Indian Journal of Ophthalmology最新文献

Uveitis is an inflammatory condition involving the iris, ciliary body, and choroid, and it represents a significant cause of vision loss in both children and adults. The primary goals of uveitis management are to control inflammation, prevent recurrences, and minimize structural damage and subsequent visual impairment. Currently, corticosteroids remain the mainstay of therapy for noninfectious uveitis. In patients with sight-threatening disease, immunosuppressive or steroid-sparing agents are commonly employed. However, for individuals who are intolerant of or refractory to corticosteroids and conventional immunosuppressive therapies, biologic agents have emerged as effective alternative treatments. Among these, anti-tumor necrosis factor alpha (TNF-α) agents have demonstrated efficacy in both uveitis and systemic autoimmune disorders. Adalimumab, an anti-TNF-α agent, was the first biologic approved by the U.S. Food and Drug Administration for the treatment of noninfectious uveitis. Prior to initiating biologic therapy, potential safety concerns, including the risk of infections and demyelinating diseases, must be carefully evaluated. Other biologic agents, such as interferons, interleukin inhibitors, and Janus kinase inhibitors, are emerging as promising therapeutic options for noninfectious uveitis. Further studies are required to better establish the long-term safety and efficacy of biologic therapies. This review highlights the role and effectiveness of biologic agents in the management of noninfectious uveitis.

Purpose: To evaluate the clinical profile, surgical outcomes, and long-term complications of 25-gauge pars plana vitrectomy (PPV) in patients with fundal coloboma-associated retinal detachment (RD).

Methods: This interventional study included 60 eyes (30 retrospective, 30 prospective) of patients undergoing 25G microincision vitrectomy surgery for RD secondary to fundal coloboma. Anatomical and functional outcomes, adjunctive procedures, risk factors for redetachment, and long-term complications were analyzed over a follow-up period exceeding 12 months.

Results: The mean patient age was 18.4 ± 8.9 years, with a male predominance (65%). Bilateral fundal colobomas were seen in 85%, with Type 1 (Ida Mann classification) being most common (41.7%). Retinal breaks were localized to the intercalary membrane in 78.3%. Anatomical success post-primary surgery was achieved in 80%, with overall success of 94.7% following resurgery. Significant visual improvement was observed from preoperative logMAR 1.95 ± 0.27 to postoperative 1.42 ± 0.55 (P < 0.001). Risk factors for redetachment included prolonged RD duration, Type 2/3 fundal coloboma, and iatrogenic breaks (P < 0.05). Common postoperative complications included glaucoma (28.3%), silicone oil emulsification (25%), and cataract progression (21.7%).

Conclusion: 25G PPV is a safe and effective surgical modality for managing fundal coloboma-associated retinal detachment, demonstrating favorable anatomical and functional outcomes. The prospective design, consistent surgical technique, and involvement of a single experienced surgeon contribute to the robustness and reliability of the results. Given the notable incidence of complications such as glaucoma and silicone oil emulsification, sustained long-term follow-up remains essential.

Purpose: To evaluate clinical and histopathological characteristics and treatment outcomes of Morbihan disease (MD) of eyelids, a rare condition characterized by chronic erythematous edema.

Design: Retrospective study.

Methods: Clinical records of patients diagnosed with eyelid and facial MD were reviewed to assess clinical features, treatment outcomes, recurrence, and histopathological findings. Nonsurgical treatments were categorized as observation, oral steroids (oral group), intralesional steroid injections (injection group), and combination group. Treatment response was classified as complete (CR), partial (PR), or no response. Intralesional injections were subdivided into low-dose (<20 mg) and high-dose (≥20 mg). Recurrence was defined as erythematous edema reappearing after CR.

