Journal of Ophthalmic & Vision Research最新文献

Purpose: To compare rigid gas permeable (RGP) contact lens comfort in patients with keratoconus who underwent corneal cross-linking (CXL) versus those without CXL surgery.

Methods: This prospective study was carried out on 41 eyes (25 patients). Specifically, 21 eyes were assigned to the CXL group and 20 eyes to the non-CXL group. All of the patients were fitted with RGP lenses. The patients were also assessed one and three months after the initial RGP fitting. They were asked to grade themselves on a scale from 1 to 4 according to the frequency and intensity of ocular discomfort, vision fluctuation, and overall comfort with RGP lenses.

Results: The mean age of participants was 24.5 $\pm$ 3.20 years. There was no significant difference in the intensity of fluctuations in vision (P = 0.30), frequency of discomfort (P = 0.29), and intensity of discomfort (P = 0.31) between the two groups during the one- and three-month follow-up interviews.

Conclusion: Based on the current study, there is no significant disparity in self-reported discomfort with RGP contact lenses between patients with keratoconus who have undergone corneal CXL and those who have not.

Purpose: To evaluate the reproducibility and intra-eye similarity of the intraocular pressure (IOP) peaks induced by the water drinking test (WDT) in treated glaucoma patients.

Methods: This prospective cohort study evaluated 99 patients (198 eyes) who were treated for primary open-angle glaucoma. All patients underwent WDT in two consecutive visits with no change in their current therapy. The interval between the tests was 4 four to six months. The tests were administered at a similar time (4:00 PM $\pm$ 1 hour). The reproducibility of the time of the IOP peaks and the correlation between the peak time of both eyes during the two consecutive WDT sessions were assessed.

Results: Of all IOP peaks, 59.6% and 71.7% occurred at the same time during the two WDT sessions in the right and left eyes, respectively. In the first and second WDT sessions, the agreements in IOP peak time between the right and left eyes were 60% and 63%, respectively.

Conclusion: The IOP peak time between the two consecutive WDT sessions was moderately reproducible, and there was a moderate agreement in the peak time between the two eyes. In light of these findings, clinicians should avoid performing simplified versions of WDT to evaluate IOP peaks.

Retinal artery occlusion (RAO) is a well-characterized ischemic ophthalmic event that may result in sudden and devastating vision loss. The etiology of RAO may vary including both arteritic and non-arteritic causes and the location of the lesion can extend from the ophthalmic artery to the branches of the central retinal artery. Given this variable causes of RAO, the clinical presentation and extent of vision loss may also differ from case to case, necessitating a prompt and thorough evaluation, including a full stroke work up. While there is currently no widely accepted standard for the treatment of RAO, there are several proposed methods that have been or are currently being investigated through retrospective studies and prospective trials. The current article aims to provide a review of the pathophysiology, clinical presentation, and management of RAO in addition to presenting a systematic review of recently published studies on treatment options for RAO.

Microbial keratitis (MK) is a sight-threatening ocular disease that needs rapid diagnosis and treatment to prevent more serious outcomes. The broad-spectrum topical antimicrobial treatment is currently the main pharmacological approach for MK management, yet its efficacy is increasingly challenged by evolving antimicrobial resistance, including multidrug resistance. Also, the ocular surface presents numerous challenges for standard topical drug delivery. The failure and ineffectiveness of current therapies have necessitated the development of novel therapeutic strategies to manage MK. With advances in nanotechnology in the biomedical field, various nanomaterials can be employed to control MK. The primary determinants of nanoparticles' vast range of applications are their size, surface properties, and chemical makeup, which also happen to be the same elements that give rise to their poisonous and dangerous effects. In this study, we provide a perspective on the contact lens-associated corneal illnesses such as MK and explore how nanotechnology might help address this significant clinical issue. In addition, safety and toxicological concerns about the increasingly widespread use of contact lenses are also discussed.

Purpose: To examine the natural adaptive course of ocular motor system in unilateral abducens nerve palsy while addressing the scarce literature on saccade dynamics and natural adaptation.

Methods: Binocular horizontal eye movements were recorded from 18 healthy adults and 21 adults with unilateral abducens nerve palsy during the acute and chronic phases. Dynamics of the paretic and non-paretic eyes were compared, and the non-paretic eye dynamics were correlated with the respective prism diopters. Non-parametric tests were used for statistical comparisons.

