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Treatment of neovascular age-related macular degeneration with anti-VEGF agents: retrospective analysis of 5-year outcomes
摘要： Purpose: To evaluate the 5-year results obtained in clinical practice in the treatment of neovascular age-related macular degeneration (nAMD) with anti-VEGF agents. Materials and methods: We retrospectively analyzed all patients with nAMD who initiated anti-VEGF treatment before October 2009. We collected data regarding visual and anatomical outcomes. Results: A total of 278 patients met the selection criteria. The mean number of intravitreal injections was 5.7 in the first year and 3.7 in the fifth year. A positive mean visual acuity variation of +3.7 Early Treatment Diabetic Retinopathy Study letters occurred in the first year, but no significant differences relative to baseline were observed thereafter. The majority of patients (71%) maintained stable visual acuity throughout follow-up. At 5 years, mean central macular thickness remained substantially inferior to baseline (-96.6 μm), and 56% of patients maintained dry retinas. Conclusion: Anti-VEGF therapy leads to long-term visual stabilization in the great majority of patients.
关键词： visual acuity,vascular endothelial growth factor,choroidal neovascularization,age-related macular degeneration
更新于2025-09-19 17:15:36
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The Effect of Capsulotomy Shape on Intraocular Light-Scattering after Nd:YAG Laser Capsulotomy
摘要： Purpose. To investigate the effects of capsulotomy shape on the visual acuity and visual quality after neodymium: yttrium aluminum garnet laser capsulotomy. Methods. In this study, a total of 42 eyes from 35 patients with posterior capsule opacification were divided into the circular and cruciate groups. The corrected distance visual acuity (CDVA), objective scatter index (OSI), modulation transfer function cutoff (MTF cutoff), Strehl ratio, and Optical Quality Analysis System values at contrasts of 100%, 20%, and 9% (OV-100, OV-20, and OV-9) were measured at precapsulotomy and 1 week and 1 month postcapsulotomy. The pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects’ satisfaction with treatment. Results. OSI values were significantly higher in the cruciate group than in the circular group at 1 week and 1 month after capsulotomy (P = 0.013 and P < 0.001). No significant difference was found in the OSI values between the two groups before capsulotomy (t = 0.52; P = 0.61). The decrease in OSI was higher in the circular group than in the cruciate group at 1 week and 1 month after capsulotomy (P = 0.036 and P = 0.019). No significant differences were found in the Strehl ratio, MTF cutoff, CDVA, OV-100, OV-20, and OV-9 between the two groups at 1 week and 1 month after capsulotomy (P > 0.05). The PDQ results showed that patients with circular-shaped capsulotomy complained less with intolerance of bright lights than those with cruciate-shaped capsulotomy. Conclusions. Circular-shaped capsulotomy can induce less intraocular light scattering and increase patient satisfaction.
关键词： visual acuity,Nd:YAG laser capsulotomy,visual quality,intraocular light-scattering,capsulotomy shape
更新于2025-09-19 17:13:59
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Subthreshold laser therapy for macular oedema from branch retinal vein occlusion: focused review
摘要： Retinal vein occlusion is the second- leading cause of vision loss by retinal vascular disease. Subthreshold micropulse laser therapy (SLT) is safer than conventional laser photocoagulation (CLP), yet existing reviews of its use for branch retinal vein occlusion (BRVO) are limited in scope. A literature search of PubMed, Google Scholar, Embase, Cochrane Library and ClinicalTrials.gov databases was conducted in August 2019 without restriction on language or publication date. Outcomes included changes in macular oedema (ME) and visual acuity (VA), and rates of complications or retreatments. Fourteen studies involving 315–405 eyes diagnosed with BRVO were evaluated. Treatment with SLT is associated with significant and durable reduction of ME and VA as early as 1 month. SLT performs comparably with conventional photocoagulation and intravitreal injections (IVIs) of ranibizumab. Subthreshold laser therapy is safer and as effective as CLP for the treatment of ME associated with BRVO. SLT may be used in combination with anti- VEGF IVIs to enhance improvement in VA and ME resolution.
