Snellen Visual Acuity Research Articles

A five-year retrospective hospital-based study of endogenous endophthalmitis in south Malaysia

Purpose: To analyse the predisposing factors, microbial profiles, source of infection, and visual outcomes of endogenous endophthalmitis seen in Hospital Sultanah Aminah Johor Bahru (Johor, Malaysia).
 Study design: Retrospective review.
 Methods: The medical records of 15 patients, of which 19 eyes were diagnosed with endogenous endophthalmitis, admitted from January 2014 to December 2018 were retrospectively reviewed.
 Results: The mean age was 55.9 ± 12.7 years (range: 31-78 years of age). There were four patients (26.7%) with bilateral involvement. Diabetes mellitus was the commonest risk factor in this study (odds ratio: 16; 95% confidence interval: 1.09-234.26). The most common source of infection was urosepsis (n = 3, 20%) followed by liver abscesses (n = 2, 13.3%), Klebsiella pneumoniae being the most common microorganism isolated (n = 4, 44.4%). Only 10.5% of eyes (n = 2) had a final Snellen visual acuity better than 6/60, while 47.4% of eyes (n = 9) had vision of no light perception.
 Conclusion: In this study, Klebsiella pneumoniae was the most common organism. Overall, endogenous endophthalmitis is associated with poor visual outcomes.

Autologous full-thickness RPE-choroid graft to treat high-risk drusenoid pigment epithelial detachment without CNV.

Objective: To report on the survival of a retinal pigment epithelium (RPE)-choroid graft translocated to treat a patient with drusenoid pigment epithelial detachment (DPED).Methods: We describe a patient with bilateral high-risk DPED where one eye was treated with RPE-choroid translocation surgery and followed up for more than two years.Results: The RPE-choroid graft surgery was straightforward and the fully perfused graft was able to support stable vision of 0.5 Snellen acuity for more than two years despite the development of a choroidal neovessel at the edge of the graft. The vision in the fellow eye dropped from 0.5 to 0.2 Snellen in the same period.Conclusion: RPE-choroid translocation may slow the progression of DPED to atrophy but it can also transform dry age-related macular degeneration (AMD) into neovascular AMD.

Establishing an Objective Measurement of Visual Acuity with a Computerised Optokinetic Nystagmus Suppression Test.

Investigating the correlation between subjective and objective VA (visual acuity) elicited with a newly developed computerised optokinetic nystagmus (OKN) suppression test ("SpeedWheel") in adults. SpeedWheel presented alternating black/white stripes moving horizontally across a LED screen. Seven VA steps were induced with Bangerter filters placed onto spectacle frames. Magnified eye movements were projected from infrared cameras inside the frames and displayed onto a smartphone. Dots whose size increased in logarithmic steps were superimposed to suppress OKN. Suppression of OKN resulted in the SpeedWheel acuity which was then correlated to Snellen acuity as measured with the Freiburg Acuity test. 28 eyes from 14 individuals were tested. FrACT-E correlated well to SpeedWheel (r: 0.89; p < 0.001). Snellen acuity was never lower than 0.14 LogMAR of SpeedWheel values. Bangerter filters showed greater mean difference to both methods indicating that this filter is not as predictable as suggested by the filter value. SpeedWheel offers a fast (< 80 sec) and reliable alternative option to measure objective VA.

Superonasal Transconjunctival Optic Nerve Sheath Decompression: A Simplified Technique for Safe and Efficient Decompression.

