European Journal of Ophthalmology最新文献

PurposePressure-Induced Stromal Keratopathy (PISK) is a rare complication of Laser in situ keratomileusis (LASIK), in which rapid diagnosis and management is crucial to avoid potential severe complications. We report the case of a PISK where the interface fluid disappeared immediately after single 30-gauge needle paracentesis.MethodsA 56-year-old man asked for refractive surgery in his left eye (LE). He reported an old blunt trauma that had required cataract surgery many years before. The endothelial cell count was 1241 cells/mm². After a first uneventful femtoLASIK treatment a refractive error persisted, therefore flap lifting retreatment was performed. At the one-week postoperative evaluation, PISK was detected, with an intraocular pressure (IOP, rebound tonometer) of 14 mmHg at the centre of the cornea and 31 mmHg at the peripheral cornea.ResultsWe immediately performed corneal 30-gauge needle paracentesis, which allowed the IOP to lower. Our patient reported rapid subjective vision improvement within the first 30 min and almost complete fluid absorption from the flap interface was noticed after 3 h. A single topical hypotensive drug was then prescribed to avoid any further IOP rise. Three weeks after the procedure the visual acuity was almost fully restored with only a mild residual refractive error.ConclusionThe ocular paracentesis was effective in treating PISK in this case. It could be considered to achieve a rapid IOP lowering in PISK, followed by topical hypotensive drugs to maintain the result. The rebound tonometer proved to be very effective in obtaining a peripheral IOP measurement in this case.

PurposeWet lab training on animal eye and surgical simulators are being utilized to enhance surgical outcomes and reduce complications. The study aimed to determine the effectiveness of structured surgical simulator training in improving the phacoemulsification surgery skills of ophthalmology residents.MethodsA retrospective study of the resident cataract surgical program from November 2019 to November 2022. The residents during our study period were categorized into two groups: Group A, representing the period without mandatory wet-lab/simulator training, and Group B, representing the period following the introduction of mandatory wet-lab/ simulator training before supervised surgeries in the operating room. Preoperative, intraoperative, and postoperative surgical data was collected and analyzed. The performance of resident cataract surgery in the two groups was compared. Outcome measures were the incidence of complications and mentor takeover rate.ResultsA total of 227 eyes were included in the study, 126 in group A and 101 in group B. Posterior capsule rupture was seen in 11 patients (8.73%) in Group A and 8 patients (5.94%) in Group B (P = 0.82) with a significantly lower need for surgeon takeover (26 cases (18.6%) in Group A and 9 cases (10.8%) in Group B (p = 0.015). Overall intraoperative and postoperative complication rates were lower in Group B (p = 0.18).ConclusionThese findings emphasize that integrating wet lab/simulator-based training into residency programs increases surgical independence of residents.

PurposeTo present the clinical and multimodal imaging features of three patients diagnosed with stellate multiform amelanotic choroidopathy (SMACH), a recently described, rare chorioretinal entity.MethodsCase series.ResultsAll patients, aged 5, 10, and 38 years, presented with unilateral, yellowish choroidal lesions extending from the fovea toward the temporal macula. Multimodal imaging was used for diagnosis. Structural disorganization of the subfoveal choroid with irregular, undulating hyperreflective alterations of the retinal pigment epithelium/Bruch's membrane complex with focal protrusions was noted in all patients, while subretinal fluid (SRF) was present in two patients at presentation on optical coherence tomography (OCT). No patient had systemic findings. The first and the third cases received intravitreal bevacizumab injections and the SRF persisted with fluctuations in both patients. In the second case, although there was no SRF initially, it occurred with fluctuations during follow-up. Throughout the follow-up periods, visual acuities remained stable in all patients without any additional treatment.ConclusionSMACH should be considered in the differential diagnosis of choroidal structural disorganization, particularly in young patients. Notably, one patient was 5 years old, which represents the youngest age reported to date. Multimodal imaging modalities are essential for the recognition of the disease and a confirmed diagnosis of SMACH may prevent unnecessary treatments such as intravitreal injections and photodynamic therapy.

