Oman Journal of Ophthalmology最新文献

Objectives: This study aims to evaluate the efficacy and safety of intravitreal brolucizumab (IVBr), a novel antivascular endothelial growth factor agent, in the treatment of diabetic macular edema (DME) by assessing both functional (visual) and structural (anatomical) improvements.

Materials and methods: A retrospective, interventional study was conducted at the ophthalmology outpatient department of Sultan Qaboos University Hospital at University Medical City. A cohort of twenty patients (60 injections) with DME received three IVBr injections (6 mg/0.05 mL) over 18 weeks. This cohort consists of 10 male and 10 female patients, with a mean age of 57.1 years (range: 35-81; standard deviation [SD] 14.37). The best-corrected visual acuity (BCVA) was measured and recorded in equivalent logMAR. The subfoveal macular thickness (SFMT) was assessed with optical coherence tomography. Statistical analysis was carried out using paired t-test, and 95% confidence intervals were calculated to compare changes in outcomes, with a significance threshold set at P < 0.05.

Results: The BCVA improved significantly from a baseline mean of logMar 0.36 (SD 0.7) to 0.22 (SD 0.5) after the third injection (P < 0.002). SFMT decreased from a mean of 517.75 μm (SD 160.27) to 287.95 μm (SD 101.31), P < 0.001. One patient developed intraocular inflammation, and no other major complications were observed. However, 35% of patients (n = 7) experienced inadequate visual improvement, attributed to underlying factors such as macular ischemia, retinal layer disorganization, disruption of the ellipsoid zone, and residual macular edema.

Conclusion: The study findings in this cohort demonstrated statistically significant improvement in BCVA and a substantial decrease in SFMT. However, more real-world studies are required to enhance the validation of this study's findings.

Orbital venolymphatic malformation (OVLM) consists of abnormal vascular channels lined by endothelial cells with venous and lymphatic components. OVLM tends to re-grow after treatment, with a recurrence rate of 71.4% after surgery. The use of sclerotherapy injection has emerged as a nonsurgical procedure as extensive surgery may cause iatrogenic damage to vital structures within the orbit. Therefore, exploring the efficacy and safety profile of bleomycin injection for OVLM in achieving proptosis reduction, recurrence rate, visual acuity improvement or stabilization, and the complication of bleomycin is considered important. Current studies showed bleomycin resulted in proptosis reduction in 87.78% of patients and stayed stable in 12.22% of patients, with a median of 6 months' follow-up. The recurrence rate was 0.76% since only one patient had the recurrence due to rebleed and chocolate cyst formation. Visual acuity improved in 63.64% of patients, while 36.36% remained stable. Minimal complications were reported, including periocular hyperpigmentation (14.5%) and inflammation (8.40%). Bleomycin injection as a sclerotherapy is considered an effective and safe treatment modality for OVLM.

A 17-year-old healthy female presented with complaints of headaches for the last year. A comprehensive ophthalmic evaluation was done. Fundoscopy revealed a torpedo-shaped lesion nasal to the optic disc in the left eye. Optical coherence tomography through the scan showed type one features. Torpedo lesions may also occur in extramacular locations. Changes in nomenclature to torpedo retinopathy can be considered when describing such lesions.

Background: Ocular injuries are common in patients with orbital fractures. However, in Tanzania, there is a paucity of studies investigating ocular injuries associated with orbital fractures. Hence, this study aimed to determine the ocular injuries in patients who have sustained orbital fractures in Tanzania.

Methods: This cross-sectional study was carried out for a year at Muhimbili National Hospital. All patients who had sustained orbital fractures were recruited for the study. The questionnaire was designed to obtain patients' sociodemographic information, presenting ocular findings, and outcomes after treatment. The data were analyzed using IBM, NY, USA ® SPSS Statistics version 27.

Results: The study included 131 patients, with 125 (95.4%) being males, and the mean age of participants was 32.22 ± 9.87 years. All patients (100%) presented with one or more ocular injuries ranging from 1-7. Most (n = 40, 30.5%) had three different ocular injuries. While all patients had minor ocular injuries, only 16 (12.2%) had major ocular injuries. During follow-up postmanagement of the orbital injuries, 12 (9.2%) patients had ocular-related complications despite the management offered.

Conclusion: The ocular injuries are evident in all patients who have sustained orbital bone fractures; however, the occurrence of major/serious ocular injury is low. Subconjunctival hemorrhage is the most frequently observed ocular injury.

Characteristic features of Noonan syndrome include dysmorphic facies, short stature, and congenital cardiac defects. Pathogenic variants in PTPN11 are one of the common causes and may result in optic nerve head anomalies. We describe the optic nerve findings in two families with Noonan syndrome due to pathogenic variants in PTPN11. Optic nerve anomalies, including an enlarged cup/disc ratio, are a feature of Noonan syndrome due to pathogenic variants in PTPN11. This optic nerve anomaly could potentially lead to the misdiagnosis of glaucoma. PTPN11 is important for functional fibroblast growth factor signaling, which, if interrupted, may lead to optic nerve dysgenesis and ocular coloboma.

