Oshika T. Contrast sensitivity and foveal microstructure following vitrectomy for epiretinal membrane. Invest Ophthalmol Vis Sci

PURPOSE. To evaluate contrast sensitivity (CS) in patients with epiretinal membrane (ERM) following vitrectomy and to investigate the relationship between CS and foveal microstructures with spectral-domain optical coherence tomography (SD-OCT). METHODS. Thirty-one eyes of 31 patients with ERM were included. We examined CS with a CSV-1000E chart, a logMAR best-corrected visual acuity (BCVA), and foveal microstructure by using SD-OCT before and at 6 months after surgery. From the CS data, the area under the log contrast sensitivity function (AULCSF) was calculated. Based on the OCT images, we quantified the mean thickness of the ganglion cell layer (GCL), the inner nuclear layer (INL), and the outer retinal layer (outer nuclear layer and outer plexiform layer [ONLþOPL]). The status of the photoreceptor inner and outer segment junction (IS/OS) and external limiting membrane (ELM) was also evaluated. RESULTS. Vitrectomy significantly improved logMAR BCVA and AULCSF. Even in patients with poor improvement of visual acuity (changes in logMAR BCVA by surgery was 0.2), postoperative AULCSF significantly increased by treatment (P < 0.05). Postoperative AULCSF showed a significant correlation with preoperative (P < 0.05) and postoperative (P < 0.05) ONLþOPL thickness, whereas other parameters were not relevant. Postoperative logMAR BCVA significantly correlated with postoperative status of IS/OS (P < 0.05) and preoperative ONLþOPL thickness (P < 0.05). CONCLUSIONS. In patients with ERM, CS improved even though their visual acuity did not recover significantly by vitrectomy. CS was associated with the thickness of outer retinal layer

COMBINATION THERAPY OF INTRAVITREAL RANIBIZUMAB AND SUBTHRESHOLD MICROPULSE PHOTOCOAGULATION FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

Purpose: To determine the efficacy of the combination therapy of intravitreal ranibizumab (IVR) and 577-nm yellow laser subthreshold micropulse laser photocoagulation (SMLP) for macular edema secondary to branch retinal vein occlusion cystoid macular edema.Methods: Retrospective, consecutive, case–control study. Forty-six eyes of 46 patients with treatment-naive branch retinal vein occlusion cystoid macular edema were enrolled. The IVR + SMLP group consisted of 22 patients who had undergone both SMLP and IVR. Intravitreal ranibizumab group consisted of 24 patients who had undergone IVR monotherapy. Intravitreal ranibizumab therapy was one initial injection and on a pro re nata in both groups, and SMLP was performed at 1 month after IVR in the IVR + SMLP group. Preoperatively and monthly, best-corrected visual acuity and central retinal thickness were evaluated using swept source optical coherence tomography.Results: Best-corrected visual acuity and central retinal thickness significantly improved at 6 months in IVR + SMLP and IVR groups. Best-corrected visual acuity and central retinal thickness were not significantly different between the two groups at any time points. The number of IVR injections during initial 6 months in IVR group (2.3 ± 0.9) was significantly greater (P = 0.034) than that in IVR + SMLP group (1.9 ± 0.8).Conclusion: The combination therapy of IVR and SMLP can treat branch retinal vein occlusion cystoid macular edema effectively, by decreasing the frequency of IVR injections while maintaining good visual acuity

Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients

Purpose: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs. Design: Retrospective, observational, multicentre, case-control study. Methods: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded. Main Outcome Measures: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs. Conclusions: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs

Changes in aniseikonia and influencing-factors following successful macula-off retinal detachment surgery

