Romanian journal of ophthalmology最新文献

Introduction: Uveitis is a disease that manifests with increased vascular permeability and occlusion, with some ischemia and inflammatory mediators. It is characterized by a wide range of pathological processes, including inflammation, increased vascular permeability and occlusion, local ischemia and cell alteration by inflammatory mediators, and is characterized by the presence of complications. Aim: To study the state of ocular hemodynamics by rheoophthalmography, as well as the immune status in patients with idiopathic recurrent anterior uveitis complicated by intraocular hypertension, Fuchs heterochromic uveitis, Posner-Schlossman syndrome, during the relapse period. Materials and methods: 93 patients with idiopathic recurrent anterior uveitis were included in this study, 8 patients with Fuchs' uveitis, and 6 patients with Posner-Schlossman syndrome. According to clinical signs, relapse and remission were considered. The control group (healthy volunteers of the same age) consisted of 27 people. In this regard, 5 groups of subjects were formed. The mean age of the patients was (M ± SD) 39.2 ± 14.6 years. According to the Median (range), the duration of the disease in patients was 2033 (350-3285) days, intraocular hypertension being recorded at P0 > 20 mm Hg. Statistical analysis was carried out in spreadsheets using STATISTICA 8.0 (StatSoft.Inc) program. Quantitative indicators were evaluated according to the correspondence to the normal distribution and to the Kolmogorov-Smirnov criterion. With a normal distribution, arithmetic means (M) and standard deviations (SD), limits of the 95% confidence interval (95% CI) and Student's t-test were calculated. Results: The volumetric blood filling of the eye according to the rheoophthalmographic indicator RQ during the period of remission of uncomplicated and complicated by hypertension anterior uveitis was reduced by 32.4%-40.5%, respectively, compared with the norm. During the period of relapse, RQ was significantly higher by 28% (p<0.05) than in remission, in the group of uncomplicated uveitis, and in the group of uveitis with increased IOP, no significant differences between the periods of remission and relapse were observed, which reflected the ischemic process in the relapse period. Volumetric blood filling in Fuchs and Posner-Schlossman syndromes in the acute period did not differ from the norm. Cellular immunity in the groups of uncomplicated and complicated by intraocular hypertension idiopathic uveitis, as well as with Fuchs and Posner-Schlossman syndromes, had a higher level of CD4 helper lymphocytes and a lower level of CD8 suppressor lymphocytes, which reflected higher values of the immunoregulatory index. The increase in the immunoregulatory index is most pronounced in Fuchs and Posner-Schlossman syndromes. Discussion: In the presented study, the incidence of idiopathic recurrent anterior uveitis complicated by intraocular hypertension was 9

Purpose: To present the case of a patient with a history of trauma and corneal foreign body in the right eye, followed by decreased visual acuity in the right eye, corneal perforation with good recovery after surgical treatment. Material and method: We report a case of a patient who presented to our clinic with a sudden decrease of visual acuity in the right eye, two months after an incident resulting in a corneal foreign body in the right eye. In the case presented, the patient applied a local medical self-treatment, an antibiotic and a topical corticosteroid. After a few weeks, the patient presented to the ophthalmologist, a foreign body was extracted from the cornea of the right eye and a topical treatment with a non-steroidal anti-inflammatory drug, a cycloplegic and an antibiotic were indicated. However, corneal perforation occurred and the patient was urgently sent to our service, where a corneal anaesthesia was also found. Results: Corneal perforation healed with a minor paracentral opacification. Discussions: Corneal perforation in our patient was due to corneal melting because of topical steroid anti-inflammatory autotherapy, late corneal foreign body extraction and topical treatment with non-steroidal anti-inflammatory drugs. Corneal anesthesia is also an important factor that enhances corneal melting and perforation. The surgical intervention performed healed the corneal perforation. Conclusions: Corneal anaesthesia and topical anti-inflammatory administration led to corneal perforation. Corneal sensitivity should be tested in patients with corneal foreign body. Corneal patching proved to be an adequate solution in this patient.