Severe, permanent vision loss is a feared sequela of untreated or refractory idiopathic intracranial hypertension (IIH). For patients with progressive vision loss despite maximally tolerated medical treatment, optic nerve sheath decompression (ONSD) remains a viable and effective option to protect vision. Our objective is to introduce a modified transconjunctival technique for ONSD and determine its safety, efficacy, and efficiency in patients with IIH. We performed analyses for a retrospective case series of consecutive patients with IIH by modified dandy criteria who underwent isolated superonasal transconjunctival optic nerve sheath decompression (stOND) at single eye institute in a large academic center from January 2013 to February 2017. Sixty-six patients were identified who met these criteria with at least 6 weeks of follow-up data. Primary outcome measures were visual field mean deviation, grading of papilledema by the modified Frisen scale, and best-corrected visual acuity. Secondary outcome measures were presence of postoperative diplopia and operative time. One hundred thirty-two eyes of 66 patients were identified; 58 were female (88%), and 8 were male (12%). The mean age was 30 years (range 13-55) with an average lumbar puncture opening pressure of 38 cm H2O. Participants mean body mass index was 36 (range 20-59) with Grade 3 papilledema on average by the modified Frisen scale. No patients experienced operative complications, postoperative diplopia, or worse visual acuity at 1 week after surgery. Average operative time was 50 minutes (range: 25-89). The median decrease in papilledema grading was 3 grades on the Frisen scale (95% confidence interval [CI], 2-3, P < 0.0001). Snellen visual acuity changes did not meet statistical significance. The average Humphrey Visual Field mean deviation change was +1.91 (95% CI, 0.58-3.24, P = 0.0052). Despite successful bilateral decompressions, 4 patients (6.1%) progressed in their visual loss. The superonasal transconjunctival approach to ONSD is a safe, efficient and effective surgical treatment for patients with deteriorating visual function due to IIH. Although additional study is required to further clarify the best timing and indications for ONSD among other treatment options for refractory IIH, providers should be aware of the reduced complication rates and efficacy of the stOND technique.

THE TEXAS TACO TECHNIQUE FOR INTERNAL LIMITING MEMBRANE FLAP IN LARGE FULL-THICKNESS MACULAR HOLES: A Short-Term Pilot Study.

To determine the efficacy of a novel application of a surgical internal limiting membrane flap technique that requires no additional surgical adjuvants in closure of large full-thickness macular holes (FTMHs). The electronic medical records of patients (n = 8) with large (>400 µm) FTMHs repaired with the "Texas Taco" technique were retrospectively reviewed. Operated patients had a mean age of 63.8 ± 19.2 (range, 19-80) years. There were five (62.5%) phakic and three (37.5%) pseudophakic eyes preoperatively. Mean follow-up time was 9.1 ± 4.7 (1.5-14.5) months. Across all patients, mean FTMH diameter at the shortest and greatest widths were 529 ± 101 (404-661) and 1,189 ± 290 (829-1,656) µm, respectively. Mean best-corrected logarithm of the minimum angle of resolution visual acuity was 1.3 ± 0.23 preoperatively (approximately Snellen acuity 20/400) and 0.66 ± 0.40 postoperatively (approximately Snellen acuity 20/100) (P < 0.001). All FTMHs remained closed at all postoperative visits. The Texas Taco technique provided anatomical and functional improvement in challenging cases of large FTMHs without the need of additional surgical adjuvants.

Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for Visual Rehabilitation in Limbal Stem Cell Deficiency

To evaluate the clinical outcomes of patients with limbal stem cell deficiency (LSCD) who were fitted with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral device. In this retrospective, interventional case series, we reviewed the charts of 31 eyes of 19 consecutive patients clinically diagnosed with LSCD who were evaluated for the PROSE device. Clinical data were reviewed before PROSE evaluation and at the last available follow-up. The main outcomes measures were best-corrected distance visual acuity (CDVA) and modified ocular involvement score (OIS), graded using a previously described system for corneal findings. Corrected distance visual acuity improved from 0.86±0.50 logarithm of the minimal angle of resolution (Snellen equivalent, 20/145) at baseline to 0.46±0.44 (Snellen equivalent, 20/58) with PROSE at the last follow-up (mean, 25.1±18.0 months; P<0.0001). In 27 eyes (87.1%) CDVA improved, with 22 eyes (71.0%) gaining 2 or more lines of Snellen acuity. When categorized by disease severity, CDVA improved in less severe eyes (stage 1) and more severe eyes (stage 2 or 3; P=0.049 and P=0.00009, respectively). Total OIS was not significantly different between baseline and last follow-up (P=0.754); however the epithelial defect score was significantly less (P=0.034). Twenty-four of 31 eyes (77.4%) continued wearing the PROSE device, with a mean daily wearing time of 10.0±4.6 hrs. In patients with LSCD, vision improved and the OIS remained stable with PROSE, suggesting that the device could be considered for visual rehabilitation in this population.

