scholarly journals Do Africans really need to go overseas for Phaco training? Performance audit of a locally trained phaco surgeon in rural Kenya

2019 ◽  
Author(s):  
Jean Claude Niyonzima ◽  
Stephen Gichuhi ◽  
Sarah Sitati ◽  
Ernest Ollando
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
P Value ◽  
Visual Outcomes ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Case Series Study ◽  
Best Corrected Visual Acuity

Abstract Purpose: To audit phacoemulsification cataract surgeries performed independently after a short - term training completed in a rural hospital in Kenya, and to benchmark the outcomes against WHO recommendations. Methods: This retrospective case-series study recruited patients who had had phacoemulsification cataract surgery at Sabatia Eye Hospital from January to December 2018. All the surgeries were performed by a single surgeon following a brief training in the same center. Data were collected retrospectively using a detailed questionnaire. Results: Of the one hundred and twenty eyes operated on during this period, one-hundred and sixteen eyes of 86 patients met the inclusion criteria. The mean age was 62 years and the majority of the eyes (83.6%) had vision less than 6/18 preoperatively. Co-morbidities included diabetic retinopathy (3.4%), age-related macular degeneration (2.6%), trauma (1.7%) and glaucoma (0.9%). Surgical complications were not severe enough to affect the final best-corrected visual acuity, unlike the comorbidities that were negatively correlated with visual outcomes (p-value< 0.001). Good outcomes were 81% against a WHO target of 80% for uncorrected visual acuity category, and 96.6% in the best-corrected visual acuity category against a target of 90%. The Royal College of Ophthalmology database of cataract surgery outcomes and the European Registry of Quality Outcomes for cataract and refractive surgery had comparable results. Conclusions: This local training model was based on apprenticeship and skills transfer. It can achieve high-quality visual outcomes meeting WHO recommendations.

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

2019 ◽  
Vol 30 (5) ◽  
pp. 1082-1090
Author(s):  
Jordi Monés ◽  
Marc Biarnés ◽  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Best Corrected Visual Acuity

Importance: To provide new insights into aflibercept effect in non-naive-treated patients with neovascular age-related macular degeneration. Purpose: To assess the efficacy of intravitreal aflibercept in patients with neovascular age-related macular degeneration without optimal response to previous anti-vascular endothelial growth factor A therapy. Design: Single-arm, multi-centre, prospective study. Participants: Patients ⩾50 years with active neovascular age-related macular degeneration, best-corrected visual acuity between 20/32 and 20/320 with suboptimal response to ranibizumab or bevacizumab. Methods: Aflibercept was administered monthly (3-first months), and bimonthly thereafter until month 8. Anatomical and functional outcomes were assessed. Main outcome measure: Percentage of eyes without intra or subretinal fluid on optical coherence tomography after 3-monthly loading doses of aflibercept. Results: A total of 46 patients were included. At week 12, 45.7% (95% confidence interval: 31.5%–60.1%) of eyes showed no fluid on optical coherence tomography. The mean (standard deviation) best-corrected visual acuity increased from 65.1 (8.3) to 69.6 (8.1) letters (+4.5 (5.8) p < 0.0001) and was stabilized at week 40 as compared to baseline. Mean central macular thickness decreased from 430 (119) µm to 323 (100) µm at week 12 (–107 (90) µm, p < 0.0001) and was reduced at week 40 (–46 (111) µm, p = 0.0056). At week 40, 21.7% (95% confidence interval: 9.8%–33.7%) had no fluid. There was a case of presumed noninfectious endophthalmitis that was successfully managed. Conclusion: Almost half of patients presented no fluid on optical coherence tomography at week 12, and there was a clinically significant improvement in best-corrected visual acuity. At week 40, one in five patients did not show intra or subretinal fluid, central macular thickness decreased and best-corrected visual acuity was stabilized compared to baseline.

scholarly journals Three-Month Results of Brolucizumab Intravitreal Therapy in Patients with Wet Age-Related Macular Degeneration

2021 ◽  
Vol 18 (16) ◽  
pp. 8450
Author(s):  
Katarzyna Michalska-Małecka ◽  
Dorota Śpiewak ◽  
Dorota Luksa
Keyword(s):  
Visual Acuity ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Membrane Flow ◽  
Membrane Area ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
The Mean ◽  
Best Corrected Visual Acuity

The purpose of the study was to evaluate changes in best corrected visual acuity, central retinal thickness, area and flow in the neovascular membrane and to compare therapeutic outcomes from baseline in patients who received three doses of Beovu (brolucizumab) at three-month follow-up. Material and methods: A prospective observational study conducted at the Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice. Eight patients with exudative form of age-related macular degeneration (AMD) were observed. Results: The mean best corrected visual acuity (BCVA) outcome increased with each subsequent visit. The mean central retinal thickness (CRT) result also improved (decreased) with each subsequent visit, except for the last measurement. A statistically significant change in neovascular membrane area was observed after the first injection. In further treatment, the membrane area underwent changes that were not statistically significant. A statistically significant change in neovascular membrane flow was demonstrated after the first and second injections. Discussion: Our study confirmed the efficacy of brolucizumab in the treatment of patients with exudative AMD in terms of improvements in best corrected visual acuity (BCVA), central retinal thickness (CRT), neovascular membrane area, and neovascular membrane flow area.

