Middle East African Journal of Ophthalmology最新文献

Purpose: To describe the nature and response of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-negative patients with hematological malignancies and other immunosuppressive causes.

Methods: This is retrospective case series of CMV retinitis patients with known immunocompromised status and negative HIV results. Patients' data were reviewed for demographics, causes of the immunosuppressed status, concomitant systemic CMV infection, and its management. Ophthalmic findings included visual acuity (VA), anterior and posterior segments findings, CMV retinitis patterns and extensions, medications, number of intravitreal injections, fundus photographs, and CMV retinitis complications.

Results: During a study period of 2 years, 17 eyes of 9 patients were diagnosed with CMV retinitis with detected CMV in blood tests. Indolent granular retinitis pattern was found in 4 eyes (23.5%), and the fulminant necrotizing pattern in another 4 eyes (23.5%). In 1 eye (5.9%), frosted branch angiitis was observed. A mixed pattern between granular and necrotizing retinitis was seen in 4 eye (23.5%). The majority (n 11, 64.7%) of the affected eyes had an extensive retinal involvement (zone 1-3). Only two eyes had no macular involvement (11.8%). A large percentage of the included patients had controlled disease course with stable vision. Out of the studied 17 eyes, deterioration in terms of VA was seen in five eyes. In two patients, the disease course was complicated by vitreous hemorrhage.

Conclusion: In the majority of the patients with HIV-negative tests who received intravitreal and/or systemic anti-CMV medications, the clinical course of CMV retinitis was controlled with final stable vision.

Numerous artificial intelligence (AI) models, including deep learning techniques, are being developed to segment choroids in optical coherence tomography (OCT) images. However, there is a need for consensus on which specific models to use, requiring further synthesis of their efficacy and role in choroid visualization in myopic patients. A systematic literature search was conducted on three main databases (PubMed, Web of Science, and Scopus) using the search terms: "Machine learning" OR "Artificial Intelligence" OR "Deep learning" AND "Myopia" AND "Choroid" OR "Choroidal" from inception to February 2024 removing duplicates. A total of 12 studies were included. The populations included myopic patients with varying degrees of myopia. The AI models applied were primarily deep learning models, including U-Net with a bidirectional Convolutional Long Short-Term Memory module, LASSO regression, Attention-based Dense U-Net network, ResNeSt101 architecture training five models, and Mask Region-Based Convolutional Neural Network. The reviewed AI models demonstrated high diagnostic accuracy, including sensitivity, specificity, and area under the curve values, in identifying and assessing myopia-related changes. Various biomarkers were assessed, such as choroidal thickness, choroidal vascularity index, choroidal vessel volume, luminal volume, and stromal volume, providing valuable insights into the structural and vascular changes associated with the condition. The integration of AI models in ophthalmological imaging represents a significant advancement in the diagnosis and management of myopia. The high diagnostic accuracy and efficiency of these models underscore their potential to revolutionize myopia care, improving patient outcomes through early detection and precise monitoring of disease progression. Future studies should focus on standardizing AI methodologies and expanding their application to broader clinical settings to fully realize their potential in ophthalmology.

Purpose: To evaluate effectiveness of human amniotic membrane (hAM) transplantation in patients with nontraumatic corneal perforation.

Methods: This retrospective chart review included the patients who underwent hAM transplantation with sandwich technique between March 2020 and January 2023 at Ege University Hospital, Turkey. Medical records of the patients including demographic data, best-corrected visual acuity that was measured with Snellen chart, detailed ophthalmological examination, and the need for additional surgical intervention after hAM transplantation were evaluated. Complications and anatomical and functional results were presented.

Results: A total 9 eyes of 9 patients with nontraumatic corneal perforations were evaluated between 2020 and 2023. Size of perforation was ≤3 mm in all the eyes. The mean age of the patients was 67.77 ± 15.52. Female-to-male ratio was 1/8. Sandwich technique was used in all patients for hAM transplantation. Five (55.55%) cases had infectious etiology and 4 (44.44%) of them had inflammatory etiology. Of the infectious corneal perforations, 3 (33.33%) were herpes simplex virus-induced neurotrophic keratopathy and 2 (22.22%) were bacterial keratitis. The mean residence time of the amniotic membrane on the ocular surface was 21 ± 8.05 days. Tectonic keratoplasty was needed in 1 (11.11%) eye. Corneal patch grafting was required in 1 (11.11%) eye. Evisceration was performed in 1 (11.11%) eye of a patient with no light perception who had no visual prognosis. Amniotic membrane detachment was observed in one patient as a surgical-related complication associated with hAM transplantation.

Conclusion: hAM transplantation is one of the successful treatment methods in treatment of relatively small corneal perforation. Considering the difficulty of finding a donor cornea and the easier access to the amniotic membrane, it seems like a good alternative treatment to reduce or postpone the need for tectonic keratoplasty.

Purpose: To evaluate whether the level of ambient illumination in winter at different locations, time of a day, sun protection, and source position remains optimum (≥1000 lux) for controlling myopia progression.

