Indian Journal of Ophthalmology最新文献

Purpose: To describe the neuro-ophthalmic presentations of intracranial aneurysms (IAs) and highlight the critical role of ophthalmologists in early detection.

Methods: A retrospective, unicentric study of patients with IAs who presented to our neuro-ophthalmology clinic at a tertiary eye care center over 6 months (February-August 2024).

Results: Nine patients with IAs were documented, of whom seven presented first to an ophthalmologist with symptoms like defective vision, diplopia, and visual field defects. Among these seven patients, the mean age was 58.9± 19.4 years (range 23-83). 71% were female. Presenting complaints included diplopia (57%) and defective vision (43%). Systemic comorbidities like diabetes and hypertension were present in 42.8%. Clinical examination revealed signs of third nerve palsy in 28.5%, sixth nerve palsy in 28.5%, and relative afferent pupillary defect and optic disc pallor in 43%. Visual field examination revealed right homonymous hemianopia in 14.2%. Magnetic resonance imaging revealed an anterior circulation aneurysm in all patients, and one also had a posterior circulation aneurysm. Multiple aneurysms were seen in 28.5%. Saccular morphology was predominant (71.4%) compared to fusiform aneurysms (28.5%).

Conclusion: Intracranial aneurysms may initially present with neuro-ophthalmic signs such as isolated cranial nerve palsies or compressive optic neuropathy. Timely imaging and multidisciplinary intervention are crucial to prevent permanent visual loss and life-threatening complications like rupture and subarachnoid hemorrhage. Ophthalmologists are pivotal in the early diagnosis of such potentially fatal conditions.

Purpose: To evaluate the efficacy and safety of 2 mg intravitreal triamcinolone acetonide (IVTA) in the management of serpiginous-like choroiditis (SLC), and study lesion resolution, recurrence, paradoxical worsening, and systemic medication burden.

Methods: This retrospective observational study included patients with SLC receiving 2 mg IVTA with a minimum follow-up of 6 months. Demographic data, clinical findings, imaging, and treatment details were retrieved from medical records. The primary outcomes were time to lesion resolution, incidence of paradoxical worsening, recurrence rate, and the need for repeat IVTA. Secondary outcomes were changes in best-corrected visual acuity (BCVA) and intraocular pressure (IOP). Use of systemic corticosteroids was also recorded.

Results: Fifteen eyes of 14 patients were analyzed. The mean age was 31.5 years, and 71.4% were managed without systemic corticosteroids. All patients received IVTA; 11 received concurrent anti-tubercular therapy (ATT). Mantoux positivity was observed in 64.2%, QuantiFERON-TB Gold in 78.5%, and both were positive in 57.1% of patients. Mean clinical and fundus autofluorescence (FAF)-based lesion resolution time was 2.7 and 5.9 months, respectively. No cases of paradoxical worsening were noted. Recurrence occurred in three eyes, two of which did not receive ATT. Mean BCVA improved from 20/50 to 20/32 (P = 0.006). IOP elevation >21 mm Hg occurred in 33.3% of eyes and was controlled with topical medications. Cataract developed in 38.4% of eyes, and one eye required surgery. The mean follow-up was 18.2 months.

Conclusion: IVTA at a 2 mg dose appears effective in lesion resolution, while minimizing systemic therapy in SLC, with an acceptable safety profile and no paradoxical worsening. Larger prospective studies are needed to validate these findings.

Purpose: To report TON in indigenous tribal communities of Northeast India, and to explore its association with Tuibur use.

Method: Retrospective study undertaken in consecutive patients presenting with unexplained gradual, painless, bilateral diminution of vision. Detailed dietary and medical history was taken. Demographic profile of subjects was noted, including age, gender, ethnicity and occupation. Duration & frequency of Tuibur use per day was noted. Clinical evaluation along with visual fields, color vision, Retinal nerve fibre layer analysis was done. All patients were started on oral Vitamin B complex supplementation, including Vitamin B12 (1500 mcg) once daily for three months. The patients were called for follow up at monthly intervals for 3 months and at 6 months.