Objective: The implementation of guideline recommendations for antibiotics prescription for the management of patients with acute infective conjunctivitis (AIC) in primary care departments remains below par. Our objective was to assess the impact of clinical audit on adherence to evidence-based indications for prescription of antibiotic eye drops in patients diagnosed with AIC, in the setting of a primary care practice in western Greece. Methods: We conducted a retrospective audit to evaluate the current prescription practice of antibiotics for the management of AIC. Following evidence-based indications for the prescription of antibiotics in AIC through literature search, and in combination with discussion and collaboration with the primary care doctors of our department, we formulated and implemented guidelines for the management of AIC. We then performed a prospective re-audit to assess the management of patients with AIC after local implementation of the guidelines. Results: A total of 158 cases were audited in the first cycle before the introduction of the guidelines, from 15th June 2019 to 7th March 2020, and 26 cases after, from 10th March 2020 to 20th November 2020. The compliance with the guidelines regarding antibiotics prescription was significantly improved from 12.0% to 84.6% between the first and the second cycles of audit. Conclusions: In this study, with the local introduction of guidelines, clinical audit significantly improved the prescription practice of topical antibiotics in patients with AIC in a primary care department. Abbreviations: AIC = acute infective conjunctivitis.

Objective: The aim of this study was to evaluate structural and vascular changes in the choroid after phacoemulsification surgery. Methods: This research comprised 50 eyes of 50 individuals who received uneventful surgical treatment for cataracts. Intraocular pressure, axial length, subfoveal choroidal thickness, and choroidal thickness in the nasal and temporal areas at 1,500-micron distance from the fovea were measured before surgery and at one and three months after surgery. At the same evaluation times, the choroidal luminal area and choroidal stromal area were calculated with the binarization method using image J software, and the choroidal vascular index (CVI) was calculated by dividing the luminal area by the total area. In addition, total surgery time and effective phacoemulsification time were recorded. Results: The patients had a mean age of 64.7 ± 8.5 years. The mean total operative time was 13.9 ± 3.8 minutes, and the mean effective phacoemulsification time was 3.8 ± 2.1 minutes. The mean intraocular pressure value was 14.4 ± 3.4 mmHg before surgery, and 13.2 ± 2.9 mmHg at the first month and 13.0 ± 2.1 mmHg at the third month postoperatively. Although there was a decrease in the intraocular pressure after surgery, no significant difference was found (p>0.05 for all). The axial length measured during the first and third months postoperatively did not significantly differ from the evaluation undertaken preoperatively (p>0.05 for all). A significant increase was detected in the subfoveal, nasal, and temporal choroidal thicknesses at the first postoperative month compared to the preoperative values (p<0.05), but no significant difference was found at the third month postoperatively (p>0.05). The mean CVI was 61.6 ± 3.5% preoperatively, 65.2 ± 4.2% at the first postoperative month, and 65.9 ± 3.9% at the third postoperative month. The increase at the first and third postoperative months was significant when compared to the evaluation made preoperatively (p=0.004 and p<0.001, respectively). Conclusion: Structural and vascular choroidal changes in the after-cataract surgery are important. In this study, it was observed that after uneventful phacoemulsification, the choroidal thickness increased at the first postoperative month and reached the preoperative values at the third month. It was also determined that CVI increased at the first and third postoperative months. CVI can offer an idea about whether cataract surgery is a predisposing factor in diseases involving the choroid. Abbreviations: CVI = choroidal vascular index.

