Journal of Ophthalmic & Vision Research最新文献

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.

Purpose: To evaluate the time required for refractive error (RE) stabilization after standard phacoemulsification cataract surgery and identify preoperative factors influencing this duration.

Methods: This prospective case series study enrolled patients who had undergone phacoemulsification cataract surgery. RE stabilization was defined as $<$ 0.50 diopter changes in spherical equivalent (SE) over two consecutive follow-ups. Participants underwent ophthalmic examinations at baseline and postoperative days 3, 7, 14, 28, and 60. Keratometric values (K-mean), corneal astigmatism, and axial length (AL) were measured preoperatively using a biometric device.

Results: A total of 163 eyes from 163 patients were included. RE stabilization occurred by day 28 in 98.8% of eyes, reaching 100% by day 60. Multivariate analysis revealed that age, gender, type of cataract (nuclear, cortical, or posterior subcapsular), best-corrected visual acuity, absolute SE, and K-mean did not significantly influence the time to RE stabilization (Ps $>$ 0.05). AL demonstrated a significant negative association with the time to RE stabilization (ß = -0.445, P $<$ 0.001). Moreover, eyes with lower preoperative corneal astigmatism exhibited a shorter time to RE stabilization (ß = 1.001, P $<$ 0.001).

Conclusion: RE stabilization is typically observed 4 weeks post-cataract surgery. Eyes with lower AL and higher corneal astigmatism exhibit a comparatively slower RE stabilization following surgery.

Purpose: To report five cases of structural weakness at the haptic-optic junction of the CT Lucia 602 intraocular lens (IOL) (Carl Zeiss Meditec Inc., Dublin, CA), including two optic breakages and three optic microfractures, while using the Yamane flanged intrascleral haptic fixation surgery (FIHFS).

Methods: A retrospective chart review of five cases that underwent Yamane FIHFS by the same surgeon between 2020 and 2022 was performed. Patients' demographics, operative technique, postoperative outcomes, and adverse events were recorded over a 12-month follow-up period.

Results: One case of optic breakage, noted on postoperative week 1 (POW1), had the optic with the trailing haptic suspended in the vitreous while both haptic flanges remained secured to the sclera, requiring IOL exchange. The second case of optic breakage was noted intraoperatively and required explantation of the IOL with subsequent placement of an iris-fixated IOL. Three cases of optic microfractures were observed with no long-term complications. All five fractures occurred at the junction of the leading haptic.

Conclusion: Optic breakage and microfractures at the haptic-optic junction are unusual complications of intrascleral fixated IOL using the Yamane technique. To the best of our knowledge, this has not been previously reported with the CT Lucia 602 IOL. The authors recommend careful selection of the IOL material for this technique to prevent possible complications.

Purpose: To assess the effect of empagliflozin on the expression of SGLT-2 and GLUT-1 in the chorioretina of streptozotocin-induced diabetic rats.

Methods: An in vivo experimental study was performed on Wistar rats. After a 2-week adaptation period, the rats were allocated to one of four groups. The group allocations were as follows: (K1) negative control (no intervention); (K2) positive control injected with streptozotocin (STZ) without treatment; (K3) positive control injected with STZ and treated with metformin; and (K4) positive control injected with STZ and treated with empagliflozin. SGLT-2 and GLUT-1 expressions were examined using the Western blot technique.

Results: SGLT-2 was expressed in the chorioretinal tissue of all groups; administration of SGLT-2 inhibitors could suppress its expression. The average band thickness indicated that SGLT-2 expression was higher in diabetic rats compared to rats with normal sugar levels. GLUT-1 expression was noticed in all groups based on the chorioretinal examination. It did not change in the metformin group, whereas the empagliflozin group showed a significant decrease in the GLUT-1 expression.

Conclusion: Both metformin and empagliflozin suppress the expression of SGLT-2 and GLUT-1 in the chorioretina of diabetic rats. In comparison, empagliflozin seems to be more potent in reducing this expression.

Purpose: To report a case of eosinophilic granulomatosis with polyangiitis (EGPA) initially presenting as orbital involvement, describe its successful management, and provide a comprehensive literature review.

Case report: A 33-year-old female patient presented with swelling, redness, tenderness, and a mass under the left upper eyelid for one month. Upper lid eversion showed a multilobulated lesion in the subconjunctival area of the same region. The patient's medical history included asthma and atrial septal defect surgery. Orbital MRI revealed a soft tissue mass infiltrating the superior and lateral aspects of the conal and extraconal regions in the anterior orbit, with extension toward the preseptal area. The lesion underwent incisional biopsy, and histopathological findings were consistent with the diagnosis of EGPA. The patient's blood tests revealed eosinophilia and a negative antineutrophil cytoplasmic antibody. After excluding other similar pathologies such as granulomatosis with polyangiitis, we observed a dramatic regression in her orbital lesion following systemic steroid therapy.