This study investigated the changes in the severity of aniseikonia after surgery for macula-off retinal detachment (RD), and the relationship between aniseikonia and retinal microstructures. The study included 26 eyes of 26 patients undergoing RD surgery. Visual acuity was measured preoperatively, and at 3, 6, and 12 months postoperatively. Degree of aniseikonia and OCT images were obtained at 3, 6, and 12 months postoperatively. The aniseikonia values (mean +/- standard deviation) at 3, 6, and 12 months postoperatively were -5.3 +/- 4.2%, -4.4 +/- 4.4%, and -3.1 +/- 3.2%, respectively. Significant improvement was observed from 3 to 12 months postoperatively (P = 0.001). Twelve months postoperatively, 14 eyes had micropsia, 1 eye had macropsia, and 11 eyes were free of aniseikonia. Stepwise multiple regression analyses revealed that the severity of aniseikonia at 12 months postoperatively was significantly associated with postoperative development of cystoid macular edema (CME) and epiretinal membrane (ERM), as well as area of preoperative RD. In conclusion, although aniseikonia was gradually relieved after RD surgery during a 1-year follow-up period, approximately half of patients had aniseikonia and almost all of them had micropsia. Aniseikonia was associated with presence of postoperative CME, ERM, and area of preoperative RD

Polyethylene Glycol-Based Synthetic Hydrogel Sealant for Closing Vitrectomy Wounds: An In Vivo and Histological Study

Purpose We conducted an in vivo study using Dutch pigmented rabbit eyes to test the usefulness of polyethylene glycol (PEG) sealant for the closure of sutureless sclerotomies in microincisional vitrectomy surgery (MIVS). Methods: Three-port, 23-gauge vitrectomy was performed on rabbit eyes. After air leakage was confirmed by the application of 0.625% povidone–iodine at the sclerotomy site, PEG sealant was subconjunctivally injected using a 27-gauge needle through conjunctival incisions to cover the sclerotomy wounds, following which it was polymerized by the application of xenon light for 60 seconds. Ophthalmological examinations and intraocular pressure measurements were conducted the day before and 1, 3, 5, and 7 days after surgery. The eyes were enucleated for histological evaluation 7 days after surgery. Results: PEG sealant was rapidly polymerized by the application of xenon light after subconjunctival injection, and it firmly sealed the sclerotomies without air leakage, as confirmed by povidone–iodine dropping, in all cases. Conjunctival and scleral wounds closed with PEG sealant were successfully attached and remained intact till the end of the follow-up period. There was no sign of postoperative hypotony or infection in any eye, and no adverse effects of PEG sealant were found. In histological examination, linear scar formation and eosinophilic staining of collagen fibers were observed at the sclerotomy sites, while the sclerotomy tunnels appeared tightly closed. Conclusions: PEG sealant can be useful for the closure of sutureless 23-gauge vitrectomy incisions in rabbits. Translational Relevance The PEG sealant may become an effective option for closing vitrectomy incisions including pediatric cases

Relationship between higher-order wavefront aberrations and natural progression of myopia in schoolchildren

This study investigated the relationship between higher-order aberrations (HOAs) and myopia progression as well as axial elongation in schoolchildren. We examined cycloplegic refraction, axial length, and wavefront aberrations prospectively in 71 myopic children. Changes in cycloplegic refraction and axial length during a 2-year study period were assessed, and their correlations with HOA components were analyzed. Sixty-four subjects ([mean ± SD] 9.2 ± 1.6 years) completed the 2-year examinations. Cycloplegic refraction was significantly changed after 2 years (P < 0.0001), and the average change (myopia progression) was −1.60 ± 1.04 D. Axial length also increased significantly (P < 0.0001), and the average increase (axial elongation) was 0.77 ± 0.40 mm. Myopia progression and axial elongation showed significant correlations with many components of corneal HOA (P < 0.0001 to P = 0.0270). Multivariate analysis showed that the total HOA of the cornea was the most relevant variable to myopia progression and axial elongation (P < 0.0001). Eyes with larger amounts of corneal HOAs showed less myopia progression and smaller axial elongation, suggesting that corneal HOAs play a role in the refractive and ocular developments in children

