Functional status and quality of life measurement among ophthalmic patients

Risk factors for surgical failure after primary scleral buckling for rhegmatogenous retinal detachment

OBJECTIVE

To identify risk factors for surgical failure after scleral buckling (SB) for primary rhegmatogenous retinal detachment (RRD) repair.

DESIGN

Single-centre retrospective consecutive case series.

PARTICIPANTS

All patients who underwent SB for repair of primary RRD at Wills Eye Hospital between January 1, 2015, and December 31, 2018, were included.

METHODS

Single-surgery anatomic success (SSAS) rate and risk factors associated with surgical failure were evaluated. A multivariable logistic regression model was completed to assess the effect of demographic, clinical, and operative variables on SSAS rate.

RESULTS

A total of 499 eyes of 499 patients were included. Overall SSAS rate was 86% (n = 430 of 499). Using multivariate analysis, surgical failure was more likely in males (adjusted odds ratio [adjusted OR] = 2.98; 95% CI, 1.58-5.62; p = 0.0007) with a macula-off status on preoperative examination (adjusted OR = 2.15; 95% CI, 1.10-4.20; p = 0.03) and preoperative proliferative vitreoretinopathy (adjusted OR = 4.26; 95% CI, 1.10-16.5; p = 0.04). Time interval between initial examination and surgery (p = 0.26), distribution of buckle or band material used (p = 0.88), and distribution of tamponade used (p = 0.74) were not significantly different between eyes with and without surgical failure.

CONCLUSION

Male sex, macula-off status, and preoperative proliferative vitreoretinopathy were factors with increased odds of surgical failure after SB for primary RRD repair. Operative characteristics, such as type of band or use of tamponade, were not associated with surgical failure.

Clinical comparative analysis of culture-proven bacterial keratitis according to prior topical steroid use: a retrospective study in a tertiary referral center of South Korea

This study analyzed the clinical characteristics of patients exposed to topical steroids before bacterial keratitis diagnosis (the prior topical steroid use, PS group), and compared these with those of the non-exposed group (the no prior topical steroid use, NPS group). We retrospectively analyzed 194 patients (PS, 34; NPS, 160) with culture-proven bacterial keratitis between 2007 and 2016. The microbiological profiles, epidemiology, predisposing factors, clinical characteristics, and treatment outcomes of PS and NPS were compared, and the risk factors for surgical intervention were evaluated. Pseudomonas spp. and Staphylococcus spp. were the most common isolates in PS and NPS, respectively, and no significant difference in the strain distribution between the two groups were observed. Significant differences were observed between PS and NPS for previous ocular surface disease (41.2%: 23.8%), initial BCVA < 0.1 (70.6%: 49.4%), epithelial defect size ≥ 5 mm2 (64.7%: 41.2%), epithelial healing time > 14 days (55.9%: 37.3%), and surgical intervention (23.5%: 8.8%). Prior topical steroid use, strong steroid use, and long-term steroid use groups were included in significant risk factors for surgical intervention. Previous exposure to topical steroids before the diagnosis of bacterial keratitis was associated with a worse initial clinical presentation and treatment outcomes. Additional multicenter studies should be conducted in the future.

Intraocular methotrexate for epithelial downgrowth: long-term outcomes in a multicentre case series

BACKGROUND/AIMS

Sheet-like type of epithelial downgrowth (EDG) is not easily amenable to surgical excision. We describe long-term outcomes in patients with EDG treated with intraocular methotrexate (MTX).

METHODS

This is a retrospective, multicentric case series including 10 eyes (nine patients) treated with intraocular MTX for sheet-like EDG. Relevant ocular history, previous EDG treatments, MTX injection regimen, long-term outcomes and complications are reported.

RESULTS

All cases were associated with intraocular surgery. Most patients were treated with 400 µm/0.1 mL MTX injections with a starting frequency of two times per week or weekly injections. Mean and SD number of injections per eye was 16±13 injections and duration of follow-up was 54±36 months (range: 7-120 months). Eradication of EDG was achieved in seven eyes of which one required a second MTX treatment course to achieve eradication, while clinical resolution with recurrence was observed in two. One treatment failure occurred despite eight weekly injections which slowed but did not halt EDG progression; the patient later requested that treatments be stopped given difficulty to come to follow-ups. Surface epitheliopathy developed in eight patients and was used to titrate MTX treatment. Six patients also developed endothelial failure.

CONCLUSION

We report the largest case series of diffuse, sheet-like EDG treated with intraocular MTX with follow-ups up to 10 years. Intraocular MTX may be used effectively to achieve eradication of EDG in cases where surgery is not amenable. However, further recommendations to guide treatment remain warranted.

Impact of Prefilled Syringes and Masking on Postintravitreal Injection Endophthalmitis

Purpose: To compare rates of endophthalmitis (1) following intravitreal injection of antivascular endothelial growth factor therapies with glass-vial preparation (GVP) vs prefilled syringes (PFS) and (2) before and after masking protocols were implemented. Methods: Medical records within a multicenter retina practice in Houston, Texas, from January 2015 to August 2021 were retrospectively reviewed. The primary outcome was rate of endophthalmitis after intravitreal injection. Results: A total of 307 349 injections were performed during the study period and 101 cases of endophthalmitis were identified (0.033%). PFS use was associated with a decreased risk of endophthalmitis (relative risk [RR], 0.320; 95% CI, 0.198-0.518, P < .001); 54 cases of endophthalmitis occurred in the GVP group of aflibercept and ranibizumab (0.052%) compared with 24 in the PFS group (0.017%). There was no difference in the endophthalmitis rates with or without universal masking (RR, 0.953; 95% CI 0.616-1.473, P = .91). Discussion: PFS use was associated with a significant reduction in the rate of endophthalmitis while the use of surgical face masks did not appear to significantly impact the rate of endophthalmitis.

Bilateral sequential and simultaneous rhegmatogenous retinal detachments: anatomic and functional outcomes

OBJECTIVE

To assess the anatomic and functional outcomes in sequential and simultaneous bilateral rhegmatogenous retinal detachment (BRRD) repair.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 218 eyes in 109 patients.

METHODS

Patients diagnosed with BRRD between 2014 and 2020 at the University Centre of Ophthalmology-CHU de Québec-Laval University were reviewed. Main outcomes were single-surgery anatomic success (SSAS) and final pinhole visual acuity (PHVA) in logMARs.

RESULTS

Of the 109 patients, 86 (79%) were male, and median (Q1, Q3) age at presentation for the first eye was 60 years (range, 54-66 years). Of these patients, 92% (n = 100) had sequential BRRD and 8% (n = 9) simultaneous BRRD. Median (Q1, Q3) duration of symptoms was shorter for second eyes (first, 7 days [range, 3-15 days] vs second, 4 days [range, 2-10 days]; p = 0.028). Second eyes also had less retinal tears (first, 2.94 ± 2.76 tears vs second, 2.38 ± 1.79 tears; p = 0.031) and better median preoperative PHVA (first, 0.46 logMAR [range, 0.14-2.30 logMAR] vs second, 0.24 logMAR [range, 0.06-0.95 logMAR]; p = 0.012). SSAS was achieved in 100 (92%) and 101 (93%) of first and second eyes, respectively (p = 1.00). Final PHVA was better for the first eye (first, 0.14 logMAR [range, 0.04-0.30 logMAR] vs second, 0.20 logMAR [range, 0.04-0.43 logMAR]; p = 0.010) but comparable at 3 months (first, 0.30 logMAR [range, 0.14-0.48 logMAR] vs second, 0.34 logMAR [range, 0.13-0.70 logMAR]; p = 0.36).

CONCLUSIONS

SSAS was similar for both eyes. The subsequent eye was more likely to be treated earlier with less advanced presentations, but at 3 months, PHVA was not significantly different between eyes. Difference in final PHVA may be attributable to longer follow-up in first eyes.

Endophthalmitis following cataract surgery: visual outcomes, microbial spectrum and complications

PURPOSE OF REVIEW

The aim of this study was to update visual outcomes, microbial spectrum and complications in eyes with endophthalmitis following cataract surgery.

RECENT FINDINGS

A single-institution, retrospective review of eyes treated for endophthalmitis following cataract surgery between 2 January 2014 and 10 January 2017. This study included 112 cases of endophthalmitis following cataract surgery, 58 of which were culture-positive (51.8%). The most isolated organisms were coagulase-negative Staphylococci (56.9%). Oral flora were present in 17.2% of cases. At 6 months, 71.7% of patients achieved visual acuity of at least 20/200 and 51.7% achieved at least 20/40 or better. Visual acuity was better in culture-negative vs. culture-positive cases (∼20/290 vs. ∼20/80, P   =  0.03), and in nonoral flora-associated vs. oral flora-associated culture-positive cases (∼CF vs. ∼20/150, P   <  0.01).

