The impact of short-term postoperative face-up position on unintentional retinal displacement after pars plana vitrectomy for rhegmatogenous retinal detachment.

OBJECTIVE: To assess the effectiveness and safety of a rigorous short-term supine position in preventing inadvertent retinal displacement after pars plana vitrectomy (PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD). METHODS: We conducted a retrospective observational analysis of a case series at two ophthalmological surgical centers. We included eyes diagnosed with macula-off RRD that maintained a strict face-up position for three hours immediately after PPV with intraoperative perfluorocarbon liquid (PFCL) and 20% sulfur hexafluoride (SF6) tamponade. Fundus autofluorescence (FAF) imaging was performed at one month post-operatively to identify unintentional retinal displacement through the detection of retinal vessel prints (RVPs) on FAF imaging using an ultrawide-field (UWF) imaging system. RESULTS: A total of 29 eyes with macula-off RRD were included in the study. The average age of the participants was 59.62 years. RRD involved one quadrant in two eyes, two quadrants in fourteen eyes, three quadrants in seven eyes, and four quadrants in six eyes. UWF-FAF imaging at one month follow-up after complete reattachment of the retina revealed RVPs in seven out of the 29 eyes (24.13%), with a mean displacement of 0.22 mm. In every case the displacement occurred downward. CONCLUSION: Our results suggest that adhering to a strict face-up position for three hours after PPV with PFCL and gas tamponade for macula-off RRD may lead to a low frequency and severity of inadvertent post-operative retinal displacement.

Retro-mode imaging in acute posterior multifocal placoid pigment epitheliopathy.

AIM: to provide a detailed description and multimodal imaging (MMI) including retro-mode imaging of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). METHODS: Case report of a young male patient presenting with APMPPE picture. Initially, visual acuity testing was performed, followed by biomicroscopic and fundus examinations along with MMI including Optical Coherence Tomography (OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), Indocyanine Green (ICG) angiography, and Retro-mode imaging. The patient was then monitored over a duration of two months. RESULTS: visual acuity was 20/20 with normal biomicroscopic examination; fundus examination detected multiple pale placoid lesions. MMI was consistent with typical APMPPE. Notably, Retro-mode imaging revealed numerous crater-like round lesions that corresponded to those observed on angiography. CONCLUSION: Retromode imaging in APMPPE can serve as a non-invasive tool that highlights the number and distribution of lesions as well as on angiography.

Fundus autofluorescence of retinal atrophy progression between fundus flavimaculatus and extensive macular atrophy with pseudo-drusen.

OBJECTIVE: To analyze the progression of macular atrophy in Fundus Flavimaculatus (FFM) versus Extensive Macular Atrophy with Pseudo-drusen (EMAP), using Spectralis® RegionFinder™ tool. METHODS: Retrospective review of patients diagnosed with FFM and EMAP. Ophthalmic imaging features were reviewed by retina specialists for each patient in both eyes. The atrophic zones were measured on fundus autofluorescence acquisitions using the RegionFinder™ tool. RESULTS: FFM group included 16 eyes of 8 patients, whose mean age was 61.42 ± 10.76 years, with a mean 4.54 ± 2.73 years of follow-up. EMAP group contained 16 eyes of 8 patients, whose mean age was 67.81 ± 3.03 years (p = 0.12), with a mean 3.62 ± 2.49 years of follow-up (P = 0.63). The atrophy progression rates were 3.73 ± 6.75 and 0.70 ± 0.98 mm2/year, for EMAP and FFM respectively. The yearly rate of progression of the atrophic areas in EMAP was 5.3 times higher than in FFM (mm2/year) (p = 0.03). CONCLUSION: The progression of the atrophy in eyes with Extensive Macular Atrophy with Pseudo-drusen (EMAP) is significantly more rapid than in eyes with Fundus Flavimaculatus (FFM).

Widefield oct-angiography-based classification of sickle cell retinopathy.

