Journal of Current Ophthalmology最新文献

Purpose: To present a 13-year-old patient with choroidal osteoma complicated by choroidal neovascularization (CNV) treated with antivascular endothelial growth factor (anti-VEGF) agents and to review the efficacy of these agents based on relevant literature.

Methods: Case report.

Results: A 13-year-old girl presented with sudden visual loss in her right eye. Ophthalmic examination revealed a large choroidal osteoma complicated by subretinal and subretinal pigment epithelium (sub-RPE) hemorrhage, suggestive of CNV. Intravitreal bevacizumab injections were administered, leading to substantial improvement in vision and resolution of subretinal and sub-RPE hemorrhage. Follow-up showed that further injections were unnecessary as the CNV regressed. Literature review identified 25 cases of CNV associated with choroidal osteoma, with bevacizumab being the most frequently used anti-VEGF agent. Multiple injections were often required, though single-dose injections also proved effective in some cases. The majority of patients experienced visual improvement following treatment.

Conclusion: Anti-VEGF agents, like bevacizumab, appear to be a promising treatment option for CNV secondary to choroidal osteoma, potentially preserving and improving vision with limited injections.

Purpose: To determine the variations in deep anterior lamellar keratoplasty (DALK) techniques in eyes with macular corneal dystrophy (MCD), and to compare visual outcomes between standard DALK and Descemet's membrane (DM) baring DALK.

Methods: A retrospective comparative case series was conducted, categorizing eyes into two groups: Group A, without DM baring, and Group B, with central DM baring. All DALK surgeries for MCD conducted between January 2010 and August 2020 at our institution were included in this study.

Results: The study comprised 29 eyes from 18 patients with a mean follow-up period of 54.85 months. Type 1 bubble was achieved in 4 eyes (13.8%), type 2 or mixed bubbles were formed in 19 eyes (65.5%), and failed big bubble formation occurred in 6 eyes (20.7%). Group A (non-DM baring) comprised 18 eyes (62.1%), while Group B (central DM baring) included 11 eyes (37.9%). No statistically significant differences were found between the groups in terms of best-corrected visual acuity, spherical equivalent, or topographic astigmatism. However, Group B demonstrated significantly improved contrast sensitivity (P < 0.01). Group A displayed persistent or recurrent MCD opacities in 11 eyes (73.3%), whereas none were observed in Group B, demonstrating a statistically significant difference (P < 0.001).

Conclusions: The incidence of type 2 or mixed bubbles in MCD cases is relatively high, facilitating central DM baring. In this series, central DM baring correlated with improved contrast sensitivity and prevented MCD opacities recurrence. Thus, it should be considered in all DALK cases for MCD if a type 2 bubble is formed.

Purpose: To explore the various applications of liquid biopsy (LB) in ophthalmology and provide a comprehensive discussion on its utility in the field.

Methods: A thorough exploration of the literature was conducted, and a total of 47 articles were included.

Results: In RB, where conventional tumor biopsies carry risks of spreading the tumor beyond the eye, LB, particularly from the aqueous humor, emerges as a promising alternative. It provides a secure means of detecting cfDNA. In addition, LB is effective in uveal melanoma, particularly through digital droplet PCR, in mutation detection and predicting disease progression. Moreover, vitreous LB proves highly effective in diagnosing vitreoretinal lymphoma, exhibiting greater sensitivity than traditional cytopathological methods. This noninvasive approach not only enhances diagnostic accuracy but also holds potential for guiding biologically targeted therapies, showcasing the ongoing advancements in LB technology poised to redefine and revolutionize the field.

Conclusion: These findings offer valuable insights for personalized treatment strategies in ocular malignancies.

Purpose: To investigate the outcomes of asymmetric (AS) Keraring intracorneal ring segments (ICRS) implantation in patients with all types, types 2 (Duck) and 3 (Snowman) of keratoconus.

Methods: The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023482841). From inception to December 2023, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science. Due to heterogeneity, a random-effects model was used for all analyses. Publication bias was evaluated using the risk of bias in nonrandomized studies of interventions tool, and sensitivity analyses included leave-one-out and Baujat methods. Meta-regression explored the effects of age, sex, and follow-up time on heterogeneous outcomes. Software R version 4.3.2 was used for statistical analysis.

