Improvement In Visual Acuity Research Articles

Therapies for Central Serous Chorioretinopathy: A Report by the American Academy of Ophthalmology

To assess the safety and efficacy of the multiple therapeutic modalities for the treatment of central serous chorioretinopathy (CSCR). A literature search of English-language studies in the PubMed database with no date restrictions was last conducted in May 2024. The combined searches yielded 612 citations, 31 of which were selected for full-text review and for inclusion in this assessment. The panel methodologist assigned a level of evidence rating to each study. Six were assigned a level I rating, 23 were assigned a level II rating, and 2 were assigned a level III rating. Studies were categorized based on treatment modalities: laser-based therapy, intravitreal therapy, laser-based therapy versus intravitreal therapy, and systemic therapies. Within those categories, they were separated based on treatments for acute versus chronic CSCR. One level I study showed that photodynamic therapy (PDT) using half-dose verteporfin for acute CSCR led to a significant decrease in subretinal fluid (SRF) with 95% of treated patients having no SRF at 12 months compared with 58% of untreated eyes with acute CSCR (P= 0.001). Anatomically, the mean CFT at 1 year was significantly lower in the treated group (161 ± 65 μm) versus the observation group (278 ± 92 μm) (P= 0.001). A second level I study compared half-dose verteporfin PDT versus 30%-dose verteporfin PDT and found that 94.6% in the half-dose PDT group had no SRF at 12 months compared with 75.4% in the 30%-dose PDT group (P= 0.004). The noninferiority of the 30%-dose PDT compared with half-dose PDT was not demonstrated. The VICI trial was a level I study that found no benefit with the use of mineralocorticoid antagonism with eplerenone for the treatment of chronic CSCR. With respect to the primary outcome of visual acuity (VA), the VICI trial found no significant difference at 12 months: 79.5 letters in the placebo group and 80.4 letters in the eplerenone group (P= 0.24). In general, the results from the other evaluated studies were inconsistent and thus inconclusive. There were no level I studies that supported the role of intravitreal anti-VEGF injections or systemic beta-blockers for patients with CSCR. A small level I study showed potential efficacy of Helicobacter pylori therapy for CSCR. There is evidence to support half-dose PDT for the treatment of acute CSCR regarding anatomic improvement, but less robust evidence supports improvement in VA or sustained anatomic benefit beyond 12 months. Intravitreal anti-VEGF injections and oral beta-blockers demonstrate inconsistent anatomic and visual benefits in patients with CSCR. The mineralocorticoid antagonist eplerenone has not been demonstrated as efficacious for treatment of chronic CSCR. The treatment of H.pylori infection may have some anatomic and visual benefit in the treatment of either acute or chronic CSCR. Acute CSCR resolves spontaneously without treatment in most eyes. Proprietary or commercial disclosure may be found after the references.

SEROUS RETINAL DETACHMENT DUE TO CRYPTOCOCCOSIS IN AN IMMUNOCOMPETENT PATIENT

Purpose: To report a case of bilateral ocular cryptococcosis in an immunocompetent patient without neurologic findings. Methods: Case report. Results: A 30-year-old healthy Caucasian man presented with painless blurred vision in the left eye. Examination showed bilateral serous detachments and white retinal lesions. The visual acuity (VA) was 20/40 in the right eye and hand motions in the left eye. Neurologic workup and serologies were negative, and a computer tomography-positron emission tomography scan showed diffuse lymph node enlargement with metabolic activity and a suspected lymphoproliferative disorder. The myelogram and immunohistochemistry were normal. A biopsy of the cervical lymph nodes was positive for Cryptococcus neoformans. He was treated with antifungal medications and had complete resolution of the subretinal fluid and VA improvement. Conclusion: Cryptococcosis is a rare entity in an immunocompetent person. A systemic workup is necessary to diagnose cryptococcosis and initiate prompt treatment.

