Association of outer retinal layer morphology with visual acuity in patients with retinal vein occlusion: SCORE Study Report 13

Purpose

To assess associations between visual acuity (VA) and the status of the photoreceptor inner segment–outer segment (IS–OS) junction in a subset of patients in the Standard Care vs COrticosteroid for REtinal Vein Occlusion (SCORE) Study.

Methodology

High-resolution time domain optical coherence tomography (OCT) scans of study eyes from a single site participating in the SCORE Study were evaluated. Integrity of the IS–OS junction in the central subfield was evaluated using a three-step scale: absent, abnormal or normal. Associations of the IS–OS status with ETDRS VA letter score and center point thickness (CPT) were investigated.

Results

Baseline OCTs of 42 eyes were evaluated. The IS–OS junction was absent in 30 (71%) and abnormal in 12 (29%). At month 12, the IS–OS junction was absent in 18 (43%), abnormal in 12 (28%), and normal in 12 (28%) eyes. At baseline, IS–OS status was significantly associated with CPT, but not with VA. At month 12, IS–OS status was significantly associated with CPT and VA, that is, absent or abnormal IS–OS was associated with increased CPT and worse VA. Change in IS–OS status was not associated with change in CPT (P=0.8). Worsening of IS–OS status was associated with loss of VA and improvement in IS–OS status to normal was associated with gain in VA (P=0.03).

Conclusion

In this data set with long-term follow-up of OCTs as part of the SCORE Study, there is a correlation between change in IS–OS status and VA. This supports further evaluation of outer retinal morphology in larger data sets.     

Visual perceptions induced by intravitreous injections of therapeutic agents

Purpose

The purpose of this study was to conduct a questionnaire-based survey of subjective visual perceptions induced by intravitreous (IVT) injections of therapeutic agents.

Patients and methods

Patients undergoing an IVT injection of ranibizumab, pegaptanib sodium, or triamcinolone acetonide were administered a questionnaire in the immediate post-injection period and at 2 weeks of follow-up.

Results

In the immediate post-injection period (75 IVT injections, 75 eyes, 75 patients), lights and floaters were reported after 20 (27%) and 24 (32%) IVT injections, respectively. In comparison, at the 2-week follow-up, the incidence of reported lights (11; 15%) was similar (P>0.05), but the incidence of reported floaters was higher (48; 64% P=0.00). Subgroup analysis for various injection subgroups (no previous injection vsprevious injection(s) in the study eye; injections in study eyes with good VA (logarithm of minimal angle of resolution [logMAR] ≤0.3) vsmoderate VA (0.7 0.3) vspoor VA (logMAR ≥0.7); injections according to pharmacological agent (ranibizumab vspegaptanib vstriamcinolone acetonide); injections in study eyes with choroidal neovascularization (of various causes) vsstudy eyes with macular edema (of various causes); and injections in phakic vspseudophakic eyes) did not reveal any statistically significant associations. Visual perceptions experienced following 15% of IVT injections gave cause for concern to the patient (mean visual analog scale score (±SD): 4.5 (±1.7)), and in 64% of cases, the patients believed that preoperative counseling would have averted the concern.

Conclusions

Lights and floaters are frequent visual perceptions following IVT injections of therapeutic agents. They can give rise to concern that could be alleviated with preinjection counseling.     

Surgical and visual outcome following 20-gauge vitrectomy in proliferative diabetic retinopathy over a 10-year period, evidence for change in practice

Introduction

The study reports 10-year anatomical and visual outcome in patients who underwent pars plana vitrectomy (PPV) for complications due to proliferative diabetic retinopathy (PDR).

Methods

Retrospective analysis of patients undergoing 20G PPV from January 1999 to May 2010 for tractional retinal detachment (TRD) and non-clearing vitreous hemorrhage (NCVH) secondary to PDR recorded prospectively on an electronic patient record. The primary aim was to study anatomical success and eyes with visual acuity (VA) of ≤0.3 logMAR at last follow-up.

