Establishment and validation of nomogram model for visual prognosis of macular edema secondary to retinal branch vein occlusion treated with ranibizumab / 中华眼底病杂志

Objective:To explore the influencing factors of visual prognosis of macular edema secondary to branch retinal vein occlusion (BRVO-ME) after treatment with ranibizumab, and construct and verify the nomogram model.Methods:A retrospective study. A total of 130 patients with BRVO-ME diagnosed by ophthalmology examination in the Department of Ophthalmology, Liuzhou Red Cross Hospital from January 2019 to December 2021 were selected in this study. All patients received intravitreal injection of ranibizumab. According to the random number table method, the patients were divided into the training set and the test set with a ratio of 3:1, which were 98 patients (98 eyes) and 32 patients (32 eyes), respectively. According to the difference of logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) at 6 months after treatment and logMAR BCVA before treatment, 98 patients (98 eyes) in the training set were divided into good prognosis group (difference ≤-0.3) and poor prognosis group (difference >-0.3), which were 58 patients (58 eyes) and 40 patients (40 eyes), respectively. The clinical data of patients in the two groups were analyzed, univariate and multivariate logistic regression analysis were carried out for the different indicators, and the visualization regression analysis results were obtained by using R software. The consistency index (C-index), convolutional neural network (CNN), calibration curve and receiver operating characteristic (ROC) curve were used to verify the accuracy of the nomogram model.Results:Univariate analysis showed that age, disease course, outer membrane (ELM) integrity, elliptical zone (EZ) integrity, BCVA, center macular thickness (CMT), outer hyperreflective retinal foci (HRF), inner retina HRF, and the blood flow density of retinal deep capillary plexus (DCP) were risk factors affecting the visual prognosis after treatment with ranibizumab in BRVO-ME patients ( P<0.05). Multivariate logistic regression analysis showed that course of disease, ELM integrity, BCVA and outer HRF were independent risk factors for visual prognosis after ranibizumab treatment for BRVO-ME patients ( P<0.05). The ROC area under the curve of the training set and the test set were 0.846[95% confidence interval ( CI) 0.789-0.887) and 0.852 (95% CI 0.794 -0.873)], respectively; C-index were 0.836 (95% CI 0.793-0.865) and 0.845 (95% CI 0.780-0.872), respectively. CNN showed that the error rate gradually stabilized after 300 cycles, with good model accuracy and strong prediction ability. Conclusions:Course of disease, ELM integrity, BCVA and outer HRF were independent risk factors of visual prognosis after ranibizumab treatment in BRVO-ME patients. The nomogram model based on risk factors has good differentiation and accuracy.

Pinpoint size port d扙ntr閑 as a predictor for better clinical outcome in pediatric endophthalmitis: A case series

Endophthalmitis is an intraocular inflammation involving both posterior and anterior segments, caused by bacterial or fungal infections. Here, we present a case series of five casespresented to the National Referral Hospital from January to December 2017. Five eyes were identified, including exogenous and endogenous odontogenic causes. All eyes were managed with vitrectomy, intravitreal antibiotics, and systemic antibiotics. Documented final best VA were 20/40 (20%), 1/300 (40%), and no light perception with phthisis bulbi (40%). Despite aggressive timely treatments, visual prognosis are poor in both endogenous and exogenous endophthalmitis. The best final VA 6/12 was found in the smallest port d抏ntr閑 size (pinpoint). Other characteristics did not show any significant clinical difference. Pinpoint size or smaller port d抏ntr閑 suggests better visual outcomes in pediatric endophthalmitis

Analysis of influencing factors related to the prognosis of visual acuity on myelin oligodendrocyte glycoprotein antibody positive optic neuritis after methylprednisolone pulse / 中华眼底病杂志

