Oman Journal of Ophthalmology最新文献

Peripheral ulcerative keratitis (PUK) is characterized by epithelial destructive lesions in the perilimbal cornea causing corneal thinning. It is an inflammatory condition commonly associated with systemic autoimmune disorders and mainly found in middle-aged females. It is a sight threatening entity with potential for severe visual impairment or loss of eye. Recognition of ocular manifestations of PUK is essential especially in the younger age group, as it is difficult to diagnose in a child. We present a unique case of a 13-year-old girl with bilateral PUK and later diagnosed with juvenile idiopathic arthritis. She was started on methotrexate tablets to control the systemic disease and advised continuation of topical cyclosporine eye drops.

Eyelid injuries associated with canalicular rupture may lead to lacrimal drainage obstruction if not repaired in time. Of the various techniques available, monocanalicular stenting is the procedure of choice. However, these stents are not only costly but also their availability is a limitation. Majority literature focuses on innovative techniques to identify the lost medial part of canaliculi. We developed a novel surgical technique for canalicular repair by inserting a 26 gauge plastic sleeve of pediatric Intravenous cannula utilizing 27 gauge metal irrigation cannula as a guiding tool.

This case report highlights a rare case of contact lens-related keratitis (CLRK) caused by the emerging pathogen Alcaligenes faecalis, which underscores the growing diversity of microorganisms implicated in ocular infections. A 28-year-old female, who had been using yearly disposable contact lenses (CLs) for the past 8 years without prior complications, developed peripheral corneal infiltrates. The infiltrates were attributed to the chronic use of CLs. Corneal scraping and CL culture results identified A. faecalis as the causative organism, a rare and novel cause of keratitis in CL users. The patient was treated promptly with broad-spectrum topical antibiotics, leading to a full resolution of the infiltrates. This is likely the first documented case of CLRK caused by A. faecalis. While A. faecalis belongs to the Pseudomonadaceae family, it did not manifest as a typical aggressive infection, suggesting a potentially less virulent course in CLRK. This case adds to the growing awareness of nonconventional pathogens in ocular infections and highlights the importance of early detection and treatment to prevent more severe outcomes.

Background: Diabetic macular edema (DME) is a leading cause of vision loss in diabetic people. DME can be treated with various medications, including intravitreal injections, laser therapy, and surgery. Early detection and treatment of DME is essential to prevent vision loss. The study aimed to describe patients' demographic and clinical characteristics with DME, optical coherence tomography (OCT) findings, and visual acuity outcomes.

Methodology: A retrospective study reviewed case records of patients with DME between 2017 and 2020. Demographic data, clinical characteristics, and examination results were extracted and analyzed using Microsoft Excel (2013). All patients clinically diagnosed with DME underwent assessment by OCT examination. DME was classified based on OCT findings. Statistical significance was observed at P < 0.05.

Results: This retrospective study included 213 eyes of 134 patients, of which 77.6% were male and 22.4% were female. Nonproliferative diabetic retinopathy (NPDR) was present in 51.64% of eyes, and PDR was present in 48.36%. Focal, diffuse, and cystoid macular edema was observed in 68, 31, and 65 eyes, respectively. Tractional macular edema was seen in 16 eyes with posterior hyaloid traction, 13 with epiretinal membrane (ERM), and one with both conditions. DME associated with subretinal fluid (SRF) detachment was seen in 8.92% of eyes. The mean (standard deviation) central retinal thickness was 284.5 (28.9), 434.0 (97.5), 426.5 (27.5), 510.5 (14.1), and 465.5 (280.7) μm in focal, diffuse, cystoid, ERM, and SRF, respectively. Increased central retinal thickness was associated with decreased visual acuity (P < 0.05).

Conclusion: The findings of this study suggest that DME is a common and visually significant complication of diabetes. The OCT findings can be used to classify DME into different subtypes, which may help to guide treatment decisions. Focal edema was the most common type of DME with the least central retinal thickness. In NPDR, focal macular edema was the most common; in PDR, cystoid edema was the most common. Cystoid edema was the most common type in the subgroup of patients with recurrent DME following anti-vascular endothelial growth factor injection.

