Best-corrected Snellen Visual Acuity Research Articles

Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease.

To investigate the retinal vascular abnormalities in both affected and fellow eyes of presumed unilateral Coats disease patients using ultra-widefield fluorescein angiography (UWF-FA) and their association with visual prognosis. A retrospective review of medical records was conducted on 30 patients diagnosed with presumed unilateral Coats disease, who were evaluated with UWF-FA from March 2003 to May 2024 at a tertiary referral hospital. Clinical features and multimodal imaging findings were evaluated, and factors related to final visual outcomes were analyzed. All 30 patients were diagnosed with presumed unilateral Coats disease at presentation, comprising 11 childhood-onset (36.7%) and 19 adult-onset patients (63.3%). Retinal vascular telangiectasia was observed in 51.7% of the fellow eyes. The extent of telangiectasia and exudate in the affected eyes did not significantly correlate with the extent of telangiectasia in the fellow eyes. In the more affected eyes, the childhood-onset group had a significantly greater extent of capillary dropout compared to the adult-onset group (5.0 clock hours vs. 2.8 clock hours, p = 0.023). In the fellow eyes, telangiectasia tended to be more frequent in the childhood-onset group, without statistical significance (63.6% vs. 44.4%, p = 0.160). In the multivariable regression analysis, the final best-corrected visual acuity (BCVA) in the more affected eyes was significantly associated with initial BCVA. The mean extent of telangiectasia in the temporal and nasal quadrants (odds ratio, 12.759; p = 0.043) and the initial BCVA of the more affected eyes (odds ratio, 11.841; p = 0.024) were identified as prognostic factors for final moderate to severe visual loss (Snellen BCVA <20 / 66). About half of the presumed unilateral Coats disease cases exhibited features of the bilateral disease. Visual prognosis is associated with the peripheral retinal telangiectasia in the temporal and nasal quadrants as well as initial BCVA in the affected eyes while it is not associated with retinal vascular abnormalities in the fellow eyes.

Eales’ disease with secondary coats’-like reaction: a case report

BackgroundEales’ disease is an idiopathic, inflammatory condition characterized by peripheral retinal phlebitis, distal non-perfusion, and neovascularization. Coats’ disease, on the other hand, is an idiopathic, retinal vasculopathy characterized by telangiectasia and yellowish exudation. Both diseases commonly affect males. Here, we report an atypical case of unilateral Eales’ disease with co-existing, secondary Coats’-like reaction in a 25-year-old male exhibiting unilateral retinal telangiectasia accompanied by subtle macular edema, extensive peripheral vascular sheathing, and distal non-perfusion in the absence of clinically visible exudation.MethodsCase report.ResultsA 25-year-old male presented with painless blurring of vision in the right eye for two months. Best-corrected Snellen visual acuity was 3/60 in the affected eye, with relative afferent pupillary defect observed, and 6/9 contralaterally. Anterior segment examination was unremarkable. Right eye fundoscopy showed aneurysmal telangiectasia at the macula, 360 degrees perivascular sheathing and telangiectasia of peripheral retinal vessels. There was no exudation, neovascularization, tractional membranes, vitritis, retinitis, and choroiditis. Left eye fundus was unremarkable. Optical coherence tomography of the macula revealed disorganization and thinning of the inner retinal layers with minimal intraretinal fluid. Fundus fluorescein angiography showed leakage from the aneurysms but not from the sheathed vessels, and an enlarged foveolar avascular zone. A well-defined zone of non-perfusion and retinal vascular telangiectasia with shunts was observed. Blood investigations ruled out metabolic, infectious, haematological, and autoimmune causes. Carotid Doppler showed no stenosis, and CT angiography of the brain did not show any vascular abnormalities. In view that no cause was identified, a diagnosis of Eales’ disease with secondary Coats’-like reaction was made. Treatment consisted of FFA-guided laser photocoagulation to the areas of non-perfusion. Intavitreal anti-vascular endothelial growth factor injection was not done in view of poor visual prognosis. The condition and visual acuity remained stable during 18 months of follow-up.ConclusionThis report highlights an atypical case of Eales’ disease with co-existing, secondary Coats’-like reaction.

Use of a Fundus Image-Based Titration Strategy for Selective Retina Therapy for Central Serous Chorioretinopathy.