Results

There were 346 eyes of 249 patients with mean age of 55.63 years and follow-up of 1.44 years. In all, 95.3% of eyes had a flat retina at final follow-up. Overall 136/346 (39.4%) eyes had final VA of logMAR ≤0.3 (Snellen 6/12) and 129 (37.3%) had logMAR ≥1.0 (Snellen 6/60). In all, 50/181 (27.6%) eyes with TRD and 84/165 (50.9%) with NCVH achieved final VA of ≤0.3 logMAR (Snellen 6/12). A total of 218 (63.1%) showed ≥0.3 logMAR improvement from baseline to last follow-up. Both preoperative VA and final postoperative (post-op) VA (P<0.001) improved significantly with each year from 1999 to 2010. The commonest peroperative complication was iatrogenic retinal tear formation (28.4%). This was a risk factor for the development of post-op retinal detachment, odds ratio: 3.90 (95% confidence interval: 1.91–7.97, P=0.0002). Silicone oil was used in 5.2% of patients at the primary procedure. In all, 9.2% required removal of non clearing post vitrectomy hemorrhage.

Conclusions

Outcomes from vitreoretinal surgery for complications of diabetic retinopathy have improved. In addition, the visual outcome after diabetic vitrectomy steadily improved over the 10-year period, which may in part be due to the move to operate on patients with better vision.     

Pilot randomised controlled trial of face-down positioning following macular hole surgery

Objective

This was a pilot randomised controlled trial (RCT) to investigate the effect of post-operative face-down positioning on the outcome of macular hole surgery and to inform the design of a larger definitive study.

Methods

In all, 30 phakic eyes of 30 subjects with idiopathic full-thickness macular holes underwent vitrectomy with dye-assisted peeling of the ILM and 14% perfluoropropane gas. Subjects were randomly allocated to posture face down for 10 days (posturing group) or to avoid a face-up position only (non-posturing group). The primary outcome was anatomical hole closure.

Results

Macular holes closed in 14 of 15 eyes (93.3% 95% confidence interval (CI) 68–100%) in the posturing group and in 9 of 15 (60% 95% CI 32–84%) in the non-posturing group. In a subgroup analysis of outcome according to macular hole size, all holes smaller than 400 μm closed regardless of posturing (100%). In contrast, holes larger than 400 μm closed in 10 of 11 eyes (91% 95% CI 58–99%) in the posturing group and in only 4 of 10 eyes (40% 95% CI 12–74%) in the non-posturing group (Fisher''s exact test P=0.02).

Conclusion

Post-operative face-down positioning may improve the likelihood of macular hole closure, particularly for holes larger than 400 μm. These results support the case for a RCT.     

The association between respiratory tract Ureaplasma urealyticum colonization and severe retinopathy of prematurity in preterm infants ≤1250 g

Aim

To evaluate the association between respiratory tract Ureaplasma urealyticum (Uu) colonization and development of retinopathy of prematurity (ROP) requiring treatment.

Methods

The infants with birthweight (BW) ≤1250 g born in a third-level neonatal intensive care unit between March 2009 and May 2010 were prospectively identified. Nasopharyngeal swabs for Uu colonization were taken in postnatal first 3 days. Culture-positive patients were reevaluated on the twelfth day by nasopharyngeal swabs for Uu. The primary outcome was to define whether there was an association between respiratory tract Uu colonization and severe ROP requiring treatment. Independent sample''s t-test or Mann–Whitney U-test was used to compare continuous variables and Chi-square test or Fisher''s exact test for categorical variables. Multivariate (backward) logistic regression analysis was performed to simultaneously measure the influence of the independent variables with ROP as the dependent variable.

Results

A total of 25 (12.1%) infants developed severe ROP requiring treatment among 206 infants who underwent ROP screening. Mean BW and gestational age of total cohort were 1013±159 g and 27.9±1.6 weeks, respectively. Multivariate analysis demonstrated that BW (OR: 0.64 (95% Cl 0.47–0.88); P=0.006), duration of mechanical ventilation (OR: 1.17 (95% Cl 1.06–1.28); P=0.001), premature rupture of membrane >18 h (OR: 3.83 (95% Cl 1.2–12.2); P=0.02), and Uu positivity in both cultures (OR: 5.02 (95% Cl 1.8–13.9); P=0.002) were independent risk factors for the development of severe ROP requiring treatment.