Result: 39 patients with bilateral involvement, mean age of 39.5 ± 11.6 years were studied. 82% were females; 97.4% belonging to tribal community. There was statistically significant improvement in visual acuity [Oculus Dexter (OD) P=0.002, Oculus Sinister (OS) P=0.007] and visual field indices after treatment.

Conclusion: TON may cause severe visual loss; however, timely management gives favourable results. Treatment involves replacing deficient nutrients and eliminating offending toxins. It is also important to consider contributory cultural and dietary practices. This is the first study linking a hitherto unheard-of toxic agent, liquid tobacco (Tuibur/Hidakphu) to optic neuropathy.

Purpose: To assess the effectiveness of switching anti-vascular endothelial growth factor (VEGF) agents in eyes with retinal pathologies that poorly respond to intravitreal bevacizumab injections.

Methods: We compared central macular thickness (CMT) and VA between eyes with suboptimal responses to at least three bevacizumab injections that either continued with bevacizumab or switched to aflibercept or ranibizumab. Eyes were categorized into group D (DME), group N (neovascular age-related macular degeneration [nAMD]), and group A - all eyes (D and N plus eyes with retinal vein occlusion (RVO) or pseudophakic central macular edema [PCME]). Each group was further divided into those continuing bevacizumab (D1, N1, A1) or switching to aflibercept or ranibizumab (D2, N2, A2).

Results: A total of 21 eyes were included in group D (8 in D1 and 13 in D2), 28 in group N (14 in N1 and 14 in N2), and 59 eyes in group A (25 in A1 and 34 in A2). In all eyes with treatment shift, CMT decreased: 38.5 (SD: 46.2), 92.6 (SD: 106.8), and 82.1 (SD: 115.6) microns in D2, N2, and A2, respectively. CMT difference was statistically significant between N1 versus N2 and between A1 versus A2 (P = 0.025 and 0.004, respectively). No significant difference in VA was observed.

Conclusion: Switching anti-VEGF agents appears anatomically beneficial in nonresponding eyes. Notably, the inclusion of a control group continuing bevacizumab despite poor response allows for a more reliable evaluation of treatment efficacy, addressing a key limitation of prior studies and contributing to the evidence-based rationale for agent switching.

Purpose: To analyze Bruch's membrane opening minimum rim width (BMO-MRW) for detecting glaucoma in patients with myopia < -6D and assessment of peripapillary retinal nerve fiber layer thickness (pRNFLT).

Methods: One eye was randomly selected from each of the 90 subjects (A-30 normal controls, B-30 with glaucoma suspect, and C-30 with primary open-angle glaucoma [POAG]). All patients underwent baseline ophthalmic evaluation. BMO- MRW and pRNFLT data were obtained using spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany). The area under the receiver operating characteristic curves (AUC) for global and sectoral thickness parameters was calculated.

Results: Sectoral analysis of BMO-MRW for the discrimination of early glaucoma in all myopic subjects showed significantly better diagnostic performance than pRNFLT in temporal (0.85 (0.77 to 0.94) P = 0.014), temporal superior (TS) (0.90 (0.83 to 0.98) P = 0.005), and nasal inferior quadrants (0.92 (0.86 to 0.97) P = 0.022) with 95% CI. When discriminating early glaucoma from the suspect, overall the diagnostic performance of BMO-MRW was higher than that of pRNFLT, with significant differences in the temperosuperior quadrant (0.85 (0.74 to 0.95) 95% CI, P = 0.047).

Conclusion: BMO-MRW had better diagnostic performance than RNFL thickness and is a useful parameter for detecting glaucoma in myopic eyes (≤-6D) with POAG.

