Visual Improvement Research Articles

Clinical Correlation of Retinal Fluid Fluctuation Represented by Fluctuation Index in Wet Age-Related Macular Degeneration: TOWER Study Report 2.

To explore outcomes and biomarkers associated with retinal fluid instability represented by a new parameter in neovascular age-related macular degeneration (nAMD). Patients with treatment-naïve nAMD receiving anti-vascular endothelial growth factor (VEGF) injections for a duration of 1 to 3 years were consecutively reviewed. Fluctuation Index (FI) of each eye, calculated by averaging the sum of differences in 1-mm central subfield thickness between each follow-up from months 3 to 24, was arranged into ascending order from the lowest to the highest and split equally into low, moderate, and high fluctuation groups. Outcomes were analyzed at 24 months. Of 558 eyes, FI values showed a negative correlation with a degree-response gradient with 24-month visual improvement. After controlling for baseline best-corrected visual acuity and potential confounders, eyes with low fluctuation gained more Early Treatment Diabetic Retinopathy Study letters than those in the moderate and high fluctuation group (Δ, 10.1 and 14.0 letters, respectively). Significant best-corrected visual acuity improvement from baseline to month 24 (11.8 letters) was observed exclusively in the low fluctuation group despite the indifference in the number of injections and types of anti-VEGF drug used among groups. Patients presenting with central subfield thickness of ≥405 µm or intraretinal fluid coinciding with subretinal fluid showed a significant association with foveal thickness instability during the maintenance phase. Apart from the central subfield thickness values, unstable macular thickening represented by the FI was associated with some baseline features and may contribute to substandard visual outcomes. FI may be a valuable tool for assessing therapeutic adequacy in the treatment of nAMD.

Accelerated hydroxychloroquine toxic retinopathy.

To report a case series of patients with retinal toxicity due to hydroxychloroquine (HCQ) within a short span of treatment. A retrospective review of case records of patients with accelerated HCQ toxicity within 1year of starting the treatment was done. Systemic co-morbidities, details of HCQ treatment, details of ocular examination, and results of multimodal investigations were noted. Nine patients (1 male, 8 females) with age ranging from 40 to 73years (mean 54.2 ± 13.4years) who showed accelerated HCQ toxicity were included. None had systemic conditions or drug history predisposing to early HCQ toxicity. The treatment duration ranged from 2 to 11months and the cumulative HCQ dose ranged from 18 to 120g (mean 45.0 ± 33.0g). The visual acuity was normal in 8 (88.9%) patients and retinal evaluation was normal in 4 (44.4%). Optical coherence tomography was abnormal in 4 (44.4%). Six (66.6%) cases had reduced sensitivity in the parafoveal point on visual field testing. All 9 cases had multifocal electroretinographic changes diagnostic of HCQ toxicity. The HCQ treatment was stopped in 8 and continued with reduced dose in 1 patient. The mean duration of follow-up was 11.2 ± 9.6months during which 5 patients showed improved mfERG and 1 patient had a stable mfERG. Visual fields improvement was noted in 2 cases. Patients on HCQ need to be kept on regular monitoring with more frequent follow-ups to detect signs of early onset toxicity and prevent permanent visual impairment. mfERG is an important diagnostic tool for HCQ toxicity.

Fibrinous nodular anterior segment membrane as a presentation of chronic postoperative Aspergillus endophthalmitis

A 63-year-old lady, with over-the-counter steroid use, presented with a gradual progressive diminution of vision 6 months after uncomplicated cataract surgery. On examination, the vision was hand movements and the anterior chamber (AC) showed a thick, irregular fibrinous membrane over the iris and pupil and a fixed hypopyon, and B-scan revealed vitritis. AC membrane and vitreous biopsy was done along with intracameral and intravitreal Amphotericin-B. Owing to the poor response and microbiological tests suggestive of Aspergillus, core vitrectomy with intravitreal Voriconazole injection was done. Significant improvement in vision and inflammation was noted, after 1 month. Fungal etiology must be suspected in the presentation of endophthalmitis as a fibrinous and nodular membrane, and all such patients must be reviewed for systemic immunosuppression.

Steroid challenge: Response to dexamethasone implant in persistent, simple central serous chorioretinopathy

A male in his 30s was diagnosed with acute central serous chorioretinopathy (CSC) in the left eye for 3 months and after an unsuccessful oral eplerenone therapy presented with persistent disease. Continuing vision blur, worsening subretinal fluid, and absent fluorescein leak on angiography prompted us (based on earlier experience) to use the novel therapy of dexamethasone intravitreal implant. Successful resolution was noted in 2 months with visual improvement. We describe the first use of an intravitreal long-acting corticosteroid implant in a case of persistent, simple CSC with a favorable outcome.

