Journal of Current Ophthalmology最新文献

Purpose: To evaluate general health-related quality of life (HRQoL) in children with congenital cataract to better understand how the condition affects their QoL.

Methods: This cross-sectional study included all unilateral aphakic children, from 2 to 7 years old, who were referred to the Farabi Eye hospital Contact Lens Clinic in Tehran, Iran from October 2018 to September 2019. Their HRQoL was assessed with the Persian version of pediatric quality of life inventory™ (PedsQL™) 4.0 Generic Core Scale.

Results: A total number of 38 children (18 girls and 20 boys) enrolled in the study. Their mean age at the time of referral was 40.05 months. Based on PedsQL 4.0 scoring instruction, Physical Functioning Scale Score (90.29), Emotional Functioning Scale Score (78.15), and Social Functioning Scale Score (88.81) were calculated. Psychosocial health summary score (83.48) and physical health summary score (90.29) were also measured using their instructions. The average psychosocial health summary score (83.48) and physical health summary score (90.29) ultimately determined the PedsQL 4.0 total score (86.89).

Conclusions: Our results revealed that congenital cataract has a bigger psychosocial impact rather than physical, according to both children and parents. This could emphasize the significance of psychosocial support and information concerning the long-term visual prognosis.

Purpose: To evaluate the visual results, intraocular pressure (IOP), use of antiglaucomatous medications, corneal graft survival rates, and complications after trabeculectomy and Ahmed glaucoma valve (AGV) implantation in patients with a history of keratoplasty (KP).

Methods: A comprehensive analysis was conducted on all patient records from the Akdeniz University Medical Faculty Ophthalmology Department who had glaucoma surgery after KP between 2014 and 2022. This corresponds to a total of 49 eyes of 49 patients.

Results: The mean visual acuity after AGV implantation was 1.9 ± 1.13 logMAR; in the trabeculectomy group, it was 1.2 ± 0.82 logMAR (P = 0.028). The mean IOP levels 6 months after AGV implantation was 15.9 ± 5.02 mmHg , and in the trabeculectomy group, it was 13.8 ± 3.43 mmHg (P = 0.170). The mean IOP levels at the patients' last visits in the AGV implantation group was 14.3 ± 3.93 mmHg, and in the trabeculectomy group, it was 13.7 ± 3.32 mmHg (P = 0.983). While the average number of antiglaucomatous drugs used by the patients before the glaucoma surgery in the AGV group was 3.5 ± 0.69, it was 3.6 ± 0.82 in the trabeculectomy group. In the AGV group, patients used an average of 1 ± 1.03 antiglaucomatous drugs after surgery, whereas in the trabeculectomy group, it was 0.7 ± 0.97. Graft failure was statistically significantly more common in the AGV group (9 patients [45%] in the AGV group and 5 patients [17.2%] in the trabeculectomy group) (P = 0.0497).

Conclusions: Both AGV and trabeculectomy resulted in comparable postoperative IOP levels. However, the trabeculectomy group demonstrated better visual acuity and higher corneal graft survival rates. Given these findings, trabeculectomy could be a favorable choice for glaucoma patients following KP, even considering the potential risk of postoperative hypotony. Ultimately, the treatment decision should be individualized based on each patient's specific circumstances and needs.

Purpose: To describe the frequency of delayed and missed visits for Juvenile idiopathic arthritis (JIA)-uveitis patients and explore the demographic factors associated with delay in clinical follow-up.

Methods: This was a retrospective chart review of patients with > 2 appointments for JIA-associated uveitis between August 1984 and October 2022. Patient visits were classified as adherent, delayed, or missed if they followed up within the recommended follow-up time, outside the recommended follow-up time window, or more than 3 years after their last visit or never.

Results: There were 106 patients with a mean age of 15.5 years (range, 1.6-50.4). A total of 3169 visits over a cumulative follow-up time of 899.4 years (mean: 8.6 years of follow-up) occurred with 71 visits (2.2%) missed and 424 visits (13.4%) delayed. Sixty-nine patients (65.1%) had at least one delayed visit. Demographic and uveitis disease characteristics were all nonsignificant factors for a delayed or missed visit. Although having military-sponsored insurance was significant (P < 0.01), all other insurance types were not significantly associated with having a delayed visit.

Conclusions: Overall, the proportion of delayed and missed visits was quite low, even during the severe acute respiratory syndrome coronavirus 2 pandemic. Although patients with military insurance appear to be at increased risk for delayed follow-up visits, other insurances, distance to clinic, and demographic characteristics did not appear to be associated with delayed or missed follow-ups.

