European Journal of Ophthalmology最新文献

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.

PurposeThis study assessed the readability, reliability and accuracy of patient information leaflets on Descemet Membrane Endothelial Keratoplasty (DMEK), generated by seven large language models (LLMs). The aim was to determine which LLM produced the most patient-friendly, comprehensible and evidence-based leaflet, measured against a leaflet written by clinicians from a tertiary centre.MethodsEach LLM was given the prompt, "Make a patient information leaflet on Descemet Membrane Endothelial Keratoplasty (DMEK) surgery." Readability metrics (FKG, FRE, ARI, Gunning Fog), reliability metrics (DISCERN, PEMAT), misinformation detection and reference analysis were recorded for each response. A weighted scoring system normalised results on a 0-100% scale.ResultsThe clinician-generated leaflet scored the highest (92%). Claude 3.7 Sonnet had the top LLM score (77.8%), with strong readability and referencing. ChatGPT-4o followed closely (70.9%) but lacked references. Moderate scores for DeepSeek-V3, Perplexity AI and Google Gemini 2.0 Flash. ChatGPT-4 and Microsoft CoPilot scored the lowest due to limited reliability and misinformation.ConclusionsLLMs show promise in generating patient education material but vary in reliability and accuracy. Claude 3.7 Sonnet was the best performing LLM, though none matched in quality to the clinician-generated leaflet. LLM-generated leaflets therefore require clinician oversight before safe clinical use.

PurposeTo explore a new suprachoroidal space (SCS) injection technique using an ingenious, handmade, and precise suprachoroidal injector based on the resistance feedback theory to treat recurrent macular edema.MethodsWe designed a suprachoroidal injector on the basis of the resistance feedback theory and fabricated it with readily available commercial materials. Nine patients with recurrent macular edema secondary to diabetic retinopathy or retinal vein occlusion who could not afford repeated anti-vascular endothelial growth factor treatment received suprachoroidal injection of triamcinolone acetonide using this injector. Changes in SCS, macular edema and visual acuity before and after injection were evaluated.ResultsIn all patients, anterior-segment optical coherence tomography revealed SCS expansion immediately after injection. At 1 month after injection, spectral-domain optical coherence tomography revealed a reduction in macular edema with average central subfield thickness decreasing from 574.56 ± 151.53 μm to 338.78 ± 61.26 μm, and best-corrected visual acuity improved from 0.87 ± 0.29 logMAR to 0.55 ± 0.24 logMAR. Complications such as increased intraocular pressure, cataract, retinal damage and fluid injection into the vitreous cavity were not observed.ConclusionsThis new injector is expected to provide an economical, safe, and precise SCS injection and may have potential for widely clinical application.

PurposeThis study aims to describe the impact on survival of non-exenteration management of orbital disease, supplemented with transcutaneous retrobulbar injection of amphotericin B (TRAMB), in a cohort of patients with COVID-19-associated ROCM, a life-threatening condition for which exenteration is generally the preferred treatment modality.Method: This retrospective cohort study included 69 COVID-19-associated ROCM patients. All patients were treated with intravenous liposomal amphotericin-B and surgical debridement of paranasal sinuses. All patients with orbital disease were treated with TRAMB (42/69); orbital debridement or extended enucleation was performed when the disease was severe or progressive; debridement of intracranial disease was done when indicated.ResultsOf the 69 patients included, at discharge, 45/69(65.2%) had cured/stable ROCM, 13/69(18.8%) died and 11/69(15.94%) were discharged on request, with progressive disease. The vision was preserved in 45/69(65%), a blind eye with preserved ocular globe in 18/69(26%), and 6/69(9%) underwent extended enucleation. At 18 months follow-up, 6/56 died, 13/56 were lost to follow-up and 37/56 were alive. The cumulative mortality was 27% (19/69). Independent risk factors for mortality were increasing age(p = 0.003), diabetic ketoacidosis(p = 0.006), severe COVID-19 (p = 0.04), and CNS involvement (p = 0.01).ConclusionIn this study, conservative orbit management sans exenteration augmented with retrobulbar injection of amphotericin B was an effective treatment modality for orbital involvement in ROCM. The mortality in our patients was comparable to reports where exenteration was the first line of treatment, with better vision and cosmetic outcomes. Further studies comparing orbit conservation with TRAMB versus exenteration may be needed to delineate further, whether this approach can be an alternative to exenteration.

PurposeTo report a rare case of acute corneal hydrops and conjunctival ulceration secondary to acquired syphilis.MethodsA male in his late 30's presented with redness, pain, and watering in both eyes and sudden loss of vision in the left eye. Examination revealed bilateral conjunctival ulcers along with well-circumscribed corneal edema with blunt stunted intrinsic vessel in the left eye. Anterior-Segment Optical Coherence Tomography revealed immense corneal edema with stunted vessels suggestive of acute hydrops.ResultsTopical moxifloxacin with oral doxycycline was administered along with oral acetazolamide. The patient's serology (VDRL) was positive with Treponema Pallidum Hemagglutination Assay positivity. Intramuscular benzathine penicillin injections (weekly; 3 injections) were given and subsequently, there was complete resolution with corneal scarring and restoration of vision to 20/60 in the left eye.ConclusionThis is the first case to illustrate acute hydrops as a presenting sign of ocular syphilis.

PurposeTo evaluate the outcome of PPV in PDR patients with a Light Perception (LP) visual acuity at the time of signing up for surgery.MethodsThis retrospective study reviewed patient records from Harbor-UCLA and Olive View Medical Centers between March 2018 and March 2022. 32 patients (32 eyes) with LP visual acuity prior to surgery were included. Preoperative, intraoperative, and postoperative data were collected. Visual outcomes were assessed at 3 months (POM3), 6 months (POM6), and final follow-up. Statistical analyses included paired T-tests for visual acuity comparisons, linear regression for outcome predictors, and logistic regression for macular detachment risk factors.ResultsSignificant visual improvement at POM3 (BCVA 20/660) and POM6 (BCVA 20/890) were observed compared to baseline, with a final follow-up BCVA of 20/600. At final follow-up, 37.5% of patients showed no improvement, with 12.5% experiencing No Light Perception (NLP). Multivariable analysis identified longer surgical duration as a significant negative predictor of achieving BCVA of 20/100 or better. Preoperative rhegmatogenous retinal detachment and a higher number of prior vitrectomies were associated with lower odds of maintaining retinal attachment at 6 months.ConclusionsPPV provides a significant improvement in visual acuity for many patients with advanced PDR. However, a substantial portion of patients experience minimal or no improvement. Identified predictors of poorer outcomes can guide preoperative counseling and decision-making. This study highlights the need for careful consideration of surgical risks and benefits in advanced PDR cases.

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.

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.

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.