Phase I/II randomized study of proton beam with anti-VEGF for exudative age-related macular degeneration: long-term results

Background/objectiveTo determine if treatment of exudative age-related macular degeneration (eAMD) using proton beam therapy (PBT) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is safe and effective long term.Subject/methodsThirty eyes with newly diagnosed eAMD were enrolled in a phase I/II prospective, sham-controlled double-masked university study. Eyes were randomized 1:1:1–24 GyE, 16 GyE or sham radiation, and treated with three initial monthly intravitreal ranibizumab or bevacizumab. Subsequent anti-VEGF reinjection was based on monthly optical coherence tomography and examination for 2 years and standard of care thereafter.ResultsA total of 23 eyes completed 2-year study follow-up, of which 16 maintained monthly follow-up. Mean best-correct visual acuity (BCVA) at 2 years was similar among treatment groups (p > 0.05). The 24 GyE group required fewer anti-VEGF injections when compared with the sham group at 2 years (4.67 ± 1.9 vs 9.67 ± 3.5; p = 0.017). Extended follow-up (mean 4 years) available in 22 eyes showed persistent reduced need for anti-VEGF therapy among eyes treated with 24 GyE compared with sham radiation (2.0 ± 1.6 vs 4.84 ± 2.4 per year, p = 0.008). New and increasing geographic atrophy (GA), noted in some eyes in all treatment groups, resulted in decreased mean BCVA from baseline for the 24 GyE group on extended follow-up (p = 0.009). Possible mild radiation retinopathy noted in 15% of eyes was not visually significant.ConclusionsInitial treatment combining PBT (24 GyE) with intravitreal anti-VEGF therapy appears to decrease the need for anti-VEGF reinjection in eyes with newly diagnosed eAMD. Radiation retinopathy risk was low and does not appear visually significant. Long-term vision was limited by GA development especially in the 24 GyE group.Subject terms: Macular degeneration, Outcomes research     

Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study

BackgroundThe prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO).MethodsDICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups.ResultsThe negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (−2.6 ± 3.5 letters vs −8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups.ConclusionEarly DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.Subject terms: Outcomes research, Retinal diseases, Lens diseases     

Peripapillary and macular choroidal vascularity index in patients with clinically unilateral pseudoexfoliation syndrome

PurposeTo investigate choroidal vascular changes using an image binarization tool in patients with clinically unilateral pseudoexfoliation syndrome (XFS).MethodsThis cross-sectional study included 150 eyes of 100 patients. The eyes were divided into three groups: (1) 50 affected eyes of patients with clinically unilateral XFS; (2) 50 unaffected fellow eyes; and (3) 50 healthy control eyes. Enhanced depth imaging optical coherence tomography scans of the macula and peripapillary regions were acquired. Images were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The choroidal vascularity index (CVI) was defined as proportion of the luminal area to the total circumscribed choroidal area.ResultsHorizontal and vertical scans revealed that the macular CVI values of the affected eyes (60.08 ± 2.06 and 62.21 ± 2.10, respectively) were lower compared with control eyes (67.31 ± 2.24; p = 0.001 and 68.11 ± 2.36; p < 0.001, respectively). Conversely, no significant difference in the macular CVI was found between unaffected fellow and control eyes (p = 0.094 and p = 0.120, respectively). The mean peripapillary CVI values of the temporal (58.73 ± 3.15), superior (59.84 ± 3.09), and inferior (56.94 ± 2.47) sectors were significantly lower in affected eyes compared to control eyes (63.21 ± 3.00, 62.07 ± 3.05, and 60.78 ± 2.88, respectively; p < 0.05 for all). In addition, the unaffected fellow eyes had significantly lower CVI values in the temporal (61.42 ± 3.07) and inferior (57.61 ± 2.56) peripapillary sectors compared with the control eyes (p = 0.007 and p = 0.005, respectively).ConclusionsThese findings suggest that XFS is associated with decreased macular and peripapillary choroidal vascularity. Furthermore, the unaffected eyes of patients with unilateral XFS may show vascularity changes in the peripapillary choroid.Subject terms: Eye diseases, Biomarkers     

Profile of patients receiving intravitreal anti-vascular endothelial growth factor injections during COVID-19-related lockdown