Purpose: To evaluate the safety and effectiveness of topical fasudil drop, as a Rho kinase (ROCK) inhibitor agent, on type 2 retinopathy of prematurity (ROP).

Methods: This comparative case series included 42 eyes of 21 premature infants with type 2 ROP. One eye of each patient was randomly assigned to receive a fasudil eye drop of 0.5% twice a day. The other eye received artificial tear drops twice a day as a control. The administration began at the time of prethreshold ROP diagnosis until 45 weeks of postmenstrual age. Funduscopic examination was performed weekly until complete retinal vascularization or progression into type 1 ROP. The extent of the retinal avascular area or progression into type 1 prethreshold ROP was compared between the two eyes of each infant. The influence of associated systemic conditions on the process of angiogenesis was also evaluated.

Results: In 5 (23.8%) premature infants, reduction of the avascular zone area was observed in eyes treated with fasudil drop compared to the other eye (P = 0.808). In 16 (76.2%) premature infants, no difference in the size of the avascular area was observed between the two eyes. None of the studied systemic factors influenced the reduction in the size of the avascular area, except for weight gain. However, the correlation between weight gain and reduction in avascular area size was only marginally significant (P = 0.052).

Conclusion: Topical 0.5% fasudil was safe, but showed no statistically significant benefit in reducing the avascular zone or preventing progression to type 1 ROP in this pilot study.

Purpose: To assess the agreement between Zywave^® II and Peramis CSO aberrometers for lower- and higher-order aberration (LOA and HOA) measurements on dynamic conditions without cycloplegia.

Methods: In this prospective comparative study, participants aged 20-45 years were examined. Exclusion criteria included previous ocular surgery or trauma, recent contact lens wear, and any ocular or systemic diseases. Each device was operated by an experienced operator who remained blind to the data obtained from the other aberrometer. We compared LOA measurements and the root mean square (RMS) of coma, spherical aberration, and total third- and fourth-order HOAs between the two devices, and the optical zone for measuring HOAs was the same in both the devices.

Results: In the study involving 42 eyes of 21 participants (52.4%, female), excellent agreement was observed in LOAs (sphere and cylinder) for both the right and left eyes, with intraclass correlation coefficients of 0.96 and 0.95, respectively, using a 6 mm pupil. In addition, good-to-excellent reliability was reported for the agreement between the two devices in total HOA (t.HOA) and the RMS error of the total aberration, for pupil sizes of 5 mm and 6 mm. However, there was poor agreement between the two devices for third- and fourth-order aberrations in both the pupil sizes.

Conclusions: The present study demonstrates agreement between the Zywave^® II and Peramis^® aberrometers in measuring sphere, cylinder, t.HOA, and total aberration. Nevertheless, notable differences were identified in third- and fourth-order aberrations, suggesting that specific measurements may not consistently align between devices, and these values should not be considered interchangeable.

Purpose: To describe a presumed case of acute retinal pigment epitheliitis (ARPE) which presented as an angular sign of Henle fiber layer hyperreflectivity (ASHH).

Methods: We report a 27-year-old male with ARPE and ASHH suggestive of Henle fiber layer ischemia.

Results: A 27-year-old male patient came with complaints of black spot in the left eye. There was a yellow lesion seen inferotemporal to the fovea, and multimodal imaging was suggestive of ARPE with ASHH. ARPE is an acute disorder affecting the ellipsoid and interdigitation zone which is seen on optical coherence tomography as ASHH sign, suggesting inflammatory insult to the photoreceptors. He was treated with oral steroids which led to the resolution of the lesion.

Conclusion: ARPE may result in the inflammatory insult of photoreceptors.

Purpose: To find the effect of thalassemia major on ocular biometric parameters including axial length (AL), anterior chamber depth (ACD), vitreous chamber depth (VCD), and lens thickness (LT).

Methods: A systematic search was carried out on PubMed, Cochrane, and Embase using a combination of keywords. The identified records undergone primary and secondary screening. The meta-analysis was done for comparing AL, ACD, VCD, and LT between thalassemia major cases and controls using pooled effect size, confidence intervals (CIs), quality assessment, and publication bias. This review was registered in the international prospective register of systematic reviews bearing code CRD42024542894.

Results: This meta-analysis included 7 studies with a total sample of 1676 individuals (cases = 851, controls = 825). The cases were having reduced AL, ACD, and VCD while increased LT compared to controls. The estimated average effect size for AL = 1.07 (95%CI: 0.47-1.68, z = 3.471, P < 0.001), ACD = 0.81 (95%CI: 0.30-1.32, z = 3.109, P = 0.002), LT = 0.82 (95%CI: 0.45-1.19, z = 4.321, P < 0.001), and VCD = 1.08 (95%CI: 0.46-1.71, z = 3.392, P < 0.001).

