European Journal of Ophthalmology最新文献

Purpose: To review all studies reporting the occurrence of white dot syndromes (WDSs) following SARS-COV-2 infection.

Methods: On May 12, 2023, we registered our protocol on PROSPERO [registration number: CRD42023426012]. Five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct were searched up to May 2023. We included all studies that reported the symptoms of WDSs following SARS-COV-2 infection. The data was extracted using a uniform Excel extraction sheet. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p-value of less than 0.05 was considered statistically significant. The publication bias of included studies was assessed using JBI Critical Appraisal Checklist for Case Reports and IHE Quality Appraisal Checklist for Case Series studies.

Results: This review included thirty-two studies involving forty-eight patients. Acute macular neuroretinopathy was the most common disease (70.8%) followed by multiple evanescent white dot syndrome (14.6%) with 58.3% of WDS after their first SARS-COV-2 infection, and paracentral acute middle maculopathy (4.1%). They were mostly unilateral (56.2%). The presenting symptoms were blurred vision (70.8%), visual field disturbance (68.7%), and photopsia (20.8%). About 35.4% of the patients improved by their treatment and future complications were persistent scotoma (4.2%) and macular edema (2.1%).

Conclusion: White dot syndromes are very rare entities. Our findings suggest a possible association between white dot syndrome onset and SARS-COV-2 infection. We recommend ophthalmologists should be aware of this suggested association to deliver better management and patients' care.

Purpose: Persistent diplopia after rectus muscle myectomy is not uncommon but challenging in patients with Graves' ophthalmopathy. We investigated the role of lateral rectus muscle resection for patients after medial rectus muscle myectomy in Graves' ophthalmopathy.

Methods: We retrospectively reviewed and collected data from patients with persistent diplopia after medial rectus muscle myectomy for Graves' ophthalmopathy who underwent unilateral or bilateral lateral rectus muscle resection. The eyeball deviations in the primary and reading positions before and after the operation were measured. A successful surgical outcome was defined as having less than five prism diopters (PD) in the primary gaze and functional binocular vision in the central 30° field postoperatively.

Results: A total of fifteen patients were included (mean post-myectomy deviation: 35.9 PD, range: 14 to -75 PD). The lateral rectus muscle resection after medial rectus muscle myectomy achieved an 80.0% success rate, with one patient over-corrected and two patients under-corrected.

Conclusions: The lateral rectus muscle resection is an effective and predictable procedure for managing residual esotropia in Graves' ophthalmopathy patients who have previously undergone medial rectus muscle myectomy.

Purpose: To compare the efficacy and safety of iStent versus Endocyclophotocoagulation (ECP) as an adjunct to cataract surgery by Phacoemulsification for treating glaucoma patients in a tertiary eye center.

Methods: Retrospective study of 67 eyes of 61 patients with glaucoma and cataract who underwent either phaco-ECP or phaco-iStent. Primary efficacy endpoint is the Intraocular pressure (IOP) reduction, while reduction of glaucoma medications is the secondary outcome. In addition to IOP and number of glaucoma medications; visual acuity, degree of disc cupping, safety profiles were all assessed at different intervals up to 12 months.

Results: A total of 40 eyes underwent phaco-ECP, and 27 eyes underwent phaco-iStent. Both groups were associated with a significant reduction in the number of glaucoma medications; however phaco-iStent group achieved slightly lower IOP levels than the phaco-ECP group. Furthermore, iStent inject had better control of IOP at the last follow-up compared to first-generation stents. Moreover; 2 or more stents significantly reduced IOP than single stent (p = 0.009 vs. p = 0.618, respectively). Phaco-iStent achieved a better reduction in the number of glaucoma medications for primary open-angle glaucoma (p = 0.007) compared to pseudoexfoliation glaucoma patients (p = 0.084). Complications were seen in 12 eyes (18%), of which five eyes in phaco-ECP (7.4%) and 7 eyes in phaco-iStent (10.4%), majority were mild and treated conservatively.

Conclusions: Both groups had equal efficacy in reducing the IOP. However, phaco-iStent seems superior in reducing the number of glaucoma medications after 1 year of follow-up compared to phaco-ECP, particularly when 2 or more stents are used. Both groups showed an overall good safety profile.