Conclusions

Respiratory tract colonization with Uu was independently associated with severe ROP requiring treatment.     

Visual function alterations in orbital tumors and factors predicting visual outcome after surgery

Purpose

To study the effect of orbital tumors on visual functions and highlight the factors predictive of visual outcome after surgery.

Methods

A prospective interventional study compared visual function parameters and fundus changes, before and after surgery, in eyes having well-defined orbital tumors with the normal fellow eye. These included visual acuity (VA), refractive error, keratometry changes, color vision, Goldmann visual field (GVF), and visual evoked response (VER).

Results

In total 28 cases (age range 7–56 years), of which the majority of tumors were vascular (46%) and lacrimal (18%) in origin, had a mean VA of 0.54±0.33 in the affected eye, which improved postoperatively to 0.66±0.31 (P=0.002). The affected eye had a median refractive error of +0.00 DS (−2.00 to 5.13), which was significantly more hyperopic than the normal eye (median +0.00 DS; range −1.25 to +1.63 DS) and normalized postoperatively. Keratometry showed higher astigmatism in the involved eye (P=0.004). The fundus showed disc pallor, edema, and/or choroidal folds, of which disc edema resolved in all cases after surgery. In all, 40% of the affected eyes had a deficient color vision and this partially improved postoperatively (P=0.25). GVF had abnormalities in 10 cases, half of which normalized postoperatively (P=0.04). The VER of affected eyes had a mean amplitude of 8.91±4.59 μv and latency of 116.3±14.7 ms, with improvement after surgery (P=0.005 and 0.001, respectively).

Conclusion

Orbital tumors adversely affected visual functions. The presenting acuity depended on disc changes, color vision abnormalities, and prolonged VER latency. The postoperative VA depended on VA at presentation, amount of proptosis, degree of hyperopia, and clinically significant VER abnormalities.     

Ocular injuries from improvised explosive devices

Purpose

To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs).

Methods

Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre.

Results

In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20–42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4–34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05).

Conclusion

Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.     

Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis

Background

To study the use of interferon-gamma release assay (IFN-γ) (IGRAs) as a diagnostic test for tuberculosis (TB)-associated uveitis (TAU).

Design

Prospective cohort study.

Participants

Consecutive new patients (n=162) with clinical ocular signs suggestive of TAU, seen >1 year period at a single tertiary center.

Methods

All subjects underwent investigations to rule out underlying disease, including T-SPOT.TB and tuberculin skin test (TST). Twenty-one subjects with underlying disease and three with interdeterminate T-SPOT.TB results were excluded. Those with T-SPOT.TB- or TST-positive results were referred to infectious diseases physician for evaluation. Anti-TB therapy (ATT) was prescribed if required. Patients'' treatment response and recurrence were monitored for six months after completion of ATT, if given; or 1 year if no ATT was given.

Main outcome measure

Diagnosis of TAU.

Results

Mean age of study cohort (n=138) was 46.8±15.3 years. Majority were Chinese (n=80, 58.0%) and female (n=75, 54.3%). TST was more sensitive than T-SPOT.TB (72.0% vs36.0%); but T-SPOT.TB was more specific (75.0% vs51.1%) for diagnosing TAU. Patients with either a T-SPOT.TB (1.44; 95% confidence intervals (CI), 0.86–2.42) or TST (1.47; 95% CI, 1.12–1.94)-positive result are more likely to have TAU. The accuracy of diagnosing TAU increases when both tests are used in combination (area under the receiver operator curve=0.665; 95% CI, 0.533–0.795). Patients with both tests positive are 2.16 (95% CI, 1.23–3.80) times more likely to have TAU. Negative T-SPOT.TB or TST results do not exclude TAU (negative likelihood ratios <1.0).

Conclusions

We recommend using a combination of clinical signs, IGRA, and TST to diagnose TAU.     

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Purpose

To evaluate the surgical outcome of combined trabeculotomy–trabeculectomy in Ghanaian children with primary congenital glaucoma.

Materials and methods

A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy–trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications.

