One year outcome and predictors of treatment outcome in central serous chorioretinopathy: Multimodal imaging based analysis

Purpose To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. Methods Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. Results At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR ( P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline ( P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively ( P = 0.09). For the 12 months follow up, the median fluid free period was greater ( P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR ( P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months ( P < 0.0001, 0.04) respectively. Conclusions Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.

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One-year results of half-dose versus one-third-dose photodynamic therapy in chronic or recurrent central serous chorioretinopathy

BMC Ophthalmology ◽

10.1186/s12886-020-01796-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jirarattanasopa Pichai ◽

Banchasakjaroen Vanchalerm ◽

Ratanasukon Mansing

Keyword(s):

Photodynamic Therapy ◽

Recurrence Rate ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Corrected Visual Acuity ◽

Half Dose ◽

One Year ◽

The One ◽

Different Doses

Abstract Background Central serous chorioretinopathy (CSC) is characterized by an accumulation of subretinal fluid (SRF) in the macula. It is usually treated by laser photocoagulation or photodynamic therapy (PDT) with consisting of different doses and power. This study aimed to compare the efficacy of half-dose PDT and one-third-dose PDT in chronic or recurrent CSC. Methods A retrospective review of patients with chronic or recurrent CSC who were treated with either a half-dose or one-third-dose PDT, and had follow up 12 months afterwards. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of subretinal fluid (SRF) at baseline as well as 1, 3, 6 and 12 months post-PDT were assessed. Results Forty-six eyes and 20 eyes received half-dose and one-third-dose PDT, respectively. The study showed efficacy of the one-third-dose PDT compared with half-dose PDT in BCVA improvement (0.10±0.04 logMAR for one-third-dose versus 0.17±0.04, for half-dose, P=0.148) and CRT improvement (125.6±24.6 μm for one-third-dose versus 139.1±16.54, for half-dose, P=0.933) at 12 months. The SRF recurrence rate was significantly higher in the one-third-dose PDT group compared with the half-dose PDT group (40.0% versus 15.2%, P=0.027) at 12-months. Conclusion At 12 months, the one-third-dose PDT was effective in terms of BCVA and CRT improvement, when compared with half-dose PDT. However, this study showed that one-third-dose PDT had a higher recurrence rate of SRF.

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One-year outcome of cystoid macular degeneration in central serous chorioretinopathy

European Journal of Ophthalmology ◽

10.1177/11206721211046497 ◽

2021 ◽

pp. 112067212110464

Author(s):

Niroj Kumar Sahoo ◽

Marco Lupidi ◽

Abhilash Goud ◽

Sankeert Gangakhedkar ◽

Felice Cardillo Piccolino ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Central Serous Chorioretinopathy ◽

Functional Outcomes ◽

Observation Group ◽

Chronic Central Serous Chorioretinopathy ◽

Micropulse Laser ◽

One Year ◽

Anatomical Outcome

Purpose: To study structural and functional outcomes of cystoid macular degeneration (CMD) in chronic central serous chorioretinopathy (CSCR). Methods: This retrospective study included 26 eyes having chronic CSCR with CMD who underwent either observation, photodynamic therapy (PDT), micropulse laser, or eplerenone therapy. Various optical coherence tomography parameters were analyzed at baseline and 1 year. Results: Number of eyes that maintained or gained vision after treatment was 63.1%, compared to a loss of 2.1 ± 1.1 lines in observation group. Sub-foveal large choroidal vessel responded to PDT ( p = 0.03); while CMT ( p = 0.035) and intra-retinal cystoid spaces (0.037) responded to eplerenone. Longer duration of the symptoms and round cystoid spaces were associated with a decrease in CMT ( p = 0.03) and decrease in cystoid spaces size ( p = 0.02) respectively on follow up. Conclusion: Treatment of eyes with CMD prevents further deterioration of vision. Round configuration of intra-retinal cystoid space has a better anatomical outcome.

