Oman Journal of Ophthalmology最新文献

Objective: The objective of the study was to determine the incidence, patterns, and risk factors for the development of retinopathy of prematurity (ROP) in infants weighing >1500 g at birth.

Materials and methods: A retrospective analysis was done of the ROP screening records between April 2019 and March 2022. All the infants with birth weight >1500 g who underwent ROP screening were included. Data collected included demographic details, details of the risk factors (respiratory distress syndrome [RDS], hypoxia, anemia, septicemia, patent ductus arteriosus, congenital heart disease [CHD], i.e., atrial septal defects or ventricular septal defects, and multiple gestations), and ocular examination findings. Statistical analyses included calculation of mean, range, Chi-square test, and bivariate logistic regression for associations of risk factors with ROP.

Results: ROP was noted in 16.6% of the 336 eyes of 168 infants. The mean birth weight and mean gestational age (GA) of the infants were 1850 ± 33 g and 33.33 weeks ± 1.71 weeks, respectively. Eighteen eyes (32.1%) had Stage I, 17 eyes (30.35%) had Stage II, and 11 eyes (19.64%) had Stage III ROP in Zone II. Aggressive ROP was seen in 8 eyes (14.28%) and stage 5 ROP in two eyes (0.59%). Male gender, GA, CHD, and RDS showed a statistically significant association with the development of ROP in these infants.

Conclusion: ROP was seen in 16.66% of our subjects. Treatment was required in 6.25% of infants. Risk factors for the development of ROP were low gestational age, male gender, the presence of RDS, and congenital heart disease.

The white dot syndromes are a group of phenotypically similar disorders characterized by multiple lesions at the level of the outer retina, retinal pigment epithelium, and choroid. Common white dot syndromes whose imaging modalities have been described in this article are multiple evanescent white dot syndrome, acute posterior multifocal placoid pigment epitheliopathy, acute zonal occult outer retinopathy, multifocal choroiditis and panuveitis, punctate inner choroidopathy, serpiginous choroiditis, and birdshot chorioretinopathy. The various imaging modalities help us to better understand the pathophysiology of the various entities and help in diagnosing, monitoring, and prognosticating them. Optical coherence tomography angiography (OCTA) is a comparatively newer tool that helps us to visualize lesions in the choroid that correlate with indocyanine green angiography (ICGA) findings. Even though it is of limited value and cannot replace ICGA, it had gained considerable interest among ophthalmologists. Similarly, the noninvasive nature of modalities such as fundus autofluorescence and OCT makes them appealing and preferable over invasive techniques such as fundus fluorescein angiography and ICGA.

This study outlines a scenario involving unilateral periocular inflammation exhibited resistance to conventional immunomodulatory therapy (IMT) and biologic response modifying agents, which was successfully managed with oral cyclophosphamide monotherapy. A 39-year-old male visited our clinic, expressing discomfort and swelling in his left upper eyelid for six months. All multidisciplinary consultations and imaging yielded normal results. He remained consistently on a dosage of 50 mg oral prednisone. Blood tests yielded results within the normal range or were negative, with the exception of the antinuclear antibody. He did not respond to conventional IMT and biological response modifier agents. Ultimately, the patient began oral cyclophosphamide. One month after commencing cyclophosphamide treatment, the oral prednisone dosage was gradually reduced without any flare-up. oral cyclophosphamide can serve as a valuable treatment for periocular inflammation that does not respond to standard conventional IMT and biologic response modifier agents.

Anterior segment ischemia (ASI) is a rare, almost forgotten complication of scleral buckle (SB) surgery. The course varies from mild self-limited to severe type causing significant vision loss. A number of local and systemic factors can precipitate ASI. It is important to be aware of these factors and take the necessary steps to avoid this complication. Despite that, if the patient develops ASI, early recognition is important. Mild cases are managed conservatively whereas severe cases will require removal of the band. We present a case of an 18-year-old male who developed a mild type of ASI post-SB surgery managed conservatively.

Context: Microbial keratitis is a potentially vision-threatening emergency that demands prompt diagnosis and treatment to ensure better vision recovery. Empirical use of broad-spectrum antimicrobial therapies is often the primary treatment modality, which is then tailored according to clinical response, cultured organisms, and their sensitivities. Since the spectrum of microbial agents associated with corneal ulcers is wide and varies from one geographical location to another, it is imperative that local microbial trends and susceptibility patterns are analyzed to enable better care in the management of these patients.

Aims: The aim of the study was to report the microbiological profile and in vitro drug susceptibility patterns of bacterial isolates obtained from patients with microbial keratitis in a single tertiary center in Andhra Pradesh over 12 years.

Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures from the years 2010 to 2021 were reviewed. Trends in bacterial and fungal etiology along with the antibiotic susceptibility profile of bacteria were analyzed.

Statistical analysis used: Frequency distribution was obtained, and percentages were calculated.

