European Journal of Ophthalmology最新文献

Objective: To investigate the prevalence of anxiety and depression, and explore their related factors in all types of diabetic retinopathy (DR) patients more precisely and accurately by multiple scales.

Methods: Beck anxiety inventory (BAI), self-rating anxiety scale (SAS), beck depression inventory (BDI), and self-rating depression scale (SDS) scores were assessed in 247 DR patients and 250 non-retinopathic diabetes mellitus (NRDM) patients.

Results: In DR patients, there were 32 patients with proliferative DR and 115 patients with impaired visual acuity. The prevalences (95% confidence interval) of anxiety were 38.5% (32.4%-44.6%) and 32.0% (26.2%-37.8%) by BAI and SAS, while those for depression were 31.6% (25.8%-37.4%) and 25.1% (19.7%-30.5%) by BDI and SDS in DR patients. BAI score (P = 0.003), BAI-defined anxiety rate (P = 0.010), SAS score (P = 0.001), SAS-defined anxiety rate (P = 0.006), BDI score (P = 0.005), BDI-defined depression rate (P = 0.028), and SDS score (P = 0.001) were increased in DR patients versus NRDM patients. In DR patients, proliferative DR independently related to BAI-defined anxiety (P < 0.001) and SAS-defined anxiety (P < 0.001). Female (P = 0.016) and proliferative DR (P < 0.001) independently associated with BDI-defined depression; female (P = 0.007), DM duration (P = 0.025), triglyceride (TG) (P = 0.026), and proliferative DR (P = 0.014) independently associated with SDS-defined depression. The combination of these independent factors showed acceptable abilities in predicting BAI-defined anxiety, SAS-defined anxiety, BDI-defined depression, or SDS-defined depression in DR patients, with area under curves of 0.626, 0.656, 0.696, and 0.741, respectively (all P < 0.001).

Conclusion: Anxiety and depression are prevalent; meanwhile, proliferative DR, female, DM duration, and TG independently relate to anxiety or depression in DR patients.

Objectives: This study aims to analyze the impact of longest treatment-free interval (TFI) between anti-vascular endothelial growth factor (anti-VEGF) injections during the first year of treatment on 5-year best-corrected visual acuity (BCVA) and recurrence of macular edema (ME) in eyes with ME secondary to branch retinal vein occlusion (BRVO).

Methods: A retrospective study including eyes with BRVO, minimum of 5-year follow-up, and available optical coherence topography (OCT) scans. Eyes underwent anti-VEGF loading dose therapy and were treated and monitored with an OCT-guided PRN regimen. Those with a history of ocular comorbidities were excluded.

Results: Total of 60 patient eyes, with 40 females and average age of 71.75 ± 11.07 years. TFI among eyes was 1 month (20%); > 1-2 months (23%); > 2-3 months (18%); > 3-4 months (17%), and >4 months (22%). Forty-three (72%) eyes experienced ME recurrence during the five-year period. Multivariate linear regression shows that TFI (-0.02 [-0.03-0.00], p = 0.021) and baseline BCVA (0.37 [0.08-0.66], p = 0.014) are significant predictors of 5-year BCVA. TFI (Cox Proportional Hazard Ratio 1.34 [1.04-1.72], p = 0.023) and number of injections in the first year (Cox Proportional Hazard Ratio 1.76 [1.01-3.06], p = 0.045) were significant predictors of ME recurrence. Gender, age, type of injection, BCVA, and CMT did not influence recurrence.

Conclusion: For eyes receiving anti-VEGF injections to treat ME secondary to BRVO, TFI is a significant predictor of 5-year BCVA and ME recurrence according to regression models. This study suggests more ME recurrence may be due to increased TFI or indicate more injections needed to treat severe BRVO.

Purpose. To report a rare case of Rosai-Dorfman-Destombes (RDD) disease in a teenage girl exhibiting mild fever, night chills, vertigo, and progressive bilateral vision and hearing loss. Method. Case report of a 15-year-old girl who underwent extensive ophthalmic multimodal imaging and a comprehensive workup evaluation. Results. Multiple choroid lesion masses in both eyes associated with systemic multifocal lymphadenopathy, involvement of the paranasal sinuses, and unusual intracranial manifestations well-shown by magnetic resonance imaging (MRI) and whole-body PET-scan. The PET-Scan and MRI imaging showed dural-based intracranial lesions, choroid-plexus signaling, and meningeal spread, as well as a focus on the paranasal sinuses, which helped determine the best biopsy location for a definitive diagnosis through immunohistochemistry. Conclusions. Here we describe a rare condition of RDD disease with bilateral visual and hearing loss associated with bilateral multiple choroid masses and neurological symptoms in an adolescent female patient. A definitive diagnosis relied on histological assessment, emphasizing the importance of interdisciplinary evaluation. RDD should be considered in the differential diagnosis of choroidal metastasis, tuberculosis, and other lymphoproliferative diseases.

Purpose: We herein report a case of subacute-onset rhino-orbital mucormycosis (ROM) in an acute leukemia patent caused by the rare but most lethal pathogenic fungus - Cunninghamella. To the best of our knowledge, this is the first case of ROM caused by Cunninghamella reported in China.

Case description: A 50-year-old Chinese female with acute leukemia (M2 type) who, following the completion of two cycles of chemotherapy, began to exhibit naso-ocular symptoms. The patient was initially diagnosed with extramedullary leukemia. As the disease progressed, the patient began to develop specific black crust-like necrosis of the right eyelids. Following multidisciplinary treatment (MDT) consultation and tissue biopsy, the patient was finally diagnosed with a rare type of ROM caused by Cunninghamella infection. Although the mortality associated with Cunninghamella infection was significantly greater than that associated with infections caused by other Mucorales, the infection was eventually controlled through the adjustment of the antifungal drug regimen and timely surgical intervention.