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One-year results of half-dose versus one-third-dose photodynamic therapy in chronic or recurrent central serous chorioretinopathy

10.21203/rs.3.rs-38736/v3 ◽

2021 ◽

Author(s):

Pichai Jirarattanasopa ◽

Banchasakjaroen Vanchalerm ◽

Ratanasukon Mansing

Keyword(s):

Photodynamic Therapy ◽

Recurrence Rate ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Corrected Visual Acuity ◽

Half Dose ◽

One Year ◽

The One ◽

Different Doses

Abstract Background: Central serous chorioretinopathy (CSC) is characterized by an accumulation of subretinal fluid (SRF) in the macula. It is usually treated by laser photocoagulation or photodynamic therapy (PDT) with consisting of different doses and power. This study aimed to compare the efficacy of half-dose PDT and one-third-dose PDT in chronic or recurrent CSC.Methods: A retrospective review of patients with chronic or recurrent CSC who were treated with either a half-dose or one-third-dose PDT, and had follow up 12 months afterwards. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of subretinal fluid (SRF) at baseline as well as 1, 3, 6 and 12 months post-PDT were assessed.Results: Forty-six eyes and 20 eyes received half-dose and one-third-dose PDT, respectively. The study showed efficacy of the one-third-dose PDT compared with half-dose PDT in BCVA improvement (0.10±0.04 logMAR for one-third-dose versus 0.17±0.04, for half-dose, P=0.148) and CRT improvement (125.6±24.6 µm for one-third-dose versus 139.1±16.54, for half-dose, P=0.933) at 12 months. The SRF recurrence rate was significantly higher in the one-third-dose PDT group compared with the half-dose PDT group (40.0% versus 15.2%, P=0.027) at 12-months.Conclusion: At 12 months, the one-third-dose PDT was effective in terms of BCVA and CRT improvement, when compared with half-dose PDT. However, this study showed that one-third-dose PDT had a higher recurrence rate of SRF.

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ANATOMICAL AND VISUAL OUTCOME OF COMBINED PHACO-VITRECTOMY VS VITRECTOMY ALONE

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i04.362 ◽

2021 ◽

Vol 31 (04) ◽

pp. 204-209

Author(s):

Irfan Muslim ◽

Asad Aslam Khan ◽

Nasir Chaudhry

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Visual Outcome ◽

P Value ◽

Corrected Visual Acuity ◽

Group A ◽

Pars Plana ◽

Group B ◽

Anatomical Outcome

Introduction Separation of Neurosensory retina from RPE(Retinal Pigment Epithelium) is described as retinal detachment. Recently Pars plana vitrectomy has emerged as a preferred surgical treatment for management of uncomplicated primary rhegmatogenous retinal detachment. Various studies have evaluated the results of combined phaco-vitrectomy, the combined approach allows faster visual recovery and has cost effectivity for patient. The rationale of this study is to compare the anatomical and visual outcome of combined phacoemulsification and vitrectomy vs vitrectomy alone Materials and methods This prospective randomized controlled trial was performed at Eye Unit II Mayo Hospital Lahore (tertiary care eye hospital in Lahore), Pakistan from August 2019 to February 2020. 36 patients full filling the inclusion criteria were divided into two groups 18 patients each. Group A was of combined Phaco-vitrectomy and Group B was of vitrectomy only. The Mann-whitney test as test of significance was applied and P≤0.05 was considered statistically significant. Results BCVA done Pre-operatively for Group A and B, P-value was > 0.05 which was insignificant. Best corrected visual acuity at first week post operatively was significantly lower in patients in which we used gasses as internal tamponade as compared those in which we used silicon oil as tamponade. The BCVA at 1 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being < 0.05. The BCVA at 3 month showed improvements in both groups, however the BCVA in group B was significantly lower than group A, P-value being < 0.05. Anatomical Outcome was seen as weather retina was attached or detached. In Group A detachment was present in all follow-ups in 2/18 patients while in Group B detachment was present in all follow-ups in 3/18 patients. The P-value was >0.05 and thus the difference between two groups was insignificant. Conclusion visual acuity did not differ among the two groups preoperatively and on first follow-up at 1 week. The P value being >0.05 in both. However there was significant difference between the two group at 1 month and 3 months follow up, P value being < 0.05 in each. The visual acuity was significantly better in Group A i.e combined phaco- vitrectomy. For anatomical outcome no difference was seen between the groups. The P value was > 0.05. So the visual outcome of group A was significantly better than group B while the anatomical outcome was the same. Keywords Phacoemulsification, Three ports pars plana vitrectomy, best corrected visual acuity, retinal detachment.