Effects of astigmatic defocus on binocular contrast sensitivity

MethodsEighteen normal volunteers (30.5 ± 6.0 [mean ± SD] years) were recruited. After correcting each refractive error by spectacles, against-the-rule (ATR) or with-the-rule (WTR) astigmatism of +1.00, +2.00 and +3.00 D was intentionally produced in both eyes, and then binocular CS was measured. The cylindrical addition of different powers (+1.00–+3.00 D) was compensated with spherical lenses so that the spherical equivalent refraction became zero in each eye. Subsequently, the above cylindrical addition was monocularly induced, and binocular CS was measured again. The relation between CS and astigmatic power, axis, and monocular or binocular astigmatism was investigated.ResultsWith binocular ATR and WTR astigmatism, increases in astigmatic power significantly correlated with decreases in the area under the log contrast sensitivity function (AULCSF). With monocular astigmatic defocus, astigmatic power addition did not affect AULCSF. With binocular astigmatic defocus of high-power (+2.00 and +3.00 D), ATR astigmatism deteriorated AULCSF more than WTR astigmatism. In a comparison between binocular and monocular astigmatic defocus, CS was significantly worse with binocular astigmatic defocus than with monocular astigmatic defocus at higher spatial frequencies regardless of astigmatic power.ConclusionsBinocular astigmatic defocus deteriorates CS depending on the amount of astigmatic power. ATR astigmatism reduces CS more than WTR astigmatism dose. In addition, binocular astigmatic defocus affects CS more severely than monocular astigmatic defocus especially at high spatial frequencies

Clinical preferences for DME in Japan

Aims/Introduction: To determine the current clinical preferences of anti‐vascular endothelial growth factor (VEGF) treatment protocols for diabetic macular edema (DME) in Japan. Materials and Methods: This was a descriptive cross‐sectional study. Answers to a questionnaire consisting of 16 questions were obtained from 176 of 278 (63.3%) surveyed ophthalmologists. Results: The results showed that 81.2% preferred intravitreal injections of anti‐VEGF antibodies as the first‐line therapy. The most important indicators for beginning anti‐VEGF therapy were: the best‐corrected visual acuity in 44.3% and the retinal thickness in 30.7%. In the loading phase, 53.4% preferred a single injection, and in the maintenance phase, 75.0% preferred the pro re nata regimen. Financial limitation (85.8%) was reported as the most important difficulty in the treatment. For combination therapy with anti‐VEGF treatment, panretinal photocoagulation, focal photocoagulations and a sub‐Tenon steroid injection were preferred. The contraindications for anti‐VEGF therapy were: prior cerebral infarction (72.7%). Regarding the use of both approved anti‐VEGF agents in Japan, ranibizumab and aflibercept, 39.8% doctors used them appropriately. Conclusions: Our results present the current clinical preferences of anti‐VEGF treatment for DME in Japan. The best‐corrected visual acuity and the retinal thickness are important indicators to institute this therapy. The majority of the ophthalmologists use anti‐VEGF treatment as first‐line therapy and prefer the 1 + pro re nata regimen

Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis : A Multicenter Cohort Study from J-CREST

Bacterial endophthalmitis is an intraocular infection that causes rapid vison loss. Pathogens can infect the intraocular space directly (exogenous endophthalmitis (ExE)) or indirectly (endogenous endophthalmitis (EnE)). To identify predictive factors for the visual prognosis of Japanese patients with bacterial endophthalmitis, we retrospectively examined the bacterial endophthalmitis characteristics of 314 Japanese patients and performed statistics using these clinical data. Older patients, with significantly more severe clinical symptoms, were prevalent in the ExE group compared with the EnE group. However, the final best-corrected visual acuity (BCVA) was not significantly different between the ExE and EnE groups. Bacteria isolated from patients were not associated with age, sex, or presence of eye symptoms. Genus Streptococcus, Streptococcus pneumoniae, and Enterococcus were more prevalent in ExE patients than EnE patients and contributed to poor final BCVA. The presence of eye pain, bacterial identification, and poor BCVA at baseline were risk factors for final visual impairment

Real-world management of treatment-naïve diabetic macular oedema : 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study

Background/aims To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). Methods Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. Results Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. Conclusion For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing