European Journal of Ophthalmology最新文献

Purpose: To investigate the predictive value of MRI-based radiomics models for the recovery of visual acuity after 12 months in patients with acute phase MOG-optic neuritis(MOG-ON).

Materials and methods: Clinical and MRI imaging data were collected consecutively from January 2021 to April 2022 from patients with acute stage MOG-ON, and the visual acuity of patients were followed up after 12 months. After stratified random sampling, patients were divided into training and test sets, and prediction models based on CE-T1WI, FS-T2WI, and combined CE-T1WI and FS-T2WI were developed.

Results: A total of 34 eyes were included, the visual acuity recovery group included 26 eyes, and the visual acuity non-recovery group included 8 eyes. The training set included 23 eyes (18 from the visual acuity recovery group and 5 from the visual acuity non-recovery group) and the test set included 11 eyes (8 from the visual acuity recovery group and 3 from the visual acuity non-recovery group). The differences in gender, age, proportion of patients with visual acuity recovery, and lesion length between the training and test sets were not statistically significant(P＜0.05). The CE-T1WI-based radiomics model had highest predictive efficacy for visual acuity recovery after 12 months in patients with MOG-ON (AUC = 0.917), followed by the combined CE-T1WI and FS-T2WI-based radiomics model (AUC = 0.838), while the FS-T2WI-based radiomics model had the worst predictive efficacy (AUC = 0.583).

Conclusions: MRI-based radiomics models have high value in predicting visual acuity recovery after 12 months in patients with acute stage MOG-ON, especially CE-T1WI.

Purpose: This report presents two cases of orbital textiloma resulting from retained surgical gauze.

Case description: Both patients presented with postoperative orbital inflammation unresponsive to medical treatment: one eight weeks after excision of an orbital cavernous hemangioma, and the other six months following surgical repair of an orbital floor fracture. CT scans of the orbit revealed well-defined lesions with a heterogeneous center. An exploratory orbitotomy retrieved a large piece of gauze that was firmly adhered to the globe and the adjacent extraocular muscle. Both patients experienced significant postoperative improvement, with no sequelae.

Conclusions: Orbital textiloma, though rare, should be considered a potential cause of persistent postoperative orbital inflammation. Prompt imaging and subsequent surgical removal are crucial for accurate diagnosis and effective treatment.

Purpose: To compare changes in angle morphology, anterior chamber depth (ACD) and refractive prediction error (PE) after phacoemulsification between pseudoexfoliative (PEX) and non-PEX eyes.

Methods: Prospective case-control study of eyes submitted to cataract surgery. Biometric data and angle parameters - Anterior Chamber Angle (ACA), Angle Opening Distance (AOD), Scleral Spur Angles (SSA) and Trabecular Iris Space Area (TISA) - were measured preoperatively and 1-month postoperatively through swept-source anterior segment optical coherence tomography. Postoperative refractive prediction error (PE) was calculated using an optimized A-constant and the Kane formula.

Results: Sixty eyes (30 PEX and 30 non-PEX) of 60 patients were included. Preoperative angle analysis revealed a lower ACA, AOD, SSA and TISA in PEX group (p < 0.05), without biometric differences (p > 0.05). A tendency for a higher magnitude of morphometric angle changes in PEX eyes was observed, with a superior increase of SSA at 500 µm (0°) and TISA at 750 µm (0°) (p = 0.030 and p = 0.041, respectively). The anterior chamber deepened in both groups (p = 0.01), with arithmetic and percentile change being higher in PEX group (p = 0.017 and p = 0.047, respectively). A significant PE hyperopic shift was observed (p = 0.035) only in PEX group.

Conclusions: Pseudoexfoliative eyes with cataract have narrower angles, revealing a tendency for higher angle opening after surgery, along with an increased ACD deepening compared to non-PEX eyes, which may be explained by PEX-associated zonular laxity. Moreover, a significant hyperopic shift was observed in PEX eyes, a relevant fact to take into consideration when selecting intraocular lens power.

Purpose: To assess the safety and efficacy of a modified suprachoroidal silicone tube (SST) shunt in patients with primary open-angle glaucoma (POAG) and pseudo-exfoliative glaucoma (PXG) in this experimental study.