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies

BackgroundTraumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study investigated the predictive risk factors for TON and analyzed the effectiveness of current treatments with respect to visual outcomes in patients with TON. MethodsThis study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score (ISS) were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity. ResultsThis study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥ 4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, mega-dose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression. ConclusionClinicians can achieve early prediction of TON in patients with an initial unconscious state and the determined risk factors. The results indicated that conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

Real-World Assessment of Second-Generation Trabecular Micro-Bypass Stents in Open-Angle Glaucoma Patients

Background/Purposes/Objective: To assess the safety and efficacy of iStent inject placement in individuals with glaucoma with open angles in real world clinical settings. MethodsA review was conducted on the medical records of individuals who received iStent inject implants starting from March 2018. The analysis focused on reductions in intraocular pressure (IOP) and glaucoma medication usage. Safety assessments encompassed intraoperative and postoperative issues, additional surgeries, and improvements in best-corrected visual acuity (BCVA). ResultsAnalysis of 55 eyes of 48 patients that underwent iStent implantation revealed a mean age of 77 years (range: 51-97). The initial average intraocular pressure (IOP) in these eyes was 20.2 ± 6.4 mm Hg. Following surgery, IOP decreased by ≥ 20% compared to preoperative levels in 21 eyes (43.8%) over the 12-month follow-up period. Notably, there was a significant reduction in medication usage by the 12-month mark (p < 0.0042). Among the evaluated eyes, 9 exhibited a response to steroids, 3 had stents that were improperly positioned, 5 had stents that were over implanted, and 1 eye experienced an episode of iris prolapse. ConclusionsThe findings from the 12-month follow-up of iStent inject implants in standard clinical settings demonstrate a notable decrease in both intraocular pressure (IOP) and medication usage in eyes with concurrent open-angle glaucoma.

Visual deterioration secondary to medial sphenoid wing meningioma: systematic assessment of patient-reported outcomes and factors contributing to recovery after surgical treatment.

Visual acuity (VA) constitutes an important outcome measure in surgery for medial sphenoid wing meningioma (SWM). This study aimed to assess the recovery of tumor-associated impairment of VA and its impact on patient-reported outcome measures (PROMs) as an indication of vision-related quality of life in patients who had undergone surgery for medial SWM. From 2009 to 2018, 153 consecutive patients with medial SWM underwent surgical treatment at the authors' institutions. Tumor-associated VA was evaluated both on admission and during postoperative follow-up examinations, using Snellen charts. Multivariable analysis was performed to identify independent predictors for postoperative improvement of VA. PROMs were collected based on the National Eye Institute 25-Item Visual Function Questionnaire. Of patients with medial SWM, 53 of 153 (35%) experienced preoperative impairment of VA. The median preoperative duration of visual symptoms was 12 (IQR 3-17) months for the entire study cohort. Multivariable analysis revealed a preoperative duration of visual symptoms ≤ 4 months to be independently associated with postoperative improvement of VA (p = 0.009). Evaluation of PROMs indicated a superior postoperative qualitative extent in the overall health (p = 0.027) and activities of daily living (p = 0.031) categories if preoperative duration of visual impairment was ≤ 4 months. The overall preoperative duration of tumor-related visual impairment significantly correlates to the extent of postoperative visual improvement as well as vision-related PROMs in medial SWM surgery. These results might aid in preoperative patient counseling and help optimize decision-making and preoperative estimation of long-term visual outcome.

A Causal Inference Approach to Mediation Analysis in Vitreomacular Traction: How Much Does Traction Resolution Mediate Functional Outcomes?

Modern mediation analysis techniques supplement the primary intention-to-treat analysis with the aim to shed light onto the treatment mechanism. We investigate to what extent the anatomic marker vitreomacular adhesion resolution (VMAR) mediates vision benefits, comparing ocriplasmin vs. a sham regimen. A causal mediation analysis is applied to randomized trial data including 218 participants with vitreomacular traction. Logistic regression models are used to estimate the total treatment effect (TTE) on binary outcomes. Outcomes, assessed at month 24, included visual acuity improvement (VA-I): ≥2-line increase in VA; visual function questionnaire improvement (VFQ-I): ≥5-point increase in the 25-item visual function questionnaire composite score (VFQ-25cs); visual function improvement (VF-I): defined as either a VA-I or a clinically meaningful improvement in the VFQ-25cs. Quantity of interest is the breakdown of TTE into an indirect (through VMAR) and direct effect to estimate the extent to which the TTE is transmitted through the mediating variable (VMAR) vs. other pathways. Causal effects are expressed as risk differences. Indirect effects for VFQ-I, VA-I, and VF-I are 5.7%, 11.8%, and 5.2%, respectively, representing the increase in the probability of a vision improvement if VMAR status were changed for each participant to the extent that it is affected by ocriplasmin. The direct effects are 8.3%, 12.1%, and 24.1% respectively, capturing the effect of treatment on the probability of a vision improvement if ocriplasmin left each participant's VMAR status unchanged. The relative treatment effect of ocriplasmin on the functional outcome VA-I is to a large extent the result of its effect on VMAR, while an improvement in the patient-reported outcomes VFQ-I or VF-I was only partially mediated by VMAR.

