Journal of Current Ophthalmology最新文献

Purpose: To determine which mechanisms are operative in releasing the extraocular myofascial tissue in response to extraocular myofascial release (EOMR) and to evaluate the effect of EOMR on saccadic velocity and esodeviation angle in patients with convergence spasm.

Methods: Fourteen patients with convergence spasm aged 20-35 participated in this research. The treatment included touching the medial rectus and its interrelated fascial tissue with the index finger pulp from over the eyelid for at least 300 s and applying very gentle and uniform pressure. We evaluated the saccadic velocity obtained from dynamic electrooculography (EOG) and the angle of deviation. The findings of dynamic EOG were used as a reliable quantitative method to assess eye movement function.

Results: The amount of esodeviation decreased significantly at both far 2.39Δ, 95% confidence interval (CI) (1.27-3.52) (P = 0.002) and near 5.57Δ, 95% CI (4.67-6.47) (P = 0.001) after two sessions of EOMR in a week. There was no significant difference in saccadic velocities before and after treatment.

Conclusion: In the short term, the EOMR only affects the static condition of the eye. Therefore, a significant improvement could be seen in the deviometric findings. However, the dynamic properties of the extraocular muscles did not improve and probably needed a more extended treatment period for acting the long-term mechanisms.

Purpose: To review the principles and different techniques of minimally invasive procedures in strabismus surgery.

Methods: This is a narrative review on minimally invasive procedures in strabismus surgery including general aspects and different new modifications on conventional strabismus surgery. We reviewed 24 articles published between 1993 and 2020.

Results: Minimal invasive procedures could be categorized into two subsets: one which minimizes conjunctival opening size and another which minimizes the muscle manipulations. Different conjunctival approaches have been introduced, such as Cul-de-sac and minimally invasive strabismus surgery incisions. Furthermore, there are different techniques for extraocular muscle weakening, strengthening, and transposition, such as mini-tenotomy, plication, mini-plication, Nishida, and modified Nishida procedures. Moreover, there are some techniques for handling strabismus in heavy eyes with high myopia and using adjustable sutures for strabismus correction.

Conclusions: Minimally invasive procedures in strabismus surgery consist of surgical procedures that minimize tissue disruption, speed up rehabilitation, and often ultimate better outcomes. These techniques could be replaced traditional methods to reduce conjunctival and lid swelling in the direct postoperative period.

Purpose: To quantify the effects of Descemet stripping automated endothelial keratoplasty (DSAEK) on corneal clarity and densitometry of patients with long-standing pseudophakic bullous keratopathy (PBK) complicated with subepithelial fibrosis.

Methods: Thirty-four eyes with PBK complicated with corneal edema for more than 6 months and subepithelial fibrosis were enrolled. All subjects underwent complete ophthalmic examination and corneal densitometry module of Pentacam HR, before and 1, 3, and 6 months after DSAEK.

Results: Thirteen patients were excluded due to postoperative complications or missed to follow-up visits. Finally, twenty-one patients' data were analyzed. Corneal densitometry measures significantly decreased in all three layers (anterior, central, and posterior) 3 and 6 months after surgery compared to preoperative values; however, the differences did not reach statistical significance in the 1^st month. Moreover, densitometry measurements were significantly lower at month 6 compared to month 1, but not at month 3 compared to month 1. Corneal densitometry of the anterior layer was significantly higher than central and posterior layers in 2 mm and 6 mm zones preoperatively and at all postoperative visits. Corneal light backscatter of each three layers was not statistically different between 0-2 mm and 2-6 mm in all pre- and postoperative visits.

Conclusions: Corneal densitometry in cases of PBK begins to improve after DSAEK in different layers in a slow and continued trend which takes up to 6 months for an effect to be seen. Interestingly, this improvement is possible even in complicated corneas with long-standing edema. Hence, corneal densitometry can be used as an objective method for quantification of the outcome of DSAEK in complicated cases of PBK.

Purpose: To evaluate the association of systemic inflammatory marker levels in macular edema with serous macular detachment (SMD) secondary to retinal vein occlusion (RVO).

Methods: Patients diagnosed with RVO were categorized into two groups based on the presence or absence of SMD: Group 1 included 30 eyes with SMD, while Group 2 included 30 eyes without SMD. Levels of neutrophils, monocytes, lymphocytes, thrombocytes, and mean platelet volume (MPV) were analyzed. Systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated and compared between the two groups.

Results: The mean neutrophil levels were significantly higher in Group 1 (P = 0.002). The mean lymphocyte, monocytes, thrombocyte, and MPV levels did not differ significantly between groups. NLR and SII levels were significantly higher in the SMD group (P = 0.004 and P = 0.016, respectively). There was no significant difference between the groups in terms of PLR. The optimal receiver operator characteristic (ROC) cut-off value of NLR for SMD was calculated as 1.55 with 73% sensitivity and 63% specificity (area under the curve [AUC] = 0.714, 95% confidence interval [CI]: 0.584-0.845). The optimal ROC cut-off value of SII for SMD was calculated as 451.75 with 63% sensitivity and 63% specificity (AUC = 0.681, 95% CI: 0.546-0.816). In this study, branch RVO was present in 48 patients, and central RVO was present in 12 patients. Neutrophil, MPV levels, and NLR, PLR, SII ratios were similar between patients with branch and central occlusion.