Purpose: The aim of the study is to compare the effects of three mydriatic agents on anterior segment parameters and intraocular pressure (IOP) in pseudoexfoliation (PEX) patients and compare the results with healthy controls.

Patients and methods: This cross-sectional study involved 25 PEX and 16 control patients. Each received three dilating drops (phenylephrine, tropicamide, and cyclopentolate) with eye examinations before and after (over 3 weeks). The measured parameters included IOP, gonioscopy grading, and Scheimpflug imaging analysis of anterior chamber depth, anterior chamber volume, anterior chamber angle, pupillary diameter (PD), central corneal thickness (CCT), and corneal volume.

Results: The mean age was 66.12 years in the PEX group and 55 years in the control group. There were no significant differences between the groups in baseline parameters, except for CCT being significantly thicker in the control group (P = 0.049). After 2 h of using the dilating drops, the PEX group showed no change in CCT and gonioscopy measurement while all the other tested parameters showed a significant increase. Phenylephrine caused the greatest increase in pupil diameter. Correlation analysis of PD versus other parameters in both groups showed only a negative significant correlation between PD and IOP when using tropicamide on the PEX patients.

Conclusion: All three dilating drops are effective in dilating PEX patients. Phenylephrine is the most effective and ideal for both clinics and surgeries. Cyclopentolate is the least effective dilator in PEX patients compared to healthy controls. Tropicamide 1% provides a good balance between pupil dilation and minimal IOP elevation, making it safer for PEX patients.

This case report presents the case of a 60-year-old man who underwent autologous lamellar scleral patch graft (SPG) repair for a large posterior pole scleral defect during pars plana vitrectomy (PPV). Initially, the patient experienced a perforating air rifle pellet injury, necessitating suturing of the entry wound. Six days later, lensectomy and PPV were performed for traumatic cataract, removal of an intraocular foreign body, dense vitreous hemorrhage, and retinal detachment. During PPV, a significant full-thickness scleral defect was found at the posterior pole and repaired using a 3.5 mm × 4.5 mm autologous lamellar SPG sourced from the superotemporal superficial sclera. Postoperatively, the graft fully adhered to the adjacent sclera without complications such as silicone oil leakage or inflammation. This case marks the first instance of utilizing an autologous lamellar SPG for such a large posterior pole defect during PPV, showcasing its effectiveness and safety for such challenging conditions.

Objectives: To evaluate the clinical outcomes of eplerenone in the management of acute central serous chorioretinopathy (CSCR).

Materials and methods: This case-control study involved 52 eyes of 52 cases of acute CSCR divided between treatment (26) and control (26) groups. Cases in the treatment group were managed by tablet eplerenone 50 mg/d. During the scheduled visits, serum electrolytes and an ophthalmic evaluation, including optical coherence tomography, were conducted. The control group was subject to observation and a similar follow-up. The Statistical Programme for Social Sciences, version 23 was used for statistical tests.

Results: The mean age in the treatment and control group was 39.15 ± 12.1 years and 36.1 ± 8.09 years, respectively. In the treatment group, 46.15% of right eyes and 53.8% of left eyes, and in the control group, 61.5% of right eyes and 38.5% of left eyes were evaluated. Visual acuity improved to 6/6 in 96.2% of treated cases and 19.2% of controls in the 2^nd month of follow-up. Subretinal fluid resolved completely in 61.52% of treated cases and 38.46% of controls at 12-week follow-up. No adverse events were reported, and by the 12^th week of follow-up, the mean serum K+ was 4.80 ± 0.157 mEq/L.

Conclusion: Acute CSCR cases managed with oral eplerenone can attain faster resolution with significant functional improvement. Eplerenone may serve as a first-line therapeutic option for acute CSCR with a better safety profile.