To study visual and neurological outcome after treatment according to ONTT protocol

To evaluate the visual and neurological outcomes of Optic Neuritis Treatment Trial (ONTT). 40 Patients presenting with optic neuritis were enrolled in this study to analyze the Visual and Neurological outcomes after treatment according to ONTT Protocol, with emphasis on signs of anaemia, protein calorie malnutrition, vitamin deficiency, generalized lymphadenopathy, sinusitis, septic foci. Patients were followed up for three subsequent visits to assess the rate of visual recovery.Maximum patient 35(87.5) treated according to ONTT protocol while 5 (12.5%) treated with oral steroids alone. Maximum 33 eyes (70.2%) attain BCVA > 6/36 after 1st follow-up (with in 1 month) while 10(21.3%) eyes attain BCVA of 6/6 after 1st follow-up. 11 eyes (25.6%) attain BCVA 6/6 after II follow-up. General prognosis for recovery of vision was good and was slightly worse in more severely affected cases in the present series. Pallor of the optic disc and defect of vision did not always correspond–3 eyes which showed temporal of the disc at the end of follow up had a final vision of 6/9 or better in each eye.

A comparative study of clinical outcome following topical versus peribulbar anesthesia in phacoemulsification surgery

The objective of our study was to evaluate and compare clinical outcomes, patients and surgeon’s satisfaction following topical versus peribulbar anesthesia in phacoemulsification surgery. A hospital based Randomized Prospective interventional Comparative Study done between November 2017 to May 2019. A total of 200 patients included in the study, ocular examination, biometry were done. Patients were randomly distributed into group1 TA (topical anesthesia) and group 2 PA (Peribulbar anesthesia), they underwent phacoemulsification with intraocular lens implantation, postoperative visual outcome and inflammation on day1 and after 1 week, VAS (Visual Analogue scale) pain scale used to analyse patients comfort and pain postoperatively. The Statistical analysis was performed by STATA 11.2 (College Station TX USA). In our study 200 participated, it was found in PA group, 60.47 ± 11.86 yrs and in TA group 59.01 ± 11.29yrs as mean age, majority were male. PA group had few complications during anesthesia and in both groups majority had no intraoperative complications. Log Mar visual acuity postoperative day 1, PA group was 0.65±0.40 and in TA was 0.49±0.32, post operative visual recovery was better in TA group patients and had less pain and more comfortable than PA. Surgeon had difficulty more with TA group patients. It was found, postoperative visual recovery was faster and better in patients with topical group with less postoperative inflammation and complications. Topical anesthesia being a non invasive procedure can be considered better than peribulbar when compared in terms of patients comfort and postoperative recovery.

Predictive value of OCT and MRI for postoperative visual recovery in patients with chiasmal compressive lesions

Purpose We aimed to investigate the predictive value of retinal thickness measured by optical coherence tomography (OCT) and mass biometrics measured using magnetic resonance image (MRI) for visual recovery after surgery for removal of a mass compressing the optic chiasm. Methods Consecutive patients who showed typical temporal visual field defect (VFD) with respect to the vertical meridian due to a chiasmal compressive mass and who underwent mass removal surgery were recruited. Ophthalmic examination was performed preoperatively and postoperatively. Retinal thickness was measured by the Cirrus OCT. The height and size of the mass and suprasellar extension (SSE) in both the sagittal and coronal planes were evaluated. Patients were divided into two groups based on the improvement in VFD (mean deviation [MD] change ≥ 5 dB: group R; others: group NR) and clinical characteristics were compared. Results Fifteen patients were included in the study. Eight (53.3%) patients were allocated into group R and others (7 patients, 46.7%) into group NR. Age, sex, initial visual acuity, initial MD was not different between the two groups. The retinal thicknesses were not different while tumor height, volume, and both sagittal and coronal SSE were significantly different between the two groups. (p = 0.029, 0.014, <0.001, and <0.001, respectively) All MRI parameters showed significant predictive value for the degree of MD recovery. Conclusion MRI showed better predictive value than OCT in predicting postoperative VFD recovery in patients with temporal VFDs due to chiasmal compressive disorder.

Macular morphologic changes following successful retinal detachment repair by scleral buckling surgery

Background/Aim: Spectral domain optical coherence tomography (SD-OCT) is very useful for accurate examination of macular microstructure. The aim of this study was to evaluate macular morphologic changes after successful retinal detachment (RD) surgery by scleral buckling using SD-OCT and assess their impact on vision repair. Methods: SD-OCT examination was performed 1, 6 and 12 months in 27 eyes following scleral buckling (SB) surgery with successful anatomical repair of rhegmatogenous retinal detachment (RRD) which also affected the macular region. The examination was performed in a 6mm diameter central macular region and included measurements of the central foveal thickness (CFT), average overall retinal thickness and thickness of the outer and inner retinal layers separately. The numerical values of operated eyes were compared with those of the fellow (control) eyes. The condition of the outer limiting membrane (ELM) and inner segment/outer segment of the photoreceptors (IS/OS) was also examined. Results: The mean total and outer retinal thickness (TRT and ORT) in the reattached regions in the operated eyes were significantly thinner than the corresponding regions of the fellow (control) eye, and throughout the follow-up period the difference was statistically significant. There was a statistically significant difference in TRT (after 1 month p=0.021, after 6 months p=0.026, after 12 months p=0.027) and ORT (after 1 month p=0.018, after 6 months p=0.019, after 12 months p=0.021) between the eyes with a longer pre-operative duration of macular detachment of 2 weeks and eyes with shorter detachment period. Disruptions of the photoreceptors IS/OS and ELM on OCT examination after one month were observed in 37.04% eyes, after 6 months in 29.6% eyes, and at the end of the follow-up period in 14.8% eyes. A statistically significant difference was found in the frequency of disruptions of the IS/OS and ELM depending on the preoperative duration of RD (p= 0.007). Conclusion: Overall decrease in the mean retinal thickness after successful anatomical repair of RD is result of decreases in the thicknesses of outer retinal layers. The alterations of the external limiting membrane and inner and outer photoreceptors segments observed on the early SD-OCT scans are mostly associated with limited visual recovery. The prolonged macular detachment leads to damage to the neurosensory tissue of the retina and especially the photoreceptors, which may explain the limited visual recovery after successful scleral buckling RD repair.

