Journal of Current Ophthalmology最新文献

Purpose: To report a rare case of central toxic keratopathy (CTK) after photorefractive keratectomy (PRK).

Methods: A 22-year-old male underwent bilateral PRK for the correction of myopic astigmatism. Preoperative refraction measurements were -2.50 -1.00 × 65 in the right eye and -3.50 diopter (D) sphere in the left eye. The intended refractive correction was -3.25 -1.00 × 65 (in the right eye) and -4.25 D sphere in the left eye. Preoperative corneal thickness measured 489 μm (in the right eye) and 491 μm in the left eye, both values exceeding the minimum safe threshold for PRK.

Results: At the 1-week postoperative evaluation, slit-lamp examination and optical coherence tomography (OCT) revealed significant central corneal haziness, thinning, and flattening, along with hyperopic astigmatism. These findings were consistent with CTK. The surgeon adopted a conservative approach, closely monitoring the patient without initiating pharmacological intervention. By the 6-month follow-up, the patient demonstrated reduced hyperopia and achieved a best-corrected visual acuity of 20/20. OCT imaging also confirmed increased central corneal and epithelial thickness, suggesting progressive recovery. Long-term follow-up over 2 years showed stable refraction and corneal thickness, with no further significant changes.

Conclusions: CTK is a rare but vision-threatening complication of refractive surgery, occurring not only after laser in situ keratomileusis but also following other refractive surgery approaches. Enhancing clinical knowledge of both its presentation and differential diagnosis is essential to avoid any unnecessary interventions.

Purpose: To evaluate the effects of two topical antiglaucomatous agents, latanoprost and brimonidine, on corneal transparency and endothelial cell characteristics in eyes with open-angle glaucoma or ocular hypertension (OHT).

Methods: This comparative cross-sectional study included 59 patients diagnosed with open-angle glaucoma or OHT, of whom 34 were on latanoprost and 25 were on brimonidine treatment. The control group consisted of 32 healthy eyes. Corneal densitometry (CD) and specular microscopy measurements were obtained, including endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and central corneal thickness (CCT).

Results: There was no statistically significant difference identified between the three groups with regard to ECD (P = 0.23), HEX (P = 0.54), and CV (P = 0.35). However, the CD values in the central layer (2-6 mm) and posterior layer (2-6 mm) were found to be significantly lower in the latanoprost-treated group. This difference reached statistical significance compared with the control group in the central layer, and with both the control and brimonidine groups in the posterior layer (P < 0.01). A significant reduction in CCT was also observed in the latanoprost group compared to the control group (P = 0.008).

Conclusions: This is a preliminary investigation to conduct a comparative analysis of corneal clarity in patients who are under antiglaucomatous medication and in a healthy population. It can be postulated that a reduction in CD values in the latanoprost-treated group may contribute to an improvement in corneal transparency due to the remodeling effect of the drug on the cornea. It can also be inferred that the lower CCT observed in the latanoprost-treated group may be attributed to the lower CD measurements in these eyes.

Purpose: To evaluate the efficacy of different autologous serum eye drop (ASED) concentrations in treating ocular surface diseases.

Methods: All articles assessing the efficacy of 20%, 50%, or 100% ASED were retrieved from PubMed, Cochrane, ScienceDirect, and EBSCO electronic databases and checked for applicability. Efficacy was evaluated based on symptom scoring, corneal staining, and tear film stability, which includes tear break-up time (TBUT) and the Schirmer's test.

Results: Seven randomized clinical trials, three cohort studies, and one prospective study were included in this review. ASED significantly improved subjective ocular symptoms (overall standardized mean differences [SMD]: -2.99; 95% confidence interval [CI]: -4.38 to -1.60), without significant difference between 20%, 50%, and 100% concentrations (P = 0.617). Overall, TBUT also showed a considerable increase (mean differences [MD]: 1.68 s; 95% CI: 0.43-2.94), remarkably with 20% ASED (MD: 2.80; 95% CI: 1.61-4.00). In contrast, the Schirmer's test showed no significant trend toward improvement (MD: 0.53; 95% CI: -0.78-1.84). A remarkable effect was observed in keratoepitheliopathy (overall SMD: -1.08; 95% CI: -1.85 to -0.32), especially in the 50% ASED subgroup (SMD: -1.54; 95% CI: -2.73 to -0.35). All outcomes showed high heterogeneity (I ² = 79.6%-97.3%). Sensitivity analyses limited to randomized controlled trials showed consistent findings, supporting the robustness of the results.

