Comparison of Improvement Rates between Distance and Near Visual Acuity in Children with Unilateral Amblyopia

PURPOSE: To compare the improvement rates of distance visual acuity (VA) with that of near VA in amblyopic eyes of children with unilateral amblyopia. METHODS: The medical records of children with unilateral amblyopia successfully treated with patching were reviewed. During subsequent visits for amblyopia treatment, subjects had best-corrected VA measured at 4 meters and 1/3 meters every 2 months. Duration of treatment to achieve equal VA between both eyes and improvement rates were compared between distance and near, and analyzed according to the cause and severity of amblyopia, or age. RESULTS: A total of 76 children with amblyopia due to anisometropia and/or strabismus started amblyopia treatment at a mean age of 5.8 years and were followed up during a mean period of 16.4 months. Baseline VA was better at near than at distance in 52 children (68.4%), and better at distance than at near in 4 (5.3%). The mean duration of treatment was 5.4 months at distance and 3.9 months at near. However, the improvement rate considering the amount of improvement of VA was faster at distance; 0.11 log MAR/month at distance, and 0.08 log MAR/month at near (p = 0.016). The improvement rate differences between distance and near did not differ based on the cause of amblyopia, or age, whereas in mild amblyopia the improvement rate of distance VA was significantly faster than near. Additionally, children with better initial near VA tended to have a faster improvement rate of distance VA. CONCLUSIONS: Although baseline VA was better at near than at distance in more patients, the improvement rate was faster at distance than at near. Children with better initial near VA appeared to have a faster improvement rate of distance VA.

Gentamicin-Induced Macular Toxicity after Transconjunctival Sutureless 23-Gauge Vitrectomy with Prophylactic Subconjunctival Gentamicin Injection

PURPOSE: To report a case of macular toxicity due to gentamicin after transconjunctival 23-gauge sutureless vitrectomy with prophylactic subconjunctival gentamicin injection. CASE SUMMARY: A 60-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. Best corrected visual acuity (BCVA) was 0.5 in the left eye and she was diagnosed with epiretinal membrane and lamellar macular hole. The patient underwent transconjunctival 23-gauge sutureless vitrectomy with epiretinal membrane removal and intravitreal gas injection. Prophylactic subconjunctival gentamicin injection was given at the end of surgery. After 1 week, fundus examination of the left eye showed multiple retinal hemorrhages around inferior temporal vascular arcade. After six weeks, the patient underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation in the left eye. After cataract surgery, BCVA of the left eye was 0.16 and atrophic change with retinal hemorrhage of the macula was observed on fundus examination of the left eye. Fluorescein angiography revealed multiple occlusion of temporal retinal arteries and capillaries of the macula. CONCLUSIONS: When a prophylactic subconjunctival drug is injected at the end of transconjunctival sutureless vitrectomy, the drug can inflow into the intraocular space through sutureless sclerotomy sites and induce retinal toxicity.