1 The mechanism for this is thought to be related to drug-induced forward displacement of the lens which causes anterior movement . 8600 Rockville Pike Bilateral simultaneous, retinal detachment has an annual incidence of 0.35 patients per 100 000 population. The third mechanism for retinal detachment is due to accumulation of subretinal fluid due to inflammatory mediators or exudation of fluid from a mass lesion. For serous detachments, management is nonsurgical. The .gov means its official. Methods We conducted the first prospective population-based epidemiological study of progressive schisis detachment over a 1-year period (2014-2015) in the UK. 2019 American Academy of Ophthalmology. This page was last edited on October 17, 2022, at 16:40. Patients undergoing cataract surgery should be counseled about the importance of reporting symptoms of retinal tears and detachments. The research team identified three cases of retinal detachment in two patients using topical pilocarpine as presbyopia treatment. A patient with constant fixed or slowly progressive visual field loss should be suspected of having a detachment until proven otherwise. We retrospectively reviewed the records of 1311 eyes, which underwent SFIOL for various indications. A thorough fundus examination to include indirect ophthalmoscopy with scleral depression and visualization to the ora serrata should be completed. Por YM, Lavin MJ. All the eyes with failed surgery had advanced PVR. Retinal detachments have been reported to occur in 6-20 per 100,000 population worldwide, but there is wide variability in incidence between the types. Copyright 2022 Elsevier Inc. All rights reserved. Miotics and retinal detachment: a survey and case report. Treatment . Feb 1982; 100(2):289-92. The patients with dislocated IOL underwent either IOL explantation along with new SFIOL (73 eyes) or refixation of the same IOL as SFIOL (212 eyes) depending on the type of IOL (as described in methods). The site is secure. There is an accumulation of fluid in the space between the neural retina and the retinal pigment epithelium known as subretinal fluid (Fig. 2006; 26: S28-S33. Lattice degeneration is considered the most important peripheral retinal degeneration process that predisposes to a rhegmatogenous retinal detachment. Ophthalmic pilocarpine is a cholinergic agonist agent approved to treat open-angle glaucoma, ocular hypertension, and more, usually given as an eye drop. Tractional retinal detachments can also be due to proliferative vitreoretinopathy after trauma or surgery. Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique. Any inflammatory disease or underlying mass should be identified and treated if possible. Careers. A dilated examination revealed an inferotemporal retinal detachment in the right eye with an associated retinal tear inferotemporally. A sclerocorneal tunnel was constructed superiorly with the help of a crescent blade. Tractional retinal detachments can be seen in proliferative retinopathy due to diabetic disease, sickle cell and other disease processes leading to neovascularization of the retina. Surgical outcomes and complications of sutured scleral fixated intraocular lenses in pediatric eyes. ECR/182/INST/TN/2013, dated 20.04.2013, Project code RET201700218) and adhered to the tenets of the Declaration of Helsinki. official website and that any information you provide is encrypted The functionality is limited to basic scrolling. The symptoms of retinal detachment often come on quickly. We are experimenting with display styles that make it easier to read articles in PMC. [5] Other peripheral lesions having slight increased risk of retinal detachment include ora bays, meridional folds and complexes, and cystic retinal tufts. Pilocarpine and other miotics have long been suspected to be associated with an increased risk of retinal detachment. The five eyes in which retina failed to reattach despite RD surgery had proliferative vitreoretinopathy (PVR) grade C or higher at the time of presentation. The differential diagnosis of retinal detachment includes retinoschisis and choroidal mass. Sen et al.also reported that one-third of the detachments in their study of post-SFIOL RRD in children occurred within 6 weeks. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. This finding was also similar to that reported by Sen et al., who reported GRT in around one-fifth of the patients. You may notice problems with The incidence of RRD in patients with a history of CGI was similar to the other cohort of patients (1.7% each). In: Taiwan Journal of Public Health, Vol. [16,18,21,22,23] However, such a finding was not noted in our study. Age distribution at the time of surgery was 57-85 years (mean 738.9) in the 23-gauge group, and 48-88 years (mean 707.2) in the 20-gauge group. 