Journal of Current Ophthalmology最新文献

Purpose: To compare the effectiveness of midazolam premedication administered through nebulization and orally as premedication in pediatric anesthesia in ophthalmic surgeries.

Methods: In this randomized controlled double-blind trial, 70 patients scheduled for strabismus surgery were enrolled and divided into two groups. Group O (oral, n = 32) received 0.5 mg/kg oral midazolam and Group N (nebulized, n = 33) received 0.5 mg/kg midazolam through nebulization. Our outcomes included satisfactory sedation of patients, parental separation anxiety, mask acceptance scores, and perioperative hemodynamics up to 30 min postpremedication.

Results: A significant difference in oxygen saturation (SpO₂) at the 30^th min emerged between nebulized and oral midazolam (P = 0.006). Ramsay Sedation scores within 30 min demonstrated comparable sedation levels between Groups N and O. Face mask acceptance scores were excellent in both groups, with no significant differences. Parental separation anxiety scores and the mask acceptance score at the 30^th min revealed no statistically significant differences at various time points (P > 0.05).

Conclusions: In pediatric patients undergoing ophthalmic surgeries, nebulized midazolam is as effective as oral midazolam for sedation. The nebulized form is better tolerated and results in significantly improved SpO₂ levels 30 min after administration. These findings indicate that nebulized midazolam is a safe and effective alternative to oral midazolam for sedative premedication in young children.

Purpose: To evaluate the diagnostic accuracy and relationship between structural and vascular measurements in pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (GEX).

Methods: Observational, case-control, and monocentric study conducted from March 2022 to April 2023. The study population comprised 153 eyes from 83 individuals divided into three groups: healthy (49), PEX (51), and GEX (53), with healthy subjects randomly selected from a cohort of nonglaucomatous patients. Structural parameters, including ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) were measured using spectral domain-optical coherence tomography (OCT). Vascular parameters were obtained from papillary and macular scans through OCT-angiography (OCT-A). The papillary whole-image vessel density (pWiVD), circumpapillary vessel density (cpVD), papillary vessel density (pVD), vessel densities in the superior, temporal, inferior, and nasal quadrants, as well as the macular WiVD, and the parafoveal and perifoveal vessel densities were measured. Structural parameters involved mean RNFL, superior, temporal, inferior, and nasal quadrant RNFL thicknesses, mean, inferior, and superior GCC thicknesses.

Results: The analysis of OCT-A parameters revealed a significant decrease in all vascular densities measured in the papillary region between the GEX and PEX groups and between the PEX and control groups, except for the pVD, which was comparable between the latter 2 groups (P = 0.051). At the level of the macular region, we found a significant decrease in the vascular densities of the superficial plexus, more pronounced in the parafoveal region, in the GEX group compared to the PEX group and in the PEX group compared to the control group. No difference was noted in the deep vascular plexus. Strong correlations were noted between cpVD and average RNFL (r = 0.83), superficial parafoveal vessel density and GCC (r = 0.72), and between cpVD and superficial parafoveal vessel density (r = 0.84). Regression analyses showed cpVD (the area under the curve = 0.958) provided the best diagnostic value in distinguishing between PEX and GEX.

Conclusions: cpVD is critical for detecting GEX, indicating that significant loss of peripapillary microvasculature with preserved structure strongly suggests GEX diagnosis.

Purpose: To review the results of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. GATT has shown efficacy in mild to moderate cases of glaucoma. Its efficacy in advanced glaucoma is uncertain, though recent studies show promising short-term outcomes.

Methods: A retrospective chart review of advanced glaucoma patients undergoing GATT with or without cataract surgery from January 2018 to April 2023 was conducted. Complete success was defined as intraocular pressure (IOP) <14 mmHg with ≥30% reduction from baseline (Criteria A) or IOP <18 mmHg and/or ≥20% reduction (Criteria B), without antiglaucoma medications. Qualified success was defined as attainment of the same with a maximum of 2 medications.