Methods: Illuminance level was recorded for 6 outdoor and 5 indoor locations using factory calibrated digital lux meter and under different measurement conditions. Outdoor locations included "open playground," "between two buildings," "between three buildings," "under a porch facing east," "under a big tree," and "under a porch facing west." Similarly, indoor locations included "rooms with multiple large windows," "rooms with a combination of light sources," "room with single artificial light," "room with multiple artificial lights," and "canopy covering the buildings."

Results: The overall median illumination level across 6 outdoor locations and 5 indoor locations were 1900 lux (803-4300 lux) and 227 lux (82-556 lux) respectively. Indoor locations showed an overall low median illuminance level (<1000 lux) irrespective of the locations and source positions. However, the illuminance level >1000 lux was recorded for "Room with multiple large windows" for specific points of time (10:00-11:00 and 13:00-14:00) in both sunny and foggy weather. The highest illumination level was recorded only in the "open playground" irrespective of various conditions such as time of the day, weather of the day, relative source position, and sun protection.

Conclusion: The ambient illumination level was optimum (≥1000 lux) for antimyopia strategy in winter for maximum outdoor locations. However, children should be motivated to spend their outdoor time during the afternoon (13:00-14:00 h) so that light intensities reaching the eye should be optimum in winter.

With the approval of the Federal Drug Agency of the USA in 2018, femtosecond laser-assisted small incision lenticule extraction (SMILE) became an officially available option in several countries including Saudi Arabia to treat myopia and astigmatism. Intense marketing by industries has placed both clients and corneal surgeons into a dilemma of the plus and minuses of this option. Although several reviews compare SMILE to other conventional methods, especially laser in situ keratomileusis, this narrative review perhaps for the first time offers a detailed summary of this procedure and compares two sets of published literature, by authors from China and other countries. The efficacy and safety of SMILE seem to outnumber the complications and high cost of the investment. Its long-term usefulness for treating high myopia and hyperopia is still a matter of research.

Purpose: It is a controversial issue whether to discontinue antithrombotic drugs during the perioperative period of cataract surgery. There are few reports on the safety of long-term aspirin use after percutaneous coronary intervention (PCI). In this study, we evaluated the bleeding risk and surgical safety of cataract phacoemulsification in patients who took aspirin for a long time after PCI, so as to provide relevant evidence for this problem.

Methods: Retrospective analysis of the cases of cataract surgery. The incidence of bleeding-related complications in patients without history of antithrombotic drugs, patients without cardiac surgery who had taken aspirin at least 1 year for secondary prevention, and patients with long-term aspirin use 1 year after PCI were compared.

Results: A total of 81 patients (81 eyes, n = 81) after PCI (≥1 year) were collected. One hundred fifty-eight patients (158 eyes, n = 158) without cardiac surgery in the aspirin group and 285 patients (285 eyes, n = 285) without history of antithrombotic drugs were collected. Subconjunctival hemorrhage and hyphema occurred in all three groups, but the difference was not statistically significant (P > 0.05). No other serious bleeding-related complications occurred in the three groups during the operation, 1 day and 1 week after operation.

Conclusion: No matter intraoperative or postoperative, bleeding-related complications are rare in patients after PCI, which demonstrates a certain degree of surgical safety and can prove the safety of cataract surgery without stopping antithrombotic drugs.

Purpose: The purpose of this study was to examine demographic and tomographic parameters in pediatric patients diagnosed with keratoconus and to evaluate the difference between early and late age periods.

Methods: This retrospective study included patients younger than 18 years of age who were diagnosed with keratoconus. All examination findings, demographic data, tomography parameters, and keratoconus stages were recorded. The patients were divided into two groups: 14 years or younger (Group 1) and those between 14 and 18 years old (Group 2). All corneal tomography parameters were compared in the subgroups and were evaluated statistically. P <0.05 was considered statistically significant.

Results: A total of 131 eyes of 71 patients were included. The mean age was 15.7 ± 1.8 (range, 10-18) years, and the female-to-male ratio was 23/48. The mean best spectacle-corrected visual acuity was 0.36 ± 0.44 (range, 0-3.1) logMAR. The averages of K1, K2, Km, and Kmax were 49.0 ± 6.2 (range, 39.6-74.5) D, 53.5 ± 7.0 (range, 43.3-76.8) D, 51.3 ± 6.5 (range, 41.5-75) D, and 59.1 ± 9.0 (range, 44.7-85.2) D, respectively, and the mean central corneal thickness (CCT) was 456.9 ± 63.5 µm (range, 261-601). The distribution of eyes with keratoconus from stages 1-4 was 5.3%, 36.6%, 38.9%, and 19.1%, respectively. When the groups were compared, K1, K2, Km, and Kmax were significantly steeper in Group 1 compared to Group 2 (P = 0.006, P = 0.004, P = 0.004, and P = 0.007, respectively). CCT and the thinnest corneal thickness values were significantly less in Group 1 (P = 0.038 and P = 0.041, respectively).

Conclusion: The decision for treatment - especially cross-linking - should be made at the right time due to the increased risk of progression in the earlier ages in pediatric keratoconus population.

Purpose: The purpose of this study was to validate the artificial intelligence-based Screening Corneal Objective Risk of Ectasia (SCORE) for the detection of corneal ectasia/risk of ectasia and to find the mean SCORE value in normal eyes.

