European Journal of Ophthalmology最新文献

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.

PurposeTo compare the corneal biomechanical characteristics following accelerated cross-linking (A-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL).MethodsForty-nine eyes from 41 patients who underwent DAI-CXL or A-CXL for progressive keratoconus were included. Visual acuity, topographic, and biomechanical data were analyzed preoperatively and 12 months postoperatively.ResultsA significant decrease in flat keratometry (K1) and thinnest corneal thickness (TCT) was observed in the A-CXL group between baseline and postoperatively (K1, p = 0.001; TCT: p = 0.007). Both groups showed a significant decrease in steep keratometry (K2) and maximum keratometry (Kmax) compared to baseline (K2: p = 0.03, p < 0.001, respectively; Kmax: p < 0.001 for both groups). Postoperatively, highest concavity time (HCT) was significantly lower (p = 0.007), and highest concavity peak distance (HCPD) was significantly higher (p = 0.034) in the DAI-CXL group compared to the A-CXL group. A significant increase in applanation 1 velocity (A1V), HCPD, and deformation amplitude (DA) (p = 0.03, 0.007, 0.02, respectively) and a decrease in Ambrósio relational thickness to the horizontal profile (ARTh) (p < 0.001) were noted in the A-CXL group at 12 months. The DAI-CXL group showed a significant decrease in HCT, integrated radius (IR), and ARTh (p = 0.006, 0.011, 0.009, respectively) between baseline and postoperative assessments. Corvis Biomechanical Factor (CBiF) and E-stage remained stable in both groups.ConclusionDAI-CXL and A-CXL demonstrate comparable efficacy in achieving visual, topographic, and biomechanical stabilization in progressive keratoconus over a 12-month period.

There are some disputes regarding the necessity of maintaining a supine position after endothelial keratoplasty (EK) to ensure graft attachment. We aimed to evaluate the efficacy of a supine position after EK in reducing the risk of postoperative graft detachment. This systematic review with meta-analysis was registered in PROSPERO under protocol CRD42024541226. PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies comparing non-supine versus supine positions after EK. We pooled risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes and mean differences (MD) with 95% CI for continuous outcomes using a random-effects model. We included two randomized controlled trials and two observational studies comprising 456 eyes, of which 173 (37.9%) were assigned to non-supine positions. There were no significant differences in the incidence of graft detachment (RR 1.09; 95% CI 0.52-2.26; p = 0.82), rebubbling rate (RR 1.05; 95% CI 0.46-2.41; p = 0.90) and need for repeat keratoplasty (RR 2.37; 95% CI 0.13-41.99; p = 0.56) between non-supine and supine groups. There was also no difference in visual acuity (MD -0.02 LogMAR; 95% CI -0.11-0.08; p = 0.75) and intraocular pressure (MD -1.44 mmHg; 95% CI -8.49-5.61; p = 0.69) between groups. Subgroup analysis of DMEK (RR 0.73; 95% CI 0.38-1.42; p = 0.35) and DSAEK (RR 1.96; 95% CI 0.95-4.04; p = 0.07) also showed no difference in graft detachment between groups. Maintaining a supine position after EK surgery did not significantly affect graft detachment, rebubbling rate, need for repeat keratoplasty, visual acuity, or intraocular pressure.

PurposeTo compare and evaluate the diagnostic performance of OCT-angiography (OCT-A) parameters in diabetic retinopathy (DR) detection compared to fluorescein angiography (FA).MethodsThis is a cross-sectional, prospective study including 118 diabetic patients (214 eyes). All patients had a complete clinical examination with FA as well as macular OCT-A imaging (3 × 3 mm, 6 × 6 mm). We compared the detection of fundamental DR lesions using both imaging modalities and assessed the diagnostic value of different OCT-A parameters.ResultsMicroaneurysms were more frequently detected by FA than with OCT-A. Intraretinal microvascular anomalies were equally visualized by OCT-A (0.27 ± 0.777) and FA (0.27 ± 0.71). Average of foveal avascular zone (FAZ) surface was less significant at superficial capillary plexus (SCP) (0.353 ± 0.107 mm²) compared to deep capillary plexus (DCP) (0.537 ± 0,135 mm²), (p < 0.001). FAZ remodeling was observed even in DR free eyes and was better identified in DCP (61.1%) than SCP (47.2%). Loss of FAZ circularity was estimated at 0.792 ± 0.081 and 0.741 ± 0.107 respectively in SCP and DCP, (p < 0.001). Average surface area of capillary non-perfusion zones (CNPZ) was 0.487 ± 0.514 mm² in SCP and 0.145 ± 0.223 mm² in DCP, (p < 0.001). The Most reliable OCT-A quantitative parameters for DR screening were: CNPZ surface in DCP (p = 0.0046), total vascular density (VDt) in the DCP (p = 0.003) and CNPZ surface in the SCP (p = 0.0027).ConclusionOCT-A enables diabetic microvascular abnormalities detection even at a preclinical stage. Certain OCT-A parameters may provide a valuable quantitative approach for diagnosis and grading of DR severity.