Results: A total of 69 eyes from 60 patients (mean age, 61.2 ± 15.3 years) were included in the study. The mean IOP decreased from 24.9 ± 10.7 mmHg preoperatively to 12.1 ± 3.0 mmHg at 6 months postoperatively. At 6 months, the complete success rate (based on Criteria A) was 66.7%, with an overall success rate of 81.9%. By 1 year (n = 52), these rates were 51.9% and 65.4%, respectively. Using Criteria B, the complete success rate was 74.2%, and the overall success rate was 95.4% at 6 months, decreasing to 57.7% and 82.7% at 1 year. Patients who had used antiglaucoma medications for <2 weeks before surgery showed significantly higher success rates at both 6 months (P = 0.01) and 1 year (P = 0.019). Combining GATT with cataract surgery also improved success rates at 6 months (P = 0.005). In addition, six eyes with previously failed trabeculectomy achieved success at 6 months, with five remaining successful at 1 year. Three eyes experienced delayed bleeds with an IOP spike, all of which met failure criteria during the follow-up.

Conclusions: GATT demonstrates encouraging short-term outcomes in advanced glaucoma, particularly in treatment-naïve patients and those undergoing combined cataract surgery. However, delayed bleeds can lead to IOP spikes and treatment failure. GATT may be considered as a viable surgical option in treatment naïve patients with advanced glaucoma. Its efficacy is bolstered when combined with cataract surgery.

Purpose: To report an uncommon complication arising from an intravitreal injection (IVI).

Methods: This case describes ocular hypotony secondary to a cyclodialysis cleft following an IVI, including its management.

Results: A 68-year-old male presented with a 5-month history of persistent hypotony and vision loss in the left eye following an intravitreal antivascular endothelial growth factor (anti-VEGF) injection. His history included rhegmatogenous retinal detachment in the right eye and chronic central serous chorioretinopathy with macular neovascularization in the left eye, treated with intravitreal anti-VEGF injections for 5 years. Clinical findings included best-corrected visual acuity (BCVA) of 20/1600 (right) and 20/150 (left), with intraocular pressure (IOP) of 16 mmHg (right) and 4 mmHg (left). Slit-lamp exam of the left eye revealed a deep pseudophakic anterior chamber, resolving vitreous hemorrhage, and chorioretinal folds without retinal breaks. Gonioscopy identified a suspected cyclodialysis cleft inferotemporally, which was confirmed by 50 MHz ultrasound biomicroscopy (UBM). The patient was treated with intraoperative argon laser photocoagulation (120 shots, 300 mW), targeting the cleft through a corneal incision. UBM, the next day, confirmed cleft closure and ciliary body reattachment. A transient IOP spike to 42 mmHg was medically controlled. Over the following weeks, IOP stabilized between 10 and 15 mmHg without medications, and optical coherence tomography showed resolution of chorioretinal folds and subretinal fluid. Final BCVA improved to 20/70 (left eye) and 20/800 (right eye postcataract surgery).

Conclusion: This report underscores a rare complication of IVIs and highlights the critical role of UBM in achieving accurate diagnostic assessment.

Purpose: To compare the efficacy and safety of Stivant^® (biosimilar bevacizumab, CinnaGen, Iran) to Avastin^® (innovator bevacizumab, Genentech, South San Francisco, CA) in premature infants with prethreshold type I retinopathy of prematurity (ROP).

Methods: Preterm infants with bilateral prethreshold type 1 ROP were enrolled in this nonrandomized contralateral clinical trial. Bilateral intravitreal bevacizumab (IVB) was administered, with Stivant^® injected in one eye and Avastin^® in the other. Patients were followed up weekly for 4 weeks, then biweekly until complete retinal vascularization. Efficacy was evaluated based on disease activity regression (plus disease regression) and complete retinal vascularization. Safety was assessed through the monitoring of adverse events such as uveitis and endophthalmitis.

Results: Forty-four infants were included in the study. The mean age at IVB injection was 34.5 weeks. Complete retinal vascularization occurred at a mean age of 60.02 weeks for Stivant^® and 59.93 weeks for Avastin^® (P = 0.59). Five patients (11.3%) underwent bilateral laser photocoagulation as rescue treatment. Our results showed that Stivant^® was noninferior to Avastin^® in retinal vascularization progress. However, this study cannot make definitive noninferiority claims due to the sample size and its design as a pilot investigation. No cases of endophthalmitis or uveitis were reported.