Purpose:The aim of this study was to analyze the impact on vision due to delay in presentation of patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, consequent to COVID-19-related travel restrictions.Methods:Data were collected retrospectively of patients who received anti-VEGF injections during four months of the COVID-19 pandemic. Visual acuities, indication for treatment were noted along with basic demographic characteristics.Results:Data were analyzed for 303 eyes of 263 patients. The indication for treatment was age-related macular degeneration (AMD) in 60 eyes (19.8%), while 162 eyes (53.5%) had Diabetic Macular Edema, 71 eyes (23.4%) had Retinal Vein Occlusion and 10 eyes (3.3%) had other diagnosis. The visual acuity in the treatment naïve eyes (Group A, n = 168) was significantly worse (P < 0.001) than those who presented for retreatment (Group B, n = 135). In Group B, there was a significant decline in vision for the entire cohort (P = 0.009) and those with AMD (P = 0.036). Those in Group B presented at a mean interval of 19.1 ± 10.6 (range, 4–64) weeks for retreatment.Conclusion:The COVID-19 pandemic has led to a delay in patients receiving anti-VEGF injections. The visual acuity is worse in both treatment naïve as well as those requiring retreatment. This could have long-term impact on vision of patients requiring this vision preserving treatment.     

Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas

ObjectivesTo report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy.SettingRefractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.DesignRetrospective case series.MethodsThe pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated.ResultsThe study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time.ConclusionSMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.Subject terms: Outcomes research, Refractive errors     

Effect of brimonidine tartrate 0.15% on scotopic pupil size and upper eyelid position: controlled trial

BackgroundTo evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution on pupil size under scotopic condition and upper eyelid position.MethodsThis study comprised 72 eyes of 36 healthy subjects. A single drop of brimonidine tartrate 0.15% ophthalmic solution was instilled in the right eye and artificial tear was instilled in the left eye. Pupil size was measured using an infra-red pupillometer under scotopic condition before and at 30 min, 2, 4, 6, 8 and 10 h after instillation. Measurement of margin reflex distance 1 (MRD1) was performed using a millimetre ruler before and after at 10 min after instillation.ResultsThe mean age of the subjects was 32.19 ± 11.43 years (range 10–52 years), 17 were female and 19 were male. Before brimonidine instillation, the mean pupil size was 6.09 ± 1.03 mm in the brimonidine eyes and 6.06 ± 1.04 mm in the control eyes. There was a significant decrease in mean pupil size at 30 min (4.45 ± 1.04), 2 h (4.49 ± 1.06), 4 h (4.59 ± 1.06), 6 h (4.89 ± 1.06) and 8 h (5.38 ± 1.02) after instillation compared to before in brimonidine eyes (p < 0.001 for all). There was a significant miosis continued for at least 6 h (5.95 ± 1.03) in control eyes (p < 0.001). There was no significant change in MRD1, before and after instillation both in brimonidine and control eyes.ConclusionsBrimonidine tartrate 0.15% had a significant miosis under scotopic condition for at least 8 h after instillation and had a significant miosis on the untreated eye for at least 6 h.Subject terms: Outcomes research, Eye manifestations     

Relationship between photoreceptor layer changes before half-dose photodynamic therapy and functional and anatomic outcomes in central serous chorioretinopathy

ObjectivesTo investigate the relationship between photoreceptor layer (PRL) changes before half-dose photodynamic therapy (PDT) and functional and anatomic outcomes in central serous chorioretinopathy (CSC).MethodsBaseline PRL changes were classified based on optical coherence tomography: (1) smooth PRL outer border without a foveal PRL defect; (2) smooth PRL outer border with a foveal PRL defect; (3) granulated PRL outer border and (4) scattered dots of PRL. The best-corrected visual acuity (BCVA), difference in the foveal outer nuclear layer (ONL) thickness between the CSC and normal contralateral eyes and ellipsoid zone (EZ) integrity 12 months after half-dose PDT were compared.ResultsIn total, 132 patients were included. Group 4 eyes had rather poor BCVA (20/2000–20/400) with little improvement (P = 0.088) at 1 year following half-dose PDT. In the other groups, the mean BCVA improved significantly to 20/25 or better (all P < 0.001). Group 1 eyes had the smallest foveal ONL thickness reduction (−5.12 ± 6.89 μm) and intact EZs (33/33), whereas Group 4 eyes had the largest foveal ONL thickness reduction (−70.00 ± 7.87 μm) and disrupted EZs (4/4). Group 2 and Group 3 eyes behaved similarly: they both had notable foveal ONL thickness reductions (−19.21 ± 18.53 and −20.75 ± 17.62 μm, respectively), but usually continuous EZs (18/19 and 69/76, respectively).ConclusionsThe PRL change category before half-dose PDT was closely related to functional and anatomic outcomes. This information could aid clinicians to better determine the timing of treatment with half-dose PDT in CSC.Subject terms: Retinal diseases, Outcomes research, Eye manifestations     