关键词： macular oedema,visual acuity,intravitreal injections,Retinal vein occlusion,subthreshold micropulse laser therapy
更新于2025-09-19 17:13:59
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Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study
摘要： Introduction: To compare the impact of non-mechanical excimer-assisted (EXCIMER) and femtosecond laser-assisted (FEMTO) trephination on outcomes after penetrating keratoplasty (PK). Methods: In this retrospective study, 68 eyes from 23 females and 45 males (mean age at time of surgery, 53.3 ± 19.8 years) were included. Inclusion criteria were one surgeon (BS), primary central PK, Fuchs’ dystrophy (FUCHS) or keratoconus (KC), no previous intraocular surgery, graft oversize 0.1 mm and 16-bite double running suture. Trephination was performed using a manually guided 193-nm Zeiss Meditec (EXCIMER group: 18 MEL70 excimer laser in the FUCHS, 17 KC) or 60-kHz IntraLaseTM femtosecond laser (FEMTO group: 16 FUCHS, 17 KC). Subjective refractometry (trial glasses) and topography analysis (Pentacam HR; corneal Casia SS-1000 AS-OCT; TMS-5) were performed preoperatively, before removal of the first suture (11.4 ± 1.9 months) and after removal of the second suture (22.6 ± 3.8 months). Results: Before suture removal, mean refractive/AS-OCT topographic astigmatism did not differ significantly between EXCIMER and FEMTO. After suture removal, mean refractive/astigmatism Pentacam/AS-OCT topographic was significantly higher (6.2 ± 2.9 D/7.1 ± 3.2 D/7.4 ± 3.3 D) than in the EXCIMER patients (4.3 ± 3.0 D/4.4 ± 3.1 D/4.0 ± 2.9 D) (p B 0.005). Mean corrected distance visual acuity increased from 0.22 and 0.23 preoperatively to 0.55 and 0.53 before or 0.7 and 0.6 after suture removal in the EXCIMER and FEMTO groups, respectively. Differences between EXCIMER and FEMTO were only pronounced in the KC subgroup. Conclusion: Non-mechanical EXCIMER trephination seems to have advantages regarding postoperative corneal astigmatism and visual acuity compared with FEMTO trephination, especially in KC. A bigger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephination on postoperative topographic and visual outcomes.
关键词： Excimer,Visual acuity,Femtosecond,Laser,Penetrating keratoplasty,Ophthalmology,Astigmatism
更新于2025-09-19 17:13:59
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Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity
摘要： The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity. A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up. Thirty-three eyes of 33 patients(mean age, 72.1 ± 16.0 y) were enrolled (mean follow-up 12.6 ± 6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥ 1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP < 5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA ≥ 2 lines with ≥ 20% reduction IOP, no reoperation for glaucoma, no IOP < 5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA ≥ 2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%). TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.
关键词： transscleral cyclophotocoagulation,diode laser,visual acuity,cyclodestruction
更新于2025-09-16 10:30:52
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Evolution of visual acuity, flap thickness, and optical density after laser in situ keratomileusis performed with a femtosecond laser
摘要： To describe the postoperative evolution of visual acuity, flap morphology, and stromal optical density femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). The study comprised 44 consecutive eyes that had FS-LASIK performed with the WaveLight FS200 and the Allegretto excimer laser to correct myopia. Visual outcomes, flap thickness, and stromal optical density were assessed 1 day, 1 week, 1 month, and 3 months postoperatively. A statistically significant improvement in the mean uncorrected distance visual acuity at 1 day (0.94 ± 0.2) and 1 week (0.93 ± 0.2) to 1 month (1.04 ± 0.2) and 3 months (1.11 ± 0.1) postoperatively (P < .05). At 3 months postoperatively, the femtosecond laser had good outcomes in efficacy (0.98 ± 0.1), safety (0.98 ± 0.1), and predictability (100% of eyes were within ± 0.5 D of emmetropia). The femtosecond-created flaps were slightly thicker than intended, the mean SD intraflap was 7.1 μm, the range between the thickest and thinnest points in each flap was 25.4 μm, and the mean flap thickness homogeneity was 7.6 μm at 3 months postoperatively. A progressive decrease in the optical density of the flap stroma and the residual stromal bed was detected during follow-up. The femtosecond laser study appears to be a safe, effective, and predictable platform to obtain LASIK flaps. The flaps were planar and homogeneous but slightly thicker than intended. The optical density of the flap stroma was slightly higher at early follow-up and decreased over time.
