Slight Improvement In Visual Acuity Research Articles

Refraction dynamics in schoolchildren with congenital partial atrophy of the optic nerve over a ten-year observation period

Introduction. Optic nerve atrophy is a degenerative condition and a prevalent cause of visual impairment, including in children. Data on refractogenesis in schoolchildren with partial atrophy of the optic nerve (PAON) are scarce, with existing literature focusing primarily on the correction of low vision associated with this disorder. Purpose: to assess the refraction dynamics in schoolchildren with congenital PAON over a ten-year observation period.Materials and methods. We conducted a retrospective analysis of refraction changes over a decade among three groups: 1) 47 schoolchildren with PAON, 2) 49 schoolchildren with ametropia without PAON, and 3) 49 schoolchildren without any ophthalmopathology.Results. All groups exhibited a trend towards myopization (р < 0.001). In groups with myopic and emmetropic refractions (without ophthalmopathology at the start), either the emergence or an increase in myopic refraction was noted. In hypermetropic children, a gradual decrease towards emmetropic refraction or a shift to myopic refraction was observed. For myopic schoolchildren using contact lenses and perifocal glasses from the ages of 11–13, myopia progression stabilized, particularly with perifocal optical correction (р < 0.01). Despite refractive changes during the school years, regular courses of functional treatment and accommodation training led to a slight improvement in visual acuity in PAON patients (by an average of 0.05 ± 0.01 (p = 0.001) in myopes and 0.06 ± 0.01 (р < 0.001) in hypermetropes) and a significant increase in visual acuity in children with normal fundus ametropia (by an average of 0.14 ± 0.02 (р < 0.001) in myopes and 0.18 ± 0.02 (р < 0.001) in hypermetropes).Conclusion. The ten-year observation demonstrates a myopization trend in all groups of schoolchildren, which holds particular relevance for those with PAON due to their inherently lower visual acuity. An optimal optical correction strategy, employing modern myopia control measures in tandem with regular functional treatment and accommodation training, is essential for a health-preserving educational approach in schoolchildren with PAON.

Achromatopsia: Long term visual performance and clinical characteristics.

Achromatopsia is an autosomal recessive cone dysfunction syndrome, characterized by absence of color discrimination, low visual acuity, photophobia, and nystagmus. Achromatopsia constitutes a common cause of visual impairment in children, with a prevalence of 1:30,000 worldwide. To characterize the clinical characteristics of achromatopsia, the main genes causing the disease in our population and the clinical course of the disease, with an emphasis on visual function stability with increasing age. Retrospective study based on medical charts of patients with achromatopsia. Patients were divided into two groups according to their age at last follow-up: older and younger than 10 years. A subset of patients with long term follow-up were analyzed separately, with patients being described in both age groups. Seventy-six patients were included in the study. The mean age was 14.28 years. Variants in the CNGA3 gene were the most common (73.6%). Clinical characteristics included photophobia (96.2%), nystagmus (93.6%), hypermetropia (72.3%) and strabismus (51.1%). In the large cohort there was no correlation of age with visual acuity (p = 0.129). In the separate subset cohort with long follow-up there was a relative improvement in visual acuity with age (p < 0.001). CNGA3 is the main gene associated with achromatopsia in our population (around ∼ 73%), which is in contrast to the distribution worldwide (∼ 25%). Most achromats suffer from photophobia and nystagmus, and the main refractive error is hypermetropia. Achromatopsia's natural course seems to be stationary, and there may even be a slight improvement in visual acuity with time.

Efficacy of oral steroid therapy in the treatment of acute maculopathy in the course of hand, foot and mouth disease – 3 case reports

Oral steroid therapy was administered in three patients with skin symptoms, diagnosed with hands, mouth and foot disease (HMFD, commonly known as “Boston’s disease”) and in the course of which there was a rapid deterioration of vision in one eye. Each of the patients had previous contact with a person with disease. Hospitalization of the first patient, during which general antibiotic therapy, antiviral drugs and short-term intravenous steroid therapy were used, brought only a slight improvement in visual acuity. Given the accompanying colour discrimination dysfunction, oral steroid therapy was introduced in this patient, already in the outpatient setting. The therapy brought a significant improvement in visual acuity in a short time and restored the ability to distinguish colours. This form of treatment was used in another two patients with similar, good result.

