Indian Journal of Ophthalmology最新文献

Myopia is a global public issue with a dramatically increasing incidence. Myopia is currently characterized by its earlier onset, quick development in preschool (0-5 years old), and continued progression particularly during the coronavirus-19 epidemic phase. It has been established that myopia experienced during childhood earlier resulted in vision impairment. In order to intervene in myopia development and offer a novel tool for earlier detection, the review attempts to identify known environmental and genetic risk factors for juvenile myopia (6-18 years old). Medline, Embase, and Web of Science databases were thoroughly searched for articles on myopia that had been published within the previous 10 years. The searches were carried out separately by two experts. The study's inclusion criteria were met by 28 articles. All studies that examined the link between risk factors and myopia were recruited. Parental myopia, near work, time spent outdoors, and a high level of education are all significant risk factors for juvenile myopia. It is clear that there is a strong environmental connection, especially in high myopia; nevertheless, more research is needed to identify any potential links between myopia and screen use. Myopia's genesis and mechanism are ambiguous and unclear. Further genetic studies could aid in examining genes to comprehend the development of myopia.

Purpose: To assess the accuracy and performance of the Butterfly IQ+ handheld ultrasound (HHUS) in detecting retinal detachments (RDs).

Methods: A cross-sectional observational study of eyes with (n = 20) and without (n = 20) RD imaged using a conventional B-scan ophthalmic ultrasound device Ellex Eye Cubed by Clarion Medical Technologies (Cambridge, ON, CA) and a portable HHUS (Butterfly IQ+). Images were compared between the modalities for qualitative differences. Agreement between the HHUS and standard ultrasonography equipment and with clinical examination was quantified using Cohen's kappa coefficient.

Results: Forty eyes of 33 patients were included in the study. Twenty eyes of 18 patients had RDs, and 20 eyes of 18 patients did not. The observed agreement in RD diagnosis between the Butterfly and the Ellex Eye Cubed was 97.5%., and the Cohen's Kappa was 0.950 (95% CI: 0.85-1.00). The observed agreement in RD diagnosis between the Butterfly IQ+ and diagnosis confirmed by the gold standard of clinical exam was 92.5%, and Cohen's Kappa was 0.850 (95% CI: 0.69-1.00). The sensitivity and specificity of the Butterfly ultrasound in RD diagnosis were 90% (95% CI: 68.3-98.8%) and 95% (95% CI: 83.2-100), respectively.

Conclusion: There was a high degree of agreement between the systems for the identification of RD. The Butterfly IQ's extreme portability and ease of use make it a viable option to screen for RDs in hospital-based consults, emergency departments, or low-resource settings.

Purpose: This study aims to assess the impact of polycythemia vera (PV) on retinal and optic nerve head (ONH) vessel density (VD) parameters, macular ganglion cell complex (mGCC) thickness, and retinal nerve fiber layer (RNFL) thickness compared to healthy controls.

Methods: Forty eyes of 20 patients with PV and 40 eyes of 20 age-gender-matched healthy controls underwent comprehensive ophthalmologic assessments and optic coherence tomography angiography (OCTA). RNFL and macular GCC measurements were obtained simultaneously with vascular parameters by AngioVue OCTA using the single-scan protocol. Peripapillary VD was examined across eight sectors, whereas parameters including RNFL, GCC, and macular VD were analyzed in four quadrants.

Results: Patients with PV exhibited significant reductions in the average RNFL thickness ( P = 0.014) and RNFL thickness in superior ( P < 0.001) and inferior ( P = 0.003) quadrants compared to controls. Additionally, mGCC thickness in all quadrants significantly reduced in the PV group ( P < 0.001). ONH VD parameters, including whole-image VD ( P < 0.001) and peripapillary VD ( P < 0.001), were significantly reduced in patients with PV. Similarly, macular VD parameters were significantly lower in the PV group ( P < 0.001).

Conclusion: This study highlights substantial vascular and structural alterations in the retina and ONH of patients with PV compared to healthy controls. These changes likely stem from microvascular dysfunction associated with PV. These findings suggest further research to understand the underlying mechanisms and develop targeted therapeutic strategies for managing ocular complications in patients with PV.

Purpose: To investigate microvascular changes in the macular and peripapillary area in prolactinoma patients by using optical coherence tomography angiography (OCTA).

Design: A retrospective study.

Methods: This study included 40 patients with treatment-naive prolactinoma and 42 healthy controls. Participants underwent comprehensive ophthalmic examinations, visual field testing, and optical coherence tomography (OCT) assessments, including retinal nerve fiber layer (RNFL) thickness, macular, and peripapillary region OCTA by using the Topcon DRI OCT Triton Swept Source-OCT system. The OCTA results were evaluated between groups and then correlated with PRL levels.

Results: The differences in best-corrected visual acuities were statistically significant among the groups. The RNFL thickness in the superior and nasal quadrants was significantly lower in the prolactinoma group. The prolactinoma group showed significant reductions in macular vessel density (VD) across all layers than the control group, except in the deep retinal capillary plexus temporal quadrants. The radial peripapillary capillary (RPC) temporal VD in the prolactinoma group was significantly lower. In patients with optic neuropathy, correlations were observed between the RPC temporal and RNFL temporal sectors (r = 0.650, P = 0.03), and between the RPC inferior and RNFL inferior sectors (r = -0.612, P = 0.045). Between PRL levels and OCTA parameters, negative correlations were observed (RPC inferior: r = -0.452, P = 0.003; DCP superior: r = -0.379, P = 0.016).

