Morphological and functional changes in the macular area in diabetic macular edema after a single intravitreal injection of aflibercept

AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperimetry.METHODS:Twenty-eight patients(42 eyes)diagnosed with DME were treated with intravitreal injection of aflibercept.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),foveal avascular zone(FAZ)area,vessel density of superficial retinal capillary plexus(SVD),vessel density of deep retinal capillary plexus(DVD),mean light sensitivity(MLS),2°fixation rate(P1),4°fixation rate(P2),and other indicators 1mo after treatment were compared;of these,BCVA was conver ted into logarithm of the minimum angle of resolution(logMAR),and the correlation among the factors was analyzed.RESULTS:After treatment,logMAR BCVA was 0.47±0.24,which was significantly better than that before treatment(0.63±0.28,P<0.001).The CRT was 359.21±107.87μm after treatment,which was significantly lower than before treatment(474.10±138.20μm,P<0.001).The FAZ area,SVD,and DVD were not significantly changed after treatment compared with the baseline.MLS was 22.16±4.20 dB after treatment,which was significantly higher than before treatment(19.63±4.23 dB,P<0.001).P2 significantly increased after treatment than before treatment(P=0.007).P1 had no significant change after treatment than before treatment(P=0.086).CONCLUSION:A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity,fixation stability,and visual acuity,possibly without causing significant changes in the retinal vascular condition in a short time.

Phacoemulsification versus small incision cataract surgery in patients with uveitis

AIMTo compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract.METHODSIn a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of &#x0003c;0.05 was considered statistically significant.RESULTSOne hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P&#x0003c;0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86&#x000b1;0.34 dioptres (D) in the phacoemulsification group and 1.16&#x000b1;0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8&#x000b1;2.9 versus 13.2&#x000b1;2.6min) (P&#x0003c;0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups.CONCLUSIONManual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

Cumulative sum analysis score and phacoemulsification competency learning curve

AIM： To use the cumulative sum analysis score（CUSUM） to construct objectively the learning curve of phacoemulsification competency.METHODS： Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture（PCR） and best-corrected visual acuity. The acceptable rate for PCR was 〈5%（lower limit h） and the unacceptable rate was 〉10%（upper limit h）. The acceptable rate for bestcorrected visual acuity worse than 20/40 was 〈10%（lower limit h） and the unacceptable rate was 〉20%（upper limit h）. The area between lower limit h and upper limit h is called the decision interval. RESULTS： There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39^ th case. He could reach best-corrected visual acuity CUSUM competency at his 22 ^nd case. The third trainee achieved PCR CUSUM competency at his 41 st case. He reached bestcorrected visual acuity CUSUM competency at his 14 ^th case.CONCLUSION： The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.

Visual acuity of urban and rural adults in a coastal province of southern China:the Fujian Eye Study

AIM:To evaluate the vision status and sociodemographic associations of visual acuity(VA)in an urban and rural population in a coastal province of southern China.METHODS:The Fujian Eye Study,a population-based cross-sectional study,was performed from May 2018 to October 2019.Totally 10044 participants over 50 years old from all nine cities in Fujian Province were enrolled,and underwent a questionnaire and a series of standard physical and ocular examinations.VA was measured by E Standard Logarithmic Visual Acuity Chart(GB 11533-1989).Data was double entered with Epi Data v3.1 for data collation and Stata/SE statistical software v15.1 was used to analyze the data.RESULTS:Totally 8211(81.8%)participants were finally included and were divided into urban populations(4678 subjects),rural populations(n=3533),coastal residents(n=6434),and inland residents(1777 subjects);4836 participants were female.The mean age was 64.39±8.87 y(median 64 y;range 50-98 y).The mean presenting VA was 0.61±0.30(0.23±0.27 log MAR),and the mean best correctedvisual acuity(BCVA)was 0.82±0.28(0.08±0.19 log MAR).In the multiple regression analysis,BCVA was significantly correlated with several socioeconomic and biologic factors,including age(P<0.001),education level(P<0.001),income(P=0.005),rural residency(P<0.001),inland residency(P=0.001)and refractive error(P<0.001),while sex(P=0.194)was independent with BCVA.CONCLUSION:Accessible services and eye health policies targeting the elderly,people with high myopia and people living in rural or inland areas are needed.

Presbyopic correction on the cornea

Purpose:The aim of this systematic review was to synthesize and appraise the evidence of the benefits of presbyopic correction on the cornea for visual function.Summary:Comprehensive search was conducted in MEDLINE using keywords like“presbylasik”,“presbyopic refractive surgery”,“corneal pseudoaccommodation”and“corneal multifocality”.We reviewed corrected and uncorrected visual acuities for distance and near(uncorrected distance visual acuity(UDVA),uncorrected near visual acuity(UNVA),corrected distance visual acuity(CDVA),distance corrected near visual acuity(DCNVA),corrected near visual acuity(CNVA)),along with the refractive outcomes in spherical equivalent(SE)and astigmatism comparing the differences observed between preoperative myopic and hyperopic patients,as well as among techniques.Thirty-one studies met the inclusion and quality criteria.Monovision provides excellent distance and near uncorrected acuities,but with a 17%retreatment and a 5%reversal rate.Initial multifocal ablations result in 12%loss of 2 or more lines of CDVA,and a 21%retreatment rate.Laser Blended Vision provides excellent UDVA,but with a 19%retreatment rate.Initial experiences with Supracor show moderate predictability and a 22%retreatment rate.Intracor results in 9%loss of 2 or more lines of CDVA.KAMRA provides excellent UDVA,with only a 1%retreatment rate,but a 6%reversal rate.Initial experiences with PresbyMAX provided excellent UNVA and DCNVA,showing excellent predictability and a 1%reversal rate.Conclusions:The findings have implications for clinicians and policymakers in the health-care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure.