Journal of Current Ophthalmology最新文献

Purpose: To report a case of presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) diagnosed through multimodal imaging.

Methods: A single case report documented with multimodal imaging.

Results: A 41-year-old asymptomatic female was referred for a second opinion regarding whitish retinal lesions in her left eye, first identified by her local optometrist 8 years prior. Her history included Hashimoto thyroiditis, with no personal or family history of tuberous sclerosis complex or neurofibromatosis. Visual acuity was 20/20 in both eyes. Fundoscopy of the left eye revealed two pearly white avascular retinal masses. Spectral-domain optical coherence tomography (SD-OCT) showed hyperreflective intraretinal masses with optical shadowing. Optical coherence tomography angiography (OCTA) demonstrated a signal void in the retinal vascular plexuses. Fundus autofluorescence showed moderate hyperautofluorescence. The lesions remained stable over 3 months.

Conclusions: PSCRAP is a rare, benign retinal tumor. Multimodal imaging, including SD-OCT and OCTA, is essential for accurate diagnosis, showing unique features such as separation from the retinal nerve fiber layer and lack of intrinsic vascularity. Our observation of two lesions raises questions about the solitary nature of this condition. Continued documentation may be necessary to differentiate from simulating lesions that may undergo subsequent growth.

Purpose: To genetically investigate a family with a clinical and ophthalmological phenotype suggestive of Stickler syndrome (STL) and the association of molecular findings with ophthalmological, clinical characteristics, and family history.

Methods: Specialized ophthalmologic evaluation using diagnostic methods such as fundoscopy, slit-lamp photography, and ocular biometry to describe the phenotypic characteristics of the index patient and family members. Genetic evaluation with genome sequencing (WGS) is to describe the genotypic characteristics of the proband and confirmation of the finding by family-specific variant sequencing (NGS).

Results: Genetic evaluation demonstrated the presence of a novel pathogenic variant NM_001854.4: C.3168+1G>A (chr1:102961865-102961865), in the intronic region that follows exon 41 of the COL11A1 in the three affected members of the family. This variant is located 1 base from the natural splicing region of this exon and consequently can impact intron removal and protein formation. As for the ophthalmological findings, the presence of low visual acuity, high axial myopia, and pathological vitreous gel with a "beaded" appearance was observed in the index case. Further clinical examination showed that other family members also had vitreous and retinal degeneration.

Conclusions: A heterozygous novel pathogenic variant in COL11A1 was identified by complete genome sequencing in a Brazilian family with STL. Ocular examination findings photographically presented confirm the characteristic features of STL type 2.

Purpose: To perform a meta-analysis to compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes.

Methods: Scopus, Embase, PubMed, and gray literature were searched for studies comparing SLT outcomes in phakic and pseudophakic patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). The mean change in intraocular pressure was compared using a standardized mean difference (SMD) meta-analysis (RevMan 5.4.1). Begg's funnel plots and Egger's test were used to assess publication bias.

Results: Eleven studies with 1058 eyes (323 pseudophakic and 735 phakic) were identified. There was no statistically significant difference in the observed efficacy of SLT between pseudophakic and phakic eyes (SMD = -0.10; 95% confidence interval = -0.24, 0.03; P = 0.14). There was no publication bias or heterogeneity (I ² = 0%; P = 0.66) detected. Subgroup analysis of studies stratified by length of follow-up in months (6, 12, and 24 or greater) revealed no significant difference in SLT efficacy at the different time points (P = 0.86, P = 0.59, and P = 0.16, respectively).

Conclusions: Our pooled and subgroup analysis revealed no significant difference in SLT response between the two populations. Our results support SLT as a viable treatment option for patients with OAG or OHT regardless of pseudophakic status.

Purpose: To determine the distribution of corneal higher-order aberrations (HOAs) measured by pentacam HR in a rural Iranian population and their relationship with age, sex, and refractive errors.

Methods: In this study, sampling was performed from villages in the north and southwest of Iran using the multistage stratified random cluster sampling method. The ocular examination included measurement of uncorrected and best-corrected visual acuity, refraction, and slit-lamp biomicroscopy. Finally, all study participants underwent corneal imaging using Pentacam HR.

