Search

Purpose: Bleb failure is a common complication after glaucoma filtration surgery. Different bleb classification schemes incorporating filtration bleb vascularization have been proposed, but the reported correlation with intraocular pressure (IOP) has been variable, possibly because of subjective vascularization grading. The purpose of the present study was to evaluate bleb vascularization after Preserflo Microshunt (PM) implantation using anterior segment OCT-angiography (AS-OCTA) as a biomarker for bleb failure., Methods: Twenty-three eyes of twenty-three patients underwent PM implantation. Up to 12 months after surgery PM scleral passage-centred AS-OCTA measurements (PLEX Elite 9000) for bleb-vessel density (BVD) determination were performed and IOP as well as necessity for surgical revisions (needling and open revision) were documented. After multi-step image analysis (region of interest definition, artefact removal, binarization, BVD calculation), the predictive value of early postoperative BVD for surgical revisions was assessed using logistic regression modelling., Results: Baseline IOP (23.57 ± 7.75 mmHg) decreased significantly to 8.30 ± 2.12, 9.17 ± 2.33 and 11.70 ± 4.40 mmHg after 1, 2 and 4 week(s), and 13.48 ± 5.83, 11.87 ± 4.49, 12.30 ± 6.65, 11.87 ± 3.11 and 13.05 ± 4.12 mmHg after 2, 3, 6, 9 and 12 month(s), respectively (p < 0.001). Nine patients (39%) needed surgical revisions after a median time of 2 months. Bleb vessel densities at 2 and 4 weeks were significantly associated with future surgical revisions upon logistic regression analysis (2 W/4 W likelihood-ratio test p-value: 0.0244/0.0098; 2 W/4 W area under the receiver operating characteristics curve: 0.796/0.909)., Conclusion: Filtration bleb vessel density can be determined using AS-OCTA in the early postoperative period and is predictive for bleb failure after PM implantation., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: The purpose of this study was to investigate the uncertainty in the formula predicted refractive outcome REFU after cataract surgery resulting from measurement uncertainties in modern optical biometers using literature data for within-subject standard deviation S w ., Methods: This Monte-Carlo simulation study used a large dataset containing 16 667 preoperative IOLMaster 700 biometric measurements. Based on literature S w values, REFU was derived for both the Haigis and Castrop formulae using error propagation strategies. Using the Hoya Vivinex lens (IOL) as an example, REFU was calculated both with (WLT) and without (WoLT) consideration of IOL power labelling tolerances., Results: WoLT the median REFU was 0.10/0.12 dpt for the Haigis/Castrop formula, and WLT it was 0.13/0.15 dpt. WoLT REFU increased systematically for short eyes (or high power IOLs), and WLT this effect was even more pronounced because of increased labelling tolerances. WoLT the uncertainty in the measurement of the corneal front surface radius showed the largest contribution to REFU, especially in long eyes (and low power IOLs). WLT the IOL power uncertainty dominated in short eyes (or high power IOLs) and the uncertainty of the corneal front surface in long eyes (or low power IOLs)., Conclusions: Compared with published data on the formula prediction error of refractive outcome after cataract surgery, the uncertainty of biometric measures seems to contribute with ⅓ to ½ to the entire standard deviation. REFU systematically increases with IOL power and decreases with axial length., (© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate the outcome in participants who underwent surgery for esophoria following one of three different methods of preoperative prism adaptation test (PAT)., Methods: This prospective, multicentre study was carried out at five eye departments from 2012 to 2019. 116 participants were included and allocated to three groups as per investigator choice: Group 1 (n = 55) had a short prism adaptation period ranging from 1 to 5 hours during their visit at the clinic. Group 2 (n = 36) underwent partial prism correction for at least 4 weeks before surgery. Group 3 (n = 25) underwent full prism correction for at least 4 weeks before surgery. Motoric success was determined by postoperative angle of deviation (AOD), and sensoric success was evaluated with Lang and Bagolini striated lens test., Results: A significant increase (p < 0.001) in AOD after PAT was observed in all groups, with no significant difference between groups (distance: p = 0.22; near: p = 0.31). Motoric and sensoric success was comparable between groups 3 months (p = 0.52; p = 0.55) and 1 year (p = 0.53; p = 0.29) after surgery. Prolonged prism adaptation (n = 24) for more than 365 days was not associated with better results., Conclusion: Our