SUMMARY

Following postcataract surgery endophthalmitis, approximately 70% of eyes achieved vision of 20/200 or better and half achieved vision of 20/40 or better 6 months after treatment. Poor visual outcomes were seen in eyes with positive bacterial cultures and with oral flora.

Staphylococcus aureus Keratitis in Taiwan: Genotyping, Antibiotic Susceptibility, and Clinical Features

Staphylococcus aureus is an important pathogen for keratitis, a vision-threatening disease. We aimed to investigate the genotyping, antibiotic susceptibility, and clinical features of S. aureus keratitis, and to explore the possible role of Panton–Valentine leucocidin (PVL), a major virulence factor of S. aureus. We recruited 49 patients with culture-proven S. aureus keratitis between 2013 and 2017 at Chang Gung Memorial Hospital, Taiwan. PVL gene, multilocus sequence type (MLST), staphylococcal cassette chromosome mec (SCCmec), and pulsed-field gel electrophoresis (PFGE) were performed. Antibiotic susceptibility was verified using disk diffusion/E test. There were 49 patients with S. aureus keratitis; 17 (34.7%) were caused by methicillin-resistant S. aureus (MRSA) and 9 (18.4%) isolates had PVL genes. The predominant genotyping of MRSA isolates was CC59/PFGE type D/SCCmec VT/PVL (+). All methicillin-sensitive S. aureus (MSSA) and approximately 60% MRSA were susceptible to fluoroquinolones. No significant differences in clinical features, treatments, and visual outcomes were observed between MRSA/MSSA or PVL(+)/PVL(−) groups. In Taiwan, approximately one third of S. aureus keratitis was caused by MRSA, mainly community-associated MRSA. Although MRSA isolates were more resistant than MSSA, clinical characteristics were similar between two groups. Fluoroquinolones could be good empiric antibiotics for S. aureus keratitis.

Anatomical and functional outcomes of retinal detachment associated with nontraumatic giant retinal tears compared to simple rhegmatogenous retinal detachment

Background

To compare the functional and anatomical outcomes of primary surgery in patients with giant retinal tear (GRT)-associated retinal detachment (GRT-RD) to patients with simple rhegmatogenous RD (RRD).

Methods

This is a retrospective study at the CHU de Québec - Université Laval. Medical records of all consecutive patients operated for RD between 2014 and 2018 were reviewed. Patients with GRT-RD and RRD were included. Preoperative, intraoperative, and postoperative data were compared between both groups, including extension of giant tears, number of RD quadrants, preoperative macula and lens status, type of surgery, best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) preoperatively and at follow-up, and single surgery anatomical success (SASS).

Results

There were 39 patients (1.7%) with GRT-RD and 1661 patients (74%) with RRD. Median [Q1, Q3] ages were 59 [52, 62] years and 62 [56, 69] years (p = 0.003), while number of affected quadrants were 2 [2, 3] and 2 [2, 3] (p = 0.96) in GRT-RD and RRD patients, respectively. In GRT-RD patients, GRT size was 120 [90, 150] degrees. Final BCVA was 0.30 [0.10, 0.30] and 0.30 [0.10, 0.40] (p = 0.76) in GRT and RRD patients, respectively. SSAS was 82% (32/39) in the GRT-associated-RD group and 90% (1495/1661) in the RRD group (p = 0.10). After correcting for other preoperative factors, GRT was a risk factor for worse SSAS (odds ratio: 0.422, p = 0.047).

Conclusions

GRT-RD is still challenging to treat, and our results suggest that it is a risk factor for poorer SSAS.

Incidence and Visual Outcomes of Endophthalmitis After Intravitreal Injection of Dexamethasone Implant vs Ranibizumab

Purpose

To compare the incidence and visual outcomes of endophthalmitis after injection of an intravitreal dexamethasone implant and injection of intravitreal ranibizumab.

Methods

This retrospective cohort study assessed endophthalmitis in eyes receiving an intravitreal injection of a 0.7 mg dexamethasone implant (DEX group), 0.5 mg ranibizumab (R5 group), or 0.3 mg ranibizumab (R3 group) between January 1, 2016, and May 31, 2018, at 2 large retina practices in the United States.

Results

Suspected endophthalmitis occurred in 5 eyes after 4973 DEX injections, 43 eyes after 163 974 R5 injections, and 6 eyes after 18 954 R3 injections. Suspected endophthalmitis was significantly more common in the DEX group (1/995) than in the R5 group (1/3813) (P = .008) but not than in the R3 group (1/3159) (P = .10). Visual acuity outcomes were similar in the 3 groups.

Conclusions

Suspected endophthalmitis might be more common after 0.7 mg dexamethasone injections than after 0.5 mg ranibizumab injections. Culture-positive endophthalmitis rates were similar across all 3 medications.

Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia

Purpose

To investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area.

Methods

This retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained.

Results

A total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > -3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was -8.66 ± 0.92 (range: -3.00--12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important.

Conclusion

In the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.

Endophthalmitis After Intravitreal Anti-Vascular Endothelial Factor Injections: Outcomes of Eyes Managed Without Microbiologic Cultures

PURPOSE

To evaluate outcomes of eyes that developed endophthalmitis after intravitreal anti-vascular endothelial growth factor injections that were managed without microbiologic cultures.

DESIGN

Retrospective, single-center, comparative cohort study.

METHODS

We included all eyes with postinjection endophthalmitis from July 1, 2013, to September 1, 2019. Endophthalmitis cases were divided into the culture group if treated with intravitreal antibiotics and a vitreous or aqueous tap sent for microbiologic sampling or into the no culture group if treated with immediate injection of intravitreal antibiotics with an anterior chamber paracentesis that was not sent for microbiologic sampling. The main outcome measures were visual acuity, the incidence of retinal detachment, and the need for additional procedures.

RESULTS

Of 165 endophthalmitis cases identified, 119 (72%) were in the culture group and 46 (28%) were in the no culture group. At endophthalmitis presentation, eyes in the culture group had a mean logMAR VA of 1.98 (∼20/1900) compared with 1.90 (∼20/1600) for eyes in the no culture group (P = .589). At the 6-month follow-up, the mean vision loss was 5.5 lines lost from baseline for the culture group compared with 2.5 lines lost for the no culture group (P = .017). Eyes in the culture group required a subsequent pars plana vitrectomy in 29 of 119 cases (24%) compared with 7 of 46 cases (15%) in the no culture group (P = .29). Six of 119 eyes (5%) in the culture group developed secondary retinal detachments compared with none in the no culture group (P = .143).

CONCLUSIONS

When access to microbiologic facility is not available, the management of postinjection endophthalmitis using intravitreal antibiotics without microbiologic cultures may be an acceptable treatment strategy.

Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle

PURPOSE

To compare outcomes following primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).

METHODS

This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated RRD repaired using PPV only or PPV-SB (full cohort: n=1516, propensity-matched cohort: n=908). The primary outcome was single surgery anatomic success (SSAS), while secondary outcomes were 3-month and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR) and final retina status.

RESULTS

In the full cohort, SSAS was achieved in 745 (91%) of PPV patients vs. 623 (89%) of PPV-SB patients (p=0.13). This was 390 (92%) vs. 314 (88%) in phakic patients (p=0.06) compared to 353 (91%) vs. 301 (90%) in pseudophakic patients (p=0.79), respectively. After matching, SSAS was achieved in 424 (93%) of PPV patients vs. 412 (91%) of PPV-SB patients (p=0.14). Median PHVA after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: p<0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: p<0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: p<0.001).

CONCLUSION

Addition of SB does not significantly change the rate of SSAS compared to PPV only in primary uncomplicated RRD. It is also associated with worse PHVA at follow-up.

Validation and comparison of five preference-based measures among age-related macular degeneration patients: evidence from mainland China

PURPOSE

To compare the psychometric properties of five preference-based measures (PBMs) among patients with age-related macular degeneration (AMD) in mainland China, including three health-related quality of life (HRQoL) measures [the 15D, the Assessment of Quality of Life (AQoL)-7D, and EQ-5D-5L] and two capability wellbeing measures [the ICEpop CAPability measure for Adults (ICECAP-A) and ICECAP measure for Older people (ICECAP-O)].

