Journal of Ophthalmic & Vision Research最新文献

Purpose: To report on the diagnostic and therapeutic approach in a patient with retinitis pigmentosa (RP), hypovitaminoses, and bilateral corneal involvement.

Case report: A 62-year-old woman, diagnosed with RP, presented with photophobia, sudden bilateral visual decline, and known long-term night blindness. Ophthalmic examination showed corneal perforation in the right eye, corneal ulcer in the left eye, and bilateral corneal hypoesthesia. She had undergone bariatric surgery and recently suspended vitamin supplementation. Blood tests revealed hypovitaminoses A, D, D3, and E. The patient underwent tectonic keratoplasty in the right eye and received topical therapy in the left eye, and then restarted vitamin supplementation as recommended by the nutritionist. Significant functional recovery was documented in both eyes at 1-, 3-, and 10-month follow-ups.

Conclusion: The case highlights the importance of an integrative approach that includes comprehensive history taking, targeted laboratory work-up, as well as accurate differential diagnosis, especially given the potential multifactorality of ocular symptoms and signs.

Purpose: To evaluate the intrasession repeatability and agreement in keratometric and wavefront measurements among three different instruments (Pentacam HR, Nidek OPD-Scan III [OPD], and Zeiss i-Profiler ${}^{\text{Plus}}$ [IPROF]) in a pediatric population with various clinical features.

Methods: This cross-sectional study included 217 eyes from 114 patients aged 6 to 17 years with different clinical features. The patients were divided into five groups: one control group (C) and four other groups, each presenting with keratoconus (KC), ocular allergy (OA), high astigmatism, or Down syndrome (DS). Statistical analyses included the intraclass correlation coefficient (ICC) for repeatability and Bland-Altman plots for agreement.

Results: The findings demonstrated excellent repeatability of keratometric parameters across all devices (e.g., K1 ICC: 99.53% for Pentacam, 98.10% for OPD, and 98.31% for IPROF). The Pentacam showed superior repeatability for aberrometry indices in the KC group, with ICC values exceeding 98% for high-order aberration root mean square (HOA RMS) and Zernike polynomials. However, in the DS group, repeatability was significantly reduced for certain parameters, such as the index of surface variance (ICC: 40.13%) and HOA RMS (ICC: 42.86%). Bland-Altman plots revealed variations among devices in asphericity, vertical coma, and HOA RMS, with the KC group exhibiting broader limits of agreement compared to the control group.

Conclusion: All three instruments showed good repeatability, with the Pentacam demonstrating superior reliability across all parameters, including aberrometry. However, agreement between devices was poor for key indices in patients with KC and DS.

Purpose: To compare the refractive accuracy of different intraocular lens (IOL) power calculation formulas in eyes with keratoconus (KCN) undergoing cataract surgery.

Methods: This retrospective case series included the medical records of patients with KCN who underwent optical biometry and cataract surgery with IOL implantation. The predicted spherical equivalent (SE) values were calculated using the Holladay 1, Hoffer Q, SRK/T, and SRK II formulas. Additionally, a subgroup analysis was performed for eyes with available data on anterior chamber depth to compare the accuracy of Haigis, Barrett Universal II, Barrett True-K, EVO 2.0, Kane, and Kane KCN formulas. The mean prediction error (PE), mean absolute error (MAE), median absolute error, and the percentage of eyes within a PE of $\pm$ 0.25 diopters (D), $\pm$ 0.50 D, $\pm$ 0.75 D, and $\pm$ 1.00 D were calculated.

Results: Forty-seven eyes of 30 patients were included. The MAE was significantly different among the Holladay 1, Hoffer Q, SRK/T, and SRK II formulas. The Holladay 1 and Hoffer Q formulas led to a hyperopic refractive shift. The SRK/T and SRK II formulas tended toward a myopic refractive outcome. The MAE was lowest for the SRK/T formula (0.39 D), followed by the Holladay 1 (0.48 D), Hoffer Q (0.59 D), and SRK II (0.87 D). Statistical analysis revealed a significantly lower MAE for the SRK/T formula compared to the Hoffer Q and SRK II formulas (P $<$ 0.05). The percentage of eyes within a PE of $\pm$ 0.50 D was 70.2% for SRK/T, 57.44% for Holladay 1, 48.93% for Hoffer Q, and 29.78% for SRK II. The subgroup analysis comprising 11 eyes showed no significant difference among six other formulas (Haigis, Barrett Universal II, Barrett True K, EVO 2.0, Kane, and Kane KCN), with Barrett True-K having the least MAE.