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Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v13i2.44 ◽

2013 ◽

Vol 13 (2) ◽

pp. 33-41

Author(s):

Devendra Maheshwari ◽

Rengappa Ramakrishanan ◽

Mohideen Abdul Kader ◽

Neelam Pawar ◽

Ankit Gupta

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Intraocular Lens ◽

Intraocular Lens Implantation ◽

Corrected Visual Acuity ◽

Lens Implantation ◽

The Mean ◽

One Year ◽

Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

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A Feasibility Randomised Control Trial of Vitrectomy Plus Standard Care Intravitreal Ranibizumab or Aflibercept Injections versus Standard Care Intravitreal Ranibizumab or Aflibercept injections Alone In Patients With Centre Involving Diabetic Macular Edema

10.21203/rs.3.rs-159886/v1 ◽

2021 ◽

Author(s):

Alistair Laidlaw ◽

Chris Hammond ◽

Matthew James Maguire

Keyword(s):

Standard Care ◽

Visual Loss ◽

Rescue Therapy ◽

Macular Thickness ◽

Randomised Control Trial ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Anti Vegf ◽

One Year

Abstract Background: Most studies indicate that vitrectomy delivers sustained improvements in macular thickness. Evidence on whether acuity is improved is inconsistent. In the presence of traction vitrectomy is thought to be visually effective. In the absence of traction vitrectomy was usually performed as rescue therapy when repeated laser treatments had failed and visual improvement may not have been possible. Studies where vitrectomy was performed early in the disease showed visual benefit. All these data also predate the current gold standard anti VEGF therapy for DME and SD OCT imaging of the vitreo retinal interface. We hypothesise that adding a vitrectomy and internal limiting membrane peel to standard care intravitreal Anti-VEGF injections in the management of CIDME will result in: improved or comparable visual outcomes, fewer anti-VEGF injections and reduced costs. Methodology: VIDEO is a pragmatic stratified, single-masked, randomised, multi centre, controlled, feasibility trial with 12 months follow up. Stratification will be based in the presence or absence of OCT evident vitreomacular traction or epiretinal membrane. The primary outcome is Distance best corrected visual acuity. Secondary outcomes are Number of injections, Rate of completed follow, Rate of recruitment, Central macular thickness on OCT, Area under the curve of CMT, Area under curve of BCVA, Rate of loss of 15 or more letters from baseline, Rate of Rescue therapy, Rate of cataract surgery, Rate of complications. Recruitment target is 100 patients with 1:1 randomisation to the treatment arm (vitrectomy + standard care) or control arm (standard care) with 12 month follow up. Standard care is treat and extend intravitreal anti-VEGF injections. Main inclusion criteria: -Patient over 18 years of age -Patient has capacity to give informed consent -Patient has not previously been enrolled in this study in regards to their other eye - Symptomatic visual loss attributable to diabetic macular oedema for less than one year -Patient has a formal diagnosis of Diabetes Mellitus -Patient has an HbA1c test (a blood test that looks at long term diabetic control) performed within the past 2 months. Ophthalmic criteria: -Symptomatic visual loss attributable to DMO for less than one year. -Best corrected visual acuity of better than 35 ETDRS letters on formal testing -Central macular thickness greater than 350 microns. Discussion: Outcomes should inform the effect size with which to inform the design of a definitive randomised control trial ISRCTN Registry ISRCTN59902040 18.12.20 retrospectively registered http://www.isrctn.com/ISRCTN59902040

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Children With Encopresis: A Study of Treatment Outcome

PEDIATRICS ◽

10.1542/peds.58.6.845 ◽

1976 ◽

Vol 58 (6) ◽

pp. 845-852 ◽

Cited By ~ 1

Author(s):

Melvin D. Levine ◽

Harry Bakow

Keyword(s):

Treatment Outcome ◽

Treatment Program ◽

Marked Improvement ◽

Medical Center ◽

Outcome Data ◽

Careful Monitoring ◽

Maintenance Program ◽

Pediatric Treatment ◽

One Year

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.

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Refractive and Visual Outcomes after Scleral Fixated Intraocular Lens Implantation in Children with Ectopia Lentis

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v12i1.22252 ◽

2020 ◽

Vol 12 (1) ◽

pp. 75-82

Author(s):

Regina Lalramhluni ◽

Soveeta Rath ◽

Ankita Shrivastav ◽

Prem Kumar Singh ◽

Rahul Mayor ◽

...

