Journal of Ophthalmic & Vision Research最新文献

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.

Purpose: To evaluate vascular changes on optical coherence tomography angiography (OCTA) in patients with diabetic macular ischemia (DMI) after systemic normobaric oxygen (NBO) therapy.

Methods: This before-after interventional studyincluded 26 eyes of 26 patients with DMI.Macular OCTA was performed before and after 1 hour of 100% NBO therapy at a flow of 10 L/min delivered by face mask. As primary outcomes, changes in OCTA metrics were evaluated using the paired t-test. Subgroup analyses were performed based on gender. The secondary outcomes included identifying parameters correlated with best-corrected visual acuity (BCVA) and factors associated with improvement in OCTA parameters.

Results: The patients included 15 males and 11 females aged 59.48 $\pm$ 9.67 years. Overall, no significant change was observed in retinal thickness; however, there was a significant decrease in retinal thickness among females and a significant increase among males (P $<$ 0.001). The foveal avascular zone (FAZ) decreased significantly from 0.38 $\pm$ 0.14 to 0.34 $\pm$ 0.12 mm² (P = 0.035). Superficial capillary plexus vessel density (SCP-VD) and deep capillary plexus vessel density (DCP-VD) at fovea increased from 13.5 $\pm$ 6.37 to 14.98 $\pm$ 6.33% (P = 0.059) and from 24.61 $\pm$ 6.75 to 26.59 $\pm$ 6.16% (P = 0.022), respectively. In males, BCVA correlated significantly with baseline DCP parameters but corresponded with none of the SCP parameters. In females, BCVA significantly correlated with pre-O2 DCP-VD of the perifoveal inferior quadrant. Finally, regression analysis did not show any parameter that could predict a favorable response.

Conclusion: Using OCTA, we observed a decrease in FAZ and an increase in DCP-VD at fovea after short-term NBO therapy for patients with DMI.

Purpose: To assess the effects of phacoemulsification, visco-synechiolysis, and trabeculectomy on eyes with a recent history of acute primary angle closure (APAC).

Methods: In this prospective nonrandomized study, we enrolled patients with cataracts, peripheral anterior synechiae (PAS), and a history of APAC attack managed with medications and laser peripheral iridotomy (LPI) within the past six weeks. Patients without signs of glaucomatous optic neuropathy (GON) underwent phacoemulsification and visco-synechiolysis (PV group). Trabeculectomy was added to this procedure for cases with signs of underlying chronic GON (PVT group). We evaluated best-corrected visual acuity (BCVA), intraocular pressure (IOP), angle opening, PAS extension, and adverse events at baseline and six months postoperatively.

Results: The PV and PVT groups comprised 8 and 12 eyes, respectively. At month six, both groups showed significant improvement in BCVA, reduced IOP, and increased Shaffer grading scores compared to baseline (all Ps $<$ 0.05). Extensive PAS ( $\ge$ 180º) significantly decreased at month six in both the PV (P = 0.008) and PVT (P = 0.002) groups compared to baseline. However, its prevalence did not significantly differ between the two groups at baseline (P = 0.288) or six months after surgery (P = 0.881). At month six, IOP was significantly lower in the PVT group than the PV group (10.83 $\pm$ 1.40 vs 13.63 $\pm$ 2.07 mmHg, P = 0.002). Nevertheless, BCVA and Shaffer grading scores were not different between the two groups at this time point (P = 0.120, and P = 0.891, respectively). No serious complications were observed in any groups during the follow-ups.

Conclusion: Patients with cataracts and a recent history of APAC without underlying chronic glaucoma may not receive additional trabeculectomy alongside lens extraction and synechiolysis.

Purpose: To evaluate the efficacy and safety of 1% pilocarpine to enhance near vision in pseudophakic patients with monofocal intraocular lens (IOL).

Methods: This prospective, nonrandomized, open-label, pre-post interventional study was conducted on patients who had a history of phacoemulsification and monofocal IOL implantation without any complications at least six months before the intervention. One drop of 1% pilocarpine solution was instilled in one of the patients' eyes, and near and distance visual acuity was assessed before and 20 minutes after monocular administration of the drop. Adverse effects were monitored for 8 hours.

Results: We studied54 pseudophakic eyes of 54 patients with a mean age of 55.02 $\pm$ 10.10 years, including 36 males (66.7%). Distance-corrected near visual acuity improved significantly after administering 1% pilocarpine (P $<$ 0.001). After treatment, no significant decrease in corrected distance visual acuity (CDVA) was observed (P = 0.60). Overall, 46 patients (85.2%) exhibited an improvement of more than one line in near vision after treatment; however, eight patients (14.8%) did not show any changes in near vision. Only two patients (3.7%) gained three lines in near vision. Headache, irritation, and nausea were observed in three patients, two patients, and one patient, respectively.

Conclusion: The monocular 1% pilocarpine solution significantly improved near visual acuity among patients with pseudophakia and featured an acceptable safety profile. Although this improvement is considerable, it may not be sufficient for complete spectacle independence. Trial registration: ClinicalTrials.gov identifier: NCT05578001.