Retrospective analysis of OCT parameters after intravitreal anti-VEGF inhibitors in neovascular AMD patients in a real-world setting

PurposeThe aim of the present study was to evaluate changes of best corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFL), total macular volume (TMV), intraocular pressure (IOP) and central retinal thickness (CRT) after intravitreal injection of ranibizumab, bevacizumab and aflibercept in patients with neovascular age-related macular degeneration (nAMD) in a clinical real world setting.MethodsIn a retrospective clinical study design, 120 patients (80 women and 40 men) were analyzed after being diagnosed with nAMD within 8 years (2010–2018). Every patient received at least 6 anti-VEGF injections in a Pro-Re-Nata or Treat-and-Extend regimen. OCT parameters (RNFL, TMV, CRT) and visual acuity (BCVA) were assessed at first diagnosis, at treatment day and during the course.ResultsIntraretinal fluid was reduced significantly in a magnitude of 88–64 µm (CRT) and 0.75–0.55 mm3 (TMV). Apart from a significant reduction immediately after the therapy start (post-3 injections) with ranibizumab (− 1.4 µm, p = 0.03), RNFL thickness remained constant. A slight improvement in visual acuity of 0.06 logMAR could initially be observed. If further injections were required, only stabilization was achieved compared to baseline visual acuity.ConclusionThe changes of OCT parameters CRT, TMV, and RNFL as well as the stabilization of functional results (BCVA) as illustrated in this study comparing effects of different anti-VEGF-agents provide evidence for the transferability of former results to a clinical real-world setting.

Effect of lutein supplementation on visual function in nonproliferative diabetic retinopathy.

The purpose of this study was to determine whether supplementation with lutein improved visual function in patients with nonproliferative diabetic retinopathy (NPDR). In this randomized, double-blind, placebo-controlled trial, 31 patients with NPDR were assigned randomly to 10 mg/d of lutein or identical placebo for 36 weeks. Visual performance indices, including visual acuity (VA), contrast sensitivity (CS) and glare sensitivity (GS) at four different spatial frequencies, were measured at baseline, week 18 and 36. At 36 weeks, a slight improvement in VA was found in the lutein group. A significant association was observed between the changes in VA and the corresponding baseline values in treatment group (r=-0.53; p=0.04). At 36 weeks, the lutein treatment group increased CS at four spatial frequencies, and the improvement achieved statistical significance at 3 cycles/degree (p=0.02). The changes in CS at 3 cycles/degree for the lutein group was marginally significantly greater than those for the placebo group (p=0.09). There was also a slight increase in GS in the lutein group up to week 36, however, no significant changes were found over time in any cycles/degree. In patients with NPDR, supplementation with lutein resulted in potential improvements in CS at low spatial frequency. Further studies are required to determine the possibility that such intervention could be used as an adjunct therapy to prevent vision loss in diabetic patients.

Hypertensive Chorioretinopathy due to Primary Renal Artery Stenosis

Purpose: To describe a case of hypertensive chorioretinopathy due to secondary hypertension caused by primary renal artery stenosis. Method: Case report by reviewing medical data. Case report: Thirteen years old male, in treating for severe hypertension, presenting substantial bilateral visual impairment one month ago. During ophthalmologic examination, best corrected visual acuity in both eyes was 20/100 and hypertensive chorioretinopathy was found at the fundoscopic examination. Fundus photography, fluorescein angiography and optical coherence tomography were performed. Imaging tests showed left renal artery stenosis and a smaller left kidney. After clinical pharmacological treatment for artherial hypertension there was a slight improvement in visual acuity. Conclusion: Primary renal artery stenosis unilateral is a condition uncommon which can evolve with hypertensive chorioretinopathy.