A 12-month prospective study to evaluate the efficacy of using the treat-and-extend regimen with intravitreal aflibercept as a Second-Line Treatment for Diabetic Macular Oedema (the TADI Study)

PurposeTo evaluate the efficacy of intravitreal aflibercept as a second-line therapy in eyes with persistent diabetic macular oedema (DMO) despite receiving initial bevacizumab treatment.MethodsA prospective multicentre study was conducted in nine academic clinics in Israel. Starting from the first follow-up visit, a treat-and-extend regimen was applied in which the treatment intervals were extended by 2 weeks based on macular thickness using SD-OCT. The primary outcome was central subfield thickness (CST) at week 52.ResultsForty-four patients (n = 48 eyes) were recruited to the study, and 43 eyes completed 52 weeks of follow-up. Patients received a mean (±SD) of 7.9 ± 3.5 bevacizumab injections before enrolment. The mean (±SD) CST under aflibercept therapy decreased from 468 ± 131 μm at baseline to 303 ± 67 μm at 52 weeks (p = 0.002), and best corrected visual acuity improved from 64 ± 15 ETDRS letters at baseline to 75 ± 8 letters at week 52 (p = 0.001). Twenty (46%) eyes met the treat-and-extend criteria and received a mean (±SD) of 10.9 ± 2 aflibercept injections.ConclusionsEyes with persistent DMO following initial bevacizumab therapy had a marked reduction in macular thickness and improved visual acuity following 1 year of treatment with intravitreal aflibercept. Less than half of the patients met eligibility criteria for extension of the treatment interval; for these patients, the treat-and-extend regimen resulted in a maximum treatment interval of 10 weeks during the first year.Subject terms: Outcomes research, Retinal diseases     

Impact of injection frequency on 5-year real-world visual acuity outcomes of aflibercept therapy for neovascular age-related macular degeneration

BackgroundTo evaluate the impact of injection frequency on yearly visual outcomes of patients treated with intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) over a period of 5 years in a tertiary ophthalmic centre.DesignSingle centre, retrospective cohort study.ParticipantsConsecutive treatment-naive nAMD patients initiated on aflibercept injections 5 years ago.MethodsThe Moorfields OpenEyes database was searched for consecutive patients who were initiated on intravitreal aflibercept for nAMD in 2013–14 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records per year were recorded for a period of 5 years. Analyses of the whole cohort and a sub-sample of 5-year completers were done. The cohort was further grouped into Group A (on continuous treatment), Group B (early cessation of treatment) and Group C (interrupted treatment) to evaluate the relation between treatment frequency and visual outcomes.Main outcome measuresThe primary end point was change in VA at 5 years; secondary outcomes included proportion of eyes that gained or maintained VA, number of injections received and the effect of treatment frequency.ResultsData were collected on 468 patients (512 eyes). Sixty-six percent of the patients completed 5-year follow-up. The mean age of the whole cohort was 79.5 ± 8.5 years and the mean baseline VA was 58.3 ± 15.4 letters. Amongst the completers, final VA change was −2.9 (SD 23.4) ETDRS letters and the cumulative number of injections over 5 years was 24.2 (10.6). Group A had three letter gain and received significantly higher cumulative number of injections over 5 years than Group B and C (31.8, 14.6 and 18.4 respectively, p = 0.001). After adjusting for age and baseline VA, on average, final VA was +8.0 letters higher in the ≥20 injections group than the <20 group (p = 0.001).ConclusionsAflibercept therapy results in sustained good visual outcome over 5 years in neovascular AMD eyes when early and persistent treatment is given.Subject terms: Macular degeneration, Vision disorders     

Choroidal vascularity index as an indicator of vascular status of choroid,in eyes with nanophthalmos