Conclusions: Stivant^® exhibited noninferiority to Avastin^® in efficacy and demonstrated a comparable safety profile in treating prethreshold type I ROP. A definite conclusion requires more extended studies with a larger sample size.

Purpose: To evaluate ophthalmologists' attitudes and approaches to learning new surgical techniques.

Methods: This cross-sectional, prospective study distributed an anonymous, voluntary web-based survey via email to surgeons of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). The survey collected data on demographics, fellowship training, practice location, the number of trainee surgeons supervised, the impact of Coronavirus disease 2019, resources for surgical learning, and perceived barriers to learning and adopting new techniques. Multiple-choice, scaled response, and open-ended questions were used in the survey.

Results: Seventy-five surveys were completed (7.1% of 1050 members). Multivariable analysis demonstrated that the number of new surgical techniques adopted over the preceding 5 years was associated with the number of trainee surgeons supervised (P = 0.003); membership of the New Zealand branch of RANZCO (P = 0.021); self-reported interest in innovation (P = 0.043); and inversely associated with the age of the surgeon (P = 0.002). YouTube was the most frequently used resource. It was used by 96% of respondents and rated the most useful resource by 95.8% of respondents. The two most frequent barriers to learning and adopting new surgical techniques were fear of adverse outcomes (90.7%) and having an existing technique with good outcomes (90.7%).

Conclusions: This is the first study exploring how ophthalmologists learn new surgical techniques. The widespread use of YouTube for surgical learning highlights the opportunity for postgraduate colleges to create or post quality-controlled online video resources for their members.

Purpose: To study the characteristics of ophthalmic comorbidities in patients with chronic plaque psoriasis.

Methods: We assessed the clinical and epidemiological attributes and characteristics of ophthalmic comorbidities of patients who had chronic plaque psoriasis for 15-25 years (mean ± standard deviation [SD], 3.9 ± 4.8 years). Out of 100 patients, 57 were males and 43 were females. In this cohort, the age range was from 19 to 77 years (mean ± SD, 41.8 ± 13.9 years). The severity of psoriasis was defined by the psoriasis area severity index (PASI) score as mild (PASI ≤6), moderate (PASI >6-12), or severe (PASI >12).

Results: Psoriasis was mild in 77, moderate in 13, and severe in 10 patients, respectively. Three patients had asymmetric oligoarthritis. In a cohort of 100 patients, there were 23 patients with moderate-to-severe psoriasis and 77 patients with mild psoriasis. In the moderate-to-severe psoriasis group, 18 out of the 23 patients also had ophthalmic abnormalities. In the mild psoriasis group, 53 of 77 patients also had ophthalmic abnormalities. Itching (n = 12; psoriasis was mild in 7, moderate-to-severe in 5 patients), decreased vision (n = 12; psoriasis was mild in 10, moderate-to-severe in 2 patients), redness (n = 9; psoriasis was mild in 5, moderate-to-severe in 5 patients;), watering/discharge (n = 8; psoriasis was mild in 6, moderate-to-severe in 2 patients), and pain or burning (n = 6; psoriasis was mild in 4, moderate-to-severe in 2 patients) were commonly complained by 31 patients. The major ophthalmic comorbidities in order of frequency observed were keratoconjunctivitis sicca/dry eye (n = 41), blepharitis (n = 29), meibomian gland dysfunction (MGD) (n = 18), conjunctivitis (n = 10), corneal abnormalities (n = 13), cataract (n = 14), retention cyst (n = 2), and anterior uveitis in 2 patients (without psoriatic arthritis). Common corneal abnormalities were punctuate keratitis (n = 7), corneal opacities (n = 4), band-shaped keratopathy (n = 1), and superficial vascularization (n = 1). Posterior segment manifestations of arteriosclerotic changes (n = 4), media haze (n = 2), and macular degeneration (n = 1) were likely to be age-related.

