European Journal of Ophthalmology最新文献

PurposeTo report a case of fungal sclerouveitis caused by Alternaria doliconidium, misdiagnosed as autoimmune scleritis and incorrectly treated with immunosuppressive therapy.ObservationsA 69-year-old man presented with progressive chronic necrotizing scleritis in his right eye following ocular trauma. Initial treatment with antimicrobial and steroid therapy showed no improvement, and a scleral biopsy yielded inconclusive results. Autoimmune scleritis was suspected, leading to treatment with systemic steroids and immunosuppressants. Upon further examination, nodular necrotizing scleritis with scleral translucency and whitish floccules in the anterior chamber was observed, prompting a suspicion of fungal etiology. Molecular analysis via PCR confirmed the presence of Alternaria doliconidium.Conclusions and ImportanceThis case underscores the importance of considering fungal pathogens in cases unresponsive to conventional treatment and the critical role of advanced molecular diagnostics. This is the first reported case of sclerouveitis caused by Alternaria doliconidium, expanding the spectrum of ocular infections associated with this genus.

There is a growing interest in the use of machine learning (ML) for the diagnosis of retinoblastoma and leukocoria, and this study aims to systematically evaluate its performance compared with reference standards. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included studies using ML to diagnose retinoblastoma or leukocoria and providing enough data for analysis of diagnostic accuracy. We calculated sensitivity, specificity, and other measures of diagnostic performance. Twelve studies were included. Pooled sensitivity for retinoblastoma and leukocoria detection was 0.972 with ML models, indicating high potential for screening. However, high heterogeneity in the analyses was observed. The review also noted biases in some studies, along with small sample sizes that would limit generalizability. ML models appear to be promising for retinoblastoma diagnosis; however, limitations in specificity and potential methodological bias need further investigation. Incorporating research that used photographs taken with smartphone cameras indicates that ML-based diagnosis may become even more widely available through the use of such technology. Future studies need to have better specificity of the model, less bias in the methodology, must be conducted on large-scale datasets and they should address the cost-effective analysis compared with traditional methods. The incorporation of ML into the practice of retinoblastoma diagnosis has the capacity to transform the mode of detecting this condition and ultimately enhance patient management.

BackgroundTo report the deviation type, visual and refractive characteristics of patients with dissociated vertical deviation (DVD) requiring unilateral or bilateral strabismus surgery.MethodsThis study included 180 patients with DVD who underwent unilateral or bilateral strabismus surgery at Farabi Eye Hospital.Age, refractive error (RE), Corrected distance visual acuity (CDVA), strabismus angle, presence of amblyopia, and postoperative outcome.ResultsThirty-eight patients were in unilateral (78.9% bilateral) group. In the unilateral group, CDVA was significantly worse in surgical eyes versus fellow eyes (P < .001). The mean spherical equivalent in surgical eyes was insignificantly hyperopic than fellow eyes (P = 0.354). The mean angle of DVD was greater at distance than near (P < .05). Furthermore, the most prevalent type was "DVD plus horizontal deviation" (47.4%), followed by pure DVD (23.7%), "combined DVD, hypertropia (HT) and horizontal deviation" (13.2%), and "HT plus DVD" (15.8%). CDVA in cases needing bilateral surgery in the right and left eye were 0.91 ± 0.17 and 0.90 ± 110.17, respectively.In the bilateral group, RE components were similar between eyes but lower than surgical eyes in patients with unilateral surgery (P < .05). Moreover, the mean angle of DVD was higher at a distance compared to near.The most prevalent type was "DVD plus horizontal deviation" (64.1%), followed by pure DVD (18.3%), "combined DVD, HT and horizontal deviation" (13.4%), and "HT plus DVD" (4.2%).ConclusionsThe study highlighted significant differences in VA, RE, and prevalence of amblyopia between the two groups.Furthermore, the varying types of coexisting deviations observed in unilateral and bilateral surgery cases emphasize the importance of personalized treatment approaches for patients with DVD.

ObjectiveLocal anesthesia represents an alternative to general anesthesia in selected patients undergoing repair for open globe injuries. This study aimed to evaluate and compare visual acuity and clinical outcomes in such patients.MethodsA systematic literature search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar. Adults (≥18 years) hospitalized with open globe injuries were included. Out of 551 articles screened, four observational studies met the inclusion criteria. Standardized Mean Differences (SMD) for continuous and Risk Ratios (RR) for dichotomous outcomes were pooled using the Inverse Variance method with a Random Effects model. Outcomes included visual acuity, wound location, wound length, and operative time.ResultsFour retrospective case series comprising 1,690 patients were included. All studies had low risk of bias per the Newcastle-Ottawa Scale. No significant difference was observed in best corrected visual acuity between groups (MD = -0.18; 95% CI: -0.45 to 0.08; p = 0.17; I² = 55%). Patients in the local anesthesia group had more anterior wound locations (MD = 1.33; 95% CI: 1.06-1.66; p = 0.01; I² = 65%). Wound length (MD = -4.97; 95% CI: -5.95 to -3.98; p < 0.00001; I² = 0%) and operative time (MD = -33.32; 95% CI: -40.82 to -25.82; p < 0.00001; I² = 0%) were significantly shorter.ConclusionLocal anesthesia was associated with more anterior wounds, shorter wound length, and reduced operative time without compromising visual outcomes. It may be a safe and effective alternative to general anesthesia in selected open globe injuries.

