Subthreshold laser treatment in retinal diseases: a mini review.

PURPOSE: To summarize the mechanism and the clinical applications of subthreshold laser (STL) in retinal practice. Subthreshold or "non-destructive" laser includes all types of laser treatments that produce minimal or no damage to the tissues and no visible signs after application. METHODS: A descriptive review of articles from literature databases (PubMed, Medline, Embase, Cochrane, Web of Science) published before August 2023, which discuss current STL treatments of retinal diseases. RESULTS: This review provides evidence for STL as a treatment option for central serous chorioretinopathy, diabetic retinopathy, age-related macular degeneration, macular edema due to retinal vein occlusion, and other maculopathies. In most published reports, STL has shown a therapeutic effect without damage to the underlying tissue. CONCLUSION: Subthreshold laser treatment has shown safety and efficacy in the management of some retinal and macular diseases. Stimulation of the retinal pigment epithelium without destroying adjacent neuroretina has been shown to be sufficient in inducing retinal repair in many clinical cases. Recent research and clinical studies continue to explore the mechanisms and improving therapeutic benefits of this technology as well as extend the range of retinal disorders treatable by this modality.

Laser Treatment of Central Serous Chorioretinopathy - An Update.

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

Diagnostic and Therapeutic Challenges in a Patient with Radiation Retinopathy Complicated by Corticosteroid-Induced Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSC) is a common chorioretinal disorder. It has been postulated that impaired retinal pigment epithelium and hyperpermeability of the choriocapillaris may be involved in the development of CSC, but the exact pathomechanism has not been established. We report an unusual case of a middle-aged man who developed CSC after triamcinolone acetonide injection for macular edema. Edema developed as a late complication of radiation retinopathy after brachytherapy for childhood retinoblastoma. Steroid treatment is an important risk factor for CSC, but the underlying causative mechanisms have not been fully elucidated. It is important to increase the awareness of this link among clinicians who prescribe exogenous corticosteroids, irrespective of the route of administration.

Laser treatment in retinitis pigmentosa-a review.

Retinitis pigmentosa (RP) is a common inherited retinal disease for which effective treatment is not yet known. This review sought to analyze the available medical literature covering the efficacy of different forms of laser treatment for RP in laboratory and clinical trials. The PubMed database was searched using the following phrases: "laser photocoagulation", "subthreshold laser", "nanolaser", "micropulse laser", "retinitis pigmentosa", "rod-cone dystrophy", and "retinal dystrophy". Results were stratified as clinical or experimental studies. Six studies involving animal models and three studies involving human subjects that examined laser treatment in RP were found. Laboratory studies on rodents favored classic laser photocoagulation as the most effective therapy for slowing the progression of proto-oncogene tyrosine-protein kinase MER-related RP. Two clinical studies on humans suggested transient but robust functional benefits of subthreshold micropulse laser treatment in RP. The available material is too scarce to define laser treatment as a standard procedure to treat RP in humans. Nondamaging retinal laser therapy should be tested more intensively in clinical trials as there is no proven negative side effect of that treatment and the theoretical background, especially the chaperone and reparative roles of heat shock proteins elicited during the procedure, supports this form of RP management.

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy.

PURPOSE: Central serous chorioretinopathy (CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors-for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment-were also assessed. MATERIALS AND METHODS: The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy (mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. RESULTS: Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. CONCLUSION: Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

Functional and morphological outcome in patients with chronic central serous chorioretinopathy treated by subthreshold micropulse laser.

BACKGROUND: Chronic central serous chorioretinopathy is a serious therapeutic problem as it may lead to significant visual impairment. The aim of this retrospective study is to evaluate functional and morphological effects, as well as factors influencing visual outcome in patients treated by subthreshold micropulse laser. METHODS: Fifty-one eyes with chronic central serous chorioretinopathy lasting longer than 4 months (18 months on average) underwent up to two sessions of subtreshold micropulse laser treatment. Change in best corrected visual acuity, central retinal thickness, central retinal volume, average central retinal thickness and maximum subretinal fluid height were measured. Relation between the effects of the treatment and the initial retinal morphological and functional parameters was then analyzed. RESULTS: The total resorption of subretinal fluid was achieved in 36 cases (70.6%). There was, however, only a minor improvement in best corrected visual acuity of approximately one line on the Snellen chart. No correlation was observed between the effects of the treatment and the duration of the symptoms, retinal morphology and initial visual acuity. Younger patients responded better to the therapy. CONCLUSION: Subthreshold micropulse laser treatment in chronic serous chorioretinopathy provides good morphological results, however significant improvement of visual acuity is not to be expected.