Keyword(s):

Intraocular Lens ◽

Visual Outcome ◽

Ectopia Lentis ◽

Corrected Visual Acuity ◽

Good Visual Outcome ◽

Induced Astigmatism ◽

The Mean ◽

The Stability ◽

Scleral Fixated Intraocular Lens

Introduction: This study was conducted to report the refractive and visual outcome after Scleral Fixated Intraocular Lens (SFIOL) implantation in children with nontraumatic ectopia lentis. Methods: Retrospective review of the medical records of 25 eyes of 15 patients who underwent SFIOL implantation in children with non-traumatic ectopia lentis. Results: The mean best corrected visual acuity (BCVA) before SFIOL implantation was 1.07 ± 0.9 logMar units [median: 0.9, Interquartile range (ΙQR): 0.415 to 1.555] which improved to 0.41 ± 0.33 logMar units (median: 0.22, ΙQR: 0.180 to 1.555) at two months postoperative follow up. In phakic group, the mean spherical refraction preoperatively was -12.04 ± 7.82 DS (dioptre sphere) (IQR: +16 to -5.875) and postoperatively was +0.93 ± 2.67DS (IQR: -0.375 to +2). In aphakic group, the mean spherical refraction preoperatively was +12.22 ± 2.05 DS and postoperatively was +1.2 ± 1.9 DS. The mean total astigmatism preoperatively was -6.44 ± 4.95 DC (dioptre cylinder) (median: 6, IQR: -10.50 to +2) and postoperatively was -1.47 ± 0.98 DC (median: -1.5, IQR: -2 to - 0.625 ). The mean IOL induced astigmatism was -1.01 ± 0.95 DC (median -0.75, IQR: -1.33 to - 0.25). The spherical refractive equivalent was within 2 Diopter (D) of the target refraction calculated preoperatively in 20 eyes and in five eyes it was more than 2 D. Conclusion: SFIOL implantation is associated with good visual outcome with a significant improvement in the refractive error. However, a longer follow up is required to assess the change of refraction and the stability of the SFIOL.

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Anatomical and Visual Outcome of Rhegmatogenous Retinal Detachment Managed with Scleral Buckling at a Tertiary Eye Centre in Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v10i2.18832 ◽

2018 ◽

Vol 10 (2) ◽

pp. 151-155

Author(s):

Roshija Khanal Rijal ◽

Raghunandan Byanju ◽

Araniko Pandey ◽

Deepesh Mourya

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Care Center ◽

Visual Outcome ◽

Scleral Buckling ◽

Interventional Study ◽

Corrected Visual Acuity ◽

Common Causes ◽

The Common

Objective: To study the anatomical status and visual outcome of scleral buckling surgery in rhegmatogenous retinal detachment (RRD) at tertiary eye care center in Nepal. Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with scleral buckling surgery performed in Lumbini Eye Institute, Nepal. All the patients underwent surgery by a single experienced surgeon and had at least 3 months follow up. Result: A total of 50 patients (50 eyes) were operated, 38 males and 12 females, with a mean age of 39.46. Retinal reattachment was achieved in 46 (92%). Improved best corrected visual acuity (BCVA) was seen in 84%, whereas in 8% BCVA was same and deteriorated in another 8%. Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with scleral buckling surgery can give good anatomical and visual outcome.

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Cognitive Therapy for Posttraumatic Stress Disorder

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.15.4.321 ◽

2001 ◽

Vol 15 (4) ◽

pp. 321-329 ◽

Cited By ~ 20

Author(s):

Patricia A. Resick

Keyword(s):

Posttraumatic Stress Disorder ◽

Treatment Outcome ◽

Cognitive Therapy ◽

Posttraumatic Stress ◽

Cognitive Processing ◽

Stress Disorder ◽

Exposure Therapy ◽

Cognitive Processing Therapy ◽

One Year

Cognitive therapy for posttraumatic stress disorder is in the early stages of development and study. This article will examine seven controlled studies that included at least a component of cognitive therapy. Two studies specifically focused on early intervention to treat PTSD and included both cognitive therapy and exposure therapy. Three studies examined cognitive processing therapy, which is predominantly cognitive therapy. Two other studies compared pure cognitive therapy with exposure therapy. Overall, cognitive therapy for PTSD appears to be highly effective compared to no-treatment, relaxation, or supportive counseling, and similar to exposure treatments. Treatment effects appear to continue through follow-up periods of up to one year. At this point, little is known about who benefits best with cognitive therapy or predictors of treatment outcome.

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