PurposeRetinopathy of prematurity (ROP) is a blinding disease, however largely preventable by timely detection of severe ROP and treatment when required. Clinical use of the DIGIROP decision support tool (DIGIROP-screen and DIGIROP-birth) can help detecting neonates at high risk of sight-threatening severe ROP needing treatment and to reduce unnecessary screening exams in low-risk infants. External validation is necessary before the tool can be used in clinical decision-making.MethodsRetrospective cohort analysis of all preterm infants who were screened for ROP at the University Hospitals Ghent Belgium from January 1, 2020, to December 31, 2022. Validation of the DIGIROP decision support tools was the primary outcome variable. In a secondary analysis pre-, peri-, and postnatal characteristics were compared in different cohorts.Results311 infants were eligible for routine ROP-screening. Infants with a (gestational age) GA beyond 30 weeks (N = 80) and those who died (N = 19) were excluded resulting in 212 infants eligible entered in DIGIROP-birth. 112 infants did not need to be screened according to DIGIROP-birth. This resulted in 94 infants entered in DIGIROP-screen. These infants had a median GA of 27 weeks, a median birth weight (BW) of 892.5 g, and 62.5% were boys. DIGIROP birth showed a sensitivity of 100%. Most important risk factors for ROP across all subgroups are GA, BW.ConclusionsThe DIGIROP decision support tool demonstrated very high performance in our setting. However, multicenter prospective validation studies with large cohorts should confirm our findings before the use of the model can be generalized in Western NICU's with similar levels of care.

PurposeTo compare the corneal biomechanical characteristics following accelerated cross-linking (A-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL).MethodsForty-nine eyes from 41 patients who underwent DAI-CXL or A-CXL for progressive keratoconus were included. Visual acuity, topographic, and biomechanical data were analyzed preoperatively and 12 months postoperatively.ResultsA significant decrease in flat keratometry (K1) and thinnest corneal thickness (TCT) was observed in the A-CXL group between baseline and postoperatively (K1, p = 0.001; TCT: p = 0.007). Both groups showed a significant decrease in steep keratometry (K2) and maximum keratometry (Kmax) compared to baseline (K2: p = 0.03, p < 0.001, respectively; Kmax: p < 0.001 for both groups). Postoperatively, highest concavity time (HCT) was significantly lower (p = 0.007), and highest concavity peak distance (HCPD) was significantly higher (p = 0.034) in the DAI-CXL group compared to the A-CXL group. A significant increase in applanation 1 velocity (A1V), HCPD, and deformation amplitude (DA) (p = 0.03, 0.007, 0.02, respectively) and a decrease in Ambrósio relational thickness to the horizontal profile (ARTh) (p < 0.001) were noted in the A-CXL group at 12 months. The DAI-CXL group showed a significant decrease in HCT, integrated radius (IR), and ARTh (p = 0.006, 0.011, 0.009, respectively) between baseline and postoperative assessments. Corvis Biomechanical Factor (CBiF) and E-stage remained stable in both groups.ConclusionDAI-CXL and A-CXL demonstrate comparable efficacy in achieving visual, topographic, and biomechanical stabilization in progressive keratoconus over a 12-month period.

To investigate the clinical features, diagnostic methods, and treatment modalities of Phthiriasis palpebrarum (PP). We conducted a systematic review of case reports and case series of PP by searching MEDLINE, Embase, and ISI Web of Knowledge databases. Demographic and clinical features were extracted and reviewed. Furthermore, a case of Phthirus pubis infestation in the eyelashes of a young boy is also described. A total of 88 records involving 110 cases were included in the final analysis. The median age at admission was 21 years, with an equal proportion of males and females. The common clinical symptoms were itching (81.7%), irritation (26.6%), and redness (17.4%), with 67% of cases exhibiting bilateral involvement. The median duration of symptoms at presentation was 4 weeks. Approximately one-third of patients were misdiagnosed and unsuccessfully treated before presentation. Complications such as conjunctivitis and keratitis occurred in 30 cases (27.5%) and 4 cases (3.7%), respectively. Slit lamp examination or dermoscopy with light microscopy were the main diagnostic modalities. A combination of treatment modalities was employed in 69.7% of the cases. The main nonpharmacological therapies included mechanical removal of lice and nits and trimming of eyelashes. Commonly used pharmacological therapies were topical petrolatum jelly and topical antibiotics/corticosteroids. Over a median follow-up of 2 weeks, symptoms and lice/nits were resolved in most patients. Ophthalmologists should be aware of the possibility of PP in patients presenting with ocular itching.