Central serous chorioretinopathy during pregnancy complicated by systemic hypertension - a case report.

We present a case of a pregnant woman with pregnancy induced systemic hypertension who developed bilateral central serous chorioretinopathy diagnosed after caesarean delivery. Central serous chorioretinopathy can occur in the third trimester of pregnancy and generally has a benign course and good prognosis. Our patient ended up with significant and permanent visual impairment in one eye. Probably in some cases, early ophthalmic diagnostic management, including optical coherence tomography could help identify patients at risk of pemanent visual impairment due to chronic central serous chorioretinopathy and assess their eligibility for subtreshold micropulse laser treatment.

Wide-Field Optical Coherence Tomography in Patients with Diabetic Macular Edema.

Background: The goal of the study was to analyze variations in central, perifoveal, and peripheral retinal thickness (RT) and choroidal thickness (CT) in patients with diabetic macular edema (DME) measured with ultra-wide-field optical coherence tomography (UWF-OCT). Additionally, correlations between RT and CT in the central, perifoveal, and peripheral sectors and the presence of selected systemic factors were evaluated. Methods: A total of 74 consecutive adult diabetic patients with DME and 75 healthy controls were included. Study participants were divided into three groups: DME patients without panretinal photocoagulation (PRP; 84 eyes), DME patients after PRP (56 eyes), and healthy controls (125 eyes). RT and CT were analyzed in three zones: a central circle of 3 mm diameter (central), a ring contained between a centered 9 mm circle and the central 3 mm circle (perifoveal), and a second, more peripheral ring between centered 18 mm and 9 mm circles (peripheral). Additionally, DME subgroups were analyzed according to the correlation of RT and CT with age, axial length, best corrected visual acuity (BCVA), diabetes duration, insulin therapy duration, body mass index (BMI), glycosylated hemoglobin (HbA1c) values, intravitreal injection (IVI) count, and the advancement of retinopathy assessed by the simplified diabetic retinopathy severity scale (DRSS). Results: The increase in RT in the far peripheral sectors in DME patients was not significant. The increases in central and perifoveal RT and lower values of CT in PRP-naive DME patients were strongly associated with poorer BCVA. Patients with DME after PRP presented with BCVA improvements significantly related to the number of IVIs. The amount of DME and RT in peripheral sectors were both independent of systemic factors such as BMI, duration of diabetes, duration of insulin intake, retinopathy severity, and HbA1c levels. Conclusions: Peripheral retinal sectors in DME patients are less affected in terms of increase in their thickness compared to central ones. Functional and morphological associations of DME with UWF-OCT testing refer to central and perifoveal sectors.

Choroidal and Retinal Thicknesses in Healthy Eyes Measured with Ultra-Wide-Field Optical Coherence Tomography.

Ultra-wide-field optical coherence tomography (UWF-OCT) has been recently introduced into clinical ophthalmological practice. To date, there are few data on the reference values of the retinal thickness (RT) and choroidal thickness (CT) measured with this technique. This study aimed to analyze the variance in RT and CT in the healthy eyes of white Caucasian patients with UWF-OCT tests performed with the largest available scan size of 23 × 20 mm. The data were analyzed with reference to the patients' age and gender and the axial length of the eyeball. The results of UWF-OCT scanning enabled us to visualize the shape of the retina and choroid in a large portion of the eyeball. Both anatomical entities became significantly thinner at the periphery. The peripheral CT was greater in the upper and temporal sectors; the RT was higher in the nasal compared to the temporal sectors. Both the choroid and retina showed a reduced thickness with age; however, the CT and RT did not show a statistically significant correlation with the axial length after adjusting for age and gender. Age-related variations in thickness were especially prominent in the choroid. The CT in UWF-OCT testing was significantly greater in females, while the RT was greater in males. UWF-OCT testing provides additional information on the anatomical structure of the retina and choroid compared to standard-field OCT.

