Visual Acuity Outcomes Research Articles

Management of Iatrogenic Iridodialysis with Single-pass Four-Throw (SFT) Pupilloplasty : A Case Report

Introduction : Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body. It occurs most commonly secondary to trauma, and it is more frequently associated with blunt traumas compared to penetrating eye injuries. Iridodialysis can also occur due to intraocular surgeries. The prevalence of iridodialysis secondary to blunt trauma was reported to be 9.3-14% as compared to 0.2% caused by cataract surgeries. Small and superiorly located iridodialysis may be left untreated. However, a more inferiorly placed, larger, or symptomatic iridodialysis warrants surgical repair.
 Case Illustration : A Male 62 years old came with chief complaint Glare on right eye after complicated cataract surgery 2 months before.Patient also complained blurry vison without redness. Examination found visual acuity 6/60 UCVA RE, iridodialysis at superior region from 10 o’clock until 1 o’clock, IOL (+) with good central, Normal Posterior Segment. Patient was treated with Single-pass Four-Throw (SFT) Pupilloplasty with local anesthesia and 1-month after Pupilloplasty we found visual acuity 6/30 UCVA RE and without any glare complaint anymore.
 Discussion : Management of this patient is a challenging case. The treatment og Single-pass Four-Throw (SFT) Pupilloplasty can give great outcome for visual acuity and glare symptom. SFT Pupilloplasty is also great and easy technique for beginner eye surgeon but for anesthesia, general anesthesia is more convenience than local ones.
 Conclusion : SFT Pupilloplasty is also great and easy techinique for iatrogenic iridodialysis.

Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.
 Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.
 Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.
 Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.

Clinical and Surgical Outcomes of Endoscopic Endonasal Approach for Giant Pituitary Adenomas: Analysis of Predictive Factors

Giant pituitary adenomas (GPAs) are defined as tumors with ≥40mm in any maximum diameter, and these tend to invade multiple intracranial compartments. Hence, treatment remains a surgical challenge. To describe the clinical and surgical outcomes of the endoscopic endonasal approach (EEA) for GPA in a pituitary referral center in Latin America and to analyze associated predictive factors. 37 patients with histologically-confirmed GPA treated solely through the EEA between a 2-year period were included. Preoperative and postoperative clinical and neuroimaging findings; surgical morbidity and mortality; and binary logistic regression analysis to assess predictive factors were analyzed. Preoperative visual impairment prevalence was 97.3%. Mean tumor volume was 32cc and gross total resection rate was 40.5%. Favorable visual acuity and visual fields outcome rate was 75% and 82.9%, respectively. In the multivariate analysis, bilateral cavernous sinus invasion (P= 0.018) and postoperative cerebrospinal fluid (CSF) leak (P= 0.036) were associated with an unfavorable visual acuity outcome, while radiation therapy (P= 0.035) was for visual fields. Similarly, intraoperative CSF leak was a predictive factor for postoperative CSF leak (10.8%) (P= 0.042) and vascular injury (13.5%) (P= 0.048). In this first Mexican clinical series, we demonstrated that the EEA is a safe and effective technique for GPA, although early diagnosis and prompt intervention may promote further visual function preservation without significant endocrine morbidity.

Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis

ObjectiveOcular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic glaucoma. DesignRetrospective cohort study. ParticipantsAll adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. MethodsThe primary outcomes were baseline and final visual acuity. ResultsA total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001). ConclusionA quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.

Rates of endophthalmitis before and after transition from povidone-iodine to aqueous chlorhexidine asepsis for intravitreal injection

