International Ophthalmology最新文献

Purpose: This study aimed to evaluate pre-treatment optical coherence tomography (OCT) biomarkers in patients with diabetic macular edema (DME) and to assess changes in these parameters and their impact on visual prognosis one year after intravitreal (IV) anti-VEGF and steroid treatment.

Methods: This retrospective study included 250 eyes of 250 patients with DME. Best-corrected visual acuity (BCVA) and routine ophthalmologic examinations were evaluated at baseline and at 4, 6, and 12 months after treatment. Spectral-domain OCT biomarkers assessed were central macular thickness (CMT), serous retinal detachment (SRD), disorganization of retinal inner layers (DRIL), hyperreflective dots (HRD), integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM), intraretinal cyst (IRC) size, vitreomacular adhesion (VMA), epiretinal membrane (ERM), and macular cube volume (MCV). Patients were classified according to letter gain as good (> 10 letters), moderate (5-10 letters), or poor (< 5 letters) responders. Statistical analyses included one-way ANOVA and Kruskal-Wallis tests with post-hoc multiple comparisons.

Results: BCVA improved significantly at 4, 6, and 12 months after treatment (p < 0.001). Mean CMT, IRC, HRD, and MCV values showed significant reductions at all follow-up visits (p < 0.001). The good responder group had significantly lower baseline BCVA and higher baseline CMT, IRC, and HRD values (p < 0.001). In contrast, the poor responder group showed a significantly higher baseline presence of DRIL (p < 0.001).

Conclusion: IV anti-VEGF and dexamethasone treatments provide significant anatomical and functional improvement in DME. High baseline CMT, HRD, and IRC values may indicate a favorable visual prognosis, whereas the presence of DRIL at baseline is associated with limited visual gain. Providing accurate prognostic information at treatment initiation may improve patient compliance.

Purpose: To evaluate retinal and choroidal microvascular changes in patients with idiopathic pulmonary fibrosis (IPF) using optical coherence tomography angiography (OCTA), and to explore whether IPF, traditionally considered a pulmonary disease, also manifests in the ocular microcirculation.

Methods: In this cross-sectional case-control study, 82 IPF patients and 82 age-, sex-, and eye-side-matched healthy controls were enrolled. All participants underwent comprehensive ophthalmic examination and macular OCTA imaging using the RTVue XR Avanti device. Vessel density (VD), foveal avascular zone (FAZ) area and perimeter (PERIM), flow area, selected area, and perfusion density were assessed in the superficial and deep capillary plexuses, outer retina, and choriocapillaris.

Results: The IPF group exhibited significantly lower superficial foveal vessel density (p = 0.030), reduced outer retina selected area (p = 0.010), and decreased choriocapillaris selected area (p = 0.003) compared to controls. No significant differences were observed in FAZ area or deep plexus vessel densities.

Conclusion: Patients with IPF demonstrate measurable microvascular alterations in both the superficial retina and choriocapillaris, supporting the concept of IPF as a systemic disease with extra-pulmonary vascular involvement. OCTA may serve as a non-invasive imaging biomarker for detecting systemic microangiopathy in fibrotic lung disease.

Purpose: To investigate the accuracy, stability, and influencing factors of 12 intraocular lens (IOL) calculation formulas in highly myopic cataract patients.

Methods: Retrospective Case Series. Clinical data were collected from highly myopic cataract patients who underwent cataract extraction surgery at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, between January 2024 and January 2025. Patients were stratified into subgroups based on axial length, keratometry, anterior chamber depth and axial length to corneal radius ratio (AL/r). The prediction error (PE), absolute error (AE), root-mean-square absolute prediction error (RMSAE) and the percentage of eyes with an absolute error within ± 0.25 D, ± 0.50 D, ± 0.75 D, and ± 1.00 D were recorded and compared for the following 12 IOL formulas: Barrett Universal II, Cooke K6, Castrop, Kane, EVO 2.0, Pearl-DGS, Hoffer QST, SRK-T, Haigis, Holladay 1, Holladay 2, and Hoffer Q. Statistical analysis was performed using Analysis of Variance (ANOVA), Friedman test, Kruskal-Wallis test, Dunn's test, and Cochran Q test.