Objective:To analyze the prognostic factors of vision of myelin oligodendrocyte glycoprotein (MOG) antibody positive associated optic neuritis (ON) after methylprednisolone pulse therapy.Methods:A clinical observational study. A total of 32 patients (47 eyes) with MOG antibody positive ON were observed and followed up in the ophthalmology department of Beijing Tongren Hospital Affiliated to Capital Medical University and Beijing Puren Hospital from March 2019 to January 2022. Clinical data including the best corrected visual acuity (BCVA) and orbital magnetic resonance imaging were recorded. The BCVA was examined by Snellen visual acuity chart, which was finally converted into the logarithm of the minimal angle of resolution (logMAR) for statistical analysis. There were 22 case (38 eyes) with complete image data. All patients were treated with intravenous methylprednisolone pulse (IVMP) for 3-5 days. According to the intervention time (from onset to glucocorticoid treatment), the patients were divided into three groups: <7 d group, 7-14 d and> 14 d group, with 16, 13, 11 eyes, respectively. The median follow-up time was 28 months. After 1 week, 1, 3 and 6 months treatment, the same equipment and methods were used for relevant examinations to observe the changes of visual acuity and the factors influencing the prognosis of visual acuity after IVMP treatment. Logistic regression and linear regression were used to analyze the prognostic correlation factors. Receiver operating characteristic (ROC) curve was used to determine the critical cut-off point of intervention timing.Results:Among the patients, 16 were male and 16 were female. The median onset age was 26 years. The onset duration time was 5-60 days. There were 18 cases (56.3%, 18/32) with abnormal serum immune indexes. The initial symptom was decreased vision with unilateral or bilateral ON. Seventeen (53.1%, 17/32) cases had unilateral ON and 15 (46.9%, 15/32) cases with bilateral ON. Thirty-six eyes (76.6%, 36/47) got optic disc edema, 37 eyes (78.7%, 37/47) accompanied by pain of ocular movement. The nadir logMAR BCVA was mean 1.69±0.13. Long T2WI signals with segmental thickening in the orbital segment of the optic nerve were obtained in 27 eyes (71.1%, 27/38) and in 24 eyes (63.2%, 24/38) with optic nerve and sheath enhancement. During the follow-up period, there were 10 cases of relapse (31.3%, 10/32). The logMAR BCVA of attacked eyes were 0.52±0.09, 0.22±0.06, 0.12±0.06, 0.10±0.06 at 1 week and 1, 3 and 6 months after IVMP treatment, respectively. The rate of BCVA improvement was the fastest at 1 week after treatment, and BCVA returned to stability at 3 months. Logistic regression analysis showed that the timing of intervention was significantly correlated with the prognosis of vision in primary onset patients (odds ratio=12.17, P=0.006), with a negative linear regression relationship ( r=-0.48, 95% confidence interval -0.71--0.17, P=0.008). Comparing the logMAR BCVA between the intervention time >14 group with the <7 group and the 7-14 group, there were statistically significant difference ( P=0.017, 0.037), respectively. The cut-off point of ROC curve to predict the optimal intervention time was 13.5 days. Other factors such as: gender, age, predisposing factor, pain of eye motion, edema of optic disc, bilateral ON, imaging changes, abnormal autoimmune indicators were not associated with the prognosis of visual acuity. Conclusion:The timing of hormone intervention in primary onset patients is an important factor affecting the prognosis of vision and the optimal intervention time window of IVMP is two weeks.

Comparison of visual function and fundus structure outcomes in long-term follow-up of retinopathy of prematurity undergoing anti-vascular endothelial growth factor agents and laser treatment / 中华眼底病杂志