ObjectiveTo assess the rate of post-intravitreal injection endophthalmitis between 2 asepsis groups: aqueous chlorhexidine 0.1% and povidone-iodine 5%. DesignRetrospective, observational cohort study. ParticipantsPatients with infectious endophthalmitis post intravitreal injection (n = 58) at a single centre from July 2009 to July 2022. MethodsRetrospective chart review of all patients receiving intravitreal injections (216 593 injections) at a single centre over 14 years. Patients from July 2009 to February 2017 received povidone-iodine 5%, and patients from March 2017 to July 2022 received aqueous chlorhexidine 0.1%. Assessed characteristics of endophthalmitis cases included demographics, visual function, intervention type, and microbiological results. ResultsThe rate of endophthalmitis was comparable for povidone-iodine (1.4:5000) and aqueous chlorhexidine (1.3:5000) (p = 0.77). Vitreous cultures were negative for 55% of patients. Visual acuity (VA) outcomes did not differ between asepsis groups nor between culture positive/negative groups. Patients having vitrectomy (PPV) had worse final vision (p = 0.08) but there was no VA difference between early and late PPV. ConclusionsAqueous chlorhexidine 0.1% is a viable and safe alternative to povidone-iodine 5% for post-intravitreal injection endophthalmitis prophylaxis and may reduce ocular surface adverse events and discomfort.

Hyperopic LASIK and postoperative corneal steepness: revisiting the 49-diopter limit.

To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). Care-Vision Laser Centers, Tel-Aviv, Israel. Retrospective study. This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P < .001) and steep (45.1 D vs 43.5 D, P < .001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P = .02), and higher sphere (4.9 D vs 2.9 D, P < .001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P < .001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P = .01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P = .99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P < .001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P < .001). Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited.

Characterizing the Journey of Geographic Atrophy Patients in Routine Ophthalmic Practice.

Geographic atrophy (GA) is a form of late-stage age-related macular degeneration (AMD). This study aims to characterize the journey of patients with GA in real-world ophthalmology practice. This is a retrospective cohort study of 100 patients with GA and 100 with intermediate AMD (iAMD). Approximately one-third of GA patients' eyes had GA at the time of their initial AMD diagnosis, and nearly half of the iAMD patients' eyes had iAMD at that time. When holding confounders constant, GA patients experienced significantly worse visual acuity outcomes, and a significantly higher proportion required referrals for low vision evaluation, needed assistance for activities of daily living, failed to meet driving standards, and met criteria for legal blindness when compared to iAMD controls. Many patients have already progressed to GA by the time they receive an AMD diagnosis, emphasizing the importance of providing early detection and intervention, especially considering novel treatment options. [Ophthalmic Surg Lasers Imaging Retina 2024;55:204-210.].

Optical Coherence Tomography Parameters and Optimal Cut-off Values for Predicting Visual Prognosis in Ethambutol-Induced Optic Neuropathy.

The objective of this study was to evaluate the prognostic value of optical coherence tomography (OCT) parameters in patients with ethambutol-induced optic neuropathy (EON) and establish their optimal cut-off values for predicting visual acuity outcomes. A retrospective cross-sectional study was conducted on 64 eyes of 32 patients with EON who underwent OCT. Peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thickness were measured using Cirrus high-definition OCT (HD-OCT) within 3 months after EON diagnosis. Visual acuity of patients was recorded and analyzed at the first visit, the 1-year visit, and the latest visit. Prognostic capacities of OCT parameters for visual prognosis were evaluated and their optimal cut-off values for predicting final visual acuity were established. Increased pRNFL thickness was significantly associated with better visual acuity at 1 year postdiagnosis and the latest visit. A significant association was established between increased pRNFL thickness and a higher rate of recovery to visual acuity >20/25 at 1 year postdiagnosis. Receiver-operating characteristic curves identified ideal cut-off values for OCT parameters as follows: pRNFL thickness of 83 μm (sensitivity 100%, specificity 48.3%) and mGCIPL thickness of 74 μm (sensitivity 100%, specificity 83.3%) for visual acuity >20/25 at 1 year, mGCIPL thickness of 61 μm (sensitivity 85.7%, specificity 71.4%) for visual acuity >20/40 at 1 year, with corresponding AUCs exceeding 0.7. Both pRNFL and mGCIPL thickness possess potential values for predicting visual outcomes in patients with EON. Future research should continue to explore the utility of OCT parameters in EON prognosis.

Revolutionizing contact lens manufacturing: exploring cutting-edge techniques and innovations for enhanced vision and comfort

Abstract This review paper delves into the advancements and innovations revolutionizing contact lens (CL) manufacturing, focusing on techniques and technologies aimed at improving vision quality and wearer comfort. The article begins by tracing the evolution of CL fabrication techniques, paying homage to Leonardo da Vinci’s early contributions. It then discusses traditional methods such as lathe-cutting, spincasting, molded lens fabrication, and the recent advent of 3D printing in CL production. The review further explores advanced CL designs, including spherical, aspheric, toric, and bifocal/multifocal CLs, highlighting their specific applications and benefits. Material innovations in lens manufacturing are examined, with an emphasis on silicone hydrogel CL, hybrid lenses combining different materials, and the development of biocompatible and gas-permeable (GP) materials. Evaluation of optical design efficiency is another crucial aspect covered in this paper, encompassing visual acuity, contrast sensitivity, through-focus curves, reading performance, peripheral refraction, and patient-reported outcomes for quality of vision. Additionally, the role of nanotechnology and surface modifications in enhancing lens properties is explored, along with advances in lens coating and surface treatments, including antimicrobial and UV protection coatings. Nanocomposites of polymethyl methacrylate (PMMA) and TiO2 showed refractive indices between 1.52 and 1.59, while combining TiO2 NPs with poly(2-hydroxyethyl methacrylate) (PHEMA) yielded values ranging from 1.47 to 1.53. PGMA-TiO2 nanocomposites exhibited refractive indices between 1.47 and 1.50. Furthermore, nanocomposites of PVP-PVA-Ag with silver (Ag) NPs achieved higher refractive indices within the range of 1.45 to 1.49. This article concludes by discussing the challenges and future directions in CL manufacturing, focusing on addressing lens discomfort, improving oxygen permeability and moisture retention, and enhancing manufacturing efficiency and scalability. Overall, this review offers valuable insights into the cutting-edge techniques and innovations transforming CL production and paving the way for improved vision correction and wearer satisfaction.

VKH disease in the elderly: Variations in clinical course as compared to VKH disease in adults.

To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) disease in elderly patients. Retrospective analysis of patients older than 50 years with VKH disease at two referral centers in India. Demographics, extraocular and ocular involvement, treatment, complications, and visual acuity outcomes were noted. In total, 69 patients (mean age at presentation: 56.4 ± 4.7 years) were analyzed; 6/69 patients had diabetes mellitus at presentation, and 10/69 had hypertension. Clinical signs included anterior chamber cells >2+ (29%), granulomatous keratic precipitates (23%), disc hyperemia (26%), neurosensory retinal detachment (34.7%), and "sunset-glow" fundus (52.1%). Patients were classified as probable (n = 50, 72.4%), incomplete (n = 18, 26%), and complete VKH (n = 1, 1.4%). The mean follow-up period was 20.2 ± 19.4 months. Improvement in mean BCVA of (0.63 LogMAR, 6 Snellen lines) was noted on the last follow-up. Patients receiving systemic steroids with immunosuppressants ( P < 0.0001) had better visual outcomes at final follow-up compared to steroids alone ( P = 0.103). Eight patients (11.6%) had complications due to systemic immunosuppressants, and 17 patients (24.6%) developed diabetes mellitus or had worsening of diabetes while on systemic corticosteroids. Few patients presented with systemic manifestations in our cohort. Those treated with steroids and concurrent immunosuppressants had better outcomes. However, therapy with immunosuppressants was encountered with major dose-limiting complications in a significant number of elderly patients with VKH syndrome.

Evaluation of visual plasticity in patients with refractive amblyopia treated using a visual perceptual learning system.

