Significant Difference In Visual Outcome Research Articles

Study of the Effect of Injection Bevacizumab through Various Routes in Neovascular Glaucoma.

ABSTRACTPurpose: To study the effect of injection bevacizumab on iris neovascularization (NVI) and angle neovascularization (NVA) and compare its efficacy in terms of visual outcome, NVI, NVA, and intraocular pressure (IOP) control between intracameral, intravitreal, and combined use.Materials and methods: This was a prospective study conducted at a tertiary center for patients of neovascular glaucoma (NVG), including 20 eyes of 20 patients. After thorough evaluation, patients were divided into three groups: Intracameral, intravitreal, or combined, according to the route of injection bevacizumab required.Results: About 30% of patients belonged to the age group 51 to 60 years of which 80% were female. In 50%, vein occlusion was the cause of NVG, and 50% needed intravitreal injection bevacizumab. After 4th week of injection 90% and after 12th week 60% were found to have absence of NVI. Patients who had IOP in the range of 11 to 20 mm Hg and 21 to 30 mm Hg showed lower IOP as compared to other groups. But no significant difference was noted in higher IOP groups. Only two patients required antiglaucoma surgery.There was no statistically significant difference in visual outcomes in any groups. In all routes, there were statistically significant changes in NVI and NVG in the 1st and 4th weeks.Conclusion: The effect of injection in all routes deteriorates after 8 weeks. Intracameral route of injection is found to be most effective in terms of control of IOP. There was no statistically significant difference in terms of improvement in best corrected visual acuity (BCVA) in any route. Injection bevacizumab is effective and statistically significant in reducing the need of antiglaucoma surgery for NVG patients.How to cite this article: Bhagat PR, Agrawal KU, Tandel D. Study of the Effect of Injection Bevacizumab through Various Routes in Neovascular Glaucoma. J Curr Glaucoma Pract 2016;10(2):39-48.

A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.

PurposeThe purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine.Patients and methodsThis was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1–0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0–2).ResultsThere were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively). In 250 eyes without high myopia (< −6D), there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417). No additional anesthesia was required in all groups.ConclusionIntracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.

Comparison of Corneal Biological Healing After Femtosecond LASIK and Small Incision Lenticule Extraction Procedure

ABSTRACTPurpose: To assess and compare the dry-eye-associated parameters and corneal biomechanical status after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).Methods: Sixty-five patients’ (128 eyes) were collected between November 2012 and April 2013. Thirty-five (69 eyes) underwent SMILE and thirty (59 eyes) underwent FS-LASIK. Visual acuity, manifest refraction, tear break-up time (TBUT), Schirmer’s test (ST), corneal sensitivity, Ocular Surface Disease Index (OSDI), corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated preoperatively and 1 day, 1 week, 1 month, 3 and 6 months postoperatively.Results: There was no significant difference in visual outcomes of SMILE and FS-LASIK (p = 0.208). TBUT, ST, CH and CRF decreased significantly after surgery in both groups (all p < 0.05); however, the decrease of TBUT, ST and CRF in the SMILE group was not as significant as that in the FS-LASIK group (all p < 0.05) and the change of CH value was comparable in both groups (p = 0.052).Corneal sensitivity was significantly decreased in the FS-LASIK group postoperatively (p < 0.05), but not significantly changed in the SMILE group (p > 0.05). OSDI scores were significantly increased after surgery for the two groups (all p < 0.05), and the scores were much higher in the FS-LASIK group than in the SMILE group (p = 0.000).Conclusion: The corneal biological healing of SMILE surgery was superior to FS-LASIK in the early period.

23‐Gauge versus 25‐Gauge vitrectomy for proliferative diabetic retinopathy: A comparison of surgical outcomes

PurposeThis study compared clinical outcomes and complications between 23‐gauge (23 g) and 25‐gauge (25 g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy.MethodsIt was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23 g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25 g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best‐corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications.ResultsVision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23 g group had significantly more patients with a day 1 IOP of &lt;6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014).ConclusionsBoth gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Visual Outcomes and Complications of Piggyback Intraocular Lens Implantation Compared to Aphakia for Infantile Cataract.