Objective:To investigate the prognosis and differences of visual function and fundus structure in retinopathy of prematurity (ROP) undergoing anti-vascular endothelial growth factor agents (VEGF) or laser photocoagulation treatment with long-term follow-up.Methods:Retrospective case control series. From January 2010 to December 2021, A total of 35 children (63 eyes) with ROP who were first diagnosed in Department of Ophthalmology, Peking University People's Hospital and followed up for as long as 5 years were included. Among them, 21 males (36 eyes) and 15 females (27 eyes) were enrolled. The average gestational age (GA) of the children at birth was 29.30±1.77 weeks. Among the included 12 aggressive ROP (A-ROP) eyes and 51 pre-threshold type 1 ROP eyes, no retinal detachment occurred. Each eye received only intravitreal injection of anti-VEGF agents or laser monotherapy after diagnosis, and divided into anti-VEGF group or laser group according to the treatment. Thirty-five eyes of 20 infants were included in the anti-VEGF group and 28 eyes of 15 infants were included in the laser group. GA, birth weight (BW) and postmenstrual age receiving first treatment were compared and no significant difference between the two groups was defined ( P=0.844, 0.859, 0.694). The number of A-ROP, pre-threshold type 1 ROP eyes were also compared, and statistically significance can be defined ( P=0.005). During the follow-up period, best corrected visual acuity (BCVA), refractive status, visual field, optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) were performed. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity for statistics. Refractive status was calculated as spherical equivalent (SE). Comparative observation of 5-year outcomes including BW, GA, fundus examination at the initial diagnosis, and BCVA, refractive status, visual field defect, central foveal thickness (CFT), subfoveal choroidal thickness (SFCT) and abnormality of peripheral retina in FFA were performed between the two groups. Differences between groups were compared using t test or nonparametric test for measurement data, and χ 2 test was used for comparison between groups in enumeration data. Results:Five years after treatment, retinal avascular areas were seen around the eyes in the anti-VEGF treatment group, with a size of 2.32±1.84 optic disc diameters, and 1 eye had fluorescein leakage at the junction of the peripheral avascular areas; eyes in the laser treatment group old photocoagulation spots were seen in the peripheral retina, and no fluorescein leakage was seen. The logMAR BCVA of the eyes in the anti-VEGF treatment group and laser treatment group were 0.15 (0.00, 0.20), 0.10 (0.00, 0.16), respectively; SE were 0.50 (-1.25, 1.31), 0.38 (-4.25, 1.75) D, respectively; mean defect (MD) values of visual field were 2.70 (1.20, 4.80), 4.25 (2.83, 6.98) dB; CFT, SFCT were 225.00±29.31, 287.18±68.56 μm and 237.17±32.81, 279.79±43.61 μm. There was no significant difference in logMAR BCVA, CFT and SFCT between the two groups ( P=0.363, 0.147, 0.622); the lower quartile of SE and visual field MD value in the laser treatment group were significantly higher than those in the laser treatment group, but there was no significant difference in the median SE ( P=0.109), and there was a statistically significant difference in the median MD value of the visual field ( P=0.037). Conclusions:Anti-VEGF agents and laser therapy can achieve similar good visual prognosis for early ROP, and the peripheral visual field can be preserved to a greater extent, however, the peripheral visual field defect in the laser group is more significant than that in the anti-VEGF group. For ROP without retinal detachment, the thickness of the retina and choroid in the fovea is generally normal.

Comparison of clinical characteristics and factors affecting prognosis vision of idiopathic and myopic macular hole / 中华眼底病杂志

Objective:To compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH).Methods:A cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age ( Wald=34.507) and logMAR BCVA ( Z=-7.703) between two groups ( P<0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C 3F 8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ 2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. Results:In IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA ( Z=-6.803, P<0.005), but no difference in visual success rate ( χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant ( χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio ( OR)=2.941, 95% confidence interval ( CI) 1.341-6.447, P<0.05], MH diameter ( OR=1.003, 95% CI 1.001-1.005, P<0.05), silicon oil filling ( OR=3.481, 95% CI 1.594-7.605, P<0.05); MMH, baseline BCVA ( OR=2.549, 95% CI 1.344-4.834, P<0.05), C 3F 8 filling ( OR=18.131, 95% CI 1.505-218.365, P<0.05) and silicon oil filling ( OR=7.796, 95% CI 0.997-60.944, P<0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA ( OR=213.329, 95% CI 46.123-986.694, P<0.05), MH diameter ( OR=0.995, 95% CI 0.992-0.997, P<0.05), silicon oil filling ( OR=0.326, 95% CI 0.115-0.926, P<0.05) and duration ( OR=1.036, 95% CI 1.005-1.067, P<0.05); MMH, baseline BCVA ( OR=13.316, 95% CI 2.513-70.565, P<0.05) and duration ( OR=1.022, 95% CI 1.001-1.044, P<0.05). Conclusions:MMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.