Amblyopia is a neurological deficit in binocular vision that affects 3% of the population and is the result of disruptions in early visual development. In this study, we used a visual perceptual learning system for the short-term treatment of children with ametropic amblyopia and evaluated the clinical efficacy of this system in terms of visual plasticity. We conducted a retrospective analysis of the clinical data of 114 children (228 eyes) with refractive amblyopia, who were aged 6.51 ± 1.51 years. Prior to the treatment, we evaluated all children with amblyopia using the visual information processing test. We determined the type of amblyopic defect according to the type of amblyopia, corrected visual acuity, and advanced visual function test results. Based on the type of defect, each child with amblyopia was given short-term visual perception training for 10 days. Finally, we compared the results of visual acuity and visual information processing tests before and after the treatment. The best-corrected visual acuity of patients was better after 10 days of visual training than that before training (P< 0.05). The perceptual eye position after training improved with statistically significant differences in horizontal and vertical perceptual eye position (both P< 0.05) compared to that before training. The number of amblyopic children without suppression in both eyes was 81 cases (71.1%) after training which was higher than that (65 cases, or 57.0%) before training, with a statistically significant difference (P< 0.05). Binocular fine stereopsis and dynamic stereopsis improved after training with a statistically significant difference (both P< 0.05). In this study, it was found that patients with amblyopia showed visual plasticity. Moreover, continuous visual perceptual learning improved the best-corrected visual acuity and recovered stereopsis in children with refractive amblyopia.

Effect of Race and Insurance Status on Treatment and Outcomes in Diabetic Retinopathy: Analysis of 43 274 Eyes Using the IRIS Registry.

Purpose: To examine disparities in visual acuity (VA) outcomes 1 year and 2 years after initiation of diabetic retinopathy (DR) or diabetic macular edema (DME) treatment in patients based on race/ethnicity and insurance status, accounting for disease severity. Methods: This retrospective analysis used the IRIS Registry and included DR patients older than 18 years with documented antivascular endothelial growth factor (anti-VEGF) treatment and VA data for at least 2 years. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to determine the severity of DR and DME presence. VA outcomes were assessed using multivariable linear regressions and anti-VEGF drug use by multivariable logistic regressions, with race and insurance status as independent variables. Main outcome measures comprised the mean VA change at 1 year and 2 years and percentage of patients treated with bevacizumab. Results: The study included 43 274 eyes. White patients presented with a higher mean VA and lower mean DR severity than Black patients and Hispanic patients. Multivariable logistic regression showed Hispanic patients were significantly more likely to be treated with bevacizumab than White patients across all insurance types, controlling for disease severity and VA. After 1 year, the letter improvement was 1.73, 1.33, and 1.13 in White patients, Black patients, and Hispanic patients, respectively. Multivariable linear regression suggested that across races, Medicaid-insured patients had significantly smaller gains in VA than privately insured patients. Conclusions: Race-based and insurance-based differences in 1-year and 2-year outcomes after anti-VEGF treatment for DR and anti-VEGF treatment patterns suggest a need to ensure earlier and more effective treatment of minority and underserved patients in the United States.

Characteristics of fundus autofluorescence imaging at 795 nm and its correlations with postoperative outcomes for idiopathic macular hole.

Vitrectomy combined with internal limiting membrane (ILM) peeling or ILM inverted flap greatly improves hole closure and vision prognosis for idiopathic macular holes (IMH). The application of indocyanine green (ICG) in MH surgery increases the visibility of ILM and the safety of surgery. However, the area of ILM peeling and the state of the flap and a closed hole has not been well observed. Fundus autofluorescence at 7935nm can show the range of ILM peeling and the state of the hole site and ILM flap by monitoring residual ICG postoperatively. However, the characteristics of fundus autofluorescence especially the site of the closed hole, and its relationship with vision prognosis have not been explored. The aim of this project was to find the autofluorescence features of the closed hole and their relation with vision. To investigate the characteristics of fundus autofluorescence imaging after ICG-assisted vitrectomy for IMH and to evaluate the correlations of fluorescence patterns at the MH site with visual acuity and macular anatomic outcomes. We retrospectively evaluated 33 IMH patients (33 eyes) who underwent a 25G pars plana vitrectomy (follow-up, 6-14.5 months). ICG staining (2.5 mg/mL) was either used to remove the internal limiting membrane (ILM) or the inverted ILM flap was overlaid on the hole. After surgery, fluorescence imaging of the fundus was obtained using a scanning laser ophthalmoscope at 795 nm. On fluorescence imaging, the area of ILM peeling in all eyes showed hypofluorescence with no changes over time. The inverted ILM flap (performed in 18 eyes) was positioned on the inferior retina and exhibited early mild hyperfluorescence with blurred edges. This was gradually enhanced up to 3-6 months postoperatively and was then attenuated. MHs showed two distinct patterns on optical coherence tomography: granular (21 eyes) and patchy hyperfluorescence (12 eyes). Best-corrected visual acuity improved postoperatively in all cases (p<0.001, Z=-4.744). VA was worse in the patchy (vs. granular) hyperfluorescence cases (p=0.011, Z=-2.548). The status of the ILM peeling area, ILM flap, and closed MH can be clearly observed using autofluorescence imaging at 795 nm. Fluorescence may be due to ICG staining of the ILM and accumulation in retinal pigment epithelium cells during ICG-assisted surgery. Granular hyperfluorescence at the MH site may indicate good anatomic and visual prognoses.

