European Journal of Ophthalmology最新文献

PurposeTo evaluate the alterations in the Schlemm's canal (SC) and trabecular meshwork (TM) morphology after phacoemulsification surgery in pseudoexfoliative glaucoma (PEXG) patients with swept-source optical coherence tomography (OCT).MethodsIn this retrospective comparative study, patients with PEXG and visually healthy individuals with cataract who underwent phacoemulsification and intraocular lens implantation surgery were included. Anterior segment OCT measurements and intraocular pressures (IOPs) were recorded at the first visit before surgery and at postoperative 1-month visits. Manual measurements obtained from OCT were as follows: SC-diameters; anteroposterior and radial SC diameter (SC-APD, SC-RD); cross-sectional area of SC (SC-CSA); and TM height (TM-H) and cross-sectional area of TM (TM-CSA).ResultsSixty-three eyes of 63 subjects were included in the study, with 43 patients having PEXG and 20 patients serving as controls. There was a significant decrease in IOP after surgery in the PEXG eyes (p < 0.001). Preoperatively, SC-diameters were significantly lower in PEXG eyes than in the control group (p < 0.001). After surgery, SC-diameters had increased significantly in PEXG eyes (p < 0.001). At the preoperative visit, TM-CSA and TM-H were higher in PEXG eyes than in the control group, but only TM-H showed a statistically significant difference (p = 0.199 and p = 0.015, respectively). There was a significant reduction in TM-CSA and TM-H in PEXG eyes after surgery (p < 0.001 and p = 0.024, respectively).ConclusionThe study showed that both SC dimensions and area increased and TM-H and TM-CSA decreased after phacoemulsification surgery in PEXG eyes. There was a significant correlation between these changes and postoperative IOP in PEXG eyes.

PurposeTo explore the emotional and social burden of congenital aniridia in patients and caregivers through narrative medicine.MethodsPatients with congenital aniridia and their caregivers were enrolled in a multicentric observational study. Sociodemographic data and personal narratives were collected through interviews or written accounts. A qualitative analysis was conducted and overarching themes identified.ResultsA total of 57 narratives were collected (31 patients, 27 caregivers). Participants reported visiting an average of 5.1 ± 5.9 healthcare facilities over their lifetime. Aniridia impacted work or school life in 39% of patients and 58% of caregivers. Most narratives focused on the lived experience of illness (95% patients, 81% caregivers) or on social perception (48% and 46%), rather than on clinical aspects (10% and 23%). Adaptation to the disease was mainly stable or progressive among adults. Emerging themes included independence, feeling misunderstood, and bullying. Caregivers emphasized the lack of specialized centers, standardized protocols, adequately trained professionals, psychological and practical support, and the lack of humanity among doctors.ConclusionsCongenital aniridia leads to progressive visual impairment with significant emotional and social consequences. Narrative medicine offers valuable insight into patients' and caregivers' lived experiences, highlighting unmet needs and concerns often overlooked in conventional clinical practice.

PurposeThis study evaluated and compared changes in pachymetry measurements at different times after applying riboflavin 0.25%, lissamine green 0.5%, fluorescein 2%, and fluorescein 0.25% - lidocaine HCl 4% eye drops.MethodsCorneal pachymetry was assessed in thirty healthy volunteers (60 eyes) using a Galilei G6^® Dual Scheimpflug topographer. Baseline measurements were taken with and without saline. Thickness was measured at 1, 5, and 15 min after dye application.ResultsSignificant increases (p < 0.001) in Central Corneal Thickness (CCT) were observed following riboflavin instillation (N = 60, at 1 min: 17 ± 7.1 µm; at 5 min: 7.1 ± 6.9 µm), fluorescein 0.25% (N = 59, at 1 min: 14.8 ± 14.1 µm; at 5 min: 9.4 ± 7.4 µm; at 15 min: 5.2 ± 6.7 µm), and fluorescein 2% (N = 10, at 1 min: 20 ± 5.7 µm; at 5 min: 18.8 ± 7 µm; at 15 min: 11.2 ± 8.4 µm). There was a high number of artifacts in the measurements with 2% fluorescein (48 eyes), and only three patients showed no artifacts. Lissamine green (N = 58) did not significantly affect pachymetry measurements.ConclusionsRiboflavin 0.25% and fluorescein 0.25% temporarily overestimated pachymetry. Fluorescein 2% caused excessive artifacts, compromising reliability. Lissamine green 0.5% showed no influence in pachymetry. Characteristics from vital dyes should be considered according to programmed examinations when using a Dual Scheimpflug topographer.

IntroductionThe aim of this study was to analyze retinal changes using optical coherence tomography angiography (OCTA) in Macular Telangiectasia type-2 (MacTel-2).MethodsThis retrospective study included 65 MacTel-2 patients (122 eyes) and 65 age- and sex-matched healthy controls (122 eyes). All participants had complete examination notes with fundus autofluorescence, fluorescein angiography, optical coherence tomography, and OCTA. Foveal avascular zone (FAZ) parameters, vascular densities (VDs), and retinal thicknesses (RT) of MacTel-2 patients were compared with healthy eyes.ResultsAcircularity index (AI) and the FAZ perimeter were significantly higher in the MacTel-2 group (p = 0.006 and p = 0.04). There was a positive correlation between AI and logMAR (r = 0.287, p = 0.001). VDs in the foveal and perifoveal temporal quadrants of the superficial capillary plexus were lower in the MacTel-2 group (p < 0.001 and p = 0.021). VDs in the foveal and all parafoveal regions of the deep capillary plexus (DCP) were also decreased compared with the control group (p < 0.05 for all). Additionally, the mean RT in the fovea and all parafoveal regions was significantly lower in MacTel-2 patients compared to controls (p < 0.001 for all).ConclusionVascular density changes in MacTel-2 is seen more frequently in the DCP. Additionally, acircularity index showed a steady worsening with disease progression, suggesting its potential use as a marker.