PurposeTo evaluate the functional and structural outcomes in patients with neovascular age-related macular degeneration (nAMD) switched from ranibizumab or aflibercept to bevacizumab.MethodsThis retrospective study included 197 eyes of 192 patients (mean age 83 ± 6 years; 38% male). Patients previously treated with ranibizumab (n = 79) or aflibercept (n = 118) were transitioned to bevacizumab. Best-corrected visual acuity (BCVA) was recorded with ETDRS charts and converted to logMAR. Spectralis SD-OCT was used to evaluate intraretinal and subretinal fluid, presence of retinal pigment epithelium detachment (PED), PED height and central retinal thickness (CRT) at baseline and after 6 months.ResultsMean BCVA decreased from 0.4 ± 0.3 to 0.5 ± 0.4 logMAR (p = 0.048). The proportion of eyes with intraretinal or subretinal fluid rose from 27% to 69% (p = 0.017). Subgroup analysis indicated greater functional and structural worsening in younger patients and in those switched from aflibercept. Mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091), mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091). In contrast, mean CRT increased substantially from 294 ± 30 µm at baseline to 310 ± 26 at 6 months (p (p < 1 × 10^-7).ConclusionsSwitching from ranibizumab or aflibercept to bevacizumab may lead to reduced visual function and an increase in structural-OCT markers of disease activity, including greater intraretinal/subretinal fluid, CRT and worsening PED features, particularly in younger individuals and in eyes previously treated with aflibercept.

BackgroundPolyhexamethylene biguanide (PHMB) 0.08% has received the orphan drug designation for management of Acanthamoeba keratitis (AK). This review aimed to evaluate the clinical efficacy and safety of PHMB, comparing outcomes across different concentrations (0.08% vs. 0.02%) using a dose-stratified meta-analysis.MethodsOnline databases were searched until February 2025 for studies on PHMB 0.02% or 0.08% as mono- or combination therapy. The primary outcome was clinical cure and secondary outcomes included conjunctival hyperemia and pain. Subgroup analyses were performed based on PHMB concentration. A random-effects model was applied; sensitivity analyses and publication bias assessments were conducted.ResultsThe pooled proportion of cure across 17 studies (923 eyes) was 75.75% (95% CI: 64.56%-84.27%; p < 0.0001; I² = 85.2%). Subgroup analysis showed the highest cure rate with PHMB 0.08% monotherapy (87.04%; 95% CI: 77.54%-92.88%), followed by 0.02% monotherapy (79.27%; 95% CI: 65.29%-88.60%) and mixed 0.02% regimens (72.59%; 95% CI: 54.86%-85.23%). Conjunctival hyperemia was reported in 15.7%, and subgroup analysis by dose revealed highest prevalence in the 0.08% PHMB group (26.4%; 95% CI: 8.4%-49.2%). Pain was reported in 11.9% (n = 225), with no significant increase at higher concentrations. The pooled proportion of overall adverse events was 40.2% (95% CI 26.2%-55.0%; p < 0.0001; I² = 81.4%). Findings were robust across sensitivity analyses, with no publication bias detected.ConclusionThis dose-stratified meta-analysis found PHMB 0.08% monotherapy to have good efficacy and tolerability, supporting its use as a first-line empirical treatment and underscoring the need for standardized protocols and comparative trials.

