European Journal of Ophthalmology最新文献

IntroductionMuscle eye brain disease (MEB) is a rare, multi-systemic autosomal recessively inherited disorder of relevance to ophthalmologists. The aim of this report is to describe a novel ocular phenotype for a genetically confirmed MEB patient using retinal multi-modal imaging.Case descriptionWe report a case of 18-year-old male patient that was referred to our tertiary unit for management of retinal detachment. Fundoscopic examination indicated optic nerve and macula hypoplasia, retinal hypo-pigmentation, and unilateral retinal detachment. There were no retinal breaks found in association with retinal detachment affecting the left eye. A well demarcated temporal pigmentary retinopathy with a 'ghost' retinal vessel in fundus autofluorescence image suggested spontaneous retinal reattachment of the retina in the right eye. Fundus autofluorescence and optical coherence tomography images revealed the novel features of internal limiting membrane disruption and sub-retinal opacity in association with neurosensory separation of the left retina, which is consistent with histopathology in the human eye and the mouse models of the disease.ConclusionsOur case suggests that retinal detachment in MEB disease should be managed conservatively in the absence of retinal breaks as spontaneous reattachment can occur. Extensive areas of non-perfusion should be treated with laser photo-coagulation to avoid the sequelae of retinal neovascularization. The mechanism for the development of retinal detachment without breaks is unknown.

PurposeCataract surgery is a fundamental procedure in ophthalmology, yet intraoperative complications such as anterior vitrectomy can compromise surgical outcomes. This systematic review and meta-analysis (CRD42025637001) aim to compare the incidence of anterior vitrectomy in cataract surgeries performed by ophthalmology residents versus experienced surgeons and assess factors contributing to surgical complications.MethodsA systematic search was conducted across EMBASE, MEDLINE, CINAHL Plus, Web of Science, ClinicalTrials.gov, PQDT Global, ARVO and AAO for studies published after 2000 that reported on anterior vitrectomy incidence in cataract surgery. Eligible studies included randomized controlled trials and observational studies. Meta-analysis was performed using STATA v. 18.0.ResultsOut of 1,190 screened studies, five studies (four retrospective cohort, one prospective cohort) involving phacoemulsification, extracapsular cataract extraction (ECCE), and femtosecond laser-assisted cataract surgery (FLACS) were included, encompassing a total of 4,918 cataract surgeries, and 208 anterior vitrectomy (AV) cases. The random-effects meta-analysis demonstrated a significant AV incidence for residents (ES = 0.04, 95% CI: [0.01, 0.06]), while the incidence for experienced surgeons was not statistically significant (ES = 0.03, 95% CI: [-0.03, 0.09]). High heterogeneity was observed among the included studies (I² = 92.1% for residents and I² = 96.7% for surgeons).ConclusionResidents may have a higher incidence of AV, highlighting the potential benefits of structured surgical training, early exposure, and mentorship in reducing intraoperative complications. Future research should explore simulation-based training and technology-assisted surgery to improve resident proficiency and patient outcomes.

PurposeiStent inject^® W is a minimally invasive surgical device aimed at creating an alternative trabecular drainage of aqueous humour, reducing intraocular pressure (IOP). International reports already support efficacy and safety, but evidence is lacking about the early-stage learning curve for this device.SettingThis research was conducted in a teaching tertiary hospital in Lisbon, Portugal.DesignRetrospective study on the first 6 iStent inject^® W implants performed by 6 certified ophthalmic surgeons.MethodsAll procedures were combined with cataract surgery (phaco + iStent inject^® W). Primary outcome was total surgical time. Secondary outcomes were complications and postoperative IOP. Outcome data were collected preoperatively and at postoperative days 1, 7, 30, and 90.ResultsThirty-six patients were included (58% female). Mean age was 73.28 ± 9.65 years. Mean surgical time of first surgery was 35.16 min (range 20 to 55), with surgical time decreasing by 8.5 min throughout the learning curve. Mean preoperative IOP was 21.81 ± 4.74 mmHg with a mean need of 2 medications. At 1-month, mean IOP was 16.00 ± 3.12 mmHg (-26.64% than baseline) while resorting to less medication (2.00 ± 0.94 to 0.66 ± 0.95; p < 0.01). Trabecular meshwork haemorrhage was the most common intra-operative complication reported, and no surgical complications requiring secondary intervention were recorded.ConclusionsiStent inject^® W was perceived as a fast-learning procedure, with a significant safety profile in the first cases. The magnitude of IOP reduction of this combined procedure makes it an interesting approach to the glaucoma patient requiring cataract surgery, performed either by a resident under supervision or a glaucoma consultant.

PurposeTo investigate the association between cognitive function and the results and reliability of standard automated perimetry (SAP) in a middle-aged birth cohort.MethodsIn this cross-sectional analysis of the prospective birth cohort, the reliability and performance of SAP were evaluated in relation to grade point average (GPA), educational attainment, and scores on the Paired Associates Learning (PAL) test among participants of the Northern Finland Birth Cohort Eye Study.ResultsHigher educational level, higher GPA, and fewer errors on the PAL test were consistently associated with better reliability and performance in SAP. However, the observed correlation coefficients were low, and differences between group comparisons were modest, accounting for only a small proportion of the variance in SAP outcomes.ConclusionWhile greater cognitive ability is positively associated with SAP performance and reliability, its impact is minimal and unlikely to be clinically significant. Further studies are warranted to determine whether higher cognitive function facilitates glaucoma diagnosis and monitoring through more reliable SAP results, or conversely, whether it may obscure glaucomatous damage by enhancing test performance beyond what is typical.

PurposeThe aim of our study was to evaluate the outcome of trabeculectomy with respect to surgeon's experience and to explore additional contributing factors.MethodsThis retrospective study was conducted analyzing consecutive single-surgeon cases from October 2019 to June 2022 receiving TE with mitomycin C. Eyes were categorized into five groups based on surgeon experience: E1 for the first 50 TEs, E2 for 51-100, E3 for 101-150, E4 for 151-200, E5 for 201-300. Complete success at one year was defined as an IOP <18 mmHg and 20%-IOP reduction without glaucoma eye drops and revision surgeries.Results300 eyes were included (mean age 68.8 ± 13.0 years, 58.3% female). 55.7% had primary open-angle glaucoma. The baseline IOP was 23.4 ± 8.7 mmHg with 3.0 ± 0.9 different antiglaucomatous medication. After 12 months, the complete success for E1 to E5, it was 83.0%, 86.7%, 87.4%, 75.3% and 79.1% (p < 0.0001) with IOP 12.8 ± 6.1, 12.8 ± 6.3, 11.5 ± 4.6, 12.9 ± 6.5, 12.9 ± 4.7 mmHg while there was a higher number of NTG cases in E4 and E5 (p = 0.04).ConclusionsEven a novice surgeon can achieve a good surgical outcome within the first 50 trabeculectomy under the guidance of an experienced surgeon. When comparing surgical results over time, it is important to incorporate case entity and severity.

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.