Journal of Ophthalmology最新文献

This study aimed to evaluate the efficacy and safety of intravitreal dexamethasone implants in the treatment of ocular toxocariasis (OT). A retrospective analysis was performed on 6 cases in which laboratory tests diagnosed OT. All patients were administered with intravitreal dexamethasone implants with or without vitrectomy. The average follow-up time was 19.7 months. All operated eyes achieved anatomic success, and all patients' visual acuity was improved. Five of these six had a visual acuity of 20/100, and three had final acuity of 20/40 or even better. Intravitreal dexamethasone implants can be used to treat different types of OT, which not only effectively control inflammation and improve the patient's vision but also reduce the use of systemic glucocorticoids.

Background: Phacoemulsification has proven to be a breakthrough technique in cataract surgery. Its popularity has grown dramatically as procedures and equipment have advanced, improving both safety and efficiency. This study presents long-term outcomes from phacoemulsification surgeries performed at the Evangelical Church Winning All (ECWA) Eye Hospital, a tertiary eye care center.

Method: This prospective clinical cohort study followed standard practices for operations performed under local anesthesia. Ophthalmologists evaluated long-term outcomes and predictors of improved visual acuity after phacoemulsification cataract surgery. The visual recovery of the patients over time was evaluated, and the factors that influence the gains in vision were identified.

Results: A total of 177 patients were subjected to treatment at our facilities during the study period. There were 116 male and 61 female patients, which resulted to a male-to-female ratio of 1 : 0.53. The average age of the patients was 59.18 years with a standard deviation of 11.38 years. Of the 259 eyes treated, 249 eyes (96.1%) achieved a high success rate with visual acuity of 6/6 - 6/18. Ten (10) eyes (3.9%) had moderate acuity between <6/18 and 6/60. Follow-up examinations over five years after phacoemulsification showed poor vision outcomes among old patients. The primary factor that affected improvement in visual acuity among patients was amblyopia, present in 30% of cases. Posterior capsular opacification and macular edema collectively accounted for 20% of poor vision cases, while optic atrophy, glaucoma, and retinal hemorrhage each represented approximately 10% of poor vision cases.

Conclusions: The phacoemulsification approach demonstrated a highly effective restoration of vision for the vast majority, while long-term data analysis indicated the potential for age-related variability in postoperative visual gains.

Purpose: To investigate effects and complications of endoscopic vitrectomy combined with 3D heads-up viewing system in treating traumatic ocular injury. Patients and Methods. This is a retrospective interventional case series in a tertiary referral center in Taiwan, and we included patients of traumatic ocular injury, and they underwent endoscopic vitrectomy combined with a 3D heads-up viewing system.

Results: Fourteen eyes of traumatic globe injury from 14 patients were studied over a 30-month period. Preoperative VA ranged from no light perception (NLP) to 6/6. Postoperative visual acuity improved in 11 of the 14 eyes (79%). Until 6 months after surgery, all eyes had attached retina. The median logMAR BCVA was 2.4 at the first visit and 1.19 at the last visit (p = 0.0028). No subject suffered from retinal detachment, endophthalmitis, or other severe complications.

Conclusions: Vitrectomy using endoscopy combined with 3D heads-up viewing system allowed early evaluation and intervention in traumatic ocular injuries. Most of our cases showed both anatomical and visual acuity improvements.

Purpose: To investigate the dropout rate of anti-vascular endothelial growth factor (VEGF) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and identify the characteristics of dropout cases.

Methods: We studied 235 eyes of 235 treatment-naïve BRVO-ME patients receiving intravitreal injection of ranibizumab. Additional intravitreal anti-VEGF drug was given when ME relapsed or persisted, and photocoagulation was performed as needed. Adherence until treatment completion was defined as disappearance of ME within 2 years after the first injection without recurrence for more than 6 months or mild ME remaining but no visual deterioration for more than 6 months without additional anti-VEGF drug. In patients with ME recurrence, those who were followed for more than 2 years were considered adherence, and those followed for less than 2 years were considered dropout. The clinical course and background of the two groups were compared.