Results: From 318 initial articles, 7 studies (3 prospective and 4 retrospective cohorts) met inclusion criteria, pooling 435 eyes from 365 patients across seven countries. Significant improvements were observed postoperatively for uncorrected distance visual acuity (mean differences [MD]: 0.49, confidence interval [CI]: 0.42-0.57), corrected distance visual acuity (CDVA) (MD: 0.18, CI: 0.07-0.29), topographic astigmatism (MD: 2.04 diopter [D], CI: 1.51-2.58 D), maximum keratometric (MD: 4.42 D, CI: 3.24-5.60 D), comatic aberration (MD: 0.56 µm, CI: 0.29-0.82 µm), refractive astigmatism (MD: -2.52 D, CI: -3.08 to -1.95 D), spherical equivalent (SE) (MD: -2.86 D, CI: -4.02 to -1.70 D), and mean keratometry (MD: 2.92 D, CI: 1.94-3.91 D). Subgroup analyses for keratoconus types 2 and 3 revealed consistent improvements across most parameters. Sensitivity analysis identified specific studies influencing heterogeneity without altering statistical significance. Meta-regression revealed associations for follow-up and male gender in SE, CDVA, and topographic astigmatism, while age showed no consistent effect.

Conclusion: The implantation of AS Keraring ICRS was safe and effective, improving visual, topographic, and refractive parameters in patients with keratoconus of phenotype types 2, 3, and all types.

Purpose: To measure the choroidal vascularity index (CVI) in newly diagnosed hypercholesterolemia patients.

Methods: This cross-sectional study included 50 treatment-naïve hypercholesterolemia patients and 50 age-matched healthy controls. None of the patients had other systemic diseases. CVI in the patient and control groups was compared. In addition, the effect of lipid levels on CVI was calculated. Analysis of covariance was used to compare groups after adjusting for axial length, age, and sex. The partial correlation coefficient was determined for the correlation between lipid levels and choroidal area in both groups. The level of statistical significance was set at P < 0.05.

Results: CVI was significantly lower in the study group (<0.001). There were no differences in total choroidal area (TCA) (P = 0.141) or luminal area (LA) (P = 0.539) between the groups. The stromal area (SA) was, however, significantly thicker in the patient group than in the control group (P = 0.006). Lipid levels and CVI were not correlated.

Conclusions: The present findings show that hypercholesterolemia patients have a significantly thicker SA and a lower CVI than healthy controls. Interestingly, the increased stromal are in the patients did not result in an increase in the TCA or compressed vascular tissues that would have presented as a reduction in LA. The present findings should be considered preliminary, and additional studies with longer follow-ups may further clarify the effects of increased SA thickness.

Purpose: To establish normative values for macular sublayer thickness in healthy Iranian children using optical coherence tomography (OCT) and to assess the effects of age and gender.

Methods: This study was part of the population-based Shiraz pediatric eye study. Of 2400 children aged 6-12 years invited, 480 were randomly selected for optical biometry and macular spectral-domain OCT (SD-OCT) imaging. Finally, 431 OCT scans from children with medium axial length (AL; 21.5-26.5 mm) were analyzed. The OCT device automatically segmented seven retinal sublayers, and their thickness was measured across Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. Thickness in the central 1-mm subfield was assessed by gender and age groups (6-9 vs. 10-12 years), adjusted for AL. Regression analysis examined the impact of age, sex, and AL on retinal sublayer thickness. Only data from the right eye were used.

Results: The mean age of participants was 9.12 ± 1.59 years (range, 6-12), with 254 (58.9%) being girls. The mean AL was 22.91 ± 0.71 mm, and the mean foveal thickness was 258 ± 8 µm. A normative database was created for the total retinal thickness and the seven retinal sublayers across the nine ETDRS subfields. Boys had longer globes (by approximately 0.4 mm; P < 0.001) and thicker foveae (by about 5 µm; P = 0.001) compared to girls. Among the seven sublayers studied, boys had a thicker ganglion cell complex layer (P = 0.014) and outer nuclear layer (ONL; P = 0.012), while girls had a thicker retinal pigment epithelium (RPE; P = 0.029). The inner nuclear layer and outer plexiform layer showed no significant differences (P = 0.075 and P = 0.810, respectively). The mean AL was 22.78 ± 0.68 mm in the 6-9 age group and 23.10 ± 0.72 mm in the 10-12 age group (P < 0.001). The older age group (10-12 years) exhibited thicker ONL (P = 0.009) and RPE (P = 0.002) layers compared to the younger group.

Conclusions: This study provides normative data for macular sublayer thickness in Iranian children aged 6-12 years using Heidelberg SD-OCT. Boys had longer ALs and thicker maculae, while girls had a thicker RPE layer. Older children had longer globes and thicker retinas, mainly due to increased ONL and RPE thickness.

Purpose: To report a case of aniridic fibrosis syndrome (AFS) after Ahmed glaucoma valve (AGV) surgery.

Methods: Case report.