Retrobulbar hemorrhage during strabismus surgery.

Purpose: This case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's capsule. Observation: Significant bleeding with subsequent proptosis was observed intraoperatively after the incision of conjunctiva and Tenon's capsule during routine strabismus surgery on the medial rectus muscle in a 5-year-old boy. Intravenous mannitol was administered intraoperatively and surgery was completed as planned. The RH receded within 24 hours without the necessity of orbital decompression. Tenon's capsule prolapse was noted on the first postoperative day and managed with surgical excision under shallow intravenous anesthesia. No damage to the optic nerve or ganglion cells was detected a week after and three months post-surgery. Conclusions and importance: Strabismus surgery bears a risk of RH at every stage of the operation. Careful hemostasis should be provided at each step of the procedure to decrease the risk of such an event. Patients after events of serious intraoperative bleeding should undergo careful post-operative investigation towards coagulation insufficiencies, though no such deficits were identified in the present case.

Advantages of the Utilization of Wide-Field OCT and Wide-Field OCT Angiography in Clinical Practice.

Wide-field (WF) retinal imaging is becoming a standard diagnostic tool for diseases involving the peripheral retina. Technological progress elicited the advent of wide-field optical coherence tomography (WF-OCT) and WF-OCT angiography (WF-OCTA) examinations. This review presents the results of studies that analyzed the implementation of these procedures in clinical practice and refers to them as traditional and ultra-wide-field fluorescein angiography (UWF-FA). A PUBMED search was performed using the terms WF-OCT OR WF-OCTA OR UWF-FA AND the specific clinical entity, and another search for diabetic retinopathy (DR), retinal vein occlusion (RVO), Coats disease, peripheral retinal telangiectasia, peripheral retinal degeneration, lattice degeneration, and posterior vitreous detachment. The analysis only included the studies in which the analyzed field of view for the OCT or OCTA exam was larger than 55 degrees. The evaluation of the extracted studies indicates that WF imaging with OCT and OCTA provides substantial information on retinal disorders involving the peripheral retina. Vascular diseases, such as DR or RVO, can be reliably evaluated using WF-OCTA with results superior to standard-field fluorescein angiography. Nevertheless, UWF-FA provides a larger field of view and still has advantages over WF-OCTA concerning the evaluation of areas of non-perfusion and peripheral neovascularization. Detailed information on the vascular morphology of peripheral changes should be obtained via WF-OCTA and not angiographic examinations. WF-OCT can serve as a valuable tool for the detection and evaluation of vitreoretinal traction, posterior vitreous detachment, and peripheral retinal degeneration, and guide therapeutic decisions on a patient's eligibility for surgical procedures.

Crossover to PDT after the unsuccessful micropulse laser treatment of central serous chorioretinopathy.

Purpose: Subthreshold micropulse laser (SML) and photodynamic therapy (PDT) are among the most effective therapeutic modalities applied to central serous chorioretinopathy (CSCR). This study aimed to evaluate the efficacy and durability of PDT in CSCR cases unresponsive to at least two SML treatments. Methods: The study included 26 consecutive eyes of 24 patients (21 males and three females) with chronic CSCR. In all cases, a lack of reduction in subretinal fluid (SRF) levels was noted after at least two consecutive SML sessions. The parameters of best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were evaluated at baseline and 1, 3 and 12 months post-PDT. Results: The mean duration of symptoms in the group was 53.81 ± 39.48 months, the mean age of the patients was 49.26 ± 12.91 years, and the mean subfoveal choroidal thickness (SFCT) was 572.11 ± 116.21 mm. Complete resorption of SRF was observed in 21 out of 26 eyes (80.77%) at 1 month and sustained in 18 cases (69.23%) at 12 months. At 12 months, in the sustained group, BCVA improved significantly from 0.39 ± 0.18 to 0.19 ± 0.2 logMAR (P = 0.01), central subfoveal thickness (CST) reduced from 316.44 ± 75.83 mm to 197.67 ± 22.99 mm (P < 0.0001), and SFCT reduced from 579.28 mm to 446.78 mm (P < 0.0001). Conclusions: PDT provides the opportunity for the successful treatment of CSCR unresponsive to SML treatment. Improvements are possible even in cases with a long duration of symptoms and significant alterations in retinal morphology. Thus, PDT should be considered for patients with prominently increased choroidal thickness.