BackgroundNormal tension glaucoma (NTG) is a common subtype of glaucoma that progresses silently and can lead to irreversible vision loss if left untreated. Emerging evidence suggests that inflammation and vascular dysfunction may play a role in its pathogenesis. C-reactive protein (CRP), a marker of systemic inflammation and atherosclerosis, has been widely studied as a prognostic indicator in various diseases. However, its potential association with NTG remains unclear. This meta-analysis aims to clarify the relationship between CRP levels in individuals with NTG compared to those without the condition.MethodsWe systematically searched PubMed, Embase, and Scopus for observational studies published up to 31 October 2023 investigating CRP levels in NTG patients and controls. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Eligible studies reporting CRP levels were analyzed using standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA meta-analysis of ten case-control studies involving 766 patients revealed that CRP levels were significantly higher in the NTG group compared to controls (SMD: 0.731, 95% CI: 0.147-1.316 ; z = 2.454; P = 0.014). However, no significant difference in CRP levels was observed between the POAG group and controls (SMD = 0.093; 95% CI: -0.160-0.345; z = 0.719; P = 0.472).ConclusionElevated circulating CRP levels were significantly associated with NTG, suggesting a potential systemic inflammatory contribution to its pathogenesis. Although CRP may serve as an adjunctive marker for identifying high-risk individuals, its clinical value remains provisional and requires confirmation in future prospective studies.

BackgroundTo describe the characteristics and outcomes of endoresection in patients with uveal melanoma previously treated with ruthenium brachytherapy or proton beam therapy.MethodsIn this retrospective study, data on the indication to perform endoresection, best-corrected visual acuity, tumor characteristics, surgery details, and characteristics of ruthenium brachytherapy or proton beam therapy were obtained.ResultsA total of 27 patients (12 men and 15 women) were included, with a median age of 63.5 (range 50.5) years. The indication for endoresection was exudative retinal detachment in 20 patients, glaucoma induced by tumor bleeding in 6 patients, and persistent inflammation in 1 patient. Ruthenium brachytherapy was performed in 6 patients, while 21 patients received proton beam therapy. In the ruthenium group, mean visual acuity before endoresection in Snellen was 0.099 ± 0.197, which increased to 0.285 ± 0.302 after endoresection (p = 0.043). In the proton beam group, mean visual acuity before endoresection was 0.030 ± 0.044, which decreased to 0.020 ± 0.036 after endoresection (p = 0.546). Mean change in visual acuity before and after endoresection was +0.186 ± 0.249 in the ruthenium group and -0.009 ± 0.053 in the proton beam group. Enucleation had to be performed in 1 eye in the ruthenium group and 8 eyes in the proton beam group. No surgery-related vascular events were observed.ConclusionsPatients previously treated with ruthenium brachytherapy have favorable post-endoresection outcomes, opposed to those treated with proton beam therapy. Patient-specific counselling is important before endoresection, as there is a wide variety in expected outcomes.

ObjectiveTo assess baseline pigment epithelial detachment (PED) and other OCT biomarkers for predicting response to faricimab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD).DesignThis was an observational, retrospective, single-arm, monocentric cohort study.Subjects and methodsFifty-seven eyes of 51 patients with naive nAMD-associated PED and treated with faricimab were included in the study. Best-corrected visual acuity (BCVA) and OCT were performed at baseline, monthly until Month 4, and at Months 6, 9, and 12. Fluid volume dynamics and other OCT biomarkers were quantified using an AI-based tool.ResultsAt Month 12, mean BCVA increased by 4 letters (P < 0.01), mean CRT decreased by 66.2 µm (P < 0.0001), and mean maximum PED height decreased by 70.4 µm (P < 0.001). AI-based PED dynamics showed rapid and sustained reductions from 488.2 nL at baseline to 166.6 nL at Month 12 (P < 0.0001), with more profound reductions in serous versus fibrous PED volume. All AI-quantified OCT biomarkers were significantly (P < 0.0001) changed from baseline after the loading phase. OCT biomarkers, PED, and fluid dynamics during the loading phase were correlated with functional and anatomic outcomes at Month 4 and Month 12.ConclusionsFaricimab had a rapid, profound and sustained drying effect on the retinas of eyes with nAMD and PED, with marked reductions in OCT biomarkers after loading and sustained to Month 12. These improvements coincided with significant improvements in BCVA. PED height, type, and volume at baseline correlated with short- and long-term treatment outcomes.