PurposeTo investigate choroidal vascular index (CVI) in eyes with nanophthalmos (NO) with the use of optical coherence tomography (OCT).MethodsMacular enhanced depth imaging OCT scans of 25 eyes of 25 patients with NO and age–gender-matched 25 eyes of 25 control subjects were analysed. Images were binarized using the ImageJ software, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were acquired. The main outcome measure was CVI, defined as the ratio of LA to TCA.ResultsTwenty-five eyes of 25 patients with NO and age–gender-matched control subjects were enrolled. The mean TCA, SA and LA were found to be significantly higher in patients with NO (2.51 ± 0.44 vs. 1.91 ± 0.35 mm², P < 0.001; 0.86 ± 0.17 vs. 0.63 ± 0.13 mm², P < 0.001; and 1.65 ± 0.29 vs. 1.27 ± 0.23 mm², P < 0.000, respectively). On the contrary, CVI did not significantly differ between the two groups (65.72, 67.68, P = 0.099).ConclusionAs a novel OCT-based marker, CVI could be used to assess vascular status of the choroid in eyes with NO and can provide better understanding of the pathogenesis of this disease.Subject terms: Eye abnormalities, Scleral diseases, Predictive markers, Hereditary eye disease, Uveal diseases     

Repeatability of total Keratometry and standard Keratometry by the IOLMaster 700 and comparison to total corneal astigmatism by Scheimpflug imaging

ObjectivesWe aimed (1) to assess the repeatability of Total Keratometry (TK) and standard keratometry (K) measurements, as provided by the IOLMaster 700 (Carl Zeiss Meditec), and (2) to compare the corneal astigmatism measured by TK to the total corneal astigmatism (TCA) measured by a Scheimpflug camera (Pentacam AXL, Oculus).MethodsTwo groups of patients were prospectively enrolled: Group A included previously unoperated eyes undergoing cataract surgery, and Group B eyes with previous myopic corneal excimer laser surgery. TK and K were measured three times by the same examiner. Repeatability was assessed based on the within-subject standard deviation (S_w), test–retest variability, coefficient of variation and intraclass correlation coefficient (ICC). In Group A, TCA was measured once and compared to TK astigmatism. Vector analysis was performed according to Næser.ResultsIn Group A (69 eyes) the mean K and TK were, respectively, 43.14 ± 1.37 D and 43.18 ± 1.37 D. In Group B (51 eyes) the mean K and TK were, respectively, 40.14 ± 2.20 D and 39.71 ± 2.35 D. The repeatability of the average K and TK was high (S_w < 0.10D). All measurements revealed an ICC > 0.9. For most measurements the variance of K and TK did not show any statistically significant difference either within groups or between groups. Vectors KP(45) were significantly different between TK astigmatism and TCA.ConclusionsTK measurements offer high repeatability in unoperated and post-excimer laser surgery eyes. TK astigmatism and TCA measurements could not be considered interchangeable.Subject terms: Outcomes research, Tomography     

Optical coherence tomography angiography characteristics of choroidal melanoma

PurposeThe purpose of this study is to evaluate tumour vasculature with optical coherence tomography angiography (OCTA) in malignant choroidal melanoma (CM).Materials and methodsPatients with unilateral CM were included in this cross-sectional observational clinical study. Applying OCTA systems operating at 840-nm wavelengths, eyes with CM were imaged. The primary main outcome measures were OCTA images, qualitative evaluation of macular and tumour vasculature, quantitative vascular density (VD), perfusion density (PD) and the foveal avascular zone disruption.ResultsThe study included 11 patients with unilateral CM and contralateral unaffected eyes as the control group. Eyes of 11 patients with CM and contralateral unaffected eyes were imaged before brachytherapy and 5 patients were imaged post brachytherapy. CM is demonstrated dense, tortuous blood vessels, uneven thickness and relatively disorganised intratumoural vasculature. In 11 eyes with CM, the VD and PD in the macular area were significantly lower within affected eyes (131.333 ± 27.807%, 3.152 ± 0.714%, p < 0.0001) than in contralateral eyes (154.208 ± 5.599%, 3.662 ± 0.127%, p < 0.0001). The VD and PD in the tumour area (67.990 ± 34.899%, 1.617 ± 0.847%, p < 0.0001) were significantly lower when compared to the macular area of affected eyes (131.333 ± 27.807%, 3.152 ± 0.714%, p < 0.0001) and the macular area of contralateral eyes (154.208 ± 5.599%, 3.662 ± 0.127%, p < 0.0001). After radiation treatment, the VD and PD in five CM eyes (116.526 ± 7.598%, 2.438 ± 0.358%, p < 0.05) were significantly lower than before treatment (141.544 ± 14.645%, 3.327 ± 0.354%, p < 0.05). Tumour regression after radiation therapy for melanomas was associated with decreased vessel density.ConclusionsOCTA can provide a dye-free, non-invasive, reliable method to monitor a variety of tumours, including CM for growth and vascularity. Upon OCTA, this could be helpful in evaluating the variety of tumour blood vessels before and after brachytherapy to judge the curative effect and whether the tumour recurred. Detection of the characteristic vascular features of CM by OCTA could make OCTA an assuring diagnostic modality to differentiate malignant lesions.Subject terms: Prognosis, Cancer     

Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase,Anti-vascular Endothelial Growth Factor and Gas

PurposeTo evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas.MethodsThis study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed.ResultsThe mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied.ConclusionsA triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.     

Silicone oil tamponade for persistent macular holes

BackgroundA variety of treatment strategies have been proposed for macular holes that persist or recur after surgery, and the debate about the best re-treatment approach is ongoing. To allow for a comparison with alternative surgical therapies, we assessed the anatomical and functional outcome of a temporary tamponade with conventional silicone oil in persistent or recurrent full-thickness macular holes.MethodsWe retrospectively investigated consecutive patients with full-thickness macular holes that persisted or recurred following vitrectomy with internal limiting membrane peeling and gas tamponade. All patients received re-treatment by temporary tamponade of silicone oil and were allowed free postoperative positioning. Anatomical closure rate was assessed by optical coherence tomography, and change of best-corrected visual acuity (BCVA) was analyzed.ResultsA total of 33 eyes of 33 consecutive patients were included. Macular hole closure following silicone oil tamponade was achieved in 30 of 33 eyes (90.9%). Median BCVA improved from 1.00 logMAR (interquartile range, 0.60–1.00) to 0.65 logMAR (0.49–1.00; p = 0.010) after silicone oil removal. In patients with macular hole closure, 61.3% exhibited functional improvement with median BCVA changing from 1.00 logMAR (0.70–1.00) to 0.60 logMAR (0.49–1.00; p = 0.0005). Mean minimal linear diameter of macular holes before primary surgery was 391.0 µm (±137.8; range 133–630), and 48.5% of macular holes were >400 µm in diameter.ConclusionsTreatment of persistent or recurrent full-thickness macular holes by temporary conventional silicone oil tamponade without postoperative positioning results in a high closure rate and a significant mean improvement of visual acuity.Subject terms: Outcomes research, Retinal diseases     

Clinical spectrum and treatment outcomes of patients with nanophthalmos

PurposeTo study the varied demographic, visual and clinical presentation of patients with nanophthalmos.MethodsRetrospective chart review of 144 consecutive subjects with nanophthalmos from January 2010 to January 2018 was done. Demographic details, visual acuity, refractive status, clinical parameters and surgical data were collected.ResultsMean age at presentation was 48.76 ± 15.99 years (5–74 years) and 55.6% were females. Median BCVA was 0.78 (6/36 Snellen equivalent) and median spherical equivalent was +10.0 (5.7–12.5) . Amblyopia was seen in 30.0% patients. Legal blindness was present in 16.7% of the study population. The mean IOP was 18.38 ± 9.38 mmHg. Angle closure disease was present in 67.7% and 35.7% had angle closure glaucoma. Presence of peripheral anterior synechia had higher odds (OR = 3.66; 95% CI, 1.71–7.84) of associated glaucoma. The mean axial length, 17.64 ± 1.74 mm was inversely correlated to the mean Retinochoroidal Sclera(RCS) thickness of 1.99 ± 0.25 mm (r = −0.28, p value < 0.001).All patients who had undergone surgery for glaucoma (n = 11) had associated intra or postoperative complication. Cataract surgery by manual small incision had more complications than Phacoemulsification (p value = 0.001). Occurrence of uveal effusion was significantly lower in eyes which underwent sclerostomy (p = 0.04)ConclusionNanophthalmos is a rare disorder with varying degree of visual impairment & amblyopia. High incidence of angle closure glaucoma was observed. Surgical management for glaucoma is often challenging with frequent complications. Cataract surgery by phacoemulsification had significantly lower complications than SICS and performing a concomitant sclerostomy reduced the occurrence of uveal effusionsSubject terms: Risk factors, Eye manifestations, Risk factors, Eye manifestations, Risk factors     