Background/Objectives: This study evaluated the clinical outcomes of selective retina therapy (SRT) for treating central serous chorioretinopathy. A fundus image-based titration method was used for laser irradiation. Methods: This retrospective cohort study included 29 eyes (29 patients) that underwent SRT for CSC. Both the pulse energy and number of micropulses were adjusted according to the fundus image. Mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), and subretinal fluid (SRF) height were measured 1, 2, 3, 4, and 6 months after SRT. Mean deviation (MD) was measured using microperimetry at 3 and 6 months post-treatment. Results: At 6 months after SRT treatment, SRF was completely resolved in 89.7% of cases (26/29 eyes). The mean Snellen BCVA significantly improved from 0.34 ± 0.31 logMAR (logarithm of the minimum angle of resolution) (20/40) at baseline to 0.24 ± 0.24 logMAR (20/32) at 6 months (p = 0.009). The 0.1 improvement in mean BCVA is equivalent to a 5-letter gain on the ETDRS chart. The mean CFT decreased significantly from 309.31 ± 81.6 μm at baseline to 211.07 ± 50.21 μm at 6 months (p < 0.001). The mean SRF height also decreased significantly from 138.36 ± 56.78 μm at baseline to 23.75 ± 61.19 μm at 6 months (p < 0.001). The mean MD was improved from -1.56 ± 1.47 dB at baseline to -1.03 ± 2.43 dB at 6 months (p = 0.07) after treatment. Conclusions: SRT using fundus image-based titration can yield favorable functional and anatomical outcomes in the treatment of CSC.

Microinvasive intrascleral double continuous suture repair surgery for cyclodialysis clefts.

The traditional suturing method for cyclodialysis cleft usually requires an incision in the sclera for direct suturing, resulting in greater damage and a high risk of postoperative complications. The purpose of this work is to propose a newly intrascleral double continuous suture repair technique for the treatment of cyclodialysis clefts. Seven patients with cyclodialysis cleft underwent microinvasive intrascleral double continuous suture repair surgery to restore the attachment of the detached ciliary body to the sclera without scleral incision. All operations were performed by the same surgeon. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), slit lamp and corneal examination results, ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) results were recorded. Closure of the cyclodialysis cleft was achieved in 7 eyes and no obvious complications occurred after the operation. Intraocular pressure increased from preoperatively 6.8 ± 1.35 mmHg (range: 4.8-8.0 mmHg) to postoperatively 12.5 ± 4.0 mmHg (range: 8.0-20.0 mmHg) (paired sample T test, P < 0.01). Best-corrected Snellen visual acuity improved from preoperatively range 20/2000-20/63 to range 20/200-20/25 at final follow-up. In short, intrascleral double continuous suture repair surgical is safe and effective in treating cyclodialysis cleft, with minimal surgical trauma.

Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage.

Background: Visual acuity (VA) assessments are crucial in ophthalmology but traditionally rely on in-clinic evaluations. The emergence of telemedicine has spurred interest in creating dependable self-administered VA tests for use beyond standard clinical environments. This study evaluated the practicality and validity of a self-administered near VA card test against traditional Snellen and Rosenbaum Pocket Vision Screener (RPVS) methods for home monitoring and enhancing clinical workflow. Methods: In a cross-sectional study, a near VA card (Hadassah Self-Visual Acuity Screener (HSVA)) was developed with written and videotaped instructions for self-use. Patients with a minimal best-corrected VA (BCVA) of 1.0 LogMAR in at least one eye were recruited from ophthalmology and optometry clinics. Outcomes included the mean BCVA difference between the self-administered values and those obtained by the examiner, and correlations between BCVA values obtained by the Snellen, RPVS, HSVA, and previous distance BCVA methods according to the patients' electronic medical records. Results: A total of 275 participants (mean age: 42.5 ± 19.4 years; range: 18-89 years; 47% female) were included. Test-retest reliability analysis of the HSVA demonstrated a very good correlation and repeatability (n = 38 patients; Rs = 1.0; p < 0.001). Accuracy analysis revealed the mean LogMAR BCVA values of an additional 237 patients obtained by the Snellen, RPVS, and HSVA methods were similar (p = 0.10). The self-test BCVA results obtained by the HSVA agreed with the masked examiner-tested VA results (n = 67 patients; p = 0.17; Rs = 0.87; ICC = 0.96). Similar results were obtained when stratification by median age (42 years) was performed. Bland-Altman analysis of the HSVA and RPVS methods demonstrated a good agreement. To assess whether the HSVA could predict the VA results in the clinically used charts, multivariate analysis was used and revealed that the HSVA predicted the RPVS results (β = 0.91; p = 0.001; R2 = 0.88), and the self-test HSVA predicted the Snellen VA results within two lines (β = 0.93; p = 0.01; R2 = 0.36). Conclusions: The home-based HSVA assessment exhibited high test-retest reliability, accuracy, and alignment with clinical-standard VA tests. Its efficacy in self-testing mirrored examiner-conducted VA assessments and accurately predicted Snellen VA outcomes, indicating the HSVA's suitability for self-monitoring in chronic ocular conditions or when access to conventional examinations is limited. The utility of self-administered VA tests may extend beyond ophthalmology and optometry, potentially benefiting primary care, emergency medicine, and neurology. Further research is needed to explore and validate the practical applications of remote VA testing.