METHODS

A convenience sampling framework was used to successively recruit inpatients with AMD who attended a large ophthalmic hospital in Jinan, China. Psychometric properties (known-group validity, concurrent validity, and sensitivity) were assessed. The agreements between PBMs were reported.

RESULTS

A valid sample of 210 AMD inpatients (median duration: 12 months) was analyzed. Overall, the AQoL-7D had the best performance based on the psychometric tests been conducted. Sufficient evidence was found on psychometric properties for other 2 preference-based HRQoL measures. The ICECAP-A outperformed ICECAP-O on known-group validity and concurrent validity whereas opposite results were found on sensitivity. The Bland-Altman plots indicate that there was no pair of PBMs that could be used interchangeably.

CONCLUSIONS

The AQoL-7D had shown better psychometric properties than other four PBMs based on Chinese AMD inpatients. The EQ-5D-5L demonstrated sufficient psychometric properties and given the availability of a Chinese-specific tariff and the recommendations of China guidelines for pharmacoeconomic evaluations, it may be prioritized to be used in China. Capability wellbeing instruments could also be considered given they provide information that goes beyond health. Further evidence on responsiveness and reliability for all five PBMs among AMD patients is required.

SURGICAL FAILURES AFTER PRIMARY SCLERAL BUCKLING FOR RHEGMATOGENOUS RETINAL DETACHMENT: Comparison of Eyes With and Without Proliferative Vitreoretinopathy

PURPOSE

To compare proliferative vitreoretinopathy (PVR)-related surgical failure and non-PVR-associated failure after scleral buckling for primary rhegmatogenous retinal detachment.

METHODS

In this single-center, retrospective, consecutive case series, eyes with surgical failure after scleral buckling for primary rhegmatogenous retinal detachment were identified. Eyes with surgical failure were categorized as PVR-associated and non-PVR-associated failure, and these groups were compared.

RESULTS

Of the 530 scleral buckling procedures performed, 69 were surgical failures (13%), of which 27 of the 530 (5%) were due to PVR and 42 of the 530 (8%) were from non-PVR causes. Patients with PVR-associated failure were more likely to be smokers (P < 0.001), have a delayed presentation after symptoms (P = 0.011), have preoperative vitreous hemorrhage (P = 0.004), and have preoperative PVR (P = 0.002). Multivariate logistic regression models showed that the odds of PVR-associated failure were greater in eyes with preoperative vitreous hemorrhage (odds ratio, 8.2; P = 0.048), preoperative PVR (odds ratio, 22.7; P = 0.023), and among previous smokers (odds ratio, 28.8; P < 0.001). Thirty-two of 69 patients (46%) required one additional surgical intervention, and 37 of the 69 patients (53%) required two or more additional interventions to achieve final reattachment.

CONCLUSION

Proliferative vitreoretinopathy-related surgical failure after primary scleral buckling was 5%. Risk factors for PVR-associated failure parallel those commonly referenced for pars plan vitrectomy, including smoking history, preoperative vitreous hemorrhage, and preoperative PVR.

Impact of patient face mask use on endophthalmitis after intravitreal anti-VEGF injections

OBJECTIVE

To compare the incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections with and without patient face masking.

DESIGN

Two-centre retrospective cohort study PARTICIPANTS: Patients receiving a total of 28 501 injections (period 1 before masking: n = 13 863; period 2 after masking: n = 14 638) METHODS: Periods before and after implementation of patient masking were compared: period 1 (July-December 2019) and period 2 (July-December 2020). All patients requiring treatment for endophthalmitis following intravitreal anti-VEGF injections were reviewed. Endophthalmitis risks were compared. Statistical simulations were run to determine the number of injections or endophthalmitis cases required to detect a statistically significant difference between both periods.

RESULTS

Five patients (0.036%) had endophthalmitis in period 1 compared with 7 patients (0.048%) in period 2. Odds ratio, 95% confidence interval, for risk of patient masking was 1.326, 0.421-4.179 (p = 0.63). Three patients (0.022%) in period 1 had culture-positive endophthalmitis compared with 2 patients (0.014%) in period 2. Risk of patient masking for culture-positive endophthalmitis was 0.631, 0.105-3.779 (p = 0.61). Assuming similar rates of endophthalmitis, 476,806 injections in both groups would be required to detect a significant difference. Alternatively, assuming that masking would increase endophthalmitis risk in period 2, a significant difference would require twice as many cases (n = 15, 0.102%) for a risk of 2.843, 1.033-7.825 (p = 0.043).

CONCLUSIONS

The implementation of patient masking in clinical practice did not significantly alter the rate of endophthalmitis following intravitreal anti-VEGF injections.

Systemic Immunosuppression and Risk of Endophthalmitis After Intravitreal Anti-Vascular Endothelial Growth Factor Injections

BACKGROUND AND OBJECTIVE

To evaluate the impact of systemic immunosuppressive therapy on the rates and outcomes of endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injections.

PATIENTS AND METHODS

A retrospective, single-center, comparative cohort study examining eyes undergoing intravitreal anti-VEGF injections from January 2016 to September 2019. Cohorts were created based on concurrent immunosuppressive therapy at time of injection.

RESULTS

Of 270,347 anti-VEGF injections administered, 1,300 injections (0.48%) were administered while on systemic immunosuppressive therapy. The odds of endophthalmitis occurring in the immunosuppression group was 9.86 (95% confidence interval [CI], 4.0-24.3; P < .001) times higher than the no-immunosuppression group. Symptom onset occurred 2.51 (95% CI, 0.15-4.870; P = .040) days earlier in the immunosuppression cohort; visual acuity at 6 months after treatment was similar in both groups.

CONCLUSIONS

Patients on systemic immunosuppressive medications undergoing intravitreal injections may be at increased risk for post-injection endophthalmitis and may have earlier symptom onset. However, visual outcomes were similar between the two groups. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S17-S22.].

Progression of optic atrophy in traumatic optic neuropathy: retrograde neuronal degeneration in humans

OBJECTIVE

We used optical coherence tomography (OCT) to document the time course of retrograde neuronal degeneration following indirect optic nerve injury.

METHODS

We retrospectively studied patients diagnosed with unilateral indirect traumatic optic neuropathy (TON). Patients with total or near-total optic atrophy were included. All patients underwent complete ophthalmological examinations, including OCT imaging, within 1 day and at 1, 2, 3, 4, 6, 8, 12, 24, and 48 weeks after trauma.

RESULTS

The mean thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL) and macular retinal ganglion cell-inner plexiform layer (mGCIPL) decreased significantly at 2 weeks after trauma (p = 0.027 and p = 0.043). Changes in mGCIPL thickness preceded changes in cpRNFL thickness. The rates of reduction in mGCIPL and cpRNFL thicknesses were greatest between 2 to 4 weeks and 4 to 6 weeks after trauma. The reduction in mGCIPL thickness then slowed, and stabilized at 12 weeks after trauma. The proportions of cpRNFL and mGCIPL losses at 2, 4, 6, 8, and 12 weeks compared to 24 weeks were 17.1, 33.7, 59.8, 77.9, and 87.9% and 30.0, 73.3, 76.1, 88.3, and 97.9%, respectively.

CONCLUSIONS

OCT revealed optic atrophy progression 2 weeks after trauma, which was most rapid from 2 to 6 weeks, and then gradually stabilized. Loss of retinal ganglion cell bodies and dendrites seemed to precede the axonal degeneration. Observations of morphological changes in retinal layers using OCT in TON patients improve our understanding of retrograde neuronal degeneration of the central nervous system.

THE EFFECT OF ENDOPHTHALMITIS ON RECURRENCE OF MACULAR EDEMA IN EYES RECEIVING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR

PURPOSE

Visual outcomes after postinjection endophthalmitis have been well-studied, but the effect of endophthalmitis on the underlying exudative disease process remains unclear. We investigate the need for continued anti-vascular endothelial growth factor injections after endophthalmitis.

METHODS

Eyes that developed endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor between January 1, 2016, and May 31, 2018, at a single academic retina practice were identified. Retrospective chart review was performed to determine 1) the proportion of eyes without recurrence of macular edema or subretinal fluid after endophthalmitis and 2) the proportion achieving a 12-week or greater interval between anti-vascular endothelial growth factor injections or exudation after endophthalmitis compared with internal controls before endophthalmitis.

RESULTS

Of 50 eyes with endophthalmitis, seven (14.0%) had no fluid recurrence at a mean of 98.1 week. Of 43 eyes with recurrence, 48.0% achieved a >12-week recurrence-free interval after endophthalmitis (vs. 8.3% before endophthalmitis; P < 0.0001). Eyes with compared to those without choroidal neovascularization were more likely to achieve this interval (60.5% vs. 8.3%, respectively; P = 0.002).

CONCLUSION

Endophthalmitis after anti-vascular endothelial growth factor injection is associated with relative stability of the underlying exudation. Further research is necessary to elucidate the mechanism, which may be useful in developing strategies and targets for the treatment of exudative macular diseases.

The Influence of Universal Face Mask Use on Endophthalmitis Risk after Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Purpose

Routine use of face masks for patients and physicians during intravitreal anti–vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE).

Design

Retrospective, multicenter, comparative cohort study.

Participants

Eyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers.

Methods

Cases were divided into a “no face mask” group if no face masks were worn by the physician or patient during intravitreal injections or a “universal face mask” group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections.

Main Outcome Measures

Rate of endophthalmitis, microbial spectrum, and visual acuity (VA).

Results

Of 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the “no face mask” group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the “universal face mask” group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51–1.18; P = 0.097). In the “no face mask” group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) in the “universal face mask” group (OR, 0.46; 95% CI, 0.22–0.99; P = 0.041). Three cases of oral flora–associated endophthalmitis occurred in the “no face mask” group (0.001%; 1 in 98 171 injections) compared with 1 (0.0005%; 1 in 211 454) in the “universal face mask” group (P = 0.645). Patients presented a mean (range) 4.9 (1–30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (~20/2200) for “no face mask” group compared with 1.65 (~20/900) for the “universal face mask” group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764).

Conclusions

In a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups.

Genotype and Long-term Clinical Course of Bietti Crystalline Dystrophy in Korean and Japanese Patients

PURPOSE

To investigate the genotype and long-term clinical phenotype of patients with Bietti crystalline dystrophy (BCD) in Korea and Japan.

DESIGN

Retrospective case series.

PARTICIPANTS

We analyzed 62 patients with clinical features of BCD who harbor pathogenic biallelic CYP4V2 variants in their homozygote or compound heterozygote.

METHODS

Data were collected from patient charts, including age, best-corrected visual acuity (BCVA), Goldmann perimetry results, fundus photography, OCT findings, fundus autofluorescence results, and electroretinography findings. We compared the clinical course of the patients with homozygous c.802-8_810de117insGC [exon7del], the most common mutation in the East Asian population, with those of the patients with other genotypes.

MAIN OUTCOME MEASURES

Best-corrected visual acuity, visual field (VF), and their changes during follow-up.

RESULTS

The mean age at the first visit was 55.2 years, with a mean follow-up of 7.1 years. The mean BCVAs at the first and last visits were 0.28 logarithm of the minimum angle of resolution (logMAR) and 0.89 logMAR, respectively. In genetic testing, c.802-8_810de117insGC was detected in 86 of 124 alleles of the patients, and 36 patients were homozygous for this mutation. The age, BCVA, VF area, central foveal thickness, and abnormal hypoautofluorescent area at either the first or last visit were not different between the exon7del homozygotes and the others. The mean BCVA changes per year were 0.089 logMAR in the exon7del homozygotes and 0.089 logMAR in the others. An age- and gender-adjusted linear regression analysis showed no association between the exon7del homozygote status and the rate of vision loss. Characteristic crystalline deposits in the posterior pole were generally observed in younger patients and disappeared over time along with progressive retinochoroidal atrophy.

CONCLUSIONS

Patients with BCD and a homozygote for c.802-8_810de117insGC accounted for more than 50% of this cohort of Korean and Japanese patients, and the clinical effect of this deleterious variant was not severe in the spectrum of CYP4V2 retinopathy.

The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti-Vascular Endothelial Growth Factor Injections

PURPOSE

To evaluate the effect of physician face mask use on rates and outcomes of postinjection endophthalmitis.

DESIGN

Retrospective, comparative cohort study.

METHODS

Setting: Single-center. StudyPopulation: Eyes receiving intravitreal anti-vascular endothelial growth factor injections from July 1, 2013, to September 1, 2019.

INTERVENTION

Cases were divided into "Face Mask" group if face masks were worn by the physician during intravitreal injections or "No Talking" group if no face mask was worn but a no-talking policy was observed during intravitreal injections. MainOutcomeMeasures: Rate of endophthalmitis, visual acuity, and microbial spectrum.

RESULTS

Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the No Talking group, and 9 out of 30,162 (0.0298%) cases occurred in the Face Mask group (odds ratio, 0.81; 95% confidence interval, 0.41-1.57; P = .527). Sixteen cases of oral flora-associated endophthalmitis were found in the No Talking group (1 in 28,341 injections), compared to none in the Face Mask group (P = .302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the No Talking group compared to the Face Mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; P = .031), though no difference was observed at 6 months after treatment (P = .479).

CONCLUSION

Physician face mask use did not influence the risk of postinjection endophthalmitis compared to a no-talking policy. However, no cases of oral flora-associated endophthalmitis occurred in the Face Mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly attributable to oral flora.

Resolution of Pseudophakic Cystoid Macular Edema: 2 mg Intravitreal Triamcinolone Acetonide versus 40 mg Posterior Sub-Tenon Triamcinolone Acetonide

PURPOSE

To compare 2 mg intravitreal triamcinolone (IVT) versus 40 mg posterior sub-Tenon triamcinolone acetonide (STT) for the treatment of eyes with pseudophakic cystoid macular edema.

METHODS

A retrospective, single-center review of eyes receiving 2 mg IVT between 3/1/2012-3/1/2017 and 40 mg STT between 1/1/2015-3/1/2017. Visual acuity (VA) and central macular thickness (CMT) were recorded at baseline, 1-, 3-, and 6-month follow-up visits.

RESULTS

Forty-five eyes were included in the IVT group and 50 eyes in the STT group. Change in VA from baseline to 1, 3, and 6 months was not significantly different between IVT and STT (6 months: 2.3 lines vs. 2.4 lines, p = .10). The IVT group achieved significantly better CMT improvement from baseline compared to STT at 1 month (255 μm vs. 187 μm; p = .03), but this difference was not present at month 3 (214 μm vs. 212 μm; p = .79) or month 6 (176 μm vs. 207 μm; p = .29). During the 6-month follow-up period, approximately 7% of eyes in the IVT group and 12% of eyes in the STT group developed ocular hypertension (p = .43), and all cases were successfully managed with topical anti-ocular hypertensive therapy or observation.

CONCLUSIONS

2 mg IVT and 40 mg STT both achieved significant improvement in vision and CMT with no significant difference between interventions at 3- and 6-month follow-up.

Endophthalmitis following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy: Changes in Incidence and Outcomes over a 9-Year Period

Aims: To evaluate whether the incidence, microbial spectrum, and visual outcomes of endophthalmitis following intravitreal injections have changed over time.Methods: Retrospective cohort study of endophthalmitis in eyes receiving intravitreal injection of anti-vascular endothelial growth factor between 2009-2012 and 2016-2017 at a single, large retina practice.Results: A total of 283,315 injections resulted in 96 suspected infectious endophthalmitis cases. Comparing 2009-2012 and 2016-2017, the rate of suspected endophthalmitis changed from 1 in 2,663 injections to 1 in 3,195 injections (p = .37). Visual outcomes 6 months after endophthalmitis were significantly better during the latter period (p = .04), with an average loss of 6.3 lines of VA in 2009-2012 compared to a loss of 3.6 lines in 2016-2017. In multivariate analysis, a "no-talking" policy during injections resulted in a trend towards a decrease in endophthalmitis incidence (p = .08). Cessation of post-injection topical antibiotic use did not independently decrease endophthalmitis incidence (p = .24) when the effect of a "no-talking" policy was taken into account. A lower rate of endophthalmitis was seen after prefilled vs. conventionally prepared ranibizumab syringe use for injection (0.014% vs. 0.035%, respectively), though this difference did not meet statistical significance (p = .16).Conclusion: The incidence of endophthalmitis after intravitreal injection decreased and visual outcomes improved between the periods of 2009-2012 and 2016-2017. A "no-talking" policy during injections was associated with a trend toward a decrease in endophthalmitis rate.