Results: The study included 67 patients (mean age, 54.3 ± 11.9 years; 65.7% male) with a mean follow-up of 1.69 ± 1.83 years. Of 57 patients who underwent nonsurgical treatments, significant differences in treatment response were observed among oral (n = 13), injection (n = 16), and combination (n = 28) groups (P < 0.001). Injection (56.2%) and combination (64.2%) groups showed higher response rates (CR or PR) than the oral group (38.4%) (P < 0.05). Recurrence was higher in the oral group (53.3%) than in the injection (26.7%) and combination (20.0%) groups (P = 0.018). High-dose injection showed better response than low-dose (70.8% vs. 50.0%, P = 0.017). Debulking surgery with blepharoplasty was performed in 23 patients (40.4%), with 91.3% achieving long-term control. Common histopathological findings included dermal edema (91.3%) and dilated lymphatic or blood vessels (60.8%).

Conclusions: Intralesional steroid injections, particularly at doses ≥20 mg, were more effective than oral steroids in treating eyelid MD. Eyelid debulking surgery is beneficial in refractory or recurrent cases.

Purpose: To assess the impact of omega-3 fatty acid (O3FA) supplements on tear inflammatory cytokines in dry eye patients with an omega-3 index below 4%.

Methods: This randomized controlled study involved 102 dry eye patients with an omega-3 index below 4%. Participants received either four capsules of O3FAs (325 mg eicosapentaenoic acid, 175 mg docosahexaenoic acid) or a placebo containing olive oil twice daily for 6 months. Patients were evaluated at baseline and 1, 3, and 6 months. The primary outcome measured changes in tear cytokines (IL-1β, IL2, IL4, IL5, IL6, IL8, IL10, IF-γ, and TNF-α). Secondary outcomes included improvements in dry eye symptoms, Nelson grade, goblet cell density, Schirmer test values, and tear film breakup time. Group means (pretreatment, 1, 3, and 6 months) were compared using repeated measure analysis of variance.

Results: At baseline, impression cytology revealed that mRNA levels of IL-1β, IL-6, IL-8, and TNF-α were elevated by 1.6- to 2.4-fold in the O3FA group and 1.74 to 2.6-fold in the placebo group (P = 0.123). The O3FA group experienced a statistically significant reduction (P < 0.05) in tear cytokines. This group showed a 60% increase in the omega-3 index at 6 months, indicating high adherence to treatment. The dry eye symptom score, goblet cell density, and Nelson grade improved significantly in the O3FA group. However, these changes were not significant in the placebo group.

Conclusion: This study underscores the potential advantages of O3FA supplementation in decreasing tear inflammatory cytokines in dry eye patients with an omega-3 index below 4%.

Purpose: Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness. Regrettably, the roles of ferroptosis-related (FR) genes in POAG remain elusive.

Design: Five GEO data sets and a series of experimentations in vitro were used for bioinformatic exploration and biological validation.

Methods: Using multiple machine learning algorithms, four critical FR genes in POAG progression were screened. The clinical value and biological function of NOX1 were comprehensively analyzed using bioinformatic approaches. A POAG in vitro model was constructed using H2O2 treatment. NOX1 effects on the viability of retinal ganglion cells (RGCs) and ferroptosis process were determined through CCK8, EdU, ROS detection, and transmission electron microscopy. Its upstream transcriptional mechanisms were determined through dual luciferase assays, and chromatin immunoprecipitation (ChIP).

Results: NOX1 was identified as the critical FR gene in POAG progression and served as an effective diagnostic biomarker. High-NOX1 expression was tightly associated with increased infiltration levels of multiple subtypes of T cells, such as T cells CD8 and T cells CD4. However, the enrichments of eight metabolic gene sets did not differ between the POAG samples with high- and low-NOX1 expression groups. Silencing NOX1 maintained RGC survival and inhibited the ferroptosis process. Mechanistically, STAT3 upregulated NOX1 by binding its promoter region that was located at the 429th to 419th bases upstream of the NOX1 transcriptional start site. NOX1 overexpression reversed the inhibitory effects of silencing STAT3 on RGC survival and the ferroptosis process.

Conclusions: NOX1 was a good biomarker for characterizing POAG and promoted POAG progression through STAT3-mediated transcriptionally activation.

Purpose: To compare the outcomes of plasma ablation and super pulse CO2 laser ablation for treatment of benign eyelid margin lesions.