Systemic treatment with a 5HT1a agonist induces anti-oxidant protection and preserves the retina from mitochondrial oxidative stress

Chronic oxidative stress contributes to age related diseases including age related macular degeneration (AMD). Earlier work showed that the 5-hydroxy-tryptamine 1a (5HT1a) receptor agonist 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT) protects retinal pigment epithelium (RPE) cells from hydrogen peroxide treatment and mouse retinas from oxidative insults including light injury. In our current experiments, RPE derived cells subjected to mitochondrial oxidative stress were protected from cell death by the up-regulation of anti-oxidant enzymes and of the metal ion chaperone metallothionein. Differentiated RPE cells were resistant to oxidative stress, and the expression of genes for protective proteins was highly increased by oxidative stress plus drug treatment. In mice treated with 8-OH-DPAT, the same genes (MT1, HO1, NqO1, Cat, Sod1) were induced in the neural retina, but the drug did not affect the expression of Sod2, the gene for manganese superoxide dismutase. We used a mouse strain deleted for Sod2 in the RPE to accelerate age-related oxidative stress in the retina and to test the impact of 8-OH-DPAT on the photoreceptor and RPE degeneration developed in these mice. Treatment of mice with daily injections of the drug led to increased electroretinogram (ERG) amplitudes in dark-adapted mice and to a slight improvement in visual acuity. Most strikingly, in mice treated with a high dose of the drug (5 mg/kg) the structure of the RPE and Bruch's membrane and the normal architecture of photoreceptor outer segments were preserved. These results suggest that systemic treatment with this class of drugs may be useful in preventing geographic atrophy, the advanced form of dry AMD, which is characterized by RPE degeneration.

DEXAMETHASONE IMPLANT FOR MACULAR EDEMA SECONDARY TO ISCHEMIC RETINAL VEIN OCCLUSIONS

To evaluate the effects of dexamethasone implant for the treatment of macular edema secondary to ischemic retinal vein occlusions (IRVO). Consecutive patients affected by macular edema related to IRVO were prospectively recruited. After a comprehensive ophthalmological examination, including visual acuity, fluorescein angiography, and optical coherence tomography, each patient received a first implant. Further re-treatments were performed on the basis of macular edema detection from the fourth month on. The primary outcome measure was the change in Early Treatment Diabetic Retinopathy Study letter score at the 12-month examination. Secondary outcome measures included changes in central foveal thickness and number of implants over the follow-up. Fifteen patients with central IRVO and 14 patients with branch IRVO were recruited. The median ETDRS letter score at baseline was 10 (Snellen Equivalent 20/640) in the central IRVO subgroup, improving to 37 (Snellen Equivalent 20/200²⁺) at the 12-month examination. The median ETDRS letter score in the branch retinal vein occlusion subgroup changed from 48 (Snellen equivalent 20/125³⁺) at baseline to 62 (Snellen equivalent 20/63²⁺) at the 12-month examination. The baseline median central foveal thickness was 749 μm in central IRVO, and 459 μm in branch IRVO, improving to 363 μm and 323 μm, respectively, at the 12-month examination. Mean number of implants was 2.8 in the central IRVO and 2 in the branch IRVO. Dexamethasone implant can reduce macular edema in eyes affected by IRVO, leading to a slight improvement in visual acuity.

Irreversible visual loss after use of Paclitaxel

We describe a case of bilateral irreversible visual loss of a 64 year-old patient after prolonged use of paclitaxel. Patient presented best corrected visual acuity of 20/400 in both eyes at first visit and optical coherence tomography showed increased macular in both eyes.After six months of the interruption of -paclitaxel therapy, the patient showed slight improvement of visual acuity reaching 20/200 in both eyes, while OCT demonstrated resolution of macular edema.

Intravitreal Bevacizumab, Plasminogen, and Pneumatic Retinopexy for Subfoveal Hemorrhage in Age-Related Macular Degeneration.

To evaluate the therapeutic effect of intravitreal bevacizumab combined with intravitreal plasminogen and pneumatic retinopexy as treatment of subfoveal hemorrhages due to exudative age-related macular degeneration. Clinical interventional case series study. Ten patients (10 eyes) with exudative age-related macular degeneration, presented with a subfoveal hemorrhage larger than 1 disc size and smaller than 5 disc sizes. They received an intravitreal injection of 50 μg of plasminogen and 0.3 mL of 100% sulfur hexafluoride gas combined with intravitreal 1.5 mg of bevacizumab, followed by 2 additional intravitreal injections of 1.5 mg of bevacizumab in an interval of 6 weeks. Mean visual acuity improved slightly, although not statistically significant (P = 0.24), from 1.56 ± 0.47 to 1.48 ± 0.60 logMAR at 1 month after the procedure and to 1.35 ± 0.54 logMAR at 3 months after baseline. Subfoveal hemorrhage recurred in none of the patients during the follow-up. In all patients, the subfoveal hemorrhage had at least partially been moved to the infrafoveal region. Pronounced degenerative subfoveal changes were the main reason for a lack of a marked increase in visual acuity after the procedure. For some patients with exudative age-related macular degeneration and a subfoveal hemorrhage larger than 1 disc size and smaller than 5 disc sizes, the combined intravitreal injection of bevacizumab, plasminogen, and gas followed by 2 additional intravitreal bevacizumab injections can lead to a stabilization or slight improvement in visual acuity, unless subfoveal degenerative changes are not too marked to prevent a gain in vision.

