While age-related macular degeneration (AMD) poses an important personal and public health burden, comparing epidemiological studies on AMD is hampered by differing approaches to classify AMD. In our AugUR study survey, recruiting residents from in/around Regensburg, Germany, aged 70+, we analyzed the AMD status derived from color fundus images applying two different classification systems. Based on 1,040 participants with gradable fundus images for at least one eye, we show that including individuals with only one gradable eye (n = 155) underestimates AMD prevalence and we provide a correction procedure. Bias-corrected and standardized to the Bavarian population, late AMD prevalence is 7.3% (95% confidence interval = [5.4; 9.4]). We find substantially different prevalence estimates for “early/intermediate AMD” depending on the classification system: 45.3% (95%-CI = [41.8; 48.7]) applying the Clinical Classification (early/intermediate AMD) or 17.1% (95%-CI = [14.6; 19.7]) applying the Three Continent AMD Consortium Severity Scale (mild/moderate/severe early AMD). We thus provide a first effort to grade AMD in a complete study with different classification systems, a first approach for bias-correction from individuals with only one gradable eye, and the first AMD prevalence estimates from a German elderly population. Our results underscore substantial differences for early/intermediate AMD prevalence estimates between classification systems and an urgent need for harmonization.
Purpose: The aim of this study was to assess the clinical features and outcome of paediatric retinal detachment (RD). Methods: Ninety-five eyes of 87 children under 18 years of age with RD were assessed. The risk factors, morphology of RD, therapeutic approach and functional results were evaluated. Results: Sixty-seven boys and 20 girls with a mean age of 10.4 years (standard deviation 5.5) presented with RD. The following risk factors were identified: myopia (23%), congenital or developmental ocular abnormalities (37%), history of ocular trauma (40%) and previous ocular surgery (27%). Seventy-seven (81%) eyes underwent surgery. The primary reattachment rate was 44%. In 18%, reattachment was achieved after several surgeries. The overall recurrence rate after surgical reattachment was 39%. Conclusions: Paediatric RD is a sight-threatening condition. Often, aggravating factors, such as delayed diagnosis, hereditary ocular abnormalities or strong vitreous adherence, are present. Hopefully, modern surgical techniques may contribute to a better outcome of RD in the future.
Pediatric CNV is a rare but sight-threatening retinal disease. So far, no standard treatment has been validated. Since the establishment of intravitreal anti-VEGF therapy, laser coagulation and photodynamic therapy have lost their significance as therapy for CNV.
We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p < 0.001). For patients with phakic eyes, the combination of vitrectomy and cataract surgery resulted in a slightly better, but insignificant increase in visual acuity than for patients with primary pseudophakia (Δ = 0.05, p = 0.46). On average, central foveal thickness regressed by 94 μm (SD 129 μm). Linear regression showed a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity (R (2) = 0.16, B = 0.71, p = 0.004). A decrease in foveal thickness by 100 μm resulted in an increase in visual acuity by 0.71 lines. Visual improvement did not significantly differ between the group of patients with intact outer retinal layers before surgery and the group of patients with preoperative defects of the retina (p = 0.085). We found a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity for patients undergoing surgery for ERM. However, the preoperative OCT status (intact vs. broken) of the outer retinal layers did not correlate with the change in visual acuity.
Purpose: The primary endpoint results from the comparing alternative ranibizumab dosages for safety and efficacy in retinopathy of prematurity (CARE-ROP) core study identified ranibizumab as an effective treatment to control acute retinopathy of prematurity (ROP). This study reports the 1-and 2-year follow-up data focusing on long-term functional outcomes and safety.
Methods:The CARE-ROP trial compared 0.12 mg versus 0.20 mg ranibizumab in 20 infants with ROP in a multicentric, prospective, randomized, double-blind, controlled study design. Sixteen patients entered the follow-up period. An ophthalmologic assessment at one year postbaseline was acquired from all 16 patients and a neurodevelopmental assessment at two years postbaseline was acquired from 15 patients.Results: Fifteen of 16 infants were able to fixate and follow moving objects at one year postbaseline treatment. One child progressed to stage 5 ROP bilaterally between the end of the core study and the 1-year follow-up (first seen at PMA 75 weeks). Mean spherical equivalents were À1.9 diopters (D) and À0.75 D in the 0.12 mg and the 0.20 mg treatment arms. Strabismus was present in seven and nystagmus in five out of 16 infants. Mental development scores were within normal limits in six out of ten patients with available data. No statistically significant difference was observed between the two treatment arms.
Conclusion:Neurodevelopmental and functional ocular outcomes 1 and 2 years after treatment with ranibizumab are reassuring regarding long-term safety. Late reactivation of ROP, however, represents a challenge during the follow-up phase and it is of utmost importance that regular follow-ups are maintained.
To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery.
The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery.
Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve.
RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.
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