Long‐term efficacy of idebenone in patients with Leber hereditary optic neuropathy according to age at symptom onset and disease phase: Results from the LEROS study

Aims/Purpose: Leber hereditary optic neuropathy (LHON) is a mitochondrial disease resulting in bilateral vision loss. Childhood‐onset LHON has a relatively good prognosis, suggesting that age influences disease progression and, potentially, treatment response. In LEROS, a Phase IV, open‐label interventional study (Clinicaltrials.gov NCT02774005), visual acuity (VA) outcomes following 24 months of idebenone treatment (IDE) were compared to those of an external Natural History (NH) cohort.Methods: LEROS included patients aged ≥12 years with a disease onset ≤5 years prior. Data from 181 patients were compared to retrospective data from a NH cohort (N = 372), matched by time since symptom onset. Here, we compare clinically relevant recovery (CRR) and clinically relevant worsening (CRW) from baseline to Month 24 in IDE eyes versus NH eyes, stratified by time since symptom onset at baseline: subacute/dynamic (≤1 year) and chronic (&gt;1 year) phase, and by age at symptom onset (&lt;18 years, ≥18 years).Results: In patients aged &lt;18 years, VA outcomes were observed, in IDE versus NH eyes, as follows: CRR: subacute/dynamic 31.8% (7/22) vs 59.1% (13/22), p = 0.048; chronic 31.3% (5/16) vs 21.6% (8/37), p = 0.241; CRW: subacute/dynamic 26.3% (5/19) vs 21.4% (3/14), p = 0.558; chronic 8.3% (1/12) vs 19.2% (5/26), p = 0.078. In patients aged ≥18 years, the following VA outcomes were observed: CRR: subacute/dynamic 51.5% (51/99) vs 22.6% (12/53), p = 0.001; chronic 32.0% (32/100) vs 12.5% (7/56), p &lt; 0.001; CRW: subacute/dynamic 25.7% (19/74) vs 62.9% (22/35), p &lt; 0.001; chronic 1.8% (1/56) vs 20.6% (7/34), p = 0.003.Conclusions: Idebenone improved the ratio of positive to negative VA outcomes. Treatment benefit was particularly pronounced in patients ≥18 years at onset, with only non‐significant positive trends observed in chronic patients &lt;18 years. Results in subacute/dynamic patients aged &lt;18 years were limited by an unusually high recovery rate in the NH cohort, warranting further study.

Real-world visual acuity outcomes for patients with naïve neovascular age-related macular degeneration treated with aflibercept, ranibizumab, or bevacizumab in the Republic of Korea.