Design: Retrospective nonrandomized comparative study.

Methods: Setting: institutional.

Study population: Thirty-eight adults with unilateral clinically benign eyelid margin lesions were nonrandomly divided into two groups based on the treatment method. Lesions <10 mm and stable for at least 6 months were included. Lesions >10 mm, suspected premalignant or malignant lesions, and patients with active systemic disease were excluded.

Intervention procedures: Group 1: plasma ablation, Group 2: super pulse CO2 laser ablation.

Main outcome measures: postoperative pain, time to wound epithelialization, postoperative complications and recurrence, and patient satisfaction.

Results: Group 1 included 20 lesions, and Group 2 included 18 lesions. The mean size of the lesions was 5.7 ± 1.7 mm and 6.2 ± 1.8 mm, respectively (P = 0.336). There was a highly significant difference between the two groups as regards mean time to wound epithelialization (9.1 ± 2.4 days in group 1 versus 21.1 ± 4.3 days in group 2, P < 0.001). Longer epithelialization time was associated with significantly greater pain (P = 0.002). In group 2, transient hypopigmentation occurred in 2 (11.1%) patients and maldirection of eyelashes in 1 (5.6%). No recurrence was observed in either group. All (100%) patients of group 1 and 88.9% of group 2 were completely satisfied.

Conclusion: Both plasma ablation and super pulse CO2 laser ablation are effective in the treatment of benign eyelid margin lesions with good cosmetic outcomes. The choice of the procedure should be individualized according to the patient's general condition, needs, and lesion characteristics.

Purpose: To evaluate the functional outcomes and complications of pars plana vitrectomy with scleral flaps covered with a two-point sutured scleral-fixated intraocular lens (SFIOL).

Methods: A retrospective, single-center, single-surgeon case study, including 97 cases. About 25 G pars plana vitrectomy with a two-point sutured scleral-fixated IOL was used as a surgical modality.

Results: This study included 97 patients and eyes with scleral IOL fixation, with a mean follow-up of 6 months. The indications for SFIOL were divided into cases of surgical aphakia (63, 64.94%), hyper-mature cataract not suitable for routine procedure (5,5.15%), traumatic cataracts not suitable for routine procedures (18,18.5%), and other categories (11,64.94%). In this study, the median ± standard deviation of best-corrected visual acuity (BCVA) values in logarithm of the minimum angle of resolution (LogMAR) pre, post 1 month, 3 months, 6 months showed statistically significant improvement in VA with P value <0.001. The most common complications as number of cases seen in our study were cystoid macular edema (four cases), Descemet membrane folds (three cases), epiretinal membrane (five cases), exposed suture knots (one case), iatrogenic retinal break (two cases), iatrogenic retinal touch (two cases), IOL edge glare (one case), IOL tilt (one case), secondary glaucoma (three cases), post-op uveitis (one case), retinal detachment (one case), no complications 73 cases out of total cases.

Conclusion: The mean BCVA improved from preoperative to postoperative 1 day, 1 month, 3 months, and 6 months (P < 0.001) using this technique. This technique, which is more time-consuming, offers advantages over other available options, including improved stability, reduced risk of complications, and enhanced visual outcome.

Purpose: To analyze the independent risk factors associated with early emulsification in rhegmatogenous retinal detachments (RRDs) and determine the association between suboptimal fill of silicone oil (SO) and the onset of early emulsification.

Design: Retrospective observational cohort study.

Methods: Single-center (institutional) study. Electronic medical records of 81 eyes (81 patients) with RRD undergoing pars-plana vitrectomy with SO injection (from July 2020 to June 2021) were evaluated. Eyes with <6 weeks follow-up, combined RDs, eyes with active inflammation (<3 months from surgery), keratoprothesis, and nystagmus were excluded. The demographic data, cause of RRD, degree of myopia, best corrected visual acuity, number of breaks, presence of inferior break, preoperative proliferative vitreoretinopathy, relaxing retinectomies, buckle encirclage, technique of oil injection, viscosity of SO, duration of tamponade, presence of suboptimal fill on ultra-widefield imaging, postoperative lens status, and intraocular pressure on follow-up were analyzed.