Insuficiencia limbar secundaria a múltiples inyecciones intravítreas

Case report A 68 year-old male with idiopathic choroidal polypoidal vasculopathy received seven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developed a localized limbal stem cell deficiency which required limbal transplantation from the same eye. Two months after surgery, a slight improvement of visual acuity was noted, along with an intact ocular surface, clear cornea and decreased inflammation. Discussion Repeated surgical trauma on the limbus and surrounding areas may damage the limbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency. Repeated intravitreal injections may be considered as one of the possible causes.

Limbal stem cell deficiency following multiple intravitreal injections

Case reportA 68 year-old male with idiopathic choroidal polypoidal vasculopathy received seven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developed a localized limbal stem cell deficiency which required limbal transplantation from the same eye. Two months after surgery, a slight improvement of visual acuity was noted, along with an intact ocular surface, clear cornea and decreased inflammation. DiscussionRepeated surgical trauma on the limbus and surrounding areas may damage the limbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency. Repeated intravitreal injections may be considered as one of the possible causes.

Grid photocoagulation combined with intravitreal bevacizumab for recurrent macular edema associated with retinal vein occlusion

Purpose:To report the efficacy of grid photocoagulation combined with intravitreal bevacizumab (IVB) for macular edema recurring after previous IVBs associated with retinal vein occlusion (RVO).Methods:This retrospective study consisted of 19 eyes with branch retinal vein occlusion (BRVO) and nine eyes with central retinal vein occlusion (CRVO), which were treated with grid photocoagulation combined with IVB for recurrent macular edema after previous IVBs. The mean duration of total follow-up was 29.3 ± 5.8 months.Results:After this combination therapy, foveal thickness was reduced, significant with slight improvement in visual acuity (VA). At 1 month after treatment, although 25 of the 28 eyes showed complete resolution of the cystoid space, the macular edema recurred to some extent in 19 eyes. Compared with initial values, final foveal thickness was reduced significantly in both BRVO and CRVO groups (P < 0.001), but improvement in VA was significant only for eyes with BRVO (P = 0.012). The total number of IVB was 2.8 ± 0.7 for eyes with either BRVO or CRVO.Conclusion:Grid photocoagulation combined with IVB has a substantial effect on reducing recurrent macular edema associated with RVO, but the effect on visual acuity is limited.

Fibrin sealant in the treatment of retinal detachment in morning glory syndrome.

To report the usage of fibrin sealant in the treatment of retinal detachment in morning glory syndrome. A case report of an 8-year-old boy with a recent, macula-off, inferior, bullous retinal detachment associated to his morning glory syndrome that was first treated by a pneumatic retinopexy. The following day, his examination revealed a total retinal detachment and subretinal gas. The patient underwent a 25-gauge pars plana vitrectomy, incomplete peeling of the glial tuft, 360° laser photocoagulation around the peripapillary staphyloma, 20% perfluoropropane endotamponade, and fibrin sealant injection to temporarily plug the slitlike retinal break visualized on the inferior border of the peripapillary staphyloma. Complete reattachment of the retina persisted after 6 months of follow-up with slight improvement in visual acuity noted by the patient. The authors believe that the usage of fibrin sealant seems to be a useful alternative in cases of retinal detachment related to morning glory syndrome with deep posterior peripapillary staphyloma, especially when persistent residual traction is suspected.