study indicates that the postoperative result is independent from the duration and amount (partial or full correction) of prism adaptation before surgery at least up to one year of follow-up. Prolonged prism adaptation (>365 days) before surgery does not improve the results., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: We aimed to describe the global and localized correlations among visual field (VF) sensitivity, optic nerve head (ONH) perfusion measured by laser speckle flowgraphy (LSFG) and neural structure measured by optical coherence tomography (OCT) in open-angle glaucoma (OAG) and to compare the floor effect for LSFG and OCT., Methods: Cross-sectional, multicenter study including one eye each from fifty OAG patients (mean age 69.3 years; average VF mean deviation, MD, -8.5 dB, range -25.17 to 0.85 dB) and fifty-one controls. Patients underwent SITA standard 24-2 automated perimetry and measurement of ONH perfusion, peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell-inner plexiform layer thickness (GCIPLT). We tested the presence of a significant change (breakpoint) in the correlation slope with VF sensitivity to assess floor effect., Results: The correlation between the LSFG parameter Mean All (MA) of the global disc area and MD (r = 0.56, p < 0.001) did not show a breakpoint, in contrast to the correlations between MD and OCT global parameters, which showed breakpoints at -8.53 and -4.05 dB for RNFLT and GCIPLT, respectively. Global and localized correlations with VF sensitivity were stronger for LSFG compared to OCT. In particular, LSFG outperformed OCT in the correlation with the central VF sector (r = 0.50, p < 0.001 and r = 0.06, p = 0.67 for MA and RNFLT, respectively)., Conclusion: The global and sectoral correlations with VF sensitivity and the favourable floor effect compared to OCT indicate LSFG as a promising tool to monitor progression particularly in late-stage glaucoma. Further longitudinal studies are warranted., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Validating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium- and Bowman-penetrating femtosecond laser-assisted arcuate incisions., Methodology: Prospective, interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser-assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity., Results: The study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was -0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D., Conclusion: The Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To determine the effect of intravitreal ranibizumab and a dexamethasone implant on aqueous humour cytokine, protein and enzyme levels and to correlate findings to morphologic and functional changes., Methods: In a prospective, randomized, controlled, double-blind study, patients with clinically significant diabetic macular oedema (CSME) were randomly allocated to receive either monthly intravitreal injections of ranibizumab (Lucentis, Novartis Pharma) or a single dexamethasone implant (Ozurdex, Pharm-Allergan) at baseline (BL). Aqueous humour samples were collected at BL and weeks 2, 8 and 20., Results: The study included 18 eyes of 18 patients. In the dexamethasone implant group, soluble intercellular adhesion molecule 1 (sICAM-1) (weeks 2 and 8), CXCL9/monokine induced by gamma interferon (MIG) (weeks 2 and 8), soluble vascular cell adhesion protein 1 (sVCAM-1) (weeks 2 and 8) and monocyte chemo-attractant protein 1 (MCP-1) (week 2) levels were significantly decreased compared with baseline. In the ranibizumab group, placental growth factor (PIGF) (week 2) and vascular endothelial growth factor (VEGF) (week 2 and 8) levels were significantly decreased compared with baseline. No significant changes in central retinal thickness (CRT) or Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA) were observed in the Ozurdex group at any time-points. ETDRS scores significantly increased at week 20 (84.88 ± 8.88 letters) compared with baseline (74.78 ± 14.85 letters), and the CRT decreased significantly at week 4 (381.00 ± 114.64 μm) compared with baseline (440 ± 144 μm) in the Lucentis group., Conclusion: The dexamethasone implant affected the aqueous cytokines and proteins MCP-1, sICAM-1, sVCAM-1 and MIG, whereas ranibizumab treatments reduced VEGF and PIGF levels. Morphological changes may diverge from cytokine changes. Results may indicate a rationale for a combination therapy for CSME using both agents, the dexamethasone implant and repeatedly administered ranibizumab injections., (© 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: We sought to describe and evaluate patients with clinically significant diabetic macular oedema (CSME) according to the improved SAVE II protocol and correlate findings with visual acuity and systemic