Idiopathic intracranial hypertension in pregnancy: about a rare case

In this work, study report the case of a 23-year-old primigravidae, in whom an idiopathic intracranial hypertension (IIH), formerly called pseudotumor cerebri, was diagnosed in the first trimester with visual field impairment, the management of which was similar to cases of benign intracranial hypertension in the general population. The parturient put under medical treatment with ophthalmological and obstetrical follow-up until 39 weeks of amenorrhea where she was cesarized for rescue of the visual prognosis. The objective of this work is to elucidate this pathology, caused by a defect of reabsorption of the CSF by the arachnoid plexus. The diagnosis is retained after elimination by radio-biological exploration of an infectious, tumor or traumatic etiology. Idiopathic intracranial hypertension has no impact on the evolution of pregnancy. In addition, the choice of delivery route is dependent on the patient's visual prognosis being brought into play.

Correlation between retinal nerve fiber layer thickness and visual prognosis in patients of Leber Hereditary optic neuropathy with 11778 mutation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the correlation between retinal nerve fiber layer(RNFL)thickness changes and long-term visual function in Leber hereditary optic neuropathy(LHON)patients with 11778 mutations, and evaluate the role of early RNFL thickness in predicting long-term visual function.<p>METHODS: A retrospective analysis with 44 eyes from 23 LHON patients who were diagnosed with 11778 G>A/ND4 mutations by mt-DNA sequencing were included. The patients were divided into two groups based on whether BCVA is above LogMAR 0.5(equivalent to 0.3 decimal,WHO Low Vision standard)or not at 30mo follow up. Then, when the RNFL data of the two groups of patients at each predetermined time point(course of disease)were obtained, the candidate cutoffs of RNFL thickness were obtained by comparing the mean RNFL thicknesses of the two groups. Based on the obtained candidate cutoff values, the eyes with different RNFL values were divided into two groups for statistical analysis to determine whether the cutoff values can be used to predict prognosis of BCVA and visual field. Finally, the earliest cutoff value of RNFL thickness that can predict both BCVA and visual field is the target value. <p>RESULTS: According to the distribution of mean RNFL values in the eyes of patients with different BCVA groups, the candidate cut-off values of RNFL were determined as: 130μm after 2mo, 100μm after 4mo, 80μm after 8mo, and 65μm after 12mo from onset. Further analysis revealed that the RNFL value exceeds 80μm of 8mo after onset can be a better cutoff value to distinguishes the long-term vision, and which can predict both MD and MS of visual field with good distinction(all <i>P</i><0.05). It was found that the long-term BCVA of 100% of the eyes with RNFL values less than 80μm after 8 months from onset was lower than LogMAR 0.5(equivalent to 0.3 decimal); while for eyes with RNFL thickness higher than 80μm after 8mo from onset, 31% of patients had vision greater than LogMAR 0.1(equivalent to 0.8 decimal), and only 34% of patients had long-term prognosis of low vision. In addition, the BCVA, MD and MS of visual field of the eyes with RNFL value exceeded 80μm were significantly better than those with eyes with RNFL less than 80μm.<p>CONCLUSION: In this study, whether the RNFL value exceeded 80μm after 8mo from onset can be used as the best predictive cut-off value for judging long-term BCVA and visual field.

Visual improvement of therapeutic plasma exchange for refractory optic neuritis patients in acute phase / 中华眼底病杂志

