Indian Journal of Ophthalmology最新文献

Purpose: To observe the effects of visual neuroplasticity training on visual perception, visual quality, and macular blood flow in patients with concomitant strabismus postoperatively.

Methods: In total, 108 patients underwent binocular strabismus correction operation, and some patients underwent neuroplasticity training. All patients underwent clinical ophthalmic examination, including measurement of best-corrected visual acuity, spherical equivalent, axis length, optical coherence tomography angiography, optical quality analysis system, and visual perception examinations.

Results: A total of 78 patients received neuroplasticity training for 1 month postoperatively, and 30 patients did not receive training. All patients underwent a visual perception examination preoperatively and at 1 day, 1 week, and 1 month postoperatively. Macular blood flow and visual quality were examined preoperatively and at 1 month postoperatively. Postoperative visual perception was better than preoperative visual perception ( P < 0.05). After neuroplasticity training, the visual perception of the trained subjects was better than that of the untrained subjects ( P < 0.05), and the blood flow in the macular area of the trained patients was lower than that of the untrained subjects ( P < 0.05). The visual quality of the untrained subjects was lower than that of the trained patients ( P < 0.05).

Conclusions: Visual inspection system could accurately evaluate binocular visual perception in patients with concomitant strabismus. After surgical alignment of the strabismus patient, training can stimulate and integrate the formation of stereovision in a short period of time, maintain the visual quality of patients after surgery, and provide conditions for the formation of binocular visual signals and binocular stereovision, but in the short term, it will lead to the decrease of macular blood vessel density and perfusion density. However, the long-term effects of training have not been proven.

Purpose: To explore the clinicopathological characteristics of immunoglobulin G4 (IgG4)-positive ocular adnexal marginal zone B-cell lymphoma (OAML) and associated patient treatment outcomes.

Methods: Medical records from patients diagnosed with IgG4-positive OAML treated at the West China Hospital between January 2016 and August 2023 were retrospectively analyzed.

Results: This study included data from 22 patients (11 males, 11 females), aged between 36 and 83 years, with disease durations from 1 month to 30 years. Sixteen cases exhibited unilateral ocular involvement (ten left eyes, six right eyes), while six exhibited bilateral involvement. Common clinical symptoms included ocular masses, eyelid swelling, and proptosis, with the orbit and lacrimal gland being the most commonly impacted sites. Among the 22 patients, 13 who were clinically suspected of having IgG4-related ophthalmic disease (IgG4-ROD) underwent serum IgG4 testing pre-operatively, revealing elevated IgG4 levels in 11 of these patients. The use of computed tomography and magnetic resonance imaging facilitated the evaluation of the location and size of lesions. All 22 patients received surgical treatment. Subsequently, 14 of these patients underwent local radiotherapy, five received post-operative chemotherapy, and three were closely observed. The follow-up period of patients in this study was 3-77 months, with an average follow-up time of 36 months. Except for one patient who died of disease progression, all others showed favorable prognoses with significant improvements.

Conclusions: These results support the classification of IgG4-positive OAML as a distinct OAML sub-type with clinical features that partially overlap with IgG4-ROD. Therefore, accurate differentiation between OAML and IgG4-ROD is imperative, necessitating timely surgical intervention and precise pathological diagnosis to prevent diagnostic errors and inappropriate treatment. Currently, no standardized treatments for IgG4-positive OAML exist, but our results suggest that standard OAML therapies are generally efficacious.

Purpose: To compare choroidal structural features in eyes with central macular atrophy related to Stargardt disease (STGD) and non-exudative age-related macular degeneration (AMD).

Methods: Twenty-five eyes of 25 Stargardt cases and 25 eyes of 25 non-exudative AMD cases were included in this retrospective study. Region Finder software was used to measure atrophic areas on blue-light fundus autofluorescence images centered on the macula. The total choroidal area (TCA), luminal area (LA), and stromal area (SA) were calculated using the ImageJ program and Niblack autolocal thresholding method. The choroidal vascularity index (CVI) was assessed.