Secondary piggyback intraocular lens for posterior microphthalmos

We describe a rare case of posterior microphthalmos (PM) submitted to cataract surgery and highlight the problem of high residual hyperopia in these eyes due to the limited commercial availability of a high-powered intraocular lens (IOL). A 50-year-old highly hyperopic man who pretended refractive surgery presented in our hospital. Pre-operative Snellen best-corrected visual acuity (BCVA) was 20/125 in the right eye with a spherical correction of +17.00 D and 20/40 in the left eye with a spherical correction of +18.75. The anterior segment and fundus exam were typical for PM. Optical axial length was 15.50 mm in the right eye and 15.53 mm in the left eye and anterior segment dimensions were within normal limits. IOL power calculation for emmetropia ranged between +51.5 and +62.5 D using modern IOL formulas. Cataract surgery was performed in a bilateral and sequential manner with the implantation of monofocal foldable acrylic +45.0 D IOL with the improvement of spherical correction to +11.00 D bilaterally. Secondary implantation of supplementary sulcus IOL with the maximum +10.0 D power was then performed bilaterally and sequentially with a final BCVA of 20/125 in the right eye with spherical correction of +5.75 D and 20/40 in the left eye with spherical correction of +5.25 D. Piggyback IOL implantation is beneficial and, in most times, necessary in PM since one IOL will not be sufficient to achieve emmetropia. Different piggyback strategies in regard to timing (primary vs. secondary) and chosen IOLs (in-the-bag, sulcus, and iris-claw) can be used.

SPONTANEOUS IMPROVEMENT OF MYOPIC RETINOSCHISIS AFTER A LONG-TERM OBSERVATIONAL PERIOD: A CASE SERIES.

To highlight spontaneous resolution or improvement of myopic retinoschisis (MR) in actively surveilled patients. Case series of five patients diagnosed with MR who did not undergo pars plana vitrectomy and were carefully monitored by a single retina specialist. Ocular and medical history were reviewed, and clinical characteristics including visual acuity and the status of the MR were monitored with spectral domain optical coherence tomography (SD-OCT) at each clinic visit. Five patients were identified to have MR without vitreomacular traction, or macular hole formation. Two patients exhibited spontaneous and complete resolution of MR without surgical intervention over an average observation time of 52.5 months. In these cases, a clinical posterior vitreous detachment was documented preceding the resolution of MR over an average time of 26.5 months. Snellen best-corrected visual acuity in these patients improved (Case 1 from 20/50 to 20/40, Case 2 from 20/30 to 20/25). The remaining three patients were monitored for an average of 52 months and showed improvement of MR via OCT imaging. Snellen best-corrected visual acuity either remained stable or improved from baseline (Case 3 stable at 20/30, Case 4 improved from 20/40 to 20/30, and Case 5 stable at 20/20). These findings suggest that conservative management of MR with observation can be considered especially in patients with challenging comorbidities (such as monocular status), and with a clinically identified posterior vitreous detachment without vitreomacular traction.

Case Report: Asymmetric Changes of Ophthalmic Findings in Bilateral Solar Eclipse Maculopathy.