Aim: Trabeculectomy is the gold standard surgery for achieving target intraocular pressure (IOP) in glaucoma. Besides the efficiency of trabeculectomy, intraoperative or postoperative complications such as, suprachoroidal hemorrhage, vitreous loss, malignant glaucoma, flat anterior chamber, hypotony, choroidal detachment, endophthalmitis, are also quite important. We present the management of excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication. Case report: A 66-year-old woman was referred to our glaucoma unit with progression of primary open angle glaucoma. No known systemic disease was observed in her history except hypertension. The best-corrected visual acuity was 20/ 63 in the right eye and 20/ 20 in the left eye. IOP was 27 mmHg and 19 mmHg (with bimatoprost timolol fixed combination and brimonidine tartrate) in the right and left eyes, respectively. We planned trabeculectomy with mitomycin C for the right eye of the patient. Excessive conjunctival and scleral retraction occurred during surgery. Autograft conjunctival tissue was prepared to cover for bare sclera area. No complications were observed in postoperative period. Seronegative spondyloarthropathy (HLA-B27-negative) was diagnosed postoperatively as a result of consultations. Discussion: Conjunctival retraction is observed as a postoperative complication after trabeculectomy. Postoperative conjunctival retraction can cause bleb leakage and hypotony, as well as predispose to infection. Nowadays, micro invasive glaucoma surgery (MIGS) is gaining popularity, especially because of its reduced complication rate compared to trabeculectomy. However, considering the IOP reduction rates, MIGS has been indicated in mild and moderate glaucoma. Conclusions: We presented the management of excessive conjunctival and scleral retraction during trabeculectomy, which has not been reported earlier. Conjunctival autograft transplantation is useful to manage this complication.

Aim: To assess efficacy of intrastromal voriconazole (ISV) in the treatment of fungal keratitis non-responding to conventional antifungals. Methods: Eighteen patients with smear positive fungal keratitis, not responding to conventional topical/ systemic antifungal therapy up to 2 weeks, were included in the study. Afterwards, they were given ISV (50 µg in 0.1 ml) around the ulcer and continued to receive conventional antifungal therapy. Responses to treatment (decrease in size of the ulcer and infiltrates) were recorded daily for 3-days, at 1-week and every 2 weeks for 3-months, or until the ulcer had healed completely. Results: The mean age at presentation was 51 ± 17.83 years. The most common organism isolated was Fusarium (17/ 18), followed by Aspergillus (1/ 18). All the patients were successfully treated in terms of corneal healing, but one case did not improve in vision due to the existence of diabetic macular oedema. 6 patients improved after a single injection, 7 had to receive 2 and 5 improved after 3 injections. The mean number of injections in 17 treated patients was 1.94 ± 0.78. Moreover, the mean resolution time was 18.50 ± 6.25 days. The size of ulcer and height of hypopyon at presentation were noteworthy risk-factors linked to management outcomes. Deeper ulcers required a greater number of injections when compared to superficial ulcers. The mean best-corrected visual acuity improved from 0.94 to 0.25 at 3 months follow-up in all the patients. Conclusion: Intrastromal Voriconazole (50 µg/ 0.1 mL) appears to be an effective adjunct therapy in cases of recalcitrant deep fungal keratitis non-responding to conventional antifungals. Though, some may require repeated injections, timely ISV administration certainly reducing the need for tectonic/ therapeutic keratoplasty. Abbreviations: ISV = Intrastromal Voriconazole, AS-OCT = anterior-segment optical coherence topography, KOH = potassium hydroxide, BCVA = best-corrected visual acuity.

We aimed to test a novel concept based on multiple IOL-implantation, targeting spectacle independence for patients with high and excessive myopia (26.0 mm < axial length; 6.0 D < refractive error). Therefore, we introduced the first results of five patients with high myopia. After clear lens extraction, one eye was targeted to emmetropia, and the other to mild myopia by implanting monofocal capsular bag IOLs with appropriate refractive powers in each case. The emmetropic eye was aimed to result in magnification and improved distance vision, while the mild myopic eye was supposed to ensure good intermediate vision. Thereafter, a Scharioth Macula Lens (SML) was implanted into the emmetropic eye in order to achieve sharp near vision. Visual acuity curves and defocus curves were plotted postoperatively. According to our results, this new concept seems to be an efficient approach of achieving appropriate uncorrected vision at all distances, by creating binocular trifocal monovision.