Results: The mean age was 59.4 ± 10.9 years in the STGD group and 68.1 ± 7.6 years in the non-exudative AMD group (P = 0.002). The mean macular atrophic area was 16.06 ± 10.61 mm2 in STGD and 11.73 ± 7.65 mm2 in non-exudative AMD (P = 0.171). The STGD group had significantly higher mean subfoveal choroidal thickness (184.0 ± 62.6 vs. 131.8 ± 62.4 µm), TCA (0.553 ± 0.201 vs. 0.406 ± 0.189 mm2), LA (0.344 ± 0.150 vs. 0.253 ± 0.124 mm2), and SA values (0.208 ± 0.062 vs. 0.153 ± 0.069 mm2) compared to the non-exudative AMD group (P = 0.004, P = 0.011, P = 0.023, and P = 0.004, respectively). However, CVI values did not differ significantly between the two groups (60.58 ± 7.4 vs. 61.93 ± 5.8%, P = 0.432). According to the results of the ANCOVA test, differences in mean SFCT, TCA, and SA persisted when the data were readjusted for age (P = 0.018, P = 0.035, and P = 0.017, respectively).

Conclusion: In non-exudative AMD with geographic atrophy, the reductions in the choroidal compartments are more pronounced than those in STGD. However, similar CVI values may suggest that controversy still exists regarding the role of choroidal compartmental changes in the development of atrophy.

Purpose: To evaluate the tilt and decentration of intraocular lenses (IOLs) in eyes that underwent phacovitrectomy for macula-off rhegmatogenous retinal detachment (RRD) repair.

Methods: In this retrospective cohort study, 63 patients with macula-off RRD who underwent phacovitrectomy were enrolled and divided into a primary implantation group (group A) and a delayed implantation group (group B) according to the time of IOL implantation. Routine ocular examinations, including optometry, were performed, and the IOL tilt and decentration were measured. Postoperative refractive prediction error and IOL tilt and decentration were compared between the two groups, and the relevant factors of IOL positions were analyzed.

Results: The mean spherical refractive prediction error (MSE) was - 0.53 ± 0.39 D in group A and - 0.09 ± 0.55 in group B. The mean absolute spherical refractive prediction error (MASE) was 0.61 ± 0.23 D in group A and 0.50 ± 0.22 D in group B. The difference in MSE ( t = -3.623, P < 0.05) but not in MASE (t = 1.866, P = 0.067) between the two groups was significant. The mean IOL tilt and mean decentration were 8.54° ±3.65° and 0.55 ± 0.18 mm in group A and 10.62° ±3.29° and 0.66 ± 0.14 mm, respectively, in Group B. Differences in tilt ( t = -2.373, P < 0.05) and decentration ( t = -2.698, P < 0.05) between the two groups were both significant. In group B, the mean time interval between phacovitrectomy and IOL implantation (T V-I ) was 25.2 ± 6.9 weeks, and the absolute values of both IOL tilt and decentration were positively correlated with T V-I .

Conclusion: In phacovitrectomy for macula-off RRD repair, primary IOL implantation leads to a postoperative myopic shift, while delayed IOL implantation may cause greater IOL tilt and decentration.

Purpose: To estimate the pupil size (at the iris plane) under photopic (P PH ) and scotopic (P S ) conditions after phacoemulsification with intraocular lens (IOL) implantation.

Methods this retrospective observational cohort study included: 190 virgin eyes from 190 patients who underwent cataract surgery with IOL implantation. Data collected with Aladdin (Topcon), AS-OCT MS-39 (CSO), and iTrace (Tracey) were SimK, mean pupillary power at 6 mm (MPP), anterior chamber depth (ACD), lens thickness (LT), axial length (AL), lens rise (LR), P PH and P S before and after surgery at 30 days, dysfunctional lens index, and opacity grade. The position of the postoperative iris plane (PIP) was measured manually with MS-39, and a multivariate regression formula was developed to predict it. Statistical analysis was performed using Statistical Package for Social Science (SPSS) (IBM).

Results: The mean and standard deviations were 42.61 ± 3.20 D for MMP at 6 mm, 3.35 ± 0.37 mm for ACD, 3.89 ± 0.18 mm for PIP ( P < 0.01), 4.55 ± 0.42 mm for LT, 0.43 ± 0.24 mm for LR, and 25.91 ± 3.03 mm for AL. The mean preoperative and postoperative topographic pupil magnification was 12% and 14.22%, respectively ( P < 0.01). Despite an increase in magnification, the postoperative pupil was smaller than the preoperative one both for scotopic and photopic conditions: The larger the preoperative pupil, the more it tends to reduce in the postoperative period.

Conclusions: Analysis of the preoperative topographic pupil alone is not sufficient for a correct indication of the optical zone and total diameter of IOL to be implanted but must be correlated with biometric data. The topographic pupil, therefore, undergoes a change in magnification from the preoperative period to the postoperative period. Furthermore, the real pupil presents a modification and, in most cases, tends to be smaller postoperatively in both photopic and scotopic conditions.