A more profound understanding of the relationship between ophthalmic findings and eye dominance is needed to guide the timely and proper treatment of binocular photic maculopathy or other macular degeneration. A patient with binocular solar maculopathy presented with asymmetric ophthalmic manifestations and changes over 14 months of observation. Early recognition of solar maculopathy can be vital for early diagnosis and better prognosis. A 21-year-old male was reported to have blurred vision after staring directly at an annular solar eclipse several times for a few seconds on June 21, 2020. His Snellen best-corrected visual acuity (BCVA) declined to 20/50 in both eyes. He was right-eye dominant according to the hole-in-the-card test. The fundoscopy found a yellow spot in the center of both maculae. Spectral domain optical coherence tomography (SD-OCT) images revealed a full thickness hyperreflectivity extending from the inner retinal layers to the retinal pigment epithelium (RPE) along with a localized disruption of the ellipsoid portion of the inner segments and RPE in both eyes. The medical history and clinical manifestations described above supported the diagnosis of solar maculopathy. SD-OCT images during follow-up indicated a diminishing disruption of the ellipsoid portion of the inner segments and RPE without treatment. Interestingly, the non-dominant left eye made a better anatomical recovery. Finally, the Snellen BCVA remained 20/20 in both eyes after 14 months. Binocular solar maculopathy can present asymmetrically and recover asymmetrically as well. The dominant eye suffered more obvious damage and poorer anatomical recovery than the non-dominant eye.

Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis.

To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis (TGU). Patients of cataract with TGU in the membranous (inactive) stage underwent cataract surgery with intraocular lens (IOL) implantation. Preoperative history and ophthalmic examination were conducted for all cases, whereas Schimphlug imaging and corneal topography were done for some patients. Postoperative follow up was done on the 1st, 2nd, and 5th postoperative days after surgery. Then, it was done at least at one, three, and six months postoperatively. Intraoperative and postoperative complications and the methods of their management were reported. Twelve eyes of 12 male children were included in this study ranging from 8 to 16y. The mean best corrected Snellen visual acuity (BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively (P<0.001). Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea. Intraoperative difficulties and complications included the poor dilatability of the drown down pupil, strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema. All cases underwent primary hydrophobic IOL implantation. Surgery for this type of cataract is relatively safe and effective. It is associated with some specific difficulties and complications that should be considered during surgery and follow up.

LEPREL1 -RELATED GIANT RETINAL TEAR DETACHMENTS MIMIC THE PHENOTYPE OF OCULAR STICKLER SYNDROME.

To describe the features of retinal detachments and high myopia in patients with novel pathogenic variants in LEPREL1 and report a possible association with nephropathy. Retrospective study of 10 children with biallelic LEPREL1 pathogenic variants. Data included ophthalmic features, surgical interventions, and genetic and laboratory findings. 10 patients (8 females) from three families with homozygous (2) or compound heterozygous (1) variants in LEPREL1 were included. At presentation, mean age was 9.9 ± 2.6 years. Mean axial length was 28.9 ± 1.9 mm and mean refraction was -13.9 ± 2.8 diopters. Bilateral posterior subcapsular cataracts were present in eight patients (80%), with lens subluxation in five eyes of three patients (30%). Rhegmatogenous retinal detachments (RRD), associated with giant retinal tears (GRT), developed in seven eyes of five patients (50%) at a mean age of 14.14 ± 5.9 years. Six were successfully reattached with mean Snellen best-corrected visual acuity improving from 20/120 preoperatively to 20/60 at last follow-up. Urinalysis in nine patients revealed microhematuria and/or mild proteinuria in six patients (67%). LEPREL1 -related high myopia confers a high risk of early-onset GRT-related RRD. The ocular phenotype may be confused with that of ocular Stickler syndrome if genetic testing is not performed. Further investigations into a potential association with renal dysfunction are warranted.

Outcomes of Pars Plana Vitrectomy with Panretinal Photocoagulation for Treatment of Proliferative Diabetic Retinopathy Without Retinal Detachment: A Seven-Year Retrospective Study.