Purpose: ChatGPT-3.5 has the potential to assist ophthalmologists by generating a differential diagnosis based on patient presentation.

Methods: One hundred ocular pathologies were tested. Each pathology had two signs and two symptoms prompted into ChatGPT-3.5 through a clinical vignette template to generate a list of four preferentially ordered differential diagnoses, denoted as Method A. Thirty of the original 100 pathologies were further subcategorized into three groups of 10: cornea, retina, and neuro-ophthalmology. To assess whether additional clinical information affected the accuracy of results, these subcategories were again prompted into ChatGPT-3.5 with the same previous two signs and symptoms, along with additional risk factors of age, sex, and past medical history, denoted as Method B. A one-tailed Wilcoxon signed-rank test was performed to compare the accuracy between Methods A and B across each subcategory (significance indicated by P $<$ 0.05).

Results: ChatGPT-3.5 correctly diagnosed 51 out of 100 cases (51.00%) as its first differential diagnosis and 18 out of 100 cases (18.00%) as a differential other than its first diagnosis. However, 31 out of 100 cases (31.00%) were not included in the differential diagnosis list. Only the subcategory of neuro-ophthalmology showed a significant increase in accuracy (P = 0.01) when prompted with the additional risk factors (Method B) compared to only two signs and two symptoms (Method A).

Conclusion: These results demonstrate that ChatGPT-3.5 may help assist clinicians in suggesting possible diagnoses based on varying complex clinical information. However, its accuracy is limited, and it cannot be utilized as a replacement for clinical decision-making.

Purpose: Eyes with pseudoexfoliation demonstrate fragile intraocular structures. The current study evaluated conjunctival thickness in pseudoexfoliation eyes as compared to a control group.

Methods: In this cross-sectional study, patients with pseudoexfoliation and an age-matched control group underwent measurement of bulbar conjunctival thickness in the superior and temporal quadrants, 1, 2, and 3 mm posterior to the limbus using anterior segment OCT.

Results: A total of 140 eyes of 140 subjects including 68 eyes of 68 patients with pseudoexfoliation and 72 eyes of 72 control subjects without pseudoexfoliation were studied. Both study groups were divided into two subgroups - those using glaucoma drops versus medication-free eyes. Total conjunctival thickness in pseudoexfoliation eyes was significantly lower than control eyes across all comparisons. Conjunctival thickness in the superior quadrant 1, 2, and 3 mm from the limbus was 177.62 $\pm$ 41.30, 235 $\pm$ 48.41, and 231.40 $\pm$ 49.81 µm, respectively in the pseudoexfoliation group versus 207.49 $\pm$ 48.92, 265.67 $\pm$ 52.66, and 262.74 $\pm$ 59.43 µm in the control group (P $<$ 0.001, $<$ 0.001, and 0.001, respectively). In the temporal quadrant, conjunctival thickness 1, 2, and 3 mm from the limbus was 193.62 $\pm$ 46.97, 198.19 $\pm$ 54.67, and 178.59 $\pm$ 57.90 µm, respectively in the pseudoexfoliation group versus 213.76 $\pm$ 47.06, 224.50 $\pm$ 56.24, and 210.26 $\pm$ 63.70 µm in the control group (P = 0.012, 0.006, and 0.003, respectively).

Conclusion: Conjunctival thickness was significantly less in pseudoexfoliation eyes than an age-matched control group which supports clinical observations of thinner and more fragile conjunctiva in these eyes with implications for glaucoma surgery.

Purpose: To evaluate the visual and refractive outcomes after toric intraocular lens (IOL) implantation compared to monofocal IOLs in pediatric eyes with cataracts and preexisting corneal astigmatism.

Methods: This case-control study was performed on 37 eyes of 37 children older than six years with visually significant congenital cataracts and corneal astigmatism greater than 1.75 diopters (D). The patients underwent lens aspiration with either monofocal (19 eyes) or toric (18 eyes) IOL implantation between June 2021 and December 2022. Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), near visual acuity, keratometry data, and residual astigmatism were evaluated preoperatively and on the fifth day as well as the first, third, and sixth months postoperatively.

Results: Preoperative mean corneal astigmatism was 2.84 $\pm$ 0.51 D in the toric group and 3.05 $\pm$ 0.79 D in the non-toric group (P = 0.563). At the final follow-up, postoperative refractive astigmatism was 0.53 $\pm$ 0.33 D in the toric group and 2.33 $\pm$ 0.8 D in the non-toric group (P $<$ 0.001). CDVA of 20/40 or better was achieved in 83.3% (n = 15) and 47.4% (n = 9) of eyes in the toric and non-toric groups, respectively (P = 0.038). Also, corrected near visual acuity of 20/40 or better was achieved in 100% (n = 18) and 78.9% (n = 15) of eyes in the toric and non-toric groups, respectively (P = 0.105).

Conclusion: The study shows that pediatric cataract surgery with toric IOL implantation is an effective method of correcting preexisting corneal astigmatism. Compared to monofocal IOL implantation, it achieves better CDVA and near visual acuity.