Is Iba-1 protein expression a sensitive marker for microglia activation in experimental diabetic retinopathy?

AIM:To investigate the changes of Iba-1 and other potential markers for microglia activation in experimental diabetic retinopathy(DR).METHODS:Male Sprague-Dawley rats were rendered diabetes via intraperitoneal injection of streptozotocin.The retinas were harvested at 1 to 24 wk after diabetes onset.Hypoxia-treated mouse microglial cell line(BV2 cells)was employed as the in vitro model to mimic diabetic condition.The expressions of Iba-1,CD11 b,ICAM-1 as well as the inflammatory factors were examined with real-time polymerase chain reaction,Western blot and immunofluorescence both in vivo and in vitro.RESULTS:Compared with age-matched normal control,the number of microglia(Iba-1 positive immunostaining)in diabetic rat retinas was increased from 1 to 24 wk of diabetes,which was most obvious at 12 wk of diabetes.Iba-1 protein expression detected by Western blot was increased slightly in diabetic rat retinas compared with that in age-matched normal control;however,there was statistically significant between two groups only at 2 wk after diabetes onset.The m RNA expression of Iba-1 was decreased significantly at 2 and 4 wk of diabetic rat retinas,and remained unchanged at 8 and 12 wk of diabetes.In BV2 cells,there was no significant change for the Iba-1 protein expression between normoxia and hypoxia groups;however,its m RNA level was decreased significantly under hypoxia.To further characterize microglial activation,F4/80,CD11 b and inflammatory factors were detected both in vivo and in vitro.Compared with normal control,the expressions of F4/80 and CD11 b as well as the inflammatory factors,such as ICAM-1,i NOS,COX2,IL-1βand IL-6,were increased significantly both in vivo and in vitro.CONCLUSION:Iba-1 protein expression might not be a sensitive marker to evaluate the activation of microglia in experimental DR.However,Iba-1 immunostaining,in combination with other markers like CD11 b and ICAM-1,could be well reflect the activation of microglia.Thus,it is of great importance to explore other potential marker to evaluate the activation of microglia.     

Normal visual acuity in 17--18 year olds

PURPOSE: The aim of this work was to establish visual acuity norms in 17-18-year-olds. METHODS: In a previous, population-based study carried out in 1998, a total of 1046 12-13-year-old children were examined with a full eye examination. In 2003, 25% (n=262) of these children were randomly selected and invited to a re-examination; 147 subjects agreed to participate and 116 attended. The examined group did not significantly differ from the original sample in terms of the prevalence of ocular and visual disorders. Best corrected monocular visual acuity (VA) was assessed with the revised 2000 ETDRS logMAR chart. RESULTS: Mean best corrected VA was -0.10 logMAR across the examined group. There was no significant difference between right and left eyes. By excluding nine subjects who had significant ametropia and/or ocular or visual pathology, mean VA increased to -0.12 logMAR (SD 0.07). The mean interocular difference in VA among normal subjects was 0.04 logMAR. CONCLUSIONS: Visual acuity in teenagers is significantly better than 0.0 logMAR and the interocular difference is low in healthy eyes.     