Choroidal metastasis with retinal detachment as the first presenting sign of lung carcinoma in a female

It is very unusual for lung carcinoma to present primarily with ocular features before respiratory symptoms. A 30-year-old female, with sudden onset painless diminution of vision in left eye (LE) of 1-week duration, was diagnosed with choroidal metastasis and retinal detachment. On imaging, she had lesions at multiple sites like lung and brain. Histopathology showed adenocarcinoma lung, followed by positive immunohistochemistry (Napsin-A and TTF-1) confirming primary adenocarcinoma lung. We managed with external beam radiotherapy and chemotherapy, resulting in vision improvement at 3 months. Thus, this case highlights a rare presentation of choroidal metastasis as the first clinical sign of adenocarcinoma lung in a female with successful outcome.

WITHDRAWN: Retinitis pigmentosa: Significant improvement with photobiomodulation

We describe the case of a 38-year-old patient with retinitis pigmentosa. Diagnosed at the age of 20, she presented a progressive decrease in visual acuity and visual field, until she developed a shotgun barrel campimetry. After starting a photobiomodulation treatment of 9 sessions every other day, the patient reported improvement in visual acuity, night vision and quality of life. Clinical evaluation showed a visual acuity of 10/10 in both eyes and a substantial improvement in visual field.

Effective Diagnosis and Treatment of Arteries Brain by Resonance Methods Diagnosis and Therapy in the Elderly

In this work, the diagnosis and treatment of cerebral arteries in elderly people (75-84 years old) was carried out. It has been established that in the elderly, the indicators for diagnosing cerebral arteries amounted to 45-50% of the condition that occurs in young people, which, of course, is a prerequisite for the occurrence of both ischemic and hemorrhagic stroke. Treatment of cerebral arteries in the elderly restored the state of the arteries and brought them closer to the state that occurred in young people, which prevented the occurrence of both ischemic and hemorrhagic stroke. In addition, because of the treatment of cerebral vessels in the elderly, there was an improvement in vision, hearing, motor activity - walking and other functions, and reduced the risk of Parkinson's disease, Alzheimer's disease, and multiple sclerosis.

Leber's Hereditary Optic Neuropathy (LHON): Clinical Experience and Outcomes after Long-Term Idebenone Treatment.

Leber's hereditary optic neuropathy (LHON) is a rare disease. Large studies are difficult to conduct; therefore, case reports provide valuable data. Since 2015, patients have been treated with Idebenone. The aim of this paper is to share our experience with diagnosing and managing patients in different stages of LHON. We designed a case series study, including four patients undergoing genetic testing and ophthalmologic examination. Criteria for Idebenone administration and follow-up were presented. All patients had mutation 11778G>A in MT-ND4. The first patient, an 82-year-old man, with long history of vision loss, had no indication for Idebenone. Two additional cases emerged within the same family: a 40-year-old brother and a 31-year-old sister. Both received Idebenone, with good outcomes only for the female. After a one-year regimen, they were lost to follow-up. The fourth patient, a 46-year-old man, was diagnosed in the subacute stage. Idebenone administration was deferred, allowing progression of visual field defects. After 17 months of treatment, visual improvement appeared. The treatment was continued for 36 months, with short interruptions, resulting in good outcomes. Our study demonstrated positive results with long-term Idebenone use. Contrary to medical literature, our female patient had a favorable evolution, despite the delayed diagnosis.

Restoration of vision by combined experimental antithymocyte therapy, and orbital radiation with high-dose steroids for severe, acute, steroid-refractory, congestive thyroid orbitopathy