The aim of this review is to highlight the importance and benefits of eye tracking in Neuromarketing, by analyzing research papers and articles from international databases such as Scopus, PubMed, Elsevier, Springer and Science Direct. After analyzing some of the most representative publications related to eye tracking in Neuromarketing, we have concluded that it can be considered one of the most important tools in determining the consumers' intent to buy medical products and services. In addition, with a mixture between standard Marketing Research methods and the eye-tracking technology, the researchers can get insight into unconscious factors that influence the consumers' choices and preferences. In conclusion, neuromarketing can prevent the waste of money spent on ineffective marketing campaigns.

Objective: Low levels of outdoor activity are known to be an important risk factor for the development of myopia in schoolchildren. This study aimed to determine outdoor and near work patterns in Polish schoolchildren before and during school closure due to the SARS-CoV-2 pandemic. Methods: All children undergoing a routine pediatric examination in the Elbląg branch of the Hygeia Clinic, together with their parents, were asked to fill an anonymous questionnaire. The subject's age, spherical equivalent (SE) refractive error, time spent outdoors, screen time and total near work in hours per day before and during the pandemic, were recorded. As substantial differences in physical activity by time of year were reported, activity patterns for June (summer) and December (winter) were recorded. Multiple logistic regression analysis was used to analyze the association between the presence of myopia and outdoor and total near work time at different timepoints. Results: A total of 61 schoolchildren aged 11.95 ± 2.74 (range 7 to 17) years were included in this study. The mean SE in the right eye was -1.78 ± 2.11 with 46% of the individuals (n=28) classified as myopic. Before the pandemic, higher time outdoors was associated with less myopic SE (OR=0.47, 95% Confidence Interval [CI] 0.24 to 0.93). During the pandemic, time outdoors among non-myopic children was similar to myopic children, both during winter and summer months (2.18 ± 1.81 vs. 1.89 ± 1.50; P=.51, and 3.47 ± 2.66 vs. 3.31 ± 1.65; P=.79 respectively). Time outdoors was not significantly associated with myopia during the pandemic (OR=1.17, 95% CI 0.64 to 2.14). Total near work was not associated with myopia at any time point. Conclusion: The long-term influence of the changing patterns of outdoor and near work on myopia prevalence and progression in our population is still to be established. Nevertheless, it is likely that the decrease of outdoor time may influence the rates of myopia in this region.

Aim: This report aims to discuss and review the diagnosis and management of acute acquired comitant esotropia (AACE) in children and to add several cases to the limited literature available on this unusual condition in the pediatric population. Materials and methods: We present two cases of AACE with large-angle deviations that were investigated and followed-up according to current recommendations. Both cases required strabismus surgery for AACE, but different procedures were chosen, with good postoperative results. Results: Unilateral recession of the medial rectus and resection of the lateral rectus (R&R) were performed in one case and bilateral medial rectus (MR) recession in the other, with resolution of the diplopia and full recovery of binocular vision. Discussion: Although isolated AACE is usually benign, studies have reported the presence of intracranial disease in up to 10% of cases, making it a potential first sign of an underlying serious pathology. Therefore, AACE should be investigated as a medical emergency and neuroimaging should be performed in all patients with unclear onset of AACE, as well as in those with associated neurological symptoms, such as headache, cerebellar imbalance, weakness, or nystagmus. Conclusion: Acute acquired comitant esotropia (AACE) is an infrequent type of esotropia that usually appears in older children. It is characterized by esotropia and diplopia with acute onset. Neurological examinations and neuroimaging should be performed to exclude any potential intracranial disease. Treatment of AACE without underlying neurological disease is focused on managing the diplopia and resolving the esotropia. Strabismus surgery has good motor and sensory results and can successfully restore good binocular function. Abbreviations: AACE = Acute acquired comitant esotropia, LR = lateral rectus, MR = medial rectus, PD = prism diopters, R&R = recession and resection, BSV = binocular single vision, PAT = prism adaptation test.