Results: Two years post-AGV surgery in both eyes, a 3-year-old aniridic female presented with grayish discoloration of the right eye for the past 3 months. A slit-lamp examination of the right eye revealed an aniridic, hypotonic eye with a totally edematous cornea. A tube of the AGV was in place with a mature cataract subluxed superiorly. In addition, a thick, whitish vascularized membrane originating from the rudimentary iris to the inferior part of the subluxed lens was observed. Ultrasound biomicroscopy investigation confirmed a thick fibrotic membrane originating from the iris root and extending to the posterior part of the cataractous lens. The intraocular pressure of the right and left eye was 0 and 11 mmHg, respectively. A B-scan of the right eye revealed an axial length of 21 mm, optic disc swelling, and shallow choroidal detachment in the anterior 2/3 of the posterior segment without retinal detachment. With the diagnosis of AFS, a pars plana vitrectomy, lensectomy, and membranectomy under keratoprosthesis and penetrating keratoplasty were planned.

Conclusions: Aniridic patients may undergo multiple ocular surgeries during their lifetime. One of the rarest surgical complications in these patients is AFS. Early diagnosis can be possible with serial slit-lamp examination and ultrasonographic studies to detect the disease in the early stages and prompt intervention. Here, in our case, the parents declined any surgical intervention.

Purpose: To introduce the applications of artificial intelligence (AI) in the clinical diagnosis and treatment of dry eye (DE) and to explore its common workflows, effectiveness, challenges, and future development directions.

Methods: This article conducts a literature review, focusing on the applications of AI in the diagnosis and treatment of DE. The primary search terms include "artificial intelligence", "machine learning", "deep learning", "computer-aided", and "Dry Eye".

Results: A total of 48 relevant original studies were identified, and their algorithms, sample characteristics, and data types were summarized. Through data analysis and image recognition, AI assists in DE examinations, identifies risk factors, aids diagnosis, and manages and monitors treatment. AI excels in enhancing diagnostic efficiency, accuracy, and objectivity, and shows promise in cloud-based treatment management. However, the applications of AI in DE also face certain challenges that need to be addressed.

Conclusions: AI has the potential to revolutionize the diagnosis of DE and recommend personalized treatment strategies. This review summarizes existing challenges and offers clinicians and researchers a comprehensive, objective overview of AI applications and workflows in DE.

Purpose: To present an integrative review of the different color vision tests, their construction specificities, and their applications in ophthalmological and neurological diseases.

Methods: The literature was searched using the online databases such as PubMed, Scopus, Web of Science, and PsycInfo. The inclusion criteria included English studies, which focused on color measurement or evaluation for clinical diagnosis, involving group comparisons of congenital or acquired color deficiencies and healthy controls, participants over the age of 18 years, and published after 1970.

Results: We provide detailed descriptions of traditional and new computerized color vision tests including the test background, the prioritized level of processing, considerations regarding whether the test is more retinal or cortical tuned, if the task/skill measured is detection, discrimination or performance in color manipulation, and when to apply the respective tests.

Conclusion: The findings highlight the strong potential of color perception assessment in identifying early retinal changes and marking the progression of diseases, sometimes in subclinical conditions, in various ophthalmological and neurological conditions.

Purpose: To describe the demographic characteristics, etiology, microbiological spectrum, and antibiotic sensitivity patterns in patients with endophthalmitis.

Methods: This is a retrospective case series spanning from May 2012 to September 2018. All included patients were diagnosed with endophthalmitis and confirmed by laboratory tests. Data were collected on patient demographics, types of endophthalmitis, and microbiologic and medical records.

Results: Nine hundred ninety-two records of patients with endophthalmitis were assessed. Of the total cases, 657 patients (66.2%) were male, whereas 335 (33.8%) were female. The mean age of the patients was 57.2 ± 22.8 years and ranged from 2 to 95 years. The type of endophthalmitis was acute postcataract surgery (44.4%), posttraumatic (26.7%), chronic postcataract surgery (6.6%), endogenous (6.4%), postintravitreal injection (5.0%), keratitis-associated (3.6%), postvitrectomy (2.7%), bleb-associated (2.4%), postkeratoplasty (1.9%), and device-related (0.1%). The most frequently isolated organisms were Staphylococcus epidermidis (11.7%), followed by Streptococcus pneumoniae (5.2%) and Streptococcus viridans (5.1%). Antibiotic susceptibility testing in patients with acute postcataract surgery endophthalmitis showed variable sensitivity of S. epidermidis isolates to vancomycin (81.4%), ciprofloxacin (76.2%), and levofloxacin (75.0%). In patients with posttraumatic endophthalmitis, high rates of zone 1 injury (61.5%), traumatic cataract (67.9%), and intraocular foreign body (IOFB) (29.8%) were observed.

Conclusions: S. epidermidis is the most common causative pathogen in patients with endophthalmitis, its increasing resistance to vancomycin and fluoroquinolones may pose some challenges to the treatment of endophthalmitis in the future. Regarding the presence of IOFB, zone 1 injury, and traumatic cataracts that might be associated with an increased risk of posttraumatic endophthalmitis, it is better to consider these aspects in penetrating eye injuries.