Neovaskulinės amžinės geltonosios dėmės degeneracijos gydymo ranibizumabu 24 mėnesių morfologiniai ir funkciniai pokyčiai

2015 ◽  
Vol 21 (3.2) ◽  
pp. 413-416
Author(s):  
Vilma Jūratė Balčiūnienė ◽  
Rosita Lažaunykaitė
Keyword(s):  
Visual Acuity ◽  
Macular Thickness ◽  
Age Related Macular Degeneration ◽  
Central Macular Thickness ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Before And After ◽  
The Mean ◽  
The Difference ◽  
Best Corrected Visual Acuity

Key words: ranibizumab, age-related macular degeneration, central macular thickness. Research objective. To evaluate influence of treatment with vascular endothelial growth factor inhibitor, ranibizumab, for best corrected visual acuity and central macular thickness in patients with neovascular age-related macular degeneration. Materials and methods. In this retrospective study were included treatment – naive patients. Intravitreal injections were performed at Lithuanian University of Health Sciences Kaunas Clinics Eye clinic. In this study were analysed the 24-month morphological and functional outcomes of intravitreal ranibizumab injections. Best corrected visual acuity was meassured using the Snellen chart (Landolt’s rings C optotypes). Optical coherence tomography images were obtained using the spectral – domain OCT (NIDEK RS – 3000 Advance (NIDEK CO LTD, Japan). The central thickness measurements were obtained from macular thickness maps using the digital caliper tool. Results. In this study were included 88 patients. Best corrected visual acuity before treatment was 0.36 ± 0.22. The difference between visual acuity before and after first injection was 0.04 ± 0.22 (p = 0.03). Before fifth injection visual acuity was 0.41 ± 0.21, after – 0.46 ± 0.22 (p = 0.05). Central macular thickness before treatment was 297.81 ± 106.04 μm. The difference between central macular thickness before and after first injection was 85.21 ± 113.37 μm (p &lt; 0.001). Before second injection central macular thickness was 273.57 ± 87.49 μm, after – 234.51 ± 58.96 μm (p = 0.002). Before fourth injection central macular thickness was 237.20 ± 40.87 μm, after – 219.10 ± 42.26 μm (p = 0.04). The mean central macular thickness significantly decreased from 298.15 ± 104.78 to 229.08 ± 56.57 (p &lt; 0.001). In 24 month of treatment the average number of ranibizumab injections was 3.61 ± 1.55. Conclusions. Our study’s results showed that over 24 month best corrected visual acuity improvement was statistically significant after first and fifth injection. Baseline compared with last injection, there was not statistically significant difference. Central macular thickness improvement statistically significant was after first, second and fourth injection. There was statistically significant decreased baseline compared with the last injection. The mean number of ranibizumab injections was 3.61 ± 1.55 in 24 month.

Effect of 2-year nutritional supplementation on progression of age-related macular degeneration

2019 ◽  
Vol 30 (2) ◽  
pp. 376-381
Author(s):  
Alberto Piatti ◽  
Antonella Croce ◽  
Danilo Mazzacane ◽  
Giovanni Traina ◽  
Lina Ambrosino ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Exact Test ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Best Corrected Visual Acuity

Purpose: To examine the effect of a long-term nutritional supplementation on age-related macular degeneration progression. Methods: In this prospective, double-blind, placebo-controlled study, 80 patients with intermediate age-related macular degeneration were randomized (2:1) to receive 1 tablet/day of a nutritional supplement containing a mixture of carotenoids, vitamins and omega-3 fatty acids or placebo. Age-related macular degeneration progression assessed by digital fundus photography (primary outcome) and best-corrected visual acuity were evaluated. Differences between arms were tested using chi-square test or Fisher’s exact test. Results: Seventy-four patients completed the follow-up at 24 months (48 in the treated arm and 26 in the placebo arm). An age-related macular degeneration progression was observed in the 2.1% of patients of the treated arm and in the 15.4% of patients in the placebo arm (p = 0.05, Fisher’s exact test). Best-corrected visual acuity data alone were not statistically significant among groups. Conclusion: A clinically meaningful stabilization of intermediate age-related macular degeneration over a period of 2 years may be obtained by treating patients with a mixture of carotenoids, vitamins and omega-3 fatty acids.

