Intravitreal ranibizumab in choroidal neovascularisation due to multifocal choroiditis and panuveitis syndrome

We report the use of intravitreal ranibizumab as initial and only treatment in a case of peripapillary choroidal neovascularisation (CNV) in a patient with multifocal choroiditis and panuveitis (MCP) syndrome. A 54-year-old woman presented with sudden reduced vision in the right eye of 2 weeks duration. A full ophthalmological examination was performed including biomicroscopy, fluorescein angiography and optical coherence tomography. A peripapillary choroidal neovascular membrane with subretinal haemorrhage extending to the fovea was revealed due to MCP syndrome. Three intravitreal injections of ranibizumab were performed with monthly intervals. There was clearance of the subretinal haemorrhage and reduction of the leakage after the first injection. The visual acuity improved to 20/20 in 3 months and remained stable at 2-year follow-up without angiographical leakage. Intravitreal injections of ranibizumab could be tried in cases of CNV due to MCP syndrome with very good response

Effect of ranibizumab on serous and vascular pigment epithelial detachments associated with exudative age-related macular degeneration

Georgios D Panos,1 Zisis Gatzioufas,1 Ioannis K Petropoulos,1 Doukas Dardabounis,2 Gabriele Thumann,1 Farhad Hafezi11Department of Ophthalmology, Geneva University Hospitals and Faculty of Medicine of the University of Geneva, Switzerland; 2Department of Ophthalmology, University Hospital of Alexandroupolis, GreecePurpose: To report the effect of intravitreal ranibizumab therapy for serous and vascular pigment epithelial detachments (PED) associated with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD).Methods: In a prospective study, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were collected for 62 eyes of 62 patients, with serous or vascular PED associated with CNV secondary to AMD. Intravitreal ranibizumab 0.5 mg was administered with a loading phase of three consecutive monthly injections, followed by monthly review with further treatment, as indicated according to the retreatment criteria of the PrONTO study. The change in visual acuity and PED height from baseline to month 12 after the first injection was determined.Results: Sixty-one eyes of 61 patients (one of the patients developed retinal pigment epithelial tear and was excluded from the study) were assessed at the 12-month follow-up examination. There were two types of PED, including vascular PED in 32 patients (Group A) and serous PED (Group B) in 29 patients. The mean improvement of mean BCVA from baseline to 12 months was 0.09 logMAR (Logarithm of the Minimum Angle of Resolution) in Group A and 0.13 logMAR in Group B. Both groups showed significant improvement of the mean BCVA 12 months after the first injection compared with the baseline value (P < 0.05). In relation to the PED height, the mean decrease of mean PED height from baseline to 12 months was 135 &micro;m in Group A and 180 &micro;m in Group B. Both groups showed significant reduction of the PED height during the follow-up period (P < 0.01). The PED anatomical response to ranibizumab was not correlated with the BCVA improvement in any of the groups. Apart from one patient who developed pigment epithelial tear no other complications were documented.Conclusion: Ranibizumab is an effective and safe treatment for improving vision in patients with serous and vascular PED, although the anatomical response of the PED to ranibizumab may not correlate directly with the visual outcome.Keywords: age-related macular degeneration, choroidal neovascularisation, intravitreal injection, pigment epithelial detachment, ranibizuma

Impact of light conditions on reading ability following multifocal pseudophakic corrections

Georgios Labiris, Panagiota Ntonti, Eirini-Kanella Panagiotopoulou, Aristeidis Konstantinidis, Maria Gkika, Doukas Dardabounis, Irfan Perente, Haris Sideroudi Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece Purpose: To examine the impact of light intensity and temperature on reading performance following bilateral pseudophakic multifocal presbyopic correction.Patients and methods: This is a prospective clinic-based trial conducted at the Department of Ophthalmology in the University Hospital of Alexandroupolis, Greece. Three groups of patients were formed (G1: patients with bilateral bifocal implantation, G2: patients with bilateral trifocal implantation, and control group: patients with bilateral pseudophakic monofocal implantation). Reading ability was quantified with the Greek version of MNREAD chart with minimal reading speed at 80 words/min for the following light intensities (25, 50, and 75 Foot-Candles [FC]) and temperatures (3,000, 4,000, and 6,000 K). Preferred light conditions for reading were assessed, as well. ClinicalTrials.gov Identifier: NCT03226561.Results: Control group demonstrated significantly lower reading ability at all light combinations with maximal ability at 75 FC and 6,000 K (0.58&plusmn;0.18 logMAR). Bifocal group presented a light-dependent reading ability that ranged from 0.45&plusmn;0.08 logMAR (25 FC and 3,000 K) to 0.40&plusmn;0.11 logMAR (75 FC and 4,000 or 6,000 K). Trifocal participants presented the best reading ability that was light intensity-independent; however, their performance was reduced at 6,000 K. G1 and G2 preferred primarily intermediate light temperature, while control participants preferred cold light temperature.Conclusion: Multifocal pseudophakic corrections improve reading ability; however, they present variable efficacy according to the light conditions. Keywords: presbyopia, light intensity, Kelvin, Foot-Candles, trifocal, bifoca

Development and Validation of the First Smart TV-Based Visual Acuity Test: A Prospective Study