Methods: This prospective observational study included 320 eyes of 160 patients undergoing screening for refractive surgery and keratoconus. All were subjected to Anterion (Heidelberg, Germany) corneal tomography. The maps were read by trained cornea specialists masked with respect to system-generated SCORE. The SCORE values were retrieved by another masked observer. The SCORE was labeled true positive if the eye was tomographically positive for ectasia/ risk of ectasia with or without clinical evidence of ectasia (i.e., clinician's diagnosis as ectasia/ risk of ectasia) and SCORE was >/=0. The SCORE test was labeled as true negative if all the maps were normal and SCORE was <0. A false-positive test was where the eye was normal but SCORE was ≥0. A false-negative test was one tomographically there was definite evidence of ectasia/ risk; with or without clinical evidence of ectasia (i.e.,clinician's diagnosis as ectasia/ at risk of ectasia) but SCORE was <0. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: The mean SCORE in normal eyes was -0.7 ± 0.6. Sensitivity was 83.3% and specificity was 80%. PPV and NPV were 46% and 96% respectively. In the keratoconus subgroup, specificity and PPV were 100%; sensitivity was 79% and NPV was 76.3%.

Conclusion: SCORE in Anterion has moderate sensitivity and specificity for detection of ectasia/risk of ectasia. It performs best in the detection of corneal ectasia. It needs to be interpreted with caution.

Purpose: To compare macula and optic-disc optical coherence tomography angiography (OCTA) metrics of adult amblyopic eyes with healthy controls and investigate whether these differ according to amblyopia etiology.

Methods: This cross-sectional study included 35 unilateral amblyopic adults (n = 35 eyes) and 35 age-matched healthy controls (n = 35 eyes). Amblyopia subgroups consisted of anisometropic (n = 12 eyes), strabismic (n = 12 eyes), and combined-mechanism amblyopia (n = 11 eyes). Foveal avascular zone area (FAZA), vessel density (VD), and retinal thickness were obtained using OCTA. Retinal thicknesses were measured at the fovea, parafovea, perifovea, and retinal nerve fiber layer. Foveal, parafoveal, perifoveal, whole-macula, intradisc, peripapillary, and whole-disc VD were recorded. Groups were compared regarding OCTA metrics after adjusting for axial length, spherical equivalent, age, gender, and signal quality index using a one-way analysis of covariance test.

Results: Amblyopic eyes had significantly lower foveal, parafoveal, perifoveal, whole-macula VD in superficial capillary plexus (SCP), and deep capillary plexus (DCP) than control eyes after adjusting for confounders (P < 0.05 for all). All amblyopia subgroups had significantly lower parafoveal, perifoveal, and whole-macula VD in SCP and DCP than control eyes after adjusting for confounders (P < 0.05 for all). There was no significant difference in retinal thickness, FAZA, intradisc VD, peripapillary VD, and whole-disc VD between amblyopic and control eyes, as well as amblyopia subgroups and control eyes.

Conclusion: These results suggest that effect of amblyopia on macular microvasculature should be considered when interpreting OCTA metrics of adults with concomitant diseases. It also supports that adult amblyopic eyes of different etiology have similar microvascular features.

Purpose: This study aims to correlate optical coherence tomography angiography (OCTA)-based retinal microvasculature changes in cases of full-thickness macular hole (FTMH) before and after vitreoretinal surgery and its relation to patient's visual recovery.

Methods: Data of 31 eyes with FTMH were evaluated preoperatively and post-operatively at 6, 12, and 24 weeks for OCTA parameters and compared.

Results: 93.55% eyes (29 eyes) showed improvement in best-corrected visual acuity at 24 weeks. The mean foveal avascular zone (FAZ) significantly reduced from 0.41 ± 0.13 mm² (preoperatively) to 0.25 ± 0.01 mm² (postoperatively at 24 weeks). Mean preoperative vessel density (VD) in the superficial vascular plexus (SVP) progressively improved to 24.2% ± 2.2%, 25.2% ± 2.1% and 25.8% ± 2.3% at 6, 12, and 24 weeks respectively from 24.4% ± 2.1% preoperatively (P = 0.0, F = 5.1). The mean VD of foveal region in the SVP significantly improved (P < 0.0, F = 13.9) while that of the parafoveal region did not improve at 24 weeks (P = 0.3, F = 1.2) when compared with its preoperative status. The mean preoperative VD in the deep vascular plexus (DVP) was 20.2% ± 2.6%. It significantly improved at 6, 12, and 24 weeks (20.3% ± 2.4%, 21.8% ± 2.3% and 22.1% ± 2.2%, respectively; P = 0.0, F = 6.9). The mean VD of foveal region and parafoveal region in the DVP showed significant improvement when compared with its preoperative status (P < 0.0, F = 39.3, P < 0.0, F = 13.7).

Conclusion: This study showed reduction in mean FAZ area and improvement in mean VD at SVP and DVP in the macula postoperatively. Routine perioperative OCTA-based documentation of macular vascularity in FTMH may throw a light in cases with anatomico-functional postoperative disparities in future.