parameters in the outpatient clinic for DR (diabetic retinopathy) management., Methods: This was a cross-sectional case series study of patients with CSME, regardless of prior treatment. Visual acuity testing was performed according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol. Optical coherence tomography (OCT) and fluorescence angiography (FA) were performed. All imaging data were evaluated according to an improved version of the SAVE grading protocol for CSME (SAVE II). The main outcome measures were SAVE II oedema types and best-corrected visual acuity. Additional parameters of a blood sample (fasting glucose, haemoglobin A1c, serum creatinine, triglycerides, cholesterol, low-density lipoproteins, and high-density lipoproteins) were taken., Results: In total, 66 eyes of 66 patients were included. The mean age of the patients was 64.9 ± 8.2 years. Two eyes were classified as SAVE oedema type 1, 19 eyes as SAVE oedema type 2, 28 eyes as SAVE oedema type 3, and 28 eyes as SAVE oedema type 4, respectively. Central retinal thickness and laboratory parameters were not significantly different between the groups. There was a statistically significant difference in ETDRS visual acuity between the SAVE groups 2 and 4 (p < 0.001) with lower vision in group 4. There was no statistically significant difference between oedema types 2 and 3 (p = 0.065) and oedema types 3 and 4 (p = 0.13)., Conclusion: There was a significant correlation between the four defined oedema types and visual acuity. Morphologic findings did not correlate with any of the evaluated blood parameters., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the effect of preoperative intraocular pressure (IOP) and the vacuum level on IOP during femtosecond laser-assisted cataract surgery., Methods: Intraocular pressure was measured in 40 enucleated porcine eyes by intracameral manometry prior, during and after vacuum application using the VICTUS femtosecond laser platform (Bausch&Lomb, Technolas Perfect Vision GmbH, Germany). Twenty combinations of different preoperative IOP levels (12, 16, 20 and 24 mmHg) and different vacuum levels (350-550 mbar) were investigated., Results: Multivariate regression analysis indicated that both the vacuum level (beta = 0.138; p < 0.001) but much stronger the preoperative IOP (beta = 0.861; p < 0.001) were predictive factors for IOP rise during vacuum application. Mean IOP was 28.23 ± 3.86, 34.23 ± 3.92, 40.35 ± 4.41 and 46.82 ± 4.11 mmHg in groups with baseline IOP of 12, 16, 20 and 24 mmHg, respectively. In the 350, 450 and 550 mbar group, and mean IOP was 35.85 ± 7.85, 37.33 ± 7.90 and 39.00 ± 8.04 mmHg, respectively. Lowering the preoperative IOP by 2 mmHg and reducing the vacuum from maximum to minimum resulted in a similar reduction in IOP during vacuum application (-3.10 ± 0.79 mmHg versus -3.15 ± 0.88 mmHg; p = 0.015). Furthermore, decreasing the baseline IOP from 20 to 12 mmHg resulted in a 30.0% reduction in intraoperative IOP., Conclusion: Preoperative IOP was a stronger predictive factor for intraoperative IOP rise than the applied vacuum level. Measurements and critical interpretation of preoperative IOP in a preliminary examination could help estimating the individual risk of significant IOP rise during femtosecond laser-assisted cataract surgery and could help taking early countermeasures in selected cases. Due to the porcine ex vivo model, further studies are needed to verify these findings., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is the standard treatment for neovascular age-related macular degeneration (AMD). As VEGF is a physiological key player for regulating retinal vascular tone, questions have been raised whether the application of anti-VEGF could induce alterations in ocular perfusion., Methods: The study included 20 eyes from 20 Caucasian patients with unilateral neovascular AMD and 20 fellow eyes. All eyes were treated with standard intravitreal injection of aflibercept (IVA). Measurements of blood flow at the optic nerve head (ONH) and the choroid were performed with laser speckle flowgraphy (LSFG). The intraocular pressure (IOP), systolic and diastolic blood pressure, heart rate, mean arterial pressure (MAP) and ocular perfusion pressure (OPP) were analysed. Measurements were performed at baseline and repeated immediately after the injection and 30 and 45 min later., Results: Mean time between injection of aflibercept and first follow-up was 8:56 ± 4:25 min. The injection led to significant rise in IOP. In the injected eyes, mean blur rate (MBR, i.e. a relative measure of perfusion and the main outcome parameter of LSFG) within the major vessels of the ONH as well as at the entire ONH region decreased significantly (p < 0.001). No change in MBR was observed in the