Chirurgie de la cataracte et dégénérescence maculaire liée à l’âge : bénéfice en termes d’acuité visuelle et de qualité de vie – étude prospective

To assess the benefits of cataract surgery in patients with age-related macular degeneration (AMD) in terms of visual acuity and quality of life. Forty-two eyes of 30 patients were included in this prospective study between October 2003 and January 2005. The eyes were divided into two groups: the first group (n=12) with geographic atrophy and neovascularization (late-stage AMD) and the second group (n=30) with drusen and retinal pigment epithelium abnormalities (early-stage AMD). Assessment included best corrected visual acuity (BCVA) and quality-of-life measures (VF-14 questionnaire) before surgery and BCVA and the VF-14 score after surgery. In the first group, there was no statistical difference but a trend toward improvement in BCVA (p>0.05). In terms of quality of life, there was a statistical difference between pre- and postoperative VF-14 (p=0.0078). In the second group, there was a statistical difference between pre- and postoperative BVCA (p<0.0001). In terms of quality of life, there was a statistical difference between pre- and postoperative VF-14 (p<0.0001). This study shows a benefit in terms of visual acuity and quality of life in the majority of patients with age-related maculopathy after cataract surgery, even in late-stage AMD. Indeed, we noted a marked improvement in visual acuity in cases of early-stage AMD and a slight improvement of visual acuity in late-stage AMD. Quality of life was improved at both stages. In conclusion, cataract surgery is justified in patients with AMD.

Can Optical Coherence Tomography Predict the Outcome of Laser Photocoagulation for Diabetic Macular Edema?

To assess the outcome of laser photocoagulation in patients with diabetic macular edema. Forty-seven patients (51 eyes) with clinically significant macular edema (CSME) undergoing grid laser photocoagulation were included. Clinical examination and optical coherence tomography (OCT) were performed at baseline and 3 to 4 months after treatment. The central foveal thickness, mean inner macular thickness (average retinal thickness in fovea and inner macular circle), and mean macular thickness were calculated. Based on the greatest OCT thickness at baseline, patients were grouped according to mild (< 300 microm; Group 1), moderate (300 to 399 microm; Group 2), and severe (> or = 400 microm; Group 3) macular edema. Group 2 showed significant reductions in central foveal thickness (23 microm, P = .02), mean inner macular thickness (18 microm, P = .02), and mean macular thickness (9 microm, P = .04) with slight improvement in visual acuity. Groups 1 and 3 did not show any significant change in macular thickness values and there was a statistically insignificant worsening of visual acuity in these groups. Patients with moderate macular thickening of 300 to 400 microm benefit most from laser treatment. OCT may help in choosing the appropriate treatment for CSME based on the degree of macular thickening. Long-term studies are warranted to confirm these findings.

Microcatheter Urokinase Infusion in Central Retinal Artery Occlusion

We treated 14 consecutive patients for acute central retinal artery occlusion. Eleven were treated with urokinase introduced through a microcatheter in the proximal segment of the ophthalmic artery. Fibrinolysis was succeeded by heparinization for two to three days. Instead of urokinase, we used tissue plasminogen activator in three patients. Vision improved markedly in four of the 14 patients. Five others had slight improvement of visual acuity, visual field, or both. In five patients, no change occurred. Such a recovery of visual acuity may be anticipated if treatment begins within the first few hours after the onset of central retinal artery occlusion. A control group of 41 consecutive patients treated conservatively showed almost no improvement in visual acuity. Eleven of these 41 patients were treated within the first six hours after the patient noticed the onset of blindness.

DALLOS CONTACT LENSES

<h3>To the Editor:</h3> —It was not our intent in any manner whatever to disparage or detract from the pioneering of Dr. Joseph Dallos in the development of contact lenses. The authors are well familiar with his work of the last 30 years. We appreciate the references offered by Dr. Dallos as admittedly identifying him with the first use of ventilated contact lenses. In the article appearing in the<i>Klinische Monatsblätter für Augenheilkunde</i>, he describes the construction of his lens and the results of its use in 12 patients, 8 of whom had keratoconus, and for these he does illustrate slight improvement in visual acuity; however, with only one exception, the patients could tolerate the lens no more than two to four hours. Tolerance, from the standpoint of both the patient's feeling of comfort and the actual ability of the eye tissues to tolerate the lens, is paramount. Weight influences this