Terms Of Visual Outcome Research Articles

Analysis of optimized profiles for ‘aberration‐free’ refractive surgery

To provide a model of an aberration-free profile and to clinically evaluate the impact of treatments based upon these theoretical profiles in the post-operative cornea. Aberration-free profiles were deduced from the Zernike expansion of the difference between two corneal cartesian-ovals. Compensation for the focus-shift effects of removing corneal tissue were incorporated by preserving the location of the optical focus of the anterior corneal surface. Simulation of the surgical performance of the profile was performed by means of simulated ray-tracing through a cornea described by its anterior surface and pachymetry. Clinical evaluation was retrospectively analysed in terms of visual outcomes, corneal wavefront aberration and asphericity changes at 3-month follow-up compared to the baseline on 100 eyes treated for compound myopic astigmatism. The proposed 'aberration-free' profiles theoretically preserve aberrations, becoming more oblate asphericity after myopic treatments, and more prolate after hyperopic ones. In the clinical evaluation, 94% of eyes were within +/-0.50 D of emmetropia. BSCVA improved significantly (p < 0.001). Induced corneal aberrations at 6-mm were below clinically relevant levels: 0.123 +/- 0.129 microm for HO-RMS (p < 0.001), 0.065 +/- 0.128 microm for spherical aberration (p < 0.001) and 0.058 +/- 0.128 microm for coma (p < 0.01), whereas the rate of induced aberrations per achieved D of correction were -0.042, -0.031, and -0.030 microm D(-1) for HO-RMS, SphAb, and coma (all p < 0.001). Induction of positive asphericity correlated to achieved correction (p < 0.001) at a rate 3x theoretical prediction. 'Aberration-free' patterns for refractive surgery as defined here together with consideration of other sources of aberrations such as blending zones, eye-tracking, and corneal biomechanics yielded results comparable to those of customisation approaches. Having close-to-ideal profiles should improve clinical outcomes decreasing the need for nomograms, and diminishing induced aberrations after surgery.

Short term outcomes of the use of high dose intravenous methylprednisolone for acute optic neuritis in a central Anatolian population

Aim: To describe the clinical characteristics and outcome of optic neuritis (ON) cases treated with high dose intravenous methylprednisolone (IVMP) in a tertiary referral clinic in Ankara, Turkey. Materials and methods: Consecutive patients in the past 5 years with acute isolated ON, who were treated with IVMP and had a follow-up of at least 3 months, were reviewed. Symptoms and findings, results of brain magnetic resonance imaging (MRI), etiologies, visual outcomes, and side effects of the treatment were evaluated. Results: Etiological causes could be elicited in 57 (85.1%) of 67 patients; the most common of which was multiple sclerosis (MS). At least 1 MS-compatible white matter lesion was present on brain MRI in 31 (46.3%) patients. Seventeen (63.0%) of those with clinically definite MS (CDMS) had ON as the initial feature of their disease (25.4% of all patients). Early treatment was associated with better short term visual outcomes. Diagnosis of MS was more possible in patients with retrobulbar neuritis and MS patients achieved better short term visual outcomes than non-MS patients with IVMP. Conclusion: The majority of our cases were associated with MS and evidence from our study confirmed the short term benefit of the standard therapy in our population.

Long term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration

Long term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration

Form deprivation amblyopia ‐ a treatable cause of blindness

Abstract Purpose Form deprivation amblyopia is associated with the obstruction or deformation of the passage of light causing degraded images on the retina. This lack of normal visual experience delays or blocks the visually driven development. If the obstacle is removed within the critical period the developing visual system has the capacity to regain visual function. Left untreated the deprivation and blocked visual experience may cause severe visual impairment and blindness. Methods To review our current understanding of the pathophysiology and risk factors in form deprivation amblyopia and to evaluate the effectiveness of treatment. The main conditions obstructing light passage during early development of vision will be described. Form deprivation amblyopia and its functional consequences are defined. Factors of importance for a satisfactory long term visual outcome are evaluated. Results Valid experimental and clinical models of form deprivation amblyopia are reviewed with focus on the role of visual deprivation per se and unequal visual input to the visual cortex, the primary site of functional change. Recent clinical observations of the visual outcome following early surgery of congenital dense bilateral and unilateral cataracts are used to evaluate the factors involved. Conclusion Form deprivation amblyopia is a complex condition with a hallmark of impaired visual acuity. For a satisfactory visual outcome early detection and intervention is important.

Management of ocular disease in epidermolysis bullosa variant: Laryngo‐onycho‐cutaneous (LOC) syndrome

Abstract Purpose To assess the long term outcomes of ocular surface reconstruction and immunomodulation in Laryngo‐onycho‐cutaneous (LOC) syndrome Methods Prospective, interventional, case series Results Four children with LOC were treated by multiple operations involving excision of ocular granulation tissue and amniotic membrane graft reconstruction. The clinical course was monitored for an average period of 4.7 years +/‐ 2 SD (range 3 to 7 years). In all patients, surgical intervention was successful in the medium term with regression of granulation tissue, visual improvement and symptomatic relief from ocular discomfort. Granulation tissue recurred in 8 months (3.7 SD). One patient received Thalidomide trial which stabilized systemic manifestations but had limited effect on ocular disease progression. Immunomodulation with Infliximab infusions stabilized ocular disease in all patients. All patients had stabilisation or slight improvement in vision. Conclusion Ocular disease in LOC syndrome can be successfully managed with repeated amniotic membrane grafts and immunomodulation. The treatment is effective in maintaining the ocular surface integrity and managing the symptoms of ocular inflammation, although long term visual outcomes remain disappointing.

Effects of Macular Ischemia on the Outcome of Intravitreal Bevacizumab Therapy for Diabetic Macular Edema

To evaluate the effects of macular ischemia on visual outcomes in patients with diabetic macular edema (DME), after intravitreal bevacizumab injections. Data on 59 eyes of 53 consecutive patients treated with intravitreal bevacizumab for DME were retrospectively reviewed. Data from preoperative fluorescein angiography (FA) tests were examined. Patients with an enlarged foveal avascular zone (FAZ), >or=1000 microm, or a broken perifoveal capillary ring at the border of the FAZ, with a distinct area of capillary nonperfusion within one disk diameter of the foveal center in the transit phase of fluorescein angiography, were defined as having macular ischemia. The patients were thus divided into two groups: with or without macular ischemia. Early Treatment Diabetic Retinopathy Study (ETDRS) scores, and foveal thicknesses measured using third generation ocular coherence tomography (OCT), were evaluated at baseline and at 1 month and 3 months after treatment. At 3 months after treatment, the mean visual acuity (VA) score decreased from a baseline VA of 0.52 +/- 0.27 (approximate Snellen equivalent, 20/63) to 0.57 +/- 0.21 (20/80) in the ischemic group. In the nonischemic group, by contrast, the VA improved from 0.66 +/- 0.34 (20/100) at baseline to 0.59 +/- 0.33 (20/80) at 3 months post-treatment. Nine of 18 eyes (50%) in the ischemic group, but only 9 of 41 eyes (21%) in the nonischemic group, experienced visual losses of >or=1 line on the ETDRS chart (P = 0.031, Pearson chi-square test). Four eyes (22%) in the ischemic group, but only 2 eyes (5%) in the nonischemic group, lost >or=3 lines (P = 0.042, Pearson chi-square test). Macular ischemia may have a negative effect on short term visual outcomes after intravitreal bevacizumab injections in patients with DME.