To compare the visual outcomes of different anti-vascular endothelial growth factor (VEGF) drugs, including aflibercept, ranibizumab, and bevacizumab, in a real-world setting in Korea. We collected data from patients who received monotherapy using one of these three anti-VEGF drugs as naïve treatment after being diagnosed with neovascular age-related macular degeneration. The number of injections and visual acuity (VA) outcomes of each cohort were obtained and pairwise comparisons were performed using propensity score matching. A total of 254 aflibercept, 238 ranibizumab, and 282 bevacizumab treatment-naïve eyes were included. The mean VA change at 3 years for all cohorts combined was -1.8 letters, and the mean number of injections was 9.4. In the direct comparison of the three drugs, the mean change in the VA letter score was +2.0 letters for aflibercept and -11.7 letters for bevacizumab (P < 0.001). The number of aflibercept injections was significantly higher than the number of bevacizumab injections (P = 0.002). The visual outcomes for aflibercept and ranibizumab were +4.7 letters and -1.9 letters, respectively, and comparable results were obtained (P = 0.13). The VA outcomes for ranibizumab and bevacizumab were also not significantly different (P = 0.09). The numbers of injections for aflibercept, ranibizumab, and bevacizumab were 10.8, 6.7, and 8.8, respectively. Significant differences were observed between the injection frequencies comparisons of aflibercept and ranibizumab and ranibizumab and bevacizumab (P < 0.001 and P = 0.002, respectively). In the Korean clinical medical environment, which included various confounding factors, especially socioeconomic ones, the aflibercept VA outcome was significantly better than that of bevacizumab, and aflibercept injections were the most numerous. These real-world data imply that the drug effect as well as the environment in which the drug can be sufficiently used affected patient final VA scores.

Demographics, Presenting Features, and Outcomes of Adult Patients with Ocular Trauma

Introduction. Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators for patients and helps to navigate treatment modalities. This is a retrospective chart review of examination and imaging findings for ocular trauma and how they correlate with treatment course and visual acuity (VA) outcomes. Methods. Adult patients with ocular trauma presenting to a single institution between January 2013 and December 2020 were evaluated. Initial examination and imaging findings were compared for associations with each other and with VA outcomes. Results. 136 ocular traumas on 134 patients were included. The median presenting logMAR VA was 2.7 (interquartile range (IQR) 1.2–3.7) with 62% open globe injuries. The most commonly reported finding on initial CT scan was globe deformity (30%), on B‐scan was choroidal detachment (20%), and on ultrasound biomicroscopy was intraocular foreign body, ciliochoroidal effusions, or angle recession (21% each). Worse vision was observed for patients positive for retinal detachment on initial B‐scan compared to those negative for this finding at 6‐month (median logMAR 2.7 vs. 0.5; P &lt; 0.0001) and at final post‐injury evaluation (median logMAR 3.7 vs. 0.4; P &lt; 0.0001). Similarly, worse VA was observed for patients with choroidal detachment on initial B‐scan compared to those without this finding at 6‐month (median logMAR 1.4 vs. 0.5; P = 0.002) and at final post‐injury evaluation (median logMAR 2.0 vs. 0.4; P &lt; 0.0001). If positive conjunctiva/sclera examination findings were identified, 66% had positive findings on B‐scan, whereas if the conjunctiva/sclera examination findings were absent, 41% had positive findings on B‐scan (P = 0.005). If anterior chamber (AC) examination findings were positive, 59% had positive findings on B‐scan, whereas if the AC examination findings were absent, 37% had positive findings on B‐scan (P = 0.03). Discussion. The predictive value of examination findings in this study may offer insight as to long‐term visual prognosis. Positive B‐scan or CT findings should increase suspicion for open globe injuries.

Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser.

To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA). This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm). Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively. The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Visual outcomes of primary keratoprosthesis implantation in transplant-naïve eyes.

Primary keratoprosthesis (Kpro) implantation may be indicated in eyes that have an expected poor prognosis following initial penetrating keratoplasty, such as eyes with limbal stem cell deficiency (LSCD). We compare visual outcomes of eyes undergoing primary Kpro to eyes that had a secondary Kpro following penetrating keratoplasty. Retrospective review of all patients who had Kpro implantation at a tertiary academic medical center from 2005-2020. Among those, eyes that had undergone primary Kpro implantation without a history of prior corneal transplantation were also identified. Eighty-four eyes of 77 patients that had undergone Kpro implantation were identified. Of those 84, 12 eyes (21.4%) of 12 patients were receiving primary Kpro since they were corneal transplant-naïve. Among individuals undergoing primary Kpro implantation compared to secondary Kpro implantation, the most common underlying diagnoses were limbal stem cell deficiency (41.7% vs 10.0%, p = 0.01304), corneal scarring not otherwise specified (25.0% vs 2.86%, p = 0.02077), and neurotrophic cornea (16.7% vs 2.86%, p = 0.1002). Eyes undergoing primary Kpro implantation had similar mean visual acuity to eyes undergoing secondary Kpro preoperatively (20/2118 vs 20/3786, p = 0.271), 3 months postoperatively (20/264 vs 20/758, p = 0.174), and at final follow up (average 3.06 years, 20/907 vs 20/3446, p = 0.070). Average follow-up time and rates of glaucoma, endophthalmitis, retroprosthetic membrane, and retinal detachment did not significantly differ between groups (all p > 0.05). All eyes that progressed to no light perception (n = 13) had undergone secondary Kpro implantation. Visual acuity outcomes were similar between primary Kpro implantation and secondary Kpro implantation. Eyes that underwent primary Kpro implantation trended toward better postoperative VA at final follow-up than secondary Kpro eyes.