Objective To evaluate the visual improvement of therapeutic plasma exchange (TPE) for refractory optic neuritis (ON) patients in acute phase.Methods Seventy-five affected eyes from 44 refractory ON patients with severe visual defect or resistance to high-dose intravenous methylprednisolone (IVMP) therapy,who were admitted to The Chinese PLA General Hospital between January 2015 and August 2016,were recruited and received TPE therapy.Among these patients,11 were male and 33 were female;the average age was 39.1 ± 13.9;31 patients had two affected eyes,13 patients had one affected eye.The course of the disease on the group of patients were more than 2 weeks,and the visual acuity worsened for more than 10 days and continued to deteriorate.TPE treatment was performed on all of the patients.BCVA was recorded before and 24 h after treatment,and the visual function was scored using visual outcome scale (VOS).At the same time,the adverse reactions of TPE treatment were observed.The paired t-test was used to compare the VOS before and after treatment.The correlation between VOS before and after treatment was analyzed by Linear-by-Linear correlation analysis.Results Among 75 affected eyes,the post-therapy VOS 3.89 ±2.13 was significantly improved from pre-therapy VOS 5.56± 1.69 (t=6.77,P＜0.001).Forty-eight of 75 eyes were improved at lease 1 score of VOS,the overall rate of visual improvement was 64.0％.Especially among the eyes with initial vision of light perception,an improved rate of 82.4％ was presented.75.0％ in those eyes with initial vision of count fingers and 67.7％ in no light perception.Linear-by-Linear correlation analysis showed a significant linear correlation between the scores of VOS before and after TPE treatment (r=0.398,P=0.01).During the course of TPE treatment,5 patients had mild adverse reactions such as low calcium reaction and allergic reaction and were well controlled after treatment.Conclusion Using TPE to treat refractory ON in acute phased can improve the visual function of patients.

Factors predicting visual improvement post pars plana vitrectomy for proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To identify factors predicting visual improvement post vitrectomy for sequelae of proliferative diabetic retinopathy (PDR).METHODS: This was a retrospective analysis of pars plana vitrectomy indicated for sequelae of PDR from Jan.to Dec.2014 in Hospital Sultanah Bahiyah,Alor Star,Kedah,Malaysia.Data collected included patient demographics,baseline visual acuity (VA) and post-operative logMAR best corrected VA at 1y.Data analysis was performed with IBM SPSS Statistics Version 22.0.RESULTS: A total of 103 patients were included.The mean age was 51.2y.On multivariable analysis,each pre-operative positive deviation of 1 logMAR from a baseline VA of 0 logMAR was associated with a post-operative improvement of 0.859 logMAR (P<0.001).Likewise,an attached macula pre-operatively was associated with a 0.374 (P=0.003) logMAR improvement post vitrectomy.Absence of iris neovascularisation and absence of post-operative complications were associated with a post vitrectomy improvement in logMAR by 1.126 (P=0.001) and 0.377 (P=0.005) respectively.Absence of long-acting intraocular tamponade was associated with a 0.302 (P=0.010) improvement of logMAR post vitrectomy.CONCLUSION: Factors associated with visual improvement after vitrectomy are poor pre-operative VA,an attached macula,absence of iris neovascularisation,absence of post-operative complications and abstaining from use of long-acting intraocular tamponade.A thorough understanding of the factors predicting visual improvement will facilitate decision-making in vitreoretinal surgery.

Clinical Manifestations and Prognosis of Patient with Traumatic Optic Neuropathy

PURPOSE: To investigate the clinical manifestations, management, ophthalmologic complications, and prognosis of traumatic optic neuropathy. METHODS: A retrospective survey of 55 patients who visited Chosun Hospital from April 2009 to February 2016 was performed. The sex, age, causes, fracture characteristics, neurologic injury, and combined craniofacial bone fractures of patients who were diagnosed with traumatic optic neuropathy were statistically analyzed. Also, we investigated the rate of visual impairment in the patients with intracranial hemorrhaging and craniofacial fracture on radiologic examination and development of sensory strabismus. RESULTS: Traffic accidents were the most common cause of traumatic optic neuropathy. Among the patients, more than 60% showed severe visual impairment of less than 0.1 that lasted until the final observation. Altitudinal visual defects were the most common visual field defect and presented as marginal atrophy and central scotoma. While intracranial hemorrhaging was showed in 52.4% of the patients, craniofacial fracture was observed in 90.5% of the patients. The initial visual acuity was decreased when the patient presented with orbital fracture located in the retrobulbar area. Intravenous high-dose steroid injection did not affect visual prognosis. Sensory strabismus occurred more commonly under conditions of poor initial vision (p = 0.007) or young age (p < 0.001). CONCLUSIONS: Traumatic optic neuropathy in Korea has a high rate of initial visual impairment with poor prognosis of vision. In addition, high-dose intravenous steroid injection did not result in visual improvement.

Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

PURPOSE: To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP). METHODS: This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair. RESULTS: The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048). CONCLUSIONS: The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.

Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

PURPOSE: To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP). METHODS: This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair. RESULTS: The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048). CONCLUSIONS: The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.

Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

PURPOSE: To identify the correlation between final visual outcome after at least 6 months of follow-up and the extent of macular ischemia on the first visit. METHODS: We performed a retrospective clinical analysis of macular ischemia using clinical records, fundus examinations, and fluorescein angiographies in 83 patients (86 eyes) diagnosed with retinal vein occlusion from January 1998 to July 2012 and followed up for over 6 months. We evaluated the extent and the location of macular ischemia, macular edema, initial and final visual acuities and systemic disease based on fluorescein angiography and optical coherence tomography performed within 2 weeks of the first visit. The patients were divided into the following 4 groups based on the extent and location of macular ischemia and edema: superotemporal, superonasal, inferotemporal, and inferonasal. RESULTS: Retinal vein occlusions (RVOs) consisted of 24 central RVOs (CRVOs) and 62 branch RVOs (BRVOs). Mean initial acuity (log MAR) was 0.35 +/- 0.31 (36 eyes) in the no macular ischemia group, 0.40 +/- 0.21 (11 eyes) in the 1-quadrant macular ischemia group, 0.71 +/- 0.32 (26 eyes) in the 2-quadrant macular ischemia group and 0.73 +/- 0.36 (13 eyes) in the over 3 quadrants macular ischemia group. Mean final acuity (log MAR) was 0.23 +/- 0.23 in the no macular ischemia group, 0.40 +/- 0.30 in the 1-quadrant macular ischemia group, 0.51 +/- 0.32 in the 2-quadrant macular ischemic group and 0.73 +/- 0.31 in the over 3 quadrants macular ischemia group. CONCLUSIONS: The initial and final visual outcomes were worse when more quadrants were affected by macular ischemia. The extent of macular ischemia was correlated with initial visual acuity and final visual outcome but not with macular edema.

The Correlations between Donor Endothelial Lenticule Thickness and Visual Prognosis in DSAEK

PURPOSE: To determine the correlations between donor endothelial lenticule thickness and visual prognosis in Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: The present study included 22 patients (22 eyes), who underwent DSAEK surgery in our clinic due to endothelial decompensation. BCVA (log MAR) was compared at 1 month, 3 months and 6 months postoperatively between the thin lenticule group and thick lenticule group (> or =130 micrometer). RESULTS: The BCVA (log MAR) at 1 month postoperatively was 0.46 +/- 0.22 in the thin lenticule group, and 0.71 +/- 0.26 in the thick lenticule group, and significant statistical correlations between donor lenticule thickness and visual acuity were observed (p = 0.025). However, no significant correlations were observed at 3 months (p = 0.129) and 6 months (p = 0.141) postoperatively. CONCLUSIONS: The thin donor lenticule ( or =130 micrometer), however, there is no difference in visual acuity between the 2 groups at 3 and 6 months postoperatively.

Neuritis óptica en niños: experiencia clínica en 13 años / Optic neuritis in children: clinic experience in 13 years

Background: In pediatric optic neuritis usually occurs after an infectious event, with papilledema, bilateral and with good prognosis, with a low incidence of conversion to multiple sclerosis. The aim of this paper is to present the clinical and laboratory characteristics of cases of optic neuritis in children. Patients and Methods: 10 clinical cases of optic neuritis in children and youth aged 5 to 17 years, referred between 1995 to 2007. Results: The median age at presentation was 11 years. 8 cases were females. Four cases with a history of respiratory infection, bilateral involvement in 8 of 10 patients and 5 cases of retrobulbar optic neuritis. Magnetic resonance imaging showed T2 hyperintensity in the optic nerves affected in 5 patients. The study of cerebrospinal fluid was normal and oligoclonal bands in all cases. The cases treated with intravenous methylprednisolone had good recovery. Two cases have multiple sclerosis. Discussion: In this series of female patients predominated and limited history of previous infection. Cases with multiple sclerosis showed no clinical differences, but more hyperintense lesions on magnetic resonance. The cases treated with methylprednisolone had good visual prognosis.