Central Corneal Thickness in Females Using Oral Contraceptive Pills

Purpose: To compare the central corneal thickness in females using oral contraceptive pills (OCP) with age matched controls.&#x0D; Study Design: Descriptive Observational study.&#x0D; Place and Duration of Study: Department of ophthalmology, University of Lahore teaching hospital, from August 2018 to December 2018.&#x0D; Material and Methods: Fifty-one females who used OCP within last one year and 38 age-matched controls were included in this study after approval from the ethical review board. Females with any systemic disease, pregnancy and lactating mothers were excluded from the study. Females with ocular diseases, like trachoma, cataract, keratitis, uveitis, corneal dystrophies, Keratoglobus, Keratoconus, ocular trauma, and high refractive errors were also excluded. Each subject underwent full ocular examination including best-corrected visual acuity using Snellen acuity chart and Bio-microscopic examination of anterior segment and the fundus. Central corneal thickness (CCT) was measured with ultrasonic pachymeter and the intraocular pressure was measured with noncontact tonometer at the time of examination. The data was collected by self-designed proforma and analyzed by using SPSS version 20.&#x0D; Results: Mean age of the females using OCP was 31.4 ± 6.8 years and mean age of age-matched controls was 32.9 ± 5.5 years (p = 0.38). Mean Central corneal thickness values were higher in OCP group when compared to controls (541.8 ± 31.39μm and 518.7 ± 36.7 μm, respectively). P value was 0.004, which was statistically significant. The mean IOP value was 14.5 ± 2.6 mm Hg in OCP group and 14.4 ± 2.8 mm Hg in the control group (P = 0.86), which was not statistically significant.&#x0D; Conclusion: Central corneal thickness values are significantly higher in patients using OCP.

DIFFUSE CHORIORETINAL ATROPHY IN CHINESE HIGH MYOPIA: The ZOC-BHVI High Myopia Cohort Study.

To explore the associations between diffuse chorioretinal atrophy (DCA) and age, sex, axial length, spherical equivalent, and best-corrected visual acuity (BCVA) among highly myopic eyes. This study included right eyes of 857 bilaterally highly myopic individuals from the ZOC-BHVI Cohort Study. Participants underwent examinations, including BCVA, ocular biometry, autorefraction, and color fundus photography. An Early Treatment Diabetic Retinopathy Study grid was applied on the fundus photographs to evaluate the location of DCA, which was graded into four categories (D0-D3). The characteristics and ocular biometry were compared between participants' eyes with and without DCA. Diffuse chorioretinal atrophy was found in 177 (20.6%) eyes. The proportion of participants with DCA in age groups of 7 to 11, 12 to 18, 19 to 39, and ≥ 40 years old was 20.9%, 9.2%, 23.1%, and 52.9%, respectively. The proportion of DCA significantly increased with longer axial length and worse myopic spherical equivalent. Eyes with DCA had poorer BCVA (Snellen visual acuity 20/36, logarithm of minimal angle of resolution 0.26 ± 0.25) than those without DCA (Snellen visual acuity 20/23, logarithm of minimal angle of resolution 0.06 ± 0.14) (P < 0.001). The BCVA gradually declined as the lesion got closer to the fovea (P for trend < 0.001). The proportion of DCA increased with older age, longer axial length, and more myopic spherical equivalent. Diffuse chorioretinal atrophy is a vision-threatening complication of high myopia where BCVA gradually worsens with foveal involvement.

NO FACE-DOWN POSITIONING SURGERY FOR THE REPAIR OF CHRONIC IDIOPATHIC MACULAR HOLES.