关键词： visual acuity,femtosecond laser,LASIK,flap thickness,optical density
更新于2025-09-16 10:30:52
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Transscleral Diode Laser Cyclophotocoagulation
摘要： To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design: Retrospective case series. Participants: Seventy-eight eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods: This study compared 52 eyes treated with slow-coagulation TSCPC with 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings, and outcomes were assessed. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), and postsurgical complications. Results: The initial mean VA was 1.94 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.73 logMAR) in the slow-coagulation TSCPC group and 1.71 logMAR (SD, 0.90 logMAR) in the standard TSCPC group (P ? 0.507). Initial IOP was 37 mmHg (SD, 13 mmHg) in the slow-coagulation group and 39 mmHg (SD, 13 mmHg) in the standard group (P ? 0.297). The follow-up periods were 16.36 and 24.68 months for the slow-coagulation and standard groups, respectively (P ? 0.124). Visual acuity remained better than light perception in 71.1% of slow-coagulation TSCPC patients and 65.0% of standard TSCPC patients (P ? 0.599). Intraocular pressure remained less than 20 mmHg in 46% of slow-coagulation TSCPC patients and 44% of standard TSCPC patients (P ? 0.870). The mean number of complications was higher in the standard group (1.46; SD, 1.24) versus the slow-coagulation group (0.62; SD, 0.75; P ? 0.002). The incidence of the need for a second procedure (slow-coagulation group, 28.8%; standard group, 23.1%; P ? 0.588) and maximum number of medications needed to control IOP after surgery (P ? 0.771) were similar between the 2 groups. Conclusions: In this case series, slow-coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques also were comparable, although standard TSCPC showed a higher incidence of prolonged inflammation after surgery. This study suggests that slow-coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged postoperative inflammation—a feared complication of TSCPC—when compared with standard pop-titrated TSCPC.
关键词： intraocular pressure,visual acuity,glaucoma,complications,slow-coagulation,transscleral cyclophotocoagulation,standard pop-titrated
更新于2025-09-12 10:27:22
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Femtosecond Laser Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Keratoconus: A Three-Year Follow-Up
摘要： Purpose. To evaluate the outcomes of femtosecond laser-assisted implantation of a 355-degree intracorneal ring (ICR) (Keraring) in patients with keratoconus in the three-year follow-up. Setting. Future Femtolaser Center, Sohag, Egypt. Design. Prospective interventional case series. Patients and Methods. A prospective case series of 38 eyes of 26 patients with keratoconus had implantation of the 355-degree ICR keraring after tunnel creation with a femtosecond laser. The uncorrected visual acuities (UCVA) and best-corrected visual acuities (BCVA), sphere, cylinder, and manifest refraction spherical equivalent (SE), and mean keratometry (K), K max, and K min were evaluated preoperatively and 3, 6, 12, 24, and 36 months postoperatively, and all complications were reported. Results. 38 eyes of 26 patients with mean age 25.92 ± 5.44 years were enrolled in the study, 11 were males (42.3%). The mean UCVA improved from 0.93 ± 0.21 to 0.63 ± 0.21 logMAR (P ≤ 0.001) and the mean BCVA from 0.67 ± 0.22 to 0.43 ± 0.26 logMAR (P < 0.001). The mean sphere, cylinder, and spherical equivalent have been changed dramatically from preoperative to 3 month postoperative, which is statistically signi?cant (P ≤ 0.001), and the changes between 1 and 2 years and 2 and 3 years are also considerable and statistically signi?cant; the K max and K min and K mean improved and the changes were statistically signi?cant (P ≤ 0.001), and the changes between one, two, and three years were also statistically signi?cant. The safety and e?cacy indices were changed through the three-year follow-up. The complications were corneal neovascularization (36.84%), corneal melting (26.3%), and ring extrusion (31.5%) at the end of the study. Conclusions. Implantation of a 355-degree intracorneal keraring using femtosecond laser improved the visual, refractive, and topographic parameters in keratoconus patients, with a high rate of ICR extrusion and instability. The study has been registered for the Pan African Clinical Trial Registry (http://www.pactr.org) database within No: PACTR201810796878908 on 29 October 2018.