Purpose:To evaluate the long-term visual outcomes and complications of the piggyback intraocular lens (IOL) implantation compared to aphakia for infantile cataract.Patients and Methods:In a comparative study from 1998 to 2007, piggyback IOL implantation (piggyback IOL group) was performed for 14 infants (23 eyes) with infantile cataract and 20 infants (32 eyes) who were aphakic (aphakia group) after infantile cataract surgery. Data were collected on logMAR visual acuity, and postoperative complications over a mean follow-up time of 6.2 ± 1.7 years and 5.8 ± 1.7 years.Results:The mean age at surgery was 7.5 ± 0.6 months and 6.0 ± 3.3 months for the piggyback and the aphakic group respectively (P > 0.05). At the last follow-up visit, visual acuity was 0.85 ± 0.73 (median = 0.70, interquartile range = 0.3–1.32) in the piggyback IOL group and 0.89 ± 0.56 (median = 0.86, interquartile range = 0.50–1.24) in the aphakic group (P > 0.05). There was a positive relationship between age and visual outcomes in the aphakic group (r = 0.4, P = 0.04) but not in the piggyback IOL group (P = 0.48). There was no significant difference between the mean myopic shift in the piggyback IOL group (∑5.28 ± 1.06 D) and the aphakic group (∑5.10 ± 1.02 D) (P > 0.05). The incidence of reoperation due to complications in piggyback IOL group was higher than aphakic group (%48 vs. %16, respectively, P ≤ 0.01). However, in patients older than 6 months, this risk was not significantly different compared to the aphakic group.Conclusions:Although piggyback IOL implantation for infantile cataract is optically acceptable as a treatment option, there is no significant difference in visual outcomes compared to aphakia. The incidence in reoperation due to complications in patients aged 6 months or younger is higher than those treated with aphakia.

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Same-Day Versus Next-Day Repair of Fovea-Threatening Primary Rhegmatogenous Retinal Detachments

Purpose: To evaluate the outcomes of same-day versus next-day repair of fovea-threatening rhegmatogenous retinal detachments (FT RRD). Design: Retrospective, multi-surgeon observational case series. Methods: Operative reports and medical records were reviewed to evaluate a number of visual and anatomic outcomes, including presenting features, intraoperative complications, and postoperative results in the repair of primary FT RRD undergoing same-day versus next-day repair with scleral buckling, pars plana vitrectomy, or both procedures. Participants: A total of 96 consecutive patients (43 same-day, 45 next-day, and eight two days later) were compared. Results: There was no statistically significant difference in visual outcomes between same-day and next-day repair at postoperative months 3 and 6 and at last follow-up (month 3 mean BCVA 20/30 same day; 20/32 next day; p = 0.82). Preoperative vision was strongly correlated with postoperative acuity. Effect of differences in length or type of visual symptoms, location of RRD, gender, or lens status on postoperative month 3 best-corrected visual acuity (BCVA) was not statistically significant. Overall, 85% of patients had a BCVA of 20/40 or better at postoperative month 3. Reoperation rate and intraoperative complications were not statistically different between the two groups. Re-attachment was achieved in all but one patient in both groups. Time in the operating room was longer for same-day surgery (2.98 ± 0.46 hours) compared to next-day surgery (2.54 ± 0.38 hours) (p < 0.001), which was statistically significant even when factoring in the type of surgery performed. However, one case did progress to a macula-off detachment in a superior RRD with breaks found in lattice degeneration. Conclusion: Next-day surgery provided equivalent visual outcomes. Emergent, same-day surgery has logistical and resource implications as it may be more expensive, may necessitate rescheduling of previously booked cases, and may limit preoperative examination by the surgeon and perioperative team.

A prospective study of treatment patterns and 1-year outcome of Asian age-related macular degeneration and polypoidal choroidal vasculopathy.

ObjectiveTo study the treatment patterns and visual outcome over one year in Asian patients with choroidal neovascular membrane secondary to age-related macular degeneration (AMD-CNV) and polypoidal choroidal vasculopathy (PCV).DesignProspective cohort, non-interventional study.Methods132 treatment-naïve patients who received treatment for AMD-CNV and PCV were included. All patients underwent standardized examination procedures including retinal imaging at baseline and follow-up. AMD-CNV and PCV were defined on fundus fluorescein angiography and indocyanine green angiography at baseline. Patients were treated according to standard of care.We report the visual acuity (VA) and optical coherence tomography (OCT) measurements at baseline, month 3 and month 12 The factors influencing month 12 outcomes were analyzed.Main Outcome MeasureType of treatment, number of Anti-vascular endothelial growth factor (VEGF) treatments, visual outcome over one year.ResultsAnti-VEGF monotherapy was the initial treatment in 89.1% of AMD-CNV, but only 15.1% of PCV. The mean number of anti-VEGF injections up to month 12 was 3.97 (4.51 AMD-CNV, 3.43 PCV, p = 0.021). Baseline OCT, month 3 OCT and month 3 VA were significant in determining continuation of treatment after month 3. At month12, mean VA improved from 0.82 (∼20/132) at baseline to 0.68 (∼20/96) at month 12 (mean gain 6.5 ETDRS letters, p = 0.002). 34.2% of eyes (38/113 eyes) gained ≥15 ETDRS letters and 14.4% (16/113 eyes) lost ≥15 ETDRS letters. There were no significant differences in visual outcome between AMD-CNV and PCV (p = 0.51). Factors predictive of month 12 visual outcome were baseline VA, baseline OCT central macular thickness, month 3 VA and age.ConclusionsThere is significant variation in treatment patterns in Asian eyes with exudative maculopathy. There is significant visual improvement in all treatment groups at one year. These data highlight the need for high quality clinical trial data to provide evidence-based management of Asian AMD.

Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration

BackgroundAge-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular...

Effect of intraoperative 5-fluorouracil and low molecular weight heparin on the outcome of high-risk proliferative vitreoretinopathy

PurposeTo evaluate the efficacy of a combination of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) during vitrectomy, as adjuvants in preventing proliferative vitreoretinopathy (PVR). DesignDouble-blind, prospective, randomized placebo-controlled trial. MethodsForty consecutive patients diagnosed with rhegmatogenous retinal detachment with high-risk PVR, were randomized to study and control groups (n=20 each). Study group (group 1) patients underwent vitrectomy with the use of both intraoperative 5-FU (0.2mg/ml) and LMWH (5IU/ml). In the control group (group 2), a similar surgery was performed without the use of adjuvants. Patients were evaluated at 1month, 3months and 6months after surgery. Postoperative retinal reattachment, recurrence of PVR, best-corrected visual acuity and complications at the end of 6months were compared between the two groups. A Chi-square statistical analysis was used on all of the outcome measures. ResultsAt 6months post-surgery, 62.5% of patients had reattached retina. There was no significant difference (Chi-square test showed x2=0.106, P=0.7447, P>0.05) in retinal reattachment in both of the groups. The rate of postoperative PVR in the control group was 55%; in the study group, the rate was 45% (the Chi-square test showed x2=0.4, P=0.5271, P>0.05), which proves statistically insignificant. In addition, there was no statistically significant difference in visual outcomes between the two groups (Chi-square test showed x2=0.1002, P>0.05), no significant difference in the complication rate and drug toxicity was noted between two groups. ConclusionsThis study fails to prove the efficacy of the intraoperative use of 5-FU and LMWH in combination as an antiproliferative regiment for the prevention of postoperative PVR or improvement in final visual acuity. At the same time, no significant complications could be attributed to the treatment.

Efficacy and Safety of Intra-Arterial Thrombolysis in Central Retinal Artery Occlusion

To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO). Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage. Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted. The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.

Combined Silicone Oil Removal with Secondary Implantation of Anterior Chamber or Sclera-fixed Posterior Chamber Intraocular Lenses

To compare the outcomes and complication rates of silicone oil removal (SOR) combined with secondary implantation of modern anterior chamber intraocular lenses (AC IOLs) versus scleral-fixated, posterior chamber IOLs (SF IOLs) in patients who lack capsular support. A prospective, nonrandomized study was performed to compare 2 groups of patients between January 2006 and February 2011. Forty eyes of 40 patients undergoing AC IOL implantation (group 1) and 34 eyes of 34 patients undergoing SF IOL implantation (group 2) were included. The mean follow-up was 22.3 ± 6.3 (range 6-42) months. The mean postoperative corrected distance visual acuity (CDVA) recorded at the last follow-up in groups 1 and 2 was 0.70 ± 0.50 and 0.65 ± 0.55, respectively (p = 0.71). A total of 35 eyes (87.5%) and 29 eyes (85.3%) in groups 1 and 2 had an improved or unchanged CDVA; 5 eyes (12.5%) and 5 eyes (14.7%) had a deteriorated CDVA. The most frequent postoperative complications in the 2 groups were transient corneal edema, elevated intraocular pressure, hypotony, and retinal detachment. The differences in the number of eyes and the total number of complications were not statistically significant for early (p = 0.06) and late (p = 0.13) complications between the 2 groups. Both secondary AC IOL and SF IOL implantation with simultaneous pars plana approach of SOR are suitable for treating silicone oil-filled, aphakic eyes. No significant difference in visual outcome or major complication rates was found between the 2 groups.

Long-Term Visual and Refractive Outcomes following Surface Ablation Techniques in a Large Population for Myopia Correction

To evaluate the visual and refractive outcome for four wavefront-guided surface ablation (WGSA) techniques (LASEK, LASEK flap-off [LASEK FO], Epi-LASIK, and Epi-LASIK flap-off [Epi-LASIK FO]) in a large myopic population. This retrospective review included 1000 myopic eyes (spherical equivalent [SE] -1.0 to -8.0 diopters [D]) treated with WGSA (VISX STAR S4 with IR) using four different epithelial management techniques. Flaps were either retained (163 Epi-LASIK, 361 LASEK) or discarded (277 Epi-LASIK FO, 199 LASEK FO). Eyes in each group were stratified to either low, mild, moderate, or high myopia based on preoperative SE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), predictability, lines lost, and haze were compared at 3, 6, and 12 months. At 1 year, UDVA and CDVA of ≥20/20 and 20/15 were comparable across the four procedure groups and within each subgroup of myopia. Predictability was less than or equal to ±0.5 D of intended correction in 96% to 99% of eyes. LASEK FO and Epi-LASIK FO outperformed the EPI-LASIK in achieved MRSE, especially in the high myopia category (-0.012, 0.040, and -0.27 D, respectively, P < 0.05). No eyes lost more than one line of CDVA; and 50% to 60% of eyes in each group gained one or more lines. No significant haze was recorded in any group. There was no statistically significant difference between groups in the preoperative MRSE and efficacy indices except for LASEK FO. At 1 year, there was no statistically significant difference in visual outcomes between techniques for any degree of myopia. However, the MRSE achieved with LASEK FO and Epi-LASIK FO were closer to emmetropia.

Strabismus in Cases of Cataract in Pediatric Age Group*

Purpose: To investigate the epidemiology of strabismus in cases of pediatric cataracts. To assess visual outcome following orthoptic treatment for amblyopia in cases of cataracts in the pediatric age group. Methods: This was a retrospective cohort study. We investigated a consecutive series of pediatric patients with congenital, developing, or traumatic cataracts who underwent surgery between January 1999 and April 2012 at our center. Patient demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results: In total, 1331 eyes of 1043 children were included: unilateral cataracts were present in 785 (59%) eyes. There were 605 (45.5%) traumatic and 726 (54.5%) non-traumatic cases. Ages at surgery ranged from 1 to 215 months. All eyes were examined for ocular alignment; 66 (5%) were found to manifest strabismus. Deviation was significantly associated with age at intervention (p p p 0.001). We found significant differences in visual outcome following amblyopia therapy (p 0.001). Conclusions: Surgical treatment with intraocular lens implantation in children with congenital, developmental, or traumatic cataracts is effective for visual rehabilitation. Orthoptic treatment made a significant difference in visual outcome (p

Global Health and the Surgeon 2013 Winning Abstract - Surgical Outcomes of Infantile Cataract Surgery

Cataract extraction is the commonest surgical procedure performed in the UK. 1 Congenital cataracts are a treatable cause of childhood visual deficit, 2 with a prevalence of 6 cases per 10,000 births. 3 Various morphological types present in infants, some being visually significant, including posterior polar cataracts located near the macula. 4 Four decades ago, infants were managed conservatively with atropine for mydriasis allowing the child to “look around the opacity”. 5 Currently, it is a predominantly surgical task, however, surgeons are facing the question of which mode of optical correction to use, either a contact lens or an intra-ocular lens. 6 , 7 Many studies have not shown a significant difference in visual outcomes afforded by contact lens or intra-ocular lens. Other factors including the time the cataract has been visually significant, poor compliance of contact lens wear, and occlusion therapy have proven to be better determinants of visual outcome. Intra-ocular lenses are associated with a significantly higher incidence of complications including glaucoma and iris prolapse. 8 Younger age at surgery is also linked to a higher rate of adverse events, especially if before six weeks of life. 9 Early lensectomy is advised to prevent the cataract affecting vision for a longer period of time, which is associated with a poor prognosis. 10 Surgeons should make an informed decision on whether parents are likely to comply with contact lens wear and, if not, advise them on intraocular lenses, the more appropriate option for non-compliant parents.

Comparison of the Surgical Outcomes of Various Methods of Endothelial Keratoplasty.

The objective of this study was to evaluate the outcomes of various techniques of endothelial keratoplasty (EK) including deep lamellar endothelial keratoplasty (DLEK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet stripping automated endothelial keratoplasty (DSAEK). This was a retrospective comparative case series. The medical records of 48 consecutive patients who have undergone EK in a tertiary eye center between January 2005 and June 2011 were reviewed. Information related to demographics, visual acuity, corneal endothelial cell count, and postoperative complications was recorded. The series included 11 eyes with DLEK, 11 eyes with DSEK, and 26 eyes with DSAEK. There was no significant difference in visual outcomes, endothelial cell loss, and postoperative complications between the 3 groups 1 year after surgery. The mean logMAR visual acuity at 12 months was 0.54 (SD, 0.26) for DLEK, 0.55 (SD, 0.47) for DSEK, and 0.63 (SD, 0.48) for DSAEK, respectively. The 6-month endothelial cell density loss was 48.4%, 39.2%, and 47.5% for the DLEK, DSEK, and DSAEK groups, respectively. Early postoperative graft dislocation occurred in 1 (9%) of the DLEK cases, 2 (18%) of the DSEK cases, and 1 (4%) of the DSAEK cases. All of these cases were successfully repositioned. Despite the various evolution and surgical modifications and development in EK in the past few years, the visual outcomes and postoperative complications between DLEK, DSEK, and DSAEK were comparable.

Cataract Surgical Outcome and Predictors of Outcome in Lumbini Zone and Chitwan District of Nepal

Purpose: To evaluate visual acuity outcome from cataract surgery based on a population-based survey among people aged 50 years and older in Lumbini Zone and Chitwan District of Nepal.Methods: A randomly selected, population-based cross sectional epidemiological study of blindness, visual impairment and cataract surgical outcome was conducted. All subjects underwent a comprehensive ocular examination by an ophthalmic assistant, while people with visual impairment (visual acuity less than 6/18) after refraction and all cataract surgical cases underwent dilated fundus examination by an ophthalmologist.Results: 5,916 people were enumerated and 5,141 (86.9%) examined. Among the 359 people who had cataract surgery, 485 eyes were included in the study. First eye surgery was before 2000 in 84 (23%), between 2000 and 2003 in 130 (36%), and after 2003 in 145 (41%). A presenting visual acuity ≥ 6/18 was achieved in 298 (61.4%) eyes (10 [17.8%] and 288 [67.1%] of aphakic and pseudophakic eyes, respectively) and best corrected vision ≥ 6/18 in 411 (84.7%) in all eyes. A presenting visual acuity less than 6/60 was found in 27 (6.3%) pseudophakic eyes. There was no significant difference in visual outcome based on age, sex, literacy, or institution. Uncorrected refractive error was the main cause (72.9%) of visual impairment in pseudophakic eyes.Conclusions: Visual acuity outcome after cataract surgery requires further improvement to meet World Health Organization standards, particularly improvement in preoperative biometry and refractive services. The same quality cataract surgery was provided in and equitably distributed throughout Lumbini Zone and Chitwan District independent of age, sex, literacy or location.