不同病因致黄斑囊样水肿患者视力下降与水肿形态的相关性分析

目的：探讨囊样黄斑水肿（ CME ）患者光学相干断层扫描（ OCT）形态,病因学和视力之间的关系。方法：本研究共搜集了本院门诊CME患者52例57眼,患者均应用OCT确诊为黄斑囊样水肿,且在同1 d进行眼底及最佳矫正视力检查。最佳矫正视力（ BCVA）检查使用E视力表和对数视力表（logMAR）,视力范围2．3 logMAR～0 logMAR（均数1．11±0．57）。通过患者病史和眼底照相进行病因诊断,根据黄斑囊样水肿最大垂直直径和黄斑厚度比率将 OCT 分为四级（一级＜30％,30％≤二级＜60％,60％≤三级＜90％,四级≥90％）,相关性是通过计算皮尔逊相关系数“r”值（ P＜0．05时有统计学意义）。结果：OCT IV 级患者视力最差（平均视力1．96±0．23 logMAR）,此时OCT分级与视力之间有显著正相关,统计学有显著差异（r＝0．729,P＜0．001）。视网膜中央静脉阻塞（ CRVO ）是引起视力严重下降最常见的疾病,（ r＝0.375, P＝0．004）。另外根据 OCT 的形态, IS／OS 层（ inner segment／outer segment ）和 ELM （ external limiting membrane ）均破环的患者视力显著下降（平均视力1．11±0．57 logMAR）,二者间具有统计学差异（ r＝－0．346,P＝0.008）。玻璃体视网膜牵拉和外视网膜层破坏均与OCTⅣ级和（r＝0．390,P＝0．003） CRVO呈正相关（r＝0．362, P＝0．006）,差异有统计学意义。结论：当CME的OCT形态表现Ⅳ级时CRVO患者视力最差。     

Long term functional and structural outcomes of laser therapy for retinopathy of prematurity

AIMS: To assess the long term functional and structural outcomes of premature babies who received diode laser photocoagulation for threshold retinopathy of prematurity (ROP). METHODS: 25 patients (43 eyes) treated with laser were recalled for assessment at a mean follow up of 11 years. A further seven patients (14 eyes) with subthreshold ROP, which had regressed spontaneously without laser treatment, were also examined. All children underwent distance acuity, near acuity, contrast sensitivity (CS), and colour vision assessments followed by a dilated fundal examination and cycloplegic autorefraction. RESULTS: The laser treated eyes had a mean distance visual acuity of 0.37 logMAR, a mean near visual acuity of 0.39 logMAR, a mean contrast sensitivity of 1.49 log CS units, and a mean spherical equivalent of -2.10D. An unfavourable distance visual acuity outcome occurred in five eyes (13.5%). An unfavourable near visual acuity outcome was also noted in the five eyes (13.5%) with poor distance visual outcome. 7% had an unfavourable structural outcome. On comparison with the control group, there was no significant difference in near acuity, CS, refraction, or colour vision between the two groups. However, there was a statistically significant difference in terms of distance visual acuity (p = 0.03). CONCLUSIONS: Laser treated eyes with favourable structural outcome have a good visual outcome. The results show a long term benefit from diode laser photocoagulation in preserving distance and near vision in eyes with threshold ROP.     

Long-term visual and retinopathy outcomes in a predominately type 2 diabetic patient population undergoing early vitrectomy and endolaser for severe vitreous haemorrhage

Purpose

To evaluate the long-term visual outcome of type 2 diabetic patients receiving early vitrectomy and endolaser for severe vitreous haemorrhage (VH).

Materials and methods

Retrospective case note review of 88 eyes (69 type 2 diabetics and 19 type 1 diabetics) of 80 patients who underwent vitrectomy and endolaser within 6 months of VH. Post-operative and most recent VA, in addition to long-term retinopathy grading, were analysed. A subset of patients fulfilling the criteria for the Diabetic Retinopathy Vitrectomy Study was compared with this study.

Results

Mean pre-operative visual acuity (VA) in the type 2 group was 0.64 logMAR, with 1 eye showing perception light (PL), 10 eyes detecting hand movements (HMs), and 7 eyes counting fingers (CFs). At the 2-week post-operative visit, the mean VA had improved to 0.46 logMAR, with two eyes showing PL, two eyes detecting HM, and one eye CF (P=0.0002); at the last review, mean VA score was 0.36 logMAR, with three eyes showing PL and four eyes detecting HM (P=0.0008). Mean pre-operative VA in the type 1 group was 0.47 logMAR, with one eye showing PL, one eye detecting HM, and two eyes CF. At the 2-week post-operative visit, the mean VA had improved to 0.37 logMAR, with one eye showing PL (P=0.002), and at the latest review, the mean VA was 0.20 logMAR (P=0.027).

