European Journal of Ophthalmology最新文献

BackgroundThis study aimed to evaluate dynamic thiol/disulfide homeostasis in the tear fluid of patients with type 2 diabetes and to investigate its relationship with the presence of diabetic retinopathy (DR), considering it as a potential biomarker of oxidative stress.MethodsA total of 96 individuals were included in the study. Participants were divided into three groups: 32 patients with diabetic retinopathy (Group 1, DR (+)), 31 patients with diabetes but without retinopathy (Group 2, DR (-)), and 33 healthy volunteers (Group 3). All participants underwent a comprehensive ophthalmological examination, including best-corrected visual acuity, slit-lamp biomicroscopy, and fundus evaluation. Tear samples were collected using Schirmer strips and stored in phosphate-buffered Eppendorf tubes at -80 °C until analysis. Total thiol, native thiol, and disulfide levels were analyzed using a spectrophotometric method. Patients with a history of intraocular surgery, trauma, glaucoma, or systemic diseases other than diabetes were excluded.ResultsThere were statistically significant differences between the groups in terms of total thiol, disulfide, disulfide/total thiol, and disulfide/native thiol ratios (p < 0.001). Total thiol levels were significantly lower, while disulfide levels and ratios were significantly higher in the DR (+) group. No significant difference was found in native thiol levels (p = 0.194). HbA1c and fasting blood glucose levels were significantly higher in the DR (+) group compared to the other groups (p < 0.001). Central macular thickness was also significantly greater in the DR (+) group (p < 0.001). Correlation analysis revealed a positive and significant relationship between HbA1c and fasting blood glucose (r = 0.551; p < 0.01), whereas no significant correlation was found between central macular thickness and glycemic parameters.ConclusionThe increased disulfide levels and disulfide ratios in the tear fluid of patients with diabetic retinopathy suggest a shift in thiol/disulfide homeostasis toward oxidative stress. These tear-based biomarkers may serve as valuable tools for the early diagnosis and monitoring of diabetic retinopathy.

IntroductionEven with recent improvements, the optimal timing of orbital implant placement after evisceration surgery - particularly in infected cases - remains unclear. This study aimed to compare the long-term outcomes of primary silicone orbital implants after evisceration for infectious and non-infectious causes, focusing mainly on implant-related complications such as exposure or extrusion.MethodsA total of 32 eyes that underwent evisceration were analyzed. Patients were divided into two groups: infectious causes (Group A, n = 10) and non-infectious causes (Group B, n = 22). Postoperative follow-up duration, implant size, histopathological results, and complications - including implant exposure or extrusion - were evaluated.ResultsDemographic characteristics were similar between the groups. The mean follow-up duration was 34.0 ± 17.7 months in group A and 28.18 ± 18.1 months in group B (p = 0.403). The mean implant size was 17.8 ± 2.6 mm in group A and 18.3 ± 1.8 mm in group B (p = 0.693). Mild symblepharon occurred in 2 patients (20%) in group A, while upper lid ptosis was noted in 2 patients (9%) in group B. No cases of implant exposure, extrusion, or sympathetic ophthalmia were observed in either group.ConclusionOrbital evisceration results in comparable long-term outcomes for both infectious and non-infectious indications, with no observed cases of implant exposure or extrusion. These findings support the safe use of primary silicone implants in both scenarios when appropriate surgical technique is applied and adequate postoperative follow-up is provided.