AimTo determine the value of central choroidal thickness (CCT) as a clinical marker in differentiating peripheral retinoschisis (PRS) and macula-on rhegmatogenous retinal detachments (mac-on RRD).MethodsIn this cross-sectional study, eyes with PRS from January 2012 to May 2021 and mac-on RRD from January 2017 to January 2019 were identified. Macular pathology was exclusionary. CCT was classified as thin, normal, or thick for all eyes. Primary outcomes assessed the proportion of eyes within each diagnostic category with thin, normal, and thick CCT.ResultsOne-hundred and sixty eyes with PRS and 59 eyes with mac-on RRD were identified. Thick (65.6%) or normal (25.0%) CCT was noted in 90.6% of eyes with PRS, while only 9.4% had thin CCT. Thin (52.5%) or normal (30.5%) CCT was noted in 83.0% of eyes with mac-on RRD, whereas only 17.0% had thick CCT's. Thick CCT was significantly observed in PRS (p < 0.0001), while thin CCT was significantly observed in mac-on RRD (p < 0.0001).ConclusionIn the absence of known refractive error or axial length, CCT may serve as a useful and readily available diagnostic tool when attempting to distinguish between two often clinically similar retinal pathologies - PRS and mac-on RRD.

IntroductionConjunctival involvement in sarcoidosis typically presents as non-scarring granulomatous inflammation; however, cicatricial conjunctivitis represents a rare and poorly characterised manifestation. There are currently no published reports of sarcoid-related conjunctival granulomas with cicatrising features responding to anti-TNF therapy. We present the first case of biopsy-confirmed conjunctival sarcoidosis with progressive scarring successfully treated with adalimumab after failure of conventional immunosuppression.Case DescriptionA 47-year-old male with biopsy-proven systemic sarcoidosis presented with recurrent anterior uveitis and progressive conjunctival granulomas, unresponsive to corticosteroids and mycophenolate. He developed forniceal foreshortening, symblepharon formation, and a dense cataract. Conjunctival biopsy confirmed non-necrotizing granulomatous inflammation. Adalimumab was initiated following disease progression on conventional therapy. Within six months, ocular surface inflammation resolved, enabling successful cataract surgery and visual rehabilitation.ConclusionTo our knowledge, this is the first documented case of sarcoid-related cicatricial conjunctivitis with histological confirmation responding favourably to anti-TNF therapy. This report suggests adalimumab may be a valuable option in cases of treatment-resistant ocular surface sarcoidosis and may guide future therapeutic decision-making.

PurposeSinonasal mucosal melanoma (SNMM) accounts for approximately 4-8% of sinonasal malignancies. SNMM frequently originates in the nasal cavity, causing nonspecific nasal symptoms that inevitably delay diagnosis. Left untreated, the tumor may extend into the orbit.Case DescriptionHerein, the authors describe two patients presenting with compressive optic neuropathy and were found to have advanced SNMM involving the orbit. Both patients presented with vision loss, decreased color vision, proptosis, conjunctival chemosis, and restricted extraocular movements. One patient was found to have a relative afferent pupillary defect. Neither patient was a surgical candidate, and both received palliative radiotherapy and immunotherapy.ConclusionsThese cases and literature review demonstrate the potential for the disease to initially manifest with orbital extension and ocular symptoms. Ophthalmologists can play a crucial role in the early detection of SNMM, which may improve outcomes, given the challenges of SNMM treatment.

ObjectiveTo analyze and compare the accuracy of different intraocular lens power calculation formulas in patients with cataract after radial keratotomy.MethodsWeb of Science, Cochrane Library, EMBASE and PubMed were searched for clinical studies published from the establishment of the database to 10th May 2024. Measurements were taken as percentage of eyes of prediction errors within ±0.5 D and ±1.0 D. A network meta-analysis was utilized to compare the different formulas as a way to identify the most advantageous ones.ResultsResults from 11 studies of 674 eyes after radial keratotomy that used 24 formulas were included. A network meta-analysis indicated that for error within the range of ± 0.5 D, Barrett true-K History and Barrett true-K Partial History were better than Double-K Holladay 1. Intraoperative Aberrometry, Double-K SRK/T, Haigis and Barrett true-K No History performed as well or better than Double-K Holladay 1. Shammas No History and Holladay 1 had poor performance. For error within the range of ±1.0 D, Shammas No History and Barrett Universal II had poor performance. No statistically significant difference was observed between the other formulas.ConclusionsFor cataract patients after radial keratotomy, Barrett true-K History and Barrett true-K Partial History were recommended if the prior medical history were available. Otherwise, no single formula is more advantageous without reference to prior medical history.

PurposeTo present the first case of multifocal vitelliform paravascular retinopathy (MVPR) identified in Turkey and to describe its multimodal imaging features and clinical course.MethodsA 59-year-old woman underwent a routine ophthalmic examination during evaluation for a chalazion. Comprehensive multimodal imaging, including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), and fluorescein angiography (FA), was performed.ResultsBest-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple, small, round, yellow-white lesions distributed along the vascular arcades and surrounding the macula bilaterally. FAF showed predominantly hypoautofluorescent lesions with areas of mixed hypo- and hyperautofluorescence. OCT sections through the lesions demonstrated disruption of the ellipsoid zone and dome-shaped hyporeflective cavities in the outer retina, while FA revealed hyperfluorescent lesions ( Figure 1). The patient had a history of diabetes and hypertension but no other systemic or ocular disease. Laboratory and systemic imaging findings were unremarkable. Full-field ERG and EOG were within normal limits.ConclusionThis case represents the first reported instance of MVPR in Turkey. The imaging features and benign, asymptomatic clinical course were consistent with those of previously reported MVPR cases. Further studies are required to clarify the underlying pathophysiology and long-term prognosis of this newly described condition.