Conclusion

Our study shows that type 2 DM patients can observe improvement in VA and stabilisation of their proliferative retinopathy after early vitrectomy and endolaser for vitreous haemorrahage, which is maintained after long-term follow-up.     

Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment

Purpose: To elucidate the relationship between the severity of vitreous haemorrhage (VH) and visual outcome in primary rhegmatogenous retinal detachment (RRD) without previous vitreoretinal surgery. Methods: We carried out a retrospective review of patients presenting with RRD and VH between January 1993 and December 2002. Diabetic retinopathy, retinal vessel occlusion and open‐globe injury patients were excluded. Study patients were separated into group 1 (eyes with mild to moderate VH) and group 2 (eyes with severe VH). Results: Our sample included 71 eyes of 71 patients (mean age 48.0 years, range 7–78 years) (median follow‐up period 19 months, range 12–140 months), of which 21 had mild, 17 had moderate and 33 had severe VH. The mean visual acuity (VA) in logMAR (logarithm of minimum angle of resolution) of the 38 eyes in group 1 improved from 1.90 (Snellen equivalent [SE] 20/1589) to 0.68 (SE 20/96). In the 33 eyes in group 2, mean logMAR VA improved from 2.42 (SE 20/5261) to 1.63 (SE 20/853). Group 2 patients were significantly older (p = 0.002), had longer duration of preoperative haemorrhage (p = 0.004), lower presenting VA (p < 0.001), worse final VA (p < 0.001), and a higher incidence of severe (grade C) proliferative vitreoretinopathy (PVR) (p = 0.002). More eyes in group 2 required silicone oil tamponade, although this was not statistically significant (p = 0.133). The overall recurrence rate of retinal detachment after primary surgery was around 21% in both groups. Conclusions: Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. Close follow‐up and aggressive surgical interventions are suggested in these patients.     

Pediatric rhegmatogenous retinal detachment

PURPOSE: To review the clinical features and surgical and visual outcomes of pediatric rhegmatogenous retinal detachment (RRD) as seen in a tertiary referral center. METHODS: Retrospective case series spanning 6 years from January 1, 1991 to January 1, 1997. Exclusionary criteria were trauma disrupting the globe and acute retinopathy of prematurity. RESULTS: The authors reviewed a series of 29 eyes in 27 pediatric patients (birth to 18 years of age) with RRD. Seventy percent of the patients were male. The mean patient age was 9.6 years. Bilateral RRD was present in 22% of patients; 89% of patients had some form of bilateral ocular pathology at initial presentation. The two most common etiologies (34% each) were myopia and eyes that had undergone surgery for another ocular disorder with subsequent development of RRD. The most common presentation was decreased vision, with a mean duration of 52 days. At presentation, 75% of the affected eyes and 48% of the fellow eyes had visual acuity worse than 20/800. The most common type of retinal break was a horseshoe tear. Late diagnosis was a common problem, evidenced by the frequency of macular detachment (79%) and proliferative vitreoretinopathy (45%) at initial presentation. The most common primary repair was a scleral buckle. Anatomic reattachment was ultimately accomplished in 72% of cases with a mean of 2.2 surgeries per eye. Average postoperative follow-up time was 21.4 months (range 4 to 61 months). At final follow-up, 41% of the affected eyes had visual acuity 20/800 or better. Thirty-eight percent of the affected eyes had a final visual acuity better than or equal to the fellow eye. CONCLUSION: In this series, pediatric RRD occurred most commonly in association with myopia (Stickler's syndrome and adolescent retinopathy of prematurity) and prior intraocular surgery. Most eyes were anatomically reattached after multiple surgeries. Forty-one percent of eyes retained vision of 20/800 or better. Preserving vision in children with RRD is of great importance, particularly given the 89% frequency of vision-threatening abnormalities in fellow eyes.     

Refractive errors and ocular motility disorders in preterm babies with and without retinopathy of prematurity.