1975 Oct;167(4):534-42. sharing sensitive information, make sure youre on a federal Retinal detachment is a medical emergency. 1 The most common (more than 5%) adverse reactions were headache and conjunctiva hyperemia. Retinal tears and retinal detachment as factors affecting visual outcome after cataract extraction complicated by posteriorly dislocated lens material. Design: Krause L, Bechrakis NE, Heimann H, Salditt S, Foerster MH. . Flashes of light in one eye or both eyes. Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage . Retinal tear: use a laser or cryotherapy to create a scar that attaches the retina to underlying tissue Retinal detachment: In this procedure, called pneumatic retinopexy, the surgeon injects a bubble of air or gas into the vitreous cavity. The .gov means its official. In this age group, the incidence of RD from trauma is . A standard three-piece non-foldable IOL (Aurolab; Madurai, India) was used. Salam GA, Greene JM, Deramo VA, Tibrewala RK, Ferrone PJ, Fastenberg DM. [5,6,7,8,9,10,11,12,13,14,15,16,17] The reported incidence of RRD after macular surgeries is also similar. those with pre-existing retinal disease, in particular, should be aware that while rare, there is the risk of retinal detachment. Additionally, in cases of media opacities, B-scan ultrasound is indicated and may be a critical diagnostic tool. / Pai, Lee Wen; Yang, Shu Chen; Lin, Mei Ling et al. Patient 2, a 46-year-old man, presented 5 weeks after initiating topical pilocarpine 1.25% drops for presbyopia. Use with caution in patients with corneal abrasion to avoid excessive penetration and systemic toxicity. [2] Retinal detachment is a sight threatening condition with an incidence of approximately 1 in 10000. [Acute onset of floaters, even without flashes, is an urgent ophthalmic warning sign]. Symptoms related to posterior vitreous detachment and the risk of developing retinal tears: a systematic review. PMC On the contrary, Luebke et al.reported a higher incidence of post-SFIOL RRD in eyes with ectopia lentis compared to other indications (14.8% vs 9.7%). It is a surgical emergency.. Serous retinal detachments may also be the presenting sign in patients with aggressive metastatic cancer, such as testicular cancer.[6]. 4.4 Special Warnings and Precautions for Use. Eyes with the congenital subluxated lens are at a marginally higher risk of developing post-SFIOL RRD. Acute Angle-Closure Glaucoma. Rhegmatogenous retinal detachment has a characteristic appearance differentiating it from a tractional or serous detachment. 2009 Nov 25;302(20):2243-9. doi: 10.1001/jama.2009.1714. [9], Retinal detachment. July 1, 2017. Rhegmatogenous retinal detachments are often due to retinal tears associated with posterior vitreous detachment or trauma. The incidence of RRD in the eyes with and without a history of CGI was 1.7% (n = 6/357) and 1.7% (n = 16/954), respectively (P = 0.996). In our series, the earliest detachment was seen after 10 days, while nearly three-fourth detachments were seen within three months. 1]. Klin Monbl Augenheilkd. Arch Ophthalmol 1930;4:621-625. and transmitted securely. However, it seems important, before the start of any kind of miotic therapy, to perform a careful examination and management of virtually all detachment-prone patients. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Apart from the eyes with failed surgery, four other eyes also had final BCVA <20/200. The adjusted relative risk of cataract in eyes that underwent retinal detachment repair with silicone oil compared with eyes that did not was 6.74 (P < .0001). Online ahead of print. Techniques for repair include pneumatic retinopexy, scleral buckle or vitrectomy, or combinations of these techniques. Retin Cases Brief Rep. 2022 Aug 12. doi: 10.1097/ICB.0000000000001309. He noted the onset of flashes and floaters 3 days after he initiated the drops. Rhegmatogenous retinal detachment is most often confused with retinoschisis and serous retinal detachment. Incidence and ocular comorbidities of rhegmatogenous retinal detachment among younger people in Taiwan. The Kaplan-Meier estimated median time to cataract was 1.8 months after surgery with silicone oil. Disclaimer, National Library of Medicine Historical data from England showed a stable admission rate for retinal detachment surgery between 1963 and 2000 and an increased rate between 2000 and 2011, with a maximum incidence rate of 15.4 per 100 000. In case retinal break(s) were noted, they were barraged with laser photocoagulation and taken up for SFIOL surgery after at least one month. 