Journal of Ophthalmic & Vision Research最新文献

Purpose: Vascular changes along with loss of the neural rim at the optic nerve head (ONH) are established hallmarks of glaucomatous optic neuropathy. The current study investigates changes in the position of major retinal vessels outside the ONH in eyes with definite or suspected glaucoma and reports its clinical associations.

Methods: This retrospective case-control study was conducted on a dataset of 2390 patients with definite or suspected glaucoma and serial photographic documentation from 2015 to 2022. Images were overlaid chronologically and examined for vascular displacement (VD) outside the margin of the ONH up to one disc diameter using the built-in fundus camera software; in the case of VD detection, the change was verified using MATLAB software. The amount of VD was measured in pixels and expressed in a unitless arbitrary ratio derived from the amount of VD in pixels divided by the largest optic disc diameter in pixels. During the study period, a small number of eyes showed evidence of VD, which made up the case group; eyes without evidence of VD from the same dataset were chosen as controls.

Results: A total of 23 eyes demonstrated VD, and 60 eyes with no evidence of VD were selected as controls. The mean amount of VD was 0.15 $\pm$ 0.01 in case eyes compared to 0.01 $\pm$ 0.01 in control eyes (P $<$ 0.001). Definite glaucomatous damage was observed in 20 (87%) eyes in the case group compared to 35 (58.3%) eyes in the control group (P = 0.014). The best-corrected visual acuity in eyes with VD, both at baseline and at the final visit, was significantly worse than in controls (P = 0.018 and P = 0.032, respectively). Eyes with VD had greater cupping both at baseline (P = 0.025) and at the final examination (P = 0.04). During the study period, 16 (69.6%) eyes with VD and 12 (20%) control eyes required glaucoma surgery (P = 0.001). Patients with VD also showed a statistical trend toward being younger (mean age, 54.5 $\pm$ 16.5 vs 61.3 $\pm$ 15.5 years, P = 0.088).

Conclusion: VD outside the ONH may occur in eyes with glaucoma and is associated with factors reflecting more significant glaucomatous damage. Eyes with VD outside the ONH have lower visual acuity, greater cupping, and require glaucoma surgery more often, indicating more significant glaucoma severity or progression.

Purpose: This study aimed to report the efficiency and safety of using intensity-modulated radiation therapy (IMRT) in treating diffuse choroidal hemangioma (DCH) in patients with Sturge-Weber syndrome (SWS).

Methods: IMRT planning was carried out for each case after patient fixation, CT simulation, and target delineation. The purpose of treatment planning was to deliver the prescribed dose of 20 Gy to at least 95% of the planning target volume (PTV). The primary follow-up goal was to evaluate the efficacy and safety of IMRT as an alternative to traditional 3D conformal radiotherapy methods. The case series involved patients with DCH and varying degrees of vision impairment who underwent IMRT.

Results: Five patients, comprising two men and three women, with an average age of 14.4 $\pm$ 3.78 years, were included in this study. These patients were followed up for an average duration of 14.4 $\pm$ 6.84 months. All patients exhibited notable reduction in subretinal fluid, significant tumor regression, and minimal side effects. Visual acuity improved in patients with pre-IMRT vision of hand motion or better.

Conclusion: The findings suggest that IMRT is a promising, low-complication treatment option for managing DCH in SWS patients, warranting further research and potential integration into clinical practice.

Giant cell arteritis (GCA) is the most common vasculitis of large and medium vessels affecting adults over the age of 50. Due to its acute ischemic damage through a systemic inflammatory process, GCA is a medical emergency with the risk of permanent vision loss. Therefore, early intervention is critical. Patients often present with well-documented systemic manifestations such as jaw claudication, headache, scalp tenderness, and fatigue. These patients are usually subject to blood tests for inflammatory markers and temporal artery biopsy. However, clinical manifestations vary considerably and may masquerade as neuro-ophthalmic manifestations that are not pathognomonic of GCA. We conducted a review to discuss documented neuro-ophthalmic manifestations and provide insight into the rare presentations to help avoid pitfalls in its diagnosis. Findings from the included articles were sorted into afferent and efferent neuro-ophthalmic manifestations. According to our literature review, the main afferent manifestations documented are ischemic optic neuropathy, retinal artery occlusion, choroidal infarction, ocular ischemic syndrome, orbital inflammatory syndrome, and strokes causing visual field loss. The efferent manifestations include cranial neuropathy (3 ${}^{\text{rd}}$ , 4 ${}^{\text{th}}$ , and 6 ${}^{\text{th}}$ ), extraocular muscle ischemia, and internuclear ophthalmoplegia. Other rare causes are tonic pupil from ciliary ganglion involvement, uveitis, and encephalopathy. If GCA is suspected, in addition to inquiring about systemic symptoms and doing a complete neuro-ophthalmic exam, these patients should be sent for inflammatory serological markers, as well as temporal artery biopsy (TAB). If clinical suspicion remains high, high-dose steroids should be started immediately.

