Journal of Current Ophthalmology最新文献

Purpose: To investigate the feasibility of transplanting cyanobacteria species Synechocystis sp. PCC6803 into the corneal stroma as a novel photosymbiotic biotherapy.

Methods: A suspension of cyanobacteria was injected into the central stroma of female New Zealand white rabbit corneas under sterile conditions. Postoperative care included topical application of Tobra Dex eye drops and gel three times daily for 7 days. Corneal optical coherence tomography (OCT) was performed to assess the distribution of cyanobacteria and any structural changes. Histopathological analysis, including SYTOX Green staining and confocal microscopy, was conducted to evaluate cyanobacterial survival and host tissue response.

Results: After 7 days of transplantation, brown-colored cyanobacteria remained localized within the corneal stroma without inducing significant corneal edema, neovascularization, or structural damage. OCT imaging identified hyperreflective regions corresponding to cyanobacterial colonization. Histological analysis confirmed a substantial number of viable cyanobacteria persisting within the stromal matrix, with only a small proportion of nonviable cells detected. No overt inflammatory response or adverse effects on corneal transparency were observed.

Conclusions: This pilot study demonstrates the survival of cyanobacteria within the corneal stroma. These findings provide preliminary evidence supporting the feasibility of ocular surface photosymbiosis as a novel therapeutic approach for hypoxia-related corneal diseases. Further studies are needed to quantify oxygen production and evaluate long-term safety.

Purpose: To evaluate the prevalence of complications at the first uveitis specialist visit in patients at a tertiary referral center in Colombia and to identify risk factors associated with multiple complications.

Methods: This cross-sectional study analyzed data from 374 patients (545 eyes) seen for the first time by a uveitis specialist between 2017 and 2022. Demographic and clinical variables, including uveitis type, duration, etiology, and complications, were collected at the initial consultation. Complications included cataracts or cataract surgery, glaucoma, macular edema, posterior synechiae, and severe vision loss. Logistic regression assessed associations between patient characteristics and the presence of three or more complications.

Results: At the first visit, 66.6% of patients presented with at least one complication, and 17.6% had three or more complications. The most common complications were cataracts or cataract surgery (31.7%), severe vision loss (25.9%), posterior synechiae (23.5%), glaucoma/ocular hypertension (21.2%), and macular edema (10.6%). Risk factors for three or more complications included chronic uveitis (odds ratio [OR]: 14.19), delays of over 100 weeks from symptom onset to consultation (OR: 7.67), noninfectious uveitis (OR: 3.32), bilateral inflammation (OR: 2.25), active inflammation (OR: 2.31), and a history of cataract surgery (OR: 6.25).

Conclusion: The high prevalence of complications on the first specialist visit highlights the need for early referral and timely management of uveitis. Delays in care, compounded by limited specialist access, likely contribute to these outcomes.

Purpose: To report a case of iris bombe caused by an enlarged Soemmering's ring in a pseudophakic eye, highlighting the diagnostic and therapeutic approach.

Methods: A detailed case involving a 91-year-old woman with a history of cataract surgery 20 years prior, who presented with acute vision loss and ocular pain in the right eye. Examination revealed corneal edema, shallow anterior chamber, and elevated intraocular pressure (IOP). Anterior segment optical coherence tomography (AS-OCT) was used to confirm iris bombe in the presence of a Soemmering's ring. Laser peripheral iridotomy (LPI) was performed as a therapeutic intervention.

Results: The performance of LPI resulted in immediate deepening of the anterior chamber and normalization of IOP. Follow-up confirmed the patency of the iridotomy and resolution of the iris bombe. The patient's condition remained stable with good vision and controlled IOP.

Conclusions: This case underscores the importance of considering Soemmering's ring in the differential diagnosis of acute angle closure in pseudophakic eyes. Early diagnosis and timely treatment with laser iridotomy can effectively manage this rare condition.

Purpose: To evaluate the efficacy and safety of brachytherapy in patients with uveal melanoma and retinal vascular tumors.

Methods: Patients who received Ruthenium-106 (Ru-106) plaque brachytherapy at the Torfeh Medical Center between March 2016 and March 2022 were examined in this retrospective case-series. We collected clinical data on tumor features, treatment details, and patient outcomes. These data were analyzed using SPSS software. Tumor regression was the primary outcome that was monitored, with complications being evaluated as secondary outcomes.

Results: Of the 80 patients, 55 had melanoma, 21 had vasoproliferative tumor (VPT), and 4 had retinal capillary hemangioma (RCH). Tumor regression was observed in 74.5% of melanoma cases and 100% of VPT/RCH cases. Significant relationships were found between tumor characteristics, such as thickness and dose rate at the apex, and treatment outcomes. Complications included radiation retinopathy and cataract formation, with recurrence rates of 16.4% in melanoma and 7.7% in VPT/RCH.

Conclusions: Ru-106 plaque brachytherapy is effective in treating various intraocular tumors, particularly VPT/RCH. Tumor thickness significantly influences treatment outcomes, emphasizing the need for tailored approaches in brachytherapy planning. However, small sample sizes for specific tumor types limited the generalization of the outcomes. Future research should focus on refining techniques and mitigating complications to improve patient outcomes in ocular oncology.

Purpose: To report the outcome of a ciliary body medulloepithelioma associated with DICER-1 syndrome treated with iodine-125 plaque brachytherapy.

Methods: An 11-year-old male with a DICER1 gene mutation, who was previously treated for pineoblastoma with craniospinal radiotherapy and systemic chemotherapy at the age of three, was referred to assess a vascularized retrolental mass in his left eye. The clinical and ultrasound evaluations, besides his initial diagnosis of DICER-1 syndrome, suggested a ciliary body medulloepithelioma.

Results: No biopsy was performed given the risks of hemorrhage and tumor cell dissemination. The patient underwent iodine-125 plaque brachytherapy. Although the patient developed a radiation-induced cataract, it was eventually treated with cataract surgery. Five years after brachytherapy, the patient maintained excellent visual acuity with no signs of tumor recurrence.

Conclusion: Plaque brachytherapy is effective in achieving long-term control of DICER1-associated medulloepithelioma.

Purpose: To determine if prolonged high-altitude exposure and resulting hyper-homocysteinemia are the independent risk factors for retinal vein occlusion.

Methods: Serum levels of homocysteine, Vitamin B12, and folate were quantified using competitive immunoassay with electrochemiluminescence in patients newly diagnosed with retinal vein occlusion residing in the lesser Himalayas. Age-matched controls without venous occlusions were chosen from the same population. Patients living at altitudes below 2000 m above sea level were excluded from the study. The sensitivity and specificity of serum homocysteine in predicting venous occlusion were determined using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression was performed to identify independent risk factors for retinal vein occlusion, after adjusting for known confounders such as gender, diabetes, hypertension, glaucoma, hyperlipidemia, and smoking.

Results: This study of 200 subjects, divided into cases and controls, found that hyperhomocysteinemia prevalence was 78% among the cases and 47% among the controls. The mean serum homocysteine levels in individuals living at elevations above 3800 m (29.1 ± 10 μM/L) were significantly higher (P < 0.001) compared to those residing at elevations below 3800 m (15.8 ± 8 μM/L). The cut-off value of serum homocysteine, determined by coordinate points on the ROC curve, was 18.8 μM/L. Logistic regression found strong links between retinal vein occlusion and high homocysteine (odds ratio [OR] = 2.62) and living above 3800 m (OR = 1.42).

Conclusion: Prolonged exposure to high altitude results in elevated homocysteine levels, indicating a potential association between hyperhomocysteinemia and retinal vein occlusion.

Purpose: To assess the levels of inflammatory cytokines and chemokines in the tears of individuals working with computers.

Methods: Tear samples were collected from 48 patients using computers for over 3 h daily (range, 6-12 h) for at least a year, and from 42 patients using computers for <3 h daily (range, 2-3 h). Tears were analyzed for the presence of interleukins (IL-2, IL-4, IL-5, IL-6, IL-10), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), IL-1β, and IL-8. The measurements were conducted using the Stripwells 10-plex assay kit from Quansys Biosciences, San Diego, CA, USA. Real-time reverse transcriptase polymerase chain reaction analysis was used to examine conjunctival impression cytology specimens for IL-1β, IL-6, IL-8, and TNF-α mRNA expression to identify cytokine origins.

Results: Cytokine levels significantly increased (P < 0.001) in the tears of subjects using computers for over 3 h/day (Group 1). Group 1, averaging 3.8 ± 1.4 years of usage, showed a significant positive correlation with tear cytokine levels (P < 0.05). Group 2, with 2.3 ± 1.1 years of usage, had a weak positive correlation. Group 1 also showed increased tear film osmolarity and reduced goblet cell density, with an inverse relationship between tear cytokines and goblet cell density.

Conclusions: Computer users' tears have higher cytokine levels that correlate with usage time. Cytokines may contribute to dry eye disease, suggesting cytokine modulators as a potential treatment for computer-related dry eye.

Purpose: To determine the functional outcomes of chandelier-assisted scleral buckling (CSB) in rhegmatogenous retinal detachment (RRD) and compare them to standard scleral buckling (SSB).

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Knowledge, and Embase up to March 2024. Studies reporting functional outcomes, particularly best-corrected visual acuity (BCVA), after CSB were included. Risk of bias was assessed using standardized tools. Meta-analysis were conducted for BCVA improvement, change in BCVA (ΔBCVA), and operation time. Publication bias and heterogeneity were evaluated using funnel plots, Egger's test, and I ² statistics.

Results: A total of 27 studies were analyzed. Meta-analysis of 1258 eyes revealed significant BCVA improvement postoperatively (mean difference [MD]: -0.51; 95% confidence interval [CI]: -0.64 to -0.38; P < 0.001). Comparative analyses of six studies showed no significant difference in ΔBCVA or anatomical outcomes between CSB and SSB, but operation time was significantly shorter for CSB (MD: -18.87 min; 95% CI: -22.70 to -15.3; P < 0.001). Meta-regression identified macular detachment and preoperative BCVA as the only factors significantly associated with postoperative visual outcomes.

Conclusions: CSB significantly improves BCVA and offers comparable functional and anatomical outcomes to SSB while reducing surgical duration. This approach mitigates the limitations of traditional scleral buckling, making it a viable and efficient option for managing RRD.

Purpose: To evaluate the long-term effects of accelerated corneal cross-linking (ACXL) in stabilizing progressive keratoconus (KC), as these effects remain unclear.

Methods: This 5-year longitudinal study included 49 eyes with progressive KC who underwent 10-min ACXL. Baseline and posttreatment assessments included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive error (sphere, cylinder, and spherical equivalent), corneal curvature indices (maximum keratometry [Kmax], flat keratometry [K1], steep keratometry [K2], and mean keratometry), corneal thickness, and corneal irregularity indices (index of height asymmetry [IHA], index of surface variance [ISV], and inferior-superior value [IS-value]). Corneal imaging was performed using Pentacam and Corvis ST. Longitudinal changes were analyzed using repeated-measures statistical models.

Results: Significant improvements were observed in UCVA and BCVA over time (P = 0.001). Keratometric indices (K1, K2, and Kmax) initially declined, indicating corneal flattening, followed by a mild regression at later time points (P < 0.005). Corneal thickness (thinnest location) decreased transiently but stabilized by year 5 (P = 0.003). Corneal topographic indices revealed mixed trends: corneal densitometry increased progressively (P = 0.001), suggesting long-term structural changes. Corneal irregularity indices (IHA, ISV, IS-value, and index of vertical asymmetry) demonstrated initial fluctuations but overall improvement, reflecting enhanced corneal regularity (P < 0.05). Posterior radius of curvature initially increased, then decreased at year 5 (P = 0.016), indicating late risk for posterior corneal steepening. Progression indices (progression index max and IS-value) showed a downward trend, supporting disease stabilization (P = 0.028).

Conclusions: This study supports the long-term efficacy of 10-min ACXL in stabilizing progressive KC, with sustained improvements in corneal irregularity indices and visual function. Early 10-min ACXL intervention is recommended to be considered for maximizing stabilization and preventing advanced disease progression.

Purpose: To evaluate the immediate impact of topical ocular hypotensive medications on peripapillary and macular blood flow in healthy adults from Northeast Iran.

Methods: A prospective, randomized, and interventional study was conducted on 80 healthy volunteers, with each volunteer having one eye treated with either brimonidine, dorzolamide, latanoprost, or timolol, all of which are ocular hypotensive medications. The study included a placebo treatment for one eye of each participant to serve as a control. At the peak effect of the drugs, all participants underwent an optical coherence tomography angiography scan of their eyes. A total of 160 eyes were included in the study.

Results: According to the findings, the use of ocular hypotensive drugs did not demonstrate any significant influence on the radial peripapillary capillary network. However, the results indicated that a single dose of dorzolamide could result in a significant increase in macular blood flow (P = 0.019). Conversely, treatment with timolol resulted in a significant decrease in macular blood flow (P = 0.002). Moreover, brimonidine significantly affected the thickness of the retinal nerve fiber layer (P = 0.02).

Conclusions: According to our findings, dorzolamide was the most effective in enhancing young adults' full macular thickness and macular blood flow. Conversely, timolol treatment was found to decrease the macular blood flow, which in turn may cause visual field defects due to optic nerve head and macular ischemia in patients with low-tension glaucoma.