Results: The mean root-mean-square (RMS) (±standard error) of total HOA in the anterior and posterior corneal surfaces was 0.498 ± 0.004 μm and 0.212 ± 0.001 μm, respectively. The mean RMS of anterior and posterior spherical aberration was 0.270 ± 0.002 μm and -0.134 ± 0.001 μm, respectively. The mean RMS of anterior horizontal and vertical coma was -0.084 ± 0.003 μm and 0.029 ± 0.004 μm, respectively. The mean RMS of posterior horizontal and vertical coma was 0.011 ± 0.001 μm and -0.011 ± 0.001 μm, respectively. The anterior HOAs were significantly different between age, sex, and refractive groups (all P < 0.05). The total anterior HOA had a statistically significant relationship with the male sex, older age, higher mean keratometry (K), and hyperopia. The anterior spherical aberration was significantly directly related to age, mean K, and hyperopia and inversely related to myopia.

Conclusions: The amounts of HOAs in the present study were different from previous studies, and these residence place differences (urban/rural) in the HOAs should be taken into account when designing refractive surgery nomograms and therapeutic and diagnostic considerations in each population. Moreover, the corneal HOAs, especially on the anterior surface, increased significantly with aging.

Purpose: To comprehensively review and evaluate the therapeutic strategies for persistent diabetic macular edema (DME), with a particular emphasis on established treatments. Furthermore, the study explores emerging and innovative therapeutic options.

Methods: A nonsystematic search was carried out using PubMed, Cochrane, Medline, and Google Scholar databases with the keywords "macular edema", "persistent", "diabetic", "therapeutic", and "emerging". We specifically looked for experimental studies, randomized clinical trials, and retrospective and prospective studies without limiting the search timeframe for the articles up to December 2023.

Results: This review delineates a comprehensive array of treatment modalities for persistent DME, encompassing anti-vascular endothelial growth factor (anti-VEGF) switching, corticosteroids, laser therapies, combination therapy, and surgical approaches. Additionally, emerging treatments were explored, featuring novel anti-VEGF agents, innovative surgical techniques, as well as inhibitors targeting Angiopoietin-2 and the Kallikrein-Kinin System.

Conclusions: It is important to employ personalized and evidence-based approaches in addressing persistent DME. The ongoing advancement in treatment paradigms will play a crucial role in the continual evolution of DME management.

Purpose: To assess the safety and efficacy of the 4-year administration of 0.01% atropine following a 1-year observation period in high myopic children.

Methods: The RAMCOM-II study continues the RAMCOM study, designed as an interventional nonrandomized study. Participants were observed for 1 year without any intervention to establish a baseline. Subsequently, children were divided into two arms: participants in the intervention group received one drop of 0.01% atropine daily at bedtime from years 1 to 5, while the control arm received no treatment and was monitored with routine clinical examinations. Annual assessments captured myopia progression, visual acuity, adverse events, and compliance. Statistical analyses compared outcomes between the two groups, considering demographic factors.

Results: At the 4-year follow-up, myopia progression from baseline in the intervention group (atropine-treated eyes) was significantly lower than in the control group (2.0 ± 2.0 diopter [D] vs. 3.2 ± 1.9 D, P = 0.01). Axial elongation also favored the intervention group. At the 5-year follow-up, similar trends persisted, underscoring the sustained efficacy of 0.01% atropine. Myopia progression remained significantly reduced in the intervention group compared to the control group (2.2 ± 2.0 D vs. 3.4 ± 1.9 D, P = 0.01). Although differences in axial elongation were less pronounced, these findings highlight the long-term benefits of 0.01% atropine in managing high myopia in children.

Conclusion: The RAMCOM-II study supports the efficacy of 0.01% atropine in controlling myopia progression over 5 years, emphasizing its promising role in pediatric high myopia management.

Purpose: To evaluate the agreement between topographical and tomographic measurements of the cornea with three methods of Placido-disc, Scheimpflug, and optical coherence tomography in normal eyes with myopic refractive error candidate for keratorefractive surgery.

Methods: Subjects within the age range of 18-55 years old candidates for keratorefractive surgery with no history of systemic disorder, eye diseases except refractive errors, and ocular surgery were enrolled in the study. The intraclass correlation coefficient and Bland-Altman diagrams evaluated the agreement between different devices.

Results: In this study, 97 subjects, including 35 men and 62 women, participated. There was a statistically significant agreement between the three corneal imaging devices' keratometry measures. Bland-Altman plots show a mean difference of 0.5 diopter (D) for mean anterior keratometry, and 95% limits of agreement reached the value ± 1.00 D for mean anterior astigmatism. Evaluation of the elevation maps showed that the central and maximum elevation of the cornea's anterior and posterior surfaces with Pentacam and Optopol have poor agreement.

Conclusion: Despite an excellent statistical agreement, the differences in the anterior keratometry values may not be clinically acceptable.