Middle East African Journal of Ophthalmology最新文献

The aim of this study is to present a case of severe chronic blepharitis secondary to psoriasis in an eye that developed phthisis bulbi during the treatment of juvenile glaucoma. A 19-year-old male patient, who had been treated for bilateral juvenile glaucoma for many years and had phthisis bulbi in his left eye for the last 4 years, presented with the complaint of chronic eyelid inflammation in the same eye for 2 years. Examination revealed hyperemia, discharge, scaling, inflammation, and diffuse edema on the lower and upper eyelids. It was determined that she had been diagnosed with psoriasis by the dermatology clinic 3 years before her history. Psoriasis-like hyperplasia was observed in the lower eyelid biopsy. He was treated with topical periocular low potency steroid ointment (1% hydrocortisone). Clinicians should be vigilant about eyelid and eye involvement in psoriasis.

Purtscher retinopathy is a hemorrhagic and vaso-occlusive vasculopathy that results from head trauma. Typically, patients present with sudden onset of painless reduction in visual acuity and a group of retinal findings including retinal hemorrhages, retinal whitening, and optic disc edema. The objectives of the study were to describe the rare occurrence of combined central retinal artery and central vein occlusion in a child with Purtscher retinopathy and to illustrate the course of visual recovery and anatomical changes over 6 months of follow-up. The data were collected from the patient file including circumstances of presentation, visual acuity, anterior segment examination, fundus photography, fundus fluorescein angiography (FFA), B scan ultrasonography (B scan), and optical coherence tomography (OCT). Follow-ups over a 6-month period with repeated imaging were documented. A 6-year-old boy presented with a complaint of bilateral vision loss which occurred 2 days after falling out of high bed. On examination, visual acuity was hand motion bilaterally. External and anterior segments exhibited regular examination, apart from traumatic iritis in both eyes. Posterior segment examination showed intraretinal hemorrhages, retinal whitening bilaterally, and exudative retinal detachment, which was confirmed by OCT and B-scan. FFA of both the eyes showed delayed arterial and venous filling with macular hypoperfusion. Comprehensive systemic workup including brain imaging, hematology, immunology, and uveitis screening was negative. The patient was treated with a high-dose oral steroid. Six months later, his vision improved to 20/40 OD and 20/28 OS. Fundus examination and OCT showed peripheral retinal atrophy but preserved subfoveal outer retinal layers, which explained the visual improvement. Treatment with corticosteroids seems to be effective in reducing retinal edema and hastened visual recovery in patients with Purtscher retinopathy. Cilioretinal artery sparing can preserve the central vision in cases with combined artery and vein occlusion.

Purpose: To report the clinical presentation, histopathological and immunohistological features of conjunctival lymphatic-venous lesions.

Methods: This was a retrospective review of 15 patients with symptomatic conjunctival lymphatic-venous lesions. The clinical features and histopathologic features of the excised tissues were reviewed. Immunohistochemical staining with antibodies against CD34 to label vascular endothelium and D2-40 to label lymphatic endothelium was performed.

Results: All patients had unilateral conjunctival involvement. The mean age was 48.9 ± 18.9 years, with more women affected (67%). No patient had impaired visual acuity secondary to the lesion. The location of the lesion was temporal in 67% of patients. The presenting symptoms included conjunctival swelling, discomfort and/or foreign-body sensation, and tearing. All lesions were excised, and none recurred. All excised lesions showed dilated channels that were lined by a flattened endothelium staining positive with CD34, surrounded by edematous lamina propria. Larger ectatic lymphatic channels demonstrated scattered D2-40 staining in the endothelial cell lining and patchy CD34 staining within the endothelial cell cytoplasm. D2-40 and CD-34 immunoreactivity did not overlap in the same cells.