Results: A total of 255 patients (255 eyes) were included in this study, comprising 113 males and 142 females, with a mean age of 57.8 ± 9.9 years. The difference in absolute errors among the 12 IOL formulas was statistically significant (χ² = 327.59, P < 0.01). Among them, the Hoffer QST formula yielded the lowest absolute error (0.33 D), followed by Pearl-DGS (0.35 D) and Barrett UII 0.35 D), while the Hoffer Q formula showed the highest absolute error (0.75 D). Notably, only the Hoffer QST and Pearl-DGS formulas demonstrated no significant correlation between their absolute errors and axial length, corneal curvature, or anterior chamber depth (all P > 0.05).

Conclusion: For highly myopic cataract patients, modern IOL formulas demonstrated superior accuracy compared to traditional formulas. The accuracy was predominantly influenced by axial length, with keratometry and anterior chamber depth playing minor roles. The Hoffer QST and Pearl-DGS formulas, in particular, showed consistent and stable performance.

Purpose: Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and chronic inflammation. Natural compounds with anti-inflammatory activity have therefore attracted increasing interest. Chelidonium majus (C. majus) latex contains bioactive alkaloids with proven anti-inflammatory properties; however, its potential role in DED has not yet been investigated.

Methods: Forty-six Wistar rats were randomized into six groups: Control, DED, Loteprednol etabonate (LE), and three C. majus latex dilutions (1/1, 1/10, 1/100). DED was induced by twice-daily instillation of 0.2% benzalkonium chloride (BAC) for 14 days. Following induction, LE or C. majus latex was administered according to group allocation; controls received vehicle. Tear volume (phenol red thread test), fluorescein corneal staining score (CSS), and Cochet-Bonnet esthesiometry were measured on days 0, 14, 21, and 28. On day 29, corneal tissues were analyzed by ELISA for TNF-α, IL-1β, IFN-γ, NF-κB, MMP-2, MMP-9, TIMP-2, AQP1, and AQP5, and underwent histopathological evaluation (H&E). Latex composition was characterized using LC-QTOF-MS. Statistical analysis included ANOVA with post hoc Tukey testing; p < 0.05 was considered significant.

Results: At week 2, the DED groups demonstrated reduced tear volume (2.13 ± 0.83 mm) and increased corneal staining scores (CSS) (4.63 ± 1.06). By week 4, tear secretion improved in the LE (4.38 ± 0.52 mm) and in the C. majus 1/1 (4.56 ± 0.56 mm), 1/10 (4.88 ± 0.52 mm), and 1/100 (4.56 ± 0.50 mm) groups, approaching values observed in the control group. CSS decreased markedly in the C. majus 1/10 (0.38 ± 0.52) and LE (1.13 ± 0.83) groups, whereas the DED group remained elevated (2.38 ± 0.52). Corneal sensitivity improved in the LE and C. majus 1/1 (3.44 ± 0.42 mm), 1/10 (3.75 ± 0.27 mm), and 1/100 (3.50 ± 0.46 mm) groups. Inflammatory cytokines and MMP-2/9 levels decreased significantly across treatment groups, with the most pronounced reductions observed in the C. majus 1/10 group. Histopathological analysis revealed better preservation of stromal architecture and reduced inflammatory infiltration in treated groups compared with the DED group.

Conclusions: Chelidonium majus latex demonstrated significant anti-inflammatory and tissue-protective effects in this experimental model, supporting further investigation as a potential adjunctive approach in inflammatory DED.

Purpose: To describe the risk factors, clinical and microbiological profile, management, and outcomes of Actinomyces odontolyticus-associated keratitis in a retrospective case series from a tertiary eye care center in South India.

Methods: A retrospective analysis was conducted on seven patients with culture-proven Actinomyces odontolyticus keratitis at the LV Prasad Eye Institute, Hyderabad, between January 2024 and April 2025. Demographic data, clinical features, risk factors, microbiological findings, treatment course, and outcomes were reviewed.

Results: Of the seven patients, five (71%) had pre-existing ocular surface abnormalities, including non-healing epithelial defects (PED) post therapeutic penetrating keratoplasties, spheroidal degeneration, and chemical injury. Six out of seven (86%) had a pre-existing PED before they developed keratitis. Four had undergone prior ocular surgeries and were on long-term topical corticosteroids (average duration 53 days). Corneal ulcers had a median size of 2.7 (IQR,1.5-4.5 mm). Five out of 7 patients responded to topical fortified cefazolin 5%, with complete resolution of infection. The average duration of medical therapy was approximately 72 days (15-150 days). Two patients required adjuvant interventions, including cyanoacrylate glue, bandage contact lens, and anterior chamber reformation for corneal perforation. Three patients underwent optical penetrating keratoplasty. The remaining four had satisfactory outcomes with medical management alone. Final best-corrected LogMAR visual acuity ranged from 2.4 to 0.40 at the last follow-up.

Conclusions: Actinomyces odontolyticus keratitis, though uncommon and often underrecognized in compromised eyes, can cause a non-healing epithelial defect and can be effectively managed with timely microbiological evaluation and appropriate antibiotic therapy.

Background: Surgically induced necrotizing scleritis (SINS) is a blinding ocular disease characterized byinfl ammation with scleral necrosis. It occurs as early as one day after ocular surgery, although it can also occur years later. Commonly, it occurs after pterygium and cataract surgeries CASE PRESENTATION: Here, we report a case of a 40-year-old woman with underlying diabetes mellitus whounderwent a successful excisional biopsy via a swinging upper eyelid approach with lateral canthotomy andcantholysis, along with disinsertion of the superior and lateral rectus muscles, for an orbital cavernous venousmalformation. However, 9 weeks postoperatively, the patient developed persistent pain in the right eye (RE),especially with lateral gaze, which was not relieved with oral ibuprofen. At 16 weeks postoperative, an RE focal areaof scleral necrosis with surrounding conjunctival injection was noted at the superotemporal bulbar region. Magneticresonance imaging of the orbit and brain revealed RE focal thickening at the posterolateral sclera, posterior to thelateral rectus muscle insertion, suggesting posterior scleritis. The patient was treated with oral prednisolone (40mg/day) followed by a tapering regimen with adjunctive methotrexate (20 mg/week). After three months of oralprednisolone and six months of methotrexate, her disease resolved with no complications.

Conclusion: SINS is a rare but potentially sight-threatening complication following orbital surgery with intraconaltumor excision. Persistent pain can be a useful clue before the clinical signs become apparent.

Background and purpose: The orbit is an unusual site for metastatic cancer. This study evaluated the ultrasonographic and MRI/CT imaging features of orbital metastasis (OM) as well as demographic, clinical, radiological, management, and outcome.

Methods: Retrospective, non-comparative single-institutional chart review of patients with OM. Records were evaluated for age at presentation, race, gender, laterality, site of primary tumor, imaging findings of orbital metastasis, treatment, and outcome.

Results: There were 12 males and 15 females whose mean age at presentation was 60 years. Twenty-three patients (85%) had known primary cancer. Primary malignancies were breast carcinoma in 12 patients (44.5%), melanoma in 5 (18.5%), and lung carcinoma in 3 (11.1%). The most present findings were ocular motility disturbances (63%), proptosis (55%), and vision loss (19%). The lesions were well-outlined in 74%, located posterior to the equator in 59%, involved only one quadrant in 56%, and involved the extraocular muscles in 74%. Ultrasound was able to detect orbital or muscle lesions in 24 patients (89%). The shape, configuration, and location of the lesion and detection of extraocular muscle involvement agreed between MRI/CT and US exams. Treatment protocols included radiotherapy, chemotherapy, immunotherapy, hormone therapy and surgical excision. Seventeen patients (63%) had died of metastasis, with a mean overall survival time of 19 months after OM diagnosis.

Conclusions: Breast carcinoma, melanoma, and lung carcinoma are the most common primary malignancies that metastasize to the orbit. OM tends to infiltrate the extraocular muscles. Ultrasound provides reliable parameters and can be used as a primary screening when evaluating suspected OM lesions. The survival time of patients with OM is generally poor.

Purpose: To investigate whether nasal anatomical alterations associated with nasal septum deviation (NSD) contribute to early functional impairment in the lacrimal drainage system, potentially indicating subclinical stages of primary acquired nasolacrimal duct obstruction (PANDO).

Methods: Sixty-nine patients with unilateral NSD were included. Individuals with clinical or radiological evidence of PANDO were excluded. Lower tear meniscus height (LTMH) and area (LTMA) were bilaterally measured using anterior segment optical coherence tomography (AS-OCT). Nasal anatomical parameters were assessed on both the deviation side (DS) and contralateral side (CS) using paranasal sinus computed tomography (PNS-CT).

Results: Both LTMH and LTMA were significantly higher on the DS compared to the CS (p < 0.001). Significant positive correlations were observed between DS-LTMH and LTMA and several nasal anatomical features, including concha nasalis inferior bone thickness (CNI-BT), attachment angle, CNI-maxillary sinus angle (CNI-MS), CNI length, and inferior nasal meatus volume (INMV) (p < 0.05). On the CS, no nasal anatomical parameter demonstrated a significant correlation with both LTMH and LTMA.

Conclusion: NSD may impair tear drainage even in the absence of clinical signs of PANDO. The observed correlations between tear meniscus parameters and specific nasal anatomical structures suggest that sinonasal alterations secondary to NSD may contribute to subclinical tear stasis. These findings highlight the potential role of nasal anatomy as an early indicator of predisposition to nasolacrimal duct obstruction in asymptomatic individuals.

Objective: This study aims to investigate the correlation between ocular surface characteristics and tear Lymphotoxin-alpha (LTA) levels in type 2 diabetes mellitus (T2DM) patients at different disease durations, in order to explore the potential role of LTA as a biomarker for the pathogenesis of diabetic dry eye syndrome (DES).

Methods: This retrospective controlled study evaluated ocular surface function in 90 subjects from June 2023 to June 2025: Group A (T2DM ≤ 5 years), Group B (T2DM > 5 years) as the study groups, and a control group (non-DM), 30 per group. Masked researchers assessed ocular surface indicators [Ocular Surface Disease Index (OSDI) score, non-invasive tear meniscus height (NTMH), non-invasive first tear film break-up time (NITBUTf), non-invasive average tear film break-up time (NITBUTav), meibomian gland loss score, eyelid margin assessment (EMS), corneal fluorescein staining score (CFS), and the Schirmer's I test (SIt)]. Tear LTA concentration was detected using immunochromatography. The relationships between the duration of T2DM and different parameters were assessed using Spearman's correlation method.

Results: The control group had higher tear LTA levels (1.79 ± 0.32 ng/mL) than both T2DM groups (Group A: 0.64 ± 0.14 ng/mL; Group B: 0.51 ± 0.12 ng/mL; P < 0.05). Ocular surface function (NTMH, NITBUTf, NITBUTav and SIt) declined, while symptom and sign scores (OSDI, EMS and CFS) increased in T2DM groups, worsening in Group B (P < 0.05). DES prevalence was higher in Group A (26.67%) and Group B (53.33%) than controls (6.67%) (P < 0.05). Tear LTA levels showed a strong negative correlation with T2DM duration, OSDI, meibomian loss, EMS, and CFS (all P < 0.05), but positively with NTMH, NITBUTf, NITBUTav, and SIt (all P < 0.05).

Conclusion: Ocular surface function in patients with T2DM deteriorates with the prolongation of disease duration. The decrease in tear LTA level may be associated with the immune imbalance mechanism of diabetic DES.

Purpose: This study aims to elucidate the classification, clinical presentation, follow-up, and treatment outcomes of elderly patients diagnosed with infectious keratitis.

Methods: This retrospective single-center analysis, conducted at a tertiary ophthalmology center (Ege University Medical Faculty Hospital, Department of Ophthalmology, Izmir, Turkiye), included 317 patients aged ≥ 60 years diagnosed with infectious keratitis between January 2012 and January 2025. Microbiological culture results, clinical course, comorbidities, treatments, and outcomes were evaluated.

Results: The female-to-male ratio was 0.89 and the mean age was 72.1 ± 7.23 years (range: 60-96 years). Positive culture results were identified in 128 (40.4%) of 317 patients, with 81 (63.3%) bacterial and 47 (36.7%) fungal infections. Streptococcus pneumoniae (29.7%) was the most common pathogen. Most lesions were central/paracentral (89.9%) and single (79.2%). The mean best-corrected visual acuity (BCVA) improved from 2.33 ± 0.99 LogMAR to 1.99 ± 1.08 LogMAR (95% CI, 0.15-0.53; paired-samples t test, p < 0.001). Most patients (76.3%) responded favorably to empirical treatment. Recurrence occurred in 34 patients, 22 required corneal transplantation, and 9 underwent evisceration. Dry eye (43.8%) and systemic immunosuppression (36.9%) were the most common comorbidities.

Conclusion: In the present study, differing from some others that report coagulase-negative Staphylococci as the predominant agent in elderly infectious keratitis patients, the most common pathogen was Streptococcus pneumoniae. This finding highlights potential regional or methodological differences. The presence of dry eye and systemic immunosuppression significantly influenced unfavorable outcomes, emphasizing the importance of addressing these risk factors. Tailored treatment strategies may improve outcomes in this population.