Results: The paretic eye, compared to the non-paretic eye, presented a slightly lower saccadic gain and velocity/amplitude ratio and a higher duration/amplitude ratio. The non-paretic eye, compared to healthy controls, showed consistent amplitude gain ( $>$ 1) and a tendency for a higher duration/amplitude ratio. In the acute phase, when the non-paretic eye was covered, the paretic eye's amplitude ratio was lower and the duration/amplitude ratio decreased significantly. In the acute phase, a greater degree of esotropia in the paretic eye was associated with a lower amplitude gain and duration/amplitude ratio in the non-paretic eye.

Conclusion: During adaptation in abducens nerve palsy, the saccade duration of the paretic eye increased, and a similar tendency was observed in the non-paretic eye. This finding likely reflects a change in the "pulse-step" pattern and may be related to plastic changes in central structures, such as the cerebellum, that support learning processes.

Purpose: To report the coincidence of acute retinal necrosis (ARN) syndrome following acute meningoencephalitis and presumed coronavirus disease 2019 (COVID-19) in an immunocompetent patient.

Case report: A 58-year-old female presented to our emergency department with sudden unilateral visual loss following a recent hospitalization for viral meningoencephalitis. Magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcription polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient. Ophthalmic examination revealed severe ocular inflammation and yellowish patches of necrotizing retinitis in the right eye, compatible with the diagnosis of ARN. The result of aqueous humor PCR was positive for varicella zoster virus (VZV). The patient received a single intravitreal ganciclovir injection and 10 days of intravenous ganciclovir, followed by oral acyclovir. The patient underwent COVID-19 screening tests: while the chest CT scan showed features highly suggestive of COVID-19, the RT-PCR was negative on two occasions. Two months later, best-corrected visual acuity improved to 20/70 in the right eye, the anterior chamber reaction and keratic precipitates resolved, and the vitreous haze decreased significantly.

Conclusion: A case of VZV-induced ARN following acute meningoencephalitis was observed in association with presumed COVID-19. This could be an incidental finding during the COVID-19 pandemic; however, it could also suggest that COVID-19 might trigger ARN in cases with latent herpes family viruses.

Purpose: This study aimed to identify predictive factors for the improvement of best-corrected visual acuity (BCVA) and reduction of central macular thickness (CMT) after treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real-world setting.

Methods: This retrospective study included patients with ME secondary to BRVO who were treated with intravitreal injection of bevacizumab as the first-line therapy and were followed up for 12 months. Demographic and clinical data, in addition to baseline spectral domain optical coherence tomography (SD-OCT) features, were considered as possible biomarkers of final BCVA and CMT. We also collected the data concerning the need for additional treatment including sectorial laser photocoagulation, change to another anti-VEGF agent, or intravitreal corticosteroid injection.

Results: A total of 161 eyes were analyzed. BCVA significantly improved from baseline to 12-month follow-up (0.6 and 0.4 logMAR, respectively; P $<$ 0.01). CMT decreased significantly during the follow-up period (from 498.0 to 325.0 $\mu$ m; P $<$ 0.01). Final BCVA correlated positively with baseline BCVA (P $<$ 0.01, r = 0.57). Older age at diagnosis and baseline SD-OCT findings including CMT, disruption of the retinal inner layers, retinal pigment epithelium (RPE) damage, and impairment of the ellipsoid zone and external limiting membrane negatively affected final BCVA (P $<$ 0.01). Multiple regression analysis identified age and BCVA at baseline as the only independent predictors of final BCVA (P = 0.001 and P $<$ 0.01, respectively). No association was found between clinical data, SD-OCT parameters, and final CMT.

Conclusion: Various clinical and SD-OCT parameters are prognostically relevant for visual improvement in ME secondary to BRVO. Age at diagnosis and baseline BCVA were found to be independent predictors of visual outcome.

Purpose: Sulfur mustard (SM) is a potent blistering agent. This alkylating chemical agent has extremely toxic effects on the eye. MMP-2 and MMP-9 are the two most important matrix metalloproteinase enzymes involved in the pathology of chemical eye injuries. Curcumin is regarded as a natural anti-inflammatory agent. This study aims to compare the anti-inflammatory effects of curcumin versus doxycycline on chemically induced corneal injuries.