1995 October; 79(10): 871872. "Metastatic mixed germ-cell neoplasm presenting as retinal detachment.". Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. [19,20] Previous studies have reported trauma and ectopia lentis to be risk factors for developing post-SFIOL RRD. Patient 1, a 47-year-old man, presented with flashes and floaters in both eyes. He noted a nasal visual field defect in his left eye that progressed to include his central vision. Miotics may cause rare cases of retinal detachment when used in certain susceptible individuals and those with preexisting retinal disease; thorough examination of the retina including funduscopy . The case records were analyzed for demographic details; indication for which SFIOL was done; the history of prior ocular injuries and surgeries; presence or absence of RRD post-SFIOL; characteristics and surgical outcome of RRD. . eCollection 2020. and transmitted securely. eCollection 2022. . Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. JAMA. [1] However, owing to the vitreous disturbance caused by the breach of the posterior lens capsule, surgery in such eyes can be complicated by rhegmatogenous retinal detachment (RRD).[2,3,4]. A retrospective study by Martinez-Castillo et al. If a cause for the traction retinal detachment cannot be determined by history, further laboratory analysis may be required to determine if diabetes, sickle cell, carotid disease or another systemic or ocular process is the source for proliferative retinopathy. Accessibility Rates of reoperation and retinal detachment after macular hole surgery. Although this monograph focuses on rhegmatogenous retinal detachment, it is pertinent to note the other major causes of retinal detachment. Fundus examination is advised in all patients before starting pilocarpine therapy since retinal detachment has been associated with the use of miotics in susceptible individuals and those with pre-existing retinal disease. - Blurred vision following a retinal detachment . Depending on whether this is a retinal tear or detachment, there are different treatment options. Federal government websites often end in .gov or .mil. The eyes in which retina failed to reattach had a high grade of proliferative vitreoretinopathy present at the time of presentation. Two partial thickness scleral pockets were made 180 apart, 1.5 mm away, and parallel to the limbus, with the help of a 25 G microvitreoretinal (MVR) trocar blade. Out of the seven eyes that did not achieve retinal reattachment, six eyes underwent further surgery. Clin Ophthalmol. Among the eyes that failed to reattach, two (9.5%) eyes had a shallow subretinal fluid inferior to the inferior arcade with good vision, while three (14.3%) had a poor prognosis due to advanced PVR changes. Kang JJ, Ritterband DC, Tolees SS, Seedor JA. E-mail: Received 2019 Oct 26; Revised 2019 Dec 25; Accepted 2020 Feb 18. Ultrasonography may help identify whether abnormalities other than glaucoma (eg, retinal detachment, intraocular tumors, etc) are present. Take this medicine only as directed. Brucker AJ, Hopkins TB. Methods: A retrospective non-randomised study of 634 macular surgery procedures was undertaken in . This study was done to analyze the incidence, risk factor(s), characteristics, and surgical outcomes of RRD in the eyes undergoing pars plana vitrectomy (PPV) with sutureless, glueless SFIOL. Retinal Detachment Surgery: The Latest in Current Management. Karthik Kumar, Piyush Kohli, [], and Kim Ramasamy. The left eye demonstrated a retinal detachment in the superior quadrant with an associated horseshoe tear at 12 o'clock. Retinal . Surgical management is indicated for rhegmatogenous and tractional detachments. In these cases, a sclerotunnel was not required. Choroidal masses can be distinguished from retinal detachment by observing the characteristics of imaging with ultrasound. Retinal detachment is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal fluid and loss of retinal function. In these cases, fluorescein angiography may be indicated to further clarify exudative processes such as macular degeneration, central serous chorioretinopathy, and Vogt-Koyanagi-Harada syndrome or other uveitic processes. However, pilocarpine treatment can induce additional myopia and accommodative