Results

A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2–8) months. Mean age at surgery was 5.9 months (range 3–16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5–38) months. The preoperative mean horizontal corneal diameter was 13.4±1.1(range 12–16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan–Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3±8.8 and 18.1±6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively.

Conclusion

The overall success for combined trabeculotomy–trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.     

Five-year visual outcome following laser photocoagulation of diabetic macular oedema

Objective

To evaluate the 5-year visual outcome associated with laser photocoagulation treatment of diabetic macular oedema (DMO), and to investigate the relationship between systemic factors and visual outcomes in a real-life setting.

Methods

The mean annual visual outcomes and systemic parameters of 100 consecutive subjects with type 2 diabetes who underwent the first session of focal/grid macular laser photocoagulation for clinically significant macular oedema between 2003 and 2004 were collected retrospectively and compared with the outcomes of the laser arm of the Diabetic Retinopathy Clinical Research Network (DRCRN trial comparing intravitreal triamcinolone acetonide injection with laser photocoagulation treatment for DMO). The primary outcome measures included the mean change in visual acuity (VA) in 5 years and the influence of systemic factors on final visual outcome.

Results

The mean change in VA at 5 years was −5.23 in a real-life setting for an inner city population. The 3-year outcome was inferior to the clinical trial results with more people gaining vision (≥15 letter gain) in the DRCRN group compared with this cohort (26 vs9%). Furthermore, three times more patients lost vision (>15 letter loss) in the real-life setting of this cohort compared with the clinical trial results of the DRCRN group (27 vs8%, respectively).

Conclusions

The visual outcomes and the control of systemic factors of patients with DMO in this cohort were inferior to those recruited for the clinical trial involving the DRCRN group.     

The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years

Objective

The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom.

Methods

Observational prospective study.

Results

A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ⩾6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14–35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15–19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0–1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81–20.24).

Conclusion

There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.     

Clinical characteristics of optic neuritis in Taiwanese children

Purpose

To document the etiology, clinical presentation, and visual prognosis of optic neuritis in Taiwanese children.

Methods

Retrospectively reviewed children younger than 18 years old with optic neuritis in Chang Gung Memorial Hospital and Chang Gung Children''s Hospital from 1998 to 2009.

Results

There were 24 children (38 eyes) with optic neuritis in that period. Overall, 14 patients (58.3%) were female and 10 patients (41.7%) were male. In total, 14 patients (58.3%) had bilateral involvement, and 10 patients (41.7%) had unilateral involvement. Out of 38 eyes, 24 (63.2%) had disc swelling. Out of 24 patients, 21 (87.5%) underwent intravenous steroid therapy (10 to 30 mg/kg/day) for 3–5 days, and followed by an oral taper. Out of 24 patients, 20 (83.3%) achieved final visual acuity (VA) of 20/40 or better. However, a poor visual outcome (four patients) (VA<20/40) was correlated with pale disc at presentation (P=0.002, Pearson χ ²-test) and age older than 10 years (P=0.012, Fisher''s exact test). Five patients were diagnosed with acute disseminated encephalomyelitis (ADEM) (21%), and three patients were diagnosed with multiple sclerosis (MS) (12.5%). Patients with ADEM did not have a better visual outcome than patients with MS (P=0.643, Fisher''s exact test).

Conclusions

Visual recovery from optic neuritis was favorable in Taiwanese children. A poor visual outcome was correlated with pale disc at presentation and patients'' age older than 10 years. ADEM is the most common associated systemic disease; MS is relatively rare.     

A new ocular trauma score in pediatric penetrating eye injuries

Purpose

To assess the prognostic value of a new ocular trauma score (OTS) in pediatric penetrating injuries.

Methods

Children ≤15 years of age that presented to the emergency room with penetrating eye injuries between April 2007 and August 2008 were evaluated prospectively. All patients were reviewed on the basis of age, gender, time of injury and how it happened, time of admission, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye pathology. Injuries were classified based on a new OTS, and we assessed the relationship with final VA and the new OTS.