To report visual and anatomical outcomes after the repair of chronic idiopathic macular holes (MHs) with no face-down positioning. We conducted a retrospective review of chronic MH cases of greater than 1-year duration that were repaired through pars plana vitrectomy with broad internal limiting membrane peeling and no face-down positioning between March 2009 and December 2017. There were 18 eyes of 18 patients that met inclusion criteria. Patients with MH duration of less than 1 year and without at least 1 month of follow-up were excluded. Macular hole staging and measurements were performed with spectral domain optical coherence tomography. Mean MH duration was 5.0 ± 6.9 years. Two-thirds of MHs had a basal diameter of more than 1,000 μm. Mean preoperative Snellen visual acuity was 20/302 and improved to a mean postoperative visual acuity of 20/112 (P ≤ 0.0001). Visual acuity improved in all patients who achieved successful anatomical closure, 94.4% (17/18) of eyes. Patients in this series with chronic MH who underwent no-face-down MH repair demonstrated a high single-surgery anatomical closure rate with a significant improvement in visual acuity.

ANATOMICAL AND FUNCTIONAL RESULTS OF INTRAVITREAL AFLIBERCEPT MONOTHERAPY FOR TYPE 1 RETINOPATHY OF PREMATURITY: One-Year Outcomes.

To evaluate the anatomical and functional outcomes of Type 1 retinopathy of prematurity 1 year after the intravitreal injection of aflibercept (IVA). This prospective cohort study enrolled Type 1 retinopathy of prematurity patients who had been treated with IVA as first-line therapy from July 1, 2015, to June 30, 2017. Patients were followed up for at least 1 year after injection. The primary outcomes were retinopathy of prematurity regression, progression, reactivation, and the occurrence of associated complications after the use of IVA. The secondary outcomes were visual acuity and refractive error at 1 year after IVA. Seventeen eyes of nine patients were enrolled in our study. A single IVA injection resulted in resolution in 15 eyes (88.2%), whereas 2 eyes (11.8%) needed retreatment. The mean Snellen visual acuity and refractive error were 6/13 ± 0.34 and -1.94 ± 2.97 D, respectively. No major ocular complications or systemic adverse effects were noted during the follow-up period, except one patient (11%) passed away at the age of 14 months due to a pulmonary infection. Aflibercept is effective and well tolerated for the treatment of Type 1 retinopathy of prematurity; it is a potential treatment option as it achieves good anatomical, visual, and refractive outcomes.

CLINICAL CHARACTERISTICS AND MOLECULAR GENETIC ANALYSIS OF A COHORT OF CHINESE PATIENTS WITH CHOROIDEREMIA.

To describe the clinical and molecular genetic characteristics of a large cohort of Chinese patients with choroideremia (CHM). Forty-eight Chinese participants from 35 families with a clinical diagnosis of CHM who harbored sequence variants in the CHM gene were enrolled. Comprehensive clinical evaluations and molecular genetic analysis of the CHM gene were performed. The median age of the 48 patients was 31.5 years (range, 5-78 years). There were 30 different sequence variants detected in 35 families; of which, 13 sequence variants were novel. The mean (±SD) best-corrected visual acuity best in logarithm of the minimum angle of resolution equivalents was 0.71 (±0.87) (range, 0.00-2.80) or approximately 20/100 in Snellen visual acuity. A significant correlation was revealed between best-corrected visual acuity best and age (P < 0.001). The trend in the change in the best-corrected visual acuity over age showed that relatively good vision remained until 20 years old. The patterns of fundus photography and fundus autofluorescence finding demonstrated that residual retinal pigment epithelium areas significantly declined in patients at the age of 20 years or older. The results of visual field and full-field electroretinography showed that these measures might be of limited value for evaluating the condition of the late stage of CHM in Chinese patients. This study described for the first time the clinical and molecular genetic characteristics of a large cohort of Chinese patients with CHM. The findings from best-corrected visual acuity best and visual field showed that the impairment of visual function in CHM might be more severe in Chinese patients than in western patients.

The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment.