Automated interpretation of retinal vein occlusion based on fundus fluorescein angiography images using deep learning: A retrospective, multi-center study.

Purpose: Fundus fluorescein angiography (FFA) is the gold standard for retinal vein occlusion (RVO) diagnosis. This study aims to develop a deep learning-based system to diagnose and classify RVO using FFA images, addressing the challenges of time-consuming and variable interpretations by ophthalmologists. Methods: 4028 FFA images of 467 eyes from 463 patients were collected and annotated. Three convolutional neural networks (CNN) models (ResNet50, VGG19, InceptionV3) were trained to generate the label of image quality, eye, location, phase, lesions, diagnosis, and macular involvement. The performance of the models was evaluated by accuracy, precision, recall, F-1 score, the area under the curve, confusion matrix, human-machine comparison, and Clinical validation on three external data sets. Results: The InceptionV3 model outperformed ResNet50 and VGG19 in labeling and interpreting FFA images for RVO diagnosis, achieving 77.63%-96.45% accuracy for basic information labels and 81.72%-96.45% for RVO-relevant labels. The comparison between the best CNN and ophthalmologists showed up to 19% accuracy improvement with the inceptionV3. Conclusion: This study developed a deep learning model capable of automatically multi-label and multi-classification of FFA images for RVO diagnosis. The proposed system is anticipated to serve as a new tool for diagnosing RVO in places short of medical resources.

Ganglion Cell Loss in the Course of Central Serous Chorioretinopathy.

INTRODUCTION: Central serous chorioretinopathy (CSCR) as a clinical entity is potentially damaging and may significantly affect retinal morphology and function, especially in the chronic form. Our study aimed to determine the amount of deficit of best corrected visual acuity (BCVA) and individual retinal layers, including ganglion cells, in different types of CSCR and with reference to its duration. METHODS: The retrospective analysis included 69 eyes of patients with resolved CSCR managed in Dobry Wzrok Ophthalmological Clinic between 1 January 2019 and 30 June 2022. The diagnosis of CSCR was based on the criteria outlined by the Central Serous Chorioretinopathy International Group. The analysis included data obtained from medical history, BCVA testing, and spectral domain optical coherence tomography (SD-OCT) measurements, with specific thickness values for individual retinal layers. The results were compared among affected eyes, unaffected fellow eyes, and healthy controls. RESULTS: BCVA values were significantly lower in acute (0.08 ± 0.12 logMAR) and chronic (0.26 ± 0.19 logMAR) cases versus controls (0.0 logMAR). The thickness of all retinal layers (central subfoveal thickness, CST; inner retina with ganglion cell complex, GC; outer retina, ORT; and photoreceptor outer segments, POS) and macular volume (MV) were significantly decreased in chronic eyes versus controls (p < 0.01). Acute eyes had significant thinning of the outer retina and POS only compared to control eyes (p < 0.01). The amount of deficit in CST, ORT, GC, and MV was strongly correlated with poorer BCVA (p < 0.001), and the deficit of CST, ORT, and GC was correlated with disease duration (p < 0.05). The subfoveal choroidal thickness was significantly greater in affected and fellow eyes versus controls (p < 0.001). CONCLUSION: Damage to the outer retina and photoreceptors occurs early in the course of CSCR, with a deficit in ganglion cells noted adjunctively in chronic forms of the disease. Further studies are required to precisely determine correlation between visual loss in CSCR and deficits in individual retinal layers.