PURPOSE: To assess the capillary non-perfusion in different concentric sectors on widefield optical coherence tomography angiography (WF-OCTA) and to correlate the ratio of non-perfusion (RNP) to the severity of sickle cell retinopathy (SCR). METHODS: This retrospective, cross-sectional study included eyes of patients with various sickle cell disease (SCD) genotypes having undergone WF-OCTA and ultra-widefield color fundus photography (UWF-CFP). Eyes were grouped as no SCR, non-proliferative SCR or proliferative SCR. RNP was assessed on WF-OCTA montage in different field-of-view (FOV) sectors centered on the fovea: 0-10-degrees circle excluding the foveal avascular zone, the 10-30-degrees circle excluding the optic nerve, the 30-60-degrees circle, and the full 60-degrees circle. RESULTS: Forty-two eyes of twenty-eight patients were included. Within each SCR group, mean RNP of the FOV 30-60 sector was higher than all other sectors (p < 0.05). Mean RNP of all sectors were significatively different between no SCR group and proliferative SCR group (p < 0.05). To distinguish no SCR versus non-proliferative SCR FOV 30-60 had a good sensitivity and specificity of 41.67% and 93.33%, respectively (cutoff RNP > 22.72%, AUC = 0.75, 95% CI 0.56-0.94, p = 0.028). To differentiate non-proliferative versus proliferative SCR, FOV 0-10 had good sensitivity and specificity of 33.33% and 91.67%, respectively (cutoff RNP > 18.09, AUC = 0.73, 95% CI 0.53 to 0.93, p = 0.041). To discern no SCR versus proliferative SCR, all sectors had optimal sensitivity and specificity (p < 0.05). CONCLUSION: WF OCTA-based RNP provides non-invasive diagnostic information regarding the presence and severity of SCR, and correlates with disease stage in certain FOV sectors.

Acute macular neuroretinopathy as the first stage of SARS-CoV-2 infection.

INTRODUCTION: To report two cases of Acute Macular Neuroretinopathy (AMN) presented as the first stage of SARS-CoV-2 infection in two European countries during the third wave of pandemic viral infection in the early months of 2021. OBSERVATIONS: A unilateral case of type 1 AMN in a man and a bilateral case of type 2 AMN in an otherwise heathy patients were reported. Sudden onset of paracentral scotoma characterized the cases with no systemic symptoms. Structural optical coherence tomography (OCT) shows multifocal middle and inner retinal hyperreflective infarctions. OCT-Angiography showed the presence of hypoperfusion of the deep capillary plexus (DCP) corresponding to the hyperreflective lesions visible on structural OCT, confirming the diagnosis. CONCLUSIONS AND IMPORTANCE: Type 1 and type 2 AMN may be the first stage of SARS-CoV-2 infection. We suggest testing all patients with AMN for SARS-CoV-2. In our cases, the natural history of AMN associated with SARS-CoV-2 infection was similar to already described cases of AMN.

Effects of Photobiomodulation in Patients Presenting with Reticular Pseudodrusen: A Retrospective Observational Case Series Study.

Background and Objectives: The purpose of this study is to describe the effects of photobiomodulation on drusen regression with patients presenting with reticular pseudodrusen (RPD). Materials and Methods: This study is a retrospective observational case series study including patients presenting with RPD who underwent treatment by photobiomodulation. All patients underwent a complete ophthalmic examination and multimodal imaging prior to treatment, including spectral-domain optical coherence tomography (SD-OCT). Eyes were treated two times per week for six consecutive weeks. Best corrected-visual acuity (BVCA) was measured prior and after treatment for all patients. The number of RPD on the SD-OCT scans centered on the macula and stages of RPD was noted at baseline and 6 months after the first treatment session. Results: Five eyes of five patients were included in the study. Mean BCVA did not change 6 months after treatment compared to baseline. Mean number of RPD per eye was 112.60 +/- 48.33 RPD at baseline and 111.6 +/- 49.29 in the same area 6 months after treatment. Changes in RPD distribution according to RPD classification were observed before and after treatment with photobiomodulation. Changes in distribution mostly concerned stages 1 and 3 RPD: Total number of stage 1 RPD was 289 and increased to 324 after treatment. Total number of stage 3 RPD was 97 at baseline and decreased to 67 6 months after treatment. Percentage of stage 1 RPD increased from 46% to 56% after treatment. Percentage of stage 3 RPD decreased from 20% to 13% after treatment. Conclusions: Changes in RPD distribution were observed before and after treatment with photobiomodulation. The number of stage 3 reticular pseudodrusen decreased while number of stage 1 reticular pseudodrusen increased after treatment.

Comparison of Multimodal Imaging for the Characterization of Geographic Atrophy.