Conclusions: ROM infection with Cunninghamella is an extremely rare and fatal fungal infection, and early recognition and diagnosis of the disease is critical to the prognosis. The subacute nature of this case may have been a positive factor in the patient's preservation of life.

Purpose: To describe an alternative technique used in massive post-traumatic cyclodialysis. Classic techniques such as direct cyclopexy are performed ab externo and entail a higher risk of endophthalmitis or ciliary body hemorrhage. Therefore we present a case report using combined sewing machine technique cyclopexy with transscleral diode cyclophotocoagulation for complete post-traumatic cyclodialysis.

Patients: Our patient is a 43-year-old woman who suffered a blunt trauma 9 months ago from an air-bag blunt in a car accident.

Methods: Technique report.

Results: Two weeks post-surgery, there has been an elevation in intraocular pressure (IOP), and the cyclodialysis has been resolved. Additionally, signs of macular hypotony, such as optic nerve head edema and vascular tortuosity, have disappeared. As anticipated, the disappearance of chorioretinal folds occurred later but has also been observed. Furthermore, the best corrected visual acuity has been improved and the induced hyperopia has been corrected from +5 (-1.75 × 20°) to +1.5 (-1.75 × 20°).

Conclusions: Combined sewing machine technique cyclopexy with transscleral diode cyclophotocoagulation for complete post-traumatic cyclodialysis could be an alternative surgical improvement to both direct and indirect cyclopexy. It entails fewer complications, such as endophthalmitis, and offers favorable aesthetic outcomes along with enhanced intraoperative visualization.

Introduction: A concave iris configuration is a characteristic feature of pigment dispersion syndrome (PDS). Therapeutic strategies to modify this configuration may be considered as first-line options for the treatment of ocular hypertension in PDS patients.

Case description: A 37-year-old male patient with myopic anisometropia presented bilateral PDS with concave iris, Krukenberg's spindle and iris transillumination defect in both eyes. The intraocular pressure (IOP) was 27 mmHg in both eyes. Optic nerve and visual field parameters were normal. The right eye was treated with a neodymium:YAG LPI. In the left eye, an implantable collamer lens (ICL) V4c model implantation for myopia correction was performed. Six-months postoperatively, both eyes evidenced an anteriorization of the iris, the morphology of the concave iris improved with the ICL V4c in place, becaming flattener in left eye. The IOP was 18 mmHg without treatment.

Conclusion: This case report reinforces the idea that in myopic patients with a concave iris, the refractive correction approach through ICL V4c implantation might also improve the iris configuration, similarly to laser peripheral iridotomy (LPI). Therefore, in this specific patient profile, this surgical procedure might be considered as a prophylactic treatment alternative to prevent the complications associated with this iris configuration, although its invasive nature should be taken into consideration.

Purpose: This study investigates the natural progression of quiescent macular neovascularization (qMNV) using optical coherence tomography angiography (OCTA).

Methods: The study monitored 30 eyes of 28 qMNV patients over a period of at least six months. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCTA were used to perform qualitative and quantitative analyses, noting any cases of activation during follow-up.

Results: Among the 30 eyes (14 female, mean age 69.70 ± 7.63 years), 21 had age-related macular degeneration (AMD) and 9 had pachychoroid neovasculopathy (PNV). The mean follow-up duration was 18.9 months. There were no significant changes in qualitative morphological features, BCVA, or choroidal thickness (p > 0.05). However, there was a statistically significant increase in the areas of MNV and flow (p = 0.043 and p = 0.018, respectively). BCVA and MNV area showed no significant correlation (p = 0.103). Four cases (13.33%) showed activation after an average follow-up period of 27.75 months (6 to 48). Additionally, extrafoveal location was identified as a significant risk factor for exudation (p = 0.033).

Conclusion: OCTA is a valuable tool for monitoring qMNV and identifying potential predictors of disease activation. The qMNV area may increase over time, even in the absence of activation. Extrafoveal location appears to be a potential risk factor for qMNV activation.

Purpose: To evaluate photobiomodulation (PBM) safety and efficacy in patient with atrophic AMD and to explore tissue effects using Spectrally Resolved Autofluorescence (SrAF) to identify a potential biomarker indicative of mitochondrial activity, the primary PBM target.

Methods: This retrospective, non-comparative case series involved six eyes of five patients with atrophic AMD, conducted at the Medical Retina and Imaging Unit, IRCCS San Raffaele Hospital in Milan, Italy. At baseline and follow-ups (after one and three months) a complete ophthalmological assessment and multimodal imaging, including spectrally resolved autofluorescence (SrAF), were performed. PBM treatment (Valeda Light Delivery System - LumiThera) was administered in nine sessions over three weeks. The SrAF images were analyzed to evaluate the effect of the treatment.

Results: Six eyes of five patients with atrophic AMD received PBM at baseline. Best corrected visual acuity (BCVA), mean central macular thickness (CMT), mean retinal sensitivity on microperimetry and the atrophic area have remained stable. No eyes developed foveal atrophy after the treatment. The image analysis in SrAF showed an increase in the highlighted area of 4.89% after one month and 17.11% after three months. No adverse systemic or local side effects were reported.

Conclusion: PBM is a safe treatment for the human retina. The evaluation of the retinal area within the green light spectrum (575 nm) in SrAF is a potential indirect biomarker of mitochondrial activity and could be used to assess treatment efficacy in clinical studies.