Conclusion: The clinical features and outcomes of the lesions in this large cohort were similar to those reported in the literature. However, the mixed immunoreactivity of the endothelial cells lining these ectatic lymphatic channels in the conjunctiva suggests that these channels are lymphatic-venous lesions. We suggest that these channels be termed conjunctival lymphaticovenous malformation rather than lymphangiectasia, which suggests ectasia of existing lymphatics. Future studies are needed to understand these lesions and their histopathologic origins.

A 16-year-old female with Sturge-Weber syndrome (SWS) presented with decreased vision in the left eye (20/100). Examination and multimodal imaging showed diffuse choroidal hemangioma with choroidal neovascularization and macular edema. Treatment with three monthly injections of intravitreal aflibercept improved vision by 4 lines with complete resolution of the macular edema sustained 4 months after the last injection. A review of the literature showed that this is the first report of successful use of aflibercept to treat macular edema and choroidal neovascularization associated with diffuse choroidal hemangioma in SWS. We suggest that early antivascular endothelial growth factor injections should be considered when faced with choroidal neovascularization associated with diffuse choroidal hemangiomas.

Purpose: A fresh-frozen human cadaveric feasibility study to investigate the feasibility of probing and stenting the nasolacrimal ducts (NLDs) of human cadavers with a novel flexible bicanalicular nasolacrimal stent.

Methods: A custom-designed bicanalicular nasolacrimal stent was made by connecting a 250 mm long, 0.9 mm diameter silicone tube to a 200 mm long stainless-steel, snake-chain probe at each end. The punctum was dilated, and the snake-chain stent fed into the nasolacrimal drainage system. The emergence of the stents from the terminal end of the NLD and retrieval with a ball probe was conducted under endoscopic guidance.

Results: Bicanalicular nasolacrimal stenting with intranasal retrieval under endoscopic guidance was successfully achieved in six NLDs of three adult cadaveric nasolacrimal drainage systems.

Conclusion: Despite being soft and flexible, the snake-chain silicon stent passes smoothly and freely through cadaveric human NLD and is easily retrieved from the nasal cavity. This novel NLD stent design may make stenting of the NLD easier and less traumatic.

Purpose: To assess the severity of dry eye in individuals with pterygium in a tertiary care hospital.

Methods: This cross-sectional study was done on 70 individuals with pterygium who were attending the outpatient department of ophthalmology. Objective dry eye tests were done, including Schirmer's tests 1 and 2, tear film breakup time, and tear meniscus height (TMH). In this study, patients with one or more positive clinical tests were diagnosed to have dry eyes. Dry eye was graded as mild, moderate, severe, or severe disabling.

Results: Among 140 eyes, 79 eyes had pterygium. According to Schirmer's test 1 in eyes with pterygium, 29.1% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. According to Schirmer's test 2 in eyes with pterygium, 25.3% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. Tear film breakup time in eyes with pterygium showed a mild dry eye in 25.3% and moderate dry eye in 17.7%. TMH in eyes with pterygium was low at 7.6%.

Conclusion: The majority of eyes with pterygium have mild or moderate dry eye according to Schirmer's test 1, Schirmer's test 2, and tear film breakup time. No eyes with pterygium have severe dry eyes. TMH was also low in a small proportion of eyes with pterygium. Dry eye evaluation by Schirmer's test and tear breakup time is, therefore, a crucial clinical tool for early detection and prompt management of dry eye syndrome in pterygium patients.

Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatism characterized by common clinical, radiological, and biological manifestations occurring on a predisposing genetic background dominated by the HLA-B27 antigen. Acute anterior uveitis is the most common extra-articular feature of SpA. The objective of this review is to describe the prevalence, demographic characteristics, factors favoring the occurrence of uveitis in patients with SpA, clinical manifestations, and their therapeutic management.

Purpose: We aimed to evaluate the success of Chat Generative Pre-trained Transformer (ChatGPT), Bing, and Bard artificial intelligence programs, which were released free of charge by three different manufacturers, in correctly answering questions about lenses, cataract, and refractive surgery, and to investigate whether they are superior to each other.