Ocular motility, refraction and visual acuity (VA) were evaluated at the age of 4 years in 136 preterm infants with gestational ages (GAs) at birth of less than 32 weeks. Group 1 (non-retinopathy of prematurity, ROP) included 87 children that had never developed ROP. Group 2 contained 19 children whose ROP had regressed spontaneously. Group 3 (cryo-ROP) was composed of 30 patients who had undergone cryotherapy for severe ROP. Strabismus was found in 13.9% of the total population. chi(2) analysis revealed that strabismus was significantly (p < 0.01) associated with prematurity (i.e. GA <29 weeks), ROP and cryotherapy. Myopia of more than 3 dpt was significantly (p < 0.001) more common in the cryo-ROP infants than in the regressed-ROP and non-ROP groups. The distribution of hypermetropia was similar in all three groups. VA was measured with the E chart. Of the 272 eyes examined, 251 (92.3%) displayed VA of more than 20/25. The majority of these eyes were from the non-ROP group (65.4%), 15.3% had regressed ROP and 21.1% belonged to the cryo-ROP group. Fifteen eyes (8 non-ROP, 3 regressed ROP and 4 cryo-ROP) presented VAs between 20/25 and 20/60. VA of less then 20/60 was found in 6 eyes (2 non-ROP, 1 regressed ROP, 3 cryo-ROP). Cryotherapy did not appear to preclude the development of good VA.     

Longterm follow-up of patients with multifocal choroiditis and panuveitis

PURPOSE: To report the visual prognosis and longterm complications in patients with multifocal choroiditis and panuveitis (MCP). METHODS: A retrospective study was performed with patients who met inclusion criteria for MCP at the Uveitis Clinic, Royal Victoria Hospital, McGill University, Montreal, Canada. Information collected included duration of follow-up, visual acuity (VA) measured at each clinical visit, ocular and systemic treatment and ocular complications observed during follow-up. RESULTS: Nineteen patients (37 eyes) with MCP with a mean follow-up of 76.9 months were studied. Kaplan-Meier survival analysis showed a decrease in the proportion of patients with a final VA > or = 20/40 over time. Cystoid macular oedema was seen in 29.7% of the eyes and was the most frequent macular abnormality observed in our group. On the other hand, choroidal neovascularization was detected in only six (16.2%) of the eyes, but was related to VA < 20/200 in four of these eyes. Glaucoma was detected in 10.8% of the eyes. Cataract (posterior subcapsular and/or nuclear) was the most common longterm complication, occurring in 40% of affected eyes. Cataract surgery improved the VA in 83.3% of these eyes. CONCLUSION: The visual acuity of patients with MCP decreases with time. Visual loss can occur from complications following the inflammation itself and/or iatrogenic induced by the chronic use of corticosteroids.     

Combined Phacoemulsification,Primary Intraocular Lens Implantation,and Pars Plana Vitrectomy in Children with Uveitis

Abstract

Purpose: To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.

Methods: Data regarding visual acuity (VA), inflammatory status, medical therapy, and complications was collected from the medical charts of 17 children (21 eyes) with chronic uveitis who underwent combined cataract surgery and PPV at the Eye Clinic, Sahlgrenska/Mölndal, between 2002 and 2011.

Results: Seventy-six percent of the children had juvenile idiopathic arthritis. Median preoperative VA was 1.70 logMAR and median VA after 12 months was 0.17 logMAR. Postoperatively, glaucoma developed in 7 eyes, cystoid macular edema in 3 eyes, and visual axis opacification requiring treatment in 5 eyes.

Conclusions: Although combined phacoemulsification, primary IOL implantation, and PPV in children with uveitis resulted in favorable visual outcome and stable inflammation in a majority of children, the technique should so far be reserved for uveitic cases with vitreous pathology.     