Methods: In this single-center, retrospective longitudinal data analysis 66 eyes of 59 patients having POAG and PXG were included and treated with modified SST shunt in combination with cataract or as a stand-alone procedure. Pre- and postoperative intraocular pressure (IOP), best corrected visual acuity (BCVA), C/D ratio and ocular adverse events (AEs) were assessed in all participants.

Results: The average follow-up period was 18.56 ± 7.93 months. Mean baseline IOP reduced from 27.02 ± 5.43 mmHg to 13.23 ± 3.70 mmHg (p < 0.001). Mean number of ocular hypotensive medications reduced from 3.17 ± 0.89 to 1.83 ± 1.44 (p < 0.001). BCVA remained stable in 49 eyes (74.2%) throughout the follow-up period. Mean baseline BCVA of 0.73 ± 0.27 slightly declined to 0.68 ± 0.30 at the final follow-up (p < 0.001). Three adverse events of special interest (AESI) were observed hypotonic maculopathy, anterior chamber inflammation with pupillary membranes, and macular edema. None of these events was related to the SST shunt. Other complications such as intra and early postoperative hyphema in 3 and tube-iris contact causing slight corectopia in 2 cases were noted.

Conclusions: The surgical technique and device studied in this work demonstrated a good safety profile and signal of efficacy. This device may serve as a bridge between minimally invasive glaucoma surgeries (MIGS) and conventional filtering or episcleral tube shunt surgeries. A larger scale prospective trial is planned.

Introduction: Dry eye disease (DED) can impact the accuracy of biometry measurements prior to cataract surgery (CS), influence visual performance post-CS, and can be exacerbated by CS. We performed a survey to evaluate the DED practice of clinicians directly caring for CS patients.

Design: Prospective face-to-face survey.

Method: Face-to-face survey consisting of 12 questions relating to CS clinicians' estimations of DED pre- and post-CS, dry eye tests performed, and the management of DED.

Result: There were one hundred and twenty-seven responders (39% consultants, 37% trainees/fellows, 8% associate specialists, 6% specialty doctors, 8% optometrists, 2% nurse specialists), with a 100% response rate. Sixty-seven percent routinely assessed for DED pre-CS, with 81% anticipating mild to moderative negative effects of CS on DED. Approximately 75% estimated that over 10% of pre-operative patients had asymptomatic DED, with another 10% or more suffering symptomatic DED. Almost 80% estimated that 10% or more of patients suffered DED post-CS. More DED tests were performed pre- compared to post-operatively (p = 0.02). More consultants performed dry eye tests post-operatively compared to non-consultants (p = 0.02). Most common treatment options included lubricating drops (95%), lid hygiene (75%) and night ointment/gels (54%). Seventy-six percent of surgeons performing CS stated they coated the ocular surface with an ophthalmic visco-surgical device and 34% limited intra-operative light exposure peri-operatively to limit DED.

Discussion: Despite the anticipated negative effects of CS on DED, 1 in 3 clinicians in our survey were not assessing routinely for DED prior to CS, and fewer dry eye tests were performed post-operatively compared to pre-surgery.

Purpose: To report a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome.

Methods: Descriptive case report.

Results: A 16-year-old girl with H syndrome was followed up in the pediatric nephrology clinic for chronic renal failure and was consulted to the ophthalmology clinic. She had low vision for more than 5 years. Slit lamp examination revealed bilateral corneal arcus . Lens and iris were normal. Axial length was 19.99 mm in the right eye and 21.85 mm in the left eye. A bilateral orange-yellow plaque was noted in the posterior pole in the funduscopic examination. Fundus autofluorescence (FAF) showed a bilateral diffuse macular hipoautofluorescence area in correspondence with the decalcified portion of the mass. Optical coherence tomography (OCT) showed a bilateral choroidal mass with a dome-shaped pushing effect on the overlying retina and damage to the outer layers of the retina. Fluorescein angiography (FA) with bilateral patchy diffuse late hyperfluorescence and B scan ultrasonography showed a bilateral solid highly reflective choroidal mass with acoustic shadowing. Orbital computerized tomography (CT) scans showed bilateral hyperdense plaques in the posterior pole. A diagnosis of choroidal osteomas was made for both eyes.