A 14-Year Retrospective Analysis of Endogenous Endophthalmitis in a Tertiary Referral Center of Southern Thailand

Purpose

To investigate patient characteristics, clinical features, common causative organisms, and visual acuity outcomes in endogenous endophthalmitis.

Methods

This was a retrospective chart analysis of patients with endogenous endophthalmitis between January 2006 and December 2019. Collected data included basic patient characteristics, presenting symptoms, causative organisms, treatments, and 3-month and 1-year visual outcomes.

Results

Twenty-nine eyes of 27 patients were included in the study. The mean age of the patients was 45.4 ± 19.9 years, and 63% were female. Visual acuity at presentation ranged from counting fingers to no light perception. Systemic comorbidities presented in 66.7% of the patients, the majority of which were related to diabetes mellitus (48.1%). The most common primary infection was a urinary tract infection. Positive blood cultures were identified in 48.1% of patients, and positive cultures from vitreous and aqueous samples were identified in 59.3% and 31.6% of eyes, respectively. Among all the specimens, Gram-positive bacteria were identified in 55.5%, Gram-negative bacteria in 22.2%, fungi in 14.8%, and mixed organisms in 7.4%. Among ocular specimens, 61.1% contained Gram-positive organisms, 16.7% contained Gram-negative organisms, and 22.2% contained fungi. Streptococcus spp. was the most common causative organism. From 29 eyes, 18 (62.1%) underwent vitrectomy, and 12 (42.9%) underwent either evisceration or enucleation. Positive vitreous culture was significantly associated with unfavorable final visual outcome. Final visual acuity ranged from 20/125 to no light perception. Although visual improvement at 3 months was significantly better in younger patients, this had no impact on final visual outcome at 1 year.

Conclusion

Eyes with positive vitreous cultures had significantly poorer visual outcomes. Despite full treatment coverage, visual prognosis was extremely poor and the rates of blindness and evisceration/enucleation were still high.

Visual Function and Visual Acuity in An Urban Adult Population

In this survey, 6,850 Baltimore residents aged 40 and older were interviewed about activities they had difficulty doing or could no longer do because of poor vision. One-fourth of the sample reported limitations in activities, most frequently reading and other near-vision tasks, because of poor vision. In addition to poor vision, general health status, educational level, and time since the last eye care visit were associated with the loss of visual function.

Endophthalmitis after Cataract Surgery: Changes in Management Based on Microbiologic Cultures

PURPOSE

To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery.

DESIGN

Retrospective, single-center, cohort study.

PARTICIPANTS

All patients treated for endophthalmitis after cataract surgery between January 1, 2014, and December 31, 2017, at a single institution.

METHODS

Endophthalmitis cases were determined from billing records and confirmed with chart review. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy.

MAIN OUTCOME MEASURES

A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity (VA).

RESULTS

A total of 111 eyes of 111 patients were treated for endophthalmitis after cataract surgery, of which 57 (51%) were culture-positive. After initial treatment of endophthalmitis, a change in clinical management after vitreous culture occurred in 9 of 111 eyes (8%), including 6 of 57 (11%) culture-positive eyes compared with 3 of 54 (6%) culture-negative eyes (P = 0.49). Change in clinical management for culture-positive eyes was based on declining vision (3 eyes), worsening clinical examination results (2 eyes), and retinal detachment (1 case). Change in clinical management for culture-negative endophthalmitis eyes was based on worsening clinical examination results (2 eyes) and declining vision (1 eye). No additional interventions were initiated on the basis of positive culture results. At final follow-up, mean logarithm of the minimum angle of resolution (logMAR) VA was 1.09 (∼20/250) for the culture-positive eyes compared with 0.59 (∼20/80) for culture-negative eyes (adjusted difference, 0.394; 95% confidence interval, 0.02-0.77, P = 0.03). Rhegmatogenous retinal detachments (RRDs) or retinal tears occurred in 19 of 111 eyes (17%) after developing endophthalmitis, and culture-positive eyes developed a secondary RRD in 11 of 57 eyes (19%) compared with 3 of 54 (6%) culture-negative eyes (P = 0.03).

CONCLUSIONS

After endophthalmitis related to cataract surgery, vitreous cultures may have prognostic value for final visual outcomes but have a limited effect on clinical management.

Association of CRX genotypes and retinal phenotypes confounded by variable expressivity and electronegative electroretinogram

IMPORTANCE

A framework for understanding the phenotypic features of CRX retinopathy was established.

BACKGROUND

To perform a phenotype-genotype correlation analysis in two groups of patients with heterozygous mutations in distinct locations of the CRX gene, encoding the cone-rod homeobox.

DESIGN

Multicentre retrospective study.

PARTICIPANTS

Twenty-one Japanese patients from 14 families with a heterozygous CRX mutation.

METHODS

Retrospective data analysis.

MAIN OUTCOME MEASURES

Clinical records on CRX mutation, symptoms, best-corrected visual acuity (BCVA), visual field, fundus photography, fundus auto-fluorescence, optical coherence tomography and electroretinograms (ERGs).

RESULTS

Six different CRX heterozygous mutations were identified in the subjects. Twelve patients from 9 families shared the p.R41W mutation and 1 patient had the p.R43C mutation, both of which affect the homeobox domain of CRX. These patients often displayed adult-onset retinal dystrophy with macular degeneration. In contrast, five patients with downstream mutations (p.S204fs, p.S213fs, p.G243X and p.L299F) displayed retinal degeneration or macular degeneration with bone-spicule pigmentation. Three asymptomatic carriers with different mutations (p.R41W, p.S213fs and p.G243X) were present in both groups. Nearly all patients and carriers had an electronegative ERG in response to a bright flash under dark adaptation. There was no cross-sectional association between patients' age and BCVA, despite progressive decline in BCVA.

CONCLUSIONS AND RELEVANCE

Heterozygous mutations within or downstream of the homeobox domain in CRX relate to the difference associated retinal phenotypes, which was confounded by variable expressivity and electronegative ERGs. CRX mutations should be considered in patients with an electronegative ERG with minimal or no macular changes.

Changes in Management Based on Vitreous Culture in Endophthalmitis After Intravitreal Anti-vascular Endothelial Growth Factor Injection

PURPOSE

To assess whether vitreous culture results affect the clinical management of patients with acute endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection.

DESIGN

Retrospective case series.

METHODS

Setting: Single-center.

STUDY POPULATION

Patients who developed endophthalmitis after intravitreal injection of aflibercept, bevacizumab, or ranibizumab between January 1, 2016, and May 31, 2018.

OBSERVATION

A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy.

MAIN OUTCOME MEASURES

A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity.

RESULTS

Of 204,986 intravitreal anti-VEGF injections performed, 60 cases (0.0293%) of endophthalmitis were identified, 18 of which were culture-positive. Six of 60 eyes (10%) had a change in clinical management. A change in clinical management was initiated in 3 of 18 (17%) culture-positive cases compared to 3 of 42 (7%) culture-negative cases (P = .357). Changes in management for culture-positive cases were performed based on declining vision (2 cases) and worsening clinical examination (1 case). Changes in management for culture-negative endophthalmitis cases were performed based on declining vision (1 case) and worsening clinical examination (2 cases). No additional interventions were initiated based on positive-culture results. Comparing vision loss from baseline by culture result, at final follow-up, oral flora-associated culture-positive cases lost 17.5 lines, non-oral flora-associated culture-positive cases lost 9.1 lines, and culture-negative cases lost 2.5 lines of vision (P < .001).

CONCLUSION

Following endophthalmitis from intravitreal injection of anti-VEGF agents, vitreous culture data may help prognosticate visual outcomes but appear to have a limited effect on clinical management.

Patients’ Perceptions of the Need for Low Vision Devices

This pilot study of the perceptions of 149 men and women, aged 50 and older, of their need for low vision devices found that the most frequently reported uses of low vision devices were for close, intermediate, and distance reading tasks; television viewing; recognizing people; and finding items.

Phenotypic Features of Oguchi Disease and Retinitis Pigmentosa in Patients with S-Antigen Mutations: A Long-Term Follow-up Study

PURPOSE

To present phenotypic features of 22 patients with S-antigen (SAG) mutations.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Twenty-one Japanese patients from 16 families with a homozygous c.924delA mutation and 1 patient with a homozygous c.636delT mutation in the SAG gene.

METHODS

Clinical records on symptoms; best-corrected visual acuity; and Goldmann perimetry, fundus photography, fundus autofluorescence (FAF), OCT, and electroretinography results were reviewed.

MAIN OUTCOME MEASURES

Best-corrected visual acuity, Goldmann perimetry results, imaging findings, and electroretinography results.

RESULTS

Ten patients had Oguchi disease and 12 had retinitis pigmentosa (RP) with mean follow-up periods of 13.8 and 10.2 years, respectively. Retinitis pigmentosa patients were older (mean age, 56.0 years) than those with Oguchi disease (mean age, 22.1 years; P < 0.001) at the initial visit. Night blindness noted in childhood was the most common initial symptom for both Oguchi disease (80.0%) and RP (91.7%) patients. Best-corrected visual acuity in the logarithm of the minimum angle of resolution (logMAR) was well preserved in Oguchi disease patients (mean, 0.02 logMAR in both eyes) but reduced in most RP patients (mean, 1.32 logMAR [right eye] and 1.35 logMAR [left eye]). Similarly, the visual field in the retinal area was preserved in Oguchi disease patients (mean, 677 mm² right eye and 667 mm² left eye) and reduced in RP patients (mean, 369 mm² right eye and 294 mm² left eye). Fundus images revealed a characteristic golden sheen with no retinal degeneration in Oguchi disease patients, excluding 2 with macular degeneration detected by FAF, OCT, or both and 1 with mild retinal degeneration confirmed by OCT and fluorescein angiography. Pigmentary retinal degeneration most evident posteriorly was observed in RP patients, accompanied by a characteristic golden sheen in 12 of 14 patients undergoing ultra-widefield fundus imaging. OCT showed disrupted macular structure, and FAF revealed variable hypofluorescence. Electroretinography identified absent rod responses in both diseases, along with relative preservation of cone responses in Oguchi disease patients. Three patients showed progressive loss of the golden sheen based on fundus images, including 1 who demonstrated RP 26 years after the initial diagnosis of Oguchi disease.

CONCLUSIONS

Retinitis pigmentosa with SAG mutations often shows a characteristic golden sheen surrounding posterior pigmentary retinal degeneration. Oguchi disease can show progressive degeneration in adulthood, rarely resulting in RP.

Development of a vision impairment score for the assessment of functional vision in dogs: Initial evidence of validity, reliability, and responsiveness

AIM

To describe the development and initial validation of a questionnaire measuring functional vision in dogs.

METHODS

A 17-item survey was designed to quantify functional vision in dogs. The Vision Impairment Score (VIS) was determined by summing responses to each question. Questions were assigned to one of five subcategories: overall vision, daily activities, peripheral vision, near vision, and distance vision. Content validity was established during development phases, and construct validity via comparing results of known groups (blind vs sighted; normal vs impaired vision; surgery to improve vision vs nonrestorative surgery), and through factor analysis. Concurrent criterion validity was determined with use of a validated health-related quality-of-life (HRQL) assessment tool. Reliability and responsiveness assessments were investigated using intraclass correlation coefficient (ICC) and effect size (ES), respectively.

RESULTS

Responses (221) from 201 dog owners were included. Compared to sighted dogs (n = 153), blind dogs (n = 48) had a higher VIS and greater impairment in all subcategories. Among sighted dogs, a higher VIS was obtained in dogs with low vision compared to those with normal vision (P < 0.001). A higher VIS was associated with poorer HRQL (P < 0.001). Perfect reliability was obtained for 6/17 questions, and excellent reliability for 11/17 questions (intraclass correlation 1.0 and >0.9, respectively), and the VIS was highly responsive to therapeutic intervention (effect size 1.46).

CONCLUSION

Results suggest the VIS may be clinically useful in assessing and obtaining a quantifiable measure of functional vision in dogs. Ongoing validation of the tool for clinical use is needed.

The Impact of Prefilled Syringes on Endophthalmitis Following Intravitreal Injection of Ranibizumab

PURPOSE

To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation.

DESIGN

Multicenter retrospective cohort study.

METHODS

All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum.

RESULTS

A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group.

CONCLUSION

In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.

Patient-reported outcome measuring tools in cataract surgery: Clinical comparison at a tertiary hospital

PURPOSE

To assess the performance of patient-reported outcome measure questionnaires and determine their appropriateness for routine use in cataract patients.

SETTING

Moorfields Eye Hospital, London, United Kingdom.

DESIGN

Prospective cohort study.

METHODS

Patients having cataract surgery between February and March 2013 were recruited. The following 4 questionnaires-Catquest-9SF, EuroQol 5-dimensions questionnaire (EQ-5D) and visual analog scale (EQ-VAS), National Eye Institute Socioemotional Scale (NEI-SES), and short-form Visual Function Index (VF-8R)-were completed preoperatively and 3 weeks and 3 months postoperatively. The questionnaires' performances were then compared. The paired Student t test and Pearson correlations were used for statistical analysis.

RESULTS

One hundred twenty-two patients were recruited; 67.2% and 61.8% completed 3-week and 3-month follow-up, respectively. The changes in the mean scores for the Catquest-9SF, EQ-5D, EQ-VAS, NEI-SES, and VF-8R at 3 weeks were 120.86% (P < .0001), 1.61% (P = .61), 3.37% (P = .09), 16.12% (P = .12), and 61.76 % (P < .0001), respectively. At 3 months, the changes were 162.42% (P < .0001), 4.54% (P = .16), 4.84% (P = .09), 54.63% (P < .0001), and 87.55% (P < .0001), respectively. Correlations between patient-reported outcome measure questionnaires and visual acuity measures were variable and weak at best.

CONCLUSIONS

It is feasible to assess patient-reported outcomes in cataract surgery as part of routine clinical practice. In addition, visual acuity might not fully reflect patients' visual function. Clinicians should consider using patient-reported outcome measure questionnaires to facilitate surgical decision-making and outcome monitoring.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

Clinical observations of vitreoretinal surgery for four different phenotypes of X-linked congenital retinoschisis

AIM

To evaluate the outcomes of vitreoretinal surgery for four different phenotypes of X-linked retinoschisis (XLRS).

METHODS

This study included thirty-one eyes of 25 patients who developed XLRS with severe complications. Among the 31 eyes, there were 7 eyes with vitreous hemorrhage, 8 eyes with retinal detachment and vitreous hemorrhage, and 16 eyes with rhegmatogenous retinal detachment. All of the patients underwent standard three-port pars plana vitrectomy. All of the eyes were divided into 4 groups before surgery according to a modified classification scheme, with the first three groups as follows: group A, with foveal cystic schisis; group B with macular lamellar schisis; and group C with foveolamellar changes. Peripheral schisis was not present in these 3 groups; however, group D was a complex group with both macular and peripheral changes. One year after surgery, we analyzed the best corrected visual acuity and postoperative anatomical and functional outcomes of these 4 groups.

RESULTS

There were 7 eyes in group A (22.6%), 1 eye in group B (3.2%), 15 eyes in group C (48.4%) and 8 eyes in group D (25.8%). Postoperative anatomical and functional outcomes were satisfactory at the last visit, while the mean visual acuity was increased to 0.27±0.11, with a significant difference (t=-1.049, P=0.000) compared with the results before surgery (0.1±0.08). Visual acuity was improved in 23 eyes (74.2%). Complications were found in three eyes: two eyes with proliferative vitreoretinopathy and traction retinal detachment 10 and 12mo after surgery, respectively; and one eye with vitreous hemorrhage 15mo after surgery. These eyes were in groups C and D. The retinas remained attached in these 3 eyes after reoperation.

CONCLUSION

We should pay greater attention to XLRS with foveolamellar changes because it is the most changeable phenotype. Once complications occur, vitreoretinal surgery can significantly improve visual acuity and restore the anatomic structure of the retina.

Combined 23-gauge transconjunctival vitrectomy and scleral fixation of intraocular lens without conjunctival dissection in managing lens complications

Background

To evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection.

Methods

A retrospective study in Chang Gung Memorial Hospital, Keelung and Taoyuan, Taiwan. Patients receiving combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of IOL without conjunctival dissection were enrolled. The ocular findings, causes of lens complication, surgical procedures, type of IOL used, and complications were documented.

