Search

Purpose: Evaluation of long‐term functional and structural outcomes in patients with primary congenital glaucoma (PCG) based on visual acuity (VA), visual field (VF) using standard automated perimetry, and peripapillary retinal nerve fibre layer thickness (pRNFL). Methods: We retrospectively reviewed medical records of all patients diagnosed with PCG in Denmark from 1977 to 2016. Severe vision loss was defined as VA <6/60 and/or VF >20 decibels (dB). Prognostic factors were evaluated in a correlation matrix. Results: The median age of the 94 patients (153 PCG eyes) was 12 years (IQR 9–16). In PCG eyes 62% had VA ≥6/18 but 22% had <6/60. VA in the better seeing eye was ≥6/18 in 90% and <6/60 in 5%. VF was measured in 59 PCG eyes and the median mean defect was 5.1 dB (IQR 2.1–9.6) with 52% better than 6 dB and 9% worse than 20 dB. Generalized pRNFL was reduced below the age‐expected 1st percentile in 29% of the 58 PCG eyes where pRNFL was measured. Poor VA, poor VF and reduced pRNFL were all correlated (p = 0.0001). More surgeries (p < 0.0001) and longer diagnostic delay (p = 0.004) were associated with poorer vision and to a lesser degree with poor VF pRNFL. Conclusion: In Denmark, most patients with bilateral PCG retain VA ≥6/18 in the better seeing eye. Poor VA was associated with poor VF. Longer diagnostic delay and more surgeries were associated with a poorer prognosis. [ABSTRACT FROM AUTHOR]

Purpose: The administration frequency of intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) in neovascular age‐related macular degeneration (AMD) have been widely discussed. The primary objective of the study was to explore the association between anatomical outcomes and changes in functional outcome. Methods: This was a retrospective cohort study of patients with newly diagnosed neovascular AMD with a minimum of 12 months of follow‐up. Only one eye per patient was included. Patients were treated according to the observe‐and‐plan or the pro‐re‐nata regimen. All patients were regularly examined from the time of diagnosis up to 24 months. The effect of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelium detachment (PED) at any time point on visual acuity (VA) was tested, as well as the long‐term effect and the risk of losing VA. Further, the variability of central retinal thickness (CRT) was calculated for each eyes' individual measures during the observation period, excluding the monthly loading phase. The prognostic effect of each factor on VA was estimated by regression analysis. The primary outcome measure was VA, which was correlated with the presence or absence of fluid, seen as IRF, SRF or PED. Results: A total of 504 treatment naïve eyes from 504 patients was included. The presence of IRF was associated with lower VA at all visits (p < 0.001). However, the presence of SRF or PED was not significantly associated with worse VA at any time point during the observation period. Patients in the upper quartile of CRT variance had a greater loss in VA after 12 and 24 months (p < 0.001). Conclusions: In this retrospective cohort study, the presence of intraretinal fluid was associated with poorer visual outcome in neovascular AMD patients treated with anti‐VEGF, but the presence of subretinal fluid and PEDs was not. This suggests that IRF is worse than subretinal fluid and PEDs for AMD outcomes and therefore requires the most intensive treatment. Further, we found that patients with the highest CRT variability during the study period had poorer visual outcomes after 12 and 24 months, indicating that stringent control of retinal fluid volume fluctuations is important to prevent visual acuity decline over time. [ABSTRACT FROM AUTHOR]

This article presents a real-world analysis of the use of intravitreal injections of ranibizumab and aflibercept for the treatment of diabetic macular edema (DMO) in the Zealand Region of Denmark from 2008 to 2021. The study included 1083 eyes of 728 patients and found that a mean of 4.1 injections were given per eye in the first year, with a gradual decline in subsequent years. Baseline visual acuity improved initially but gradually declined over time. The study also found that lower baseline visual acuity, younger age, and lower baseline HbA1c levels were associated with better outcomes. Overall, the results suggest that anti-VEGF treatment can initially improve visual acuity in DMO patients, but a gradual decline is observed over time. [Extracted from the article]

Purpose: To report 10‐year, real‐world experiences with intravitreal therapy (IVT) using vascular endothelial growth factor inhibitors for neovascular age‐related macular degeneration (nAMD). Methods: Retrospective single‐centre review of IVT‐log 2007–2019 with a treatment‐as‐needed regimen and ETDRS visual acuity charts. Results: The 4,678 treatment‐naïve eyes of 3,668 patients received a mean of 5.4 IVT in the first year and 4.0–4.3 IVT yearly thereafter. Baseline mean best corrected visual acuity (BCVA) was 57.9 (±16.4) letters (6/18) that improved a mean +2.1 (±0.2) letters at the first follow‐up visit and gradually declined to −5.0 (±2.2) letters after 10 years. At baseline, there were 29% with BCVA ≥6/12. This proportion increased to 31–37% until year 9. There were 8% with BCVA loss of ≥3 lines at the first follow‐up visit increasing to 34% after 10 years. Poorer baseline BCVA was associated with larger increase in BCVA (p < 0.0001, multiple linear regression). The 2,566 (55%) discontinued eyes had a mean baseline BCVA of 56.9 (±16.4) letters compared with 61.5 (±15.9) letters for eyes remaining in treatment. In year 0–7, the discontinued eyes lost an additional mean 2–4 letters (last observation carried forward) but were similar thereafter. There were 12.6% (74 of 585 eligible eyes) that were still in treatment after 10 years. At baseline, 10% had bilateral nAMD. Of patients with unilateral presentation, 17% had received fellow‐eye IVT after 5 years. Conclusion: A treatment‐as‐needed regimen stabilized BCVA in active nAMD up to 10 years in most eyes. Baseline BCVA was the most important prognostic factor. [ABSTRACT FROM AUTHOR]

This review provides an update on open-angle glaucoma with a special focus on the current non-invasive treatment modalities, side effects and interactions to topical pressure-lowering eye drops that all treatment providers should be aware of. We highlight current challenges in terms of timely diagnosis and compliance and outline promising areas of research within the field.

Unlabelled: Ballpoint pens are important tools for the daily work of the physicians. However, a practical challenge seems to be that they disappear just when one needs them most. We call this the ballpoint pen paradox. We have studied the fate of 60 ballpoint pens in an outpatient clinical setting. Five physicians, five nurses and five medical secretaries were equipped with four barcode-tagged ballpoint pens. During follow-ups, we systematically searched the participants' coat and the department for the barcode-tagged ballpoint pens. We illustrated the migration of the ballpoint pens using a diagram and tested fit of linear and exponential trend line. The ballpoint pens displayed a tremendous migration in the department. Disappearance from the coat was exponentially with a half-life of 9 days - only 23% were left after 18 days. Disappearance from the department was linear with a 3% loss per day - only 42% were left after 18 days. Ballpoint pens have a high migration and turnover rate. The fate is unknown for a great amount of ballpoint pens. They are treated carelessly, which finally results in waste of time and resources. It may be that the ballpoint pen paradox can be diminished by phasing out ballpoint pens of low quality., Funding: not relevant., Trial Registration: not relevant.