PurposeWe report diagnostic and therapeutic dilemmas in the difficult case of compressive optic neuropathy with severe visual acuity and visual field loss with subsequent visual recovery in both eyes, in a patient with Graves’ orbitopathy (GO) by a combination of experimental antithymocyte therapy, orbital radiotherapy with high-dose steroids.MethodsA 72-year-old man presented with severe vision loss in both eyes. The visual symptoms had appeared over a year before the GO diagnosis. He was initially misdiagnosed with neuroborreliosis and optic neuritis based on brain and orbital magnetic resonance imaging. There was no exophthalmos. The ophthalmological examination included visual acuity, visual field, tonometry in primary and upgaze eye position, optical coherence tomography (OCT), pattern electroretinogram (PERG), pattern, and flash visual evoked potentials (PVEP and FVEP). The patient received experimental therapy with ATG, followed by high-dose of intravenous steroids and orbital radiotherapy.ResultsDelayed VEP peaks became shorter after treatment. After systemic and local therapy lowering of intraocular pressure was achieved. Abnormal PERG has been found three months before ganglion cells atrophy was detected in OCT. Visual acuity and visual field improvement occurred in both eyes after therapy, despite partial left optic nerve atrophy. The patient regained full decimal visual acuity (1.0 right from as poor as 0.3 to 1.0 in the right eye and from hand movements to 0.9 in the left. Severe visual field loss with advanced absolute scotomata has improved to slight relative scotomata. The duration of follow-up time after the treatment was 4 months.ConclusionsIntensive treatment of steroid-resistant Graves’ orbitopathy (GO) may prevent total optic nerve atrophy. Despite severely advanced optic neuropathy, this report emphasizes the necessity of therapy even with nearly complete visual function loss hence there is always a possibility to regain full visual acuity and visual field. Patients with tense orbital septum may not present with significant exophthalmos, thus delaying the correct diagnosis of orbitopathy. A supporting sign of GO was the difference in intraocular pressure in the primary and upgaze eye positions. Electrophysiological examinations are helpful in the diagnosis and monitoring of GO therapy. To our knowledge, this is the first report of this kind presenting visual function restoration and structural recovery in a patient with advanced optic neuropathy in GO.

Digging for gold: evaluating the authenticity of saffron (Crocus sativus L.) via deep learning optimization

IntroductionSaffron is one of the most coveted and one of the most tainted products in the global food market. A major challenge for the saffron industry is the difficulty to distinguish between adulterated and authentic dried saffron along the supply chain. Current approaches to analyzing the intrinsic chemical compounds (crocin, picrocrocin, and safranal) are complex, costly, and time-consuming. Computer vision improvements enabled by deep learning have emerged as a potential alternative that can serve as a practical tool to distinguish the pureness of saffron.MethodsIn this study, a deep learning approach for classifying the authenticity of saffron is proposed. The focus was on detecting major distinctions that help sort out fake samples from real ones using a manually collected dataset that contains an image of the two classes (saffron and non-saffron). A deep convolutional neural model MobileNetV2 and Adaptive Momentum Estimation (Adam) optimizer were trained for this purpose.ResultsThe observed metrics of the deep learning model were: 99% accuracy, 99% recall, 97% precision, and 98% F-score, which demonstrated a very high efficiency.DiscussionA discussion is provided regarding key factors identified for obtaining positive results. This novel approach is an efficient alternative to distinguish authentic from adulterated saffron products, which may be of benefit to the saffron industry from producers to consumers and could serve to develop models for other spices.

Semi-RainGAN: A Semisupervised Coarse-to-Fine Guided Generative Adversarial Network for Mixture of Rain Removal

Images taken in various real-world scenarios meet the symmetrical goal of simultaneously removing foreground rain-induced occlusions and restoring the background details. This inspires us to remember the principle of symmetry; real-world rain is a mixture of rain streaks and rainy haze and degrades the visual quality of the background. Current efforts formulate image rain streak removal and rainy haze removal as separate models, which disrupts the symmetrical characteristics of real-world rain and background, leading to significant performance degradation. To achieve this symmetrical balance, we propose a novel semisupervised coarse-to-fine guided generative adversarial network (Semi-RainGAN) for the mixture of rain removal. Beyond existing wisdom, Semi-RainGAN is a joint learning paradigm of the mixture of rain removal and attention and depth estimation. Additionally, it introduces a coarse-to-fine guidance mechanism that effectively fuses estimated image, attention, and depth features. This mechanism enables us to achieve symmetrically high-quality rain removal while preserving fine-grained details. To bridge the gap between synthetic and real-world rain, Semi-RainGAN makes full use of unpaired real-world rainy and clean images, enhancing its generalization to real-world scenarios. Extensive experiments on both synthetic and real-world rain datasets demonstrate clear visual and numerical improvements of Semi-RainGAN over sixteen state-of-the-art models.

Updates on Emerging Interventions for Autosomal Recessive ABCA4-Associated Stargardt Disease.