Results: 179 patients (76.2%) adhered to treatment and 56 patients (23.8%) dropped out. Mean follow-up periods in adherence and dropout groups were 23.4 and 7.1 months, respectively. There were no significant differences between the two groups in demographic and baseline factors of age, gender ratio, distance from home to hospital, visual acuity, and foveal thickness (FT). At the last follow-up, visual acuity was significantly poorer in the dropout group than in the adherence group (0.23 vs. 0.11 logMAR, p=0.003), and FT was significantly greater in the dropout group than in the adherence group (316 vs. 273 µm, p=0.002). Reasons for dropout included patient declining further treatment in 12.5%, progression of dementia in 8.9%, others, and unknown in 64.3%.

Conclusion: The clinical outcome of patients who dropped out of anti-VEGF therapy for BRVO-ME was worse compared to patients who adhered to therapy, and the reasons for discontinuation varied.

Objective: To assess repeatability and agreement of central vault for implantable collamer lens (ICL) measured by the Tomey OA-2000 biometry and Spectralis optical coherence tomography (OCT).

Methods: In this prospective study, the central vault was measured by the Tomey OA-2000 biometer and Spectralis OCT in 84 eyes (43 patients) after ICL implantation at six month follow-up. Three consecutive scans were obtained by one experienced technician using Tomey OA-2000 and the Spectralis OCT in the same day. The coefficient of variation (CoV), intraclass correlation coefficient (ICC), within-subject standard deviation (Sw), and 2.77 Sw were calculated to assess the repeatability and reproducibility. The paired t-test and Bland-Altman plots were used to analyze the differences and agreements of central vault measured by two devices.

Results: Repeatability of the central vault measured by Tomey OA-2000 biometer and Spectralis OCT showed that the CoV was 2.71% and 1.66%, respectively. The ICC for both devices was 0.996 and 0.999, respectively. The paired t-test showed that central vault measured by Tomey OA-2000 biometer was -7.25 ± 23.57 microns lower than that measured by Spectralis OCT (P = 0.006). The mean difference between measurements for Tomey OA-2000 and ASM-OCT with 95% limits of agreement (LoAs) was -38.94 to 53.44 μm.

Conclusion: Both Tomey OA-2000 biometer and Spectralis OCT displayed good repeatability for the measurement of central vault of ICL. Good reliability and agreement were observed between Tomey OA-2000 biometer and Spectralis OCT. Both instruments are useful but not replaced each other for central vault measurements.

Introduction: Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators for patients and helps to navigate treatment modalities. This is a retrospective chart review of examination and imaging findings for ocular trauma and how they correlate with treatment course and visual acuity (VA) outcomes.

Methods: Adult patients with ocular trauma presenting to a single institution between January 2013 and December 2020 were evaluated. Initial examination and imaging findings were compared for associations with each other and with VA outcomes.

Results: 136 ocular traumas on 134 patients were included. The median presenting logMAR VA was 2.7 (interquartile range (IQR) 1.2-3.7) with 62% open globe injuries. The most commonly reported finding on initial CT scan was globe deformity (30%), on B-scan was choroidal detachment (20%), and on ultrasound biomicroscopy was intraocular foreign body, ciliochoroidal effusions, or angle recession (21% each). Worse vision was observed for patients positive for retinal detachment on initial B-scan compared to those negative for this finding at 6-month (median logMAR 2.7 vs. 0.5; P < 0.0001) and at final post-injury evaluation (median logMAR 3.7 vs. 0.4; P < 0.0001). Similarly, worse VA was observed for patients with choroidal detachment on initial B-scan compared to those without this finding at 6-month (median logMAR 1.4 vs. 0.5; P = 0.002) and at final post-injury evaluation (median logMAR 2.0 vs. 0.4; P < 0.0001). If positive conjunctiva/sclera examination findings were identified, 66% had positive findings on B-scan, whereas if the conjunctiva/sclera examination findings were absent, 41% had positive findings on B-scan (P = 0.005). If anterior chamber (AC) examination findings were positive, 59% had positive findings on B-scan, whereas if the AC examination findings were absent, 37% had positive findings on B-scan (P = 0.03). Discussion. The predictive value of examination findings in this study may offer insight as to long-term visual prognosis. Positive B-scan or CT findings should increase suspicion for open globe injuries.

