European Journal of Ophthalmology最新文献

PurposeThis is the first report that describes a case of Kabuki syndrome with peripheral retinal ischemia and neovascular glaucoma.Case reportA 44-year-old woman with genetically confirmed Kabuki syndrome was referred with bilateral elevated intraocular pressure (circa 50mmHG in both eyes), and longstanding poor vision and high myopia (6/60 vision right, counting fingers left eye). Slit-lamp examination revealed bilateral microcornea (10 mm), right eye angle neovascularization, and 3 mm left eye hyphema associated with 360° rubeosis iridis confirmed on fluorescein angiography. Fundoscopy showed a cup-to-disc ratio of 0.5 in right eye and significant peripapillary chorioretinal atrophy, with coloboma-like features in left eye. Widefield fluorescein angiography showed asymmetrical peripheral retinal ischaemia, with telangiectatic mid-peripheral vessels, which leaked in the late phase of fluorescein angiography. A diagnosis of secondary neovascular glaucoma due to ischaemic retinal vasculopathy was made.ConclusionThis case expands the known ocular phenotype of Kabuki syndrome to include peripheral retinal ischaemia and neovascular glaucoma.. It highlights the importance of early, comprehensive ophthalmologic assessment and multidisciplinary management in patients with Kabuki syndrome, especially when complicated by vision-threatening conditions like neovascular glaucoma.

BackgroundTo present our results using a novel "flapless" trocar-assisted intrascleral fixation technique for Carlevale intraocular lens (IOL) Implantation without conjunctival opening.MethodsRetrospective, non-comparative study of consecutive patients undergoing this technique. Patients older than 18 years who had at least two years post-operative follow-up were included.Results61 eyes of 61 consecutive patients were included in the analysis. The study sample included 55.74% males with a median age of 76 years (interquartile range (IQR): 67-82 years). The mean follow-up period was 48.9 months (SD ± 14.38) and the range was between 26 and 76 months. A statistically significant difference was observed between the median pre-operative visual acuity value (1.8LogMAR, IQR: 1.0-1.8) and the median postoperative value visual acuity (0.05 LogMAR, IQR: 0.0-0.1). No intraoperative complications occurred and, the Carlevale IOL was well centered in all cases. No haptic exposure was observed during the follow-up period.ConclusionThe results of our study demonstrate that the proposed technique is a simplified, safe and effective surgical approach for placement of the Carlevale IOL. Further studies are needed to validate our data and explore the results of a longer follow-up.

AimTo evaluate long-term postoperative visual outcomes and safety profile comparing immediate surgical treatment versus delayed management (more than one day) following posterior capsular rupture during cataract surgery.Material and MethodsThis retrospective cohort study included 154 eyes with posterior capsular rupture treated at Fondation Rothschild Hospital, Paris, from March 2022 to June 2023. Patients were divided into two groups: immediate management (same day, n = 117) and delayed management (>1 day, n = 37). Primary outcome was final corrected visual acuity. Secondary outcomes included postoperative complications, refractive outcomes, and intraocular lens (IOL) positioning.ResultsThe delayed group showed significantly higher rates of posterior vitrectomy (91.89% vs 21.37%, p < 0.001), iris/scleral fixated IOLs (21.62% vs 4.27%, p = 0.003), and multiple surgical interventions (2.35 ± 0.72 vs 1.20 ± 0.55, p < 0.001). Despite these differences, final visual acuity showed no statistically significant difference between groups (0.298 ± 0.364 vs 0.203 ± 0.308 LogMAR, p = 0.140). Multivariate analysis confirmed no association between timing of intervention and long-term visual acuity (OR: 1.58 [0.535-4.65], p = 0.409). Endothelial decompensation was significantly higher in the delayed group (8.11% vs 0.85%, p = 0.043), while other complications showed no significant differences.ConclusionDelayed IOL implantation following posterior capsular rupture can achieve satisfactory long-term visual outcomes comparable to immediate management, despite involving more complex cases requiring advanced surgical techniques. However, the increased risk of endothelial decompensation warrants careful monitoring. These findings suggest that delayed management is a viable option when immediate intervention is not feasible or optimal.

PurposeTo compare the analgesic efficacy of 2% lidocaine gel and 0.4% oxybuprocaine eye drops in patients undergoing pterygium surgery, focusing on perioperative pain assessed in the early postoperative period and postoperative discomfort over one month.MethodsSixty-eight adult patients with bilateral primary nasal pterygia underwent two separate surgeries, one in each eye, at least 30 days apart. Each eye was randomly assigned to receive either 2% lidocaine gel or 0.4% oxybuprocaine eye drops for topical anesthesia. Pain perception was evaluated using the Visual Analog Scale (VAS) at 24 h and 30 days after surgery. VAS scores at 24 h reflected early perioperative pain as recalled in the immediate postoperative period, encompassing discomfort related to the surgical experience. Secondary outcomes included oral analgesic use during the first postoperative day and complications.ResultsThree patients declined second-eye surgery after marked discomfort during the first procedure performed with oxybuprocaine. The final sample comprised 133 eyes (68 eyes with oxybuprocaine, 65 with lidocaine gel). Mean VAS scores were significantly lower in the lidocaine group at 24 h (3.95 ± 3.14 vs. 5.09 ± 3.06; p = 0.037) and 30 days (1.55 ± 2.14 vs. 2.69 ± 2.37; p = 0.004). Analgesic intake within 24 h was less frequent with lidocaine gel (7.4% vs. 17.6%; p = 0.145). No complications were observed.ConclusionsTopical 2% lidocaine gel provided superior analgesia compared with 0.4% oxybuprocaine, resulting in lower early perioperative pain assessed postoperatively and reduced postoperative discomfort after pterygium surgery, while maintaining an excellent safety profile.