Results

In total, 30 eyes in 29 patients (41.38% female, 58.62% male) with a mean age of 6.83±4.00 years (range: 1–15 years) were included in the study. Initial VA, which was evaluated in 22 patients, was as follows: no light perception (NLP) in 2 (9.09%) patients, light perception (LP) to hand motion (HM) in 8 (36.36%) patients, counting fingers in 6 (27.27%) patients, 0.1–0.5 in 4 (18.18%) patients, and ≥0.6 in 2 (9.09%) patients. Final VA, which was evaluated in 27 patients, was as follows: NLP in 3 (11.11%) patients, LP to HM in 3 (11.11%) patients, counting fingers in 2 (7.41%) patients, 0.1–0.5 in 11 (40.74%) patients, and ≥0.6 in 8 (29.63%) patients. The relationship between initial VA and final VA was statistically significant (P<0.001).

Conclusions

The new OTS calculated at initial examination may be of prognostic value in children with penetrating eye injuries.     

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Purpose

To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment–outer segment (IS–OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair.

Methods

Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS–OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively.

Results

Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS–OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS–OS (ELM^c/IS–OS^c group); 29 eyes (51.8%) had continuous ELM with discontinuous IS–OS layers (ELM^c/IS–OS^d group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM^d/IS–OS^d group). The ELM^d/IS–OS^d group had the lowest visual gain at 6 months (P=0.03). At 6 months, a restoration of the integrity of IS–OS layer was observed in 51.7% eyes in the ELM^c/IS–OS^d group and in 5% in the ELM^d/IS–OS^d group (P=0.001).

Conclusions

When both ELM and IS–OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS–OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.     

Prevalence and risk factors for refractive errors and ocular biometry parameters in an elderly Asian population: the Singapore Longitudinal Aging Study (SLAS)

Purpose

To determine the prevalence rates of refractive errors and pattern of ocular biometry in a multi-ethnic elderly Asian population.

Methods

A population-based study of 1835 residents aged 55–85 years, evaluating the refractive error and ocular biometry parameters, including axial length (AL) and anterior chamber depth.

Results

The age-standardized prevalence of myopia, hyperopia, astigmatism, and anisometropia were 30.0% (95% confidence interval (CI): 29.6, 30.4), 41.5% (95% CI: 41.1, 41.9), 43.5% (95% CI: 43.1, 44.0), and 22.1% (95% CI: 21.7, 22.4), respectively. Male gender (P=0.02), age ≥75 years (P=0.033), and higher educational level (P<0.001) were significantly associated with higher rates of myopia in multivariate analyses. The prevalence of astigmatism was higher in persons with diabetes (odds ratio (OR) 1.4, 95% CI: 1.03, 1.90, P=0.031). AL was longer in Chinese than other ethnic groups (23.7 vs23.4 mm, P=0.018), and in men compared with women (24.2 vs23.4 mm, P<0.001). AL was associated with increasing height (AL increased by 0.3 mm for every 10 cm increase in height, P<0.001).

Conclusion

There is a high prevalence of myopia in elderly Singaporeans, consistent with trends seen in younger populations in Asia. Male gender and higher education were independent risk factors for myopia. These data suggest that higher rates of myopia in East Asians compared with Caucasians may not be a recent phenomenon.     

The UK National Cyclodiode Laser Survey

Purpose

To evaluate current practice of transscleral diode laser cyclophotocoagulation (cyclodiode) laser treatment among consultant ophthalmologists in the United Kingdom.

Methods

A 31-question survey was emailed to all practising consultant ophthalmologists who were members of the Royal College of Ophthalmologists. All non-responders were sent a postal version of the questionnaire. This paper looked at cyclodiode practice patterns and consisted of questions on demographic data, transillumination, and power settings, factors influencing practice, post-operative care, and repeat treatment.

Results

A total of 510 participants (53.6%) responded. A total of 180 (35.3%) responders reported performing cyclodiode laser treatment, of which 84 (46.7%) were glaucoma subspecialists (GSS). Initial median power settings used were 1500 mW and 2000 ms. The average number of applications delivered per sitting was 25.5±1.2 applications for GSS vs20.6±2.0 for non-GSS in a seeing eye (P=0.0013). In all, 65% routinely transilluminated the globe of which 78% were GSS and 52.3% were non-GSS (P=0.0009). In all, 43% of the GSS vs17% of the non-GSS lowered power settings in uveitic glaucoma (P=0.013). In blind eyes, 30% of the GSS vs12% of the non-GSS increased energy levels (P=0.0014). In all, 60% of the responders performed cyclodiode at any visual acuity, whereas 22% performed combined cyclodiode and cataract surgery.

