European Journal of Ophthalmology最新文献

Purpose: To describe a case of CBL syndrome presenting with life-threatening pediatric Epstein-Barr virus (EBV) infection and sight-threatening rod-cone dystrophy (RCD) masquerading as severe panuveitis.

Methods: Single case report with results of whole-exome sequencing (WES) analysis in the proband and his parents. Data were collected from July 2009 to December 2022.

Results: A 35-month-old boy presented with severe primary EBV infection complicated by encephalitis and hemophagocytic lymphohistiocytosis. The clinical picture abated with systemic corticosteroids. Genetic testing revealed a heterozygous germline pathogenic variant in the CBL gene c.1141T > G (p.Cys381Gly). At 6 years old, he developed a severe bilateral panuveitis requiring multiple lines of immunosuppressants, mostly to control refractory cystoid macular edema (CME). During follow-up, intraretinal pigment deposits and peripheral retinal atrophy started to appear. Full-field electroretinogram (ffERG) revealed a pattern consistent with RCD. Repeat WES targeting known inherited retinal disease (IRD) genes was negative. A diagnosis of CBL syndrome complicated by RCD masquerading as severe bilateral panuveitis was made, and CME treatment was switched to oral acetazolamide.

Conclusions: CBL syndrome can present with severe EBV infection early in life. RCD masquerading as severe panuveitis is also a possible feature of CBL syndrome. RCD should be kept in mind in patients with this syndrome who present with idiopathic intraocular inflammation and are refractory to IMT. Carbonic anhydrase inhibitors (CAI) should be tried early to treat CME.

Background: The aim of the study is to utilize swept-source OCT for imaging the rear sclera near the ONH, calculating the thickness of the SL and lamina, and examining how these measurements correspond to various metrics.

Design: Cross-sectional design with a prospective approach.

Materials and methods: The study included 96 glaucoma patients and 39 control subjects, all with axial lengths greater than 23 mm. Swept-source OCT was used to visualize the subfoveal and ONH regions. Thicknesses of SL and lamina were then calculated from the "B-scan" visuals collected. In order to confirm the consistency of the calculation, "intraclass correlation coefficients" were computed from specific "B-scans". The study compared the thickness of the SL and lamina in subjects with NTG to those with POAG. A "Pearson correlation" was conducted to analyze the connections between the thickness of the SL and lamina with various ocular parameters.

Results: Swept-source OCT enabled the measurement of posterior SL thickness in 65.9% and laminar thickness in 89.8% of the subjects. The consistency of measurements taken by different observers and by the same observer varied from moderate to excellent. There was a notable variation among the NTG and POAG sets in terms of subfoveal SL thickness, with measurements of 680.84 ± 170.60 mm and 486.55 ± 125.21 mm, respectively. The connection among subfoveal SL thickness and axial-length was discovered to be negative in subjects with NTG, but this was not observed in subjects with POAG. The variation in connection among the 2 subject groups was statistically important (r [ L0.687, P < 0.002).

Conclusions: "Swept-source OCT" identified variations in posterior SL thickness between NTG and POAG eyes. The subfoveal scleral thickness showed a negative association with axial-length, particularly in eyes with normal-tension glaucoma.

Introduction: Late capsular bag distension syndrome (CBS) is a rare complication of the ^lcataract surgery.

Aim: The aim is to present 9 cases with delayed presentation and describe their successful management with surgical approach.

Method: A two-year retrospective review of 9 cases was undertaken. Anterior segment optical coherence tomography (AS-OCT) was used to confirm this diagnosis. Aspiration of the milky fluid with 26 gauge needle followed by capsular bag lavage was performed and aspirated fluid was examined.

Results: Patients showed signs of late CBS 6,56 ± 1,94 years after uncomplicated phacoemulsification with intraocular lens (IOL) implantation into the capsular bag. All 9 patients presented with a turbid fluid collection within the distended capsular bag. AS-OCT showed a hyper-reflective material in the space between the IOL and distended posterior capsule.

Conclusion: Awareness of the manifestations of CBS and choice of the correct imaging modality may lead to regular diagnosis and successful treatment. Management with aspiration of the milky fluid and lavage of the capsular bag is technically safe and effective procedure. It has the advantage of microbial testing of the fluid. AS-OCT is useful tool to differentiate this condition clearly from IOL opacification and posterior capsule opacification.

Purpose: To describe the successful use of plasma rich in growth factors (PRGF-Endoret®) and internal limiting membrane peeling for full thickness macular hole in Macular Telangiectasia type 2.

Case presentation: A case report of a full thickness macular hole (FTMH) associated with Macular Telangiectasia (MacTel) type 2 is described. 25-G vitrectomy with internal limiting membrane (ILM) peeling and use of (PRGF-Endoret®) was performed. Several ophthalmological visits were conducted and multiple diagnostic tests were carried out including optical coherence tomography (OCT) and fluorescein angiography. A 72-year-old man under follow-up for MacTel type 2 presented with worsening vision in his left eye, with a best visual corrected acuity (BVCA) of 20/80. OCT demonstrated a FTMH in the left eye measuring 264 µm. A 25-gauge pars plana vitrectomy surgery was performed with ILM peeling, use of PRGF-Endoret® and tamponade with 20% sulfur hexafluoride (SF6). Three weeks after surgery, complete anatomical closure was observed with a BVCA of 20/40, which improved to 20/25 one year after the surgery.