Main outcome measures: Univariate and multivariate logistic-regression analysis was performed to determine the independent risk factors associated with SO emulsification.

Results: The mean age of the patients was 39.4 ± 18.7 years. The mean duration of oil tamponade was 8.6 ± 7.3 months. 58.0% eyes had suboptimal SO fill. On multivariate analysis, age of the patient (P = 0.032), use of encirclage (0.006), and duration of oil-in-situ (0.015) were noted to have a significant association to SO emulsification. On analysis of eyes with oil duration <6 months (n = 37), suboptimal fill was a significant associate to emulsification (P = 0.025).

Conclusions: Suboptimal fill of SO in RRDs has a higher risk of early emulsification.

To describe a novel, low-cost, and high-quality intraoperative video recording setup for oculoplastic surgery using a magnetic neck-mounted smartphone holder and iPhone with the Final Cut Camera app. A magnetic neck mount (Tianzhu Insta 360, China) and an iPhone 16 Pro Max were adapted for surgical recording by securing the holder around the binocular base of the operating microscope. The magnetically attached phone provided a stable and adjustable platform, allowing intraoperative view adjustments via the microscope's handles or foot pedal without compromising sterility. The Final Cut Camera app enabled 4K video capture with manual control of focus, exposure, and white balance. Its Live Multicam feature allowed simultaneous multi-angle recording and real-time monitoring via a compatible iPad, enabling an assistant to control framing and clarity intraoperatively. A multi-port adapter was used to support continuous power and external memory. Over six months, more than 50 oculoplastic procedures, including dacryocystorhinostomy, orbitotomy, and eyelid surgeries, were successfully recorded using this setup. All recordings were stable, centered, and of high image quality. Screenshots captured during surgery clearly depicted anatomical structures under standard operating room lighting. This smartphone-based recording method offers a simple, cost-effective, and ergonomically practical alternative to traditional surgical video systems in oculoplastic procedures. Its adaptability, ease of use, and compatibility with sterile environments make it an ideal solution for surgical documentation and teaching, especially in resource-limited settings.

Purpose: To compare cataract images obtained using portable slit-lamp devices with those taken from the standard slit-lamp built-in camera.

Design: Prospective, single-center, comparative digital imaging validation study.

Methods: A total of 198 slit-lamp images were taken from 66 patients with cataracts using a smartphone slit-lamp prototype ("MIDAS"), a tablet with a portable slit-lamp ("I.C.P."), and a slit-lamp with a custom-mounted digital camera ("ASC"). An ophthalmologist, an optometrist, and a family medicine resident independently graded the images according to Nuclear Opalescence (NO) and Nuclear Colour (NC) of the Lens Opacities Classification System III. The intraclass correlation (ICC) for the devices was calculated. Graders' confidence and subjective assessment of image quality were assessed through a 5-point Likert scale questionnaire.

Results: For NO, ICC was fair for MIDAS (0.619, 95% confidence interval [95% CI] = 0.426 to 0.754) and I.C.P. (0.585, 95% CI = 0.373 to 0.733) but poor for ASC (0.394, 95% CI = 0.088 to 0.609). For NC, ICC was excellent for all (MIDAS, 0.837, 95% CI = 0.755 to 0.895; I.C.P., 0.851, 95% CI = 0.775 to 0.904; ASC, 0.892, 95% CI = 0.837 to 0.930). Grader confidence was the highest for ASC images (85.5%), followed by I.C.P. (69.1%) and MIDAS (65.6%). Subjective assessment of image quality was the highest for ASC images (96.5%), followed by I.C.P. (77.3%) and MIDAS (74.2%).

Conclusions: Portable slit-lamp devices had excellent ICC for assessing NC and fair ICC for assessing NO. Graders expressed greater confidence and higher perceived image quality for the standard slit-lamp built-in camera.