To investigate the efficacy and safety of primary intravitreal triamcinolone acetonide (IVTA) in eyes affected by diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Retrospective observational study METHODS: The medical records of patients who attended our clinic from March 2013 to September 2018 with refractory macular were reviewed. We included the patients who were injected at least one IVTA and completed 6 months of observation. Best-corrected Snellen visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs) were examined at baseline and at 1 month, 2 months, 3 months, and 6 months. Sixty-four eyes of 54 subjects were included. The mean VA was improved significantly at all time points compared to pre-treatment (P < 0.0001), with the greatest mean improvement at 1 month (0.3 logMAR). The reduction in mean CMT was also significant at all follow-up examinations compared to baseline (P < 0.0001), with the greatest decrease at 1 month (113.68 ± 53.78 μm). A poorer VA before injection was a factor that influenced visual gain 1 month post treatment (0.247 logMAR units/unit increase in baseline VA, P = 0.006). The most common AE associated with IVTA treatment was elevated IOP (11 eyes), observed significantly more often after IVTA injections containing a preservative (25.8%) than after those that were preservative-free (9.1%) (P = 0.033). IVTA injection can be an alternative steroid treatment for DME refractory to anti-VEGF therapy.

Visual outcome of Pars Plana Vitrectomy following Endophthalmitis – A Vitreo-retinal Surgeon's Experience

Purpose: To determine the visual outcome of pars plana vitrectomy following endophthalmitis.&#x0D; Methods: A retrospective hospital-based study of 20 eyes of consecutive patients who had pars plana vitrectomy by a particular surgeon following endophthalmitis in the Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh from August – December 2017. Using the Snellen's visual acuity chart, post-operative distant visual acuity improvement was graded 0– 9, with 0 meaning no improvement in visual acuity, and 9 meaning nine lines of improvement in visual acuity from presenting best corrected visual acuity.&#x0D; Results: Pre-operative corrected distant visual acuity (CDVA) ranged from perception of light to 6/36. Seventy percent of the patients had postoperative visual improvement of varying degrees. The mean pre-operative and post-operative CDVA were 2.20 logMAR and 1.40 logMAR respectively. All the patients tractional retinal detachment and corneal laceration with rhegmatogeneous retinal detachment as co-morbidities did not have visual improvement, and this was statistically significant (p-value = 0.007). There was an association (although not strong) between age range and postoperative visual improvement (p-value = 0.639).&#x0D; Conclusion: Pars plana vitrectomy helps to prevent or minimize ophthalmic complications from endophthalmitis, thus making it a necessary line of treatment endophthalmitis. Pars plana vitrectomy is therefore a safe and desirable definitive treatment for endophthalmitis, and it confers a good chance of visual improvement.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Orbital Reconstruction via Deformable Titanium Mesh Following Spheno-Orbital Meningioma Resection: Ophthalmic Presentation and Outcomes.

To present a surgical approach to reconstruction of the bony orbit following resection of spheno-orbital meningioma utilizing deformable titanium mesh while emphasizing the ophthalmic presentation and outcomes of the repair. A retrospective chart review received International Review Board approval, and 20 patients met the inclusion criteria. All patients underwent resection of spheno-orbital meningioma followed by orbital reconstruction with deformable titanium mesh. Pre- and postoperative ophthalmic exam findings were recorded. Outcome measures include Snellen visual acuity, performance on automated Humphry 30-2 perimetry, extraocular motility, Hertel exophthalmometry, associated complications, and recurrence. A literature review of the use of titanium to reconstruct the orbit following resection of spheno-orbital meningioma was performed. Visual acuity improved (9/20) or remained the same (8/20) in 85% of patients. Fifteen of the 20 patients had pre- and postoperative visual fields performed, and 93% (14/15) experienced substantial improvement or no change with full fields. Of the 12 patients who had extraocular motility disturbance following surgery, 25% (3/12) had preexisting defects that did not change, 58% (7/12) returned to normal, and 17% (2/12) had new onset dysfunction that did not improve. Proptosis was reduced by a mean of 4.4 mm. Complications were rare and inconsequential, and recurrence was observed in 20% (4/20) at an average of 43 months following surgery. Orbital reconstruction using deformable titanium mesh is both safe and effective in the setting of resection of spheno-orbital meningioma. This study is the largest known report of orbits reconstructed with deformable titanium mesh in the available literature.The ophthalmic presentation of spheno-orbital meningioma and postoperative results are presented following description of orbital reconstruction utilizing deformable titanium mesh.