Conclusion: This study concludes that AL, ACD, and VCD were significantly less while LT was significantly greater in cases than in controls.

Purpose: To analyze the results of the long-term outcome of pneumatic displacement (PD) with intravitreal bevacizumab (IVB) for subfoveal hemorrhage (SFH) secondary to polypoidal choroidal vasculopathy (PCV)/macular neovascularization secondary to neovascular age-related macular degeneration (n-AMD).

Methods: This is a retrospective and interventional study executed in the population of southern part of India who attended a tertiary care ophthalmic hospital over a decade. Patients who presented with a complaint of diminution of vision following SFH secondary to PCV or n-AMD who were treated with PD using sulphur hexafluoride (SF₆) along with IVB were included in the study. The patients were followed up for at least 24 months posttreatment. Finally, a dataset of 54 patients was chosen who fulfilled all the criteria and a thorough analysis on their long-term outcome was done.

Results: The mean age at baseline was 57.55 ± 13.02 years. Average treatment delay was measured 9.43 ± 5.22 days. Best-corrected visual acuity (BCVA) on presentation was 1.07 ± 0.46 in logMAR. The average size of the SFH was measured 4.46 ± 1.17-disc diameter area. The average long-term follow-up was measured 29.33 ± 4.53 months. Final BCVA improved to 0.74 ± 0.62 in logMAR (P < 0.001). Overall improvement in BCVA was significantly better, although only a minority of patients (n = 24, 44.44%) improved BCVA ≥ 0.3 in logMAR. Subgroup analysis reveals smaller SFH (≤2 disc diameter) and presentation earlier than 1 week shows comparatively better visual outcome.

Conclusions: The study shows encouraging results on the long-term follow-up with respect to anatomical and visual acuity outcome. This serves as the second largest dataset on PD with IVB for SFH secondary to PCV/n-AMD in ophthalmic literature.

Purpose: To introduce a novel surgical technique for repositioning a dislocated XEN63^® gel stent in patients with open-angle glaucoma, to synthesize contemporary findings on complications associated with stent dislocation, and to comment on related management strategies.

Methods: A 75-year-old male with primary open-angle glaucoma experiencing XEN63 dislocation underwent this new surgical procedure. Key steps included identifying the scleral leakage site with Trypan Blue, performing precise scleral incisions, and careful stent repositioning. A mini-review on XEN dislocation was conducted through literature searches using PubMed, Embase, Medline, Web of Science, and Google Scholar, focusing on causes, complications, and management strategies. Relevant studies were selected based on specific inclusion criteria and a consensus process involving multiple reviewers.

Results: The technique successfully repositioned the stent, with postoperative recovery indicating normal intraocular pressure and correct stent positioning. Initial postsurgery assessments confirmed stent functionality and correct placement. Pathophysiological mechanisms related to dislocation, type of dislocation, and relative management was also presented summarizing the findings based on current literature.

Conclusions: The study presents an effective, conservative management method for repositioning dislocated XEN63 gel stents using an ab externo approach. This technique offers a less traumatic alternative to current practices by avoiding the need for additional devices or scleral pocket creation. The accompanying mini-review provides a comprehensive overview of XEN dislocation, enhancing the strategy for managing such complications. Further research, including broader case series or comparative studies, is essential to solidify these findings.

Purpose: To report a case of early orbital hemorrhage following four-petal evisceration and highlighting the clinical presentation, diagnostic process, and surgical management.

Methods: A 49-year-old male patient, with a history of chronic renal insufficiency on renal replacement therapy and anticoagulation treatment, presented with sudden painful proptosis 1 week after four-petal evisceration. Orbital magnetic resonance imaging revealed a hyperintense area suggestive of hemorrhage around the implant. Initial management involved intravenous steroid therapy to alleviate symptoms.

Results: Despite the administration of steroids, the patient's proptosis and associated symptoms persisted. This led to the decision to perform surgical intervention. The surgical procedure encompassed the removal of the silicone implant, evacuation of the hemorrhage, and subsequently reinsertion of the same implant. Postoperatively, the patient's symptoms improved significantly.

Conclusions: To our knowledge, this report represents the first case of early orbital hemorrhage developed following four-petal evisceration. This case underscores the potential for the development of early orbital hemorrhage following four-petal evisceration. Prompt recognition and appropriate surgical intervention are crucial for the management of the hemorrhage and preserving orbital function.