Central serous chorioretinopathy (CSCR) is a common condition typically affecting young and middle-aged individuals. In its chronic form, it can lead to changes in retinal morphology and significant visual impairment. This disorder occurs basically in two forms: acute and chronic, depending on its duration. The study aimed to determine the amount of morphological and functional deficit occurring in the course of acute and chronic CSCR and refer it to healthy controls. The analysis of 69 resolved cases of CSCR was performed, including results of visual acuity testing and spectral domain coherence tomography (SD-OCT) measurements. Visual acuity was significantly lower in both acute and chronic groups compared to healthy control eyes, with greater deficit in the chronic group. Analysis revealed also a significant thinning of the retina in the chronic group versus control group. Chronic group demonstrated substantial loss of ganglion cells, which was not noted in acute form of the disease. Acute eyes demonstrated only a partial deficit in the outer retina, with the ganglion cell layer remaining intact. The amount of deficit of all retinal layers was strongly correlated with poorer visual acuity and disease duration.

Presbyopia: What We Do Know and What We Do Not Know in 2022.

The subject of presbyopia has accompanied clinical ophthalmic practices around the world for centuries [...].

Biometric Risk Factors for Central Serous Chorioretinopathy.

INTRODUCTION: Central serous chorioretinopathy (CSCR) is a common disease that in chronic form can lead to significant visual impairment. Hence, the systemic and local risk factors of CSCR have been analyzed to possibly prevent its onset. The goal of the present study was to find the biometric parameters characteristic for CSCR. METHODS: The study included 66 eyes of 60 consecutive patients who were diagnosed with acute or chronic CSCR between January 01 2021 and June 30 2021. There were 46 males and 14 females with a mean age of 48.8 ± 10.0 years in the study cohort. Six patients had symptomatic binocular disease. The axial length and retinal parameters of all patients were measured with spectral domain optical coherence tomography (SD-OCT), and refraction error was tested after cycloplegia. The results of the affected eyes were compared with those of healthy fellow eyes (with exclusion of eyes previously affected by CSCR or with any other ocular disorder) (39 eyes) and the control group (75 eyes), and correlated to the duration of the disease. RESULTS: No significant differences were revealed in axial length between the affected eyes, healthy fellow eyes, and controls (23.31 ± 1.06 mm versus 23.59 ± 1.20 mm versus 23.33 ± 1.19 mm, respectively). The distribution of refraction errors was similar in the three analyzed groups. A hypermetropic shift was noted in the affected eyes versus controls (p = 0.030); however, no difference was noted in refraction error between the healthy fellow CSCR eyes and controls (p = 0.418). Both acute and chronic CSCR cases, as well as their fellow eyes, demonstrated significantly greater choroidal thickness compared with healthy individuals (p < 0.001). Longer disease duration was correlated with a significant deficit in macular volume and average central retinal thickness (p < 0.05). CONCLUSIONS: CSCR is a clinical entity that can occur in patients with every type of refraction error. A shorter axial length of the eyeball is not associated with the diagnosis of CSCR; however, increased choroidal thickness is typical of this entity. Longer disease duration is correlated with the loss of retinal thickness and volume.

Central serous chorioretinopathy (CSCR) is nowadays classified as a clinical entity belonging to the spectrum of pachychoroid disorders characterized by increased choroidal thickness. Quite often, a shorter axial length and hypermetropia were thought to cause choroidal congestion, and as such, were believed to be associated with the incidence of CSCR. This study aimed to evaluate this relationship in the context of the disease duration. The analysis included comparisons among affected CSCR eyes, healthy fellow eyes, and a control group. The results did not prove a relationship between a shorter eyeball or any specific refraction error and CSCR. Both acute and chronic cases of CSCR presented with significantly greater values of choroidal thickness compared with healthy individuals. A loss of retinal thickness and volume was observed with a longer disease duration.

Regression of Neovascularization after Panretinal Photocoagulation Combined with Anti-VEGF Injection for Proliferative Diabetic Retinopathy-A Review.

Proliferative diabetic retinopathy (PDR) poses a significant therapeutic problem that often results in severe visual loss. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. Conversely, intravitreal anti-VEGF therapy has served as an alternative treatment for PDR. This review aimed to evaluate the effects of PRP combined with anti-VEGF therapy on the regression of neovascularization (NV), including functional outcomes and incidence of complications. The MEDLINE database was searched for articles evaluating regression of NV using a combination of the following terms: "proliferative diabetic retinopathy", "anti-VEGF", "panretinal photocoagulation", and "combined treatment". The search yielded a total of 22 articles. The analysis of their results indicated PRP combined with ant-VEGF therapy as superior over PRP alone in the management of PDR. Combination treatment yields better and faster regression of NV and a lower incidence of serious complications, such as vitreous hemorrhage and the need for pars plana vitrectomy. Nevertheless, complete regression of NV is not achieved in a significant proportion of patients. Further research is needed to establish the most effective schedule for intravitreal injections as an adjunct to PRP. The current literature shows that in some cases, cessation of anti-VEGF injection in combination treatment for PDR can lead to relapse of NV.