Among the mucosal involvement in Stevens-Johnson syndrome (SJS), the eye is a significant component. Severe complications may result in vision impairment and, in extreme cases, the loss of the globe. Therefore, it is essential that ocular manifestations are effectively managed. The classification of ocular SJS/toxic epidermal necrolysis (TEN) in acute and chronic stages has evolved over time. In light of these developments, the management of the disease has also undergone significant improvements. Amniotic membrane transplantation (AMT) represents an efficacious approach to controlling acute inflammation, particularly in cases of severe or extreme severity. Practical methods, such as ProKera® or sutureless AMT, have been introduced. To successfully manage the chronic stage, it is of the utmost importance to correctly identify the underlying problem. In addition to various techniques such as minor salivary gland transplantation and punctal occlusion, the rehabilitative management of the ocular surface also encompasses the utilization of specially designed scleral lenses, namely Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE). Autologous mucosal membrane grafting, a technique that has been in use for many years, has recently seen a resurgence in popularity. In the context of limbal stem cell transplantation procedures, the introduction of cultured limbal epithelial transplantation and simple limbal epithelial transplantation represents a significant advancement. Although the success rate of keratoplasty and keratoprosthesis remains low, establishing good ocular surface homeostasis beforehand significantly improves the outcome.

Purpose: Adherence to glaucoma medication helps prevent disease progression. Barriers to adherence exist, particularly in low- and middle-income countries. We explored factors influencing medication adherence from the perspectives of patients and ophthalmologists in India.

Design: Cross-sectional, qualitative study.

Methods: Semi-structured interviews with a purposive patient sample prescribed intraocular pressure (IOP)-lowering eyedrops and ophthalmologists involved in glaucoma care at a tertiary center. The theoretical domains framework (TDF) of behavior change guided deductive and inductive thematic analysis of interview transcripts to identify personal, sociocultural, and environmental influences on adherence.

Results: Twenty-two participants (n = 11 patients, n = 11 ophthalmologists) were recruited. Seven TDF domains were key to patient adherence and practitioner management. Patient barriers mapped to TDF domains: Environmental context and resources (difficulties obtaining medication, lifestyle changes, hospital system issues), Memory, attention and decision processes (forgetfulness), and Skills (difficulty administering drops). Practitioner barriers related to Environmental context and resources (time constraints and medication availability). Patient enablers mapped to Social influences (family support), Knowledge (understanding glaucoma and treatments), Beliefs about consequences (perceived treatment necessity), and Behavioral regulation (establishing routines). Ophthalmologist enablers included Environmental context and resources (organizational infrastructure), Knowledge (knowing how to classify adherence, awareness of non-adherence), Skills (effective communication), Memory, attention and decision processes (tailoring patient care), Social professional role/identity (professional responsibility), and Social influences (practitioner influence).

Conclusions: A complex interplay of factors influences adherence. Identifying modifiable behaviors provides a basis for developing culturally sensitive interventions to reduce barriers, enhance patient and family support, and equip practitioners with tools to manage non-adherence effectively.

Purpose: To evaluate the safety of routine hydrodissection in a subset of posterior polar cataracts (PPC) in which the posterior capsule (PC) can be visualized beneath the polar opacity using preoperative swept-source anterior segment optical coherence tomography (SS-AS-OCT).

Design: Prospective interventional study.

Methods: The study included eyes with PPC undergoing cataract surgery by standard phacoemulsification or femtosecond laser platform. Preoperative SS-AS-OCT imaging was performed to assess the PC, which was then classified as continuous (Group 1), abrupt (Group 2), or dehiscent PC (Group 3). PPC with dehiscent PC was excluded. In Group 1, phacoemulsification was performed with routine hydrodissection and nuclear rotation. In Group 2, hydrodelineation was performed, and nucleus rotation was avoided. Chamber stability was maintained, and PC polishing was avoided in both groups. The outcome measure was to assess the incidence of posterior capsular rupture (PCR) in Groups 1 and 2.

Results: The cohort included 70 eyes (57 patients), categorized as Group 1 PPC [54 eyes (77.1%)] and Group 2 PPC [16 eyes (22.9%)] based on preoperative SS-AS-OCT imaging. One eye in Group 1 developed PCR (1.9%) with routine hydrodissection, and four eyes in Group 2 developed PCR (25%). The negative predictive value of SS-AS- OCT with gentle hydrodissection was 98.1%.

Conclusion: Preoperative SS-AS -OCT helps identify low-risk PPC cases, in which gentle hydrodissection and nucleus rotation can be performed for efficient nucleus and epinucleus management.