Reading performance of patients with uveitis-associated cystoid macular edema

PURPOSE: To evaluate the extent of the visual impairment caused by uveitis-associated cystoid macular edema (CME) and compare the results with lesion size. DESIGN: Observational case series. METHODS: setting: Uveitis outpatient clinic of the Department of Ophthalmology and Optometry, Medical University of Vienna. patient population: CME was verified in 30 eyes of 30 consecutive uveitis patients with optical coherence tomography and lesion size was assessed with retinal thickness analyzer. main outcome measures: Distance visual acuity (VA) (measured with Early Treatment Diabetic Retinopathy Study charts), reading acuity, and reading speed (tested with Radner Reading Charts). Results were compared with nonaffected partner eyes. RESULTS: Distance VA was logMAR 0.22 +/- 0.15 in CME eyes vs -0.02 +/- 0.17 in healthy controls. Reading acuity was 75% of logMAR in CME eyes vs 92% of logMAR in control eyes (P = .01). The mean reading speed was 148.4 +/- 36.6 words per minute in patients with CME vs 168.9 +/- 36.3 in patients without CME (P = .04). Reading acuity correlated with both lesion size and distance VA (r = 0.61; P = .01 and r = 0.53; P = .028, respectively). Neither anatomical classification of uveitis nor gender or age had a significant influence on the evaluated parameters. CONCLUSIONS: Reading acuity and reading speed were considerably more impaired than distance visual acuity. The assessed parameters showed a better correlation to lesion size and seem to be a better reflection of macular dysfunction. Analyzing reading function is an important factor when following patients with CME and evaluating success of treatment modalities.     

The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy

PURPOSE: To describe changes of the foveal photoreceptor layer using optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) and evaluate the correlation with visual acuity (VA) loss. DESIGN: Observational case series. METHODS: We studied 28 eyes with acute or chronic CSC using high-resolution OCT. The tomographic findings of the detached foveal photoreceptor layer were compared with VA. Sixteen eyes also were evaluated after foveal reattachment. RESULTS: The outer photoreceptor layer (OPL) in the detached fovea was preserved in 14 eyes, of which 13 had symptoms for <1 year and atrophic in 14 eyes with symptoms for >1 year. The preserved OPL had an even profile in 7 eyes and a granulated profile in 7 eyes. Mean VA was 0.19 logMAR with a preserved OPL and 0.72 logMAR with an atrophic OPL (P <.001). Cases seen after the detachment resolved included 6 eyes with preserved even OPL, 5 eyes with preserved granulated OPL, and 5 eyes with atrophic OPL. Mean final VA was 0.06 logMAR in eyes with preserved OPL and 0.90 logMAR in eyes with atrophic OPL (P <.001). The VA improved in 73% of eyes with preserved OPL and no eyes with atrophic OPL (P = .025). The VA recovered completely in 83% of eyes with preserved even OPL and no eyes with preserved granulated OPL (P = .015). CONCLUSION: High-resolution OCT demonstrates changes in the foveal photoreceptor layer in CSC that highly correlate with VA loss and may predict visual recovery after macular reattachment.     

Recurrence risk factors of intravitreal ranibizumab monotherapy in retinopathy of prematurity: a retrospective study at one center

