Visual Outcome in Ocular Sarcoidosis: Retrospective Evaluation of Risk Factors

Purpose. To analyze risk factors associated with poor visual outcome in patients with ocular sarcoidosis. Methods. In this retrospective study, charts of 44 patients with uveitis and biopsy-proven sarcoidosis were reviewed. Ocular parameters evaluated were as follows: location, type of uveitis, visual acuity, presence of posterior synechia, iris nodules, vitritis, snowballs, chorioretinal lesions, retinal vasculitis, papillitis, macular edema, cataract, and glaucoma. Final visual acuity of the worst-seeing eye at last follow-up was the outcome considered in univariable and multivariable analyses. Visual acuity of the worst-seeing eye was stratified into 2 categories according to the threshold 20/50 (≤20/50 and >20/50). Results. A total of 44 patients with bilateral uveitis were studied. The majority of patients presented with panuveitis (52%), granulomatous type (61%), posterior synechia (62%). The most frequent vision-threatening complications were cystoid macular edema (56%) and cataract (56%). The median best-corrected visual acuity in the worst-seeing eye at presentation and at end of follow-up was respectively 0.4 (interquartile range [IQR] 0.26–0.80) and 0.63 (IQR 0.36–1.00). At univariable analysis, the presence of iris nodules (p=0.049), cystoid macular edema (p=0.007), and cataract (p=0.007) were clinically significant conditions for a visual outcome of 20/50 or worse in the worst-seeing eye. In multivariable analysis, cystoid macular edema (p=0.034) was the only statistically significant predictor associated with unfavorable visual outcome. Conclusions. In this study, we attempted to find risk factors related to poor visual outcome in patients with ocular sarcoidosis. The results suggest that only the presence of cystoid macular edema was significantly associated with worst visual outcome.

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Presentation, surgery and 1-year outcomes of childhood cataract surgery in Tanzania

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316042 ◽

2020 ◽

pp. bjophthalmol-2020-316042

Author(s):

Furahini Godfrey Mndeme ◽

Blandina Theophyl Mmbaga ◽

Mchikirwa Msina ◽

Judith Mwende ◽

Sonia J Vaitha ◽

...

Keyword(s):

Visual Acuity ◽

Low Income ◽

Visual Outcome ◽

Low Income Countries ◽

Similar Proportion ◽

Poor Visual Outcome ◽

A Prospective Study ◽

Good Vision ◽

Childhood Cataract

BackgroundRecent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania.MethodsWe conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary.ResultsPreoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes.ConclusionThree-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.

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Clinical characteristics of progressive nonarteritic anterior ischemic optic neuropathy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.04.06 ◽

2021 ◽

Vol 14 (4) ◽

pp. 517-522

Author(s):

Omer Y. Bialer ◽

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Color Vision ◽

Symptom Onset ◽

Systemic Risk ◽

Clinical Characteristics ◽

Visual Outcome ◽

Ischemic Optic Neuropathy ◽

Systemic Risk Factors

AIM: To study whether patients with progressive nonarteritic anterior ischemic optic neuropathy (NAION) present earlier than patients with stable NAION and to describe their clinical characteristics and visual outcome. METHODS: This was a retrospective chart review. All patients with NAION seen during the acute stage from January 2012 to December 2018 were reviewed. Patients were included if they had documented disc edema and follow up of at least 3mo. Patients with progressive NAION were identified if they worsened in 2 out of 3 parameters: visual acuity ≥3 Snellen lines; Color vision ≥4 Ishihara plates; the visual field defect involved a new quadrant. The clinical characteristics, time from symptom onset to presentation, systemic risk factors and visual outcome were compared to patients with stable NAION. RESULTS: Totally 122 NAION cases met the inclusion criteria. Mean age was 58.1y (range 22-74), 70% were men. Twenty cases (16.4%) had progressive NAION. Patients with progressive NAION did not differ from stable NAION in their demographics, systemic risk factors or in their initial visual deficit. At last follow up, median visual acuity was 1.0 logMAR (IQR 0.64-1.55) in patients with progressive NAION, vs 0.18 (IQR 0.1-0.63) in stable NAION (P&#x003C;0.001). Median color vision testing was 0 plates correct (IQR 0-2.5%) vs 92% plates correct (IQR 50%-100%) in the stable NAION group (P&#x003C;0.001). Patients with progressive NAION differed in the time from symptom onset to presentation (median 2d vs 5d, P=0.011). CONCLUSION: We find no identifiable risk factors associated with progressive NAION. Progressors arrive earlier for ophthalmological evaluation.