Conclusion: The SRK/T was the most accurate IOL power calculation formula in this study, and Holladay 1 could be an alternative choice. SRK II had the lowest accuracy in predicting refractive outcomes. Among modern formulas, Barrett True-K demonstrated the highest accuracy in eyes with KCN.

Ocular surface diseases (OSDs) are conditions that affect the eye's surface layers, including the cornea, conjunctiva, and glandular network, causing discomfort, visual disturbances, and tear film instability. OSDs include dry eye disease (DED), blepharitis, meibomian gland dysfunction, keratitis, conjunctivitis, and related disorders. These diseases represent a leading cause of ocular morbidity and are often accompanied by chronic inflammation, irritation, redness, and pain. Royal Jelly (RJ), a substance produced by worker bees, has been widely studied in ophthalmology for its therapeutic properties, including its ability to restore tear secretion, treat glaucoma and DED, and inhibit the production of reactive oxygen species (ROS). RJ is rich in proteins, fatty acids, and phenolic compounds, which contribute to its anti-inflammatory, antioxidant, antibacterial, vasodilatory, antitumor, and cholesterol-lowering properties. This review examines the pharmacological benefits of RJ, strategies to optimize its formulation, and methods for developing eye drop formulations-such as microemulsions and eye gels-for the treatment of OSDs. The literature supports RJ as a complementary therapy for OSDs due to its reported anti-inflammatory, antioxidant, and antimicrobial properties. Although preliminary studies are promising, more extensive clinical trials are required to establish standardized treatment protocols and confirm the efficacy and safety of RJ. The therapeutic potential of RJ components lies in their immunomodulatory properties, making them a compelling option for the treatment of OSDs. Further research is necessary to clarify their role in ocular regenerative medicine and expand their applications in clinical practice.

Purpose: This study aimed to determine the efficacy of ceftazidime-containing nanofibers in treating corneal ulcers induced by the bacterium Pseudomonas aeruginosa in an animal model.

Methods: This animal-assisted intervention involved 12 adult male New Zealand rabbits, each weighing between 3.5 and 4 kg. The animals were randomly assigned to two groups of six: an intervention group that received a ceftazidime nanofiber insert treatment and a control group that received no treatment. In the intervention group, the right eye was used as a test sample for ulcer induction and ceftazidime-loaded nanofiber examination, while the left eye served as a control to observe any inflammatory or irritating symptoms caused by the nanofiber in the absence of the active pharmaceutical compound. Examinations were performed daily, with slit lamp images taken on days 2, 4, 6, 9, 12, and 15. Clinical responses were recorded and graded according to a clinical examination table.

Results: Prior to the intervention, both groups exhibited a similar severity of corneal ulcers. After 48 hours, four of the six rabbits in the intervention group were positive for Pseudomonas aeruginosa in their cultures, and the remaining two tested negative. Meanwhile, in the control group, three rabbits had positive cultures and three had negative cultures. After 96 hours from the onset of the treatment and the application of the ceftazidime nanofiber insert, three rabbits that initially presented with positive cultures exhibited negative cultures in the subsequent examinations; however, one rabbit still had positive smear and culture results. On day 9, the intervention group showed complete disappearance of infiltration and epithelial damage. However, the rabbit eyes in the control group demonstrated increased signs of involvement on days 6 and 9 compared to the previous examinations. Furthermore, the clinical results indicated a significant difference in the mean corneal ulcer scores between the two groups (P $<$ 0.001).

Conclusion: Given the observed effectiveness of the developed nanofiber in treating corneal ulcers induced by P. aeruginosa, this nanodrug delivery system has the potential to serve as a viable option for ocular drug delivery.

Purpose: To present a case of bilateral diffuse uveal melanocytic proliferation (BDUMP), which is a rare paraneoplastic syndrome that causes progressive visual loss in patients with an underlying malignancy.

Case report: A 59-year-old female patient presented with bilateral visual loss, which had started three months earlier. She had a history of treated ovarian cancer a year before. Fundus examination showed multiple red-orange subretinal patches with irregular and elevated pigmented tumors in both eyes, scattered over the fundus. Multimodal imaging was also consistent with BDUMP. She was referred to a clinical oncologist and underwent screening for systemic metastasis, which revealed multiple foci of secondary malignancies.

Conclusion: Ophthalmologists should be aware of this extremely rare condition. Although there is currently no effective treatment for ocular symptoms, the patient should be promptly referred to an oncologist for systemic screening and potential treatment of the primary site malignancy.

Purpose: Different contact lens (CL) materials have been associated with different behaviors of pre-lens tear film components in the short term. The purpose of this randomized crossover and double-masked study was to compare the effect of wearing hydrogel and silicone hydrogel CLs on pre-lens tear film status.