Autosomal recessive Stargardt disease (STGD1) is an inherited retinal degenerative disease associated with a mutated ATP-binding cassette, subfamily A, member 4 (ABCA4) gene. STGD1 is the most common form of juvenile macular degeneration with onset in late childhood to early or middle adulthood and causes progressive, irreversible visual impairment and blindness. No effective treatment is currently available. In the present article, we review the most recent updates in clinical trials targeting the management of STGD1, including gene therapy, small molecule therapy, and stem cell therapy. In gene therapy, dual adeno-associated virus and non-viral vectors have been successful in delivering the human ABCA4 gene in preclinical studies. For pharmaceutical therapies ALK-001, deuterated vitamin A shows promise with preliminary data for phase 2 trial, demonstrating a decreased atrophy growth rate after two years. Stem cell therapy using human pluripotent stem cell-derived retinal pigment epithelium cells demonstrated long-term safety three years after implantation and visual acuity improvements in the first two years after initiation of therapy. Many other treatment options have ongoing investigations and clinical trials. While multiple potential interventions have shown promise in attenuating disease progression, further exploration is necessary to demonstrate treatment safety and efficacy.

Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: A systematic review and meta-analysis.

Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO. We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) using a random-effects model. Seven studies involving 2560 patients were included. EVT was associated with significantly higher likelihood of early neurological improvement (OR, 2.31 [95% CI, 1.38-2.91]; p < 0.00001) and visual field normalization (OR, 3.08 [95% CI, 1.76-5.38]; p < 0.0001) compared to BMM. Rates of good functional outcomes (mRS 0-2) were comparable between the two arms (OR, 0.88 [95% CI, 0.70-1.10]; p = 0.26). Symptomatic intracranial hemorrhage (sICH) was comparable between the two groups (OR, 1.94 [95% CI, 0.96-3.93]; p = 0.07). Mortality was also similar between the two groups (OR, 1.36; [95% CI, 0.77-2.42]; p = 0.29). In patients with iPCAO, EVT was associated with visual and early neurological improvement but with a strong trend toward increased sICH. Survival and functional outcomes may be slightly poorer. The role of EVT in iPCAO remains uncertain.

Comparison of functional and morphologic changes between brolucizumab and faricimab in neovascular age-related macular degeneration.

This study aimed to compare functional and morphologic changes in the loading phase between patients with treatment-naïve macular neovascularization (MNV) due to neovascular age-related macular degeneration (nAMD) treated with either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. We retrospectively studied 92 consecutive eyes of 90 patients with neovascular nAMD who were scheduled to receive IVBr (42 eyes of 41 patients) or IVF (50 eyes of 49 patients) injections between October 2021 and December 2022. All patients received three consecutive monthly injections of 6.0 mg/0.05 mL brolucizumab or 6.0 mg/0.05 mL faricimab. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and central choroidal thickness (CCT) at baseline and 1, 2, and 4 months after the initial treatment were measured and compared between the groups. Thirty-seven eyes in IVBr group and forty-seven eyes in IVF group who finished treatments in the loading phase were assessed at the follow-up examination. The BCVA, CFT, and CCT changed significantly after loading phase in both groups (P < 0.05 for both comparisons). The IVBr group had more rapid improvement of the BCVA (P = 0.037) at 1 month than the IVF group, but there was no difference at 4 months (P = 0.367). The CFT and CCT decreases tended to be greater in the IVBr group than in the IVF group throughout the follow-up period. Of the five eyes excluded from the IVBr group, one eye (2.4%) each had intraocular inflammation (IOI) and was a non-responder, and two eyes (4.8%) had retinal pigment epithelial tears after treatment. Of the three eyes excluded from the IVF group, two eyes (4.0%) did not respond to the treatment. Both IVBr and IVF injections were well-tolerated and improved the VA in treatment-naïve patients with MNV due to nAMD after a loading phase, although IVBr caused a trend towardfaster visual improvements in the BCVA. The IVBr group also had greater reductions of the CFT and CCT than the IVF group. However, the potential for adverse events and no response to treatment with each drug are considerations.

Review and evaluation of recent advancements in image dehazing techniques for vision improvement and visualization

Review and evaluation of recent advancements in image dehazing techniques for vision improvement and visualization

Real-World Experience With Teprotumumab in Patients With Dysthyroid Optic Neuropathy.