Purpose: The purpose of this study was to compare the performances of infrared (IR), fundus autofluorescence (FAF), and multicolor (MC) imaging in the characterization of geographic atrophy, with a focus on the possibility to detect incomplete retinal pigmented and outer retinal atrophy (iRORA) on en face imaging. Methods: The ground truth was established by two graders evaluating atrophy on spectral-domain optical coherence tomography (SD-OCT) images. A score for visibility of foveal sparing and margins of atrophy was attributed. Measurement of the atrophic area and the fovea-to-margin distance were performed. Accuracy of detection of foveal sparing was evaluated through comparison with B-scan images ground truth, with/without the inclusion of patients with foveal iRORA. Results: Seventy patients were included in this study. Foveal sparing and atrophy's margins subjective visibility were significantly higher rated on MC images compared to IR and FAF (P < 0.005 and P < 0.001). Agreement with OCT B-scan assessed foveal sparing revealed a significantly higher area under receiver operating characteristic curves (AUROC) for MC images at the analysis performed both with (0.876) and without (0.853) inclusion of patients with foveal iRORA (P < 0.001 and P = 0.006). Quantitative measurements revealed lower atrophy extension (P = 0.026) and fovea-to-margin distance (P = 0.019) with MC imaging. Conclusions: MC imaging performed better at foveal sparing assessment, especially in the setting of foveal iRORA. MC also resulted in higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins compared to both FAF and IR. Translational Relevance: MC rated significantly higher in foveal sparing and atrophy detection, higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins, compared to FAF and IR.

Management of Anterior Stromal Necrosis After Polymethylmethacrylate ICRS: Explantation Versus Exchange With Corneal Allogenic Intrastromal Ring Segments.

PURPOSE: To evaluate management of keratoconic eyes with anterior stromal necrosis overlying the intracorneal ring segment (ICRS), by either ICRS explantation alone or exchange with corneal allogenic intrastromal ring segments (CAIRS). METHODS: Among 643 Intacs SK (Additional Technology, Inc) inserted at one institutional center, 16 eyes (15 patients) with overlying spontaneous anterior stromal necrosis were identified. Data included size of stromal defect and refractive and topographical findings before ICRS insertion, before anterior stromal necrosis, and 6 months after intervention. RESULTS: The 10-year incidence of anterior stromal necrosis after femtosecond laser-assisted ICRS insertion was 5.5%. Eight eyes underwent ICRS removal only and 8 eyes had ICRS exchanged with CAIRS. In the first group, CDVA worsened from 0.14 before melt to 0.28 logMAR after removal (P = .10), simulated keratometry (SimK) and maximum axial keratometry (Kmax) increased from 44.73 to 46.34 diopters (D) (P = .14) and from 49.23 to 52.26 D (P = .14), respectively, and coma worsened from 0.87 to 1.52 D (P = .02). In the CAIRS group, CDVA of 0.16 before melt improved to 0.11 logMAR postoperatively (P > .99), and topographic indices stabilized with SimK, Kmax, and coma mildly altering from 45.31 to 45.44 D (P > .99), from 49.25 to 49.64 D (P > .99) and from 0.87 to 0.81 D (P > .99), respectively. Whether the ICRS were explanted or exchanged, the visual and topographic mean values were better than those reported before ICRS implantation, whereas higher order aberrations in eyes without CAIRS regressed to levels before ICRS insertion. At the site of melt, thinnest residual stromal thickness averaged 327 µm with ICRS removal and 490 µm with CAIRS. Eyes with larger melt areas resulted in less optimal results with CAIRS implantation. CONCLUSIONS: Early experience in the management of anterior stromal necrosis by exchange of polymethylmethacrylate ICRS with CAIRS seems to avoid stromal thinning and confer better visual and topographic results, which were more pronounced with thicker segments. The benefit of CAIRS in large stromal melts needs to be investigated. [J Refract Surg. 2022;38(4):256-263.].

Deep learning-based classification of retinal vascular diseases using ultra-widefield colour fundus photographs.

OBJECTIVE: To assess the ability of a deep learning model to distinguish between diabetic retinopathy (DR), sickle cell retinopathy (SCR), retinal vein occlusions (RVOs) and healthy eyes using ultra-widefield colour fundus photography (UWF-CFP). METHODS AND ANALYSIS: In this retrospective study, UWF-CFP images of patients with retinal vascular disease (DR, RVO, and SCR) and healthy controls were included. The images were used to train a multilayer deep convolutional neural network to differentiate on UWF-CFP between different vascular diseases and healthy controls. A total of 224 UWF-CFP images were included, of which 169 images were of retinal vascular diseases and 55 were healthy controls. A cross-validation technique was used to ensure that every image from the dataset was tested once. Established augmentation techniques were applied to enhance performances, along with an Adam optimiser for training. The visualisation method was integrated gradient visualisation. RESULTS: The best performance of the model was obtained using 10 epochs, with an overall accuracy of 88.4%. For DR, the area under the receiver operating characteristics (ROC) curve (AUC) was 90.5% and the accuracy was 85.2%. For RVO, the AUC was 91.2% and the accuracy 88.4%. For SCR, the AUC was 96.7% and the accuracy 93.8%. For healthy controls, the ROC was 88.5% with an accuracy that reached 86.2%. CONCLUSION: Deep learning algorithms can classify several retinal vascular diseases on UWF-CPF with good accuracy. This technology may be a useful tool for telemedicine and areas with a shortage of ophthalmic care.