AIM: To identify risk factors of recurrence of this disorder after intravitreal ranibizumab (IVR) monotherapy. METHODS: Totally 33 eyes of 19 patients who underwent initial IVR treatments for type 1 retinopathy of prematurity (ROP) at our center were retrospectively reviewed between April 1, 2016 and December 31, 2017. Patient demographics, the side of ROP, multiple gestations, Apgar scores, zone, stage, plus disease, postmenstrual age at injection, surfactant therapy, blood transfusion therapy, hemorrhage before IVR, hemorrhage after IVR, gestational diabetes mellitus, pregnancy-induced hypertension, anemia, intraventricular hemorrhage, sepsis, respiratory distress syndrome, carbohemia, and congenital heart defects were recorded. Adjusted hazard ratios (HRs) and 95% confidence intervals were determined after adjusting for potential confounders using multivariate proportional Cox regression. RESULTS: Of the 33 eyes, 12 (36.4%) had ROP recurrences 45.3 (5.1, 50.9)mo after initial IVR treatments. The independent risk factors for ROP recurrences were zone (¢ò vs ¢ñ, HR: 0.056, P=0.003) and gestational diabetes mellitus (no vs yes, HR: 0.095, P<0.001). The mean uncorrected visual acuity for four recurrence eyes was 0.46 logMAR (0.13, 0.70) at 55.0 (51.0, 58.9) mo after the initial IVR treatment. The mean uncorrected visual acuity for 10 eyes without recurrence was 0.46 logMAR (0.19, 0.63) at 48.0 (43.8, 58.4) mo after the initial IVR treatment. CONCLUSION: Two independent risk factors for type 1 ROP recurrence after IVR treatment involving zone¢ñand gestational diabetes mellitus are identified, and the mean uncorrected visual acuity is 0.46 logMAR at 51.0 (44.0, 58.9)mo. The findings of this study are important for follow-up management and for improving the visual function of ROP patients.     

Clinical usefulness of the baby vision test in young children and its correlation with the Snellen chart

AIM: To investigate the efficacy of a new visual acuity (VA) screening method, the baby vision test for young children. METHODS: A total 105 eyes of 65 children aged 2-8y were included in the study. Acuity testing was conducted using a standardized recognition acuity chart (Snellen visual chart: at 3 m) and the baby vision model assessment. The baby vision device includes a screen, a near infrared camera and a computer. Children were seated at a measured distance of 33-40 cm from a display for testing. VA was estimated according to the highest resolution the children could follow. Decimal VA data were converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. The VA results for each child were recorded and analyzed for consistency. RESULTS: The mean VA measured using the Snellen visual chart was 0.62±0.32, and that assessed using the baby vision test was 0.66±0.27. The 95% limit of agreement was -0.609 to 0.695, with 95.2% (100/105) plots within the 95% limits of agreement. VA values of the baby vision test were significantly correlated with those of the Snellen chart (R=0.274, P=0.005). CONCLUSION: The baby vision test can be used as a relatively reliable method for estimating VA in young children. This new acuity assessment might be a valid predictor of optotype-measured acuity later in preverbal children.     

Assessment of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) scleral lens on visual acuity for corneal irregularity and ocular surface disease

Purpose

To describe changes in visual acuity in patients fit with the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) with irregular corneas compared to those with ocular surface disease, as well as describe patient demographics and fitting indications for PROSE at an academic medical center.

Long-term effect of intravitreal triamcinolone in the nonproliferative stage of type II idiopathic parafoveal telangiectasia

PURPOSE: To report the visual outcomes and ocular complications of intravitreal triamcinolone acetonide (IVTA) in the treatment of the nonproliferative stage of type II idiopathic parafoveal telangiectasia (IPT). METHODS: Retrospective, multicenter, uncontrolled interventional case series of 19 eyes of 14 consecutive patients with the nonproliferative stage of IPT that had undergone at least one intravitreal injection of 4 mg of triamcinolone acetonide. Demographic, medical, and ocular data were obtained through chart review. The main outcome measures included best-corrected visual acuity at several timepoints of follow up and ocular complications. RESULTS: At baseline the mean logMAR visual acuity was 0.83 +/- 0.41 (Snellen 20/135, range 0.3-2). After an average follow-up of 21.2 months (range 6-44 months), the mean logMAR visual acuity remained essentially unchanged from baseline. At 3 months, the logMAR visual acuity was 0.86 +/- 0.44 (Snellen 20/145, P = 0.8378), at 6 months 0.86 +/- 0.42 (Snellen 20/145, P = 0.8149), at 12 months 0.87 +/- 0.46 (Snellen 20/148, P > 0.9999), at 18 months 0.84 +/- 0.35 (Snellen 20/138, P = 0.8385), and at the last follow-up 0.82 +/- 0.44 (Snellen 20/132, P = 0.9301). Seven eyes were reinjected once. Ten of 19 eyes (53%) developed cataract (3 eyes underwent phacoemulsification and intraocular lens implantation) and 7 of 19 eyes (37%) had an elevated intraocular pressure, none of which required surgical treatment. CONCLUSION: IVTA does not seem to improve visual acuity in most eyes with the nonproliferative stage of IPT.     