关键词： keratoconus,Keraring,refractive error,femtosecond laser,visual acuity,corneal topography,intracorneal ring
更新于2025-09-12 10:27:22
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Assessment of Vitreous Structure and Visual Function after Neodymium:Yttrium–Aluminum–Garnet Laser Vitreolysis
摘要： Purpose: Neodymium:yttriumealuminumegarnet (Nd:YAG) laser treatment is performed on vitreous ?oaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with vitreous ?oaters who previously underwent laser treatment with untreated control participants and healthy persons without vitreous ?oaters using quantitative ultrasonography to evaluate vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision. Design: Retrospective, comparative study. Participants: One eye was enrolled for each of 132 participants: 35 control participants without vitreous ?oaters, 59 participants with untreated vitreous ?oaters, and 38 participants with vitreous ?oaters previously Nd:YAG-treated. Of these, 25 were dissatis?ed and sought vitrectomy; 13 were satis?ed with observation. Methods: The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision. Main Outcome Measures: Results of NEI-VFQ-39, QUS, BCVA, and CSF. Results: Compared with control participants without vitreous ?oaters, participants with untreated vitreous ?oaters showed worse NEI-VFQ-39 results, 57% greater vitreous echodensity, and signi?cant (130%) CSF degradation (P < 0.001 for each). Compared with untreated eyes with vitreous ?oaters, Nd:YAG-treated eyes had 23% less vitreous echodensity (P < 0.001), but no differences in NEI-VFQ-39 (P ? 0.51), BCVA (P ? 0.42), and CSF (P ? 0.17) results. Of 38 participants with vitreous ?oaters who previously were treated with Nd:YAG, 25 were dissatis?ed and seeking vitrectomy, whereas 13 were satis?ed with observation. Participants seeking vitrectomy showed 24% greater vitreous echodensity (P ? 0.018) and 52% worse CSF (P ? 0.006). Multivariate linear regression models con?rmed these ?ndings. Conclusions: As a group, participants previously treated with Nd:YAG laser for bothersome vitreous ?oaters showed less dense vitreous, but similar visual function as untreated control participants with vitreous ?oaters. Because some treated eyes showed less dense vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures.
关键词： Neodymium:yttriumealuminumegarnet (Nd:YAG) laser,vitreous ?oaters,best-corrected visual acuity,quantitative ultrasonography,contrast sensitivity function
更新于2025-09-12 10:27:22
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Micropulse laser for glaucoma in children
摘要： The optokinetic nystagmus (OKN) response (induction/suppression) correlates with subjective visual acuity (VA) in adults but has not been studied extensively in school-aged children. We investigated the correlation between subjective and objective VA as elicited with a new computerized OKN suppression test ("SpeedWheel") in adults and school-aged children. Fifteen children (6-12 years) and 27 adults with refractive errors, amblyopia, cataract, age-related macular degeneration and thyroid associated orbitopathy underwent testing of subjective VA with E- and Landolt C-symbols (Freiburg Acuity and Contrast Test [FrACT]) and objective VA (SpeedWheel) on a LCD screen. Statistical analysis: linear regression, Spearman correlation and Bland-Altman plots. Mean difference against the mean was 0.01 when SpeedWheel was compared to Landolt C, but 0.15 when compared to E-symbols. Overall, SpeedWheel correlated very strongly to FrACT ('E': r = 0.85; P < 0.001; Landolt C: r = 0.81; P < 0.001). This also held true in children ('E': r = 0.74; P < 0.003; Landolt C: r = 0.69; P < 0.005). In ocular disease, SpeedWheel appears to underestimate subjective VA. In 2 patients with loss of vision of unknown origin, subjective VA was lower than SpeedWheel VA. This is in agreement with the findings of Fukai et al. and could indicate aggravation or malingering. C? etinkaya et al found no correlation between OKN induction and subjective VA in 52 children. Thus OKN suppression rather than induction may be a better objective acuity test. SpeedWheel can assess visual acuity in in adults as well as in school aged children.
关键词： adults,SpeedWheel,visual acuity,optokinetic nystagmus,children
更新于2025-09-12 10:27:22