Results

We included 40 eyes from 39 patients (27 male, 12 female) with a mean age of 59.5 [standard deviation (±) 14.8] years old. The mean follow-up duration was 6.8 ± 5.4 months. The cause of lens complications was ocular trauma in 24 (60%) eyes, cataract surgery complications in 11 (28%) eyes, and spontaneous subluxation of crystalline lens in 5 (13%) eyes. The overall best corrected visual acuity (BCVA) (logMAR) improved from 1.359 ± 0.735 to 0.514 ± 0.582 (p < 0.001). The BCVA also improved significantly in each group with different causes of lens complications. Preoperative BCVA was the only factor associated with the postoperative visual outcome (p = 0.008). Most surgery-related complications were self-limited, including mild vitreous hemorrhage (5%), microhyphema (5%), transient elevated intraocular pressure (3%), and transient hypotony (3%). Cystoid macular edema and IOL decentration was found in 3 (8%) eyes and 1 (3%) eye respectively.

Conclusions

Combined 23-gauge transconjunctival vitrectomy and scleral fixation of IOL without conjunctival dissection is effective and safe in managing a wide variety of lens complications, with good postoperative comfort and visual recovery.

Trial registration

Retrospective study, not applicable.

Electronic supplementary material

The online version of this article (10.1186/s12886-018-0776-4) contains supplementary material, which is available to authorized users.

Glaucoma drainage device implantation with adjunctive intravitreal bevacizumab in neovascular glaucoma: 3-year experience

Purpose

To evaluate the outcome of glaucoma drainage device (GDD) implantation with and without intravitreal bevacizumab (IVB) injection in treating neovascular glaucoma (NVG) at Cipto Mangunkusumo Hospital Jakarta, Indonesia.

Patients and methods

This retrospective study involved 39 eyes with NVG which underwent GDD implantation between 2012 and 2014. Thirty eyes underwent GDD implantation alone (control group) while 9 eyes underwent GDD implantation and IVB injection (IVB group). Visual acuity (VA), intraocular pressure (IOP), number of antiglaucoma medications, and success rate were compared between groups.

Results

There were no significant differences in preoperative characteristics. On the last visit, VA was 2.6 (0.2–4.0) logMAR in the control group and 2.3 (0.4–4.0) logMAR in the IVB group (P=0.97). In the control group, final VA was significantly worse compared to initial VA (P<0.01), while in IVB group VA was apparently stable (P=0.24). Final IOP was 16.3±10.3 mmHg in the control group and 12.0 (2.0–49.0) mmHg in IVB group (P=0.40). The number of antiglaucoma medications was similar between groups (P=0.57). Surgical success rate in the IVB group (66.7%) was better than the control group (56.7%), but this difference was not statistically significant (P=0.71). Kaplan–Meier survival analysis showed the probability of success 37 months after surgery as 53.6% in the IVB group and 31.6% in the control group. No significant difference was found between the groups (P=0.45).

Conclusion

In cases of NVG, GDD combined with IVB could maintain VA compared to GDD alone. However, there were no significant differences in final IOP, number of antiglaucoma medications, and surgical success rate.

Development of the Ultra-Low Vision Visual Functioning Questionnaire (ULV-VFQ)

Purpose

To develop and psychometrically evaluate a visual functioning questionnaire (VFQ) in an ultra-low vision (ULV) population.

Methods

Questionnaire items, based on visual activities self-reported by a ULV population, were categorized by functional visual domain (e.g., mobility) and visual aspect (e.g., contrast) to ensure a representative distribution. In Round 1, an initial set of 149 items was generated and administered to 90 participants with ULV (visual acuity [VA] ≤ 20/500; mean [SD] age 61 [15] years), including six patients with a retinal implant. Psychometric properties were evaluated through Rasch analysis and a revised set (150 items) was administered to 80 participants in Round 2.

Results

In Round 1, the person measure distribution (range, 8.6 logits) was centered at −1.50 logits relative to the item measures. In Round 2, the person measure distribution (range, 9.5 logits) was centered at −0.86 relative to the item mean. The reliability index in both rounds was 0.97 for Items and 0.99 for Persons. Infit analysis showed four underfit items in Round 1, five underfit items in Round 2 with a z-score greater than 4 cutoff. Principal component analysis on the residuals found 69.9% explained variance; the largest component in the unexplained variance was less than 3%.

Conclusions

The ULV-VFQ, developed with content generated from a ULV population, showed excellent psychometric properties as well as superior measurement validity in a ULV population.

Translational Relevance

The ULV-VFQ, part of the Prosthetic Low Vision Rehabilitation (PLoVR) development program, is a new VFQ developed for assessment of functional vision in ULV populations.

Better Visual Outcome by Intraocular Lens Ejection in Geriatric Patients with Ruptured Ocular Injuries

Ocular trauma is one of the leading causes of visual impairment worldwide. Because of the popularity of cataract surgeries, aged individuals with ocular trauma commonly have a surgical wound in their eyes. The purpose of this study was to evaluate the visual outcome of cases that were coincident with intraocular lens (IOL) ejection in the eyes with ruptured open-globe ocular injuries. Consecutive patients with open-globe ocular injuries were first reviewed. Patients’ characteristics, corrected distance visual acuities (CDVAs) over 3 years after the trauma, causes of injuries, traumatic wound patterns, and coexistence of retinal detachment were examined. The relationships between poor CDVA and the other factors, including the complications of crystalline lens and IOL ejection, were examined. A total of 105 eyes/patients [43 eyes with rupture, 33 with penetrating, 28 with intraocular foreign body (IOFB), and 1 with perforating injuries] were included. Rupture injuries were common in aged patients and were mostly caused by falls, whereas penetrating and IOFB injuries were common in young male patients. CDVAs of the eyes with rupture injuries were significantly worse than those of the eyes with penetrating or IOFB injuries. CDVA from more than 50% of the ruptured eyes resulted in no light perception or light perception to 20/500. CDVA of the ruptured eyes complicated by crystalline lens ejection was significantly worse than that of those complicated by IOL ejection. The wounds of the ruptured eyes complicated by IOL ejection were mainly located at the superior corneoscleral limbus, whereas those of the eyes complicated by crystalline lens ejection were located at the posterior sclera. There were significant correlations between poor CDVA and retinal detachment and crystalline lens ejection. These results proposed a new trend in the ocular injuries that commonly occur in aged patients; history of cataract surgery might affect the final visual outcome after open-globe ocular injuries.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients' complaints and ocular diagnoses

PURPOSE

This study aimed to assess the consistency between patients' complaints and their eye diseases.

DESIGN

Cross-sectional study.

METHODS

RESULTS: The frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively).

CONCLUSIONS

Visually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.

Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration

PURPOSE

To assess changes in vision-related quality of life (VR-QoL) among patients with treatment-resistant neovascular age-related macular degeneration (nAMD) following intravitreal aflibercept treatment over 48 weeks.

METHODS

We conducted a prospective study in which 49 patients with nAMD resistant to anti-vascular endothelial growth factor therapy were switched to intravitreal aflibercept. Patients were treated with three loading doses every 4 weeks followed by injections every 8 weeks, for a total of 48 weeks. Ophthalmic examinations performed at each visit included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurement. The National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess VR-QoL at baseline and weeks 24 and 48. Changes in NEI VFQ-25 composite and subscale scores were analyzed using paired t tests. The relationship between the change in VR-QoL and changes in BCVA and CMT, and the impact of the better-seeing eye (BSE, defined as the eye reading the greater number of letters at baseline) vs. the worse-seeing eye (WSE, the fellow eye to the BSE) were assessed.

RESULTS

Mean NEI VFQ-25 composite scores improved significantly at weeks 24 and 48 compared to baseline (4.5 ± 9.2 and 4.4 ± 11.8, respectively, all p < 0.01). Among subscales, general vision and near and distance activities showed significant improvements at weeks 24 and 48 (all p < 0.05). Improvement in the NEI VFQ-25 composite score was significantly associated with increased BCVA at week 48 (β coefficient = 0.43, p = 0.029), but not with change in CMT (β coefficient = -0.007, p = 0.631). There was no association between VR-QoL changes and BSE or WSE.

CONCLUSION

Despite previous anti-VEGF treatment in this cohort, overall VR-QoL improved following aflibercept therapy over 48 weeks. This improvement was related to improved vision in treatment eyes regardless of whether they were the BSE or WSE.

Postinjection Endophthalmitis Rates and Characteristics Following Intravitreal Bevacizumab, Ranibizumab, and Aflibercept

PURPOSE

To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept.

DESIGN

Multicenter, retrospective cohort study.

METHODS

All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti-vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded.

RESULTS

A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection.

CONCLUSIONS

Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.

Postdischarge Falls and Readmissions: Associations with Insufficient Vision and Low Health Literacy among Hospitalized Seniors

The role of patient-level risk factors such as insufficient vision has been understudied. Because insufficient vision may interfere with health literacy assessments, the full impact of low health literacy among older patients with impaired vision is unknown. We sought to determine whether senior inpatients' insufficient vision and low health literacy are associated with adverse outcomes postdischarge, specifically falls and readmissions. We conducted an observational study of adult medicine inpatients at an urban hospital. Visual acuity and health literacy were screened at bedside. Outcomes data were collected by telephone 30 days postdischarge. Among 1,900 participants, 1,244 (65%) were reached postdischarge; 44% had insufficient vision and 43% had low health literacy. Insufficient vision was associated with postdischarge falls among participants ≥65 years (adjusted odds ratio [AOR] 3.38, 95% confidence interval [CI] 1.42-8.05), but not among participants <65 years (AOR 1.44, 95% CI 0.89-2.32). Low health literacy was associated with readmissions among participants ≥65 years (AOR 3.15, 95% CI 1.77-5.61), but not among participants <65 years (AOR 0.78, 95% CI 0.56-1.09). The results suggest the need to implement screening for older inpatients' vision and health literacy. Developing effective interventions to reduce these risks is critical given national priorities to reduce falls and readmissions.

Gene Therapy for Leber Hereditary Optic Neuropathy: Initial Results

PURPOSE

Leber hereditary optic neuropathy (LHON) is a disorder characterized by severe and rapidly progressive visual loss when caused by a mutation in the mitochondrial gene encoding NADH:ubiquinone oxidoreductase subunit 4 (ND4). We have initiated a gene therapy trial to determine the safety and tolerability of escalated doses of an adeno-associated virus vector (AAV) expressing a normal ND4 complementary DNA in patients with a G to A mutation at nucleotide 11778 of the mitochondrial genome.

DESIGN

In this prospective open-label trial (NCT02161380), the study drug (self-complementary AAV [scAAV]2(Y444,500,730F)-P1ND4v2) was intravitreally injected unilaterally into the eyes of 5 blind participants with G11778A LHON. Four participants with visual loss for more than 12 months were treated. The fifth participant had visual loss for less than 12 months. The first 3 participants were treated at the low dose of vector (5 × 10(9) vg), and the fourth participant was treated at the medium dose (2.46 × 10(10) vg). The fifth participant with visual loss for less than 12 months received the low dose. Treated participants were followed for 90 to 180 days and underwent ocular and systemic safety assessments along with visual structure and function examinations.

PARTICIPANTS

Five legally blind patients with G11778A LHON.

MAIN OUTCOME MEASURES

Loss of visual acuity.

RESULTS

Visual acuity as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) eye chart remained unchanged from baseline to 3 months in the first 3 participants. For 2 participants with 90-day follow-up, acuity increased from hand movements to 7 letters in 1 and by 15 letters in 1, representing an improvement equivalent to 3 lines. No one lost vision, and no serious adverse events were observed. Minor adverse events included a transient increase of intraocular pressure (IOP), exposure keratitis, subconjunctival hemorrhage, a sore throat, and a transient increase in neutralizing antibodies (NAbs) against AAV2 in 1 participant. All blood samples were negative for vector DNA.

CONCLUSIONS

No serious safety problems were observed in the first 5 participants enrolled in this phase I trial of virus-based gene transfer in this mitochondrial disorder. Additional study follow-up of these and additional participants planned for the next 4 years is needed to confirm these preliminary observations.

A 12-year review on the aetiology and surgical outcomes of paediatric rhegmatogenous retinal detachments in Hong Kong

PURPOSE

To evaluate the aetiology, clinical features, and surgical outcomes of paediatric rhegmatogenous retinal detachments (RRD) in Hong Kong.Patients and methodsThis is a retrospective consecutive case series of all patients aged 18 or under who underwent primary retinal detachment repair in the Hong Kong Eye Hospital from January 2000 to December 2012.ResultsForty-nine eyes of 47 patients were included. The mean age was 14, and the mean follow-up duration was 6.2 years. The most common aetiology for RRD was idiopathic (28.6%), followed by high myopia (24.5%), atopic dermatitis (AD) (18.4%), congenital and developmental abnormalities (16.3%), trauma (8.2%), and intraocular inflammation (4.1%). The mean preoperative visual acuity was LogMAR 1.0±0.8 (Snellen equivalent 6/60). The primary anatomical success rate in this series was 65.3%, and the final anatomical success rate was 85.7%. The mean postoperative visual acuity was LogMAR 0.9±1.2 (Snellen equivalent 6/48). Patients with congenital and developmental abnormalities or AD had worse anatomical and functional outcomes than patients who had no predisposing factor or high myopia.

CONCLUSIONS

The primary and overall anatomical success rates in our series were comparable with existing literature. High myopia is the most commonly identifiable risk factor in Hong Kong and AD is associated with a higher re-detachment rates and a poor visual outcome.

Reduced health-related quality of life among Japanese college students with visual impairment

Background

Although previous studies have shown detrimental effects of visual impairment on health-related quality of life (HRQOL), they were primarily conducted on elderly individuals with visual impairment. The objective of this cross-sectional study was to investigate if HRQOL is impaired in young college students with visual impairment and to explore the relationships between HRQOL and other factors. It was hypothesized that visual impairment is not influential enough to lower the HRQOL of young people due to their better physical fitness and more flexible mentality.

Methods

A total of 21 college students (mean age = 25 years old) with varying degrees of visual impairment completed the short form (SF)-36 health survey and questionnaires on daily physical activities. Subjects were grouped depending on the type of visual impairment: blind (n = 11) or severely impaired (n = 10). In addition, grip strength and single-leg standing balance were assessed.

Results

No between-group differences were found in the SF-36 scores. However, compared to the general Japanese standards (50.0 ± 10.0), the Vitality scores of the blind group were lower (41.9 ± 7.2, p = 0.004) and the Physical Function scores of the severely impaired group were higher (55.3 ± 2.4, p = 0.001). In addition, a negative correlation was found between standing balance (variability of foot center of pressure) and the Physical Component Summary score of the SF-36 (r² = 0.35, p = 0.005).

Conclusions

These findings suggest that even among young people severe visual impairment leads to reductions in some components of HRQOL.

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

AIM

To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC) using ultrasound biomicroscopy (UBM).

METHODS

Patients (n=23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.

RESULTS

The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05), whereas there was no significant difference between the two groups at the latter follow-up (P>0.05). Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.

CONCLUSION

Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

Factors Contributing to 50-ft Walking Speed and Observed Ethnic Differences in Older Community-Dwelling Mexican Americans and European Americans

BACKGROUND

Mexican Americans comprise the most rapidly growing segment of the older US population and are reported to have poorer functional health than European Americans, but few studies have examined factors contributing to ethnic differences in walking speed between Mexican Americans and European Americans.

OBJECTIVE

The purpose of this study was to examine factors that contribute to walking speed and observed ethnic differences in walking speed in older Mexican Americans and European Americans using the disablement process model (DPM) as a guide.

DESIGN

This was an observational, cross-sectional study.

METHODS

Participants were 703 Mexican American and European American older adults (aged 65 years and older) who completed the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA). Hierarchical regression models were performed to identify the contribution of contextual, lifestyle/anthropometric, disease, and impairment variables to walking speed and to ethnic differences in walking speed.

RESULTS

The ethic difference in unadjusted mean walking speed (Mexican Americans=1.17 m/s, European Americans=1.29 m/s) was fully explained by adjustment for contextual (ie, age, sex, education, income) and lifestyle/anthropometric (ie, body mass index, height, physical activity) variables; adjusted mean walking speed in both ethnic groups was 1.23 m/s. Contextual variables explained 20.3% of the variance in walking speed, and lifestyle/anthropometric variables explained an additional 8.4%. Diseases (ie, diabetes, stroke, chronic obstructive pulmonary disease) explained an additional 1.9% of the variance in walking speed; impairments (ie, FEV1, upper leg pain, and lower extremity strength and range of motion) contributed an additional 5.5%. Thus, both nonmodifiable (ie, contextual, height) and modifiable (ie, impairments, body mass index, physical activity) factors contributed to walking speed in older Mexican Americans and European Americans.

LIMITATIONS

The study was conducted in a single geographic area and included only Mexican American Hispanic individuals.

CONCLUSIONS

Walking speed in older Mexican Americans and European Americans is influenced by modifiable and nonmodifiable factors, underscoring the importance of the DPM framework, which incorporates both factors into the physical therapist patient/client management process.