Management and Clinical Outcomes of Eyes With Posterior Segment Intraocular Foreign Bodies Seen at a Tertiary Referral Center.

BACKGROUND AND OBJECTIVE: This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB). PATIENTS AND METHODS: The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed. RESULTS: The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA (P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success (P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA (r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal (P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis (P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome. CONCLUSIONS: The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].

Comparison of intravitreal ranibizumab and aflibercept for the treatment of diabetic macular edema: a real-world study.

PURPOSE: To compare the visual and anatomic outcomes of intravitreal ranibizumab versus aflibercept in patients with diabetic macular edema (DME) in a real-world study. METHODS: This is a single-center retrospective comparative study of treatment-naïve patients who received intravitreal ranibizumab or aflibercept administration for DME for at least 12 months on an as needed regimen following three-monthly loading doses. The primary outcomes of the study were the mean change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV). Factors to potentially affect these parameters were also analyzed. RESULTS: A total of 100 eyes (66 patients) were included in the study. Fifty two eyes received ranibizumab and 48 eyes in aflibercept injections. At the end of follow-up, the improvement in mean BCVA was similar in both groups (p = 0.38). While the decrease in mean CMT at the 4th-month visit was significantly higher in the aflibercept-treated group than in the ranibizumab-treated group (p = 0.02), there was no difference between the two groups at the end of the 1-year follow-up (p = 0.25). There was no significant difference between the two groups in terms of change in mean CMV during the follow-up (p = 0.26, p = 0.27 at 4 and 12 months, respectively). The mean number of injections were also similar between groups (4.5 ± 1 vs. 4.6 ± 1.1 respectively, p = 0.63). CONCLUSION: In a real-world setting, ranibizumab and aflibercept were both found to be effective in the first-line treatment of DME. Patients with DME who received fewer injections in the real-world could achieve visual and anatomical results comparable to randomized controlled trials participants.

The Relationship between Clinical Findings and Viral Load in Adenoviral Keratoconjunctivitis.

The aim of this study was to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were assessed. Real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. Patients were divided into three subgroups according to baseline viral load (<107, 107-108, >108 human adenovirus [HAdV] copies/mL). The duration of follow-up, HAdV DNA copy number, treatment regimen, and detailed clinical findings, including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. This study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (P < 0.05). The clinical findings and ocular complications of Ad-Kc were similar in the treatment groups at the final examination (P > 0.05). Our results show that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determining the initial viral load in Ad-Kc may help understand the clinical course of the disease better and prevent complications.

Improved contact lens fitting after corneal cross-linking in eyes with progressive keratoconus.

OBJECTIVES: The study aimed to assess the possible effects of corneal cross-linking (CXL) on contact lens (CL) fitting in patients with progressive keratoconus who initially had CL intolerance. METHODS: A retrospective review was performed of the medical records of patients who had stopped CL wear due to discomfort prior to CXL and who were fitted with CLs after CXL. All eyes were evaluated pre- and 1, 6, 12, 24 months postoperatively. Data collected included pre- and post-CXL refraction, corneal topographic data, uncorrected visual acuity, and best-corrected visual acuity (BCVA). CL comfort was evaluatedusing theLikert scale post-CXL. RESULTS: A total of 20 eyes from 14 patients were included in the study. Preoperative Kmax values significantly decreased by 2.8 D at 6 months and by 4.1 D at 12 months after CXL (p < 0.001 for both). CLs were prescribed on average 12 ± 2.5 months after CXL. The mean duration of successful CL wear was 10.4 ± 2.8 months during the follow-up period. Subjective CL comfort scores were satisfactory post-CXL. CONCLUSION: CXL not only halts the progression of keratoconus but may also improve CL tolerance by providing a more regular shaped cornea in these patients. Ongoing corneal topographic changes in the late postoperative period after CXL may have a positive effect on CL fitting.

Use of new-generation hybrid contact lenses for managing challenging corneas.

INTRODUCTION: To evaluate the safety and efficacy of new-generation hybrid contact lenses (HCL) among patients with irregular astigmatism. METHODS: Medical records of 25 patients fit with new-generation HCL (Eyebrid® and AirFlex®) were retrospectively reviewed. The data collected included etiology of irregular astigmatism, uncorrected visual acuity, manifest refraction, spectacle-corrected visual acuity (S-CDVA), steep / flat keratometric values, corneal astigmatism, records of rigid / soft CL fitted before HCL, all parameters of the trial lenses, and the final prescribed HCL parameters and HCL-CDVA. RESULTS: The study included 34 eyes from 25 patients (nine females and 16 males) with an average age of 29 ± 13 (ranging from 8-56) years. In total, 25 eyes with keratoconus, four with post - keratoplasty astigmatism, three with irregular astigmatism due to corneal trauma and two with residual astigmatism after radial keratotomy were fit with HCL. The mean S-CDVA (logMAR) improved significantly from 0.76 ± 0.41 to 0.14 ± 0.15 with HCL (p < 0.01). The most common indication for HCL was inability to fit with rigid gas permeable (RGP) lenses (22 eyes). The average number of lenses to successful fit was 1.4 (mode, 1; median, 1) and ideal fit was achieved with the first trial lens in 25 eyes (73%). Seven patients (nine eyes, 36%) discontinued lens use within the first 6 months because of discomfort (six eyes, 24%), ocular allergy (two eyes, 8%) and tearing of contact lens (one eye, 4%). DISCUSSION: New-generation HCL may be a suitable option for fitting challenging corneas with irregular astigmatism that cannot be rehabilitated efficiently with rigid lenses.

Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy.

BACKGROUND: With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This combined surgery offers several advantages besides limitations. The aim of this study is to assess the outcome and complications of phacoemulsification combined with pars plana vitrectomy (PPV). PATIENTS AND METHODS: In this retrospective review, medical charts of patients undergoing phacovitrectomy for coexisting cataract and various vitreoretinal disorders were analyzed. Patient demographics, retinal diagnosis, visual acuities (VA) in logMAR, intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Clear corneal phacoemulsification and 23-gauge transconjunctival PPV were administered in all cases. RESULTS: Eighty-four eyes of 64 (76.2%) males and 20 (23.8%) females were enrolled. The average age of patients was 59.5 ± 13.8 (18-81). The average period of follow-up was 7.2 ± 7.5 months (1-36). The vitreoretinal diagnoses were as follows: 28 (33.3%) rhegmatogenous retinal detachment, 23 (27.4%) vitreous hemorrhage, 12 (14.3%) intraocular foreign body, 12 (14.3%) epiretinal membrane, 4 (4.8%) macular hole, 4 (4.8%) tractional retinal detachment, and 1 (1.2%) vitreomacular traction. The most common intraoperative complications were miosis and rupture of the posterior capsule (92.9% and 8.3%, respectively). In 8 (9.5%) cases, there was fibrin in the anterior chamber. Posterior synechia developed in 7 (8.3%) of cases. No severe increase in intraocular pressure was evident. CONCLUSION: Phacoemulsification combined with PPV is a safe and efficient way of management in cases where cataract coexists with vitreoretinal pathologies.