spasms. The Ocusert pilocarpine system: advantages and disadvantages. Retinal reattachment was achieved in 76.2% eyes, while 66.7% eyes required only one surgery. Next to central retinal artery occlusion, chemical burns to the eye, and endophthalmitis, it is one of the most time-critical eye emergencies encountered in the emergency setting. The retina is a thin layer of light-sensitive tissue on the back wall of the eye. Clipboard, Search History, and several other advanced features are temporarily unavailable. Multicenter case series of 3 eyes from 2 patients. Br J Ophthalmol. The https:// ensures that you are connecting to the The annual incidence was 5.4 per 100,000 population. An important part in the successful repair of retinal detachment with pneumatic retinopexy involves head positioning so that the gas bubble tamponades the retinal tear. Retinal detachment. At the time of presentation, seven eyes had total RD; while the rest 15 eyes had localized RRD. Retina. Today, I saw an entry in the American Journal of Ophthalmology. The incidence of RRD in eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post-OGI repair was 1.4% (n = 6), 2.5% (n = 7), 1.1% (n = 3), 3.4% (n = 5), 0 and 1.2% (n = 1), respectively (P = 0.382). Risk factors include: Myopia (most common) Age (50-75yr) Previous eye surgery or injury. Because the time interval after which a new Pilokarpin lameller unit is required lasts up to 1 week, the total amount of accommodation and miosis is much smaller than when applying daily 2% pilocarpine drops. Review of Presbyopia Treatment with Corneal Inlays and New Developments. One in 119 dogs has some form of glaucoma in its lifetime. Surv Ophthalmol. In case of dislocated lens or nucleus drop, pars plana lensectomy (PPL) was done with the help of a vitrectomy cutter or a fragmentome, depending on the hardness of the lens. A recent multicenter case series identified a possible association between the risk of retinal detachment and the use of pilocarpine eye drops. Any association between categorical data was seen using Chi-square/Fisher exact test while the difference in continuous data between two groups was seen using student's t-test/MannWhitney test. Treatment of detached retina by searing the retinal tears. Less common reactions (1% to 5%) were blurred vision, eye pain, visual impairment, eye irritation, and increased lacrimation. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Tractional detachments have smooth concave surfaces with minimal shifting with eye movements. A comparative study on surgical outcomes of glued intraocular lens and sutured scleral fixated intraocular lens implantation. Before the initiation of therapy, patients should be appropriately informed regarding symptoms of retinal tears or detachment, which include flashes, floaters, and visual field loss. Retinal detachment can be falsely diagnosed as retinoschisis or choroidal mass. Bajgai P, Tigari B, Singh R. Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for dislocated intraocular lenses. Arch Ophthalmol. Go SL, Hoyng CB, Klaver CC. In the vast majority of cases, a retinal break will be identified with proper examination, thus confirming a rhegmatogenous retinal detachment. Acute-onset floaters and flashes: is this patient at risk for retinal detachment? The patient had started pilocarpine 1.25% drops 1 month prior for presbyopia in both eyes. Please enable it to take advantage of the complete set of features! A second mechanism involves proliferative membranes on the surface of the retina or vitreous. The article describes two patients who had retinal detachments after use of pilocarpine 1.25% eye drops, which were started for presbyopia. A P value of less than 0.05 was considered to be statistically significant. . People taking certain kinds of eyedrops have an increased risk of developing a retinal detachment. Epidemiology. [13,24,25], Vitrectomy was the best option for the treatment of RRD in these eyes as they all had undergone prior vitrectomy. Pneumatic retinopexy involves the injection of an intraocular gas bubble along with retinopexy using cryotherapy or laser, typically in a clinic setting. [4] In 1945 after the development of the binocular indirect ophthalmoscope by Charles Schepens, MD, techniques . Sen P, S VK, Bhende P, Rishi P, Rishi E, Rao C, et al. The incidence of RRD may actually have been lower because the patients who have had good postoperative vision are more likely to be lost to follow-up. Fifty consecutive 23-gauge cases and 50 consecutive 20-gauge cases were