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Evaluation of the Effectiveness of Treatment with Dexamethasone Intravitreal Implant in Cystoid Macular Edema Secondary to Retinal Vein Occlusion

BioMed Research International ◽

10.1155/2018/3095961 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Simone Donati ◽

Carlo Gandolfi ◽

Simona Maria Caprani ◽

Jennifer Cattaneo ◽

Laura Premoli ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Cystoid Macular Edema ◽

Treatment Guidelines ◽

Functional Improvement ◽

Functional Evaluation ◽

Dexamethasone Intravitreal Implant ◽

Vein Occlusion

Purpose. To evaluate retinal functional improvement by means of visual acuity and retinal sensibility examination after intravitreal dexamethasone implant in patients affected by cystoid macular edema secondary to retinal vein occlusion. Methods. Twenty-six consecutive patients affected by retinal vein occlusion complicated by cystoid macular edema were enrolled in this prospective interventional study. All patients underwent a baseline complete ophthalmological evaluation as well as retinal angiography, OCT examination, and microperimetry evaluation. Each patient was treated with intravitreal injection of a long-term steroid implant (Ozurdex, Allergan). Follow-up evaluations were performed at months 1, 3, and 6 and completed by OCT and MP1 examination. Clinical data underwent statistical analysis. Results. Baseline functional evaluation showed mean visual acuity of 0,63±0,42 LogMAR and retinal sensitivity of 7,93±4,73 dB (mean±standard deviation); after treatment, at day 30 we found, respectively, 0,43±0,38 LogMAR (p<0.05, compared to baseline) and 10,15±4,410 dB (p<0.05); at day 90, we found 0,44±0,32 (p<0.05) and 9.61±4,29 dB (p<0.05); at day 180, we found 0,41±0,31 (p<0.05) and 9,95±3,79 dB (p<0.05). Fixation pattern improved significantly (p<0.05), showing a stable fixation in 30% of patients at baseline, increasing to 77% of patients at day 180. Baseline morphological evaluation showed a central retinal thickness (CRT) of 398,21±181,65 μm after treatment; we found a CRT of 222,64±95,21 μm at day 30 (p<0.05, compared to baseline), 307,50±120,25 μm (p<0.05) at day 90, and 294,93±135,86 μm (p<0.05) at day 180. About 15,3% patients showed already at month 3 a recurrence of macular edema. They underwent a retreatment before month 6 as for treatment guidelines. Conclusion. Our detailed analysis showed the significative increase in retinal function in the early phases of the follow-up. Retinal sensibility showed a stronger correlation than VA in macular edema reabsorption, better underlying the progressive functional recovery and increase in quality of vision and life for the patients. This trial is registered with ClinicalTrials.gov NCT03559491.

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Effect of Alternate Treatment with Intravitreal Corticosteroid and Anti-VEGF for Macular Edema Secondary to Retinal Vein Occlusion

Journal of Ophthalmology ◽

10.1155/2021/5948113 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Young Hwan Bae ◽

Seong Mi Kim ◽

Jin Young Kim ◽

So Hyun Bae ◽

Hakyoung Kim ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Visual Outcome ◽

Vascular Endothelial ◽

Vein Occlusion ◽

Anti Vegf ◽

Treatment Naïve ◽

Endothelial Growth Factor

Purpose. To evaluate whether treatment with intravitreal corticosteroid and anti-vascular endothelial growth factor (VEGF) injections alternately can improve treatment outcomes of macular edema (ME) caused by retinal vein occlusion (RVO). Methods. This dual-center retrospective study included 112 eyes with treatment-naïve ME secondary to RVO that were alternately treated with intravitreal corticosteroid and anti-VEGF injections (33 eyes, alternate group) or treated only with intravitreal anti-VEGF injections (79 eyes, anti-VEGF group) on a pro re nata basis. Results. During the 12-month follow-up period, the alternate group achieved a visual acuity gain of 0.39 logMAR, while the anti-VEGF group achieved a gain of 0.21 logMAR ( P = 0.042 ). The alternate group demonstrated a reduction in the central macular thickness of 229.9-μm, while the anti-VEGF group achieved a reduction of 220.1 μm ( P = 0.887 ). The alternate group required an average of 5.2 injections, while the anti-VEGF received 4.2 injections ( P < 0.001 ). In a propensity score-matched cohort to compensate for the differences in the injection numbers between the two groups, the alternate group achieved a better visual acuity gain than the anti-VEGF group at month 12 (0.39 logMAR vs. 0.17 logMAR, P = 0.048 ). Conclusions. In ME secondary to RVO, treatment with intravitreal corticosteroid and anti-VEGF injections alternately resulted in a more favorable visual outcome compared with intravitreal anti-VEGF monotherapy.

