International Ophthalmology最新文献

Purpose: To determine the prevalence and demographic profile of keratoconus (KC) among high school students in Nairobi County, Kenya.

Methods: In this population-based, prospective, cross-sectional study, multistage cluster sampling was used to select the participants. All students underwent visual acuity measurement, auto-refraction, retinoscopy and corneal topography. Students with a scissors reflex on retinoscopy or corneal topography patterns suspicious of KC were referred for corneal tomography.

Results: A total of 3051 students from 29 schools, with a mean age of 17.4 ± 1.6 years (range: 13-25 years) were screened. The prevalence of KC was 1.7% (n = 51) (95% CI, 1.2-2.2) and of KC suspects was 3.8% (n = 117) (95% CI, 3.2-4.6). There were no significant associations between the prevalence of KC and gender, age or ethnicity (all p > 0.05). In the KC group, 88.2% (n = 45) were unaware of their condition, 52.9% (n = 27) were treated for allergic conjunctivitis, 45.1% (n = 23) required spectacles, 11.8% (n = 6) were recommended contact lenses in at least one eye and 49.0% (n = 25) were recommended corneal cross-linking.

Conclusions: Among adolescents, the results of this study indicate a higher prevalence of KC compared to that reported in South Korea, Norway, Brazil and Caucasians in New Zealand, but less than that reported in some countries in the Middle East. Given the high prevalence revealed in this study, a national school screening program and clinical guidelines for screening, diagnosis and management of KC is recommended.

Objective: Near-infrared reflectance (NIR) is a commonly performed noncontact and rapid imaging technique. This paper reviews the clinical applications of NIR for diagnosing and monitoring retinal diseases.

Methods: A comprehensive search was conducted across the Pubmed database. A total of 105 articles were finally included in this article. Images were acquired from the authors own clinical experience.

Results: The article describes the imaging utility of NIR for diagnosing and deomonstrating findings in various conditions. These include retinal vascular diseases, age-related macular degeneration (AMD), vitreoretinal interface pathologies, retinal dystrophies, inflammatory chorioretinopathies, phakomatoses, retinal toxicities, photic injury, choroidal cavitary lesions, choroidal neoplasms, and choroidal Vascular Lesions.

Conclusion: NIR is widely acquired during OCT imaging, and is advantageous at imaging with low illumination levels and through narrow pupils or opaque media. NIR offers valuable information for the diagnosis and follow-up of retinal disease, and is highly recommended to utilize for clinical decision-making in ophthalmology.

Purpose: To investigate the efficacy of a comprehensive surgical approach for rejuvenation of the aging lower periorbita.

Methods: Between February 2018 and January 2023, 80 eyes of 40 patients with lower lid dermatochalasis (LLD), lower lid laxity (LLL) or orbicularis laxity of the lower lid (OL) admitted to the oculoplastic surgery department of our clinic were included in the study. 18 eyes had LLD, 14 eyes had LLL, 18 eyes had LLD and LLL, and 30 eyes had LLD, LLL and OL. Patients were re-evaluated preoperatively, postoperatively at 1st week, 1st month and 6th month. In the LLD scoring, skin laxity was evaluated as 1 point for skin laxity, 2 points for fat prolapse, 3 points for tear trough deformity, 1 point for LLL and 1 point for OL. Patients with a total score below 3 points were defined as mild, and patients with a score of 3 and above were defined as advanced.

Results: Of the 40 patients, 30 were female (75%), 10 were male (25%) and the mean age was 56.7 years (45.67 years). Eighteen (22.5%) eyes underwent lower lid blepharoplasty (LLB) only, 14 (17.5%) eyes underwent lateral retinacular suspension (LRS) only, 18 (22.5%) eyes underwent LLB and LRS, 30 (37.5%) eyes underwent LLB, LRS and orbicularis muscle suspension (OMS).78 (97. 5 eyes with upper lid dermatochalasis underwent concomitant upper lid blepharoplasty (ULB) and 42 eyes (52.5%) with brow ptosis underwent additional browpexy. As a result of scoring, 34 eyes (42.5%) had mild and 46 eyes (57.5%) had severe lower periorbital aging. As a result of combined surgical treatments for each sign of aging of the lower periorbita in all patients, complications such as lid malpositioning, corneal exposure, orbital hemorrhage were not seen in any eye and surgical and cosmetic success was achieved.

Conclusion: In patients with varying degrees of lower periorbital aging, a comprehensive surgical treatment can provide effective and safe results in rejuvenating the lower periorbital area. Additional treatments such as LRS and OMS have the advantage of providing a comprehensive approach to skin and muscle tightening while maintaining support to the lateral canthus and improving the lid-cheek junction.

Purpose: To determine the anatomical parameters of puncta in Turkish population without any complaint of epiphora, using anterior segment optic coherence tomography (AS-OCT).

Materials and methods: The healthy participants between 26 and 83 years old who applied to our outpatient clinic from May 2022 to June 2022 for spectacle prescription or the accompanying person of the patients were included in the study. All participants underwent AS-OCT (Revo 60, OPTOPOL Technology, Zawiercie, Poland).

Results: This study included 105 eyes of 53 healthy participants, 27 (54 eyes) of the patients were male and 26 (51 eyes) of them were female with a mean age of 55.6 years (SD: 14.8, Range: 26-83 years). The mean external punctum width and internal punctum width values were 509.1 ± 101.5 μm (222-788 μm) and 229.2 ± 69.2 μm (108-459 μm), respectively. The mean value for vertical canaliculi depth was 637.8 ± 167 μm (337-1045 μm).

Conclusions: OCT is a non-invasive and objective diagnostic method in the clinical diagnosis and treatment of punctal lesions and provides useful information in terms of visualizing the punctum and vertical canaliculus supplying anatomical data.

Purpose: To evaluate the role of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Serratia marcescens, and Moraxella catarrhalis in the nasal and ocular surface flora, along with their metabolic activities in children with unilateral congenital nasolacrimal duct obstruction (CNLDO).

Methods: Swabs were taken from the bilateral inferior meatus and ocular surface of 26 children with unilateral CNLDO before probing. Nasal and ocular surface swabs from non-operated eyes of children who underwent unilateral blepharoptosis or strabismus surgery formed the control group. The quantitative polymerase chain reaction (qPCR) method was used to analyze the samples.

Results: The detection of Streptococcus pneumoniae in the nasal flora, Staphylococcus aureus in the ocular surface flora, and Haemophilus influenzae and Serratia marcescens in both the nasal and ocular surface flora was higher on the obstructed sides of children with CNLDO compared to the controls (p < 0.05). Obstructed sides in children with CNLDO showed a significant difference for Moraxella catarrhalis in the ocular surface and Streptococcus pneumoniae, Staphylococcus aureus, Serratia marcescens, and Moraxella catarrhalis in the nasal flora compared to the patent sides (p < 0.05). Metabolite analysis revealed that betaine, L-carnitine, L-leucine, and L-alanine were negatively regulated in the presence of these bacteria.

Conclusions: Significant changes in bacterial composition in the nasal and ocular surface flora may be a cause or a result of CNLDO. More comprehensive microbiological studies that evaluate the entire microbiome would be helpful in understanding CNLDO.

Purpose: To investigate the role of hematological and atherogenic biomarkers in evaluating systemic inflammation and cardiovascular risk in patients with pseudoexfoliation syndrome.

Methods: This retrospective study included 200 patients, 90 with pseudoexfoliation (PEX) syndrome (Group 1) and 110 healthy controls (Group 2). Twelve-hour fasting blood samples were collected to measure complete blood count, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) (neutrophil x platelet/lymphocyte), systemic inflammatory response index (SIRI) (neutrophil x monocyte/lymphocyte), pan-immune inflammation value (PIV) (neutrophil x platelet x monocyte/lymphocyte), C-reactive protein (CRP), uric acid, glucose, triglycerides (TG), total cholesterol, HDL, LDL, non-HDL, and triglyceride-glucose (TyG) index (Ln (TG [mg/dL] × glucose [mg/dL]/2)). The groups were compared based on these measurements.

Results: The two groups were similar in terms of age and gender (p > 0.05). No statistically significant differences were observed between the groups for PLR, SII, CRP, glucose, total cholesterol, HDL, LDL, and non-HDL (all p > 0.05). However, systemic inflammation markers-NLR, MLR, SIRI, PIV, and uric acid were significantly higher in Group 1 compared to Group 2 (all p < 0.05). Among the atherogenic biomarkers used to assess cardiovascular risk, triglycerides and the TyG index were significantly higher in Group 1 (p < 0.05, p < 0.001).

Conclusion: Pseudoexfoliation syndrome is characterized by the accumulation of fibrogranular material primarily on the anterior lens capsule and pupillary border. PEX deposits are not limited to ocular structures but are also found in the heart, liver, and various vascular structures. It has been suggested that PEX is an independent risk factor for cardiovascular diseases and that systemic inflammation plays a role in the disease's pathogenesis. The significant biomarkers identified in this study may provide guidance in monitoring the disease.

Purpose: To assess the safety and the efficacy of the "Sub-400 corneal cross-linking (CXL) protocol" for progressive keratoconus (KC) in ultrathin corneas.

Methods: The study included thirty four patients with progressive KC, who underwent CXL using the "Sub-400" protocol due to intraoperative thinnest corneal pachymetry ranging from 295 to 398 μm after epithelial removal. After the epithelium was removed, the following ultraviolet A irradiation was applied at a fluence of 3 mW/cm² and the duration was adjusted based on the specific corneal stromal thickness. In addition to slit-lamp microscopy and visual acuity assessment, our evaluation included measurements of the maximal anterior keratometry value (Kmax), mean anterior and posterior K values (Kmean), thinnest corneal thickness (TCT), central corneal thickness, intraoperative pachymetry, and corneal endothelial cell density (ECD) preoperatively and 1 year postoperatively. Stromal demarcation line depth (DL) was measured in the first postoperative month.

Results: At the first year postoperative follow-up visit, 88% (30 eyes) exhibited tomographic stability, with average values of change in Kmax (ΔKmax) 0.61 ± 6.45 D after CXL. None of the eyes showed signs of endothelial decompensation. The mean DL depth was 250.76 ± 44.05 μm. Moderate positive correlations were observed between DL and ultraviolet A irradiation time, DL, and intraoperative stromal thickness (r = 0.473, p = 0.005 and r = 0.517, p = 0.002, respectively). ΔKmax was negatively correlated with preoperative Kmax (r =  - 0.559, P = 0.001) and positively correlated with preoperative TCT (r = 0.373, P = 0.030).

Conclusion: The "Sub-400 protocol" for CXL has a broad application possibility for ultrathin corneas with KC and has shown promising results.

Absract: PURPOSE: To investigate the signal intensity ratio (SIR) of orbital tissue to white matter in orbital magnetic resonance imaging (MRI) for assessing graves' orbitopathy (GO).

Methods: This study enrolled a total of 42 patients (79 eyes) with GO as the GO group, 10 patients (20 eyes) diagnosed with graves' disease (GD) without orbitopathy during the same period as the GD group, and 23 normal individuals with negative MRI results and no thyroid or eye diseases as the healthy control (HC) group. The signal intensity of the lacrimal gland (LG), extraocular muscle (EOM), ipsilateral temporal muscle (TM), ramus mandibulae, and white matter (WM) on MRI images was measured. Patients in the GO group were categorized into active and inactive GO subgroups.

Results: The SIRs in the GO, GD, and HC groups showed significant differences. SIR-LG in relation to WM and SIR-EOMs in the GO group were significantly higher than those in the GD and HC groups. The SIRs in the active GO group were higher than those in the inactive GO group with significant differences, except for SIR-LG/TM. SIR-EOM/WM demonstrated higher accuracy than other SIRs in identifying GO activity. The area under the curve for SIR-EOM/WM was 0.81 (95% CI 0.71-0.91), with a sensitivity of 69.6%, specificity of 87.9%, and a cut-off value of 1.50.

Conclusion: SIR-LG/WM and SIR-EOMs are objective indicators for discriminating between GO and the other two groups. Furthermore, SIR-EOM/WM may serve as a simpler quantitative MRI biomarker for identifying GO activity and are worthy of clinical generalization.

Purposes: Congenital microphthalmia with orbital cyst (CMOC) is a severe ocular developmental malformation. This article aims to provide assistance for genetic counseling and further exploration of more effective treatments.

Methods: A combined systematic search of PubMed electronic database by using Boolean operators AND and OR was conducted, choosing the following keywords: "microphthalmos", "microphthalmia", "cyst", "morbidity", "congenital cystic eye", "histopathological", "molecular genetics", "syndrome", "treatment", "therapy", "surgery" and "surgical" etc. After the initial screening of these articles, repetitive literatures were excluded.

Results: 63 articles were selected. This article reviewed the research progress on the incidence of CMOC, its relationship with congenital microphthalmos and congenital cystic eye, histopathology and molecular genetics studies, particularly the syndromes associated with this condition and the current treatment status.

Conclusion: CMOC is essentially a disease caused by gene mutations, and there is no effective treatment that achieves consistent relief. Further research to clarify the genotype-phenotype and inheritance patterns of this disease may be a valuable research direction for exploring effective treatment methods and guiding clinical genetic counseling.