Wavefront-guided Excimer Laser Ablation Using Photorefractive Keratectomy and Sub-Bowman’s Keratomileusis: A Contralateral Eye Study

To explain the basic science and clinical evidence that has led to the development of a new technique in corneal refractive surgery--sub-Bowman's keratomileusis (SBK). A comprehensive review of the literature and report of a contralateral eye study of 50 patients (100 eyes) enrolled at 2 sites (25 patients per site) and randomized according to the dominant eye was conducted. All eyes underwent a wavefront-guided refractive correction using the Alcon LADARVision4000 System. In one eye, an 8.5-mm, ETOH-assisted photorefractive keratectomy (PRK) was performed. In the second eye, an 8.5-mm, 100-microm flap was attempted using a 60 kHz IntraLase FS femtosecond laser. Pre- and postoperative tests included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, wavefront aberrometry, retinal image quality, contrast sensitivity, and biomechanical response of the cornea. Patients completed subjective questionnaires at each follow-up. Clinical results demonstrate that SBK provides quicker visual recovery, although the data suggest that the 3- and 6-months results are similar in terms of visual outcomes. Reichert Ocular Response Analyzer results demonstrate that its impact on the cornea is similar to PRK. This study indicates that SBK provides the visual recovery of a LASIK procedure with the Optical Response Analyzer results similar to PRK.

Acute demyelinating optic neuritis: a review

Acute demyelinating optic neuritis (ON) is a leading consideration in the differential diagnosis for young adults presenting with sudden onset of painful unilateral visual loss. Multiple sclerosis (MS) is believed to be the most common etiology for ON. Nearly 50% of MS patients will develop ON, and in 15-20% of cases, ON will be the initial manifestation of the illness. Conventional and emerging magnetic resonance imaging (MRI) techniques have provided greater insight into the pathophysiology of ON, and conventional MRI has also allowed clinicians to better estimate the future risk of MS. At 10 years after ON, patients with zero, one, or two or more brain lesions on T2-weighted MRI sequences demonstrated a 22%, 52%, and 56% risk of developing MS, respectively. Treatment with high dose intravenous methylprednisolone may accelerate visual recovery in patients with acute ON, but has little impact on long term visual outcome. Disease modifying therapies in patients with acute demyelinating ON should be considered as a treatment option at the time of initial presentation in those patients whose initial brain MRI shows demyelinating lesions as these therapies have been shown in to be effective at reducing the future risk of MS.

Ethnic variations in the incidence and outcome of severe retinopathy of prematurity

Background: The aim of this study was to assess the incidence and outcome of severe retinopathy of prematurity (ROP) among different ethnic groups in a geographically defined population in the U.K. Severe ROP was defined as any stage 3 or worse disease. Methods: This was a retrospective study of children born over a 6-year period with a birth weight of 1250 g or less. Threshold ROP was treated with diode laser. Results: Severe disease developed in 37 out of 355 neonates (10.4%) who underwent ROP screening. The difference in the incidence of severe ROP between infants of Caucasian and South Asian ethnic origin was not statistically significant: 10.2% vs. 10.8% (odds ratio = 1.06; 95% confidence interval: 0.44 to 2.57). This conclusion held after single-variable adjustment for birth weight, gestational age, and score on the Clinical Risk Index for Babies. The incidence of threshold ROP was 3% among infants of both Caucasian and South Asian ethnic origin. There was no significant difference in terms of visual outcome between the Caucasian and South Asian infants. Interpretation: This study showed no statistical evidence for a difference in the incidence or outcome of severe ROP among infants of South Asian ethnic origin compared with those of Caucasian origin. Although the small numbers in our study mean that a clinically important difference cannot be excluded, it is very unlikely that the 5-fold higher incidence in Asian babies described in the literature is correct for the population from which our subjects were drawn.

Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma

Vitreous surgery has been advocated as an alternative treatment of selected retinal detachments with choroidal colobomas. To study the long term anatomical and visual outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade. Retrospective study conducted in a tertiary eye care hospital. Fourty two eyes of 40 patients with retinal detachments related to coloboma of the choroid without any peripheral breaks were analyzed. All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil. Endolaser was performed along the coloboma border. Silicone oil was removed in 50% of patients. The main outcome measures were retinal reattachment and visual recovery. SPSS (Statistical Package for the Social Science), version 10.0 was used for analysis. The retina in all cases (100%) undergoing vitrectomy were completely reattached intra-operatively. After a mean follow-up of 14 months, 37 (88.1%) eyes had attached retina. The best corrected visual acuity was 10/200 or better in 33 (78.4%) eyes. The best corrected visual acuity improved from a preoperative median of counting fingers (range 20/40 to perception of light) to median best corrected visual acuity of 20/200 (range 20/40 to perception of light) at the end of 6 months. Of the 50% (21) cases that underwent silicone oil removal, two eyes had re-detachment of retina. Pars plana vitrectomy along with silicone oil tamponade for retinal detachment related to choroidal coloboma improves the long-term anatomical and visual outcome.

Intravitreal triamcinalone acetonide for refractory uveitic cystoid macular oedema: longterm management and outcome

To establish the role of intravitreal triamcinalone acetonide (TA) in the long term management of refractory uveitic cystoid macular oedema (CMO) and to determine the long term visual outcome in these patients. This is a retrospective observational case series. All patients had resistant CMO and active inflammation. The primary outcome measure was complete resolution of CMO on ocular coherence tomography. Visual acuity and intraocular pressure were also monitored. Twelve eyes of twelve patients received 2 (n = 10) to 4 (n = 2) mg of intravitreal TA. All had previously been unresponsive to orbital floor steroids. Fluorescein angiography was performed where indicated. There was complete resolution of CMO in all patients. Nine patients had improvement in acuity at there final follow up (mean follow up 40.5 months). Seven had improved by 2 lines (58%). In 3 patients there was no visual improvement. These 3 failed to respond to re-treatment. Five other patients were re-treated because of recurring CMO and deteriorating VA (median time to re-treatment 4 mths). The mean number of re-treatments for this group with orbital floor TA was three. 41.6% of patients developed ocular hypertension (33.8 mhg mean). One required a trabeculectomy. 2 mg of intravitreal TA is effective even in cases of resistant uveitic CMO. Although re-treatment is often required, the initial response to treatment can be maintained by subsequent orbital floor steroid injections.

Outcome Analysis of Cataract Surgery Following Therapeutic Keratoplasty

To assess the results of cataract surgery, in terms of visual outcome and effect on graft survival, in eyes that have previously undergone therapeutic penetrating keratoplasty for infective keratitis. Case records of patients who had undergone cataract surgery alone (group A) or in combination with regrafting (group B) following initial therapeutic penetrating keratoplasty between January 2000 and December 2001 were reviewed retrospectively. Main outcome measures studied were visual acuity, astigmatism, and effect of the cataract surgery on graft survival. Results were compared with eyes undergoing cataract surgery after optical keratoplasty and between eyes in groups A and B. Frequency of cataract surgery after therapeutic keratoplasty was significantly greater than that following optical keratoplasty [68 (52%) versus 47 (21%); P<0.001]. Fifty-eight eyes of 58 patients undergoing cataract surgery after therapeutic penetrating keratoplasty were analyzed in detail. Mean follow-up period was 8.9 months (+/-7.6 months). Thirty eyes underwent cataract surgery alone (group A), and 28 eyes underwent cataract surgery with regrafting (group B). Eyes that had undergone therapeutic keratoplasty were significantly more likely to have opaque grafts requiring regrafting at the time of cataract surgery than eyes that had undergone optical keratoplasty [28 (48.3%) versus 5 (10.6%); P<0.001]. Incidence of graft failure after cataract surgery did not differ significantly in eyes that had undergone therapeutic or optical keratoplasty. Final visual acuity at last follow-up was 6/12 or better in 25 eyes (43%). There were no significant differences between eyes in groups A and B in terms of final visual acuity, astigmatism, or graft failure rates. Visual results of cataract surgery following therapeutic keratoplasty are comparable to those following optical keratoplasty. Combining a repeat keratoplasty for a failed graft with the cataract surgery does not significantly affect the final outcome.

Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms

Objective: To determine the long term visual and neurological outcome of patients diagnosed with cavernous sinus aneurysms (CCAs). Methods: Prospective follow up for at least five years or until death...

Laser-assisted subepithelial keratectomy for myopia: two-year follow-up

The authors conducted a prospective comparative study to assess and compare the clinical results (efficacy, safety, stability, and postoperative pain or discomfort) of laser-assisted subepithelial keratectomy (LASEK) and conventional photorefractive keratectomy (PRK) for the correction of low to moderate myopia. Laser-assisted subepithelial keratectomy was performed in one eye and PRK was performed in one eye in 92 patients who underwent bilateral treatment. Both procedures were performed with the Nidek EC-5000 excimer laser using the same parameters and nomogram, with the first eye being randomized. The preoperative mean spherical equivalent was −4.65 diopters (D) ± 3.14 D standard deviation (range, −1.75 D to −7.50 D). The mean pain level was significantly lower on days 1 to 3 in the LASEK eyes (P < .05). The mean uncorrected visual acuity was significantly better in LASEK (0.87) than PRK eyes (0.64) at 1 week (P < .05) but virtually identical at 1 month (0.89 vs 0.78), 1 year (0.91 vs 0.88), and 2 years (0.94 vs 0.92). The mean corneal haze was significantly lower in LASEK eyes (0.21) than in PRK eyes (0.43) (P < .05). The mean spherical equivalent at 2 years was −0.23 ± 0.46 D for LASEK eyes, and −0.18 ± 0.53 D for PRK eyes (not significant). There were no statistically significant differences between LASEK and PRK eyes in safety and efficacy indices. Overall, 86% of patients preferred LASEK over PRK. The authors conclude that LASEK provides significantly quicker visual recovery, less postoperative pain, and results in less subepithelial haze than PRK, although the long- term visual and refractive outcomes are virtually identical with the two procedures.—Michael D. Wagoner

Supplemental oxygen for the treatment of prethreshold retinopathy of prematurity.

Oxygen has long been implicated in the pathogenesis of retinopathy of prematurity (ROP) and is rigorously monitored in today's neonatal intensive care units. Recent research using a feline model has shown an improvement in ROP outcome of kittens treated with supplemental oxygen. Current treatment for ROP by retinal ablation is not without complications so a non-invasive method of treatment is preferred. The possible effects of long term oxygen supplementation on chronic lung disease, length of hospital stay and growth and development are, however, unknown. To determine whether, in preterm or low birth weight infants with prethreshold ROP, targeting higher as compared to normal transcutaneous oxygen levels or pulse oximetry levels when using supplemental oxygen reduces the progression of ROP to threshold disease and improves visual outcome without any adverse effects. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants and journal handsearching. An additional literature search of the MEDLINE (1966-June 2002), EMBASE (1980-April 2002), and CINAHL (1982-April 2002) databases was conducted in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR, The Cochrane Library Issue 2, 2002). All randomised or quasi randomised studies comparing higher versus normal target oxygen levels in preterm or low birthweight infants with prethreshold ROP were eligible for inclusion. The methodological quality of the one eligible trial was assessed independently by two authors for the degree of selection, performance, attrition and detection bias. Data regarding clinical outcomes including progression to threshold ROP, blindness or severe visual impairment, mortality, respiratory morbidities and long term growth were extracted and reviewed independently by two authors. Results were compared and differences resolved as required. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group. The one trial included in this review enrolled 649 infants. There was a trend for supplemental oxygen to reduce the progression to threshold ROP, however this did not reach statistical significance (RR 0.84, 95% CI 0.70, 1.02). A subgroup analysis of those infants without plus disease showed significantly fewer infants progressing to threshold ROP in infants treated with supplemental oxygen. However this analysis was not pre-specified so these results should be interpreted with caution. No significant effects were detected on blindness or severe visual function at three months corrected age, mortality, pneumonia, chronic lung disease or weight gain. Adverse pulmonary events were more common in the higher oxygen saturation group and these infants were in hospital and on supplemental oxygen for longer. Longer term visual outcomes were not reported. The results of this systematic review do not show a statistically significant reduction in the rate of progression to threshold ROP with supplemental oxygen treatment, but reveal increased adverse pulmonary sequelae with higher oxygen targeting in this group of preterm infants. Future research needs to be directed towards the question of whether infants without plus disease are more likely to respond to supplemental oxygen therapy than those with plus disease.