fellow eye. Choroidal blood flow was maintained stable in both eyes., Conclusion: Intravitreal injection of aflibercept (IVA) led to a short-term reduction in perfusion only in the treated eye. This was independent from IOP, indicating a direct pharmacological effect. No changes in choroidal perfusion were observed during the first 45 min after the injection., (© 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Recent research suggests that infants and toddlers succeed at a wide range of non-elicited-response false-belief tasks (i.e., tasks that do not require children to answer a direct question about a mistaken agent's likely behaviour). However, one exception to this generalization comes from verbal anticipatory-looking tasks, which have produced inconsistent findings with toddlers. One possible explanation for these findings is that toddlers succeed when they correctly interpret the prompt as a self-addressed utterance (making the task a non-elicited-response task), but fail when they mistakenly interpret the prompt as a direct question (making the task an elicited-response task). Here, 2.5-year-old toddlers were tested in a verbal anticipatory-looking task that was designed to help them interpret the anticipatory prompt as a self-addressed utterance: the experimenter looked at the ceiling, chin in hand, during and after the prompt. Children gave evidence of false-belief understanding in this task, but failed when the experimenter looked at the child during and after the prompt. These results reinforce claims of robust continuity in early false-belief reasoning and provide additional support for the distinction between non-elicited- and elicited-response false-belief tasks. Three accounts of the discrepant results obtained with these tasks - and of early false-belief understanding more generally - are discussed., (© 2011 The British Psychological Society.)

Until recently, it was generally assumed that the ability to attribute false beliefs did not emerge until about 4 years of age. However, recent reports using spontaneous- as opposed to elicited-response tasks have suggested that this ability may be present much earlier. To date, researchers have employed two kinds of spontaneous-response false-belief tasks: violation-of-expectation tasks have been used with infants in the second year of life, and anticipatory-looking tasks have been used with toddlers in the third year of life. In the present research, 2.5-year-old toddlers were tested in violation-of-expectation tasks involving a change-of-location situation (Experiment 1) and an unexpected-contents situation (Experiment 2). Results were positive in both situations, providing the first demonstrations of false-belief understanding in toddlers using violation-of-expectation tasks and, as such, pointing to a consistent and continuous picture of early false-belief understanding.

Purpose: To evaluate the effect of repeated intravitreal injections of bevacizumab (Avastin(®)) in patients with proliferative diabetic retinopathy and persistent new vessels after panretinal photocoagulation., Methods: In this prospective study we investigated 11 eyes of 10 diabetic patients with persistent new vessels after previous complete panretinal photocoagulation. Complete ophthalmological examinations were performed at baseline and during monthly follow-up visits until the final follow-up at 6 months. Colour fundus photography, fluorescein angiography (FA) and macular optical coherence tomography (OCT) were performed. The area of leakage (mm²) found in the FA was used to demonstrate the effect of bevacizumab on retinal new vessels. Patients received 1.0 mg of intravitreal bevacizumab at baseline and at each of the monthly follow-up visits when reappearance of retinal new vessels was documented., Results: At the 1-week follow-up visit, 73% of the treated eyes showed complete regression of retinal new vessels. Eight eyes were assigned to retreatments at the 3-month follow-up because of the reappearance of retinal new vessels. After 6 months, 36% of the eyes were found to have reappearance of retinal new vessels. The retreatment rate was 1.9 ± 0.7 and the mean interval to retreatment was 2.9 ± 1.0 months. The mean leakage area decreased from 7.2 ± 2.6 mm² at baseline to 1.2 ± 0.9 mm² at the final follow-up visit. BCVA increased from 59.2 ± 14.6 Early Treatment Diabetic Retinopathy Study (ETDRS) score (range 40-80) to 70.7 ± 8.5 at the final visit (p = 0.017)., Conclusion:   Intravitreal bevacizumab led to a significant reduction of retinal new vessels for a mean period of 2.9 months. A 3-monthly retreatment regime might be a valid method to control retinal new vessels in diabetic patients with persistent new vessels., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)