Purpose: To quantify the presence of early structural alterations in the outer retinal layer and choroid among healthy subjects and diabetic patients with no or mild diabetic retinopathy, and to establish the correlation between the measured structural parameters and retinal sensitivity.

Methods: In total, 31 eyes from subjects with type 2 diabetes and 29 eyes from healthy subjects were enrolled. Optical coherence tomography was used to measure outer retina layers and choroid, while microperimetry was used to characterize the changes of visual function in a 6-mm diameter area at macula. Quantitative analysis of structural and functional changes was performed between groups and the structure-function correlations were determined.

Results: The thickness of myoid and ellipsoid zone, choroid and the mean retinal sensitivity were significantly smaller in diabetic group than that in controls (all P values < 0.05). Besides, thinner choroid and outer retina was associated with the decreased retinal sensitivity，especially in diabetic patients (r = 0.377, P = 0.048; r = 0.401, P = 0.034; respectively). Final multiple regression models showed the outer retinal thickness (ORT) (P = 0.033), choroidal thickness (P = 0.003) and the interaction between ORT and choroidal thickness (P = 0.001) were significant predictors to retinal sensitivity.

Conclusions: Thinning of choroid and outer retina were significantly correlated with reduced retinal sensitivity, which indicate outer retina and choroid might be potential imaging markers for evaluation of visual function related to neural impairment in type 2 diabetic patients without or in the early stage of diabetic retinopathy.

Purpose: To document a case involving a patient previously diagnosed with Behçet's disease which proved unresponsive to multiple immunomodulatory therapies, and was subsequently diagnosed with secondary cytomegalovirus retinitis and appropriately treated.

Methods: This is a case report focused on the images.

Results: A 39-year-old female, previously diagnosed with Behçet's disease unresponsive to multiple immunomodulatory therapies, sought a second opinion at our clinic due to more floaters and a scotoma in her left eye for a few months. Her right eye had become blind as a result of multiple glaucoma and vitreoretinal surgeries. Her best corrected visual acuity was 20/60 in the left eye. A Slit lam examination of the left eye showed 1+ cells and flare in the anterior chamber along with 1+ cells in the anterior vitreous with no vitreous haze. Dilated fundoscopy of the left eye reveled an atrophic lesion in the inferior macula. Fluorescein angiography demonstrated a mixed hypo- and hyperfluorescent lesion in the left eye. Optical coherence tomography macula demonstrated an atrophic lesion in the inferior macula of the left eye. All laboratory findings were predominantly negative or within the normal range, except for the presence of antibodies to VZV and CMV in the blood. Polymerase chain reaction analysis of the vitreous sample uncovered the presence of CMV, leading to appropriate curative and prophylactic treatment for the patient.

Conclusions and importance: In patients with resistant noninfectious uveitis, particularly those experiencing underlying disease reactivation, the possibility of infections, especially opportunistic ones, should be taken into consideration.

Purpose: To describe a case of full thickness macular hole after intravitreal brolucizumab injection in neovascular age-related macular degeneration, which has not been reported to date.

Case description: A 65-year-old male patient received brolucizumab intravitreal injection therapy for neovascular macular degeneration of the right eye. He received multiple intravitreal anti-VEGF injections on a pro re nata regimen and developed a full thickness macular hole.

Outcome: Surgical treatment was performed with pars plana vitrectomy of the right eye. Full thickness macular hole was successfully treated.

Conclusion: Although a full thickness macular hole following intravitreal brolucizumab injection is an uncommon complication, it requires caution.

Purpose: Isolated acquired superior rectus palsy (ASRP) is extremely rare. The goal of this report is to describe the clinical manifestations and surgical protocols for treatment of isolated traumatic ASRP.

Design: Retrospective observational case series.

Method: Records of patients presenting with traumatic isolated ASRP from 2011 to 2020 were retrospectively reviewed. Variables analyzed included nature of the damage, ocular alignment, ocular motility, binocular vision, fundus photography, imaging and surgical treatment.