Conclusions: The use of PRGF associated with ILM peeling may be a useful tool in the treatment of macular holes associated with MacTel Type 2 with excellent anatomical and functional outcomes.

Purpose: To investigate the effectiveness and safety profiles of Direct Selective Laser Trabeculoplasty (DSLT).

Materials and methods: Retrospective study of 15 eyes of 10 patients diagnosed with open angle glaucoma (OAG) or ocular hypertension (OHT) who underwent DSLT in June 2023 at University Hospitals of Leicester, UK. We defined success as IOP reduced ≥20% from baseline with no additional medications needed or as a decrease in the number of anti-glaucoma medications while maintaining target IOP. We also considered secondary outcomes such as final BCVA and final number of anti-glaucoma medications.

Results: At the fourth month visit, success was reached in 11 eyes (73.3%). We registered 4 failures (26.7%). Mean IOP at baseline was 22.7 ± 4.4 mmHg and was reduced to 18.7 ± 4.2 mmHg (p = 0.008). The absolute mean reduction of IOP in the group of eyes that maintained unchanged the number of medications was 5.4 ± 2.7 mmHg, as baseline IOP was 21.4 ± 4.3 mmHg, and final IOP was 15.9 ± 2.3 mmHg, with a 25.7% reduction (p = 0.003). Mean BCVA remained unchanged (0.1 ± 0.1 logMAR, p = 1.00). No significant adverse events requiring surgical or clinical intervention were observed.

Conclusion: DSLT showed profiles of effectiveness and safety comparable with those of SLT in the literature and consistent with the results obtained in previous studies on DSLT itself. DSLT may represent a valid alternative to traditional SLT.

Introduction: Melanotic schwannoma (MS) is a rare neoplasm composed of Schwann cells with melanosomes in various maturation stages. While MS is typically observed in spinal nerve roots or peripheral nerves, their involvement in intraocular structures is uncommon. Here, we present a case of spontaneous globe rupture as the presenting feature of intraocular extension of a MS.

Methods: Enucleation was performed to remove the lesion. Confirmatory light microscopy and immunohistochemistry were used to properly diagnose and differentiate from conventional schwannoma and uveal malignant melanoma.

Results: The ocular tumor in our patient showed melanin pigmentation with positive melanocytic markers. The tumor revealed spindle and epithelioid cells proliferating in fascicles, which has previously been described for MS. No choroidal invasion, moderate nuclear pleomorphism, and a low mitotic rate were observed supporting a diagnosis of MS in our patient.

Conclusion: With reports of MS with high recurrence and metastatic spread rates, there have been some suggestions that MS should be considered an aggressive malignancy. This case highlights a dramatic presentation of a rare ocular malignancy with some features of aggressiveness. Our case report endorses the importance of close monitoring for local recurrence or metastasis to prevent a poor outcome.

Objective: To investigate the prevalence of anxiety and depression, and explore their related factors in all types of diabetic retinopathy (DR) patients more precisely and accurately by multiple scales.

Methods: Beck anxiety inventory (BAI), self-rating anxiety scale (SAS), beck depression inventory (BDI), and self-rating depression scale (SDS) scores were assessed in 247 DR patients and 250 non-retinopathic diabetes mellitus (NRDM) patients.

Results: In DR patients, there were 32 patients with proliferative DR and 115 patients with impaired visual acuity. The prevalences (95% confidence interval) of anxiety were 38.5% (32.4%-44.6%) and 32.0% (26.2%-37.8%) by BAI and SAS, while those for depression were 31.6% (25.8%-37.4%) and 25.1% (19.7%-30.5%) by BDI and SDS in DR patients. BAI score (P = 0.003), BAI-defined anxiety rate (P = 0.010), SAS score (P = 0.001), SAS-defined anxiety rate (P = 0.006), BDI score (P = 0.005), BDI-defined depression rate (P = 0.028), and SDS score (P = 0.001) were increased in DR patients versus NRDM patients. In DR patients, proliferative DR independently related to BAI-defined anxiety (P < 0.001) and SAS-defined anxiety (P < 0.001). Female (P = 0.016) and proliferative DR (P < 0.001) independently associated with BDI-defined depression; female (P = 0.007), DM duration (P = 0.025), triglyceride (TG) (P = 0.026), and proliferative DR (P = 0.014) independently associated with SDS-defined depression. The combination of these independent factors showed acceptable abilities in predicting BAI-defined anxiety, SAS-defined anxiety, BDI-defined depression, or SDS-defined depression in DR patients, with area under curves of 0.626, 0.656, 0.696, and 0.741, respectively (all P < 0.001).

Conclusion: Anxiety and depression are prevalent; meanwhile, proliferative DR, female, DM duration, and TG independently relate to anxiety or depression in DR patients.