Optic Atrophy Occurring with Anti‐Tumor Necrosis Factor Alpha Therapy: A Case Report

Ocular involvement related to treatment with tumor necrosis factor alpha inhibitors is a rare adverse effect that may lead to irreversible outcomes. We illustrate through this report a case of optic atrophy under Etanercept in a patient with spondyloarthritis. The diagnosis was suspected due to visual acuity impairment, and was confirmed by ophthalmological examination. Although the TNF-blockers were discontinued and corticosteroids were administered, the follow-up examination did not reveal any improvement in visual acuity. This is a potential serious complication of TNF inhibitors that rheumatologists should recognize when monitoring patients with rheumatic diseases.

Endoscopic transorbital approach for recurrent spheno-orbital meningiomas: single center case series

Endoscopic transorbital approaches (ETOAs) are finding wide application for skull base lesions, particularly for spheno-orbital meningiomas (SOMs). These tumors have high recurrence rates, and second surgery can often represent a challenge. In this study we analyze our experience of management of recurrent SOMs through a slightly modified eyelid crease approach. Between May 2016 and September 2023, in the Department of Neurosurgery of Fondazione IRCCS Policlinico San Matteo (Pavia, Italy), five consecutive recurrent SOMs have been treated using an endoscopic transorbital approach. Demographic data, preoperatory deficits, lesions characteristics, histology, grade of resection, eventual adjuvant treatments, complications, outcome in terms of symptoms improvement and cosmesis, and hospitalization are described. One patient maintained a right lateral rectus muscle palsy that was already present in the preoperatory, no cerebrospinal fluid (CSF) leaks were reported. All patients had postoperative periorbital edema, but no other systemic complication was found. All patients had proptosis improvement, two had visual acuity improvement, and best cosmetic outcome was obtained in all cases. Hospitalization varied between 4 and 6 days. ETOAs in the management of recurrent SOMs are safe and have good outcome. Right selection of patients is mandatory, but when feasible, endoscopic surgery can allow a virgin route to a previously operated tumor, guaranteeing a good strategic option.

Unlocking Clinical Insights and the Life-Changing Impact of Low-Vision Devices in Primary Open-Angle Glaucoma Patients.

Objective To elucidate the clinical profile of visual impairment (VI) and the effect of low-vision devices (LVD) among patients with primary open-angle glaucoma (POAG). Methodology A retrospective observational study was used. Case records of patients who reported to the low-vision care clinic with POAG were recruited for the study. Glaucoma was defined according to the International Society for Geographical and EO classification. Demographic data, visual acuity (LogMAR), clinical diagnosis, visual fields, occupation, and LVD prescribed were extracted from the records. The visual acuity pre- and post-use of LVD was compared. Visual acuity improvement while using the LVD was noted. Results Of the 200 POAG cases, 20% (n=40) had severe, 15.5% (n=31) had profound (<3/60), 20.5% (n=41) profound (<1/60), and 26.5% (n=53) had total blindness in the VI category. Significant improvement was noted for both distance and near vision (p=0.004 and p=0.000, respectively) for single-vision glasses, and significant improvement (p=0.000) was also noted for patients corrected for both distance and near correction (bifocal/progressive). Patients with severe visual field loss (p=0.004) and with a visual field defect of <10 degrees (p=0.000) both showed a significant improvement in near vision with low-vision rehabilitation. The proportion of patients earning showed improvement following LVD use compared to those who did not have self-earning (60% vs. 40.24%,p=0.0116). Conclusion LVD significantly improved near vision in POAG patients with advanced glaucoma, a visual field defect of less than 10 degrees. To effectively manage POAG patients with low vision, it is vital to understand both the ocular diseases causing VI and the patient's visual requirements and provide timely management.

Retinal damage promotes mitochondrial transfer in the visual system of a mouse model of Leber hereditary optic neuropathy

Lenadogene nolparvovec is a gene therapy which has been developed to treat Leber hereditary optic neuropathy (LHON) caused by a point mutation in the mitochondrial NADH dehydrogenase 4 (ND4) gene. Clinical trials have demonstrated a significant improvement of visual acuity up to 5 years after treatment by lenadogene nolparvovec but, surprisingly, unilateral treatment resulted in bilateral improvement of vision. This contralateral effect – similarly observed with other gene therapy products in development for MT-ND4-LHON – is supported by the migration of viral vector genomes and their transcripts to the contralateral eye, as reported in animals, and post-mortem samples from two patients. In this study, we used an AAV2 encoding fluorescent proteins targeting mitochondria to investigate whether these organelles themselves could transfer from the treated eye to the fellow one. We found that mitochondria travel along the visual system (optic chiasm and primary visual cortex) and reach the contralateral eye (optic nerve and retina) in physiological conditions. We also observed that, in a rotenone-induced model of retinal damage mimicking LHON, mitochondrial transfer from the healthy to the damaged eye was accelerated and enhanced. Our results thus provide a further explanation for the contralateral beneficial effect observed during clinical studies with lenadogene nolparvovec.

Assessing the clinical efficacy of phacoemulsification cataract extraction in treating acute primary angle closure and fellow primary angle closure suspect eyes using AS-OCT.

This study aimed to compare anterior segment parameters pre-and postoperatively in acute primary angle closure (APAC) and fellow primary angle closure suspect (PACS) eyes using anterior segment optical coherence tomography (AS-OCT) and evaluate the clinical effectiveness of cataract extraction in the treatment of APAC and fellow PACS eyes. Quantitative measurements of various parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), iridocorneal angle contact index (ITCI), iris thickness (IT), iris volume (IV), and iris curvature (IC), were obtained using Tomey CASIA2 AS-OCT on 60 eyes from 30 patients (APAC eyes and their fellow PACS eyes) before and after surgery. Simultaneous analysis of the differences between the APAC eyes and fellow PACS eyes in these parameters, visual acuity (VA), and intraocular pressure (IOP) were performed. After surgery, both the APAC eyes and fellow PACS eyes (a total of 60 eyes) showed a significant increase in ACD and ACV, compared to preoperative measurements. Furthermore, LV and ITCI significantly decreased postoperatively. In the PACS group, IC significantly decreased postoperatively, while there was no statistically significant difference in the APAC group. In the APAC group, there was a significant decrease in IOP and improvement in VA at 1 day, 1 week, and the final follow-up compared to preoperative levels. The IOP values in the PACS group were within the normal range across various time points. VA in the PACS group showed significant improvement at 1 week postoperatively and at the final follow-up compared to preoperative levels. Significant differences of VA were observed in the initial, preoperative, first postoperative day, first postoperative week, and final follow-up, with better outcomes observed in the PACS group compared to the APAC group. Lens extraction surgery can significantly improve anterior segment crowding in APAC and PACS eyes. For APAC eyes, combined cataract extraction with intraocular lens implantation and gonioscopy-assisted goniosynechialysis under direct visualization is feasible and safe. Further, in the fellow PACS eye of APAC patients with either significant or mild cataracts, phacoemulsification can maintain or improve preoperative visual acuity to varying degrees and stabilize IOP.

Effect of autologous serum after amniotic membrane transplantation for persistent corneal ulcers.