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia.

Background: Enhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision. Methods: The study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between -0.25 and -0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months' visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias. Results: Binocular uncorrected visual acuities at 12 month's visit were 0.13 â€‹± â€‹0.16, 0.06 â€‹± â€‹0.08, 0.07 â€‹± â€‹0.09 and 0.15 â€‹± â€‹0.09 logMAR for far distance, 80 â€‹cm, 66 â€‹cm and 40 â€‹cm respectively. Corrected binocular visual acuities at 12 months were 0.00 â€‹± â€‹0.00, 0.05 â€‹± â€‹0.07, 0.05 â€‹± â€‹0.06, 0.13 â€‹± â€‹0.16 respectively for distance, 80 â€‹cm, 66 â€‹cm and 40 â€‹cm. Automated refraction spherical equivalent at 12 months' visit stood at -0.70 â€‹± â€‹0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled -0.49 â€‹± â€‹0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 â€‹± â€‹0.16 logMAR without correction and 1.81 â€‹± â€‹0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case. Conclusions: EDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.

Long-Term Variations in Retinal Parameters after Uncomplicated Cataract Surgery.

Background: Cataract phacoemulsification surgery provides excellent refractive results; however, it also elicits changes in the posterior segment of the eye. This study aimed to determine changes in retinal parameters measured by spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) after an uncomplicated cataract surgery, including the impact of effective phacoemulsification time (EPT). Methods: The study included 44 patients without retinal abnormalities, followed up after unilateral uncomplicated cataract phacoemulsification in a single ophthalmological unit. Patients were evaluated for the following parameters at baseline and at 2 weeks, 3 months, and 12 months after the surgery: best corrected visual acuity, central retinal thickness (CRT), average central retinal thickness (CRTA), central retinal volume (cube volume (CV)), vessel density central (VDC), vessel density full (VDF), vessel perfusion central (VPC), and vessel perfusion full (VPF). The EPT recorded at each procedure was used as a covariant for the evaluation of changes in retinal parameters after the surgery. Analysis included 44 eyes for SD-OCT and 17 for OCTA evaluation, according to adopted scan quality thresholds. Results: A significant increase in CRT, CRTA, and CV was noted at each follow-up point compared with baseline. The rising tendency was observed in the first 3 months after the surgery, with a decline over the subsequent months. The VPF parameter showed a stable improvement after the surgery. The analysis of covariance did not confirm any significant effect of the EPT on variations in CRT, CV, CRTA, VDC, and VPF and there was a weak effect on the VDF parameter. Conclusions: Uncomplicated cataract surgery results in an increase in retinal thickness and volume in the first few months after the surgery, followed by a spontaneous decline in these parameters in the subsequent months. A long-standing improvement is noted in the VPF parameter.

Significant Visual Impairment after Short-Lasting Central Serous Chorioretinopathy.

A 37-year-old man experienced two episodes of central serous chorioretinopathy (CSCR) with the onset within a 7-month period, one in each eye. The diagnosis was made based on spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), and fluorescein angiography. The presence of subretinal neovascularization and polypoidal choroidal vasculopathy were excluded. Each CSCR episode lasted for approximately 6 months and resolved completely after laser photocoagulation (left eye) and photodynamic therapy (right eye). In the right eye, subthreshold micropulse laser treatment and oral eplerenone were initially administered because of a verteporfin shortage, but they were not effective. Final best-corrected visual acuity was 0.8 logMAR in the left eye and "counting fingers" in the right. SD-OCT revealed significant retinal thinning in both eyes despite FAF, showing no major loss of retinal pigment epithelial cells. A significant reduction of ganglion cell complex thickness occurred in the right eye. Acute CSCR can result in significant visual impairment, even when short-lasting.