stage of cataract, amblyopia treatments, and myopia understanding.

Visual Acuity after AcrySoft®IQ PanOptix®/PanOptix® TORIC Lens Implantation in Relation to Preoperative Pupil Size Values, Angles Alpha and Kappa Examined using the iTrace Analyzer

Visual acuity of 35 patients (49 eyes) implanted with AcrySoft®IQ PanOptix® spherical or toric lenses by Alcon was analyzed considering preoperative pupil size, angles alpha and kappa, the values of which were obtained in the examination using iTrace analyzer. Overall, no statistically significant changes in visual acuity were observed for changing values of the above parameters, except in the preoperative group with hyperopia, in which visual acuity to far distances improved with increasing pupil size. In some patients after refractive lens exchange, a slight deterioration in visual acuity to far distances was observed compared to preoperative values obtained with best correction; however, this did not have a significant impact on the level of patient satisfaction.

The Investigation of the Effect of Hyperglycemic Changes on Psychophysical Measurements of Visual Function in Pseudophakic People Living with Diabetes Mellitus.

PurposeThe purpose of this study was to show the effect of increasing blood glucose level (BGL) on psychophysical visual function represents by visual acuity and contrast sensitivity in pseudophakic people living with diabetes (PDM).Study DesignThis was quasi-experimental, quantitative study using a pretest–posttest approach.MethodsThe study was conducted at Gamalakhe community health centre located in Gamalakhe township and included a sample of 50 pseudophakic people living without diabetes mellitus (PWDM) and 50 pseudophakic PDM. BGL as well as psychophysical measurements of visual function were measured preprandial and postprandial. Visual acuity (VA) was measured at distance (4 m) and near (40 cm) using logMAR VA charts, and contrast sensitivity (CS) was measured at 50 cm using a Mars chart. The data collected were captured and subsequently analyzed using SPSS version 25.ResultsGlycemic changes measured preprandial and postprandial observed a mean increase of 2.06±1.35 mmol/L (p=0.350) and 1.08±0.47 mmol/L (p=0.291) in pseudophakia PDM and pseudophakic PWDM, respectively. CS showed a mean increase of 0.01±0.10 (p=0.23) and 0.002±0.02 (p=0.19) log units in PDM and PWDM, respectively; however, the independent t-test showed this was insignificant between PDM and PWDM (p=0.27). A insignificant mean increase of 0.01±0.04 log units (p=0.25) and 0.001±0.01 (p=0.32) in distance VA of pseudophakic PDM and PWDM was found, respectively. A mean increase of 0.001±0.01 log units (p=0.32) and 0.01±0.03 (p=0.06) near logMAR VA of pseudophakic PDM and PWDM was found, respectively.ConclusionAcute hyperglycemic changes do not result in overall significant changes in visual acuity and contrast sensitivity in pseudophakic PDM and PWDM for an increase in glycemia of 2 mmol/L. We recommend studies investigate if changes occur for glycemic increases exceeding 2 mmol/L.

Management of Limbal Dermoids by Simple Excision in Young Children.

To report the visual outcomes, refractive results, and complications of simple excision for limbal dermoid in the first 8 years of life. This retrospective chart review included all children aged 8 years or younger who underwent excision of a grade I or II limbal dermoid without involvement of the visual axis between the years 2000 and 2019. Nineteen patients met the inclusion criteria. Their mean age was 4.2 ± 2.0 years (age range: 9 months to 8 years). The mean change in visual acuity was +1 ± 2.3 lines. The mean astigmatism was 3.20 ± 1.80 diopters (D) preoperatively and 3.50 ± 2.20 D at the last visit; the mean change in the astigmatism power was +0.20 ± 1.20 D (range: -1.50 to +2.75 D). Epithelial healing occurred in a mean of 8 days. No complications such as perforation were encountered. All patients had a good cosmetic outcome. Reepithelialization led to good cosmetic outcomes after this quick, simple, and uncomplicated procedure. There was no significant change in visual acuity or astigmatism, so amblyopia and astigmatism reduction are poor indications for limbal dermoid excision. Families should be counseled preoperatively that correction of the astigmatism and patching will remain essential in the postoperative management of amblyopia. [J Pediatr Ophthalmol Strabismus. 2021;58(3):196-201.].

Perifoveal Chorioretinal Atrophy after Subretinal Voretigene Neparvovec-rzyl for RPE65-Mediated Leber Congenital Amaurosis

To report an anatomic change following subretinal injection of voretigene neparvovec-rzyl (VN) for RPE65-mediated Leber congenital amaurosis. Multicenter, retrospective chart review. Patients who underwent subretinal VN injection at each of 4 participating institutions. Patients were identified as having perifoveal chorioretinal atrophy if (1) the areas of atrophy were not directly related to the touch-down site of the subretinal cannula; and (2) the area of atrophy progressively enlarged over time. Demographic data, visual acuity, refractive error, fundus photographs, OCT, visual fields, and full-field stimulus threshold (FST) were analyzed. Outcome measures included change in visual acuity, FST, visual fields, and location of atrophy relative to subretinal bleb position. A total of 18 eyes of 10 patients who underwent subretinal injection of VN were identified as having developed perifoveal chorioretinal atrophy. Eight of 10 patients (80%) developed bilateral atrophy. The mean age was 11.6 years (range, 5-20 years), and 6 patients (60%) were male. Baseline mean logarithm of the minimum angle of resolution visual acuity and FST were 0.82 (standard deviation [SD], 0.51) and-1.3 log cd.s/m2 (SD, 0.44), respectively. The mean spherical equivalent was-5.7 diopters (D) (range,-11.50 to+1.75 D). Atrophy was identifiable at an average of 4.7 months (SD, 4.3) after surgery and progressively enlarged in all cases up to a mean follow-up period of 11.3 months (range, 4-18 months). Atrophy developed within and outside the area of the subretinal bleb in 10 eyes (55.5%), exclusively within the area of the bleb in 7 eyes (38.9%), and exclusively outside the bleb in 1 eye (5.5%). There was no significant change in visual acuity (P= 0.45). There was a consistent improvement in FST with a mean improvement of-3.21 log cd.s/m2 (P < 0.0001). Additionally, all 13 eyes with reliable Goldmann visual fields demonstrated improvement, but 3 eyes (23.1%) demonstrated paracentral scotomas related to the atrophy. A subset of patients undergoing subretinal VN injection developed progressive perifoveal chorioretinal atrophy after surgery. Further study is necessary to determine what ocular, surgical delivery, and vector-related factors predispose to this complication.

The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

Compared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.