Conclusions

This survey highlights a wide variation in the use of cyclodiode laser treatment amongst GSS and non-GSS. However, the most frequently used practice may not be the optimal practice. A more individualised parameter according to the condition of the eyes may optimise the outcome.     

Comparison of foveal-sparing with foveal-involving photodynamic therapy for myopic choroidal neovascularization

Purpose

To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia in eyes treated with photodynamic therapy (PDT), and to determine the effect of lesion location and foveal involvement on visual prognosis.

Methods

Interventional case series of 24 consecutive patients with myopic CNV treated with PDT. The main outcome measure was final LogMAR visual acuity (VA).

Results

Of 24 eyes, the CNV lesion was subfoveal in 11 and extrafoveal in 13. Overall, the mean LogMAR VA at 24 months was 0.72. Extrafoveal CNV lesions achieved significantly better final VA compared with subfoveal CNV (LogMAR 0.45 vs 1.05, P=0.012). Eyes with extrafoveal CNV lesions were subdivided into foveal-sparing PDT (where the PDT laser spot did not involve the foveal center) and foveal-involved PDT (where the PDT laser covered the fovea). At all time points, the group with foveal-sparing PDT had significantly better VA compared with the foveal-involved group. The final LogMAR VA for the foveal-sparing PDT group was 0.26 compared with 1.00 for the foveal-involved PDT group (P=0.003). At 24 months, 77.8% of foveal-sparing PDT cases achieved VA of ≥20/40, compared with 25% of foveal-involved PDT cases and 9.1% of subfoveal CNV lesions (P=0.006).

Conclusion

For patients with myopic CNV, foveal-sparing PDT results in significantly better long-term visual outcomes compared with those with foveal-involved PDT. Foveal-sparing PDT may be of value for treatment of myopic CNV patients who are not suitable for treatment with anti-vascular endothelial growth factor injections.     

Anatomical and functional outcomes in contusion injuries of posterior segment

Purpose

To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment.

Methods

Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center.

Results

In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2–34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy.

Conclusion

Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.     

New superior–inferior visual field asymmetry indices for detecting POAG and their agreement with the glaucoma hemifield test

Purpose

To describe and measure the discriminatory performance of three new superior–inferior asymmetry indices for detecting primary open angle glaucoma (POAG) and to compare these with the glaucoma hemifield test (GHT).

Methods

In all, 412 control and 247 POAG eyes were selected from a visual field database of patients attending the Manchester Royal Eye Hospital. Age-adjusted defect asymmetries were calculated for each of the 22 vertically mirrored test point pairs used in the GHT. The three new indices, hemifield mean difference (HMD) and hemifield standard deviation (HSD) of the asymmetry values along with the number of test pairs (NP) falling outside the 85% probability limits of the control population, were calculated. ROC curves of the indices and GHT were constructed. Agreement between the indices was explored with a proportional Venn diagram and 3 × 3 contingency tables. Cases of disagreement between the indices were reviewed.

Results

The area under the ROC curves were HMD=0.745 (95% confidence interval (CI) 0.705–0.786), HSD=0.864 (95% CI 0.833–0.894), NP=0.863 (95% CI 0.832–0.893) and GHT=0.792 (95% CI 0.754–0.829). The Venn diagram and contingency tables highlighted the good agreement between HSD, NP and GHT. Agreement was 78% (HSD vs GHT) and 82% (NP vs GHT) in the control sample and 70% (HSD vs GHT) and 71% (NP vs GHT) in the POAG sample. Five cases are presented where disagreement existed between the indices.

Conclusions

The new HSD and NP asymmetry indices perform better than GHT in differentiating between normal and POAG eyes in this data set. GHT can fail to detect significant asymmetry, detected by HSD and NP, when an early defect crosses sector boundaries.     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.