European Journal of Ophthalmology最新文献

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.

Purpose: This cross-sectional study evaluated the prevalence of inclusive author submission guidelines across ophthalmology journals.

Methods: Journals were identified from the 2021 Journal Citations Report (Clarivate Analytics). Independent reviewers rated each author submission guideline as "inclusive" for satisfying at-least one of six criteria: i) included examples of gender inclusive language; ii) recommended the use of gender-inclusive language; iii) distinguished between sex and gender; iv) provided educational resources on gender-inclusive language; v) provided a policy permitting name changes (e.g., in case of gender and name transition); and/or vi) provided a statement of commitment to inclusivity. The primary objective was to investigate the proportion of journals with "gender-inclusive" author submission guidelines and the elements of the gender-inclusive content within these guidelines. A secondary objective was to review the association between "gender-inclusivity" in author submission guidelines with publisher, origin country, and journal/source/influence metrics (Clarivate Analytics).

Results: Across 94 journals, 29.8% journals were rated as inclusive. Inclusive journals had significantly higher relative impact factor, citations, and article influence scores compared to non-inclusive journals. Of the 29.8% of inclusive journals, the three most common domains were inclusion of an inclusivity statement (71.4% of inclusive journals), distinguishing between sex and gender (67.9%), and provision of additional educational resources on gender reporting for authors (60.7%).

Conclusion: A minority of ophthalmology journals have gender-inclusive author submission guidelines. Ophthalmology journals should update their submission guidelines to advance gender equity of both authors and study participants and promote the inclusion of gender-diverse communities.

Purpose: To describe retinal and choroidal vascular changes following an exercise stress test (ET) in patients with effort angina and to determine whether optical coherence tomography angiography (OCT-A) could play a role in the prediction of ischemic cardiac events.

Methods: Prospective comparative study including patients with effort angina. All patients underwent OCT-A before and after an ET was performed. Blood flow, intercapillary spaces, and vessel density were analyzed in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Vessel density in the choriocapillaris and the parameters of the central avascular zone (CAZ) were also analyzed.

Results: Of the 38 eyes included in the study, a decrease in blood flow was found in 39.5% in the large SCP vessels, in 50% in the capillaris of the SCP, and in 81.6% in the DCP. An increase in intercapillary spaces was observed in the SCP in 68.4% of eyes and in the DCP in 55.3% of eyes. A statistically significant decrease in the DCP density was observed after an ET (p = 0.03). There were no significant modifications in the CAZ parameters, the SCP density, nor the choriocapillaris density. Patients with a positive ET had a decreased DCP density in 83.3%. Among patients with an increased DCP density, 92.85% had a negatif ET.

Conclusion: This pilot study suggests that DCP density significantly decreases after an ET. The DCP appears to be most affected in patients with effort angina. A larger trial is needed to further investigate these hypotheses.

Submacular haemorrhage (SMH) is an emergency, and the most important immediate action in the treatment of SMH is the early displacement or evacuation of subretinal heme from below the fovea, followed by simultaneous or sequential treatment of the underlying cause. Photoreceptor damage can occur immediately after the onset of SMH for a variety of reasons, including toxins released from the blood, the diffusion barrier created by the blood for oxygen delivery and nutrition to the outer retinal layers, and shearing forces on the outer retinal layers, resulting in permanent visual deterioration. A clinician's decision to treat SMH is influenced by a number of factors, including presenting visual acuity, duration of visual symptoms, SMH aetiology and characteristics, availability of intraocular gases and tissue plasminogen activator, and pars plana vitrectomy facilities. For many clinicians, the duration of visual symptoms is the most important and first consideration when planning SMH treatment. Very little emphasis is given to the SMH's imaging characteristics. Currently, there are several treatment options for SMH removal. There is a need to develop a simplified treatment algorithm for SMH that is less reliant on the patient's visual complaints, considers heme characteristics on basic retinal imaging, and has the potential to achieve uniform and predictable treatment outcomes in real-world situations. In this short article, we discuss the various factors that can assist clinicians in the management of SMH and present a simplified treatment algorithm based on the SMH's retinal imaging characteristics.

Introduction: Keratoconus patients turn to the internet for answers to their disease expectations. Webpages are not filtered or submitted to evaluation before getting published. We aim to evaluate the quality and readability of the online information regarding keratoconus in Portugal and Brazil.

Methods: Two independent ophthalmologists and one ophthalmologist supervisor evaluated 30 Portuguese and 30 Brazilian websites by order of appearance in Google with the word "Queratocone" and "Ceratocone", respectively. Two quality scores were used: a quality index of consumer health information (DISCERN) and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated with 3 scores: FleschKincaid Reading Ease (FRE), FleschKincaid Grade (FKG) and Automated Readability Index (ARI).