Antecedentes: En pediatría la neuritis óptica generalmente se presenta después de un cuadro infeccioso, con edema de papila, que suele ser bilateral y tiene buen pronóstico. La conversión a esclerosis múltiple es baja. Nuestro objetivo es presentar las características clínicas y de laboratorio de casos de neuritis óptica en pediatría. Pacientes y Método: Se analizan 10 casos clínicos de neuritis óptica en niños y jóvenes entre 5 y 17 años, referidos entre los años 1995 a 2008. Resultados: La edad media de la serie fue de 11 años. 8 casos eran de sexo femenino; cuatro tenían antecedentes de infección respiratoria. En 8 de 10 pacientes el compromiso fue bilateral y 5 casos evolucionaron con neuritis óptica retrobulbar. La resonancia magnética mostró hiperintensidad en T2 en los nervios ópticos afectados en 5 pacientes. El estudio de líquido cefalorraquídeo y bandas oligoclonales fue normal en todos los casos. Los pacientes tratados con metilprednisolona endovenosa tuvieron buena recuperación. Sólo dos casos evolucionaron a esclerosis múltiple. Discusión: En esta serie predonimaron los pacientes de sexo femenino y el antecedente infeccioso fue poco frecuente. Los casos que evolucionaron a esclerosis múltiple no mostraron diferencias clínicas; sólo presentaron mayor cantidad de lesiones hiperintensas en la RM. Tuvieron mejor pronóstico visual los enfermos tratados con metilprednisolona.

Clinical Characteristics of Leber's Congenital Amaurosis in Korea

PURPOSE: To study the clinical characteristics and visual prognosis of Leber's congenital amaurosis in Korea. METHODS: Children who were diagnosed with Leber's congenital amaurosis at Seoul Natioanl University Children's Hospital between 1992 and 2004, were included in this study. The medical records pertaining to the clinical characteristics and visual outcomes of the patients were retrospectively reviewed. RESULTS: The mean age of the patients at presentation and during the subsequent follow-up period was 15.5 and 62.7 months, respectively. The principal symptoms included lack of fixation (69.0%) and nystagmus (23.8%). At first observation, nystagmus was found in 40 patients, and the appearance of the fundi were variable, including 'normal' (23.8%), pigmentary degeneration (54.8%), vascular attenuation (35.7%) and macular coloboma (19.0%). At the age of three to five years, 44.4% of patients had hyperopia greater than +5D. At the time of last follow-up, the visual acuities of the patients who were examined after the age of four were 'hand motion' in 68.7%, > or =20/400 in 9.4%. No patient had visual acuity better than 20/200. Eight (25%) patients could read with glasses or low-vision aids. CONCLUSIONS: The visual prognosis of patients with Leber's congenital amaurosis was poor in most cases, but a majority of our patients displayed a stable clinical course. Progression was rare, and one fourth of the patients were able to read with appropriate aides. In conclusion, regular follow-up care to assess visual function is necessary for optimal outcomes.

Clinical Characteristics of Leber's Congenital Amaurosis in Korea

PURPOSE: To study the clinical characteristics and visual prognosis of Leber's congenital amaurosis in Korea. METHODS: Children who were diagnosed with Leber's congenital amaurosis at Seoul Natioanl University Children's Hospital between 1992 and 2004, were included in this study. The medical records pertaining to the clinical characteristics and visual outcomes of the patients were retrospectively reviewed. RESULTS: The mean age of the patients at presentation and during the subsequent follow-up period was 15.5 and 62.7 months, respectively. The principal symptoms included lack of fixation (69.0%) and nystagmus (23.8%). At first observation, nystagmus was found in 40 patients, and the appearance of the fundi were variable, including 'normal' (23.8%), pigmentary degeneration (54.8%), vascular attenuation (35.7%) and macular coloboma (19.0%). At the age of three to five years, 44.4% of patients had hyperopia greater than +5D. At the time of last follow-up, the visual acuities of the patients who were examined after the age of four were 'hand motion' in 68.7%, > or =20/400 in 9.4%. No patient had visual acuity better than 20/200. Eight (25%) patients could read with glasses or low-vision aids. CONCLUSIONS: The visual prognosis of patients with Leber's congenital amaurosis was poor in most cases, but a majority of our patients displayed a stable clinical course. Progression was rare, and one fourth of the patients were able to read with appropriate aides. In conclusion, regular follow-up care to assess visual function is necessary for optimal outcomes.

