European Journal of Ophthalmology最新文献

Purpose: To evaluate the incidence and to describe the characteristics of the intrableb pigmentation (IBP) following XEN63 implantation.

Methods: Retrospective case series of three eyes presenting a pigment dispersion in the filtering bleb after a XEN63 implantation for uncontrolled IOP. Demographic, clinical and imaging data were obtained from medical records.

Results: Three out of 40 patients who underwent XEN implantation (average age 70.67 years) showed an IBP during the 12 months postoperative period. The mean time of IBP onset was 50 days (range, 15-90). The slit lamp examination showed two IBP patterns: a "diffuse" pattern (2 patients) with multiple spots of pigmentation inside the bleb; a "punctiform" pattern (1 patient), with a single spot at the distal end of the device. The AS-OCT imaging confirmed the presence of IBP appearing as a hyperreflective spot/s in the context of the filtering bleb. The patient with the punctiform IBP experienced a distal XEN ostium obstruction with a decrease in bleb function. In one case the diffuse IBP occurred after a successful needling procedure. All the patients' IOP reported at the end of the follow-up was below 21 mmHg.

Conclusion: The development of IBP might occur after XEN implantation in various times and with different patterns. The IBP pattern can provide meaningful clues on the bleb filtering function. A proper follow-up based on slit lamp biomicroscopy, IOP measurement, and AS-OCT imaging is recommended to manage potential complications related to IBP.

Purpose: After 15 years of accumulated experience in the Descemet Membrane Endothelial Keratoplasty (DMEK) technique, this surgical method has demonstrated a high reproducibility and success rate. However, certain ocular conditions such as aphakia and previously vitrectomized eyes remain challenging. We describe a novel technique designed to improve surgical time and postoperative outcomes in these specific scenarios.

Methods: Following delivery of the Descemet membrane graft into the anterior chamber (AC), a small air bubble was injected beneath the graft. One edge of the graft was grasped using the forceps. Subsequently, the external corneal surface was tapped, until the graft was unrolled.

Results: In our experience, this technique has consistently led to a reduced surgical time and excellent anatomical outcomes, achieving complete membrane attachment.

Conclusions: The technique developed and described herein provides a valuable surgical alternative for achieving successful DMEK outcomes in complex cases.

Background/objectives: Glaucoma can impact the ability to perform daily life activities such as driving. In such tasks, reaction time is critical to detect hazards. Understanding the modalities that affect response times is thus essential for clinical care.

Subjects/method: Simple reaction time tasks, in which participants respond as fast as possible to a stimulus, constitute a basic measure of processing speed. Simple reaction times to visual and auditory stimuli were compared to assess whether glaucomatous patients exhibit a general slowing in execution speed or a specific slowing in response to visual signals.Twenty participants with primary open angle glaucoma, 16 age-matched normally sighted controls and 16 young controls were instructed to press the space bar of the computer as soon as they detected a visual (a 3° black ring) or an auditory (a 440 Hz sound) signal. The two modalities were tested in independent blocks of 63 trials.

Results: Participants with glaucoma were significantly slower than young and older controls in the visual modality but not in the auditory modality, in which simple reaction times did not differ significantly between groups.

Conclusion: This study suggests that the reduced processing speed in glaucoma cannot be attributed to motor or attentional impairments and probably results from a delay in the transmission of visual information.

This study aimed to describe a case series of patients diagnosed with orbital reactive lymphoid hyperplasia (RLH) at a single tertiary care centre. A retrospective review was conducted by searching electronic medical records at Liverpool University NHS Foundation Trust (LUHFT) from 1^st December 2021 - 1^st December 2023, to identify all patients with a histological diagnosis. Ten patients with an orbital histological diagnosis of RLH were identified. Median age at diagnosis was 56.5 years. Proptosis was the most prevalent presenting symptom, while other signs included palpable mass, ptosis, and diplopia. Eight patients were treated with oral prednisolone, with 20% (two) achieving complete remission. Additional treatments utilised in these cases encompassed doxycycline, mycophenolate, ciclosporin, and azathioprine.This case series represents one of the few reports focusing exclusively on orbital RLH. Notably, bone erosion was observed in this study, a finding that has been scarcely linked to RLH in the literature.

Purpose: To evaluate long-term anatomical and functional outcomes in eyes undergoing scleral fixation of aniridic black diaphragm intraocular lens (BDIOL).

Methods: Total 38 eyes that underwent scleral fixation of BDIOL for secondary aniridia following ocular trauma with aphakia with absent posterior capsule or primary congenital aniridia with subluxated lens were retrospectively analyzed. Final visual acuity, early and late complications were examined. Correlation analysis was done.

Results: The mean follow-up was 28 months (range 6 to 66 months). The mean preoperative visual acuity of 1.82 ± 0.90 logMAR improved to 0.69 ± 0.61 (p = 0.00). The mean spherical equivalent refractive error of 7.88 ± 4.85 diopters improved to -0.69 ± 1.52(p = 0.00). Complications were seen in 9 eyes (23.6%). Early complications were raised intraocular pressure (IOP) in 2 eyes and one eye with suture site infection which were managed conservatively. Late complications were corneal decompensation 3eyes (7.8%), retinal detachment, hypotonic maculopathy and refractive surprise in 1 eye each (2.6%). None reported IOL tilt or dislocation. The patients noticed a significant reduction in glare disability and photophobia. No significant association was found between pre-operative factors such as prior surgical procedures, history of trauma and length of follow-up with surgical outcomes.

Conclusions: Scleral fixation of BDIOL is an effective option in eyes with aniridia and aphakia without capsular support that have undergone multiple previous surgeries. Despite severe damage, the BDIOL helps reconstruct the anterior segment and give a good quality of vision with minimal complications rate.

Purpose: To describe the efficacy and safety outcomes of NPB^® macular buckle (MB) in myopic traction maculopathy (MTM).

Methods: A monocentric, prospective cohort study of the naïve eyes who underwent MB surgery, alone or combined with pars plana vitrectomy (PPV) for MTM, using the new NPB^® buckle, between December 2022 and June 2024. The anatomical results, postoperative complications, and MB ease of use were analyzed as the main outcomes. Secondary outcomes included changes in best-corrected visual acuity (BCVA), axial length (AL), and intraocular pressure (IOP).

Results: Forty eyes of 39 patients were included, 34 (85%) were female. MB implantation alone was performed in 32 eyes (80%) and combined surgery in 8 (20%). At the final visit, 22 eyes (56,4%) "resolved" and 17 (43,6%) "improved" their retinal status, and 26 eyes (66,7%) "resolved", 8 (20,5%) "improved" and 5 (12,8%) "unchanged" their foveal status. Thirteen (32,5%) had repositioning surgery mainly due to MB decentration. Early complications (month 1) included diplopia in 3 eyes (7,5%) and elevation deficit without diplopia in 2 (5,0%). Late complications (month 6) involved mild buckle exposure in 3 cases (7,5%). No cases required MB removal or additional PPV. BCVA improved from 0,61 ± 0,35 to 0,49 ± 0,38 logMAR (p = 0,013), AL changed from 31,5 ± 2,2 to 30,0 ± 2,2 mm (p < 0,001), and IOP changed from 16,0 ± 2,7 to 14,5 ± 3,3 mmHg (p = 0,013), between the baseline and the final visit.

Conclusions: The new MB model is an effective and safe technique for MTM treatment as a first-line strategy, alone or in combination with PPV.

Introduction: Severe visual deprivation during infancy can lead to long-term changes in ocular development, including significant differences in axial length (AL) between eyes. This case report presents three adult patients with monocular infantile visual deprivation who developed substantial AL interocular differences. The aim is to explore the impact of early visual deprivation on AL and its potential implications for myopia progression.

Case report: Three male patients, aged 19, 42, and 50, were evaluated at the Ophthalmology Department of the University Hospital of Naples "Federico II." Each patient had a history of severe visual deprivation in one eye during infancy. The first patient experienced a dense corneal fibrovascular membrane from a chemical burn at age 1. The second suffered total corneal stromal scarring from a chemical burn at age 2. The third developed dense leukoma following infective keratitis at 0.3 years. Ophthalmological evaluations included refractive assessment, biomicroscopy, fundus examination (where feasible), electroretinogram (ERG), and A-Scan ultrasound. Affected eyes exhibited severe visual impairment (light perception in two patients, and 1.6 logMAR in the third), while the fundus could not be fully explored, and echographic assessment was used to exclude major chorioretinal changes. ERG findings were within normal limits, despite presumed early developmental impact on the retina due to lack of form vision. However, AL measurements revealed a 5.8-6.3 mm increase in the affected eyes compared to the healthy ones.