Teprotumumab, an insulin-like growth factor I receptor inhibitory antibody, improved proptosis, diplopia, inflammatory signs/symptoms, and quality of life in patients with active thyroid eye disease (TED) in clinical trials. The trials excluded patients with dysthyroid optic neuropathy (DON). Recently, many case reports and case series have reported the successful use of teprotumumab to treat DON. Here, we review the data from published cases and our clinical experience in treating patients having DON with teprotumumab. A literature search was conducted of patients with DON treated with teprotumumab from January 2020 through September 2022. Data from DON patients from the authors' (M.A.T. and C.A.B.) clinical practice were included. Primary outcome measure was mean (SD) improvements for visual acuity, color vision, and visual fields. Improvements in proptosis and clinical activity score (CAS) and diplopia were compared before and after teprotumumab administration. Ten observational studies/case reports were identified along with 2 patients in our practice. In all, there were 24 active TED patients with DON (37 eyes) who were treated with teprotumumab. Mean (SD) age was 66.5 (13.6) years and 13 (54%) were females, disease duration ranged from 2 months to >15 years. 22/24 patients had none, minimal improvement or progression of visual loss with intravenous/oral corticosteroids, orbital decompression (n = 9), and orbital radiation (n = 2). There were 2 patients who received teprotumumab as the only therapy. Overall, 88% (21/24) reported improvement in visual acuity after teprotumumab and in 75% (18/24), improvement in vision was observed after just 2 infusions of teprotumumab. Three eyes had decompression surgery in close proximity to teprotumumab infusions and were excluded from analyses. Mean (SD) improvement in visual acuity was 3.73 lines (SD 3.74), range 2-15 lines in 33 eyes. The mean (SD) improvement in the mean deviation on visual field testing in 15 eyes was 5.6 db (3.0 db). Mean (SD) improvement in proptosis was 4.37 mm (SD: 2.11) (20 patients, 32 eyes); and clinical activity score: mean reduction of 5.1 (1.3) for 18 patients. Teprotumumab was well tolerated in all but one patient. Adverse events reported included fatigue, dysgeusia, hearing loss, nausea, hyperglycemia, and muscle spasms. Teprotumumab is an effective treatment for DON in our experience and in published cases in whom treatment with steroids, surgery, or orbital radiation was unsuccessful.

Autologous neurosensory retinal transplantation.

Macular hole is a full-thickness neuroretinal defect in the fovea. The surgical solution is the removal of the internal limiting membrane (ILM) during vitrectomy with gas filling. Several surgical techniques have been described for the closure of refractory macular holes (about 5%), that reappear after successful surgery or do not close despite surgery. This article presents the first autologous neurosensory retina transplantation performed in Hungary for a large, refractory, full-thickness macular hole, with a brief overview of macular hole surgery. In September 2022, we performed a combined phacovitrectomy with ERM/ILM peeling and SF6 gas filling due to cataract, epiretinal membrane (ERM), and large macular hole due to the deterioration of vision in our patient's left eye for months, with a visual acuity of 6%. We drew the patient's attention to the importance of postoperative head positioning, which she ignored. With a visual acuity of 4%, due to a refractive macular hole (at the base: 983 μm, at the smallest diameter: 609 μm), on December 14, 2022, autologous neurosensory retina transplantation was performed using intraoperative OCT (Zeiss ARTEVO 800). At the end of the surgery, decalin was left in the eye to keep the graft in place, and the patient spent 5 days in a supine position. The decalin was removed with another operation, followed by C3F8 gas filling. 8 weeks after surgery, we documented a closed macular hole with 20% visual acuity, which was stable during the 6-month follow-up. Among the options considered for the resolution of refractory macular holes, autologous neurosensory retinal transplantation, which results in a visual improvement of our patient, is an intervention worth considering. Intraoperative OCT was a great help in performing the surgery. Although the decalin left temporarily in the eye helps to keep the transplant in place, it requires a continuous supine position and another operation is essential to remove it. Further experience is needed to establish the exact indication for autologous neurosensory retinal transplantation. Orv Hetil. 2023; 164(38): 1511-1517.

Intravitreal allogeneic mesenchymal stem cells: a non-randomized phase II clinical trial for acute non-arteritic optic neuropathy

