International Ophthalmology最新文献

Background: Allergic ocular surface disease affects 20-40% of populations globally, with seasonal patterns undocumented in south Asian populations, limiting evidence-based resource planning in resource-constrained settings.

Methods: This prospective cross-sectional study enrolled 201 consecutive patients (mean age 33.1 years, 49.8% female) from a tertiary care ophthalmology outpatient department over 12 months. Participants underwent standardized assessment: Ocular Surface Disease Index (OSDI ≥ 23), Schirmer's test (< 5 mm/5 min), and tear break-up time (TBUT < 5 s). Environmental data were obtained from the Meteorological Department.

Primary outcome: seasonal clustering of disease presentation.

Results: Disease severity was significantly elevated during high-prevalence seasons: OSDI 40.99 versus 34.04 (difference 6.95; 95% CI: 2.83-11.07; p < 0.001); Schirmer's test 2.71 mm versus 3.40 mm (p = 0.006); TBUT 2.38 versus 3.48 s (p < 0.001; Cohen's d =  - 0.831). Diagnostic criterion achievement was 58.3% versus 35.0% (p = 0.001). Season emerged as the independent predictor (OR 0.363; 95% CI: 0.199-0.663; p = 0.001), with each 1 °C temperature increase associated with 0.041-s TBUT reduction (r =  - 0.313; p < 0.001).

Conclusions: Allergic ocular surface disease exhibited pronounced seasonal clustering driven primarily by temperature-mediated tear film destabilization. These findings support anticipatory healthcare resource planning-seasonal appointment augmentation and pharmacotherapy stockpiling-for resource-constrained facilities.

Purpose: This study aims to compare the effects of cooled versus room-temperature irrigation solutions on preoperative and early postoperative choroidal vascularity in patients undergoing pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) peeling.

Methods: In this prospective, randomized, comparative study, 54 patients underwent standard 23-G PPV performed by a single surgeon. During the procedure, 27 patients received cooled irrigation solutions (Group 1), while the remaining 27 patients were treated with room-temperature irrigation solutions (Group 2). Central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were measured preoperatively and five to ten minutes postoperatively in both groups. The preoperative-to-postoperative changes within each group and the differences between the two groups were analyzed.

Results: In Group 1, significant differences were observed in both SFCT and CVI values between the preoperative and postoperative measurements (p = 0.002 and p = 0.002, respectively), whereas the mild reduction in CVI in Group 2 (p = 0.012) did not remain statistically significant after Bonferroni correction. However, no statistically significant differences were found in the magnitude or percentage of preoperative-to-postoperative changes between the groups (p > 0.05). A two-way repeated measures ANOVA revealed significant reductions in CMT, SFCT, and CVI following PPV in both groups (p < 0.05).

Conclusion: PPV caused an early postoperative decrease in choroidal perfusion, which was significant in the cold irrigation group. However, there was no significant difference between cooled and room-temperature irrigation solutions.

Introduction: Thyroid eye disease (TED) is an autoimmune-mediated inflammatory condition of the orbit leading to hypertrophy and inflammation of the orbital extra-ocular muscles (EOMs). Previous studies have sought to quantify this enlargement, but due to the anatomical proximity and limitations in imaging quality, have measured the superior rectus (SR) and Levator Palpebrae Superioris (LPS) complex together rather than measuring the individual muscles.

Methodology: Retrospective manual measurements from high-field (3-Tesla) fat-suppressed contrast-enhanced T1-weighted magnetic resonance imaging (MRI) of the orbits were taken from patients diagnosed with TED. To produce a control group, orbital MRIs were measured from patients being investigated for other non-TED related orbital pathology.

Results: 47 patients were included with TED with 78 orbits measured (L: 42 R: 37). In the control group, 111 patients with 163 orbits measured were included. In the TED cohort the mean ratio of LPS to SR size was 1.04 (SD: 0.53) compared to 0.947 (SD 0.33) in the non-TED cohort with no statistically significant difference (p = 0.3381). The LPS in the TED cohort had a mean muscle thickness of 2.4 mm (SD 0.895), which was higher than the non-TED cohort (p < 0.01) which had a mean thickness of 1.56 mm (SD 0.36). This study found LPS enlargement occurred in 48.7% of TED orbits.

Conclusion: This study demonstrates that absolute LPS enlargement is a common finding in TED, occurring in nearly half of affected orbits. This is the first study to individually segment and quantify the extent of enlargement of the LPS relative to the SR using modern medical imaging.

Background: The primary treatment for managing epilepsy consists of anti-seizure drugs (ASDs). Nevertheless, their prolonged use has been associated with various ocular complications. The structural alterations, such as thinning of the retinal nerve fiber layer (RNFL) and macular edema, have received limited research attention in younger adults undergoing extended ASD treatment.

Objective: This study aimed to evaluate the structural and functional changes in the eyes specifically, refractive error, tear film quality, macular health, and RNFL thickness among young adults who are on long-term ASD therapy.

Methods: A cross-sectional investigation involved 340 subjects aged between 20 and 40, comprising 200 ASD users and 140 healthy controls matched by age. All participant underwent a thorough ocular assessment that included best-corrected visual acuity (BCVA), subjective refraction, intraocular pressure, Schirmer's I & II tests, tear breakup time (TBUT), slit-lamp examination, fundus photography, and Optical Coherence Tomography (OCT) for analysis of the retinal nerve fibre layer (RNFL) and macula. The statistical evaluation was conducted using the Kruskal-Wallis H test, with significance established at P < 0.05.

Results: Users of ASD exhibited a significantly higher average refractive error (-2.50DS/ ± 1.00DC) compared to controls (-0.75DS/ ± 0.75DC180). Tear metrics were considerably lower, with Schirmer's I & II and TBUT demonstrating significant disparities in sodium valproate users (P < 0.001). OCT findings indicated early signs of macular edema in 10% of ASD users, particularly among those on sodium valproate and topiramate. RNFL thickness displayed an average reduction of 8.5 µm relative to controls (P = 0.042), with the most pronounced thinning noted in users of lamotrigine and levetiracetam.

Conclusion: Prolonged ASD treatment is linked to observable changes in ocular structure, including dry eye disease, myopia, macular edema, and RNFL thinning. These outcomes highlight the necessity for routine ophthalmic evaluation and collaborative care to prevent irreversible visual impairment in individuals with epilepsy.

Purpose: To evaluate the diagnostic utility of the Prognostic Nutritional Index and Controlling Nutritional Status score in patients with retinal vein occlusion.

Methods: In this retrospective case-control study, 55 patients diagnosed with retinal vein occlusion between Jan 2019 and May 2024 and 110 healthy controls were examined. Demographic data, systemic comorbidities, laboratory parameters, the Prognostic Nutritional Index and the Controlling Nutritional Status score were compared between groups. Binary logistic regression analysis was used to identify independent predictors of retinal vein occlusion; receiver operating characteristic curve analysis was used to evaluate the discriminative performance of Prognostic Nutritional Index and Controlling Nutritional Status score.

Results: The mean age (p = 0.311), and gender distribution (p = 0.226) were similar in retinal vein occlusion and control groups. Hypertension was more prevalent in retinal vein occlusion group (89.1% vs. 60.9%, p < 0.001). Mean Prognostic Nutritional Index (45.62 ± 1.52 vs. 45.59 ± 2.41, p = 0.557) and median Controlling Nutritional Status scores (0 vs. 0, p = 0.129) were similar between groups. In multivariate logistic regression analysis, only hypertension independently predicted retinal vein occlusion (OR = 5.12; p = 0.001). Prognostic Nutritional Index demonstrated poor discrimination (AUC = 0.528; p = 0.557) for retinal vein occlusion.

Conclusions: Prognostic Nutritional Index and Controlling Nutritional Status score, which are valuable prognostic biomarkers in some chronic systemic and ophthalmologic diseases, could not distinguish retinal vein occlusion cases from controls. Hypertension remains the principal modifiable risk factor for retinal vein occlusion.

Background: Cataract is a leading cause of reversible visual impairment in older adults and is strongly associated with reduced quality of life and increased depressive symptoms. Although cataract surgery restores visual function, its psychological impact- particularly on depression and hopelessness-remains insufficiently explored.

Methods: This prospective observational study included 71 patients undergoing standard phacoemulsification with intraocular lens implantation. Visual function, depression, and hopelessness were assessed preoperatively and at 4 and 12 weeks postoperatively using the NEI VFQ-25, Beck Depression Inventory (BDI), and Beck Hopelessness Scale (BHS). Subgroup analyses were conducted for gender, marital status, employment, socioeconomic status, and education level. Statistical analyses included paired-sample tests, repeated-measures ANOVA or Friedman tests, and Cohen's d effect size calculations.

Results: Best-corrected visual acuity improved significantly from 0.61 to 0.10 logMAR. NEI VFQ-25 subscales-particularly general vision, near and distance activities, colour vision, peripheral vision, and mental health-showed marked postoperative improvement (all p 0.001; large effect sizes). Mean BDI scores decreased from 18.56 ± 5.5 to 14.14 ± 4.7, shifting from "moderate" to "mild" depression by week 12. BHS scores declined from 12.79 ± 2.1 to 10.42 ± 2.2 (both p 0.001), indicating significant but more limited improvement in hopelessness. Subgroup analyses revealed greater psychological recovery in males, married individuals, actively working participants, and those with higher socioeconomic status.

Conclusion: Cataract surgery substantially improves both visual function and psychological well-being. Enhancements in visual acuity and NEI VFQ-25 scores parallel significant reductions in depressive symptoms and modest, yet meaningful, declines in hopelessness. Sociodemographic factors influence recovery patterns, underscoring the importance of individualized patient counselling. Cataract surgery should be recognised not only as a visual rehabilitation procedure but also as a valuable intervention supporting emotional and mental health in older adults.

Purpose: The objective of this article is to delineate a novel surgical technique designed to maintain the globe in a well-stabilized state within a homogenous medium, irrespective of pressure variations during retinal detachment procedures.

Methods: Six patients suffering from rhegmatogenous retinal detachment were enrolled in our study. A novel technique was employed to stabilize the globe's tonus, and media management was conducted through continuous injection of perfluorodecalin via an infusion port.

Results: The mean age of patients was 63.16 ∓  ± 6.52 years. The average intraocular pressure on the first postoperative day and at the one-month follow-up were 14.33 ∓  ± 3.54 mmHg and 12.83 ∓  ± 3.89 mmHg, respectively. At the conclusion of the one-month follow-up period, none of the patients exhibited any signs of redetachment, epiretinal membrane (ERM), proliferative vitreoretinopathy, or silicone oil-related complications.

Discussion: Maintaining the globe in a well-stabilized position within a homogeneous medium, despite pressure fluctuations during retinal detachment surgery, is of utmost significance. Our technique presents a straightforward and efficacious solution to this challenge, particularly in cases involving giant retinal tears that may pose additional difficulties during retinal detachment repair.

Purpose: To evaluate the efficacy and safety of PreserFlo MicroShunt in a UK tertiary glaucoma centre at one year follow-up.

Methods: this is a retrospective, single-centre study of eyes with glaucoma that underwent PreserFlo MicroShunt implantation. Success was defined as IOP between 6 and 21 mmHg (range 6-17 and 6-14 mmHg was also evaluated) and a reduction of at least 20% of preoperative IOP; success was defined as complete (CS) if without hypotensive medications, and as overall (OS), if with or without medications. Secondary outcomes included final IOP, final number of glaucoma drops, final BCVA.

Results: a total of 69 eyes were included in the study. The CS and OS for IOP 6-21 mmHg were achieved in 73.9% and 79.7%, respectively. For the range of IOP 6-17 mmHg, 72.5% and 78.3%, and for the range of IOP 6-14 mmHg, 55.1% and 58.0%. The mean IOP was significantly reduced from 24.7 ± 7.2 mmHg at baseline to 12.4 ± 5.0 mmHg (p < 0.0001). The most frequent adverse event was transient early hypotony (28.9%), followed by hyphaema (11.5%) and choroidal effusion (8.6%). Aqueous misdirection occurred in two pseudophakic eyes with primary angle-closure glaucoma (PACG), representing a rare but vision-threatening complication in this setting.

Conclusion: PreserFlo MicroShunt was effective and safe in the follow-up period and achieved IOP results in the low teens.

Purpose: To evaluate the quantitative changes in subfoveal choroidal thickness (CT), retinal thickness, and choroidal vascularity index (CVI) following upper eyelid blepharoplasty in patients with dermatochalasis, using spectral-domain optical coherence tomography (SD-OCT).

Methods: This retrospective study included 78 eyes of 78 patients (mean age: 57.9 ± 8.7 years) who underwent upper eyelid blepharoplasty between May 2024 and May 2025. Only right eyes with high-quality SD-OCT images obtained both preoperatively and at 3 months postoperatively were included. Retinal thickness was assessed in 9 ETDRS subfields. Subfoveal CT and CVI were measured using horizontal B-scan images. CVI was calculated based on the binarization method described by Agrawal et al., using ImageJ software. Pre- and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests depending on normality.

Results: Subfoveal CT significantly increased after surgery (287.22 ± 39.67 µm to 294.23 ± 39.74 µm; p = 0.030). A marked increase in CVI was also observed (61.48 ± 9.13% to 63.63 ± 9.13%; p < 0.001). No significant differences were detected in most retinal segments, except for the inferior inner (p = 0.016) and inferior outer (p = 0.002) regions, which showed statistically significant thickening postoperatively.

Conclusions: Upper eyelid blepharoplasty is associated with measurable structural changes in the posterior segment, including increased subfoveal CT and CVI, as well as regional thickening of the inferior retina. These findings suggest that blepharoplasty may influence choroidal hemodynamics and retinal adaptation beyond its functional and cosmetic benefits.