Deep Learning to Distinguish ABCA4-Related Stargardt Disease from PRPH2-Related Pseudo-Stargardt Pattern Dystrophy.

(1) Background: Recessive Stargardt disease (STGD1) and multifocal pattern dystrophy simulating Stargardt disease ("pseudo-Stargardt pattern dystrophy", PSPD) share phenotypic similitudes, leading to a difficult clinical diagnosis. Our aim was to assess whether a deep learning classifier pretrained on fundus autofluorescence (FAF) images can assist in distinguishing ABCA4-related STGD1 from the PRPH2/RDS-related PSPD and to compare the performance with that of retinal specialists. (2) Methods: We trained a convolutional neural network (CNN) using 729 FAF images from normal patients or patients with inherited retinal diseases (IRDs). Transfer learning was then used to update the weights of a ResNet50V2 used to classify the 370 FAF images into STGD1 and PSPD. Retina specialists evaluated the same dataset. The performance of the CNN and that of retina specialists were compared in terms of accuracy, sensitivity, and precision. (3) Results: The CNN accuracy on the test dataset of 111 images was 0.882. The AUROC was 0.890, the precision was 0.883 and the sensitivity was 0.883. The accuracy for retina experts averaged 0.816, whereas for retina fellows it averaged 0.724. (4) Conclusions: This proof-of-concept study demonstrates that, even with small databases, a pretrained CNN is able to distinguish between STGD1 and PSPD with good accuracy.

Amblyopia risk factors among pediatric patients in a hospital-based setting using photoscreening.

PURPOSE: The aim of our study was to determine the prevalence of amblyopia risk factors in children visiting the American University of Beirut Medical Center (AUBMC) using automated vision screening. METHODS: This was a hospital-based screening of 1102 children aged between 2 and 6 years. Vision screening was performed using PlusoptiX S12 over 2 years (2018-2020). The need for referral to a pediatric ophthalmologist was based on the amblyopia risk factors set forth by the American Association for Pediatric Ophthalmology and Strabismus. Referred patients underwent a comprehensive eye examination. RESULTS: A total of 1102 children were screened, 63 were referred for amblyopia risk factors (5.7%); 37/63 (59%) underwent comprehensive eye examination and 73% were prescribed glasses. Of the non-referred group of children, 6.35% had astigmatism, 6.25% were hyperopic and 3.27% were myopic. The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. Refractive amblyopia risk factors were associated with the presence of systemic disorders. Bland-Altman plots showed most of the differences to be within limits of agreement. CONCLUSION: Using an automated vision screener in a hospital-based cohort of children aged 2 to 6 years, the rate of refractive amblyopia risk factors was 5.7%. Hyperopia was the most commonly encountered refractive error and children with systemic disorders were at higher risk.

The role of future treatments in the management of neovascular age-related macular degeneration in Europe.

Anti-vascular endothelial growth factor (VEGF) agents have transformed the management of patients with neovascular age-related macular degeneration (nAMD) over the past two decades. However, as more long-term real-world data become available, it is clear that treatment outcomes are inferior to those reported in large, controlled clinical trials. This is largely driven by undertreatment, that is, not maintaining a consistent injection frequency to achieve sustained VEGF suppression, whether due to patient non-compliance, an important injection burden, or non/incomplete anatomical response. Newer therapeutic advances under evaluation hold promise in achieving more, for less. We review the latest drugs currently in or having successfully finished phase III clinical trials, and determine their potential place in the management of patients with nAMD in Europe.

Bilateral retinal artery occlusions as the first manifestation of extramedullary central nervous system involvement in relapsed acute myeloid leukaemia.