PurposeThe aim of this research was to investigate the contribution of histatin peptides in the pathophysiology of keratoconus.MethodsThis prospective study investigated the presence of histatin peptides in corneal epithelial samples taken from 66 adult patients with keratoconus (stage 1, n = 22; stage 2, n = 21; and stage 3, n = 23) and 20 postmortem controls. The histatin-1, -3, and -5 levels were measured using the ELISA method.ResultsHistatin-3 significantly increased in stage 1 (control, 274.05 ± 15.72 ng/mg total protein, vs. patients, 528.17 ± 47.45 ng/mg total protein, p < 0.001) and stage 2 (374.33 ± 15.05 ng/mg total protein, p < 0.05), but no changes for histatin-1 and -5 levels were observed. Histopathological analysis showed that corneal epithelial cell thickness increased in keratoconus, and this increase augmented proportionally with the stages. The histopathological scores were significantly elevated in stages 2 and 3. Interestingly, positive correlations were observed between histatin-1 and histatin-3 levels in all stages.ConclusionThese preliminary data suggest that histatin-3 may be involved in the early stages of keratoconus. These findings are preliminary and should be confirmed in larger, prospective cohorts.

PurposeThis study aimed to develop a reproducible manual segmentation method using a computer-assisted technique and to (1) compare extraocular muscle volumes between TED patients and healthy controls and (2) assess the intra- and inter-observer reliability of this method.MethodsA retrospective study of MRI scans was performed on 13 patients previously diagnosed with TED and 16 healthy controls. Image segmentation and the derived muscle volume measurements were performed by two independent observers using the software 3D slicer. The groups compared muscle volumes, and intra- and inter-observer reproducibility was assessed.ResultsA statistically significant difference in muscle volume was demonstrated; the mean medial and lateral recti volumes in the TED group were 1342.75 and 1066.7 mm³, respectively, compared to 787.67 and 764.3 mm³ in the control group. The segmentation protocol appears to have good inter-observer reliability. The intraclass correlation coefficient was good for inter-observer measures of the medial recti and intra-observer measures of both horizontal recti.ConclusionThis volumetric analysis verifies that structural MRI contains useful information regarding muscle volume in patients with TED compared to healthy controls. Building a dataset of segmented MRI volumes will help facilitate the creation of supervised machine-learning models for automated volumetric analysis of the extraocular muscles.

PurposeOcular involvement is exceedingly uncommon, and to date, no conjunctival hibernoma has been reported in humans. We present the first such case in a patient with von Hippel-Lindau (VHL) syndrome.Case reportA 32-year-old woman with genetically confirmed type 1 VHL disease presented with a long-standing, progressively enlarging, painless subconjunctival mass in her only functional eye. Systemic history included multiple cerebellar hemangioblastomas, bilateral nephrectomy for renal cell carcinoma, and an endolymphatic sac tumor. Ophthalmic examination revealed a firm, elevated, subepithelial nodular lesion on the bulbar conjunctiva of the left eye, partially prolapsing beyond the palpebral fissure. The lesion was non-tender, non-ulcerated, and showed no surface inflammation. The eye had phthisis bulbi and residual retinal hemangioblastoma. Orbital magnetic resonance imaging demonstrated a 1.2 × 0.9 × 0.7 cm homogeneous, well-circumscribed lesion, hyperintense on T2-weighted fat-suppressed images, confined to the conjunctiva without scleral, orbital, or bony involvement. Surgical excision revealed a cream-gray, lobulated mass composed of multivacuolated eosinophilic cells with granular cytoplasm. Immunohistochemistry showed strong S-100 positivity and low Ki-67, consistent with hibernoma. Despite a positive deep margin, the patient declined further surgery; no recurrence was observed at three months.ConclusionThis is the first documented case of conjunctival hibernoma in humans and the second reported association with VHL. Conjunctival hibernoma should be considered in the differential diagnosis of vascular conjunctival lesions, particularly in patients with VHL.

PurposeTo evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with complete vitreous chamber fluid-air exchange via pars plana in vitrectomized patients with unstable compartmentalization between the anterior and posterior segment.MethodsThis case series presents a modified (full-filling) DSAEK technique, involving complete fluid-air exchange via pars plana, in six eyes with endothelial dysfunction and corneal edema who had undergone prior vitrectomy and lacked stable anterior-posterior segment compartmentalization (aphakic, iris-claw IOL, scleral fixed IOL, IOL in the ciliary sulcus). Preoperative and postoperative data, including visual acuity, corneal thickness, and endothelial cell density, were collected. The primary outcome was single-surgery graft adhesion; secondary outcomes included complications, re-bubbling rate, and visual acuity improvement.ResultsThe full-filling DSAEK technique achieved complete graft adhesion in all cases at all follow-up visits, with improved visual acuity and decreased corneal thickness. No major complications were recorded, including donor graft dislocation and need of rebubbling.ConclusionWhen performing DSAEK, completely filling the ocular cavity with air via pars plana is a safe and effective technique in poorly compartmentalized vitrectomized eyes to achieve graft adhesion and improving surgical success.