Results: Sites from private hospitals or clinics were the most prevalent in both countries, followed by health platform sites. Final JAMA benchmark was 1.13 ± 1.18 in Portugal and 1.07 ± 1.00 in Brazil. Final DISCERN was 34.07 ± 11.71 in Portugal and 38.17 ± 10.51 in Brazil. FRE and FKG scores denoted "difficult to read" and "college school level" in both countries; ARI denoted "professor" level in Portugal and "college student" level in Brazil needed to understand the text, a statistically significant difference. There was no correlation between Google ranking and quality and readability scores.

Discussion and conclusions: The information on keratoconus available online to Portuguese-speaking patients is of poor quality and difficult to interpret. Ophthalmologists have a shared responsibility to tackle this challenge through multifold efforts. Educating our patients on how to find reputable websites can help them navigate their life with keratoconus.

Background: To evaluate intrascleral plug stability and correct centring of the IOL in three different surgical techniques using intraoperative anterior segment OCT.

Methods: This retrospective scientific study was conducted by reviewing patient records from the Ophthalmology Unit at the Civico Hospital of Palermo, covering the period between 2021 and 2022. Three distinct groups of patients, each consisting of 7 eyes from 7 individual patients, were included in this study. The first group received a quadrangular scleral flap (3.5 × 3.5 mm) that covered intrascleral plugs. The second group had two intrascleral pockets created with the insertion of plugs inside these pockets. The third group had one intrascleral pocket created to cover the intrascleral plugs. Intraoperative anterior segment (AS)-OCT was used to monitor the positioning of the plugs and the tilt of the IOL. The analyzed parameters are: best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, macular thickness, endothelial cell loss, intraoperative and postoperative complications, IOL tilting, and optic plate decentration.

Results: The examined parameters showed uniformity among the groups. Postoperative best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure (IOP), pachymetry, and macular thickness exhibited no significant differences between the three groups. Endothelial cell loss ranged between 10.4% and 13.1% across the patient groups. No intraoperative or postoperative complications were reported. No IOL tilting or optic plate decentration was reported. The duration of surgeries was similar among the groups.

Conclusions: The three different scleral fixation techniques have been shown to be equally effective, demonstrating the usefulness of intraoperative AS-OCT for the stability and centring of Carlevale IOLs.

Purpose: the aim of the present study is to analyse the composition of the currently available topical antiseptic products and the related scientific evidence, and to discuss the implications of their use in the prevention of endophthtalmitis.

Methods: products available on the market until February 2024 were considered. Information provided on the illustration leaflet of each product were analysed. Literature search was made on the effectiveness of these new products, focusing on those available in Italy. Articles indexed in Pubmed until June 2024 were included in the present study.

Results: labelling of these products represents an issue, since most of them are presented as eye lubricants and a clear labeling of their indication as perioperative prophylaxis is needed. While promising in vitro studies have been performed, in vivo evidence is still lacking.

Conclusions: products with antiseptic activity may be promising to address the issue of endophthalmitis prevention. However, more evidence on the subject is needed.

Purpose: To comprehensively characterize the quality of vision (QV) in an otherwise healthy population undergoing bilateral consecutive cataract surgery with the implantation of a monofocal intraocular lens (IOL) and to propose a graphical illustration.

Setting: Centro Hospitalar e Universitário de Coimbra, Portugal.

Design: Cross-sectional study.

Methods: This study included patients that underwent sequential bilateral cataract surgery with implantation of a monofocal acrylic foldable single-piece IOL. Patients were evaluated at the 3rd postoperative month in terms of bilateral uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA); sphero-cylindrical refraction; bilateral reading speed and contrast sensitivity function (CSF); corneal topography/tomography; aberrometry; pupillometry; negative dysphotopsia (ND); Catquest-9SF and Quality of Vision (QoV) questionnaires.

Results: Both eyes from 26 (n = 26) consecutive patients with mean age of 68 years ± 6.68 were included. UDVA mean was logMAR = 0.01 ± 0.04, and CDVA was logMAR = 0.00 ± 0.04. The average reading speed was 110.42 words/minute. The CSF showed a descendent curve for higher spatial frequencies and was lower with glare. ND was present in 1.92% of the patients. Catquest-9SF mean was 95.46% and QoV mean score was 4.48 points. A radar graph showing median scores across the multiple variables assessed was produced demonstrating a wide panorama of QV.

Conclusion: Patients' satisfaction was correlated with CSF, reading speed, CNVA and residual spherical equivalent. To the author's best knowledge, this study establishes, for the first time, a comprehensive panorama of visual performance through a radar graph that can be utilized to describe the QV.