Indian Journal of Ophthalmology最新文献

Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy and causes significant morbidity in patients. Anti-vascular endothelial growth factor (VEGF) agents are the mainstay of treatment for DME, with steroid implants being used for the treatment of anti-VEGF resistant eyes. Over the years, several classification systems have been devised to describe the patterns of DME using optical coherence tomography (OCT). With the advent of effective treatments, it has become imperative that imaging cues are not merely used for classifying the disease but also as biomarkers for prognostication of disease activity and treatment response. In this aspect, newer imaging findings such as hyperreflective dots, photoreceptor integrity, and disorganization of retinal inner layers have been characterized in detail by several authors. Macular perfusion analysis using OCT angiography is the latest in the armamentarium for imaging DME. In this narrative review, we have summarized all relevant literature related to the ultrastructural imaging-based biomarkers of DME and their correlation to treatment.

Purpose: This study aims to evaluate the efficacy of various tomographic indices, both established and novel, in predicting endothelial decompensation leading to either spontaneous corneal transplantation or transplantation following cataract surgery in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods: In this cross-sectional, retrospective study, we reviewed the files of 93 eyes from 54 FECD patients undergoing regular follow-up. We recorded clinical metrics such as morning visual disturbance (MVD) and corrected distance visual acuity. In addition, we extracted topographic measurements including central corneal thickness (CCT); corneal volumes (CVs) within 3, 5, and 7 mm diameters (CV3, CV5, CV7); corneal central-to-peripheral volume ratios (CPVRs) for 3/5 mm (CPVR-3/5) and 3/7 mm (CPVR-3/7); peripheral volume index; thinnest point; corneal thickness spatial profile at 2, 4, 6, and 8 mm (CTSP2, CTSP4, CTSP6, CTSP8); corneal central-to-peripheral thickness ratio at 4 mm (CPTR4); and percentage of thickness increase at 2, 4, and 6 mm (PTI2, PTI4, PTI6), loss of regular isopachs (LRI), displacement of the thinnest point (DTP), and focal posterior surface depression (FPSD).

Results: Receiver operating characteristic curves revealed a CCT area under the curve (AUC) of 0.732, with an optimal threshold of 596.5 µm yielding 79.7% sensitivity and 63.6% specificity. CTSP4 demonstrated an AUC of 0.706 with a 616.5-µm threshold (77.4% sensitivity, 60.6% specificity), and CPTR4 showed an AUC of 0.588 with a 0.963 threshold (62.3% sensitivity, 60.6% specificity). Notably, MVD presented a statistically significant odds ratio of 4.63 (95% confidence interval = 1.76-12.86). In univariate analyses, LRI, DTP, and FPSD were risk factors for progression, whereas in multivariate analyses, LRI was an independent risk factor for progression.

Conclusion: The findings suggest that MVD and LRI serve as most significant predictive markers, while CCT, CTSP4, and CPTR4 were average predictive markers for FECD progression, underscoring their potential in guiding clinical decisions and interventions.

Purpose: To observe the changes in corneal epithelial thickness after FS-LASIK and Trans-PRK surgery and to investigate the impact of corneal epithelial remodeling on Q-value and HOA.

Methods: In this prospective cohort study, 50 patients (100 eyes) underwent FS-LASIK and 45 patients (90 eyes) underwent Trans-PRK. Anterior segment OCT was used to measure the corneal epithelial thickness in different corneal zones (central zone: 0-2 mm; paracentral zone: 2-5 mm; and mid-peripheral zone: 5-6 mm) preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. The correlation between △CET in the superior, nasal, inferior, and temporal region at 6 months postoperatively and △Q and △HOA was analyzed.

Results: At 6 months postoperatively, the epithelial thickness increased in the central, paracentral, and mid-peripheral zones in FS-LASIK and Trans-PRK. Central epithelial thickness and different regions of the paracentral zone and mid-peripheral exhibited significant thickening ( P < 0.001). In the para-central zone and mid-peripheral zone, the △CET in different regions after LASIK and Trans-PRK was positively correlated with △Q ( P < 0.05) and △HOA ( P < 0.05).

Conclusion: After FS-LASIK and Trans-PRK, significant epithelial thickening was observed. Epithelial changes in different regions lead to different Q-values in different regions and have different effects on HOA. This has a certain guiding significance for the design of refractive surgery, and minimizing the increase of Q-value may improve the postoperative visual quality.

Purpose: To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes.

Methods: We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed.

Results: Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR ( P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis.