Conclusion: Neutrophil levels, NLR, and SII were found to be significantly higher in eyes with SMD secondary to RVO.

Purpose: To report two rare cases of orbital cholesterol granuloma (CG) presenting with ptosis and proptosis.

Methods: The first case was a 31-year-old male presented with progressive ptosis of the left eye (LE) during the past year and the second case was a 35-year-old male presented with proptosis of the right eye (RE) for 5 months ago. Orbital computed tomography revealed a cystic well-demarcated lesion in the superotemporal orbit with adjacent bone erosion in the LE of the first case and the RE of the second case.

Results: In both cases, the tumor was excised completely through an anterolateral orbitotomy approach. Histopathological evaluation showed fibroconnective tissue with cholesterol clefts surrounded by granulomatous inflammation consistent with the diagnosis of CG. The symptoms of patients were resolved after surgery.

Conclusions: CG of the orbit is a rare lesion that commonly occurred in the superotemporal area. Erosive bone expansion is the characteristic finding of this lesion that can be mistaken with lacrimal gland malignancies. Hence, it is essential to keep CG in mind in the differential diagnosis of lacrimal gland masses.

Purpose: To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management.

Methods: This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management.

Results: This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned.

Conclusions: Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Purpose: To investigate the choroidal structure in keratoconic patients with different severity using the choroidal vascularity index (CVI) derived from image binarization on enhanced depth imaging optical coherence tomography scans (EDI-OCT).

Methods: Sixty-eight eyes from 34 keratoconus (KCN) patients and 72 eyes from 36 healthy subjects were recruited in this prospective, noninterventional, comparative cross-sectional study. EDI-OCT was employed to measure choroidal parameters, including choroidal thickness (CT), total choroidal area (TCA), luminal area, stromal area, and CVI.

Results: Subfoveal CT was 354.6 ± 66.8 μm in the control group and 371 ± 64.5 μm in the KCN group (P = 0.86). There was no significant difference between control and KCN groups in terms of TCA (0.66 ± 0.14 mm² vs. 0.7 ± 0.12 mm²; P = 0.70), luminal area (0.49 ± 0.10 mm² vs. 0.53 ± 0.08 mm²; P = 0.67), and stromal area (0.16 ± 0.05 mm² vs. 0.17 ± 0.05 mm²; P = 0.84). CVI was also comparable in the control group (75.4% ±3.4%) and the KCN group (75.6% ±4.5%; P = 0.43). There was also no significant correlation between other choroidal parameters and KCN severity indices.

Conclusion: It seems that CVI as well as other choroidal biomarkers were not significantly different between patients with KCN and healthy subjects.

Purpose: To investigate the agreement between the Oculus and Metrovision perimeters in the visual field evaluation of glaucoma patients.

Methods: In this cross-sectional study, 41 consecutive glaucoma patients were enrolled. After detailed clinical examinations, visual field testing was performed for all patients using the Oculus and Metrovision perimeters. The interval time between the two visual field examinations was 30 min.

Results: A total of 22 participants were male (53.7%) and the mean ± standard deviation (SD) age was 58.6 ± 9.1 years. The absolute average of the mean deviation (MD) in the oculus perimeter (8.24 ± 4.92 dB) was higher compared to the Metrovision perimeter (4.02 ± 4.62; P < 0.001). This difference was also evident in the Bland-Altman graph. The loss variance (pattern SD) values of Oculus perimeter (28.58 ± 16.40) and Metrovision perimeter (28.10 ± 28.45) were not significantly different; although based on the Bland-Altman plots in the lower MDs, the agreement is better and the data dispersion is lower, and in the higher MDs, the agreement is lower. The parameters of four visual field quadrants were also compared and showed poor correlations (P < 0.001).

Conclusion: The Oculus and Metrovision perimeter devices have good agreement in lower MDs; however, they cannot be used interchangeably.

Purpose: To report the clinical course and optical coherence tomography (OCT) findings of ocular angiostrongyliasis.

Methods: A 36-year-old female with a history of ingesting regular raw freshwater shrimp and other raw food presented with acute unilateral painless visual loss in the right eye. Her right eye's best-corrected visual acuity (BCVA) was 1 ft of the count finger. Fundus examination showed vitritis, generalized retinal pigment epithelial alteration, and a moving roundworm in the vitreous at the 6 o'clock position. Macular OCT of her right eye showed thinning of the retina, loss of the external limiting membrane and ellipsoid zone, subretinal hyper-reflective material clumping, and hyper-reflective foci at the superficial choroidal layer.

Results: The patient was administered oral and topical prednisolone. The roundworm, identified as Angiostrongylus cantonensis, was wholly extracted from the vitreous using a 23G sclerotomy port and pars plana vitrectomy. The final BCVA was 1 ft of the count finger.

Conclusion: This case report describes an infrequent presentation and illustrates the clinical course and OCT findings of ocular angiostrongyliasis.