Background/AimsThe goal of glaucoma care is to preserve vision and quality of life This study aimed to develop, and rank patient-centered priorities for glaucoma care in Croatia and compare them with the perspectives of ophthalmologists.MethodsA five-phase, Delphi-based national study was conducted involving patients of the Croatian National Glaucoma Referral Center and Croatian ophthalmologists. An initial 20-item questionnaire was completed by 75 patients to identify patient priorities in glaucoma care. The most frequent responses were synthesized into a final 12 patient-centered priority statements, which patients and clinicians ranked independently. Rankings were compared overall and across prespecified patient and clinician subgroups.ResultsThe 20-item questionnaire informed a final 12-item survey completed by 130 patients and 97 ophthalmologists. Highest-ranking items across stakeholders were impaired quality of life and fear of losing sight or independence; patient associations ranked lowest. Clinicians emphasized reducing topical therapy burden and side-effects, whereas patients prioritized innovative and curative treatments (including vision restoration), faster, simpler diagnostics, and better communication with clinicians. Subgroup analyses showed stable patterns across clinician groups; among patients, later disease stage shifted focus toward disease control, longer treatment duration increased preference for innovation, and urban-rural differences were minimal.ConclusionThis study provides a ranked, stakeholder-informed set of glaucoma-care priorities for Croatia. Patient perspectives centered on preventing sight loss, preserving independence, and reducing treatment burden, while highlighting unmet needs in innovation, diagnostics, and communication. These findings complement ongoing European Glaucoma Society initiatives and may inform future Europe-wide strategies in patient-centered glaucoma care.

A 7-year-old boy, diagnosed with bilateral congenital glaucoma presented with elevated intraocular pressure (IOP). Anterior segment optical coherence tomography (AS-OCT) of the right eye revealed an artificial plane within the Haab's striae (HS), corresponding to separation of the Descemet membrane-pre-Descemet layer (DM-PDL) complex. Following medical reduction of IOP, slit-lamp examination demonstrated linear reddish discoloration within the HS, which was confirmed on AS-OCT as a hyperreflective intra-lamellar collection of blood between the posterior stroma and endothelium. The eye had not undergone any previous intraocular surgery or trauma. This observation represents a unique instance of de novo intra-lamellar hemorrhage within Haab's striae in an unoperated eye. The presumed mechanism involves reflux of blood into Schlemm's canal, with secondary ingress into the artificial plane created by partial DM-PDL separation, possibly triggered by a Valsalva maneuvre combined with low IOP. This finding underscores the potential anatomical continuity between the PDL and the trabecular meshwork, as previously demonstrated histologically. Recognition of this phenomenon is important to distinguish it from postoperative endothelial hemorrhage or corneal blood staining and to expand our understanding of corneal structural responses in congenital glaucoma. To our knowledge, this is the first reported case demonstrating intra-lamellar bleeding within a pre-existing Haab's striae, documented non-invasively using high-resolution AS-OCT.

PurposeThis study compares the anatomical and functional outcomes of two treatments for acute submacular haemorrhage (SMH): pars plana vitrectomy with subretinal recombinant tissue plasminogen activator (tPA) and gas tamponade versus intravitreal tPA and gas injection.MethodsA retrospective single-centre study was conducted of patients treated for acute SMH at Buckinghamshire Healthcare NHS Trust between January 2016 and December 2022. Patients received either intravitreal tPA and gas ± anti-VEGF (Group A) or pars plana vitrectomy with subretinal tPA and gas tamponade ± anti-VEGF (Group B). The primary outcome was anatomical success, defined as displacement of haemorrhage from the fovea. Secondary outcomes were visual acuity (VA) improvement, central foveal thickness (CFT) reduction, and complication rates.ResultsEighty eyes from 73 patients (mean age: 79.8 ± 11.5 years; 57.5% female) were analysed, with 53 eyes in Group A and 27 in Group B. Anatomical success was achieved in 71.6% of Group A and 77.8% of Group B. VA improved in 66% of Group A and 63% of Group B. CFT decreased by over 50% in both groups. No statistically significant differences were found between the two treatment groups and in anatomical or functional improvement.ConclusionIn this real-world study, both approaches effectively displaced SMH and improved vision with comparable outcomes, suggesting that treatment selection may be best determined by patient-specific and logistical factors.