Randomised clinical trial of lensectomy versus lens aspiration and primary capsulotomy for children with bilateral cataract in south India

AIMSThe primary objective was to determine which surgical technique gave the best long term visual outcome for infants and young children with bilateral symmetrical cataract in south India. Secondary objectives...

Results of small incision extracapsular cataract surgery using the anterior chamber maintainer without viscoelastic

AIMSTo assess the efficacy of extracapsular cataract surgery using the anterior chamber maintainer (ACM) without the use of viscoelastic. To compare the effects of this surgical technique on non-diabetic and...

Longer term visual outcome of eyes with retinopathy of prematurity treated with cryotherapy or diode laser

AIMSVisual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed.METHODS17 patients, representing 30 eyes treated...

Topical plus subconjunctival anesthesia for phacotrabeculectomy: One year follow-up

Purpose: To evaluate the results of topical plus subconjunctival anesthesia for phacotrabeculectomy surgery and postoperative glaucoma control over 1 year.Setting: Pacific Eye Center, Brisbane, Australia.Methods: In this retrospective study of consecutive patients with glaucoma and cataract, topical plus subconjunctival anesthesia was used for combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy). Patients with proliferative diabetic retinopathy or neovascular glaucoma were excluded.Results: Thirty-eight eyes had phacotrabeculectomy using topical plus subconjunctival anesthesia over 2 years. Patients reported no discomfort intraoperatively or postoperatively, and none required intravenous sedation. Eighty-one percent of patients achieved a best corrected visual acuity of 20/40 or better 6 months after surgery. Mean drop in intraocular pressure (IOP) was 5.91 mm Hg at 3 months and 5.86 mm Hg at 12 months, at which time IOP was controlled without additional medication in 72% of patients. There were no serious complications postoperatively.Conclusion: In this series, no patient reported intraoperative or postoperative discomfort and surgical results were excellent in terms of visual outcome and IOP control.

The global impact of eye injuries

Using data compiled from the ophthalmic literature and WHO's Blindness Data Bank, the available information on eye injuries from an epidemiological and public health perspective has been extensively reviewed. This collection of data has allowed an analysis of risk factors, incidence, prevalence, and impact of eye injuries in terms of visual outcome. However, most of the estimates are based on information from More Developed Countries (MDCs). The severity of eye injuries can be assessed through proxy indicators such as: (i) potentially blinding bilateral injuries; (ii) open-globe injuries; (iii) endophthalmitis; (iv) enucleation or (v) defined visual impairment. Major risk factors for ocular injuries include age, gender, socioeconomic status and lifestyle. The site where the injury occurs is also related to a risk situation. Available information indicates a very significant impact of eye injuries in terms of medical care, needs for vocational rehabilitation and great socioeconomic costs. The global pattern of eye injuries and their consequences emerging from the present review, undertaken for planning purposes in the WHO Programme for the Prevention of Blindness, suggests that: – some 55 million eye injuries restricting activities more than one day occur each year; – 750,000 cases will require hospitalization each year, including some 200,000 open-globe injuries; – there are approximately 1.6 million blind from injuries, an additional 2.3 million people with bilateral low vision from this cause, and almost 19 million with unilateral blindness or low vision. Further epidemiological studies are needed to permit more accurate planning of prevention and management measures; a standardized international template for reporting on eye injuries might be useful to this effect, along the lines of the reporting occurring through the US Eye Injury Registry.