Machine Learning-Based Radiomics of the Optic Chiasm Predict Visual Outcome Following Pituitary Adenoma Surgery

Preoperative prediction of visual recovery after pituitary adenoma surgery remains a challenge. We aimed to investigate the value of MRI-based radiomics of the optic chiasm in predicting postoperative visual field outcome using machine learning technology. A total of 131 pituitary adenoma patients were retrospectively enrolled and divided into the recovery group (N = 79) and the non-recovery group (N = 52) according to visual field outcome following surgical chiasmal decompression. Radiomic features were extracted from the optic chiasm on preoperative coronal T2-weighted imaging. Least absolute shrinkage and selection operator regression were first used to select optimal features. Then, three machine learning algorithms were employed to develop radiomic models to predict visual recovery, including support vector machine (SVM), random forest and linear discriminant analysis. The prognostic performances of models were evaluated via five-fold cross-validation. The results showed that radiomic models using different machine learning algorithms all achieved area under the curve (AUC) over 0.750. The SVM-based model represented the best predictive performance for visual field recovery, with the highest AUC of 0.824. In conclusion, machine learning-based radiomics of the optic chiasm on routine MR imaging could potentially serve as a novel approach to preoperatively predict visual recovery and allow personalized counseling for individual pituitary adenoma patients.

Predictive Value of Ectopic Inner Foveal Layer Without Internal Limiting Membrane Peeling For Idiopathic Epiretinal Membrane Surgery

Purpose: To investigate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) diagnosed with idiopathic epiretinal membrane (iERM) patients who were peeled up only ERM in eyes with EIFL.Materials and Methods: Patients diagnosed with iERMs who have undergone PPV including only ERM peeling were enrolled into the study; and follow-up findings were recorded at baseline, months 3, 6, 12, and final examinations, retrospectively. EIFL was divided into four grades from mild to severe. Pre- and postoperative anatomical changes were measured by spectral domain optical coherence tomography (SD-OCT) imaging method. The association between EIFL and other SD-OCT parameters with best corrected visual acuity (BCVA) was assessed before and after PPV surgery.Results: One-hundred thirty eight eyes of 106 patients with EIFL (mild to severe) were included in the study. The higher thickness of EIFL was significantly correlated with lower baseline BCVA (r = 0.575, p = 0.020) and final BCVA (r=0.748, p= 0.001). Although, EIFLs continued in advanced stage cases (stage 3 and 4) (64 eyes (82%)) at final visit, observed in 8 eyes (23 %) in early stage (stage 2) of iERMs. Above all, a strong positive correlation was found between EIFL thickness and ERM recurrence rate (r=0.876, p <0.001). Recurrence ERM was detected in 27 eyes, which were found in 2 eyes (%7) at stage 1, 3 eyes (%9) at stage 2, 10 eyes (%23) at stage 3, and 12 eyes (%33) at stage 4 (p<0.001).Conclusion: A negative relationship was found between the severity of EIFL and postoperative anatomical and visual recovery. In terms of surgical timing, early stages (stage 1 and 2) may be preferred for providing good anatomical and visual recovery and low recurrence rate following surgery. In relation to further anatomical and visual yields, additional internal limiting membrane peeling may not be an essential procedure for early grades of iERMs (stage 1 and 2).

Optic Tract Shrinkage Limits Visual Restoration After Occipital Stroke

Background and Purpose: Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage. Methods: Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage. Results: OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (<6 months poststroke) while chronic participants (>6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0. Conclusions: Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.

Presentation of Infectious Keratitis to ED during COVID-19 Lockdown

Objectives. To compare presentation of infectious keratitis during COVID-19 lockdown with previous years, assess relative severity, and compare outcomes between COVID-19 and pre-COVID-19 era groups. Methods. Acute presentations of infectious keratitis during a strict government-mandated COVID-19 lockdown period were analysed retrospectively (March–May 2020). Data were compared with the same periods in 2018-2019. The clinical notes of patients undergoing corneal scrapes were reviewed, and data were collected on treatment, culture growth, surgical interventions, visual outcomes, admission rates, and risk factors. Results. There were 37% fewer presentations of infectious keratitis to the ED in 2020 (N = 29, 47, and 45, respectively). Risk factor profiles and microbial data were similar across all periods. Admission rates and use of fortified antibiotics were lower in 2020. COVID-19 era cases recovered less vision (LogMAR 0.26, 0.67, and 0.45, respectively; p = 0.04) and were more likely to require surgical intervention (10%, 4%, and 2%, respectively; OR 3.4 (CI 0.7–17.9, p = 0.1)). Conclusion. A concerning fall in presentations of infectious keratitis to ED during the pandemic lockdown was observed. Though societal behaviour changed during the lockdown, our data suggest it is unlikely that the incidence of infectious keratitis fell significantly. It is unclear how and where these patients were treated. We postulate that lower levels of visual recovery and higher rates of surgical intervention may have been caused by delays in accessing care. To minimise avoidable ocular morbidity as COVID-19 resurges, we must communicate clearly with patients and health professionals on how to access available emergency eye care services.

Bilateral fingolimod-associated macular oedema development after cataract surgery

Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.