To review clinical outcomes of patients with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) who underwent pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP) without retinal detachment (RD) repair. Retrospective chart review of the rate of postoperative clinical findings and visual acuity in patients with PDR from May 2014 to August 2021. Pars plana vitrectomy with endolaser PRP was performed in 81 eyes of 81 patients (mean age of 62.1 ± 10.5 years). At a median follow-up of 18 months, mean Snellen best-corrected visual acuity (BCVA) significantly improved from 20/774 preoperatively to 20/53 at last follow-up (P < 0.001). Postoperative complications and clinical findings included VH (12.3%), diabetic macular edema (DME) (12.3%), ocular hypertension (8.6%), RD (4.9%), and need for additional PPV (6.2%). Eyes with PRP performed within 6 months before surgery had a lower frequency of developing postoperative VH (5.3%) compared to eyes that received PRP more than 6 months before surgery (27.3%, P = 0.04). Eyes that received preoperative anti-vascular endothelial growth factor (VEGF) treatment (2.0%) had a lower frequency of postoperative VH compared to eyes that did not receive anti-VEGF treatment (14.3%, P = 0.04). Eyes that received intraoperative sub-tenon triamcinolone acetonide developed postoperative DME (4.0%) less frequently than eyes that did not receive sub-tenon triamcinolone acetonide (26.7%, P = 0.04). In patients with PDR and VH, PPV with PRP yielded significant improvements in visual acuity and resulted in overall low rates of recurrent postoperative VH. Preoperative anti-VEGF and PRP laser treatment were associated with lower rates of postoperative VH. Furthermore, intraoperative use of sub-tenon triamcinolone acetonide was associated with a lower rate of postoperative DME. Pars plana vitrectomy with endolaser PRP in conjunction with the aforementioned pre- and intraoperative therapies is an effective treatment for patients with PDR and VH.

Clinical presentation and macular morphology in retinitis pigmentosa patients.

Optical coherence tomography (OCT) is a noninvasive, frequently used imaging technology that enables detailed viewing of retina anatomy. It is used to monitor disease progression in retinitis pigmentosa (RP) eyes, including detecting changes in retinal thickness. The purpose of the study is to determine the clinical presentation and macular morphology in RP eyes using OCT imaging. A retrospective review of case records and OCT scans in eyes diagnosed with RP in two ophthalmic clinics in Nigeria. Biodata, Snellen best-corrected visual acuity (BCVA), intraocular pressure (IOP), vertical cup-to-disc ratio (VCDR), and presence of maculopathy were determined. Data were analyzed using IBM SPSS version 22.0 (IBM Corp. Armonk, NY, USA). Fifty-five eyes of 28 patients (18 males and 10 females), with a mean age of 47.16 ± 15.56 years (22-77 years), were studied. 40-49 years was the most frequent age group, 28.6%. Severe visual impairment occurred in 22% of eyes and myopia in 32%. Twenty-nine percent had undergone cataract surgery or had a significant cataract. The mean IOP was 11 mmHg, and the mean VCDR was 0.46. On OCT examination, macular atrophy was the most common finding in 74.5% of eyes, epiretinal membrane in 16.3%, cystoid macular edema in 7.3%, vitreomacular adhesion in 5.4%, and vitreomacular traction in 1.8%. There was no association between macular morphology, macular thickness, and BCVA (P = 0.155, P = 0.424). OCT provides information on macula structure in RP eyes. About 14.5% of eyes had a normal macula, while 85.5% had a maculopathy, confirming that RP eyes have a higher rate of maculopathy than non RP eyes. OCT evaluation of an RP eye should be a standard workup for the early detection of such maculopathy and monitoring for disease progression.

Remote vision testing of central retinal acuity and comparison with clinic-based Snellen acuity testing in patients followed for retinal conditions.

The unmet need for remote monitoring of visual function with home-based, patient-centric technologies became increasingly palpable during the COVID-19 pandemic. Many patients with chronic eye conditions lack access to office-based examinations. Here, we evaluate the efficacy of the Accustat® test, a virtual application for measuring near visual acuity on any portable electronic device via telehealth. Thirty-three adult subjects from the telehealth remote monitoring service of a retina practice performed the Accustat® acuity testing at home. All patients underwent in-office general eye examination with additional fundoscopic examination and optical coherence tomography retina imaging. Best corrected visual acuity assessment using a Snellen chart was compared with remote visual acuity assessment with the Accustat® test. Visual acuity was analyzed and compared between the best-corrected near visual acuity potential achieved on the Accustat® and in-office distance best-corrected Snellen visual acuity. The mean logarithm of the minimum angle of resolution (logMAR) visual acuities of all eyes tested using the Accustat test was 0.19 ± 024 and for the office Snellen test 0.21 ± 0.21. A linear regression model with 95% confidence intervals reveals that there is a strong linear relationship between Accustat logMAR and office Snellen logMAR. Bland-Altman analysis demonstrated 95.2% significant agreement between Accustat and Office Snellen's best corrected visual acuity. Intraclass correlation coefficient (ICC = 0.94) demonstrated a strong positive correlation between at home versus office visual acuity. There was a high correlation between the visual acuity measured with the Accustat near vision digital self-test and the office Snellen acuity test, suggesting the potential utility of scalable remote monitoring of central retinal function via telehealth.