Purpose: To compare the results and success rates of patients with epiphora due to punctal stenosis operated with the "canalicular triangular flap punctoplasty" and the "triangular three -snip punctoplasty" using anterior segment optical coherence tomography (AS-OCT).

Methods: This study is a retrospective cohort analysis of patients who were diagnosed with punctal stenosis and underwent canalicular triangular flap or triangular three-snip punctoplasty between September 2021 and June 2022.

Results: The study included 80 eyes of 43 patients consisting of 15 males and 28 females. Forty eyes underwent canalicular triangular flap punctoplasty (Group A) and 40 eyes underwent triangular three-snip punctoplasty (Group B) technique. The mean age of the patients was 63.9 ± 10.9 years (37-88 years). In Group A, the anatomic success was 100% and functional success was 95% at 6 months. In Group B, 77.5% functional success and 75% anatomic success were achieved at 6 months.

Conclusions: The canalicular triangular flap technique was more successful in providing punctal patency both anatomically and functionally than the triangular three-snip punctoplasty. AS-OCT is a method that provides objective, quantitative results in the diagnosis and follow-up of punctal stenosis and may be used more widely in punctum and vertical canaliculi pathologies.

Purpose: To evaluate the impact of pharmacologic pupil dilation on axial length (AL) measurement in patients with dense cataracts and previous failed AL measurements carried out without pupil dilation.

Design: Retrospective case series.

Methods: All participants underwent swept-source optical coherence tomography (SS-OCT) biometry. Patients with unsuccessful AL measurements due to dense cataract underwent an additional SS-OCT biometric evaluation after pupil dilation, and the SS-OCT AL measurement was compared to the immersion ultrasound.

Results: The study included 3668 eyes of 3668 patients who underwent SS-OCT between October 2021 and March 2023. Of them, 102 eyes (2.8%) had failed AL measurements because of dense cataract. Eighty-seven of those 102 eyes underwent a repeat SS-OCT biometric exam following pharmacologic pupil dilation, after which AL measurements were successfully achieved in 27 (31.0%) of the 87 eyes. These measurements were found to be consistent with immersion ultrasound, supporting the validity of SS-OCT biometer measurements post dilation.

Conclusions: Pharmacologic pupil dilation improved the rate of successful SS-OCT biometrically measured AL in patients with failed AL measurement due to dense cataract.

Purpose: To study the effect of corneal white-to-white diameter on Pentacam Scheimpflug cornea tomography and Corvis ST corneal visualization Scheimpflug technology parameters in myopic eyes.

Methods: In this retrospective cross-sectional study, 190 eyes of 190 Chinese myopic patients (spherical equivalent range: -1.25 D to -11.00 D) assessed for refractive surgery using Pentacam and Corvis ST devices were included. Patients were divided into groups based on corneal diameter: group A <12 mm, and group B ≥12 mm. Age, gender, spherical equivalent, Pentacam variables, and Corvis ST variables were collected. Statistical analysis was performed using IBM SPSS Statistics (Version 28.0).

Results: There were 110 patients in group A and 80 patients in group B, with no statistically significant difference in age, gender, or spherical equivalence. For Pentacam data, group A had significantly higher Belin/Ambrosio Enhanced Ectasia Display (BAD-D) scores than group B (0.88 vs. 0.44) and pachymetric progression index (minimum, average, and maximum), and steeper front keratometric values, whereas group B had larger anterior chamber depth and maximum Ambrosio-relational thickness (ARTmax) (462.54 vs. 503.93). BAD-D indices, pachymetric progression indices, and front keratometric values had negative correlations with corneal diameter, whereas ARTmax and back keratometric values had positive correlations. For Corvis ST data, group A had a significantly higher corneal biomechanical index (CBI) (negatively correlated) while group B had a higher Ambrosio relational thickness to the horizontal profile (ARTh) (473.60 vs. 570.78) (positively correlated).

Conclusion: Corneal diameter influences both Pentacam and Corvis ST parameters, with smaller corneal diameters having a higher BAD-D and a lower ARTmax and ARTh. In addition, this is the first study to report a correlation between posterior surface corneal power and corneal diameter. As refractive surgery evaluation relies on these parameters, taking corneal diameter into account would improve both sensitivity and specificity in pre-refractive surgery screening for ectasia/keratoconus.