PurposeSinonasal mucosal melanoma (SNMM) accounts for approximately 4-8% of sinonasal malignancies. SNMM frequently originates in the nasal cavity, causing nonspecific nasal symptoms that inevitably delay diagnosis. Left untreated, the tumor may extend into the orbit.Case DescriptionHerein, the authors describe two patients presenting with compressive optic neuropathy and were found to have advanced SNMM involving the orbit. Both patients presented with vision loss, decreased color vision, proptosis, conjunctival chemosis, and restricted extraocular movements. One patient was found to have a relative afferent pupillary defect. Neither patient was a surgical candidate, and both received palliative radiotherapy and immunotherapy.ConclusionsThese cases and literature review demonstrate the potential for the disease to initially manifest with orbital extension and ocular symptoms. Ophthalmologists can play a crucial role in the early detection of SNMM, which may improve outcomes, given the challenges of SNMM treatment.

There are some disputes regarding the necessity of maintaining a supine position after endothelial keratoplasty (EK) to ensure graft attachment. We aimed to evaluate the efficacy of a supine position after EK in reducing the risk of postoperative graft detachment. This systematic review with meta-analysis was registered in PROSPERO under protocol CRD42024541226. PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies comparing non-supine versus supine positions after EK. We pooled risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes and mean differences (MD) with 95% CI for continuous outcomes using a random-effects model. We included two randomized controlled trials and two observational studies comprising 456 eyes, of which 173 (37.9%) were assigned to non-supine positions. There were no significant differences in the incidence of graft detachment (RR 1.09; 95% CI 0.52-2.26; p = 0.82), rebubbling rate (RR 1.05; 95% CI 0.46-2.41; p = 0.90) and need for repeat keratoplasty (RR 2.37; 95% CI 0.13-41.99; p = 0.56) between non-supine and supine groups. There was also no difference in visual acuity (MD -0.02 LogMAR; 95% CI -0.11-0.08; p = 0.75) and intraocular pressure (MD -1.44 mmHg; 95% CI -8.49-5.61; p = 0.69) between groups. Subgroup analysis of DMEK (RR 0.73; 95% CI 0.38-1.42; p = 0.35) and DSAEK (RR 1.96; 95% CI 0.95-4.04; p = 0.07) also showed no difference in graft detachment between groups. Maintaining a supine position after EK surgery did not significantly affect graft detachment, rebubbling rate, need for repeat keratoplasty, visual acuity, or intraocular pressure.

PurposeTo compare and evaluate the diagnostic performance of OCT-angiography (OCT-A) parameters in diabetic retinopathy (DR) detection compared to fluorescein angiography (FA).MethodsThis is a cross-sectional, prospective study including 118 diabetic patients (214 eyes). All patients had a complete clinical examination with FA as well as macular OCT-A imaging (3 × 3 mm, 6 × 6 mm). We compared the detection of fundamental DR lesions using both imaging modalities and assessed the diagnostic value of different OCT-A parameters.ResultsMicroaneurysms were more frequently detected by FA than with OCT-A. Intraretinal microvascular anomalies were equally visualized by OCT-A (0.27 ± 0.777) and FA (0.27 ± 0.71). Average of foveal avascular zone (FAZ) surface was less significant at superficial capillary plexus (SCP) (0.353 ± 0.107 mm²) compared to deep capillary plexus (DCP) (0.537 ± 0,135 mm²), (p < 0.001). FAZ remodeling was observed even in DR free eyes and was better identified in DCP (61.1%) than SCP (47.2%). Loss of FAZ circularity was estimated at 0.792 ± 0.081 and 0.741 ± 0.107 respectively in SCP and DCP, (p < 0.001). Average surface area of capillary non-perfusion zones (CNPZ) was 0.487 ± 0.514 mm² in SCP and 0.145 ± 0.223 mm² in DCP, (p < 0.001). The Most reliable OCT-A quantitative parameters for DR screening were: CNPZ surface in DCP (p = 0.0046), total vascular density (VDt) in the DCP (p = 0.003) and CNPZ surface in the SCP (p = 0.0027).ConclusionOCT-A enables diabetic microvascular abnormalities detection even at a preclinical stage. Certain OCT-A parameters may provide a valuable quantitative approach for diagnosis and grading of DR severity.