Conclusion: Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

A 45-year-old male presented with diminution of vision in the right eye (RE) for the past 2 weeks. He underwent sequential bilateral cataract surgery 25 years ago, with an intraocular lens in RE, which was his better eye. The left eye was aphakic with a thick fibrous membrane at the pupillary plane. Visual acuity was hand movement in the RE with the iris claw lens and total bullous retinal detachment (RD). The axial length with RD was 28.6 mm in RE and 29 mm in the left eye (LE). We did a vitrectomy with scleral imbrication, endolaser, fluid gas exchange, and tamponade in the RE. The LE developed RD subsequently, and he underwent similar surgical procedures in his LE. The best corrected visual acuity in his RE was 20/80, and that in the LE was 20/120 on follow-up. RD with staphyloma is a surgical challenge as the thin atrophic retina at the posterior pole fails to conform to the concavity of staphyloma. Vitrectomy with tamponade alone does not take care of staphyloma and has more chances of recurrent detachment or persistent fluid at the posterior pole. Scleral imbrication shallows the staphyloma cavity and shortens the axial length, thereby giving a good surgical outcome.

The management of intermediate and posterior uveitis poses a significant challenge of achieving adequate drug concentrations in the posterior segment over the chronic nature of the disease. Systemic agents seldom reach effective drug levels, and even with low maintenance or tapering doses, it is hard to avoid systemic toxicity. The use of intravitreal and periocular injections is often unable to prevent recurrences due to their short half-life. Since the emergence of intravitreal implants (Vitrasert, Retisert), it has become possible to circumvent these therapeutic challenges. A detailed review in the PubMed index yielded 155 articles, of which 22 were analyzed based on exclusion criteria. A recent shift from surgically sutured to minimally invasive injectable implants mainly indicated for noninfectious uveitis is evident from the literature. This review article also provides insights into dexamethasone (Ozurdex) and recent fluocinolone acetonide (Yutiq, Iluvien) implants with particular emphasis on their improved safety and efficacy. Dexamethasone implants favor the therapeutic goal of prevention of recurrences, whereas the use of fluocinolone implants helps to attain better visual outcomes due to their longer duration of action. Thus, the review provides recent literature supporting the role and indication of sustained release intravitreal implants in the management of noninfectious intermediate and posterior uveitis.

Purpose: To demonstrate the treatment efficacy of intravitreal dexamethasone (DEX) implant in chronic recurrent/persistent central serous chorioretinopathy (CSC).

Design: Prospective, non-randomized, open-label study.

Methods: In this study, subjects with chronic CSC without signs of choroidal neovascularization (CNV) received intravitreal DEX implant therapy. The primary outcome measure was the change in visual acuity. Changes in central macular thickness (CMT) and change in subfoveal choroidal thickness (SFCT) on optical coherence tomography (OCT), incidence of recurrent fluid, and safety of DEX implant were secondary outcome measures. Subjects were followed up for a minimum of 3 months after DEX implantation.

Results: In total, 20 eyes of 20 subjects (mean age: 47 ± 9 years) with a median disease duration of 23.5 months were enrolled. With a single injection of DEX implant, a reduction in CMT was noted in 90% of eyes. Complete resolution of subretinal and intraretinal fluid was noted in 55% of eyes within 3 months of injection. A significant improvement in vision (mean Log MAR visual acuity: 0.66 ± 0.49 vs. 0.54 ± 0.45; P = 0.020), mean CMT (338 ± 110 microns to 238 ± 73 microns; P < 0.001) and SFCT (514 ± 95 microns to 445 ± 111 microns; P < 0.001) was noted over 3 months. Recurrent fluid was noted in 50% of eyes after a mean follow-up duration of 7 ± 4 months. Elevated intraocular pressure, managed by topical therapy, was noted in six eyes.

Conclusion: The consistent improvement in visual acuity, fluid resolution, and reduction in choroidal thickness suggests a possible role for DEX implants in managing chronic CSC. A larger randomized trial is warranted.

Context: Chemical injury to eyes causes limbal stem cell deficiency (LSCD), which leads to conjunctival epithelium and underlying stromal changes. Simple limbal epithelial transplant helps to restore corneal epithelium and corneal stromal clarity. These changes are documented in this prospective eye study.

Purpose: To report the changes in epithelial/stromal (E/S) reflectivity ratio and corneal stromal densitometry following simple limbal epithelial transplantation (SLET) in patients with unilateral chemical burn-induced LSCD.

Methods and material: It is a prospective imaging study of cornea before and after SLET. Corneal densitometry with Pentacam and epithelial and stromal reflectivity on anterior segment optical coherence tomography were analyzed for five patients (n = 5 eyes), who underwent autologous SLET for unilateral chemical burn-induced LSCD.

Statistical analysis used: Mann-Whitney U-test and Pearson correlation.

Results: A significant improvement in E/S reflectivity was noted at 1 month ( P < 0.05) after SLET, and this was maintained until the end of 6 months. The densitometry measurements decreased in the entire cornea at every level, that is, anterior, central, and posterior cornea. However, the values did not normalize till the last follow-up at 6 months.

Conclusions: A trend of normal corneal epithelization exists in eyes undergoing SLET. Densitometry at all the levels, the anterior, central, and posterior cornea, also decreases after SLET. SLET improves visual outcomes in LSCD eyes not only by epithelization but also by reducing stromal scarring.