Conclusion: The diagnosis of EGPA, a rare clinical presentation, is crucial for ophthalmologists because it provides early recognition of the systemic disease and can help slow its progression by initiating appropriate treatment in a timely manner.

Purpose: To evaluate and compare the clinical features and efficacy of botulinum toxin A (BTX-A) injection versus surgery in acute-onset concomitant esotropia (ACE) in children.

Methods: This retrospective comparative clinical study was conducted on 40 children with ACE. The patients were assigned to either the surgery group (n = 23) or the BTX-A group (n = 17). Successful motor outcomes were defined as residual esodeviation of $<$ 5 prism diopters (PD), while successful sensory outcomes were defined as the presence of any evidence of sensory fusion or stereopsis.

Results: The average treatment age in this study was 7.02 $\pm$ 3.72 years in the BTX-A group and 6.41 $\pm$ 2.83 years in the surgery group. There were 5 cases of type I (12.50%), 26 cases of type II (65.00%), and 9 cases of type III (22.50%) for ACE. The deviation before treatment was +(41.35 $\pm$ 16.90) PD at near and +(39.71 $\pm$ 14.94) PD at distance in the BTX-A group. In the surgery group, the results were +(49.22 $\pm$ 18.25) PD at near and +(47.00 $\pm$ 18.53) PD at distance. After treatment, based on the measured deviation, total motor success was 95.00% (38/40) at near and 90.00% (36/40) at distance. Following treatment, 94.59% (35/37) of patients with ACE exhibited fusion, 86.84% (33/38) had near stereopsis, and 72.97% (27/37) had distance stereopsis. The motor and sensory success rates were not significantly different between the BTX-A and surgery groups. There were no statistically significant differences in motor outcomes or sensory outcomes among the three subtypes of ACE (all P $>$ 0.05).

Conclusion: In our study, type II was the most common clinical classification for ACE. Favorable outcomes could be achieved with both BTX-A injection and surgery. There was no difference in motor or sensory outcomes regardless of clinical classification. BTX-A injection is minimally invasive, allows early intervention, and may be the preferred approach for managing ACE in children.

This systematic review investigated the role of artificial intelligence (AI) in the knowledge, attitude, and performance of ophthalmology residents. We conducted a comprehensive systematic search in international databases including PubMed, Web of Science, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Education Resources Information Center (ERIC) using keywords "artificial intelligence", "deep learning", "ophthalmology", "ocular surgery", and "education" and their synonyms. The keywords were extracted from medical research studies published from January 1, 2018 to April 15, 2024. The quality of these studies was evaluated by using the STORBE, JADA, and JBI appraisal tools. Six studies were selected based on the defined criteria. Specifically, five of these studies investigated the effectiveness of AI interventions on the performance of ophthalmology residents in diagnosing myopia, corneal diseases (using a confocal microscope), staging of diabetic retinopathy, abnormal findings in posterior segment ultrasonography, including retinal detachment, posterior vitreous detachment, and vitreous hemorrhage, and 13 fundus diseases. One study investigated the residents' attitudes about the application of an AI model for providing feedback in cataract surgery. All six studies showed positive results. Due to the small number of studies found through our systematic search and the variations in the investigated outcomes and study settings, it was not possible to conduct a meta-analysis. Despite the positive reports on improving the diagnostic performance of residents and their attitude toward the usability of AI models in cataract surgery, it is recommended that more studies be conducted in this area. These studies should replicate previous investigations using similar study settings while maintaining high quality standards and addressing existing limitations.

Purpose: We present a case of hemolacria, which emerged as an unusual mass in the lacrimal sac.

Case report: A nine-year-old girl presented with intermittent unilateral hemolacria and episodes of dacryocystitis with no further remarkable medical or surgical history. CT scan indicated the presence of well-defined calcified tissue enclosed within the lacrimal sac. Following external dacryocystorhinostomy, well-formed firm tissue resembling bony tissue was extracted and sent for pathological evaluation, along with biopsies from the lacrimal sac. Histopathological analysis revealed heterotopic bone formation with nonspecific inflammation of the lacrimal sac. No underlying cause was discernible in the complementary assessment, and no recurrence was noted at one-year follow-up.

Conclusion: A child with hemolacria was found to have heterotopic ossification in the lacrimal sac with no discernible underlying cause.