Long-term follow-up of primary silicone oil tamponade for retinal detachment secondary to macular hole in highly myopic eyes: a prognostic factor analysis

PurposeTo investigate the risk factors associated with retinal detachment recurrence after first vitrectomy in high myopic eyes with macular hole retinal detachment (MHRD).MethodsPatients with high myopic eyes with MHRD who underwent pars plana vitrectomy and silicone oil (SO) tamponade with a follow-up period more than 12 months and more than 3 months after SO removal were included in this retrospective study. Logistic regression was performed to determine the risk factors associated with retinal re-detachment.ResultsA total of 45 eyes from 43 patients were included in this study (11 male and 34 female patients). The retinal re-detachment rate after the first removal of silicon oil was 35.5% (16/45) in a mean postoperative follow-up time of 35.64 ± 32.94 months. Complete macular atrophy on fundus photography (odds ratio (OR) = 17.021, 95% confidence interval (95% CI): 2.218–130.609, p = 0.006) was a risk factor for MHRD after SO removal, while internal limiting membrane (ILM) peeling (OR = 0.091, 95% CI: 0.013–0.633, p = 0.015) and duration of SO tamponade (OR = 0.667, 95% CI: 0.454–0.980, p = 0.039) were protective factors.ConclusionFor high myopic eyes with MHRD, complete macular atrophy was a significant risk factor for retinal re-detachment after silicon oil removal. ILM peeling and the duration of silicon oil tamponade were protective factors.Subject terms: Retinal diseases, Risk factors     

One-year results of two-site trabeculotomy in paediatric glaucoma following cataract surgery

PurposeThe management of glaucoma following cataract surgery (GFCS) in children is challenging. This study looks at the results of two-site trabeculotomy in paediatric aphakic/pseudophakic glaucoma, 1-year post operatively.MethodsThis prospective, institutional study was performed on 33 eyes with GFCS in patients aged ≤14 years. Patients underwent two-site trabeculotomy using the rigid-probe trabeculotome, through a superonasal and an inferotemporal scleral flap. Intraocular pressure (IOP), medications, complications and success rates at 1 year were reported. Success was defined as IOP < 23 mmHg or 30% IOP reduction, on the same or fewer number of medications at 1 year, without the need for another glaucoma procedure.ResultsTrabeculotomy was performed on average 3.5 years after the cataract surgery. Patients were aged 5.73 ± 1.79 years. We excluded four eyes in which >180° incision could not be achieved. A 360° incision was achieved in 14 eyes (48%). There was a significant reduction in IOP and medications at 1, 3, 6 and 12 months (p < 0.001). At 1 year, mean IOP reduction was 48.2 ± 31.5%. Success was achieved in 26 eyes (89.6%), of which 15 were controlled without medications. There was no significant difference in IOP, medications or success between aphakic and pseudophakic eyes nor between eyes that had 360° trabeculotomy and eyes that had a 180–270° incision. Three eyes (10.3%) required another glaucoma procedure. One eye required core vitrectomy for vitreous haemorrhage.ConclusionsTwo-site trabeculotomy can be used as an effective and safe first-line procedure in paediatric GFCS eyes that do not have extensive peripheral anterior synechiae.Subject terms: Education, Biotechnology     

Incidence,characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees’ perspective