This review article explores the etiology of oculomotor palsies-including third, fourth, and sixth cranial nerve palsies-and addresses the application of botulinum toxin type A (BoNT-A) in the management of these conditions, along with its associated complications and side effects. The objective is to assess BoNT-A's potential efficacy and its role across various types of nerve palsies. A comprehensive analysis of relevant studies reveals that BoNT-A holds promise as a therapeutic option in managing these conditions. BoNT-A injection into the lateral rectus muscle proves to be an effective treatment for addressing post-traumatic third nerve palsy. This is achieved by providing symptom relief and diminishing the necessity for subsequent surgical interventions. In the context of fourth nerve palsy, BoNT-A injection into the inferior oblique or inferior rectus muscles presents potential benefits but is accompanied by certain limitations. Additionally, previous studies have shown that BoNT-A injection into the antagonist medial rectus muscle for treatment of sixth nerve palsy results in favorable outcomes, such as contributing to functional improvement. The literature highlights the importance of timing, dosage, and grade of muscle dysfunction when administering BoNT-A injections. BoNT-A injection is an effective option to manage different types of cranial nerve palsies and improve binocular function. Furthermore, it plays an integral role in preventing antagonist muscle contracture and, hence, the need for future surgical intervention.

Purpose: To assess the performance of a hybrid Transformer-based convolutional neural network (CNN) model for automated detection of keratoconus in stand-alone Scheimpflug-based dynamic corneal deformation videos (DCDVs).

Methods: We used transfer learning for feature extraction from DCDVs. These feature maps were augmented by self-attention to model long-range dependencies before classification to identify keratoconus directly. Model performance was evaluated by objective accuracy metrics based on DCDVs from two independent cohorts with 275 and 546 subjects.

Results: The model's sensitivity and specificity in detecting keratoconus were 93% and 84%, respectively. The AUC of the keratoconus probability score based on the external validation database was 0.97.

Conclusion: The hybrid Transformer-based model was highly sensitive and specific in discriminating normal from keratoconic eyes using DCDV(s) at levels that may prove useful in clinical practice.

Retinal degenerative diseases (RDD), which impair photoreceptors, the retinal pigment epithelium (RPE), and associated retinal cells, result in severe vision loss. For patients with advanced RDD, tissue replacement therapies, such as transplantation, offer potential pathways to visual rehabilitation. While fetal retinal transplantation has shown some promise in preclinical and clinical studies, human pluripotent stem cell (hPSC)-derived retinal organoids (ROs) present a promising alternative. ROs are three-dimensional tissues that replicate key aspects of retinal development, making them viable candidates for transplantation. However, the path toward clinical application faces two primary challenges: achieving Good Manufacturing Practice (GMP)-compliant production and overcoming technical difficulties associated with safe transplantation. Current RO production protocols are often limited by variability in tissue morphology, yield, and reproducibility, while transplantation efforts are hindered by rosette formation and mechanical damage to the subretinal space. Recent innovations, including automated bioreactor systems and optimized surgical techniques, offer potential solutions. Further advances in understanding and preventing rosette formation are essential to improve transplantation outcomes. Continued research and technological development are necessary to unlock the full potential of ROs for visual rehabilitation in patients with retinal degeneration.

Purpose: To report the second documented case of spontaneous sickle cell retinopathy due to hemoglobin SE disease, and the third in association with this condition overall.

Case report: An asymptomatic 19-year-old African American woman with hemoglobin SE disease and no other significant past medical history presented for a routine eye exam. Fundoscopy revealed two sunburst lesions in the temporal periphery of her right eye and one such lesion in the temporal periphery of her left eye. No definitive signs of neovascularization were detected on fluorescein angiography, although multiple areas of abnormal vasculature and distal non-perfusion were observed.

Conclusion: Spontaneous peripheral retinopathy can develop at an early age in hemoglobin SE disease. Given the risk for complications, pediatric screening with regular fundoscopic examination may benefit such patients.

Purpose: To compare refractive error and angle of deviation in patients with congenital esotropia (CET) and congenital exotropia (CXT).

Methods: This retrospective study reviewed the medical documents of 246 patients with CET (n = 206) and CXT (n = 40) admitted to Farabi Eye Hospital, Iran, from 2012 to 2022. All patients were between 6 and 12 months old at the time of admission. Refractive error components and angles of deviation in these patients were recorded and analyzed.

Results: In patients with CET, the mean sphere, cylinder, and spherical equivalent (SE) were 2.59 ± 2.28 diopters (D), -0.42 ± 0.57 D, and 2.38 ± 2.28 D, respectively. Also, the mean horizontal deviation at near was 45.5 ± 12.3 prism diopters (Δ) (range, 20-98 Δ). The most common range was 44-55 Δ (40%), followed by 33-44 Δ (28%) and 55-65 Δ (12%). On the other hand, the mean sphere, cylinder, and SE in patients with CXT were 1.88 ± 1.84 D, -0.39 ± 0.69 D, and 1.69 ± 1.74 D, respectively. Also, the mean horizontal deviation at near was 45.0 ± 17.1 Δ (range, 20-105 Δ). For the CXT group, deviation ranges of 33-44 Δ (37%), 44-55 Δ (32%), and 22-33 Δ (15%) were most prevalent. The mean sphere and SE were significantly higher in the CET group than in the CXT group (P = 0.010).

Conclusion: This study found a distinct refractive profile and distribution of the angle of deviation in patients with CET versus CXT. Patients with CET demonstrated significantly greater hyperopia than those with CXT.

Treatment of posterior segment fibrosis is an unmet challenge in ophthalmology. Fibrotic responses complicate the pathology and treatment of age-related macular degeneration, diabetic retinopathy, retinal detachment, and other retinal diseases resulting in severe visual impairment. There is a lack of clear understanding of the exact mechanisms and different cell types taking part in retinal and preretinal fibrosis. This review discusses the current knowledge regarding various aspects of the intracellular signaling pathways impacting vitreoretinal fibrotic processes, focusing on the cellular and molecular mechanisms, summarizing the results of preclinical and clinical studies, and suggesting strategies for future investigations.