One-year outcomes of the Polish treatment program for the wet form of age-related macular degeneration using intravitreal therapy

2020 ◽  
Vol 30 (3) ◽  
pp. 586-594
Author(s):  
Małgorzata Figurska ◽  
Anna Matysik-Wożniak ◽  
Joanna Adamiec-Mroczek ◽  
Joanna Dolar-Szczasny ◽  
Marta Misiuk-Hojło ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Treatment Program ◽  
Median Number ◽  
Age Related Macular Degeneration ◽  
Therapeutic Program ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Treatment Naïve ◽  
Best Corrected Visual Acuity

Purpose: To report 12-month outcomes of a Polish National Treatment Program using aflibercept and ranibizumab in eyes with wet, age-related macular degeneration in routine clinical practice. Material and Methods: This was a non-randomized, retrospective, observational multicenter study. Anonymous data contained in the electronic Therapeutic Program Monitoring System were utilized in this study. Results: The study population consisted of 2828 eyes from 2718 patients. The median age was 76.0 [70.0, 81.0] years; 61.7% were female. Best corrected visual acuity increased from 58.86 [50.05, 69.95] letters to 65.1 [50.1, 73.9] letters (p < 0.001). The median change in best corrected visual acuity was 0.0 [−4.0, 12.2] letters: 2.9 [−2.9, 15.1] letters for treatment-naïve eyes and 0.0 [−4.0, 8.8] letters for those continuing treatment (p < 0.001). The median central retinal thickness was significantly reduced from 341.0 [281.0, 422.0] to 275.0 [221.0, 344.0] μm (p < 0.001). The median number of visits was 9.0 [8.0, 9.0]. The median number of injections was 7.0 [6.0, 8.0]: 8.0 [7.0, 8.0] for treatment-naïve eyes and 6.0 [5.0, 7.0] for those continuing treatment (p < 0.001). Conclusion: Eyes treated as part of the Polish therapeutic program gained functional stability and morphological improvement. Treatment-naïve eyes showed the greatest functional benefit.

scholarly journals Correlation between visual acuity, external limiting membrane and photoreceptor status in patients with neovascular age-related macular degeneration treated with bevacizumab

2017 ◽  
Vol 74 (9) ◽  
pp. 849-853
Author(s):  
Dragana Ristic ◽  
Miroslav Vukosavljevic ◽  
Marko Kontic ◽  
Petar Ristic ◽  
Dubravko Bokonjic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Age Related Macular Degeneration ◽  
Type I ◽  
Type Ii ◽  
External Limiting Membrane ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Number Of Patients ◽  
The Mean ◽  
Best Corrected Visual Acuity

Background/Aim. The integrity of outer retinal structures, primarily the photoreceptor layer, is important because of its direct correlation with visual acuity. The aim of this study was to investigate the correlation between best-corrected visual acuity (BCVA), the foveal photoreceptorinner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) in patients with neovascular age-related macular degeneration (NVAMD) after the treatment with bevacizumab, as well as the correlation between the above-mentioned parameters and different types of neovascular membrane, classified by fluorescein angiography (FA). Methods. The study included 82 patients with NVAMD, treated with intravitreal bevacizumab. All patients underwent a basic ophthalmological examination, FA and optical coherence tomography (OCT). Based on the results of FA, all the patients were divided into two main groups ? type I (the occult and minimally classic) and type II (classic and predominantly classic) of the choroidal neovascular membrane (CNV). The OCT images revealed either the presence or the absence of IS/OS and ELM. Results. After the treatment, the mean best corrected visual acuity improved significantly in both groups (p < 0.01). Preserved IS/OS and ELM were registered in a smaller number of patients as compared to the condition before the treatment (p < 0.01). After the treatment, the mean BCVA was significantly better in patients with preserved IS/OS and ELM (p < 0.01). In addition, we registered a higher number of patients with preserved ELM in the first group than in the second group (p < 0.01), whereas there was no significant difference in the integrity of IS/OS between the groups (p > 0.05). Conclusion. The patients with preserved IS/OS and ELM achieved better final visual acuity as compared to the patients without preserved IS/OS and ELM. In our patients, the absence of IS/OS and ELM were more frequent in type II (classic and predominantly classic) CNV than in type I (the occult and minimally classic) CNV.

scholarly journals Prognostic Factors of Early Morphological Response to Treatment with Ranibizumab in Patients with Wet Age-Related Macular Degeneration

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Oldřich Chrapek ◽  
Jiří Jarkovský ◽  
Martin Šín ◽  
Jan Studnička ◽  
Petr Kolář ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Therapeutic Response ◽  
Age Related Macular Degeneration ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Significant Difference ◽  
Best Corrected Visual Acuity ◽  
Ranibizumab Treatment

Aim. To assess the significance of age, gender, baseline best corrected visual acuity, baseline macula thickness, and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age-related macular degeneration.Methods. From 09/2008 to 06/2013 we evaluated 1153 newly diagnosed, treatment-naïve patients treated with ranibizumab. Based on the morphological findings in the macula following the initial 3 injections of ranibizumab, the patients were divided into two groups based on active and inactive choroidal neovascularization.Results. After the initial 3 injections of ranibizumab, we examined the sample of 841 eyes with active CNV and 312 eyes with inactive CNV. In the inactive group, we found a statistically higher proportion of occult CNV (P<0.001) and lower incidence of CNV greater than 5DA (P < 0.001) compared with the active group. We found no statistically significant difference in age, gender, baseline best corrected visual acuity, or baseline macula thickness between the inactive and active groups.Conclusion. Occult CNV and CNV smaller than 5DA are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment.

Sign in / Sign up

Export Citation Format

Share Document