Fundoscopy findings of diabetic and/or hipertensive patients

Objective: To analyze the prevalence of alterations in funduscopy of patients with Diabetes Mellitus (DM) and/or Systemic Arterial Hypertension (SAH) referred to the Ophthalmology Reference Service, located in a Basic Health Unit of the city of Patos, Paraíba). Methods: A descriptive, cross-sectional study with a quantitative approach, which involving a total of 22 patients. For data collection, a questionnaire on ocular health was used. In addition, the research members participated in the Snellen visual acuity test and visual acuity [...]

PATCHING RETINAL BREAKS WITH HEALAFLOW IN 27-GAUGE VITRECTOMY FOR THE TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT.

To report the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) repaired by 27-gauge pars plana vitrectomy combined with Healaflow patch and air tamponade. In an initial vitro experiment, we observed and compared the dissolution and displacement of the dispersion spots of 0.05-mL Healaflow and sodium hyaluronate. We then performed a prospective, interventional cohort study on 38 eyes in 37 consecutive patients with primary rhegmatogenous retinal detachment. All eyes underwent pars plana vitrectomy combined with Healaflow patch and air tamponade; the postoperative period did not involve prone positioning. The primary and final anatomical attachment rate, best-corrected visual acuity, and intraoperative and postoperative complications were evaluated. In the in vitro experiment, the viscoelastic Healaflow remained adherent with no change in the size of the area; however, the control dissolved completely in the balance solution. The patient study included 16 women (43.2%) and 21 men (56.8%) (mean age, 59.5 ± 9.5 years; mean follow-up period, 8.9 ± 3.8 months). A single break was present in 21 (55.3%) and 2 to 5 breaks in 17 cases (44.8%). The macula was involved in 25 (65.8%) and attached in 13 cases (34.2%) intraoperatively. Initial reattachment was achieved in 37 (97.4%) and final reattachment in 38 cases (100%). In one case (2.6%), the macula redetached because of failure of the chorioretinal scar to develop around the treated break. Mean preoperative and postoperative best-corrected visual acuities were 1.02 ± 0.82 logarithm of the minimum angle of resolution (median Snellen acuity: 20/125, range: 20/20,000-20/20) and 0.23 ± 0.17 logarithm of the minimum angle of resolution (median Snellen acuity: 20/32, range: 20/100-20/20), respectively (P < 0.001). Intraocular pressure was elevated transiently in 28 eyes (73.7%). There were no other intraoperative complications or postoperative scleral incision leakage. A 27-gauge pars plana vitrectomy combined with Healaflow patch, and air tamponade results in a high reattachment rate in the treatment of rhegmatogenous retinal detachment. Thus, patients can benefit from early visual recovery and less complications.

Surgical Decompression or Corticosteroid Treatment of Indirect Traumatic Optic Neuropathy: A Randomized Controlled Trial.

Traumatic optic neuropathy (TON) is a rare cause of severe permanent visual impairment after injury. Traumatic optic neuropathy may occur due to sharp trauma (direct injury) that damages the optic nerve directly or due to damage from the transmitted forces after a concussive blow to the head or orbit (indirect injury). The management of indirect TON remains controversial. Either surgical decompression or mega dose corticosteroid is used for managing indirect TON. However, no consensus exists regarding the definitive treatment. We designed a randomized controlled trial study to investigate this issue. Only patients with indirect TON and normal vision before the injury were enrolled. The patients' data were recorded, and fine cut facial computed tomography scan was performed to exclude those with retrobulbar hematoma. All the study subjects were randomly allocated to either the mega dose steroid (30 mg/kg stat and 15 mg/kg every 6 hours for 3 days) group or the surgical decompression group. The patients were followed up at 1 week, 1 month, 3 months, 6 months, and 9 months. During each follow-up, the Snellen visual acuity (VA), visual field, color change, fundus findings, and intraocular pressure were evaluated. These data were compared and analyzed using the Mann-Whitney U test and odds ratio. The short form questionnaire was used to analyze the lift quality difference between the two groups. Thirty patients were enrolled, 12 in the surgical group and 18 in the steroid treatment group. There were no significant differences in the improvement rate, improvement degree, and life quality between the groups. However, the odds ratios are 5, 10, 2.5, and nonavailable in the cutoff points of no light perception (NLP), light perception (LP), hand movement, and counting finger in surgery group. In steroid group, they are 1, 1, 1, 1.83 in each cutoff points. Patients with better VA than NLP had better life quality than those with NLP VA (P = 0.005). Other cutoff point groups had no significant difference. Patients with worse initial VA (eg, NLP and LP) had a higher chance of benefiting from surgical treatment and experiencing improvements in the life quality.