Methods: Seventy questions related to lens, cataract, and refractive surgery were obtained from the study questions section of the American Academy of Ophthalmology 2022 to 2023 Basic and Clinical Science Course Lens and Cataract and Refractive Surgery Books. The questions were asked separately for the ChatGPT, Bing, and Bard artificial intelligence programs. The answers were compared with answer keys and grouped as correct or incorrect. The accuracy rates of artificial intelligence programs were compared statistically.

Results: ChatGPT, Bing, and Bard chatbots gave correct answers to 35 (50%), 43 (61.4%), and 50 (71.4%) questions asked, respectively. The rate of correct answers to the questions of the Bard artificial intelligence program was significantly higher than that of ChatGPT (P = 0.009, Pearson's Chi-square test).

Conclusion: Although the currently released artificial intelligence chatbots can be used to access accurate information about lenses, cataracts, and refractive surgery, one should always be careful about the accuracy of the answers given.

Purpose: The purpose of this study was to report the visual and anatomic results at 12 and 24 months using the protocol of 3 monthly pro re nata (PRN) injections for diabetic macular edema (DME).

Methods: This was a retrospective chart review of 97 eyes with DME treated with a protocol of cycles consisting of 3 monthly injections of anti-vascular endothelial growth factor drugs on a PRN basis. Change in visual acuity was the main outcome measure. Macular thickness, number of injections, cycles, and visits in years 1 and 2 of follow-up were secondary outcomes.

Results: Ninety-six patients with a mean age of 60.9 ± 9.96 years were followed for a mean of 22.17 ± 12.30 months. Ninety-two (95.9%), 3 (3%), and 1 (1%) patients were started on bevacizumab, ranibizumab, and aflibercept, respectively. Of bevacizumab patients, 17 (18.2%) were eventually switched to aflibercept. The mean 12-month improvement (standard deviation [SD]) was + 3.3 (17.4) letters (95% confidence interval [CI] = +0.36-+7.05, P < 0.001) after an average (SD) of 5.97 (2.98) injections over a mean (SD) of 1.7 (1.0) three-injection cycles. The mean 24-month improvement (SD) was + 5.6 (13.0) letters (95% CI: -0.28-11.05, P = 0.0186) after an average (SD) of 8.72 (6.31) injections over a mean (SD) of 2.9 (2.1) three-injection cycles. The mean central macular thickness (SD) at baseline, 12 months, and 24 months was 374 ± 120, 322 ± 88, and 305 ± 70 µm. Optical coherence tomography was fluid free at 12 and 24 months in 27.6% and 46% of eyes, respectively.

Conclusion: Comparable to real-world studies, this protocol can stabilize or improve vision in more than 85% of DME patients over 24 months. The most important factor in improvement of vision is increasing number of injections and visits.

Purpose: The purpose of the to determine the prevalence of cataract and study the relationship of smoking and other potential risk factors with visually significant cataract.

Methods: This is a cross-sectional study based on the Azar cohort databases including 11,208 participants aged 35-70 years of the general population. According to the questionnaire, participants were divided into five groups in terms of smoking. Eye examinations were performed in two steps. The first step was performed by an optometrist, and in the second step, participants with poor red reflex or visual acuity of <8/10 were examined by an ophthalmologist for diagnosing cataract.

Results: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of visually significant cataract was 7.2%. The frequency of ex-smoking in the male and female population in the cataract group was significantly higher than that in the noncataract group (male: P = 0.008, female: P = 0.01), but after adjustment for age and education level, lost its significance (male odds ratio [OR] = 1.1 [0.8-1.5], P = 0.4; female OR = 1.5 [0.5-4], P = 0.3).

Conclusion: There is no association between cigarette smoking in different doses and the history of smoking with cataracts but other factors such as aging, education level, and underlying diseases including diabetes mellitus, hypertension, and myopia have statistically significant association with visually significant cataract.