Extended depth of focus versus trifocal for intraocular lens implantation: An updated systematic review and meta‐analysis

Aims/Purpose: To compare the extended depth of focus (EDOF) versus trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation.Methods: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to include studies comparing EDOF versus trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence and patient satisfaction.Results: A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = −0.23; p = 0.001) and spherical equivalence (MD = −0.11, p = 0.0001) compared to EDOF IOL. No difference was observed in cylinder (MD = −0.03, p = 0.25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, p &lt; 0.00001) and distance‐corrected near visual acuity (MD = 0.12, p = 0.002). Post‐operative corrected distance visual acuity (MD = −0.01, p = 0.01) was significantly improved for the EDOF group, although no difference was noted in post‐operative uncorrected distance visual acuity (MD = 0.00, p = 0.84), uncorrected intermediate visual acuity (MD = 0.01, p = 0.68) or distance‐corrected intermediate visual acuity (MD = −0.01, p = 0.39). Defocus curve favoured trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, p = 0.10), glare and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, p = 0.03) and spectacle independence (odds ratio = 0.26, p = 0.02).Conclusions: Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos and glare were not statistically different between both groups.

Long‐term efficacy of idebenone in patients with Leber hereditary optic neuropathy in the LEROS study: Analysing change in visual acuity over time according to age at symptom onset

Aims/Purpose: Leber hereditary optic neuropathy (LHON) is a mitochondrial disease leading to progressive, bilateral vision loss. Childhood‐onset LHON has a relatively good prognosis, suggesting that age at onset influences disease progression and potential response to treatment. In LEROS, a Phase IV, open‐label interventional study (ClinicalTrials.gov NCT02774005), visual acuity (VA) outcomes following 24 months of idebenone treatment (IDE) were compared to those of a Natural History (NH) cohort.Methods: LEROS included patients aged ≥12 years with a disease onset ≤5 years prior. Data from 181 patients were compared to retrospective data from a NH cohort (N = 372), matched by time since symptom onset. Here, we compare the difference in least squares‐mean VA change, or delta VA, from baseline to Month 24 in treated eyes versus those in the NH cohort (a negative value favours IDE). Eyes were stratified by time since symptom onset at baseline: subacute/dynamic (≤1 year) and chronic (&gt;1 year) phase, and by age at symptom onset (&lt;18 years, ≥18 years).Results: In treated subacute/dynamic eyes from the &lt;18 years group (n = 22 IDE), delta VA was +0.38 logMAR (p = 0.020) relative to the NH cohort (n = 22). In the chronic phase, delta VA was −0.08 logMAR (n = 16 IDE vs n = 37 NH eyes; p = 0.405). In subacute/dynamic eyes from the ≥18 years group, delta VA was −0.18 logMAR (n = 99 IDE vs n = 53 NH; p = 0.060). In the chronic phase, delta VA was −0.21 logMAR (n = 100 IDE vs n = 56 NH; p &lt; 0.001).Conclusions: In eyes of patients ≥18 years at symptom onset, VA improvement at Month 24 was greater in idebenone‐treated versus untreated NH eyes. Treatment benefit was particularly apparent in the chronic phase, corresponding to &gt;10 additional letters on the ETDRS chart. In subacute/dynamic eyes, spontaneous VA recovery was unexpectedly high in the NH cohort. In chronic eyes from patients &lt;18 years, a non‐significant trend favouring idebenone was observed.