Conclusions: This report presents a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome that has not been previously reported in the literature. Patients diagnosed with this syndrome should undergo routine eye examination, and due to the progressive nature of histiocytosis, they should also be followed closely ophthalmologically.

Purpose: To evaluate the effectiveness of the PAUL Glaucoma Implant (PGI) and the adjunctive impact of intraoperative Mitomycin C (MMC) on surgical outcomes in patients with neovascular glaucoma (NVG).

Methods: This retrospective, comparative study included NVG patients who underwent PGI implantation. The cohort was divided into two groups: Group 1 (PGI without MMC) and Group 2 (PGI with MMC). Inclusion criteria encompassed a minimum 12-month postoperative follow-up and preoperative light perception. Surgical success was defined as maintaining intraocular pressure (IOP) between 6-21 mmHg without additional surgical intervention from the third month to the end of the 12-month follow-up. Failure due to hypotony was defined as an IOP ≤5 mmHg.

Results: The study enrolled a total of eighty-one patients, with 40 patients in Group 1 and 41 in Group 2. There were no significant differences in the demographic data and baseline ocular characteristics between the groups. Group 1 required more medications at 1, 3, 6, and 12 months (p < 0.05 for all). Surgical success rates at 12 months were 85% for Group 1 and 87.8% for Group 2, with no statistically significant difference between the groups (p = 0.140). Group 2 demonstrated a lower frequency of additional glaucoma procedures (p = 0.003) and delayed ripcord suture removal (p = 0.0001).

Conclusions: Incorporating MMC as an adjunct to PGI implantation may improve IOP control and decrease the requirement for additional medications and surgical interventions in NVG patients. However, there was no statistically significant difference between the two groups in terms of the surgical success criterion.

A 42 year old Afro-Caribbean man underwent Baerveldt Glaucoma Implant (BGI) surgery for silicone oil induced glaucoma. Three months following initial surgery, the 3-0 prolene ripcord suture was removed. Anterior segment OCT demonstrates the position of the intracameral portion of the tube before and after the 3/0 prolene stent suture (PSS) removal. Ex-vivo experiments further demonstrate the variation in tube position using straight vs curved segments of 3/0, 4/0 and 5/0 PSS passed through the BGI lumen. Glaucoma tube surgeons should consider how the rigid nature of the prolene stent suture could influence the position of non-valved tubes within the eye, both during tube implantation and after prolene suture removal.

Objective: To report an unusual manifestation of normal tension glaucoma(NTG) in a young female as presenting feature of Takayasu arteritis (TA).

Methods: We present a case of a 24-year-old woman who was initially diagnosed with NTG, with characteristic optic disc and retinal nerve fiber layer (RNFL) changes, and corresponding visual field defects. Further evaluation with CT angiography revealed that the patient had newly diagnosed TA.

Results: NTG was likely a manifestation of the underlying vasculitis. patient was initially started on oral prednisolone by the rheumatologist which was changed to steroid-sparing immunotherapy with methotrexate 15 mg once weekly and hydroxychloroquine 200 mg. The patient has been on regular follow-up for last one year with adequate IOP control and no progression of glaucomatous changes since presentation.

Conclusion: This case highlights the importance of comprehensive ophthalmic evaluation in patients with NTG and the need to consider systemic conditions, such as TA, as potential underlying cause in young female patients presenting with NTG.

Background: To describe a case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than three decades following penetrating keratoplasty.

Methods: Case Report.

Results: A 79-year-old White woman presented with declining vision, right eye worse than the left. She had previously undergone bilateral penetrating keratoplasty (P.K.) for Fuchs Endothelial Keratoplasty 35- and 34- years ago, of the right and left eye respectively. The slit-lamp biomicroscopy exam revealed corneal edema as well as presence of guttae affecting bilateral grafts. She underwent PK of the right eye. Histopathological analysis of the removed PK graft showed posterior nodular excrescences consistent with guttae.

Conclusion: Guttae development in corneal grafts is relatively uncommon and the mechanism of this entity remains unclear. The observation of guttae development in transplanted grafts has raised questions surrounding donor cornea screening and evaluation by eye banks, as well as those relating to recipients' genetics and intrinsic factors that lead to guttae recurrence in the transplanted grafts. We herein describe the case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than 34 years following penetrating keratoplasty.