Conclusions: The ophthalmic comorbidities, such as blepharitis, MGD, conjunctivitis, keratoconjunctivitis sicca, corneal abnormalities, and presenile cataract, can occur in patients with psoriasis. These are largely asymptomatic and subtle findings that are often missed. They require an early consult to ophthalmology for appropriate management. The major limitations in this study are that it is a single-center, cross-sectional study design that has a low number of patients, lacks a healthy patient control group, and there is a lack of long-term follow-up.

Purpose: To study was to study the efficacy of autologous platelet-rich plasma injections (PRPi) in the treatment of dry eyes.

Methods: This prospective, interventional study was conducted at a tertiary eye care center, India. One hundred and sixty eyes of 80 patients with newly diagnosed dry eyes were included. One eye received PRPi (cases = 80 eyes), and the other eye of the patient received a lubricating drop (control = 80 eyes). Cases who did not improve at 1-month follow-up (FU) were reinjected with PRP. The outcomes were measured on the basis of ocular surface disease index (OSDI), Schirmer's test (ST), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface staining (OSS) score done at baseline and 1-month, 2-month, 3-month, and 6-month FU.

Results: Sixty cases showed a significant improvement in all the outcome measures at 1 month (P < 0.001), when compared to controls; whereas, 20 cases had to undergo repeat injections. On FU at 2 months, 16 cases (out of those 20 cases) showed a significant improvement (P < 0.05), while 4 cases still did not improve clinically at 3 months. All the outcome parameters (ST, NIBUT, TMH, and OSS and OSDI scores) maintained a significant improvement at 6-month FU, including those four cases (P < 0.001). All the patients were highly satisfied with the intervention.

Conclusion: PRPi, as a monotherapy given on pro-re-nata basis, is a simple and efficacious modality of treatment in dry eyes, verified by improvement in subjective and objective tear film parameters.

Purpose: To report a rare case of uveal melanoma (UM) and Von Hippel-Lindau (VHL) syndrome in a patient who underwent whole exome sequencing (WES) to identify the possible genetic cause of the disease.

Methods: A 54-year-old patient was referred to the eye clinic at the Rassoul Akram Hospital in 2016 due to complaints of blurry vision. In addition to UM, he later developed retinal capillary hemangioblastomas in his eye and a central nervous system hemangioblastoma. Proband had a family history of prostate cancer, breast cancer, skin cancer, and acute myeloid leukemia. After analyzing the Sanger sequencing and multiplex ligation-dependent probe amplification of the VHL genes, no mutations were found, leading to the decision to perform WES.

Results: WES disclosed a heterozygous known pathogenic nonsense variant: c.274C>T (p.Arg92*) in exon 3 of gene FCGR1A.

Conclusions: Our examination indicated that FCGR1A: c.274C>T (p.Arg92*) may have contributed to the co-occurrence of UM and VHL disease. In the future, FCGR1A could be a promising therapeutic approach for retinal cancer due to its role in several cancers and retinal degeneration. To gain a better understanding of its pathogenesis mechanism, it is recommended to conduct functional analysis using appropriate animal models before using the variant in genetic counseling.

Purpose: To comprehensively review the treatment approach for acyclovir (ACV)-resistant herpes simplex keratitis (HSK).

Methods: We thoroughly searched Web of Science, PubMed, and Scopus for relevant keywords and conducted this narrative review which explores the diagnosis of ACV-resistant HSK, and discusses alternative treatment strategies, reports previous cases.

Results: Treatment strategies for ACV-resistant HSK include increasing ACV doses, switching to oral valacyclovir (VACV), and using topical antivirals such as foscarnet (FOS), ganciclovir (GCV), trifluridine, and cidofovir. Debridement of lesions and emerging antiviral agents are also considered. The review emphasizes the importance of diagnosing cytomegalovirus in ACV-resistant cases and explores new treatments like helicase primase inhibitors and BX795. Insights from the authors' clinical experience contribute to understanding ACV-resistant HSK and provide valuable guidance for clinicians managing this condition.

Conclusions: HSK is a leading cause of ocular complications in HSV infections, potentially causing visual impairment. ACV has been the primary treatment, but rising ACV resistance necessitates alternative strategies. Options include increased ACV doses, oral VACV, topical FOS, GCV, interferon, and lesion debridement. Clinicians should also explore emerging treatments for ACV-resistant HSK.