Results: Of the 8529 microbial keratitis samples, 3581 corneal scrapings were culture positive which included Gram-positive bacteria (1054/3581, 29.4%), Gram-negative bacteria (476/3581, 13.2%), fungi (2051/3581, 57.2%), and parasites (369/3581, 10.3%). The most common fungal isolate was Fusarium species (557/1748, 31.8%) followed by Aspergillus flavus (495/1748, 28.3%). Similarly, the most common Gram-positive bacteria included Streptococcus pneumoniae (297/891, 33.3%) and Staphylococcus species (213/891, 23.9%), and the most common Gram-negative bacteria was Pseudomonas aeruginosa (294/403, 72.9%). Overall susceptibility patterns showed that Gram-positive bacteria were susceptible to vancomycin (92%), cefazolin (88%), and chloramphenicol (86%), while Gram-negative bacteria were most susceptible to gentamicin and amikacin (81%). The susceptibility to amikacin and gentamicin increased significantly from 71% in 2010 to 92% in 2021 and 74% in 2010 to 92% in 2021, respectively. In comparison, the susceptibility of fluoroquinolones for both Gram-positive and Gram-negative bacteria did not show any significant change over the study period.

Conclusions: The prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study reinforced that fluoroquinolones and vancomycin continue to be good empiric therapies for treating bacterial keratitis in Andhra Pradesh.

Direct carotid cavernous fistula is an abnormal arterio-venous connection from the carotid artery to the cavernous sinus (CS), resulting in high-pressure arterial blood entering the low-pressure venous CS. Most often, it occurs posttrauma and presents with ipsilateral orbital signs. In this report, we describe the case of a 54-year-old man, who presented with a late-onset right-sided red eye and diplopia following contralateral (left sided) orbital trauma (road traffic accident 7 months ago). Ocular examination revealed signs of Lateral rectus palsy, axial proptosis, and elevated intraocular pressure with dilated episcleral vessels in the right eye. Clinical findings were consistent with the diagnosis of right-sided direct CCF. To our surprise, digital subtraction angiogram revealed a left CCF with prominence of signs on the contralateral side. He underwent near-total endovascular coiling of the fistula, with initial aggravation of symptoms followed by near-total resolution.

Neuro-optometric rehabilitation has a broad range of potential rehabilitative applications in neurological and developmental conditions affecting the eye. There is a dearth of evidence supporting its effectiveness, especially in adults. To address this issue, we systematically reviewed literature published in English between January 2000 and June 2022, obtained from search engines such as PubMed, EMBASE, Scopus, and CINAHL, using keywords including "neuro optometry," "rehabilitation" or a related term, and "oculomotor problem" or "neurological problem" or a related term. Duplicates were eliminated through Mendeley software, and the quality of the selected studies was evaluated using JBI's critical appraisal tools. Two authors independently reviewed six full-text articles. Relevant data were extracted to Microsoft Excel, and a third author reviewed it. Any uncertainties were resolved through consultation with the last author. Selected studies included adults who had oculomotor problems resulted either from traumatic brain injury/stroke/cerebrovascular accidents and managed with various rehabilitative therapies. Office-based, home-based, or combination therapies with duration ranging from 8 to 12 weeks with the frequency of 2-5 sessions/week were found effective in managing oculomotor problems in adults. However, there is a need for more clinical studies with a larger sample size in this regard.

Objective: This study aims to describe a novel technique for implanting an intraocular lens (IOL) in the sulcus using a 10-0 nylon suture in cases of intraoperative posterior capsular rupture (PCR) with inadequate capsular support, anterior capsular extension during continuous curvilinear capsulorrhexis extending to the posterior capsule, or posttraumatic cataract.

Methods: The study included 52 patients who underwent surgery at our hospital, during which an IOL was implanted with the assistance of a 10-0 nylon suture. All patients completed a 1-year follow-up period.

Results: In 48 of the 52 patients, the IOL remained stable. However, in two patients, the IOL dropped into the vitreous cavity approximately 1-month postsurgery. These two individuals required IOL explantation, pars plana vitrectomy, and secondary IOL (SFIOL) implantation.

Conclusion: Implanting an IOL in cases involving intraoperative PCR with inadequate capsular support, anterior capsular extension to the posterior capsule during continuous curvilinear capsulorrhexis, or posttraumatic cataract can be challenging. The technique of IOL implantation with the assistance of a 10-0 nylon suture, as described in this study, offers a straightforward and safe approach. In addition, it can help alleviate the financial and psychological trauma associated with a second surgery for both the patient and the surgeon.

Thyroid eye disease (TED), also known as thyroid-associated ophthalmopathy, is an autoimmune disorder caused due to a complex interplay between autoantigens including the thyroid-stimulating hormone receptor and the insulin-like growth factor-I receptor. TED is characterized by progressive proptosis or diplopia. This systematic review aimed to compare the efficacy of the newer monoclonal antibody - teprotumumab and intravenous methylprednisolone (IVMP) in TED patients. We performed a systematic review of previously published studies from 2013 to June 2023. A total of 329 articles were screened; among them, 111 non-duplicate publications were identified. After the screening of titles and abstracts, 156 publications were excluded; then, another 47 published papers were excluded after the full-text screening. The remaining 15 eligible studies were included in this systematic review. The majority of studies used either teprotumumab alone or in combination with others. Among 15 studies, eight studies used teprotumumab in TED patients, whereas remaining 7 studies used a standard treatment regimen. This systematic review provides an overview of the existing treatment options using monoclonal antibody - teprotumumab and IVMP in TED patients. The overall assessment provides a finding that antibody - teprotumumab is is a good choice compared to conventional IVMP for providing better outcomes in patients with TED.