Purpose: Assessing the applicability of an algorithm developed for keratoconus detection in adolescents. This algorithm relies on optical coherence tomography (OCT) and incorporates features related to corneal pachymetric and epithelial thickness alterations.

Methods: We retrospectively reviewed charts of patients under the age of 18 and divided them into four groups according to the Belin-Ambrosio display (Pentacam): normal, manifest, and subclinical keratoconus, as well as very asymmetric eye with normal topography and tomography (VAE-NTT). Corneal and epithelial thickness maps (Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Germany) were evaluated by a human grader. In the first step, if at least one of four parameters (pachymetry minimum (pachy min), pachy minimum-median (min-med), pachy superonasal-inferotemporal (SN-IT), or epithelial (epi SN-IT)) exceeded its cut-off value, the eye was considered as suspect. In the second step, the combined presence of coincident thinning of total cornea and epithelium as well as concentric epithelial thinning lead to the diagnosis of keratoconus. Receiver operating characteristic (ROC) curves were generated to determine area under the curve (AUC), sensitivity, and specificity for the parameters.

Results: The study involved 19 pediatric patients diagnosed with keratoconus, comprising 29 manifest keratoconic eyes, 3 eyes with subclinical keratoconus, and 5 VAE-NTT eyes. In addition, 22 eyes from 11 normal adolescents were included in the analysis. The AUC values of parameters in step 1 were 0.889 for pachy min, 0.997 for pachy min-med, 0.893 for pachy SN-IT, and 0.998 for epi SN-IT. When both steps were performed, this algorithm captured all manifest and subclinical pediatric keratoconic eyes. When all eyes of the keratoconus patients were combined, step 1 had 97.3% sensitivity and step 2 had 100% specificity.

Conclusion: Using this OCT-based approach in adolescents yielded a high level of agreement with the current gold standard, tomography. Using them together, potentially also with other examinations may improve the diagnostic accuracy of KC in the pediatric population. Integration of this approach into the software of the device to facilitate automated evaluations is desired.

Background: Diabetic mellitus is a vision-threatening disease because it causes diabetic retinopathy worldwide. The main focus of this research is to determine the prevalence and assess the visual outcome in diabetic retinopathy and macular edema patients by injecting Bevacizumab clinically.

Methods: This hospital-based trial case was conducted in Khulna BNSB Eye Hospital, Bangladesh. This study is based on a prospective cohort with a population of macular edema in 41 eyes of 25 diabetic patients, of whom 94 were diagnosed with diabetic retinopathy in 320 type 2 diabetes mellitus patients. The treating physician inserts 1.25 mg (0.05 ml) into the patient's eye. We have used optical coherence tomography (OCT) and colour fundus photography (CFP) for an eye check performed on all patients before and after the injection of Bevacizumab. The method results analyze the effects of the technique using IBM SPSS 25.

Results: The study population selected 25 patients with 41 eyes for clinical investigation by injection of Bevacizumab. The net effects of this study on five eyes with macular edema were entirely resolved. It was BCVA from 6/6 to 6/9. The 29 eyes were partially resolved, which is called improved visual acuity, and BCVA was 6/12 to 6/60. In the case of seven eyes, we found that the vision did not change before or after the Avastin injection. No change was seen in seven eyes of macular edema due to the effects of the Avastin injection before and after.

Conclusions: In clinical trial-based research, Bevacizumab (Avastin) is best effective for diabetic retinopathy (DR) and diabetic macular edema (DME) patients.