Introduction: Diabetic retinopathy (DR) is a leading cause of vision loss globally, and its burden is increasing, particularly in regions with a high prevalence of diabetes like Oman. Early detection and timely intervention are crucial for preventing vision loss and improving patient outcomes. This study aimed to evaluate referral patterns and screening outcomes for DR at Bowsher Specialized Polyclinics (BSP) in Muscat, Oman.

Methodology: In this cross-sectional study conducted between January 1 and December 31, 2023, data were retrospectively collected from the electronic health records of 6677 patients referred to BSP. The assessment included referral sources, reasons for referral, patient demographics, waiting times, screening results, and follow-up plans.

Results: A high proportion of external referrals (79%), with 90.6% being routine. Nearly half of the referrals were for DR screening, and among those screened, 16.9% had abnormal findings, with mild nonproliferative DR (NPDR) being the most prevalent. Males showed a significantly higher proportion of abnormal screening outcomes. In addition, mean waiting times were long (145.8 days), and 39.5% of patients were defaulters.

Conclusions: These findings highlight the need for targeted interventions to optimize referral pathways, expand screening capacity, and enhance patient engagement to improve DR management.

Background: Glaucoma accounts for 15% of global blindness. Secondary glaucoma, that is, glaucoma resulting from numerous ocular or systemic disorders, shows poor intraocular pressure (IOP) control with ocular hypotensive agents or filtering surgery in late stages. The present study was aimed to study the clinical profile of patients with secondary glaucoma at a tertiary hospital.

Materials and methods: The present study was a single-center, cross-sectional, observational study, conducted in patients with raised IOP associated with an antecedent cause or ocular pathology visiting the department of ophthalmology, a tertiary care center in western India.

Results: A total of 70 eyes of 70 patients were included in the study, out of which 38 (54.3%) were males, and majority of patients were between 41 and 60 years of age (44.3%). Common causes of secondary glaucoma were inflammatory glaucoma (22.9%), psuedophakic glaucoma (17.1%), postkeratoplasty glaucoma (15.7%), postvitreoretinal surgery glaucoma (10%), steroid-induced glaucoma (10%), and lens-induced glaucoma (7.1%). Best-corrected visual acuity was <6/60 in 27 (38%) patients, 6/60 - 6/18 in 34 (48.6%), and better than 6/18 in nine (12.9%) patients. The highest recorded IOP was more than 50 mmHg in 11.4% of patients, 31-50 mmHg in 20%, and <30 mmHg in 68.6% of patients. Forty-nine (75.4%) patients had open angles, and 16 (24.6%) had angle closure on examination.

Conclusion: Anterior segment inflammation is the most common cause of inflammatory glaucoma. Patients with silicon oil as a vitreous substitute are at a higher risk of developing postvitreoretinal surgery glaucoma.

Purpose: The purpose of the study was to assess color vision (CV) and contrast sensitivity (CS) in patients with primary angle closure glaucoma (PACG) and primary angle closure (PAC) and to correlate these changes with age-matched controls. In addition, to asses this correlation with optical coherence tomography (OCT) retinal nerve fiber layer (RNFL).

Materials and methods: CV (using D-15 and Ishihara test) and CS (using Spaeth Richman Contrast Sensitivity Test [SPARCS] and Pelli Robson test) were analyzed in patients with PACG (Group 1) (33 eyes), PAC (Group 2) (27 eyes), and controls (Group 3) (60 eyes). OCT RNFL and Humphrey visual field testing was also done for cases and controls.

Results: Out of a total of 33 eyes in Group 1, 2 (6%) eyes had no defect, 20 (60.6%) had protan defects, 2 (6%) had deutran defects, and 9 (27.3%) eyes had tritan defects. Of the 27 eyes in Group 2, 1 (3.7%) eye had no CV defect, 19 (70.3%) eyes had protan defects, and 7 (25.9%) eyes had tritan defects. None of the eyes in Group 2 had a deutran defect. Forty-seven (78.3%) eyes from Group 3 had no CV defect, 10 eyes (16.6%) had a protan defect, and 3 (5%) of the eyes showed a tritan defect. All Group 1 and Group 2 eyes had a C-Index of >1.4. Twenty-eight eyes had a total SPARCS score <70, 18 eyes belonged to Group 1, and 10 eyes belonged to Group 2. There was no statistically significant difference in central and peripheral CS (in all the quadrants) between Groups 1 and 2.

Conclusion: Qualitative and functional vision parameters are affected even in PAC patients before PACG sets in clinically. Hence, early and regular screening of these parameters is required.

The rising use of biologicals, especially the anti-tumor necrosis factor α inhibitors (anti-TNF-α inhibitors) such as adalimumab, certolizumab pegol, etanercept, and infliximab in cases of recalcitrant uveitis with systemic associations have proved to be an effective treatment of choice. However, it also carries an additional risk of developing infections like tuberculosis in an endemic country like India. We present an interesting case of a young male with a history of chronic juvenile idiopathic arthritis treated with adalimumab. He eventually went on to develop ascites, which were presumed to be tubercular in etiology, and hence, an immediate cessation of the biologic was required. The case highlights the known complications of adalimumab and also emphasizes the need for close monitoring of patients on adalimumab.