International Ophthalmology Clinics最新文献

Background: Although all ophthalmology residency graduates must fulfill the competencies outlined by The Accreditation Council for Graduate Medical Education (ACGME), the accrediting body for ophthalmology residency programs in the United States, there remains no standardized means of assessing surgical competency.

Methods: A needs analysis was conducted by the Association of University Professors of Ophthalmology (AUPO) of primary stakeholders including residents, faculty, and program directors to identify steps required to determine resources needed to assess surgical competency in ophthalmology resident training.

Results: Three separate yet related needs were identified: determining a definition for competency in essential tasks, determining competency in advanced tasks, and the creation of educational resources that facilitate achievement of both levels of competency.

Conclusion: AUPO developed the Surgical Curriculum for Ophthalmology Residents (SCOR) to provide surgical standards and instructional resources for residents and faculty training the residents. The SCOR program seeks to set the standards for surgical competency at both the basic and advanced levels during residency training.

Cataract surgery is one of the most performed surgeries worldwide, often necessitating postoperative eye drops to manage infection, inflammation, and pain. However, complex regimens, patient adherence challenges, and environmental concerns have led to growing interest in "dropless" cataract surgery, which eliminates or reduces the need for postoperative drops by delivering medications intraoperatively through injections or drug-eluting implants. This review provides an overview of dropless cataract surgery, focusing on common medications used including antibiotics, steroids, nonsteroidal anti-inflammatory drugs, and intraocular pressure medications. Intracameral antibiotic use has become widespread, with strong evidence showing that it effectively reduces the risk of postoperative endophthalmitis without the need for additional topical antibiotics. Steroids, typically delivered through subconjunctival injections or sustained-release implants, show promise in safely and effectively controlling inflammation, though further research is needed to validate fully dropless approaches. Nonsteroidal anti-inflammatory drugs and intraocular pressure medications are less frequently included in dropless regimens, with mixed evidence regarding their impact on long-term outcomes. For patients, dropless cataract surgery can help simplify postoperative care and potentially lower out-of-pocket costs. For health systems, recent analyses suggest dropless surgery could reduce overall costs and decrease environmental waste by reducing consumption of eye drop bottles. Future research should focus on assessing true dropless approaches and optimizing medication delivery. Overall, dropless cataract surgery offers many potential benefits for patients, health systems, and the environment. Additional high-quality evidence substantiating these benefits would help advance its adoption globally.

This review highlights recent developments in the management of adenoviral conjunctivitis (AC), the most common cause of viral conjunctivitis, which can lead to serious complications like subepithelial infiltrates, pseudomembrane formation, and conjunctival scarring. This paper discusses the pathogenic serotypes, particularly those responsible for epidemic keratoconjunctivitis (EKC), and new treatment options, with a focus on povidone-iodine (PVP-I). Diagnosis of AC is primarily based on clinical evaluation, although laboratory testing and imaging may support the assessment. Recent investigation suggests that PVP-I is a promising treatment option, as it can reduce viral load and alleviate symptoms, with minimal adverse effects. However, further research is needed to refine the optimal treatment protocols for PVP-I.

Corneal transplantation is an exceedingly common and pivotal procedure in the management of corneal disease. The increasing demand for corneal transplantation underscores the importance of current guidelines and methodologies for donor tissue screening and collection. A recent FDA notice of inspectional focus on United States eye banks brought concerns about donor sepsis being a source for recipient infections and improper eye bank screening practices. However, there is evidence to suggest that septic donors do not increase the risk of transmission of infections associated with corneal grafts. This is additionally important given the growing need for more corneal graft tissue to maximize the use of suitable tissue. Eye banks also have a number of protocols to consider when screening donors for the presence of sepsis, providing a unique challenge given the broadness of the term. This paper provides an overview of trends in clarification of the term "sepsis" as well as the screening protocol in eye banks.

Keratoconus, characterized by loss of corneal structural integrity causing stromal thinning, has both surgical and nonsurgical management options. While corneal cross-linking is being increasingly used to halt the progression of keratoconus, it is reserved for patients with milder disease and thicker corneas. Tissue addition keratoplasty has recently emerged as a treatment option for patients with more advanced keratoconus. Studies of available tissue addition keratoplasty techniques, including Bowman layer transplantation, corneal allogenic intrastromal ring segments, and intralamellar keratoplasty, show flattening of corneal keratometry and improved visual outcomes, with increased rates of contact lens fitting. The purpose of this review is to discuss available options regarding tissue addition keratoplasty.

Objective: The goal of this study was to conduct a systematic review of publications from the past 20 years on the ocular and periorbital manifestations and complications of molluscum contagiosum (MC), as well as to discuss common diagnostic and therapeutic approaches.

Background: MC is a common skin infection with rare ocular manifestations. These presentations are primarily in children with atopic dermatitis (AD) and adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Though rare, ophthalmologists must recognize ocular manifestations early to prevent complications and reduce infection spread, particularly among immunocompromised individuals and pediatric patients.

Methods: We searched PubMed, SCOPUS, and Cochrane Library for studies on ocular and periorbital MC published between December 7, 2002 and December 7, 2022. English full-text articles on ocular MC were included, whereas systematic reviews and non-English texts were excluded. Generalized background information and statistical data were extracted from articles outside these criteria when necessary.

Results: AD was the most common risk factor in pediatric patients, whereas HIV/AIDS and immunocompromise were prevalent risk factors in adults. Lesions primarily presented on periorbital skin and eyelid margins, with rare ocular surface lesions. Excision and curettage were the most common treatments; while highly active antiretroviral therapy commonly resolved lesions for patients with HIV/AIDS. Secondary follicular conjunctivitis, the most frequent sequela, is often resolved with lesion removal.