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Effect of Aflibercept on Cystoid Macular Edema Associated with Central Retinal Vein Occlusion. Results from a District Hospital in the United Kingdom

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-0786-7872 ◽

2019 ◽

Vol 236 (04) ◽

pp. 547-550

Author(s):

Georgios Panos ◽

Vassileios Kostakis ◽

Grazyna Porter

Keyword(s):

Visual Acuity ◽

Adverse Effects ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Cystoid Macular Edema ◽

Vein Occlusion ◽

Intravitreal Aflibercept ◽

Central Retinal Vein

Abstract Purpose The purpose of this study was to report the efficiency and safety of intravitreal aflibercept for the treatment of cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). Methods This is a retrospective cohort study. Ten naive eyes of ten patients with CME secondary to CRVO were included. All eyes received a loading dose of 3 monthly aflibercept injections followed by as-needed injections at monthly follow-up visits. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated at baseline and at the end of the follow-up period. Results The median follow-up period was 6 months (range: 6 – 9). The median number of injections was 4 (range: 3 – 5). Median BCVA improved from 1.05 LogMAR units (range: 0.7 – 1.6) at baseline to 0.65 (range: 0.4 – 1.6) at the end of the follow-up period (p = 0.02). Median CRT improved from 690 µm (range: 561 – 1235) at baseline to 243 µm (range: 207 – 531) at the end of the follow-up period (p = 0.002). The power of all statistical tests was greater than 0.8. No adverse effects or complications were documented. Conclusion Intravitreal aflibercept treatment for CME secondary to CRVO significantly improved both macular anatomy and visual acuity without adverse effects.

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The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema

Journal of Clinical Medicine ◽

10.3390/jcm9041066 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1066

Author(s):

Tommaso Verdina ◽

Rossella D’Aloisio ◽

Andrea Lazzerini ◽

Cecilia Ferrari ◽

Edoardo Valerio ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Cystoid Macular Edema ◽

Retrospective Chart Review ◽

Topical Steroids ◽

Before And After ◽

Laser Treatments ◽

Posterior Capsule Rupture ◽

Yellow Laser

Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon’s triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.

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Surgical and visual outcomes of posterior dislocated lens fragments after cataract surgery during 5-years at a tertiary eye hospital of North India

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i2.27824 ◽

2019 ◽

Vol 11 (2) ◽

pp. 172-180

Author(s):

Lagan Paul ◽

Manisha Agarwal ◽

Shalini Singh ◽

Rahul Mayor ◽

Chanda Gupta ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Cataract Surgery ◽

Visual Outcome ◽

Vitreous Cavity ◽

Age Related Macular Degeneration ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

Age Related

Objective: To determine the surgical and visual outcomes of posteriorly dislocated lens fragments in the vitreous cavity in patients undergoing cataract surgery. Methods: A total of 149 eyes of 149 patients from 2013 to 2018 were included in the study. The primary cataract surgery was performed either at the base hospital and its peripheral centres or referred from elsewhere. Pars plana vasectomy and nucleus removal was performed along with implantation of intraocular lens, wherever possible. Success was defined as best corrected visual acuity (BCVA) ≥ 6/12 at 3 months follow up. Poor visual outcome was defined as per WHO guidelines as BCVA ≤ 3/60. Results: Posterior capsular rupture and dislocation into vitreous cavity most frequently occurred during phaco-fragmentation in cases of phacoemulsification and during nucleus delivery in cases of small incision cataract surgery. Early vitrectomy was performed within 3 days in 36.2% of cases and within 14 days in 63.8% of cases. Successful visual outcome was achieved in 85.2% of patients at 3 months follow up after vitrectomy. Iatrogenic retinal break occurred in five patients during vitrectomyand five patients had retinal detachment. Poor visual outcome was observed in 12eyes, out of which glaucomatous optic neuropathy seen in 5 cases, cystoid or diabeticmacular edema in 4 cases and age related macular degeneration in 3 cases. Conclusion: Posterior dislocation of lens can be successfully managed in majority of cases with vitreoretinal surgical intervention. The timing of vitrectomy whether performed early or late did not affect the visual outcome. The most important predictorof final visual acuity after PPV for retained lens fragments is a less complicated clinical course without any associated complications such as retinal detachment, cystoidmacula edema and glaucoma. Expertise of the primary cataract surgeon could not be assessed in this study, though surgeon grade with more experience is an important factor in the assessment of complications during the cataract surgery.