BackgroundCentral serous chorioretinopathy (CSCR) is an idiopathic disease characterized by changes in the macular region between the neurosensory retina, the choroid and retinal pigment epithelium (RPE).ObjectiveCompare pupillometry responses in CSCR patients with those of healthy individuals using automated pupillometry.MethodsA total of 52 subjects were included in the study (26 acute CSCR and 26 control). All subjects underwent a complete ophthalmologic examination, including optical coherence tomography (OCT) and enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Both static and dynamic pupillometry measurements were performed under scotopic (0.1 cd/m²), mesopic (1 cd/m²), low-photopic (10 cd/m²), and high-photopic (100 cd/m²) light conditions. Dynamic pupillometry (resting PD, contraction amplitude, latency, duration, contraction velocity, dilation latency, and resting duration and velocity) measurements were performed using a white light stimulus in the dark.ResultsOn static pupillometry, low-photopic and scotopic pupil diameters were larger in the acute CSCR group (p = 0.003 and p = 0.048, respectively), with no between-group differences under mesopic or high-photopic conditions. In the acute CSCR group, dynamic pupillometry parameters of contraction amplitude, dilation duration, and dilation latency significantly decreased (p = 0.024, p = 0.011 and p = 0.036, respectively), while initial pupil diameter and contraction latency increased (p = 0.026 and p = 0.047, respectively).ConclusionsThe results of this study support the idea that autonomic nervous system dysfunction plays a contributing role in the pathophysiology of the disease and suggest that pupillometry can be used as a non-invasive screening tool for autonomic dysfunction.

PurposeTo describe the clinical features, intraoperative findings, and management outcomes of children with congenital nasolacrimal duct obstruction (CNLDO) complicated by atonic lacrimal sac.MethodsA retrospective review was conducted on children diagnosed with CNLDO and intraoperatively confirmed atonic lacrimal sac between January 2017 and December 2023 at two tertiary centers. Data included demographics, clinical findings, type of obstruction, intervention, and outcomes. Success was defined as normal fluorescein dye disappearance with absence of epiphora or discharge.ResultsSixty-eight eyes of 65 children (median age, 3.5 years; range, 6 months-12 years; 60.3% males) were analyzed. Membranous obstruction was identified in 82.4% and firm obstruction in 16.2% of eyes. Probing alone was performed in 55 eyes (80.9%), while probing with additional intraoperative procedures were performed in 13 (19.1%), including silicone intubation in 11 and balloon dacryoplasty in 2. Success after the primary procedure was 67.6% at a mean follow-up of 9.9 ± 14.9 months. Younger age and membranous obstruction correlated with higher success. The additional procedures with probing did not have a significant impact on successful outcomes. Of 22 failures, 13 underwent secondary Dacryocystorhinostomy (DCR), all achieving complete anatomical and functional resolution.ConclusionsAtonic lacrimal sac represents an uncommon subtype of complex CNLDO. Most cases respond favorably to standalone probing combined with prolonged lacrimal sac compressions, particularly in younger children with membranous obstruction. DCR remains an effective second-line treatment for refractory cases.

PurposeTo evaluate the incidence of postoperative retinal displacement (RD) following three surgical techniques-pars plana vitrectomy (PPV), scleral buckling (SB), and pneumatic retinopexy (PR)-for macula-off rhegmatogenous retinal detachment (RRD).MethodsIn this retrospective observational study, 183 eyes with primary macula-off RRD were treated between June 2021 and June 2023 at a tertiary care retina center. Patients underwent one of three surgical techniques: PPV, SB, or PR. RD was assessed using fundus autofluorescence imaging and correlated with early face-down positioning (EFP) and other clinical variables.ResultsRD incidence varied by technique: 36.3% after PPV, 21.2% after SB, and 8.1% after PR. In PPV cases, gas tamponade was associated with higher RD rates than silicone oil (68.4% vs. 29.8%, p = 0.010), and perfluorocarbon liquid (PFCL) use was associated with increased RD (44.1% vs. 0%, p = 0.009). Adherence to EFP had no significant protective effect (p = 0.985). Metamorphopsia was more frequent in patients with RD (p = 0.040); final visual acuity was similar across groups.ConclusionsRD is most common after PPV and least frequent after PR. Surgical choices, particularly tamponade type and PFCL use, significantly influence RD risk and should guide surgical planning.

PurposeFollowing European Medicines Agency (EMA) approval, France implemented a managed access program (MAP) to provide brolucizumab to patients with neovascular age-related macular degeneration (nAMD) who lacked treatment alternatives. The French MAP data analysis evaluated efficacy and safety of brolucizumab in brolucizumab-naïve patients.MethodsOf 599 patients enrolled between February 2022 and January 2024, 360 pretreated with anti-VEGF therapy but brolucizumab-naïve were assessed at baseline for clinical and anatomical benefits of brolucizumab in a close-to-real-world setting.ResultsAfter 18 months, patients received a median of eight injections, maintaining visual acuity and achieving a mean central subfield macular thickness (CSMT) reduction of -92.0 µm among those with baseline CSMT ≥300 µm. Intraretinal fluid, subretinal fluid, and pigment epithelial detachment occurred in 32.8%, 75.3%, and 61.7% patients at baseline, and 16.5%, 47.0%, and 51.3% patients at 18 months. Patients previously requiring Q4 or Q5-Q7 injections successfully extended their intervals to Q8 or longer. Intraocular inflammation rate was 8.0% (n = 29).ConclusionResults demonstrated functional and anatomical benefits of brolucizumab in patients with refractory or suboptimally controlled nAMD, with a manageable safety profile. These findings highlight the potential of brolucizumab to reduce treatment burden in chronic nAMD.