PURPOSE:To report spectral domain optical coherence tomography (OCT) findings of a patient who experienced bilateral visual loss after a motorcycle accident.METHODS:A 51-year-old man presented to the emergency department complaining of bilateral visual loss after a motorcycle falling down. A complete ophthalmologic examination and OCT testing were made on the same day of the accident. Follow-up was made at 2 days, 2 weeks, 5 months, and 12 months adding central visual field assessment using Humphrey automated perimetry.RESULTS:At presentation, best-corrected visual acuity was 20/200 in both eyes, anterior segment was normal, and fundus examination showed a bilateral macular edema confirmed by OCT. After 2 days, visual acuity recovered to 20/25. Optical coherence tomography findings showed foveal detachment, hyperreflective clump below external limiting membrane, and hyperreflectivity of Henle layer nasally to the fovea. After 15 days, visual acuity was 20/20, but vision was altered by a paracentral scotoma and some irregularities of OCT findings persisted. At 1 year of follow-up, best-corrected visual acuity was 20/20, and paracentral scotoma was very tiny in the right eye, whereas larger and deeper in the left eye. Optical coherence tomography was normal in the right eye, whereas some fragmentations of interdigitation zone were still evident in the left eye.CONCLUSION:We report a case of bilateral whiplash maculopathy from vitreoretinal traction subsequent to road traffic accident. After 1 year of follow-up, visual acuity was restored but paracentral scotoma persisted. Optical coherence tomography appearance of the left eye was still abnormal.

Purpose: To evaluate the efficacy and the rate of side effects of the pegylated aptamer pegaptanib in the treatment of patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and a history of previous arterial thromboembolic events (ATEs). Methods: Twenty-three eyes of 23 patients with subfoveal CNV due to AMD and cerebrovascular accidents (n = 12) and myocardial infarction (n = 11) in the previous 6 months received intravitreal pegaptanib 0.3 mg according to a pro re nata regimen and were followed for 12 months. The paired Student t test was used to evaluate mean changes in best-corrected visual acuity (BCVA; primary outcome measure) and central foveal thickness (CFT). Results: The mean patient age was 71.5 ± 4.6 years; there were 14 women and 9 men. The CNV was type 1, 2, and 3 in 18, 3, and 2 eyes, respectively. The mean BCVA improved from 0.67 ± 0.23 logMAR at baseline to 0.52 ± 0.31 logMAR at the end of 12-month follow-up (p = 0.044). Thirty-five percent of patients achieved ≥3 Early Treatment Diabetic Retinopathy Study lines improvement at 12 months. Mean CFT at baseline (381 ± 111 µm) decreased to 304 ± 82 µm at 12 months (p = 0.008). Patients received a mean of 4.3 ± 1.3 (range 3-7) injections. No systemic or ocular side effects occurred; no patient experienced further ATEs. Conclusions: Intravitreal pegaptanib can be considered a viable treatment option for patients with AMD-related CNV who are at high risk of ATEs.

Purpose : To present functional and anatomical outcomes in the second year of follow-up of 48 eyes of 44 patients that presented with CSDME and were treated with subthreshold micropulse 577 nm laser photostimulation. Methods : Consecutive case series of patients that presented from November 2013 through November 2015. As in the ퟌrst report (ARVO 2015-Poster Number 1764-A0197) patients were divided into two groups: a) with central macular thickness (CMT) ≤ 400 μm (31 patients) and b) with CMT > 400 μm (13 patients) at baseline. Laser photostimulation was performed with a 577 nm laser in the micropulse delivery mode in a sub-visiblethreshold manner, with no signs of laser impacts discernable during treatment and at any time post-operatively. Measurable outcome variables were best corrected visual acuity (BCVA) and CMT. Mean follow-up was 12 months (6-18 mo) Results : In the second year about half of the patients completed the follow-up with respect to the ퟌrst year. The main reason was their shift to intravitreal anti-VEGF treatment; one second reason was the loss to follow-up. The mean BCVA in the group with CMT <400 um was 0.56 ± 0.17 before treatment and 0.6 ± 0.19 after treatment. Mean CMT before treatment was 335.6 ± 36.2 um and 286 ± 64.7 um after treatment. Considering visual acuity outcomes, in this group 2 eyes had a gain of more than 15 letters, 2 eyes had a gain of more than10 letters, 20 eyes were stable and 3 eyes had a loss of more than 5 letters, 1 eye or more than 10 letters. The mean BCVA in the group with CMT >400 um was nd 0.43 ± 0.15 before treatment and 0.59 ± 0.29 after treatment. Mean CMT was 452.4 ± 42 um before treatment and 334.25 ± 79.8 um after treatment. Considering visual acuity outcomes in this group, 5 eyes had a mean gain of more than 10 letters, 2 eyes of more than 10 letters letters, 5 remained stable, 1 eye had a loss of more than 5 letters, and non eyes lost more than 10 letters. Conclusions : Laser photostimulation using the 577 nm yellow laser in the micropulse emission mode maintains its eퟙcacy in stabilizing / improving BCVA and in reducing / eliminating DME in 27 over 31 and 12 over 13 of the patients that remained in the study. There is no concern about safety, having virtually no collateral eퟍects. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Here we report a case of unexplained sudden visual loss after removal of silicone oil for rhegmatogenous retinal detachment repair. A patient with visual loss in one eye after removal of silicone oil was investigated with best-corrected Snellen visual acuity assessment, fundus biomicroscopy, optical coherence tomography, color fundus photograph, fluorescein angiography, electrophysiologic examination, automated perimetry, and visual evoked potentials. Best-corrected Snellen visual acuity was 20/30 while the silicone oil was in place. Visual acuity dropped dramatically to 20/200 after silicone oil removal. No other complications associated with oil removal were noted. The retina remained attached. Visual evoked potentials revealed decreased amplitude due to a damaged optic nerve, while the earliest central visual field defects disappeared unexpectedly almost 2 years after the last surgical procedure. No other abnormalities were demonstrated. Vision loss is a possible complication of silicone oil and removal. This case was distinguished by the permanent decrease of visual acuity despite the unexplained and quite complete recovery of the foveal threshold with no other relevant visual field defects.