Retinal artery and vein occlusion are rare devastating complications of central nervous system (CNS) leukaemic infiltrates of the retina and its vasculature. Only a handful of reports exist wherein CNS relapse presents with retinal vascular occlusions. This is usually accompanied by optic nerve swelling and subretinal infiltrates. We present a case of bilateral retinal artery occlusion as a first manifestation of CNS relapse in a patient with acute myeloid leukaemia without optic disc oedema and retinal infiltrates.

Streptococcus salivarius endogenous endophthalmitis.

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

Repeatability of Zone Averages Compared to Single-Point Measurements of Maximal Curvature in Keratoconus.

PURPOSE: To evaluate the repeatability of curvature zone averages centered on the point of maximum curvature (Kmax) compared to that of the single-point Kmax. DESIGN: Comparative reliability analysis. METHODS: Setting: American University of Beirut Medical Center, Beirut, Lebanon. STUDY POPULATION: Sixty-five eyes of 65 adult keratoconus patients. Patients with other ocular disease, history of ocular surgery or trauma, and contact lens wear within 2 weeks of image acquisition were excluded. OBSERVATION PROCEDURES: Eyes were evaluated with 3 consecutive scans using the Galilei dual Scheimpflug-Placido system. MAIN OUTCOME MEASURES: Repeatability of axial and instantaneous Kmax single points, and zone averages with radii of 0.1-2.0 mm, centered on them. Repeatability was assessed by within-subject standard deviations, repeatability limits (r), and intraclass correlation coefficients. RESULTS: Axial curvature zone averaging yielded clinically acceptable repeatability only in eyes with Kmax ≤50 diopters (D), for radii of 1.5 mm and 2.0 mm (r = 0.87 D and r = 0.76, respectively, vs r = 0.91 for the single-point axial Kmax). Compared to instantaneous Kmax, clinically acceptable repeatability was achieved with instantaneous zone averages of at least 1.5 mm radius in eyes with Kmax ≤50 D (r = 0.99 D and r = 0.70 D, respectively) and 2.0 mm radius in eyes with Kmax >50 D (r = 2.28 D and r = 0.87 D, respectively). For all eyes, the repeatability limit of the location of Kmax was 0.82 mm and 0.80 mm for axial and instantaneous curvature, respectively. CONCLUSIONS: Instantaneous curvature zone averages centered on Kmax yielded a greater improvement in repeatability than axial zone averages and reached clinical adequacy with radii of at least 1.5 mm, for eyes with Kmax ≤50 D, and with a 2.0 mm radius for eyes with Kmax >50 D.

Intraocular Migration of Porous Polyethylene Malar Implant Used for Treacher Collins Eyelid Reconstruction.

Lower eyelid colobomas associated with Treacher Collins syndrome can be challenging to repair because of associated orbital and midfacial dysostosis. Alloplastic implants such as porous polyethylene have been advocated as readily available malar implants to help improve eyelid retraction. The authors report the first case of porous polyethylene implant insidious migration into the orbit with subsequent scleral penetration. A 14-year-old male with Treacher Collins syndrome, presented with a 3-week history of left eye pain, redness, and eyelid swelling unresponsive to topical treatment. He previously had bilateral lower lid coloboma repair with alloplastic implant placement and full-thickness skin grafts. On exam, he had left eye injection and chemosis, with left hypotropia and complete restrictive ophthalmoplegia. Imaging revealed displacement of implant into the orbit with adherence and impingement on the eye globe.

Five-Year Results of Combined Small-Aperture Corneal Inlay Implantation and LASIK for the Treatment of Hyperopic Presbyopic Eyes.