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Clinical Characteristics Associated with the Development of Cystoid Macular Edema in Patients with Cytomegalovirus Retinitis

Microorganisms ◽

10.3390/microorganisms9061114 ◽

2021 ◽

Vol 9 (6) ◽

pp. 1114

Author(s):

Hye-Ji Kwon ◽

Gisung Son ◽

Joo-Yong Lee ◽

June-Gone Kim ◽

Yoon-Jeon Kim

Keyword(s):

Risk Factors ◽

Optical Coherence Tomography ◽

Visual Acuity ◽

Macular Edema ◽

Acute Phase ◽

Cystoid Macular Edema ◽

Clinical Characteristics ◽

Development Zone ◽

Cmv Retinitis ◽

Different Characteristics

We evaluated the incidence and characteristics of eyes with cytomegalovirus (CMV) retinitis according to the occurrence of cystoid macular edema (CME) and identified the risk factors of its occurrence. Patients diagnosed with CMV retinitis and examined using optical coherence tomography were classified according to the development of CME. The CME group was further divided according to the presence of active retinitis at the time of CME development. The demographics, serologic findings, ophthalmic presentations, ocular treatments, and visual prognosis were compared. CME was identified in 25 eyes (17 eyes with active retinitis and 8 eyes with inactive retinitis) out of the 67 eyes with CMV retinitis. Visual acuity was worse in the CME group than in the non-CME group. The CME group had longer CMV viremia duration, zone 1 involvement, and larger extent of CMV retinitis. While CME with concurrent active retinitis developed in eyes with direct foveal involvement of retinitis in the acute phase and required more ganciclovir injections after CME development, CME without active retinitis developed in eyes with larger extents of involvement and more intravitreal ganciclovir injections before CME development. Zone 1 involvement and longer CMV viremia duration were independently associated with the occurrence of CME. CME, which caused visual deterioration, developed in considerable patients with CMV retinitis and had different characteristics according to the presence of active retinitis.

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Pseudophakic cystoid macular edema after uneventful small incision cataract surgery

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175460 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5386

Author(s):

Abhishek Ghelani ◽

Khushnood Sheikh ◽

Manisha Shastri ◽

Abhishek Patel

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Macular Edema ◽

Cystoid Macular Edema ◽

Anterior Segment ◽

Clinical Profile ◽

P Value ◽

Small Incision Cataract Surgery ◽

Small Incision

Background: To study the clinical profile of patient undergone small incision cataract surgery. To measure the incidence of CME after manual SICS and phacoemulsification method of cataract extraction.Methods: It`s a hospital based prospective study carried in ophthalmology dept. patients with normal clinical profile with no history of hypertension, diabetes mellitus, or any ocular trauma or infection/inflammation are randomly selected for cataract surgery either phacoemulsification or manual SICS and were regularly followed till sixth week after cataract surgery. During follow up complete examination including visual acuity, anterior segment examination fundoscopy and FFA done.Results: Out of 115 patients, 59 were operated by phacoemulsification and 56 were operated by manual SICS. 59were operated by phaco, 9 patients lost in follow up. Out of these, 2 patients developed CME. One was operated by phaco and the other by SICS (P value = 1.000) BCVA 6/9 or more after second follow up was seen in 42.45% of phaco patients and 40.56% of SICS patients which is statistically insignificant (P value = 0.343607).Conclusions: With advent of modern cataract surgery, rapid visual rehabilitation and unaided best corrected visual acuity is achieved with negligible early and late postoperative complications and thereby cystoid macular edema.

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