PURPOSE To investigate the simultaneous association of several psychophysical measures with reading ability in patients with mild and moderate low vision attending rehabilitation services. METHODS Standard measurements of reading ability (Minnesota Reading [MNREAD] charts), visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts), contrast sensitivity (Pelli-Robson charts), reading contrast threshold (Reading Explorer [REX] charts), retinal sensitivity, and fixation stability and localization (Micro Perimeter 1 [MP1] fundus perimetry) were obtained in 160 low vision patients with better eye visual acuity ranging from 0.3 to 1.0 logarithm of the minimum angle of resolution and affected by either age-related macular degeneration or diabetic retinopathy. RESULTS All variables were moderately associated with reading performance measures (MNREAD reading speed and reading acuity and REX reading contrast threshold), as well as among each other. In a structural equation model, REX reading contrast threshold was highly associated with MNREAD reading speed (standardized coefficient, 0.63) and moderately associated with reading acuity (standardized coefficient, -0.30). REX test also mediated the effects of Pelli-Robson contrast sensitivity (standardized coefficient, 0.44), MP1 fixation eccentricity (standardized coefficient, -0.19), and the mean retinal sensitivity (standardized coefficient, 0.23) on reading performance. The MP1 fixation stability was associated with both MNREAD reading acuity (standardized coefficient, -0.24) and MNREAD reading speed (standardized coefficient, 0.23), while ETDRS visual acuity only affected reading acuity (standardized coefficient, 0.44). CONCLUSIONS Fixation instability and contrast sensitivity loss are key factors limiting reading performance of patients with mild or moderate low vision. REX charts directly assess the impact of text contrast on letter recognition and text navigation and may be a useful aid in reading rehabilitation.

Purpose: To assess whether reading ability and microperimetry improve as demonstrated for visual acuity after surgery for macular hole and macular pucker. Methods: Fifty-nine consecutive patients underwent pars plana vitrectomy for macular pucker (n = 41) or full-thickness macular holes (n = 18). Functional assessment was made at 3, 6, and 12 months after surgery and included far visual acuity (Early Treatment Diabetic Retinopathy Study charts), retinal sensitivity using the microperimeter (MP1, Nidek Technologies, Padova, Italy), and reading ability (MNRead charts). Results: An improvement was recorded both for macular holes and puckers not only for visual acuity, but also for reading acuity and mean central retinal sensitivity (P < 0.01 for the overall comparisons between baseline and follow-up values). Maximum reading speed was already good at baseline both for puckers and holes overall, and a significant mean improvement was recorded only in patients with macular hole at 6 and 12 months (P < 0.01). Although eyes with macular holes had worse baseline visual function compared with puckers (P < 0.01 for all measures of visual function except for reading speed), they recovered to similar levels thanks to greater improvement (P < 0.05 for the difference in improvement during follow-up between puckers and holes for all measures of visual function). No differences were found among indocyanine green or trypan blue staining compared with no staining for internal limiting membrane removal based on all outcome measures (P > 0.05 for the overall difference of visual function improvement during follow-up). Conclusion: The improvement found for visual acuity after vitrectomy for macular hole and pucker also regards retinal sensitivity and reading ability for up to 12 months. This is reassuring concerning the benefits for the patients, and this shows that visual acuity is a valid functional measure for investigating the efficacy of macular surgery.