Indian Journal of Ophthalmology最新文献

Purpose: To present the clinical features and management outcomes in a series of patients with orbital and adnexal sarcoidosis.

Methods: This was a retrospective analysis of 19 histopathologically proven cases of orbital and adnexal sarcoidosis over the past ten years. The data analyzed included demographic details, clinical and imaging features, and management outcomes. The response to treatment was categorized based on clinical improvement at the last follow-up as complete resolution, partial resolution, or no resolution.

Results: There were 15 (78.9%) females and four (21%) males. The mean age at presentation was 51.05 ± 14.35 years. Upper lid swelling was the most common sign (n = 6), followed by lacrimal gland enlargement (n = 5). The specific locations of involvement were orbital soft tissues (n = 8), lid (n = 5), lacrimal gland alone (n = 3), lacrimal sac (n = 1), extra ocular muscles (n = 1), and conjunctiva (n = 1). An incisional biopsy was performed on 16 patients, and an excisional biopsy on three. Of those undergoing excisional biopsy, the lesion was located in the superonasal extraconal space in one and in the superotemporal lid in two. Twelve patients (63.2%) had systemic involvement at presentation. No further treatment was necessary for patients who underwent excisional biopsy. Additional treatments included oral steroids (n = 10) and systemic immunosuppressants (n = 5). Six patients were lost to follow-up. Complete resolution of signs and symptoms was noted in 11 patients (84.6%), while partial resolution was seen in two patients. The mean duration of follow-up was 7.56 ± 12.63 months.

Conclusion: Sarcoidosis can affect any part of the orbit or adnexa, with varied presentations depending on the involvement. Excisional or incisional biopsies, along with systemic steroids and immunosuppressants in select cases, remain the mainstay of treatment.

Purpose: To analyze the utility of biologics in noninfectious uveitis and other ocular inflammatory diseases in a South Indian patient population.

Methods: This was a retrospective observational study conducted at the uveitis and ocular inflammatory diseases clinic of a tertiary eye care hospital in South India between 2016 and 2023.

Results: Records of 76 patients on biologics were retrieved from our databases. The mean age was 34.84 ± 17.383 years. In 75% of patients, the duration of follow-up was 52.75 months. Overall, anterior nongranulomatous uveitis was the most common anatomic type of uveitis (34.21%). HLA B27-associated uveitis was the most common etiology (34.21%) in whom biologics were used. Patients <18 years of age formed 23.7% with a mean age of 10.77 ± 2.75 years. Mean duration of follow-up in patients <18 years of age was 36 months. In this subgroup, panuveitis was the most common anatomic subtype (61.1%) and juvenile idiopathic arthritis was the most common etiology (27.7%). The most commonly used biologic in this study was adalimumab (36.84%). Additional conventional immunomodulators were used along with biologics in 50 patients (65.78%), of which methotrexate was the most common (50%). Adalimumab and rituximab were biosimilars, while tofacitinib was the generic version. There was a significant decrease in the mean number of flareups post-biologics ( P = 0.001). Adverse effects were seen in 14 patients (18.42%). The success rate of biologics was low in the parsplanitis group <18 years (33.3%), Blau-associated uveitis (50%), and idiopathic uveitis (30%).

Conclusion: In this study, we have analyzed the results of biologics in different anatomic types of ocular inflammation and etiologies. The success rate of biologics was low in parsplanitis, idiopathic uveitis, and Blau-associated uveitis and higher in other etiologies.

Purpose: To describe the epidemiological profile and clinical characteristics of ocular and periocular tumors in patients presenting to three tertiary care referral centers in North and Central India.

Methods: Hospital-based consortium study.

Settings and design: Retrospective, descriptive, observational study.

