European Journal of Ophthalmology最新文献

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.

PurposeTo describe the demographic profile and clinical features associated with upper eyelid (UL) hyperlaxity in the Indian subcontinent.MethodsRetrospective chart review of 100 consecutive patients with UL hyperlaxity, presenting at a tertiary eye centre in India, between January 2016 to February 2022. The data collected included the demographics, clinical features including the ophthalmic and systemic manifestations, and management outcomes.ResultsThe average age at presentation was 42.71 (±18.73) years. Majority were males (83%). Syndromic associations included Down's syndrome (2%) and Ehler-Danlos syndrome (1%). Of the 45 investigated, obstructive sleep apnea was diagnosed in 24% cases. Adnexal manifestations included concurrent lower eyelid laxity (70%), blepharoptosis (41%) of which 38% were aponeurotic, lower eyelid retraction (37%), chalazia (25%) of which 58% were either recurrent, multiple, or both, lacrimal gland (LG) prolapse (11%), lash ptosis (11%), lower eyelid ectropion (8%), entropion (5%), and recurrent dacryoadenitis (3%). Chronic papillary conjunctivitis (66%) was the most common ocular surface abnormality followed by meibomian gland dysfunction (31%). Seven cases (7%) had eyelid imbrication syndrome (EIS), of which 60% had retinopathy of prematurity. Surgical management was recommended in 25% cases, indications being ptosis (13%), generalized eyelid laxity (11%), and recurrent globe luxation (2%).ConclusionUL hyperlaxity can be associated with a myriad of ophthalmic manifestations. One should look for novel findings such as EIS, dacryoadenitis, LG prolapse, and lower eyelid retraction in these cases.

PurposeThe aim of this article is to describe the outcomes of a case series using our own variation of the four-petal evisceration technique which may minimize the rate of orbital implant exposure through a simple approach.MethodsOur new technique consists of incompletely dividing the first two scleral flaps, thus creating four incomplete petals that can be sutured over the orbital implant. A case series with a minimum follow-up of 12 months is reported.ResultsOne hundred and twenty-two eyes of 121 patients who underwent evisceration surgery using the described technique are included. No cases of implant exposure or extrusion were observed, and an ocular prosthesis could be adapted in all cases with no complications during a minimum follow-up of 12 months.ConclusionsThe modified "incomplete" four-petal evisceration technique is a safe and accessible technique that may help prevent orbital implant exposure and can be considered a valid alternative in various clinical scenarios.

PurposeTo evaluate anterior scleral thickness (AST) in patients with ocular hypertension (OHT) using anterior segment-optical coherence tomography (AS-OCT).MethodsForty-two eyes of 21 patients with OHT and 40 eyes of 40 healthy participants were included in this cross-sectional study. AST was measured at the level of the scleral spur (SS)(AST-0), 1000 µm posterior of the SS (AST-1), and 2000 µm posterior of the SS (AST-2) in the nasal and temporal quadrants using AS-OCT.ResultsThe mean ages were 58.2 ± 12 (27-78) for OHT group; 54.2 ± 9.8 (21-70) years for control group (p > 0.05). The mean nasal AST-0, AST-1 and AST-2 were 647 ± 25.7 (592-689), 490.7 ± 16.4 (453-526), 513.6 ± 19.2 (481-554) µm in OHT group; 701.7 ± 44.9 (605-785), 521.7 ± 33.4 (433-579), 535.5 ± 33.3 (449-599) µm in control group, respectively. The mean temporal AST-0, AST-1 and AST-2 were 667 ± 28.9 (620-723), 495.9 ± 18.7 (459-545), 509.3 ± 24 (430-596) µm in OHT group; 718.1 ± 45.9 (618-796), 525.3 ± 29.8 (456-583), 533.4 ± 41 (450-611) µm in control group, respectively. Mean ASTs measured at all three points in OHT group were significantly thinner than in control group in both nasal and temporal quadrants (p < 0.05).ConclusionWe found that the scleral thickness was significantly thinner in OHT patients. It is still unknown whether the sclera plays a role in the OHT pathogenesis by affecting the biomechanical response of the globe to IOP elevation. Or conversely, sclera may undergo structural changes secondary to long-term IOP elevation in OHT. Although there are hints about the relationship between sclera and IOP, the mechanisms are still unclear.

PurposeTo investigate the effect of nutritional status on pupillary responses in children aged 5 to 18 years.MethodsThis cross-sectional study comprised 92 eyes of malnourished children and 80 eyes of age- and gender-matched healthy children based on BMI Z-score. Serum ferritin, hemoglobin, serum 25-hydroxyvitamin D, and vitamin B12 levels were recorded. Pupillary responses were taken using Sirius topography (CSO, Italy) with the automated pupillometry function. Static pupillometry consisted of pupil diameters at scotopic, mesopic, and photopic luminances. In dynamic pupillometry, the mean pupil dilation speed at the 10th second was calculated by dividing the distance by time in each 0.2 s period.ResultsNo significant difference was observed between the groups regarding age, gender, visual acuity, and spherical equivalent (p > 0.05). Mean hemoglobin, serum ferritin, serum 25-hydroxyvitamin D, and vitamin B12 levels were lower in malnourished children than healthy children (p < 0.001). The malnutrition group had lower mean pupil diameters under all luminance and higher speed of pupil dilation compared to the control group (p < 0.05). While malnutrition subgroups were similar in terms of pupil diameters under all luminance (p > 0.05), the speed of pupil dilation was significantly different between the groups (p = 0.024). BMI z-score was positively correlated with mesopic and photopic pupil diameter but also negatively correlated with the speed of pupil dilation (p < 0.05).ConclusionMalnourished children have smaller pupil diameters and higher speed of pupil dilation than healthy controls, indicating an autonomic impairment.