PurposeTo examine the incidence, characteristics and outcomes of posterior capsular rupture (PCR) cases amongst the ophthalmology trainees and to evaluate the trainees’ confidence in managing PCR.MethodsA two-staged cross-sectional study was carried out between September 2017 and April 2018 in the North East of England, UK. All ophthalmology trainees were surveyed on their confidence level in managing PCR and the characteristics and outcomes of their PCR cases.ResultsFifteen (71.4%) out of 21 trainees completed the study. The mean number of phacoemulsification was 268.9 ± 250.9 cases (range, 0–705) per trainee. There were 82 (1.9%) cases of PCR reported among 4303 phacoemulsification. PCR occurred most commonly during quadrant removal (44.0%) and cortex removal (21.3%). The best-corrected visual acuity (in logMAR) improved significantly from 0.47 ± 0.32 preoperatively to 0.20 ± 0.19 postoperatively (p < 0.001). The supervising consultant took over 80.5% of the PCR cases. The PCR rate decreased significantly from 3.1% at 0–100 cases to 0.6% at 301–400 cases (p = 0.004) and to 0.4% at >500 cases (p = 0.005). Confidence in managing PCR (without supervision) improved from 0% (9/9) at junior level to 50% (3/6) at senior level, and the average number of anterior vitrectomies performed was 0.6 ± 0.9 (range: 0.0–2.0).ConclusionsWe observed a low PCR rate among the trainees in our region, with the majority of cases achieving good visual outcome. A significant reduction in PCR rate was observed at the threshold of >500 cases. There is however a lack of confidence among trainees in managing PCR, highlighting the need for devising new training strategies in this area.Subject terms: Lens diseases, Epidemiology, Outcomes research     

Deep optic nerve head morphology and glaucoma progression in eyes with and without laminar dot sign: a longitudinal comparative study

PurposeTo investigate the association between the laminar dot sign (LDS) and the deep optic nerve head (ONH) structure in eyes with primary-open-angle glaucoma (POAG).MethodsEighty-four eyes of 84 patients with POAG were prospectively included. All of the patients underwent stereo optic disc photography (SDP), red-free retinal nerve fibre layer (RNFL) photography, SS-OCT, and standard automated perimetry. By evaluating the SDP, patients were classified into laminar dot sign (LDS) and non-LDS groups. The deep structure of the ONH including the anterior prelaminar depth (APLD) and prelaminar tissue thickness (PTT) were quantitated using SS-OCT. Progression was assessed by structural or functional deterioration during the average 4.3 ± 1.2 years of follow-up.ResultsThe LDS group had deeper APLD (405.47 ± 107.55 vs. 302.45 ± 149.51, P < 0.001) and thinner PTT (74.34 ± 24.46 vs. 137.29 ± 40.07, P = 0.001) relative to the non-LDS group. By multivariate analysis, thin PTT was significantly associated with the presence of LDS (odds ratio = 0.939, P < 0.001). Structural progression was detected in 45 eyes (84.9%) in the LDS group and 8 eyes (25.8%) in the non-LDS group. Functional progression was demonstrated in 29 eyes (34.5%) in the LDS group and 6 eyes (19.4%) in the non-LDS group. The eyes with LDS had a significantly higher risk of glaucoma progression (χ² = 5.00, degree of freedom = 1, P = 0.033).ConclusionsIn eyes with POAG, the presence of LDS was associated with thinner prelaminar tissue and faster disease progression.Subject terms: Optic nerve diseases, Outcomes research, Optic nerve diseases, Outcomes research, Optic nerve diseases     

The effect of home education on myopia progression in children during the COVID-19 pandemic

ObjectivesTo evaluate the effect of the COVID-19 pandemic restrictions on myopia progression (MP) in school age children.MethodsA total of 115 children aged 8–17 years with a diagnosis of myopia who had been followed-up for at least three years, were included in this study with a retrospective and single-centre design. The subjects’ age, the history of myopia in the family, the time spent in front of a screen, the digital devices used during home education (computer, tablet, smartphone, television), the time spent in open air (hours/day), the refractive error (RE) (spherical equivalent value) detected before the home education period and the changes in the myopia over the years, were recorded.ResultsThe mean age was 12.06 (±2.29) years. Only the right eyes were included. The glasses use duration was 3.57 (±0.74) years. The annual MP amount 0.49 (±0.26), 0.41 (±0.36) and 0.54 (±0.43) dioptres (D) for the 2017, 2018 and 2019 years before home education, respectively, (p > 0.05), and 0.71 (±0.46) D in 2020, during home education. The increase in MP amount in 2020 compared to the 2019 and 2018 years was statistically significant (p < 0.003). MP was statistically significantly less in children who participated in open-air activities for 2 h a day and those who lived in detached houses (p = 0.004, p = 0.006, respectively).ConclusionDuring home confinement, education programmes of school children should be designed while taking into account preventive measures for MP, in particular for allowing children to spend at least 2 h of outdoor time per day.Subject terms: Outcomes research, Paediatrics