Prognostic Factors of Visual Acuity in Diabetes Mellitus

PURPOSE: We performed a retrospective study to investigate the risk factors for visual prognosis in diabetes mellitus patients. METHODS: We reviewed 179 patients (358 eyes) who visited our hospital from January 1990 to January 2004. RESULTS The final visual outcome showed improvement in 28 (7.8%) eyes, no change in 193 (53.9%) eyes and worsening in 137 (38.3%) eyes. Duration of diabetes mellitus (p=0.01), diabetic retinopathy (p=0.001), higher grade diabetic retinopathy (p=0.002), progression of cataract (p=0.002), glaucoma (p=0.011), control of hypertension (p=0.001) and an abnormally low glomerular filtration rate (p=0.004) were all indicative of a high risk for decreased visual acuity. But other factors (age, type of diabetes mellitus, abnormality of electrocardiography, HbA1c, serum lipid) were not significantly correlated with visual prognosis (p>0.05). CONCLUSIONS: We concluded that duration of diabetes mellitus, diabetic retinopathy, higher grade diabetic retinopathy, cataract, glaucoma, control of hypertension and abnormally low glomerular filtration rate were the risk factors of decreased visual acuity.

Prognostic Factors of Visual Acuity in Diabetes Mellitus

PURPOSE: We performed a retrospective study to investigate the risk factors for visual prognosis in diabetes mellitus patients. METHODS: We reviewed 179 patients (358 eyes) who visited our hospital from January 1990 to January 2004. RESULTS The final visual outcome showed improvement in 28 (7.8%) eyes, no change in 193 (53.9%) eyes and worsening in 137 (38.3%) eyes. Duration of diabetes mellitus (p=0.01), diabetic retinopathy (p=0.001), higher grade diabetic retinopathy (p=0.002), progression of cataract (p=0.002), glaucoma (p=0.011), control of hypertension (p=0.001) and an abnormally low glomerular filtration rate (p=0.004) were all indicative of a high risk for decreased visual acuity. But other factors (age, type of diabetes mellitus, abnormality of electrocardiography, HbA1c, serum lipid) were not significantly correlated with visual prognosis (p>0.05). CONCLUSIONS: We concluded that duration of diabetes mellitus, diabetic retinopathy, higher grade diabetic retinopathy, cataract, glaucoma, control of hypertension and abnormally low glomerular filtration rate were the risk factors of decreased visual acuity.

Visual Prognosis of Culture-Proven Bacterial Endophthalmitis

PURPOSE: To evaluate the factors contributing to the visual outcome of patients with culture-proven bacterial endophthalmitis. METHODS: We reviewed medical records of all eyes with infectious endophthalmitis between January 1996 and June 2005. The causative bacteria were identified in 18 of 90 eyes, for which we evaluated their clinical features and factors influencing their visual prognosis. RESULTS: Bacterial endophthalmitis occurred after cataract surgery in 6 of 18 eyes, after trabeculectomy or glaucoma implant surgery in 4 eyes, after trauma in 3 eyes, after intravitreal triamcinolone injection in 1 eye, and after endogenous endophthalmitis in 4 eyes. The culture results were similar between gram positive and gram negative organisms. Final vision was 0.1 or better in 6 of the 18 eyes. Final visual acuities showed statistically significant correlation with causative organisms (p=0.018). CONCLUSIONS: For effective management of bacterial endophthalmitis and prediction of prognosis, we recommend thorough bacterial culture. Also, further investigation with a large population is needed.