(1) Background: While smartphones are among the primary devices used in telemedical applications, smart TV healthcare apps are not prevalent despite smart TVs’ penetrance in home settings. The present study’s objective was to develop and validate the first smart TV-based visual acuity (VA) test (Democritus Digital Visual Acuity Test (DDiVAT)) that allows a reliable VA self-assessment. (2) Methods: This is a prospective validation study. DDiVAT introduces several advanced features for reliable VA self-testing; among them: automatic calibration, voice recognition, voice guidance, automatic calculation of VA indexes, and a smart TV-based messaging system. Normal and low vision participants were included in the validation. DDiVAT VA results (VADDiVAT) were compared against the ones from: (a) the gold-standard conventional ETDRS (VAETDRS), and, (b) an independent ophthalmologist who monitored the self-examination testing (VARES). Comparisons were performed by noninferiority test (set at 2.5-letters) and intraclass correlation coefficients (ICCs). DDiVAT’s test-retest reliability was assessed within a 15-day time-window. (3) Results: A total of 300 participants (185 and 115 with normal and low vision, respectively) responded to ETDRS and DDiVAT. Mean difference in letters was −0.05 for VAETDRS–VARES, 0.62 for VARES–VADDiVAT, and 0.67 for VAETDRS–VADDiVAT, significantly lower than the 2.5 letter noninferiority margin. ICCs indicated an excellent level of agreement, collectively and for each group (0.922-0.996). All displayed letters in DDiVAT presented a similar difficulty. The overall accuracy of the voice recognition service was 96.01%. ICC for VADDiVAT test-retest was 0.957. (4) Conclusions: The proposed DDiVAT presented non-significant VA differences with the ETDRS, suggesting that it can be used for accurate VA self-assessment in telemedical settings, both for normal and low-vision patients. © 2022 by the authors

Ranibizumab for the treatment of degenerative ocular conditions

Magdalini Triantafylla,1 Horace F Massa,2 Doukas Dardabounis,1 Zisis Gatzioufas,2 Vassilios Kozobolis,1 Konstantinos Ioannakis,1 Irfan Perente,1,3 Georgios D Panos1,21Department of Ophthalmology, University General Hospital of Alexandroupolis, School of Medicine, University of Thrace, Alexandroupolis, Greece; 2Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Switzerland; 3Beyoglou Eye Research and Teaching Hospital, Istanbul University, Istanbul, TurkeyAbstract: Degenerative ocular conditions, such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and myopic degeneration, have become a major public health problem and a leading cause of blindness in developed countries. Anti-vascular endothelial growth factor (VEGF) drugs seem to be an effective and safe treatment for these conditions. Ranibizumab, a humanized monoclonal antibody antigen-binding fragment, which inhibits all biologically active isoforms of VEGF-A, is still the gold standard treatment for the majority of these pathological entities. In this review, we present the results of the most important clinical trials concerning the efficacy and safety of ranibizumab for the treatment of degenerative ocular conditions.Keywords: age-related macular degeneration, diabetic macular edema, retinal vein occlusion, anti-VEGF, safety, efficacy, quality of lif

Premium Monovision versus Bilateral Myopic Monovision, Hybrid Monovision and Bilateral Trifocal Implantation: A Comparative Study

Purpose: Contemporary monovision techniques use premium intraocular lenses (IOLs), either in both eyes or at least in the non-dominant one. Primary objective of this study was to compare the efficacy of premium monovision (implantation of the trifocal diffractive Panoptix IOL in the non-dominant eye and the bifocal hybrid refractive-diffractive Restor IOL in the dominant eye), against bilateral myopic monovision (implantation of the monofocal SN60WF IOL targeting −0.50 D in the dominant eye and −1.25 D myopia in the non-dominant one), hybrid monovision (implantation of Panoptix in the non-dominant eye and SN60WF in the dominant eye) and bilateral trifocal implantation (with bilateral Panoptix implantation). Methods: This is a prospective, comparative, clinic-based trial. Cataract patients populated four study groups: Monovision Group (MoG), Multifocal Lens Group (MfG), Hybrid Monovision Group (HmG) and Premium Monovision Group (PmG). Binocular Uncorrected Distance Visual Acuity (UDVA), Uncorrected Reading Acuity and Critical Print Size at 60cm (UIRA, UICPS) and at 40cm (UNRA, UNCPS), contrast sensitivity, vision-related functional impairment, dysphotopsia symptoms and spectacle dependence were evaluated 6 months following the operation of the second eye. A mathematical model was constructed, which calculated the relative efficacy of each surgical intervention. Results: A total of 120 participants were recruited and populated equally the study groups. Significant improvement of preoperative UDVA was observed in all study groups. No significant differences could be detected in postoperative UDVA and UIRA (p = 0.24) among study groups, while significant differences were noticed in UICPS (p = 0.04), UNRA (p = 0.02) and UNCPS (p = 0.01). Dysphotopic phenomena (glare and shadows) were significantly more in the MfG arm followed by the PmG group (p = 0.04 and p = 0.02, respectively), while perceived difficulty and spectacle independence rates were significantly better in PmG group. PmG presented the best overall relative efficacy. Conclusion: All surgical techniques present satisfactory outcomes. Premium monovision seems to demonstrate the best outcomes. © 2022 Labiris et al