To investigate the effect of adding autologous serum eye drops to the postoperative regime after amniotic membrane transplantation for severe persistent corneal ulcers. Forty eyes of 40 patients with persistent corneal ulcers were randomly assigned to artificial tears (sodium hyaluronate 0.2%, ATs group, n=20) or autologous serum eye drops (ASEDs, n=20) following treatment with amniotic membrane transplantation. Digital slit lamp images were acquired from all patients before and 30d post treatment. The area with fibrovascular tissue was calculated using Image J. Central corneal sensitivity was assessed by Cochet-Bonnet aesthesiometry before and one month after treatment. Scar tissue transparency was assessed with a novel optical densitometry. Mean age of patients was 61.65±16.47y and 57.3±19.11y in the ATs group and ASEDs group, respectively. Twenty-two male and 18 female patients were included in the study. The improvement in visual acuity was significantly greater in the ASEDs group (0.14±0.04) than the ATs (0.08±0.04; P=0.00046). Cochet-Bonnet aesthesiometry improved significantly after treatment with a similar rate between groups. There were no statistically significant differences in the area of postoperative fibrovascular tissue between the two groups (P=0.082). The success rate in the two groups was similar. The difference in densitometry between the ATs and ASEDs group was statistically significant (P=0.042) with greater reduction from baseline in the ASEDS group. Autologous serum eye drops can lead to better visual acuity, more stable results and improved densitometry and should be considered in the postoperative care following amniotic membrane transplantation.

Photobiomodulation in Ophthalmology: A Comprehensive Review of Bench-to-Bedside Research and Clinical Integration.

Photobiomodulation (PBM), also known as low-level laser therapy, is an emerging therapeutic modality in ophthalmology, attracting increasing interest for its potential to manage a variety of ocular conditions. PBM employs low-energy light within the red and near-infrared spectrum to penetrate biological tissues, where it interacts with cellular chromophores. This interaction is believed to enhance mitochondrial function, boost adenosine triphosphate (ATP) production, and reduce oxidative stress, leading to improved cellular repair and tissue regeneration. Recent bench research has demonstrated PBM's efficacy in cellular and animal models, showing its ability to modulate inflammatory processes and promote healing in retinal and corneal diseases. For instance, in retinal models, PBM has been observed to reduce apoptosis and support cell survival under stress conditions. Similarly, studies in corneal models suggest that PBM can accelerate wound healing and reduce scarring. Clinical trials further corroborate these findings, revealing that PBM can enhance treatment outcomes in several ocular diseases, including age-related macular degeneration, diabetic retinopathy, and dry eye disease. Patients undergoing PBM have reported improvements in visual acuity, reduced retinal inflammation, and better tear film stability, highlighting its potential as an adjunctive therapy. This review also explores the integration of PBM into clinical practice, discussing current treatment protocols, safety considerations, and the latest advancements in PBM technology. By offering a holistic overview, the review aims to provide clinicians and researchers with valuable insights into PBM's role in modern ophthalmic care, emphasizing its potential to enhance treatment strategies and improve patient outcomes.

Predictive Factors for Functional and Anatomical Outcomes After Anti-VEGF Treatment for Macular Edema in Patients with Branch Retinal Vein Occlusion.

This study aimed to identify predictive factors for the improvement of best-corrected visual acuity (BCVA) and reduction of central macular thickness (CMT) after treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real-world setting. This retrospective study included patients with ME secondary to BRVO who were treated with intravitreal injection of bevacizumab as the first-line therapy and were followed up for 12 months. Demographic and clinical data, in addition to baseline spectral domain optical coherence tomography (SD-OCT) features, were considered as possible biomarkers of final BCVA and CMT. We also collected the data concerning the need for additional treatment including sectorial laser photocoagulation, change to another anti-VEGF agent, or intravitreal corticosteroid injection. A total of 161 eyes were analyzed. BCVA significantly improved from baseline to 12-month follow-up (0.6 and 0.4 logMAR, respectively; P 0.01). CMT decreased significantly during the follow-up period (from 498.0 to 325.0 m; P 0.01). Final BCVA correlated positively with baseline BCVA (P 0.01, r = 0.57). Older age at diagnosis and baseline SD-OCT findings including CMT, disruption of the retinal inner layers, retinal pigment epithelium (RPE) damage, and impairment of the ellipsoid zone and external limiting membrane negatively affected final BCVA (P 0.01). Multiple regression analysis identified age and BCVA at baseline as the only independent predictors of final BCVA (P = 0.001 and P 0.01, respectively). No association was found between clinical data, SD-OCT parameters, and final CMT. Various clinical and SD-OCT parameters are prognostically relevant for visual improvement in ME secondary to BRVO. Age at diagnosis and baseline BCVA were found to be independent predictors of visual outcome.