Results: A total of 3184 patients were diagnosed with 3557 ocular and periocular tumors over 11 years from 2010 to 2021. Of these, 2395 (67.33%) were benign, 84 (2.36%) were premalignant, and 1078 (30.30%) were malignant. The most common location was the ocular surface (n = 1294, 37.09%), followed by the eyelid (n = 1185, 33.97%), intraocular (n = 624, 17.88%), and orbit (n = 454, 13.01%). The most common tumors were retinoblastoma (n = 483, 13.57%), ocular surface squamous neoplasia (OSSN) (n = 301, 8.46%), and dermoid cyst (n = 167, 4.69%). In the pediatric age group, retinoblastoma was the most common tumor (n = 483, 13.57%), while in adults, it was OSSN (n = 301, 8.46%). The stage at presentation for malignant tumors was divided into in-situ (57.14%), local spread (8.16%), and metastasis (32.83%). For specific tumor locations, the stages were 78.83%, 17.51%, and 2.18%, respectively, for eyelid tumors; 51.76%, 27.05%, and 17.64%, respectively, for orbital tumors; 88.37%, 5.81%, and 5.19%, respectively for ocular surface tumors; and 35.71%, 14.15%, and 50.28%, respectively, for intraocular tumors.

Conclusions: Identifying the epidemiological characteristics of ocular and periocular tumors will aid in early diagnosis and timely intervention. Intraocular tumors showed delayed diagnosis, advanced stages at presentation, and required patients to travel longer distances for treatment, indicating the need for strengthened diagnostic and treatment facilities to improve access to care.

Ocular surface squamous neoplasia (OSSN) is the most common neoplasia of the anterior segment. Accurate and timely diagnosis, including detailed clinical assessment and imaging, is essential to ascertain the extent of the disease. The gold standard treatment for OSSN has evolved over the years, transitioning from wide-margin surgical excision using the "no-touch" technique to topical immunotherapy, plaque brachytherapy, and targeted immunotherapy. The choice of treatment modality depends on a tailored approach based on the initial presentation and progression of the disease. This review consolidates a comprehensive understanding of the variable clinical presentations of OSSN, diagnostic and imaging techniques, and available treatment options. It also provides a foundation for the oncologic principles of managing OSSN while offering insights into future therapeutic approaches.

Purpose: To determine the influence of different types of orbital fractures on the radiographic post-treatment outcomes.

Methods: The investigation was a retrospective cohort study involving CT data of all patients who underwent delayed primary or secondary surgery for orbital/zygomatico-orbital trauma between 2019 and 2021. The sample was divided into three groups 1, 2, and 3: isolated floor, floor and medial wall, and combined orbit and zygomatic complex fractures. The type of orbital fracture was the exposure, while the outcome measures were reduction in enophthalmos and intraorbital volume and linear relationship between the two variables. Data were analyzed for variance between groups and association. Statistical significance was set at < 0.05.

Results: Forty-four patients (3 females and 41 males) with a mean age of 28.6 years were included in the study. Reductions in enophthalmos ( P < 0.001) and intraorbital volume ( P = 0.003) demonstrated significant variance between the groups. For every cubic centimeter of reduction in volume, the reduction in enophthalmos was 0.78 mm ( P < 0.001) in isolated floor fractures, 0.60 mm ( P = 0.013) in combined fractures involving the floor and medial walls, and 0.24 mm ( P = 0.456) in combined fractures of the orbit and zygoma.

Conclusion: Correction of enophthalmos strongly depends on the type of orbital fracture. There exists a significant linear relationship between enophthalmos and intraorbital volume in fractures involving the internal orbit.

Purpose: In the third wave of the coronavirus disease 2019 (COVID-19) pandemic, despite progressive vaccination coverage, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was rapidly spreading and the possibility for ocular transmission of COVID-19 was most relevant. This study aimed to determine the presence of SARS-CoV-2 RNA in tears as detected by real-time polymerase chain reaction (RT-PCR), among individuals who tested COVID-positive during the third wave of the COVID pandemic.