Conclusion: MC may cause ocular surface, eyelid, and periorbital lesions, often leading to conjunctivitis. Regular skin examinations for pediatric patients with AD and vigilant childcare monitoring can limit transmission. Enhanced training for ophthalmologists on MC presentation and treatment is recommended.

Objective: This article aims to review the current literature on the severity of global corneal blindness (CB), summarize the current challenges of corneal eye banks in low and middle-income countries (LMICs), and highlight key principles and opportunities for improvement in corneal eye banking in these countries.

Methods: In this article, we reviewed available literature pertinent to global CB and corneal transplantation (CT), and eye banking in LMICs, in addition to supplementation with personal communication with eye banking staff working in LMICs.

Results: CB is a major cause of global blindness and visual impairment, with numerous etiologies varying by geography, socioeconomics, and age. CT remains the mainstay in surgical intervention for CB, with a robust corneal eye banking system playing a critical role in efforts to decrease the amount of CB. Four vital functions of eye banks include consent, recovery, processing, and distribution, with challenges and opportunities present within each. Eye bank infrastructure in LMICs has had numerous successes and setbacks in the last 20 and much work remains to be done.

Conclusions: Much remains to be done in the aim to treat global CB, however, the establishment of ethical, efficient, and high-quality corneal eye banks with subsequent CT acts as a key pillar in the multifaceted approach. With the ultimate goal of self-sufficiency, many eye banks in LMICs lead by example in surmounting challenges shared internationally, and set the stage for others to seize the opportunity to provide tissue to cure CB.

Purpose: To evaluate outcomes of ultracomplex retinal detachment (UCRD) repairs performed at a large county hospital.

Materials and methods: Retrospective chart review of patients who underwent a UCRD repair, defined as a funnel retinal detachment (RD), RD associated with ocular trauma, or RD requiring retinectomy, 5000 centistoke silicone oil or perfluorocarbon heavy liquid (PFO). The outcomes examined were visual acuity (VA), anatomic success, and phthisis development.

Results: Fifty eyes met inclusion criteria; 7 (14%) had a funnel RD, 14 (28%) had a history of ocular trauma, 34 (68%) had a retinectomy, 19 (38%) used 5000 centistoke silicone oil, and 12 (24%) used PFO. The mean follow-up time was 10.9±6.9 months. At 3 months, vision had remained stable or improved for 64% of eyes and the macula was attached for 66% of eyes. The mean preoperative VA was 2.5±0.5 logMAR, and the mean VA at 3 months was 2.4±0.7 logMAR with no statistically significant difference (P=0.30). With multivariate regression, preoperative VA was a statistically significant predictive factor of postoperative VA at 3 months. Nine (18%) of eyes developed phthisis, a mean of 11.4±5.1 months after UCRD repair.

Conclusions: Surgical intervention for UCRD can stabilize vision and achieve anatomic success.

"The eyes are a window to the brain," prompting the investigation of whether retinal biomarkers can indicate Alzheimer disease (AD) and cognitive impairment. AD is a neurodegenerative condition with a lengthy preclinical phase where pathologic changes in the central nervous system (CNS) occur before clinical symptoms. Mild cognitive impairment (MCI) often precedes AD. As part of the CNS, the retina exhibits similar pathologic changes related to AD as those seen in the brains of patients with MCI. Noninvasive imaging technologies such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) allow high-resolution visualization of the retina, providing an opportunity to screen and monitor AD noninvasively. In this review, we summarize the relationship between AD and retinal pathology detected by OCT and OCTA. The most common findings in patients with AD include peripapillary retinal nerve fiber layer thinning, decreased macular thickness, an enlarged foveal avascular zone, and decreased vascular densities in the superficial and deep capillary plexuses. These retinal changes correlate with magnetic resonance imaging (MRI) findings of cerebral atrophy, positron emission tomography (PET) findings of increased amyloid load, and neuropsychological testing results suggesting cognitive dysfunction. We conclude that retinal microstructural and microvascular abnormalities may serve as biomarkers for the early detection and clinical monitoring of AD and as tools for evaluating potential treatment effects. Future studies should focus on standardizing protocols for in vivo ophthalmic imaging to measure retinal pathology in AD and MCI.

Purpose: Diabetic retinopathy and diabetic nephropathy are two major life-altering complications of diabetes mellitus. Identifying permissive and protective factors for diabetic retinopathy and nephropathy is imperative so that diabetic quality of life can be optimized and downstream complications can be minimized.

Methods: We performed a large retrospective chart review of 997 patients at a county medical center with a majority Hispanic population. Through multivariable regression analysis, we identified significant factors associated with the presence of diabetic retinopathy or diabetic nephropathy. We also identified patients with a discordance between diabetic control and the severity of diabetic retinopathy and nephropathy.

Results: Chronic kidney disease, baseline HbA1c, and systolic blood pressure were found to be positive risk factors for both diabetic retinopathy and diabetic nephropathy. Beta-blocker use and insulin use were identified as positive risk factors for diabetic retinopathy but not diabetic nephropathy. A higher body metabolic index (BMI) was found to be protective for diabetic retinopathy. We identified 7 patients with poor diabetic control (HbA1c >10%) but no diabetic retinopathy. There were no outlier patients found in the low glycemic exposure group.

Conclusions and importance: Our results are similar to other large-cohort reviews identifying factors associated with diabetic retinopathy and nephropathy. We identified a small cohort with discordance between diabetic control and the development of diabetic retinopathy or nephropathy. Future studies should be conducted looking into reasons for the anomalous progression of disease in certain patients.