Improvement of acuity following motion adaptation: the role of low spatial frequencies

Improvement of acuity following motion adaptation: the role of low spatial frequencies

Assessment of visual function in patients with posterior fossa tumours

Introduction. Posterior fossa tumours (PFTs) frequently present with ophthalmic complaints. The literature is mainly focused on PFTs affecting the pediatric age group, and the post-treatment visual outcomes (VOs) are scarcely reported. Objective. To evaluate the VOs at 6 months following the index surgery in patients with PFTs. Materials and methods. This retrospective study involved 50 patients of all age groups who underwent surgical resection of PFTs in the Department of Neurosurgery. The patients with PFTs, except those with low-grade tumours, received concurrent chemo-radiotherapy. Pre- and postoperative (6 months after the index surgery) ophthalmic examinations were done and compared. VOs included colour vision, night vision, visual acuity (VA), pupillary function (size, reactivity), papilledema grade, splinter haemorrhage, retinal venous dilatation, strabismus (esotropia and hypertropia), and nystagmus. Results. The patients were mainly aged 1–10 years (22%) with slight female predominance (52%). The most common PFTs were brainstem glioma and pilocytic astrocytoma (each 18%). At 6 months, there was no significant change in colour and night vision, pupil size and reactivity, splinter haemorrhage, and hypertropia (all p-values&gt;0.05). A significantly lesser proportion of patients had moderate VA (p-value=0.013), retinal venous dilatation (p-value=0.001), and grade 1 (p-value=0.005) as well as grade 4 papilledema (p-value=0.041). Moreover, a significantly greater proportion of patients had grade 0 papilledema (p-value&lt;0.0001). While the incidence of nystagmus and esotropia increased significantly (both p-values&lt;0.0001). Conclusion. At 6 months, the majority of the patients had good VOs, including significant improvement in moderate VA, papilledema, and retinal venous dilatation. While nystagmus and esotropia increased significantly.

Clinical efficacy of a head-mounted device for central vision loss

Central vision loss (CVL) is a major form of low vision that remains inadequately managed worldwide. This study evaluated the clinical efficacy of a novel head-mounted device (HMD), Onyx, designed to enhance visual function and vision-related quality of life for CVL patients. It employs a projection system that enables patients to leverage their residual peripheral vision for environmental awareness. It also integrates artificial intelligence to augment the automatic recognition of text, faces, and objects. In this single-center, prospective cohort study, 41 binocularly low vision patients with CVL were instructed to use Onyx for 4 to 6 h daily over a one-month period. Various metrics were assessed, including near and distance visual acuity (VA), recognition abilities for faces and objects, and the low vision quality-of-life (LVQOL) questionnaire scores, at the start and end of the study. The results showed significant improvements in near VA for 60.98% of the participants, distance VA for 80.49%, and recognition ability for 90.24%. 68.29% of the participants showed significant improvements in the LVQOL scores. Improvement in recognition ability was negatively correlated with baseline recognition ability. Additionally, improvement in the LVQOL scores was correlated with age and the baseline LVQOL score. Overall, the study found that the novel HMD significantly improved visual function and vision-related quality of life for low vision patients with CVL, highlighting the potential benefits and the need for further evaluation of such devices.

SEQUENTIAL PARS PLANA VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENTS WITH PERIPHERAL BREAKS AND CONCOMITANT NONCAUSATIVE MACULAR HOLE IN NONHIGHLY MYOPIC PATIENTS.

To present the anatomical and functional results of sequential pars plana vitrectomy for treating rhegmatogenous retinal detachment with peripheral breaks and concomitant noncausative macular holes (MHs) in nonhighly myopic patients. Medical records of patients who underwent rhegmatogenous retinal detachment surgical repair between 2017 and 2023 were reviewed. Of 980 patients with rhegmatogenous retinal detachment, 10 had concurrent MH and underwent sequential pars plana vitrectomy for rhegmatogenous retinal detachment repair and air endotamponade, followed by MH repair using the inverted internal limiting membrane flap technique and C2F6 endotamponade after a minimum of 1 week. The main outcomes measured were best-corrected visual acuity change, retinal reattachment rate, MH closure rate, and closure type. The retinal reattachment rate was 90% after the primary surgery and 100% after subsequent surgery. Macular hole closure was achieved in all cases. Macular hole diameters ranged from 291 to 702 µm. Anatomical recovery showed mainly 1A closure types (90%). Functional recovery demonstrated significant best-corrected visual acuity improvement, with a mean visual acuity gain of 1.58 ± 0.41 the logarithm of the minimum angle of resolution. For this infrequent pathology, sequential surgery using the inverted internal limiting membrane flap technique and air/gas endotamponade yielded favorable anatomical and functional outcomes. This controlled and standardized approach using sequential surgeries contributes to the achievement of consistent results.