Result: Of the 23,498 strabismus surgeries performed, 16 (0.07%) were identified as being attributable to traumatic isolated ASRP. Iatrogenic injury during orbital/brain tumorectomy was the most common cause for ASRP, followed by injury resulting from a sharp object, blunt instrument, car accident, dog bite, accidental fall and explosion. The main clinical features were hypotropia and deficient supraduction of the affected eye, accompanied by exotropia, extorsion, decreased vision and ptosis. The imaging examination showed the superior orbital wall fracture in 3 cases and superior rectus rupture in 7 cases. Inferior rectus recession and/or superior rectus resection comprised the major surgical procedures employed for these cases. Vertical deviations were reduced from 45.60 ± 17.52 PD preoperatively to 12.20 ± 12.97 PD postoperatively after an average of 22.70 months at follow-up, with a success rate of 50%.

Conclusion: Traumatic isolated ASRP comprised only 0.07% of cases receiving strabismus surgery at our hospital. Orbital imaging is essential to identify whether muscle rupture, orbital fractures and/or other possible disorders are present. Superior rectus resection and inferior rectus recession represented the most frequently used surgical procedures.

Purpose: To describe the clinical and imaging features of circumscribed choroidal hemangiomas (CCH) and their treatment outcomes with Ruthenium-106 (¹⁰⁶Ru) plaque brachytherapy.

Methods: Retrospective study of 24 patients (24 eyes) diagnosed with CCH and treated with ¹⁰⁶Ru plaque between 2017 and 2022. Analysis included pre- and post-treatment clinical and imaging features such as tumor regression, reduction in height, subretinal fluid (SRF) resolution, and change in best-corrected visual acuity (BCVA).

Results: The mean age at presentation was 36 years (range, 16-57). The most common tumor location was the temporal quadrant (n = 19) with macular involvement (n = 13). Associated features were macular SRF (n = 22) and inferior exudative retinal detachment (n = 10). Nineteen of the 24 patients underwent primary treatment, whereas 5 patients underwent plaque as a salvage treatment. The mean tumor apex dose was 40 Gy. At a median follow-up of 7.5 months (range 3-65 months), 18 eyes showed complete regression, whereas 6 eyes showed partial regression. The mean height decreased from 4.8 (SD 1.28) mm at presentation to 2.5 (SD 1.63) mm. Median BCVA improved from logMAR 1.2 (IQR 0.4-2) at baseline to logMAR 1.05 (IQR 0.1-1.95) (p = 0.4). Complete resolution of the macula and tumor SRF was observed in 15 (68%) and 13 (57%) eyes, respectively. The radiation-related complications observed were radiation maculopathy (4 eyes), retinopathy (1 eye), and vitreous hemorrhage (1 eye).

Conclusion: Ruthenium-106 plaque brachytherapy is effective for CCH (> 3 mm height) as a primary and salvage treatment for tumors unresponsive to other modalities.

Purpose: Ocular ischemic syndrome can be the first and only hint of life-threatening carotid artery disease. The early recognition of carotid stenosis-related retinal signs, as well as the comprehension of the pathophysiology behind retinal changes could become relevant for physicians to predict the risk of stroke. The aim of this study is to assess the carotid artery disease-induced early structural retinochoroidal changes by means of swept-source optical coherence tomography (SS-OCT).

Methods: A prospective observational study was conducted in 72 eyes with carotid stenosis. According to the degree of stenosis, the participants were divided into a normal group (34 eyes), a mild-moderate stenosis group (22 eyes), a severe stenosis group (16 eyes). SS-OCT and OCTA were performed to scan macular fovea. Central macular thickness (CMT), subfoveal choroidal thickness (SCT) and foveal avascular zona (FAZ) area were the major measurements for our study.

Results: CMT was significantly thicker in group 3 when compared to group 2 and 1. SCT was significantly thinner in group 3 vs group 1, being thicker in group 2 when compared to group 1. No significant differences were obtained when comparing FAZ in the superficial and middle capillary plexus although it was significant when comparing the FAZ in the deep capillary plexus between group 1 and 3.

Conclusion: internal carotid artery stenosis greater than 70% leads to a significant increase in CMT and a decrease in SCT prior the development of clinical findings of ocular ischemia syndrome.