Clinical characteristics and outcome of current standard management of central retinal artery occlusion

To investigate the visual outcomes in acute central retinal artery occlusion (CRAO) with current standard therapy at two university teaching hospitals. Retrospective analysis of two cohorts of CRAO patients from John Hopkins Hospital (JHH; USA), and Flinders Medical Centre (FMC; Australia), treated with current standard therapy. The outcome measures were visual acuity, and subsequent ocular and systemic ischaemic events. The mean follow-up period was 11.2 +/- 13.1 months in the JHH cohort and 35.4 +/- 34.9 months in the FMC cohort. The frequency distribution of vascular risk factors and the incidence of subsequent ischaemic events were similar for the patients from both institutions. All patients from JHH were treated as inpatients, whereas 79% of patients from FMC were treated as outpatients. More patients in the JHH cohort underwent paracentesis, ocular massage or were treated with intraocular hypotensive agents (76%) than in the FMC cohort (26%); however, there was no significant difference in visual outcome between the two cohorts (P = 0.114). Despite differences in management of CRAO between two institutions in different countries, visual outcomes were similar. This suggests a lack of efficacy of current standard treatment in acute CRAO.

Traumatic optic neuropathy: a review of 24 patients.

To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre. A retrospective study was conducted involving 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009. Twenty-four patients (27 eyes) were included. All cases involved were males. Mean age was 33 years old. Motor vehicle accident was the major cause (83.3%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 81.5%) with associated periorbital haematoma (22 eyes) and subconjunctival haemorrhage (20 eyes). Majority of patients (19 patients, 79.2%) presented with more than one bony fracture of skull or orbit and 5 patients (20.8%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (45.8%) had been treated with intravenous and oral corticosteroids. The other 7 patients (29.2%) were treated conservatively and the third group (6 patients, 25.0%) was on intravenous corticosteroids only. Eleven of 12 eyes (91.7%) treated with intravenous and oral corticosteroids had shown 1 line improvement of visual acuity. Those eyes treated conservatively (77.8%) had shown 1 line improvement of visual acuity. As for patients treated with intravenous corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with conservative management was not significant (P=0.386). Patients treated with intravenous corticosteroids alone have shown no visual improvement statistically(P<0.05). Patients treated with intravenous followed by oral corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticosteroids and patients treated conservatively (P=0.368). No patient underwent surgical decompression of the optic nerve. In this series, the follow up ranges from 6 months to 3 years. Most of the traumatic optic neuropathy patients presented with periorbital haematoma, subconjunctival haemorrhage and orbital wall fractures. Patients treated with intravenous followed by oral corticosteroids have better visual outcome compared to conservative management.

Early Postoperative Pain and Visual Outcomes Following Epipolis-LaserIn SituKeratomileusis and Photorefractive Keratectomy

PurposeTo compare early postoperative pain and visual outcomes after epipolis-laser in situ keratomileusis (epi-LASIK) and photorefractive keratectomy (PRK) in the treatment of myopia.MethodsA retrospective chart review was designed and included 49 eyes in 30 patients who underwent epi-LASIK and 54 eyes in 29 patients who underwent PRK. During the early postoperative period (days 1 to 5), pain, uncorrected visual acuity (UCVA), and time to epithelial healing were recorded. Visual outcomes were followed for up to six months.ResultsMean preoperative spherical equivalent refraction for the epi-LASIK group was -3.99±1.39 diopters (D) and that of the PRK group was -3.54±1.27 D. The pain scores on the fourth postoperative day were significantly higher in the epi-LASIK group than in the PRK group (p=0.017). Duration of pain in the epi-LASIK group was longer than in the PRK group (p=0.010). Mean healing time was significantly longer in the epi-LASIK group than in the PRK group (p<0.000). In addition, UCVA in the epi-LASIK group at postoperative days 1 and 3 were significantly lower than those in the PRK group (p=0.021 and p<0.000, respectively). Uncorrected visual acuity at one week and one month after epi-LASIK were lower than those after PRK (p=0.023 and p=0.004, respectively).ConclusionsIn the epi-LASIK patients, pain relief, corneal healing, and visual recovery seemed to be slower during the early postoperative period compared to those of the PRK patients. With longer duration of follow-up, however, there were no significant differences in visual outcome between the two groups.