Use of in vivo confocal microscopy in suspected Acanthamoeba keratitis: a 12-year real-world data study at a Swedish regional referral center

PurposeTo report real-world data (RWD) on the use of in vivo confocal microscopy (IVCM) in handling cases of suspected Acanthamoeba keratitis (AK) cases at a regional referral center during a 12-year period.MethodsRetrospective study of patients with suspected AK presenting at a regional referral center for IVCM in Sweden from 2010 to 2022. Demographics, symptoms, outcomes, and clinical management were analyzed, and IVCM images were interpreted.ResultsOf 74 included patients with suspected AK, 18 (24%) were IVCM-positive, 33 (44%) were IVCM-negative, 15 had inconclusive IVCM results (20.2%), and 8 (11%) were referred for a second opinion based on IVCM, 4 of which were IVCM-positive (5.5%), yielding an overall IVCM-positive rate of 29.5%. Cultures were taken in 38 cases (51%) with only 2 cases (2.7%) culture-positive for AK. Of IVCM-negative cases, cultures were taken in 22 (67%) of cases and 100% of these were AK-negative. IVCM-positive cases had more clinic visits (median 30, P = 0.018) and longer follow-up time (median 890 days, P = 0.009) than IVCM-negative patients, while visual acuity improvement did not differ (P > 0.05). Of IVCM-positive cases, 10 (56%) underwent surgery despite prior anti-amoebic treatment, and 14 (78%) had 3 or more IVCM examinations during follow-up, with cysts (100%), dendritic cells (89%) and inflammatory infiltrate (67%) as the most prevalent features. Longitudinal IVCM indicated improvement in cysts, dendritic cells and subbasal nerves with treatment, while clinical resolution was not always consistent with complete absence of cysts.ConclusionsIn a real-world setting, IVCM has a high reliability in classifying AK-negative cases, while IVCM detects AK-positive cases more frequently than the gold-standard culture method, leading to its preferential use over the culture method where time or resources are limited. Despite this, a subset of cases are IVCM-inconclusive, the clinical course of referred patients is long requiring many hospital visits, and visual acuity in most cases does not improve with medical treatment alone. Information sharing across centers and standardization of referral and diagnostic routines is needed to exploit the full potential of IVCM in AK patient management.

Basic is Better? An Assessment of National Outcomes in Prehospital Airway Management in Critical Acuity Pediatric Trauma: Outcomes of Pediatric Prehospital Airway

BackgroundConsensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs). ObjectivesThis retrospective study compared prehospital basic-airway procedures (B-AP) versus advanced-AP (A-AP) among PTPs, comparing scene time, transport time and improvement in acuity from scene to emergency department. MethodsThe 2020 National Emergency Medical Services Information System was used to study patients 1-18 years-old with pre-hospital AP. A-AP were compared with B-AP using Chi2, Wilcoxon rank sum, multivariable logistic and linear regression models in terms of improvement in acuity, and transport and scene times. Results3325 cases included 672 A-AP and 2653 B-AP; 39 esophageal combi- or dual lumen tubes, 48 LMA, and 585 orotracheal intubations. Overall failure rate: A-AP 8.77% vs B-AP 1.09% (p<0.0001). Adjusted models identified reduction in scene time for B-AP vs. A-AP (estimate: 4 minutes 51 seconds, 95% CI 9 minutes 49 seconds - 6 seconds; p= 0.01). B-AP were associated with improved acuity (OR 1.19, 95% CI 1.11-1.27; p< 0.001) after adjusting for revised trauma score, provider type, urbanicity, time spent at scene, and demographic variables. ConclusionPrehospital B-AP were associated with shorter scene time and improvement in acuity compared to A-AP in PTPs. Variability in airway management practices across US regions is high, leaving room for improvement in standardization of care and training.