Conclusion: Infantile severe visual deprivation can lead to significant interocular AL differences in adulthood. These findings underscore the importance of investigating the underlying mechanisms to better understand and manage myopia progression in similar cases.

Purpose: To study the outcomes of diode laser transscleral cyclophotocoagulation (TSCPC) with trans-corneal transillumination using a novel low-cost torchlight method in refractory glaucoma.

Methods and analysis: This prospective interventional study included patients with refractory glaucoma who underwent TSCPC with trans-corneal transillumination (TSCPC-TI) using a novel low-cost torchlight method. Patients completing a minimum 6-month follow-up were analyzed. They were compared to a historical control group of patients who underwent TSCPC without transillumination (TSCPC-No TI) at 6-month follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups.

Results: 32 eyes of 29 patients comprised the TSCPC-TI group and were compared with 39 eyes of 37 patients in the TSCPC-No TI group. The TSCPC-TI group required lower energy than the TSCPC-No TI group (46.15 ± 22.8 Vs 80.65 ± 56.1 J p < 0.001). At 6-month follow-up, the TSCPC-TI group required lesser AGM for IOP control (2.33 ± 1.02 vs 3.02 ± 1.32 p = 0.01). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 6 months follow-up (15.6% vs 41% p = 0.03%). The success and response rates were 71.8% Vs 23.1%; p < 0.0001 and 87.5% Vs 51.2%; p = 0.001 significantly high in the TSCPC-TI group. The TSCPC-No TI group had a significantly high failure rate (12.5% Vs 48.2% p = 0.001). Hypotony (n = 1) and phthisis (n = 2) were noted TSCPC-No TI group.

Conclusions: TSCPC with transillumination with a low-cost torchlight resulted in a more efficient and effective cycloablation than TSCPC without transillumination.

Purpose: To evaluate the efficacy of topical treatment with 5-Fluorouracil (5-FU) 0.5% in cases of Ocular Surface Squamous Neoplasia (OSSN), and to assess the tolerance of patients undergoing treatment.

Methods: Patients with clinical diagnosis of OSSN referred to the Ocular Oncology division from the Federal University of Sao Paulo, Brazil, were recruited for the current study. Patients were treated with topical 5-FU 0.5% using a regimen of 4 times daily for 10 days, followed by a 3-week drug holiday, continued up to 3 cycles before an alternative treatment. Lesions were evaluated at baseline and throughout treatment. Treatment adherence was assessed using the Morisky Medication Adherence scale. Any adverse events along the treatment were noted.

Results: A total of 30 eyes of 30 patients adherent to the treatment were included in the study. Among the total cases treated with 5-FU 0.5%, 24 patients achieved therapeutic success after a mean treatment duration of 21.71 ± 7.77 days, representing a success rate of 80.00% (95% CI: 60.75-91.18%). For each 1 mm2 increase in the lesion area, the odds of treatment success decrease by 6% (OR: 0.94; 95%CI: 0.88-0.99; p = 0.033). Only mild adverse events such as ocular discomfort, ocular burning and tearing were observed along the treatment in 8 patients.

Conclusions: Topical 5-FU 0.5% is an effective therapeutic option in the treatment of OSSN, with an 80% therapeutic success rate, showing good tolerability. The size of the lesion was identified as a factor influencing treatment success, therefore it should be taken into consideration when defining treatment approaches.

Purpose: To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents.

Methods: This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values.

Results: There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n = 15), dexamethasone sustained release implant (DEX)(n = 22), ranibizumab (n = 19), and bevacizumab (n = 23). Statistically significant improvement in CRT was seen in all injection groups (p < 0.05) while improvement in mean BCVA was significant only in the TA group (p = 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p = 0.01).

Conclusions: Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.