Predictors for Visual Outcome After Silicone Oil Removal in Eyes with Complicated Retinal Detachment.

To determine the predictors for visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment. A total of 182 eyes with complicated retinal detachment that had undergone SOR were retrospectively reviewed. Snellen best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded at baseline, 1 day, 1 month and 3 months postoperatively. Good visual outcome was defined as best-corrected visual acuity of ≥20/200 at 3 months visit. Factors predicting visual outcome were evaluated using univariate and multivariate analysis. After SOR, anatomical retinal reattachment was noted in 165 eyes (90.66%). Good visual outcome (VA ≥ 20/200) was achieved in 104 eyes (57.14%) at 3 months after SOR. For the eyes that remained attached after SOR, the percentage of good visual outcome was 63.03%. With univariate and multivariate analysis, visual acuity before SOR (p<0.001), circumferential peripheral retinopexy (p=0.037), additional endolaser during SOR (p=0.004), and pseudophakia status at the last follow up (p=0.021) were associated with visual outcome. Complications after SOR included redetachment (9.4%), hypotony (6.6%) and bullous keratopathy (1.7%). While anatomically attached retina was achieved in most of the patients, the functional outcomes were still much lower. Good BCVA before SOR and pseudophakia status at the last follow up were predictors for good visual outcomes, whereas circumferential peripheral retinopexy and additional endolaser during SOR were predictors for poor visual outcomes after SOR in eyes with complicated retinal detachment.

Therapeutic Effect of Intense Pulsed Light in Patients with Sjögren's Syndrome Related Dry Eye.

This prospective randomized study evaluated the efficacy and safety of intense pulsed light (IPL) and meibomian gland expression (MGX) as polytherapy for Sjögren’s Syndrome-related dry eye (SS-DE). The study enrolled 55 participants with SS-DE, 27 for the treatment group and 28 for the control group. The treatment group underwent three IPL-MGX treatments, three weeks apart. A randomly-selected eye from each patient was assessed at baseline and on weeks 9, 12, and 15 for Snellen best-corrected visual acuity (BCVA), intraocular pressure, Ocular Surface Disease Index (OSDI) score, conjunctival congestion, tear meniscus height, non-invasive tear breakup time (NBUT), Schirmer’s I test (SIT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, eyelid margin abnormality, MGX and meibum quality. OSDI, NBUT, CFS, MGX, and meibum quality were significantly improved in both groups, particularly in the treatment group. The eyelid margin abnormality improved significantly in the treatment but not in the control group on weeks 12 and 15. Snellen BCVA, conjunctival congestion, and SIT improved significantly in the treatment group, but the two groups were statistically similar. Our results indicated that three IPL-MGX sessions could significantly improve the subjective and objective characteristics of SS-DE, representing a promising treatment strategy.

Ocular anterior segment and corneal parameters evaluation in celiac disease

This observational case–control study evaluated the anterior ocular segment parameters of patients with celiac disease with a Scheimpflug imaging system and compared them with those of a healthy controls group, highlighting potential differences related to the underlying pathogenetic mechanisms of the disease. Seventy celiac patients and 70 healthy subjects were assessed with a comprehensive ophthalmological evaluation, including clinical history, Snellen best-corrected visual acuity, axial length (AL) measurements with IOLMaster, and anterior segment tomographic evaluation with Pentacam HR. The measurements of all keratometry values, astigmatism, steep axis, anterior and posterior Q value (asphericity), pupil diameter, pupil center, corneal apex, the thinnest point, corneal volume, anterior chamber depth from the epithelium, anterior chamber depth from endothelium, anterior chamber volume, and iridocorneal angle were also appraised. The two study groups were comparable and similar for gender, age, and AL, with no statistically significant differences regarding all analyzed tomographic parameters. Thus, ocular anterior segment parameters of celiac patients are not significantly different from those of healthy subjects, suggesting no underlying pathogenetic implications of celiac disease affecting the assessed structures. Nevertheless, a routine ophthalmological examination for all celiac patients should be recommended throughout their lifetimes due to the potential ocular manifestations of the disease.