Methods: The HCE-2 cell line was used as a model for corneal cells. The effective concentrations of 2-chloroethyl ethyl sulfide (CEES) - as an analog of SM - doxycycline, and curcumin were determined using the MTT assay. The gene expression of MMP-2, MMP-9, and tissue inhibitors of metalloproteinase (TIMP-1) was evaluated by the real-time PCR method. Also, the activity of MMP-2 and MMP-9 enzymes was determined by zymography.

Results: The expression of the MMP-2 and MMP-9 genes increased 5- and 3.3-fold after exposure to CEES, respectively. Following the treatment with curcumin and doxycycline, MMP-2 expression decreased significantly. Also, after treatment with curcumin and doxycycline, the MMP-9 expression decreased 2.5- and 1.6-fold, respectively. The reduction in activity was 32% for MMP-2 and 56% for MMP-9 after treatment with curcumin. The corresponding values were 12% and 40% following doxycycline treatment. There was no significant difference between the effects of curcumin and doxycycline on reducing MMP-2 expression, but the difference was statistically significant in the case of MMP-9.

Conclusion: Doxycycline and curcumin can inhibit MMP expression and activity in chemically exposed corneal cells. Curcumin has a greater ability than doxycycline to inhibit MMP-2 and MMP-9 enzymes; however, the difference is statistically significant only in the case of MMP-9. After further validation, these substances can be introduced as anti- inflammatory agents to treat corneal chemical burns.

Purpose: Since ptosis is an early feature of chronic progressive external ophthalmoplegia (CPEO), patients are commonly misdiagnosed with other causes of ptosis. This study aims to report the type and frequency of misdiagnosis and time lag to diagnosis and the palpebral fissure transfer (PFT) procedure in patients with CPEO.

Methods: This is a retrospective analysis of consecutive patients with CPEO who underwent PFT between 2006 and 2017. The data on previous diagnoses and treatments, age at definitive diagnosis of CPEO, and clinical manifestations were recorded. While the diagnosis of CPEO was based on clinical examination, 75% (24/32) of patients had undergone a confirmatory muscle biopsy and genetic tests.

Results: There were 32 patients (19 females) with a mean age of 24.8 years (range, 13-36) at the final diagnosis and 34.1 years (range, 15-56) at the time of PFT. Also, 78% (25/32) of patients had been initially misdiagnosed with congenital ptosis (60%; 15/25) and ocular myasthenia gravis (OMG) (40%; 10/25). The majority of patients (20/32) had one to three previous eyelid surgical procedures, of which 90% (18/20) were performed before the definitive diagnosis of CPEO. The mean time lag from the first surgical procedure to CPEO diagnosis and PFT was 6.2 and 14.7 years, respectively.

Conclusion: In a referral center, 78% of the patients with CPEO were initially misdiagnosed with congenital ptosis and OMG, and 56% of them underwent ptosis repair before the diagnosis. While the onset of the disease was in the first or second decades of life, diagnosis was delayed up to a mean age of 25 years. Reviewing early family photos and paying attention to other signs of CPEO could prevent misdiagnosis.

Purpose: To evaluate the effect of cataract surgery and visual impairment and the associated risk factors on the frequency of falls among older adults in northeast Iran.

Methods: This cross-sectional study, conducted between 2019 and 2020, analyzed the potential risk factors of falling in older adults over 50 years of age. To this end, 380 patients were randomly selected by convenience sampling and classified into two groups: those who had undergone cataract surgery in the last 12 months (surgery group) and those who had not (cataract group). The data were collected from the medical records and face-to-face interviews, and logistic regression was used to identify potential risk factors for falling.

Results: The frequency of falls in the cataract and surgery groups was 18.9% and 11.6%, respectively. The mean decimal visual acuity of the dominant eye was significantly lower in the cataract group than in the surgery group (P $<$ 0.001). There were no significant differences in the mean number of medications used, Charlson Comorbidity Index score, Instrumental Activities of Daily Living score, and 10-Meter Walk Test speed between the two groups. According to the results of backward logistic regression, taking more than four medications per day and slow gait speed were the most important factors influencing the frequency of falls in older adults.

Conclusion: Logistic regression analysis indicated that undergoing cataract surgery is not a significant protective factor against falls. However, older adults in the surgery group experienced fewer falls than in the other group. Besides, the results suggest that taking more than four medications daily and having a slow gait speed are significant fall risk factors.