BackgroundAn effective treatment for acute non-arteritic ischemic optic neuropathy (NA-AION) has not been known or proven yet. Previous studies have suggested a neuroprotective effect of allogeneic bone marrow-derived mesenchymal stem cells. This study aims to report the results of a clinical trial on patients with acute non-arteritic optic neuropathy (NA-AION) treated with an intravitreal injection of allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) (MSV®).MethodsWe conducted a prospective, non-randomized, clinical phase-II study (Eudra CT number 2016-003029-40; ClinicalTrials.gov Registry NCT03173638) that included 5 patients with acute unilateral NA-AION diagnosed within 2 weeks after symptom onset and who received an intravitreal injection of allogeneic BM-MSCs (0.05 ml; cell concentration: 1.5 × 106cells/mL). The patients underwent regular ophthalmological examinations and were followed for one year.ResultsIn this trial, allogeneic BM-MSCs appeared to be safe as no patients developed signs of acute nor chronic intraocular inflammation or a significant change in intraocular pressure, although an epiretinal membrane was developed in one patient. A retrolental aggregate formed shortly after the injection spontaneously disappeared within a few weeks in another phakic patient, leaving a subcapsular cataract. Visual improvement was noted in 4 patients, and amplitudes of P100 on the visually evoked potentials recordings increased in three patients. The retinal nerve fiber layer and macular ganglion cell layer thicknesses significantly decreased during the follow-up.ConclusionsBesides the development of an epiretinal membrane in one patient, the intravitreal application of allogeneic BM-MSCs appeared to be intraocularly well tolerated. Consequently, not only NA-AION but also BM-MSCs deserve more clinical investigational resources and a larger randomized multicenter trial that would provide stronger evidence both about safety and the potential therapeutic efficacy of intravitreally injected allogeneic BM-MSCs in acute NA-AION.Trial registration: Safety Assessment of Intravitreal Mesenchymal Stem Cells for Acute Non-Arteritic Anterior Ischemic Optic Neuropathy (NEUROSTEM). NCT03173638. Registered June 02, 2017 https://clinicaltrials.gov/ct2/show/NCT03173638.

A design methodology to consider occupants’ spatial adjustment and manage view content in adaptive façade design for improving visual comfort

ABSTRACT Occupants’ spatial adjustment (OSA) is one of the critical adaptive behaviours in buildings because it affects occupants’ comfort and contents of view. However, OSA for contents of view management from facade (e.g. sky, other construction, and greenery) have not been quantified to be integrated into other aspects of multi-objective building design, particularly façade design. The current study develops a design methodology and a correspondent plugin tool to incorporate OSA and content view calculation for visual comfort improvement. To this end, first, a test cell and outdoor and indoor environment were modelled, and façade geometric variables and OSA variables (location and direction of occupant’s sight) were set. After that, images were captured from hypothetical occupants’ locations inside in different directions of sight while façade transformation alternatives were recorded to the occupants’ content view images. Next, python image processing was linked to the Grasshopper modelling environment for content view analysing and quantification to be integrated into the optimisation process linked with visual comfort objectives. The designed methodology helped improve occupants’ visual comfort by optimising façade form and managing OSA for optimum daylight availability, glare minimisation, and enhancing occupants’ content view. Illuminance and discomfort glare probability (DGP), useful daylight illuminance (UDI), and spatial daylight autonomy (sDA) were used to shed light on the daylight performance of the proposed scenarios. Results demonstrated that a unique OSA and integrated façade configuration at any point in time and seasons that are suitable for the occupant’s daylight availability management, decreases perceived glare, and enhances the content view.

Reliability of intraoperative visual evoked potentials (iVEPs) in monitoring visual function during endoscopic transsphenoidal surgery

ObjectiveTo refine a reliable and reproducible intraoperative visual evoked potentials (iVEPs) monitoring protocol during endoscopic transsphenoidal surgery. To assess the reliability of baseline iVEPs in predicting preoperative visual status and perioperative iVEP variation in predicting postoperative visual outcome.MethodsSixty-four patients harboring tumors of the pituitary region were included. All patients underwent endoscopic endonasal approach (EEA) with iVEPs monitoring, using a totally intravenous anesthetic protocol. Ophthalmological evaluation included visual acuity and visual field studies.ResultsPreoperatively, visual acuity was reduced in 86% and visual field in 76.5% of cases. Baseline iVEPs amplitude was significantly correlated with preoperative visual acuity and visual field (p = 0.001 and p = 0.0004, respectively), confirming the reliability of the neurophysiological/anesthetic protocol implemented.Importantly, perioperatively the variation in iVEPs amplitude was significantly correlated with the changes in visual acuity (p < 0.0001) and visual field (p = 0.0013). ROC analysis confirmed that iVEPs are an accurate predictor of perioperiative visual acuity improvement, with a 100% positive predictive value in patients with preoperative vision loss.ConclusionsiVEPs during EEA is highly reliable in describing preoperative visual function and can accurately predict postoperative vision improvement.SignificanceiVEPs represent a promising resource for carrying out a more effective and safe endoscopic transsphenoidal surgery.