Posterior segment findings by spectral-domain optical coherence tomography and clinical associations in active toxoplasmic retinochoroiditis

Toxoplasmic retinochoroiditis is a common, potentially blinding parasitic infection. We sought to define the spectrum and frequency of signs of active toxoplasmic retinochoroiditis by spectral domain optical coherence tomography (SD-OCT), and to identify clinical associations. Ninety eyes of 90 individuals presenting consecutively to a tertiary referral uveitis service with active toxoplasmic retinochoroiditis and gradable SD-OCT scans were evaluated prospectively. SD-OCT features were collated, and associations with lesion location, primary versus recurrent episode, serological status, human immunodeficiency virus infection and best-corrected Snellen visual acuity were explored. Active toxoplasmic retinochoroiditis presented with thickened (65%) and hyperreflective (61%) retina, choroidal thickening (55%) and hyporeflectivity (61%), hyperreflective vitreous dots (80%) and deposits (36%), and posterior hyaloid thickening (35%) on SD-OCT. Most signs occurred with similar frequency across clinical groups. Retinal hyporeflectivity (17%) was significantly associated with a visual acuity of 20/200 or worse at resolution. Our observations demonstrate that active toxoplasmic retinochoroiditis has diverse SD-OCT signs and that none are universally present. Retinal hyporeflectivity—suggesting liquefactive necrosis—predicts poor visual outcome.

Internal limiting membrane peeling for large macular hole: Tailoring the rhexis to the shape of the hole.

Purpose:To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates.Methods:This is a single-center interventional case series. conducted between 2016 and 2020. The minimum follow-up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ≥600 μm) were enrolled; vertical hole diameters were also measured using spectral-domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc-diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best-corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t-test. IBM SPSS (ver. 26) was used for analysis.Results:The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 μm (range: 600–1020 μm) and 602 μm (490–844 μm), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow-up (mean: 28 months, median: 34 months; range 4–48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001).Conclusion:All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes.

Charles Bonnet Syndrome in Patients with Open-Angle Glaucoma: Prevalence and Correlation to Visual Field Loss

To determine the prevalence and characteristics of Charles Bonnet Syndrome (CBS) and its relation to visual field loss (VFL) in patients with open-angle glaucoma (OAG). Prospective, cross-sectional study. Adult patients (n= 337) with manifest OAG with verified VFL and without significant macular disease or extraocular conditions known to cause visual hallucinations. Patients attending the glaucoma outpatient department of the Skåne University hospital, Malmö, Sweden, between April 1, 2018, and December 31, 2018, were consecutively evaluated for inclusion. Potentially eligible patients admitting to having complex visual hallucinations were interviewed to explore the characteristics of their hallucinatory experiences. Recent automated visual field examinations were available for all participants, and swept-source OCT was performed in participants with CBS to rule out previously undiagnosed macular pathology. The correlation between potential risk factors and CBS was evaluated with logistic regression analysis. Prevalence of CBS in patients with OAG. Charles Bonnet Syndrome was found in 7.1% (95% confidence interval [CI], 4.7-10.6) of patients with OAG. Participants with CBS were more likely to have at least 1 eye with a visual field index (VFI) of ≤30% compared with those without CBS (71% vs. 34.2%; P= 0.001). Although the best-corrected visual acuity (BCVA) in the worse eye was significantly lower in participants with CBS (decimal equivalent of Snellen BCVA: 0.25 vs. 0.6, P= 0.003), 33% of these participants had a BCVA of ≥0.5 in the worse eye. In multivariable analysis, CBS was correlated to the VFI of the better eye (odds ratio, 0.984; 95% CI, 0.969-0.998, P= 0.030) and the BCVA of the worse-seeing eye (odds ratio, 0.210; 95% CI, 0.046-0.952, P= 0.043). Charles Bonnet Syndrome was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, 1 of 3 patients with CBS hada BCVA of ≥0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms ofCBS in patients with glaucomatous VFL even when visual acuity is preserved.

ACUTE RETINAL NECROSIS: Difference in Outcome by Viral Type and Options for Antiviral Therapy.

To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options. The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate. Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis. Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.