included in the study. [22] Other authors also have reported an incidence of 1.515.4% in eyes with ectopia lentis. Serous detachments show a smooth retinal surface and shifting fluid depending on patient positioning. Results. All the eyes were pre-operatively screened for the presence of any retinal breaks. [12] A total of 278 eyes of 272 patients developed RRD during an 11-year period, 1988-1998, with a population of 465,947. The study was conducted with the approval of the Institutional Review Board (Registration No. . Using reading glasses can be difficulty and annoying, for sure. As eye drops it is used to manage angle closure glaucoma until surgery can be performed, ocular hypertension, primary open angle glaucoma, and to bring about constriction of the pupil following its dilation. 36, No. Overall, retinal reattachment was achieved in 16 (76.2%) eyes. The second haptic was also tucked into the other scleral pocket. There are certainly some factors that affect this risk such as myopia which increases the risk. Detachment of the retina signifies an inward separation of the sensory part of the retina from the retinal pigment epithelium (RPE). Statistical analysis was performed with STATA statistical software, Version 11.1 (StataCorp, College Station, Texas, USA). Comparison of clinical outcomes between iris-fixated anterior chamber intraocular lenses and scleral-fixated posterior chamber intraocular lenses in Marfan syndrome with lens subluxation. Patient 2, a 46-year-old male, presented 5 weeks after initiating topical pilocarpine 1.25% drops for presbyopia. This process can occur in three ways. Eyes with the congenital subluxated lens are at a marginally higher risk of developing post-SFIOL RRD. He noted a nasal visual field defect in his left eye that progressed to include his central vision. According to several studies, patients undergoing PPV to manage retained lens fragments experienced a higher incidence of long-term complications (e.g., corneal edema, uveitis, glaucoma and retinal detachment) when the performance of this procedure was delayed. A dilated examination revealed a superior retinal detachment from 11 to 3 o'clock with subretinal fluid extending into the macula. The site is secure. Retinal detachment (see the image below) refers to separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE, choroid). Lewis H. Peripheral Retinal Degenerations and the Risk of Retinal Detachment. After single RD surgery, retinal reattachment was achieved in 14 (66.7%) eyes. Unable to load your collection due to an error, Unable to load your delegates due to an error. A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances. [4] In 1945 after the development of the binocular indirect ophthalmoscope by Charles Schepens, MD, techniques for retinal detachment repair improved. Before 2005; 123: 1237-41. In the last 50 years techniques in scleral buckling, pneumatic retinopexy and vitrectomy have made the repair of retinal detachments significantly more manageable with better visual outcomes. To do so may increase the chance of side effects. Sen et al.reported a success rate of 87.5%, with 68.7% eyes requiring single surgery. Correspondence to: Dr. Piyush Kohli, Department of Vitreo-Retinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India. HHS Vulnerability Disclosure, Help Ultrasound is a useful imaging modality to evaluate choroidal masses or posterior scleritis. sharing sensitive information, make sure youre on a federal Patients with known risk factors for retinal detachment should have serial dilated fundus examinations with scleral depression, often yearly. Am J Ophthalmol 2003; 136:155160. [7] Sen P, Shaikh SI, Sreelakshmi K. Rhegmatogenous retinal detachment in paediatric patients after pars plana vitrectomy and sutured scleral-fixated intraocular lenses. They hypothesized that the drug may cause anterior lens migration, which . The indications for which patients underwent SFIOL were subluxated lens (n = 442, 33.7%), dislocated IOL (n = 285, 21.7%), surgical aphakia (n = 263, 20.1%), congenital lens subluxation (n = 146, 11.1%), nucleus drop (n = 90, 6.9%), and post-open globe injury (OGI) repair (n = 85, 6.5%). After core vitrectomy, the haptics of the same IOL were externalized and incarcerated into the scleral pockets. This was a retrospective study conducted at a tertiary-care eye hospital in South India. Retinal Detachment is an eye disorder, wherein the retina gets separated from the underlying layer of blood vessels, which supplies oxygen and other nutrients to it. Would you like email updates of new search results? Pilocarpine (Salagen), which for many years was a mainstay of therapy for glaucoma, has long been associated with retinal . FOIA Sen et al.also reported a significant loss of BCVA due to the development of RD with recurrence of RD and associated increased number of surgeries having a negative impact on the final visual outcome.