PURPOSE: To evaluate the efficacy of simultaneous laser in situ keratomileusis (LASIK) and small-aperture corneal inlay (KAMRA; AcuFocus, Inc) implantation in hyperopic presbyopic eyes at 5 years postoperatively. METHODS: This was a retrospective single-center study of patients with hyperopia and presbyopia who underwent simultaneous LASIK and corneal inlay implantation by two experienced refractive surgeons. These patients were regularly observed for 5 years and evaluated with serial corneal tomographies and refractive assessments for uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), and manifest refraction spherical equivalent (MRSE). RESULTS: Twenty-four eyes of 24 patients were included. Mean age was 53.63 ± 4.11 years (range: 47 to 63 years) and mean preoperative MRSE was +1.52 ± 0.64 diopters (D) (range: +0.50 to +3.00 D). UNVA was 0.04 ± 0.06 logMAR at 1 month and 0.02 ± 0.05 logMAR (J1+ equivalent) at 5 years postoperatively. In comparison, preoperative DCNVA was 0.44 ± 0.20 (J5/J6 equivalent) (P < .001). At 5 years postoperatively, UDVA was 0.16 ± 0.18 logMAR (20/30 Snellen equivalent), and 23 of 24 eyes (95.8%) had UNVA of J3 or better. Two eyes (8.3%) lost one line of CDVA. One corneal inlay needed readjustment but none were explanted. Eight eyes (25%) developed regression in UNVA with hyperopic shift, which responded to a 3- to 4-month course of topical steroids, with 3 eyes showing patchy haze on the undersurface of the corneal inlay. CONCLUSIONS: Simultaneous LASIK and KAMRA inlay implantation, evaluated for 5 years postoperatively, shows some efficacy and predictability in improving UDVA and UNVA in hyperopic presbyopic eyes. However, late-onset regression with hyperopic shift, possible loss of CDVA, and occasional haze remain challenges. [J Refract Surg. 2020;36(8):498-505.].

Comparison of intraoperative vs postoperative optical coherence tomography measurement of implantable collamer lens vaulting.

PURPOSE: To compare intraoperative vs postoperative optical coherence tomography (OCT) measurements of implantable collamer lens (ICL) vaulting. SETTING: American University of Beirut Medical Center, Beirut, Lebanon. DESIGN: Prospective observational cohort study. METHODS: Patients with myopia or myopic astigmatism undergoing ICL insertion in which intraoperative OCT measurements were obtained were included. Exclusion criteria included coexisting ocular problems and previous ocular surgery. The outcome measures were ICL vaulting as determined by OCT intraoperatively and postoperatively at 1 day, 1 week, 1 month, and 3 months. RESULTS: Forty-five eyes of 26 patients were included. Mean age was 27.23 ± 6.47 years (range 17 to 48 years), and mean manifest refraction spherical equivalent was -10.20 ± 3.92 diopters (D) (range -20.50 to -4.50 D). Mean ICL vaulting measured 731 ± 215 µm intraoperatively, 648 ± 219 µm at 1 day, 640 ± 204 µm at 1 week, 628 ± 212 µm at 1 month, and 632 ± 210 µm at 3 months postoperatively (P = .0009, with all postoperative vaulting measurements statistically similar to each other, but significantly different from the intraoperative measurement). However, intraoperative ICL vaulting had high predictability of postoperative vaulting at 3 months with r = 0.81 (P < .0001), and Bland-Altman analysis demonstrates a relatively constant difference between the 2 measurements as plotted against their mean with a bias of 98.27 µm and tight 95% limits of agreement range. CONCLUSIONS: Intraoperative ICL vaulting measured by OCT correlated highly with postoperative OCT vaulting and can be considered a reliable tool to predict the final ICL vault.

Long-Term Effect on HbA1c in Poorly Controlled Diabetic Patients Following Nonmydriatic Retinal Image Review at the Time of Endocrinology Visit.

Background:Patient education demonstrates variable benefits on diabetes control.Introduction:To examine the effect of discussing nonmydriatic retinal imaging findings during a single endocrinology visit on HbA1c levels after 6, 12, and 60 months.Materials and Methods:Patients with HbA1c >8.0% and diabetic retinopathy were previously recruited for a prospective study looking at the change in HbA1c at 3 months between those assigned to a session of nonmydriatic imaging with discussion of retinal findings and those assigned to routine endocrinology evaluation alone. The patients were subsequently evaluated at 6, 12, and 60 months after the initial intervention.Results:Fifty-three of the 57 originally recruited intervention subjects (93%) and 48 of 54 subjects in the original control group (89%) were evaluated at 6 and 12 months and 44 patients in each group (75% and 81%, respectively) at 60 months. At 6 months, the intervention group maintained larger decreases in median HbA1c compared to control (-1.1 vs. -0.3, respectively, p = 0.002) with a trend persisting at 12 months (-0.6 vs. -0.2, respectively, p = 0.07). After 60 months, there was no significant difference in the median change in HbA1c between treatment and control groups (0.3 vs. 0.1, respectively, p = 0.54).Discussion:The short-term improvement in HbA1c resulting from discussion of retinal findings persists throughout the first year in this diabetic cohort, but its magnitude declines with time and becomes statistically insignificant at some point between 6 and 12 months.Conclusions:In patients with poorly controlled diabetes, retinal imaging review may help improve glycemic control but may require repetition periodically for benefit beyond 6 months.