PurposeTo evaluate the impact of oxidative stress and the antioxidant defense system in the pathogenesis of proliferative vitreoretinopathy (PVR).MethodsIn this prospective study, three groups of patients undergoing pars plana vitrectomy (PPV) were included: Group 1 included patients with rhegmatogenous retinal detachment (RRD) complicated by grade C PVR; Group 2 included patients with RRD without PVR; and Group 3 (control group) consisted of patients undergoing PPV for macular hole or vitreomacular traction. At the initiation of PPV, approximately 0.2 ml of a vitreous sample was obtained. Samples were analyzed for total oxidant status (TOS, µmol H₂O₂ equivalent/L), total antioxidant status (TAS, mmol Trolox equivalent/L), and oxidative stress index (OSI, TOS/TAS).ResultsA total of 60 eyes from 60 patients were included (n = 20 per group). The mean TAS levels were 1.23 ± 0.62 in Group 1, 1.41 ± 0.64 in Group 2, and 1.84 ± 0.52 in Group 3 (p = 0.008). The mean TOS levels were 18.62 ± 8.56, 14.32 ± 6.57, and 10.42 ± 5.82 in Groups 1, 2, and 3, respectively (p = 0.005). There was a statistically significant difference in OSI values between the groups (Group 1: 24.4 ± 31.51; Group 2: 13.31 ± 13.79; Group 3: 6.88 ± 6.26) (p = 0.001).ConclusionElevated TOS and OSI levels, along with reduced TAS levels in the vitreous samples of patients with PVR, suggest that oxidative stress and impaired antioxidant defense may play a critical role in the pathogenesis of PVR.

ObjectiveTo evaluate the efficacy and short-term safety of botulinum toxin type A (BTX-A) injection into the inferior oblique muscle for treating inferior oblique overaction (IOOA) in a pediatric cohort.MethodsWe conducted a retrospective cohort study at King Khaled Eye Specialist Hospital & Research Center, Riyadh, Saudi Arabia, including children aged 2-15 years with IOOA treated with BTX-A injections between June 2022 and September 2024. Data on demographics, baseline IOOA grade, associated strabismus, and postoperative complications were collected. All included eyes had a baseline IOOA grade of 2+ to 4+ and underwent a 5.00 units injection of BTX-A (Botox, Allergan Inc., Irvine, California, USA) to the inferior oblique muscle in a trans-conjunctival technique. The primary outcome was IOOA resolution, defined as postoperative IOOA grade of 0 or +1 at three months following the injection.ResultsTwenty-three patients (42 eyes) were analyzed. Median age was 6 years (IQR: 5-8), with 56% were female. Bilateral IOOA was present in 83% of included patients, esotropia in 91%, and exotropia in 9%. Three months after injection, 54% of eyes achieved complete or near complete IOOA resolution, and 76% improved by at least one grade. Exotropia decreased from 36% at two weeks to 5% at three months (p < 0.001), while ptosis declined from 29% to 2% (p < 0.001).ConclusionsBTX-A injection into the IO muscle is effective and safe for primary IOOA, with significant short-term improvement and minimal transient complications. The long-term sustainability of the IOOA improvement post BTX-A injection is unknown.

PurposeMelkersson-Rosenthal Syndrome is a rare neuro-mucocutaneous disease characterised by recurrent orofacial swelling, facial palsy and lingua plicata. Patients often do not present with the complete triad of symptoms which can make this a diagnostic challenge. We present three cases of suspected MRS seen in our tertiary eye unit, highlighting the challenges in diagnosis and management of MRS.Case descriptionsCase 1 is a 54-year-old female with a background of neuro-sarcoidosis who presented with a several year history of bilateral upper lid swelling and recurrent facial nerve palsy. She experienced complete resolution of symptoms after a period of observation.Case 2 is a 49-year-old female who had a one-year history of recurrent facial nerve palsy associated with facial, neck and lip swelling. She was treated with oral steroids but did not experience complete remission.Case 3 is a 74-year-old female who presented with an 18-month history of bilateral peri-orbital swelling. Biopsy of skin and orbicularis showed granulomatous inflammation. She was treated with oral non-steroid anti-inflammatories as well as topical and oral steroids but without complete resolution.ConclusionMRS is a rare but important differential in patients with recurrent peri-orbital swelling. Given the recurrent nature of MRS and its associations with severe systemic diseases, early recognition and a multi-disciplinary approach is essential to diagnosis and management.