眼钝挫伤致眼底损伤的玻璃体手术治疗

目的评价玻璃体手术对眼钝挫伤引起的眼底损伤的疗效。方法对1992年10月～1998年3月连续收治的、经玻璃体手术治疗的眼球钝挫伤101例(105只眼)作回顾性研究。结果按伤情分为4组：玻璃体积血23只眼,玻璃体积血伴视网膜脉络膜破裂或视神经损伤25只眼,外伤性视网膜脱离46只眼以及视网膜巨大裂孔11只眼。手术后77只眼(73.3%)视力改善,其中0.02～0.6者占65.7%(38只眼在0.1～0.6,占55.0%),2只无光感眼恢复 了0.1以上视力,26只眼(24.8%)视力不变;2只眼(1.9%)视力下降。视网膜复位54只眼, 占视网膜脱离及视网膜巨大裂孔者的94.7%。结论严重眼球钝挫伤可造成多种眼底损害和视力丧失,适时的玻璃体手术可挽救大多数伤眼。(中华眼底病杂志,1999,15:100-102)     

Impact of amblyopia on vision at age 12 years: findings from a population-based study

AIMS: To report prevalence of amblyopia and long-term impact of its treatment on vision in a population-based sample of 12-year-old Australian children. METHODS: Logarithm of minimum angle of resolution (logMAR) visual acuity (VA) was measured in 2353 children (response rate 75.3%); visual impairment was defined as VA<6/12. Amblyopia was defined using various criteria of best-corrected VA, together with an amblyogenic factor and absence of significant organic pathology. Corroborative historical data on previous diagnosis and treatment were obtained from parental questionnaires. RESULTS: Forty-four children (1.9%) were diagnosed with amblyopia, unilateral in 40 and bilateral in four. Isolated anisometropia was the most frequent cause (41%), followed by strabismus (25%), combined anisometropia and strabismus (23%), and high ametropia (9%). Myopia, hyperopia, and astigmatism were present in 28, 51, and 44% of amblyopic children, respectively, compared to 12, 4, and 9% of non-amblyopic children. Mean best-corrected VA in amblyopic eyes was 44.5 logMAR letters (Snellen equivalent 6/9), range: 11-60 letters. Most children with amblyopia (84%) had been treated. Only 27% were visually impaired in their amblyopic eye. CONCLUSIONS: This report documents a low amblyopia prevalence in a population of 12-year-old Australian children. Amblyopic visual impairment was infrequent in this sample despite absence of mandatory vision screening.     

Long-term observation of vitrectomy without subretinal hemorrhage management for massive vitreous hemorrhage secondary to polypoidal choroidal vasculopathy

AIM: To describe the long-term observation of vitrectomy without subretinal hemorrhage (SRH) management for massive vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV). METHODS: This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy (PDT) as needed. The main outcome measures were best-corrected visual acuity (BCVA), postoperative adverse events and the recurrence of VH. RESULTS: The average follow-up period was 25.5±9.2mo (range 12-35mo). Mean BCVA at baseline (2.16±0.39 logMAR) had improved significantly, both 3mo after surgery (1.42±0.66 logMAR, P<0.001) and by the last visit (1.23±0.74 logMAR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes (16.3%) and ciliary body detachment in 4 eyes (4.7%). Nineteen eyes (22.1%) received following treatment with ranibizumab injections without/with PDT, and 15 (17.4%) were resolved. Four eyes (4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis, thicker SRH (beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis (beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION: Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.