Conclusion: ASED was effective in improving subjective ocular symptoms, tear break-up time, and keratoepitheliopathy across different concentrations but did not significantly affect Schirmer's test.

Purpose: To assess the patient barriers to adherence with corticosteroid eye drops in patients with ocular inflammatory disorders across the United States.

Methods: This was a multicenter study of adult and pediatric patients with uveitis undergoing treatment with corticosteroid eye drops. Sites included the Johns Hopkins Wilmer Eye, the University of Texas at Austin, the University of Wisconsin-Madison, the University of Minnesota, the Minneapolis Veterans Administration Hospital, and the Washington University of St. Louis. Eligible patients completed a self-reporting survey to assess barriers to adherence with corticosteroid eye drops.

Results: The survey was completed fully by 94 subjects and partially by 20 (115 in total), of whom were 66% White, 60% female, and 47% had a college or advanced degree. While some patients (5.5%, n = 6) self-reported never taking their corticosteroid eye drops as prescribed, most reported taking the drops as directed (54.1%, n = 59) or at least 90% of the time (29.4%, n = 32). Reasons for nonadherence were explored: 56% of patients used a corticosteroid eye drop more than once a day, and 13% found frequency a limitation to adherence. Many patients had polypharmacy, 43% took 4 or more medications, and 50% took 1 or more drops in addition to a corticosteroid eye drop. Patients also reported difficulty reading the writing on drop bottles (39%) and poor vision limiting application into the eye (17%). Almost a quarter (24%) of patients occasionally ran out of their drop before the next refill. Most patients did not report cost (98%) or insurance loss (97%) as a barrier to obtaining a refill.

Conclusions: Barriers to corticosteroid eye drop treatments for ocular inflammatory disease include difficulty with medication frequency, polypharmacy, medication administration, missing refills, and running out of medication early. Addressing these barriers may improve adherence with corticosteroid eye drops to achieve treatment goals.

Purpose: To investigate the longitudinal changes in choroidal thickness following photorefractive keratectomy (PRK) in young adult myopes.

Methods: The study population (age: 28 ± 1 years) consisted of 14 myopic subjects who underwent PRK for myopia correction, and a control group of 13 myopic subjects who did not undergo PRK. Measures of choroidal thickness were obtained at baseline in the control group, and before PRK in the treatment group, and then following 1-week, 1-month, 3 and 6 months. Changes in choroidal thickness across different regions were analyzed over time and between groups using linear mixed models.

Results: The mean spherical equivalent refraction was -3.36 ± 0.31 diopter (D) in the treatment and -2.58 ± 0.30 D in the control group (P > 0.05) at baseline. Longitudinal changes in choroidal thickness were significantly different between the two groups (group by time interaction, P < 0.001). The mean wide-field choroidal thickness increased 1-week post-PRK in the treatment group (8 ± 3 μm), with this change in choroidal thickness significantly greater than the change in the control group (-1 ± 3 μm; P = 0.04). However, changes in the mean wide-field choroidal thickness were not significantly different between the two groups in 1-, 3-and 6-month follow-up visits (all P > 0.05). The observed longitudinal changes were not different across the macular and extramacular regions (P > 0.05).

Conclusions: Small magnitude thickening of the choroid was found to occur uniformly across the wide-field region within 1 week following myopic PRK. However, this change in choroidal thickness was transient and no longer observed within 6 months post-PRK.

Purpose: To identify recent research trends on advancing glaucoma treatment through materials science and focus on publications from different countries, institutions, and authors.

Methods: We retrieved and analyzed data from January 1, 2015, to October 24, 2024, on the advancing glaucoma treatment through materials science research field from the Web of Science Core Collection database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends.

Results: A total of 936 publications were identified, and the annual global publications increased steadily, from 44 to 93, during this period. The United States (267 publications, 9934 citations), Egyptian Knowledge Bank (52 publications, 1262 citations), and Jui-Yang Lai (20 publications, 986 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into eight clusters: (1) surgical materials; (2) nanoparticle retinal protection; (3) eye drops; (4) drug delivery characteristics; (5) contact; (6) ocular drug delivery mechanisms; (7) bioavailability and optimization; and (8) release technologies. Regarding the average appearing years (AAYs) of the keywords, "microshunt" (AAY: 2023.25), "MIGS" (AAY: 2022), and "d-optimal design" (AAY: 2021.5) were recognized as the hotspots in the short run.

Conclusions: This study highlights advancements in materials science for glaucoma treatment, including biomaterials, nanotechnology, and nanoengineering. These innovations enable better drug delivery, improved devices, and surgical materials, promising more effective, personalized, and minimally invasive therapies for improved patient outcomes.

Purpose: To apply one- and left-handed phacoemulsification from the inferior nasal site for a case of rheumatoid peripheral ulcerative keratitis complicated by peripheral corneal thinning, which presented difficulties for standard two-handed cataract surgery.

Methods: A case report.

Results: The patient was an 80-year-old Japanese woman with the progression of peripheral ulcerative keratitis in the periphery of both eyes and a history of rheumatoid arthritis. Both eyes exhibited peripheral ulcerative keratitis, with the right eye particularly affected around the entire circumference of the cornea, except for the inferior nasal site. The disease subsided with the use of soft contact lenses and betamethasone and cyclosporine administration. The cataract progressed to a mature stage, and the density of corneal endothelial cells decreased to approximately 600/mm². A right-handed surgeon, positioned at the lower left corner of her face, performed phacoemulsification using a one- and left-handed technique, without performing paracentesis, through a sclerocorneal incision from the inferior nasal site of her right eye. Postoperatively, her best-corrected visual acuity improved to 20/25 from hand motion.

Conclusions: A patient with almost total circumferential thinning of the cornea, which appeared to be a challenge for standard cataract surgery, could undergo successful cataract surgery with the selection of an appropriate incision site and technique. The findings of this case report may provide valuable insights for the development of safe surgical strategies for cataract surgery in cases characterized by severe, almost circumferential peripheral thinning of the cornea.

Purpose: To critically evaluate the current evidence on the influence of lifestyle factors on glaucoma risk and progression. Glaucoma, a leading cause of irreversible vision loss globally, poses a significant clinical challenge. The pathogenesis of glaucoma is multifactorial, involving mechanisms beyond intraocular pressure (IOP). Effective treatments for reducing IOP exist, yet progressive vision loss remains a common occurrence among glaucoma patients, underscoring the need for further research. Age, ethnicity, family history, and high myopia are recognized risk factors; however, they are difficult to modify. In contrast, lifestyle factors such as physical activity, smoking, and diet may offer opportunities for risk reduction, but the relationships between these factors and glaucoma are not yet well understood.

Methods: A narrative review of literature was conducted by searching multiple databases, including PubMed, Google Scholar, Scopus, and the Cochrane Library, focusing on peer-reviewed studies published between August 2009 and October 2024. An extensive range of keywords, such as glaucoma, intraocular pressure, lifestyle factors, diet, sleep pattern, alcohol consumption, smoking, anxiety, stress, body mass index, and caffeine, were employed individually and in combination to ensure a comprehensive search.

Results: Lifestyle factors, such as mindfulness-based stress reduction, cognitive-behavioral therapy, and sleep apnea management, may be efficacious in reducing intraocular pressure fluctuations and neuroinflammatory damage. In addition, a healthy diet, body mass index, and regular physical activity may contribute to reduced glaucoma risk.

Conclusions: This review underscores the potential of lifestyle modifications as a complementary strategy in glaucoma management. Further research is necessary to explore evidence-based associations between lifestyle factors and glaucoma.