[13]. Although eyes with congenital lens subluxation were at a higher risk of developing RRD than other eyes, the difference was not statistically significant. An official website of the United States government. the display of certain parts of an article in other eReaders. This is known as a rhegmatogenous retinal detachment. In their study, the final reattachment rate in eyes with and without PVR was 75% and 100%, respectively. 1979 Jan;86(1):95-8. doi: 10.1016/s0161-6420(79)35529-4. 2020 Jul; 68(7): 14321435. American Academy of Ophthalmology. . Although these cases of retinal detachment cannot be definitively associated with the initiation of the pilocarpine therapy, the incidence shortly after initiation of treatment is . J Exp Pharmacol. Gonin J. 1978 Apr;85(4):558-66. doi: 10.1016/s0002-9394(14)75255-9. Examination of the anterior vitreous for pigment (Schaffer's sign) or vitreous hemorrhage is critical. SFIOL explanation was not required in any of the eyes. [3] . Bookshelf Change in variables after a procedure was done with the help of paired t-test. The surgical outcome of post-SFIOL RRD is good. 2021 Oct 21;165:D5850. Vitrectomy was then done. Outcomes of glued foldable intraocular lens implantation in eyes with preexisting complications and combined surgical procedures. showed that the incidence of rhegmatogenous retinal detachment after ICL implantation was 2.07%, which occurred on average 29.12 months after surgery, and 68.75% of retinal detachment cases had only one ruptured hole . Since all patients underwent vitrectomy, manipulation in the posterior segment was safe. Major Potential Hazard, High plausibility. The incidence of RRD in the eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post-OGI repair was 1.4% (n = 6), 2.5% (n = 7), 1.1% (n = 3), 3.4% (n = 5), 0 and 1.2% (n = 1), respectively (P = 0.382). Studies have shown that the incidence of retinal detachments caused by tears in the retina is fairly low, affecting approximately one in 10,000 people each year. In case the dislocated IOL was a single-piece IOL, it was explanted through the sclerocorneal tunnel and a new three-piece IOL was installed as SFIOL following the steps as described above. History of closed-globe injury (CGI) was present in 27.2% eyes.Twenty-two eyes (1.7%) developed RRD. An official website of the United States government. Contraindicated- Pilocarpine Steroid drops for . A rhegmatogenous retinal detachment has a corrugated appearance and undulates with eye movements. 2022 Aug 24;16:2781-2795. doi: 10.2147/OPTH.S375577. Rhegmatogenous Retinal Detachment Following Initiation of Pilocarpine Hydrochloride Ophthalmic Solution 1.25% for Treatment of Presbyopia. DOI: 10.1016/S0886-3350(13)80499-3 Corpus ID: 24931275; Incidence of retinal detachment after cataract surgery and neodymium:YAG laser capsulotomy @article{Powell1995IncidenceOR, title={Incidence of retinal detachment after cataract surgery and neodymium:YAG laser capsulotomy}, author={Stephanie Powell and Randall J. Olson}, journal={Journal of Cataract and Refractive Surgery}, year={1995 . Pars plana vitrectomy and lensectomy for ectopia lentis with and without the induction of a posterior vitreous detachment. The incidence of RRD in eyes with and without CGI was 1.7% each (P = 0.996).Twenty-one eyes underwent RD surgery. METHODS: This is a cross-sectional study on patients who underwent IT-LPI with neodymium: yttrium-aluminum-garnet laser who were followed up for a minimum of 3 months . Rizzo S, Belting C, Genovesi-Ebert F, di Bartolo E. Incidence of retinal detachment after small-incision, sutureless pars plana vitrectomy compared with conventional 20-gauge vitrectomy in macular hole and epiretinal membrane surgery. Bethesda, MD 20894, Web Policies Incidence Rare Increased in diabetic patients after lens removal and vitrectomy or any breach in the posterior capsule. Final best-corrected visual acuity (BCVA) of 20/60 and <20/60 to 20/200 and <20/200 was seen in eight (38.1%), four (19.0%), and nine (42.9%) eyes. Pilocarpine-nave patients: Initiate with 1% concentration as higher concentrations are often not tolerated .
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