Evaluation of the Choroid in Eyes With Retinitis Pigmentosa and Cystoid Macular Edema.

To study the anatomical choroidal features associated with the presence of cystoid macular edema (CME) in eyes with retinitis pigmentosa (RP). A total of 159 eyes (from 159 patients) with a diagnosis of RP were enrolled in this retrospective cross-sectional case-control study and divided into two groups based on the presence (67 eyes) or absence (92 eyes) of CME. Retinal and choroidal features were evaluated on spectral domain optical coherence tomography including central macular thickness (CMT) and subfoveal choroidal thickness (CT). Total choroidal area (TCA), choroidal luminal area (LA), and choroidal stromal area (SA) were measured and the choroidal vascularity index (CVI) was calculated in all study eyes. Average age was 49.2 ± 14.9 and 47.1 ± 15.5 years (P = 0.40) and logMAR Snellen visual acuity (VA) was 0.4 ± 0.6 (median 0.3, 20/40) and 0.2 ± 0.4 (median 0.1, 20/25) in the RP groups with and without CME, respectively (P = 0.05). Mean CMT was 334.1 ± 93.5 and 252.6 ± 47.6 μm in the RP groups with and without CME, respectively (P < 0.001). The subfoveal CT was significantly increased in the RP group with versus without CME (294.2 ± 110.9 μm vs. 198.1 ± 75.5 μm, respectively, P < 0.001). In patients with CME, the CVI was lower (P < 0.001) and the TCA, LA, and SA were all significantly higher (P < 0.001). In patients with CME associated with RP, the choroid exhibited significantly greater subfoveal thickening and decreased CVI. The choroid may be an important factor to consider in the etiology of CME in patients with RP.

Pars Plana Vitrectomy for Resistant Cystoid Macular Edema.

To evaluate the results of pars plana vitrectomy for cystoid macular edema (CME) resistant to medical treatment. Quasi-experimental study Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, from January to July 2019. This study recruited 30 eyes of 30 patients with cystoid macular edema confirmed on optical coherence tomography that was refractory to medical treatment. Eyes with diabetic fibrous proliferation, optic atrophy, neo-vascular glaucoma, membrance and macular retinal pigment epithelial atrophy were excluded from the study. All patients underwent 23 G pars plana vitrectomy followed by epiretinal membrane / internal limiting membrane (ERM/ILM) peeling and gas injection. In 11 eyes, perfluoropropane gas was injected; while in 19 eyes, sulfurhexafluoride gas was injected. Main outcome measures included pre- and post-op Snellen's visual acuity and central macular thickness (CMT). All patients completed their follow-up of six months. Mean age of 16 male and 14 female patients was 54.30 ±3.70 years. Postoperative Snellen's visual acuity improved to 0.61 ±0.08 from 0.11 ±0.04 and postoperative central macular thickness improved to 223.80 ±40.20 μm from 578.00 ±26.57 μm. Both differences were statistically significant (p<0.001). Pars plana vitrectomy with ERM / ILM peel and gas injection for CME refractory to medical treatment is an effective treatment. There was significantly improved best corrected visual acuity (BCVA) postoperatively along with decreased CMT on optical coherance tomography (OCT).