European Journal of Ophthalmology最新文献

PurposeMelkersson-Rosenthal Syndrome is a rare neuro-mucocutaneous disease characterised by recurrent orofacial swelling, facial palsy and lingua plicata. Patients often do not present with the complete triad of symptoms which can make this a diagnostic challenge. We present three cases of suspected MRS seen in our tertiary eye unit, highlighting the challenges in diagnosis and management of MRS.Case descriptionsCase 1 is a 54-year-old female with a background of neuro-sarcoidosis who presented with a several year history of bilateral upper lid swelling and recurrent facial nerve palsy. She experienced complete resolution of symptoms after a period of observation.Case 2 is a 49-year-old female who had a one-year history of recurrent facial nerve palsy associated with facial, neck and lip swelling. She was treated with oral steroids but did not experience complete remission.Case 3 is a 74-year-old female who presented with an 18-month history of bilateral peri-orbital swelling. Biopsy of skin and orbicularis showed granulomatous inflammation. She was treated with oral non-steroid anti-inflammatories as well as topical and oral steroids but without complete resolution.ConclusionMRS is a rare but important differential in patients with recurrent peri-orbital swelling. Given the recurrent nature of MRS and its associations with severe systemic diseases, early recognition and a multi-disciplinary approach is essential to diagnosis and management.

PurposeTo describe the demographic profile and clinical features associated with upper eyelid (UL) hyperlaxity in the Indian subcontinent.MethodsRetrospective chart review of 100 consecutive patients with UL hyperlaxity, presenting at a tertiary eye centre in India, between January 2016 to February 2022. The data collected included the demographics, clinical features including the ophthalmic and systemic manifestations, and management outcomes.ResultsThe average age at presentation was 42.71 (±18.73) years. Majority were males (83%). Syndromic associations included Down's syndrome (2%) and Ehler-Danlos syndrome (1%). Of the 45 investigated, obstructive sleep apnea was diagnosed in 24% cases. Adnexal manifestations included concurrent lower eyelid laxity (70%), blepharoptosis (41%) of which 38% were aponeurotic, lower eyelid retraction (37%), chalazia (25%) of which 58% were either recurrent, multiple, or both, lacrimal gland (LG) prolapse (11%), lash ptosis (11%), lower eyelid ectropion (8%), entropion (5%), and recurrent dacryoadenitis (3%). Chronic papillary conjunctivitis (66%) was the most common ocular surface abnormality followed by meibomian gland dysfunction (31%). Seven cases (7%) had eyelid imbrication syndrome (EIS), of which 60% had retinopathy of prematurity. Surgical management was recommended in 25% cases, indications being ptosis (13%), generalized eyelid laxity (11%), and recurrent globe luxation (2%).ConclusionUL hyperlaxity can be associated with a myriad of ophthalmic manifestations. One should look for novel findings such as EIS, dacryoadenitis, LG prolapse, and lower eyelid retraction in these cases.

PurposeThe aim of this article is to describe the outcomes of a case series using our own variation of the four-petal evisceration technique which may minimize the rate of orbital implant exposure through a simple approach.MethodsOur new technique consists of incompletely dividing the first two scleral flaps, thus creating four incomplete petals that can be sutured over the orbital implant. A case series with a minimum follow-up of 12 months is reported.ResultsOne hundred and twenty-two eyes of 121 patients who underwent evisceration surgery using the described technique are included. No cases of implant exposure or extrusion were observed, and an ocular prosthesis could be adapted in all cases with no complications during a minimum follow-up of 12 months.ConclusionsThe modified "incomplete" four-petal evisceration technique is a safe and accessible technique that may help prevent orbital implant exposure and can be considered a valid alternative in various clinical scenarios.

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.