Conclusion: Our study revealed reduced VD in the macula and RPC temporal regions in patients with treatment-naive prolactinoma. OCTA holds significant importance in detecting potential retinopathies and vasculopathies. Future research should focus on examining pre- and post-treatment changes in treatment-naive patients without ON to better understand the impact of prolactinoma.

Purpose: To evaluate the effects of normal vaginal delivery (NVD) and cesarean section (CS) on the retina, optic disc, and choroid in healthy pregnant women by using optical coherence tomography (OCT).

Methods: This prospectively designed study included 60 healthy pregnant women, of whom 30 underwent NVD and 30 underwent CS. Ophthalmological examinations and OCT scans were performed on all pregnant women during the third trimester and the first postpartum week. The measurements were compared between the two visits within each group. Central retinal thickness, ganglion cell layer and inner plexiform layer (GCL + IPL) thickness, peripapillary retinal nerve fiber layer thickness, and optic disc morphology were determined using OCT scans. Central, nasal, and temporal choroidal thicknesses were manually measured using HD-line OCT. Choroidal vascular parameters were calculated from HD-line OCT scans by using a special image processing module. The ratio of the luminal choroidal area to the total choroidal area was determined as the choroidal vascular index (CVI).

Results: In the NVD group, the thinning in the mean and inferior pRNLF, the decrease in the rim area, and the increase in the mean cup/disc and cup volume at the first postpartum week were found to be statistically significant (P < 0.05). In the same group, the CVI was calculated as 0.69 ± 0.02 in the third trimester and 0.66 ± 0.03 in the first postpartum week (P = 0.001). In the CS group, except for the increase in the GCL + IPL thickness, no significant difference was detected in the measurements of the retina, optic disc, and choroid (P < 0.001 and P > 0.05).

Conclusion: This is the first study to evaluate the effect of the delivery method on the retina, choroid, and optic disc. In NVD, changes in the choroidal vascular structure and optic disc morphology can be observed in the early postpartum period, which may be attributed to hormonal effects.

Purpose: To determine the earliest characteristics of retinal and optic disc alterations in diabetic children without diabetic retinopathy (DR) changes by using optical coherence tomography angiography (OCTA).

Settings and design: This was a prospective, non-interventional case-control study that involved 25 patients with type 1 diabetes mellitus (T1DM) without clinical signs of DR and a demographically similar group of 25 healthy children as the control.

Methods: The retina and optic disc were examined using OCTA.

Statistical analysis used: Correlations between the OCTA parameters and clinical predictors were evaluated.

Results: Twenty-five patients (median age: 14 years, interquartile range [IQR]: 13-15.9 years; 12/25 [48%] girls) with T1DM and 25 age-matched controls were enrolled. The patients had a tendency toward thinner fovea (232.5 µm) as compared to the controls (244.3 µm) ( P = 0.142). Superficial vascular density was significantly lower in the DM group compared to the controls (48.90 ± 2.3 vs. 50.91 ± 3.1, P = 0.015). However, no such differences were observed at deeper vascular densities. The patients also had lower whole-disc (48.65 vs. 50.21, P = 0.029), disc interior (49.14 vs. 52.11, P = 0.044), superior (50.67 vs. 53.45, P = 0.039), and peripapillary capillary densities (50.49 vs. 52.68, P = 0.033). There was no statistical correlation between retinal/optic disc angiography parameters and clinical predictors.

Conclusion: In diabetic children without visual impairment or DR, signs of microvasculopathy were found in the superficial macular vascular density and inside the disc.

Allergic conjunctivitis (AC) comprises a group of conditions triggered by environmental allergens, substantially diminishing the quality of life, particularly among children and adolescents. The mechanical impact of eye rubbing in patients with AC is known to induce biomechanical alterations in the cornea. Modern instruments enable the detection and quantification of these corneal biomechanical changes. The ocular response analyzer and CorVis ST have become standard tools for assessing corneal biomechanical properties. We conducted a review of studies that have investigated corneal biomechanics in patients with AC using both devices to elucidate the association between corneal biomechanical changes and early ectasia development. Our analysis highlights significant findings regarding the tomographic biomechanical index parameter in corneal biomechanics among patients with AC. These findings underscore the importance of ocular screening for all patients to promptly detect subclinical keratoconus changes, thereby improving disease management and outcomes.

Purpose: This study was conducted to assess patients' outcome and satisfaction with the eye care received with telemedicine and physical consultation at a tertiary care hospital during and after the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A descriptive study was carried out on 6052 patients who consulted for eye illness at a tertiary care hospital between April 2020 and December 2022. An outcome scoring system was developed and validated for the assessment of patient outcome after providing treatment on telemedicine consultation and physical consultation. Outcome scores for various symptoms were compared pretreatment and posttreatment. Telehealth Usability Questionnaire (TUQ) was used through an online survey to assess patients' satisfaction with teleophthalmology services during the COVID-19 pandemic. An 18-item Patient Satisfaction Questionnaire (PSQ-18) was used to assess the same with physical consultation.

Results: A total of 6052 patients were included in the study. Physical consultation group had 2485 patients (41.06%) and the telemedicine group had 3567 patients (58.93%). Male patients constituted 63.11% and females were 36.89%. There was a significant improvement in outcome scores for pain and redness in both physical and telemedicine consultation groups (P < 0.0001). All subgroups of TUQ had significantly high scores (including usefulness, ease of use and learnability, interface quality, interaction quality, and satisfaction and future use), except one subgroup (reliability). Uneducated patients were significantly more satisfied with telemedicine compared to educated patients (P = 0.044).

Conclusion: Majority of patients expressed satisfaction with teleophthalmology services. The recent pandemic paved the way for the future integration of telemedicine in ophthalmology, especially if virtual eye examinations attain a higher level of reliability.