Journal of Ophthalmic & Vision Research最新文献

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days.

Case report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5.

Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Purpose: To evaluate the clinical characteristics and visual acuity outcomes of patients who presented with endophthalmitis prior to and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This multicenter retrospective case series with historical controls included consecutive patients presenting with any form of endophthalmitis from March 1, 2019 to September 1, 2019 (pre-COVID-19) and from March 1, 2020 to September 1, 2020 (COVID-19) at Mayo Clinic Rochester (MCR), Health System (MCHS), Arizona (MCA), and Florida (MCF) sites. Cases were divided into "pre-COVID-19" versus "COVID-19" groups depending on when they first presented with endophthalmitis.

Results: Twenty-eight cases of endophthalmitis presented to all Mayo Clinic sites during the study period. Of these, 10 patients presented during the first six months of the COVID-19 pandemic. During the same six-month period the year prior, 18 patients presented with endophthalmitis. Endophthalmitis etiology (post-injection, post-cataract extraction, post-glaucoma filtering surgery, post-pars plana vitrectomy, endogenous, and others) was similar between both groups (P = 0.34), as was post-injection endophthalmitis rate (P = 0.69), days to presentation (P = 0.07), initial management (P = 0.11), culture-positivity rate (P = 0.70), and need for subsequent pars plana vitrectomy (P = 1). Visual acuity outcomes were similar between both groups at six months, however, the mean LogMAR visual acuity at presentation was worse in the COVID-19 group compared to the pre-COVID-19 group (2.44 vs 1.82; P = 0.026).

Conclusion: Clinical characteristics and the post-injection endophthalmitis rate were similar during both periods, however, patients presented with worse vision during the pandemic suggesting that the pandemic may have contributed to delayed presentation, regardless, outcomes are still poor.

Purpose: To report a case of Alport syndrome presenting with bilateral giant full-thickness macular holes, hypertensive chorioretinopathy, and exudative retinal detachment.

Case report: A 20 year-old man, a known case of Alport syndrome on hemodialysis, was referred to our clinic with bilateral vision loss initiated about 10 years prior to presentation, which exacerbated in the month prior to our visit. Bilateral large full-thickness macular holes, hypertensive chorioretinopathy, and exudative retinal detachment were detected in fundus examination. The patient had previous genetic counseling confirming the diagnosis of Alport syndrome. During follow-up, macular holes were covered with a thick epiretinal membrane and visual acuity decreased progressively in two weeks. Pars plana vitrectomy was performed in the right eye. Two weeks following surgery, the macular hole was closed and visual acuity improved significantly.

Conclusion: Bilateral giant full-thickness macular holes are uncommon presentations of Alport syndrome. The retinal findings may be caused by an inefficient type IV collagen presenting in the Bruch's membrane and in the internal limiting membrane. Pars plana vitrectomy can be considered to repair macular holes in these patients.

Purpose: To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn.

Methods: This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients' faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation.

Results: The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P $<$ 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º $\pm$ 1.01º and 1.19º $\pm$ 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 $\pm$ 0.018 and 1.018 $\pm$ 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P $<$ 0.001).

Conclusion: All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.

Pachychoroid disease spectrum is a recent term that has been associated with an increasing number of phenotypes. This review discusses updated findings for each of the typical pachychoroid entities (central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, peripapillary pachychoroid syndrome, and focal choroidal excavation), as well as two relatively new additions (peripapillary pachychoroid neovasculopathy and peripheral exudative hemorrhagic chorioretinopathy). Here, we discuss the potential pathogenic mechanisms for these diseases and relevant imaging updates. Finally, we argue for a consistent classification scheme for these entities.

Purpose: To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with an inverted internal limiting membrane (ILM) flap over the optic disc. A narrative review of ODPM pathogenesis and surgical management techniques are also provided.

Case report: This prospective interventional case series included three eyes of three adult patients (25-39 years old) with unilateral ODPM and a mean duration of unilaterally decreased visual acuity of 7.33 $\pm$ 2.40 months (4-12 months). The pars plana vitrectomy with posterior vitreous detachment induction was performed on eyes, followed by an inverted ILM flap insertion over the optic disc and gas tamponade. Patients were followed for 7-16 weeks postoperatively; best-corrected visual acuity (BCVA) improved dramatically in one patient from 2/200 to 20/25. BCVA in other patients improved two and three lines - to 20/50 and 20/30, respectively. A significant anatomical improvement was achieved in all three eyes, and no complication was detected throughout the follow-up period.

Conclusion: Vitrectomy with inverted ILM flap insertion over the optic disc is safe and can yield favorable anatomical improvement in patients with ODPM.

Purpose: To evaluate parental perspectives of accessing eye care for children aged under seven years.

Methods: The survey was conducted during September 2020 to March 2021 using online applications and distributed to parents whose children were between the ages of three and seven years. The survey included parents' background, their knowledge of the provision of eye-care services, and the possible barriers that existed to access eye-care services. The relationship between parents' knowledge, barrier scores, level of parental education, and demographic or socioeconomic status was assessed using nonparametric tests.

Results: In total, 1037 questionnaires were completed. The respondents were from 50 cities across Saudi regions. The participants' age was 39 $\pm$ 7.5 years, and 54% of them had at least one child under the age of seven (n = 564). Further, 47% had not taken their children for vision screening at reception/year one (n = 467). In addition, 65% of them were not aware of the mandatory screening program at reception/year 1; whereas, only 20% (n = 207) knew how to access eye-care services; and only 39% of the children had undergone any kind of eye or vision test. The pathways to eye care and the cost of eye services/glasses were the main limitations. The parents' responses were significantly influenced by their demographic and socioeconomic characteristics (Kruskal Wallis, P $<$ 0.05).

Conclusion: There was a need for enhancing parent information on how to access eye care for young children and the currently available vision screening programs. Finally, a national protocol to cover the cost of the eye exam as well as spectacle prescription shall be proposed as a mean of incentive.

Purpose: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in eyes with functioning tube shunts.

Methods: This was a retrospective chart review of primary open-angle glaucoma (POAG) patients with a functioning tube who underwent phacoemulsification and had $\ge$24 months of follow-up. The primary end point was defined as surgical failure (IOP $>$ 21 mmHg) at month 24, progression to no light perception (NLP) vision, glaucoma reoperation, or implant removal. Surgical failure defined as IOP $>$18 and $>$15 mmHg, changes in visual acuity (VA), IOP, and number of medications were assessed.

Results: Twenty-seven eyes of 27 patients with moderate or severe POAG were included. The mean age of the patients was 64.2 $\pm$ 10.8 years. The interval between the tube shunt and phacoemulsification was 28.8 $\pm$ 25.0 months. At the end of the study, four (14.8%) eyes met the failure criteria; the average time to failure was 9.3 $\pm$ 3.8 months. The causes of failure were high IOP in two (50.0%) and glaucoma reoperation in two (50.0%) eyes; however, no eyes progressed to NLP vision. Surgical failure defined as IOP $>$18 and $>$15 mmHg showed an increasing failure rate (18.5% and 48.5%, respectively).Themean IOP and medications number remained stable at month 24 compared to baseline (P = 0.131 and P = 0.302, respectively). Initially, VA showed improvement, with the greatest improvement at 6 months (P = 0.001), but at 24 months the improvement was no longer significant (P = 0.430).

Conclusion: Phacoemulsification in patients with functioning tubes did not change the mean IOP in most of the patients (86.2%); the number of medications also did not increase.