Methods: Among 90 patients admitted with mild to severe COVID-19 infection (ranging from asymptomatic to severe symptoms), separate conjunctival samples were obtained from both eyes without topical anesthesia taking precautions to avoid contamination. Inferior fornices of the eyes were swept slowly with sterile Dacron swabs for 10 s or until visibly wet. They were inoculated directly in a viral lysis buffer containing carrier RNA and transported to the Virology Laboratory for the detection of SARS-CoV-2 RNA by RT-PCR. Conjunctival swabs were declared positive based on cycle threshold values of <37.

Results: Seven of 180 conjunctival swabs were positive (3.9%). Five patients had unilateral positive and one patient had bilateral positive conjunctival swabs. Thirty-six (40%) patients had their conjunctival swabs taken on the same day of detection of the first positive nasopharyngeal swab, while the rest (54) had their conjunctival swabs taken up to 3 days later. Overall, 20 (22.2%) patients were symptomatic for COVID-19.

Conclusion: Considering the contagious nature of SARS-CoV-2 in the third wave, there is a possibility that ocular surface fluid might have been a contributing factor along with other modes of transmission of COVID-19.

Purpose: To analyze the outcomes of botulinum toxin A injection in acute acquired comitant esotropia (AACE).

Methods: This is a retrospective study that included cases diagnosed as AACE between January 2022 and February 2023. Patients who were treated with Botox and completed a minimum 3 months follow-up were included in the study. All the patients underwent a complete ophthalmic, orthoptic examination and neuroimaging. The effects of age, onset of esotropia, screen time, deviation pre injection, mode of injection (transconjunctival/ open sky) and whether injection was administered in one/both eyes on successful outcome were analysed.

Results: Twenty-seven patients (20 male, seven female) were included in the study. The median age was 10 years. The median deviation for distance and near preinjection was 35 and 40 prism diopters, respectively. Complete resolution of symptoms was noted in 18 patients (66.6%). Four patients needed prisms, two required repeat injections, and one each needed surgery and divergence therapy. Six patients developed ptosis. None of the risk factors seemed to affect outcomes.

Conclusion: Botulinum toxin injected into the medial rectus is a safe and viable option for AACE. Preinjection counseling about ptosis, recurrence needing prisms, reinjection, or surgery is important.

Purpose: To study the effectiveness of botulinum toxin A (BTX-A) in the treatment of patients with acute acquired comitant esotropia (AACE) due to excessive use of mobile and laptops in the COVID era in the pediatric population and adolescents.

Methods: This was a retrospective, interventional study of pediatric patients and young adults who presented with AACE and received unilateral or bilateral BTX-A. All the patients complained of binocular diplopia and sudden onset of esotropia with a history of mobile or laptop usage during the COVID era (2020-2023). Twenty-seven patients with acute-onset esotropia in 3 years (2020-2023) were included. All patients were administered 2.5-7.5 units of BTX-A (Botox, Allergan, India) into the unilateral or bilateral medial rectus muscle of the deviating eye under short general anesthesia or local anesthesia. The main outcome measures were pre- and post-injection angle of deviation, pre- and post-injection stereopsis, final level of stereopsis achieved, recurrence, and whether strabismus surgery was later required.

Results: The mean age of patients was 12.85 ± 7.15 years (range: 4-25 years). The mean dosage of Botox was 6 U (2.5-7.5 U). The mean follow-up was 6 months (6 months-2 years). The mean preoperative angle of deviation (AOD) was 41.11 ± 10.9 prism diopters (PD) for distance and 41.67 ± 10.9 PD for near. The maximum effect of BTX-A was seen at 1 month; post-injection AOD was 13.65 ± 14.7 PD for distance and 14.87 ± 15.8 PD for near ( P < 0.001). Over half of the patients achieved optimal outcomes, with improvements in stereopsis and sensory fusion. Early intervention (within 3 months of symptom onset) significantly correlated with treatment success.

Conclusion: While BTX-A therapy for acute-onset esotropia demonstrates efficacy, patient-specific considerations are essential. This study highlights the evolving nature in the digital age and early administration of BTX-A along with close follow-up to monitor residual and recurrence of esotropia. The surgical intervention can increase the final success rate.