Methods: Soft CL wearers were recruited and randomly fitted with a hydrogel (omafilcon A) and a silicone hydrogel (stenfilcon A) CL. Tear evaporation rate, non-invasive tear break-up time (NIBUT), tear film lipid layer thickness, and partial blink rate were measured without CLs and 30 minutes after the insertion of CLs. The outcomes were analyzed using repeated measures analysis of variance or the Friedman test.

Results: Twenty-four CL wearers (6 men and 18 women) aged 23.3 $\pm$ 3.9 years were included. Tear evaporation rate was higher with the hydrogel CL (98.6 $\pm$ 59.4 g/m²/h; P = 0.043) and the silicone hydrogel CL (99.7 $\pm$ 60.6 g/m²/h; P = 0.037) compared to no CL wear (69.9 $\pm$ 41.3 g/m²/h). NIBUT was lower (P = 0.019) with the silicone hydrogel CL (12.7 $\pm$ 6.2 s) than with no CL wear (18.5 $\pm$ 9.8 s). Lipid layer thickness was lower with the hydrogel CL (64.9 $\pm$ 15.5) than with the silicone hydrogel CL (75.8 $\pm$ 14.0; P $<$ 0.001) and no CL wear (75.9 $\pm$ 14.2; P = 0.001). No statistically significant differences were found in the partial blink rate.

Conclusion: This study demonstrated that both hydrogel and silicone hydrogel CLs disrupt the tear film by increasing tear evaporation and causing tear film instability. However, CL materials affect the pre-lens tear film status differently. Further studies with longer wearing times are required.

Purpose: To present our experience with patients who developed donor-implanted guttata (DIG) following uncomplicated corneal endothelial transplantation.

Case report: Three patients who underwent Descemet membrane endothelial keratoplasty were diagnosed with DIG, which was confirmed by confocal microscopy. Two of the cases received corneas from the same donor and experienced delayed recovery of corneal transparency despite fully attached grafts.

Conclusion: Fuchs endothelial dystrophy is a common condition within the general population and is likely to be present in donor corneas. We assessed three cases of DIG, and the results highlight the need for improved screening of this condition prior to transplantation and its consideration in the early postoperative period if corneal edema is present despite graft attachment.

Purpose: To compare the graft survival rates and visual outcomes in patients with keratoconus (KCN) undergoing deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PKP) and identify possible risk factors.

Methods: This retrospective longitudinal study enrolled patients with KCN who underwent corneal transplantation at Labbafinejad Medical Center (Tehran, Iran) between 2006 and 2016. We utilized a one-to-one coarsened exact matching (CEM) approach. Matching considered the recipient's sex, donor age, and the presence and extent of corneal neovascularization in the recipient.

Results: A total of 213 patients with KCN who underwent PKP (49.8%; n = 106) or DALK (50.2%; n = 107) were enrolled. After CEM was performed, 67 patients in the PKP group were well-matched with 67 patients in the DALK group. There was no significant difference in terms of baseline characteristics between the two groups. Kaplan-Meier survival analysis showed that the percentage of patients free of graft rejection in a one- and three-year follow-up was 78.7% and 74.5% in the PKP group, and 95.3% and 95.3% in the DALK group, respectively. On univariate analysis, the strongest risk factor predictive of graft rejection was corneal vascularization in both the PKP and DALK groups, followed by recipient age only in the PKP group and dry eye disease only in the DALK group. In a multivariate Cox regression analysis, PKP was identified as an independent predictor of graft rejection, but not of graft failure. The DALK and PKP groups were comparable in terms of postoperative best-corrected visual acuity (BCVA; P = 0.48) and suture complications (P = 0.87).

Conclusion: In patients with KCN, DALK demonstrated comparable outcomes to PKP in terms of BCVA, but showed superiority in graft rejection-free survival. Corneal vascularization was the major recipient risk factor for graft rejection and failure.

Purpose: Leiomyosarcoma (LMS) is an aggressive tumor with a high metastatic rate that rarely metastasizes to the periocular region.

Methods: A 50-year-old male with a previous two-year history of primary stage IV LMS presented with metastatic retroperitoneal LMS, which was initially incorrectly described as an eyelid chalazion refractory to medical management. An excisional biopsy sent to pathology revealed metastatic retroperitoneum LMS. There was resolution of ocular irritation following biopsy, and an oncology referral was made.

Conclusion: This case of metastatic LMS to the eyelid mimicking a chalazion is rare, as only six other cases have been described previously. Our case contributes to this discussion by highlighting the importance of considering metastatic disease and performing a full-thickness biopsy in a patient presenting with a non-resolving eyelid chalazion. Recognizing tumor spread to the eyelid can be an important step in the diagnosis, surveillance, and management of metastatic LMS.