Romanian journal of ophthalmology最新文献

Introduction: Advances in technology and technique have led to a significant improvement in the prognosis after cataract surgery. However, there are complications that can significantly affect this prognosis, such as posterior capsule rupture and corneal decompensation. For vitreous prolapse associated with posterior capsule rupture, classic or pars plana anterior vitrectomy is required. Aim: The aim of the study was to compare corneal endothelial cell destruction after cataract surgery associated with posterior capsule rupture and classical and pars plana anterior vitrectomy, respectively. Material and method: The study was prospective, on 12 consecutive cases of cataract surgery associated with posterior capsule rupture. Classical anterior vitrectomy was performed in group A, with 5 patients, while pars plana anterior vitrectomy was performed in group B. For all cases, the Stellaris phacoemulsification device (Baush & Lomb, tm) and the associated vitrectomy device was used. Results: Pars plana anterior vitrectomy had a statistically significant lower rate of corneal endothelial damage, both in absolute value and as a percentage of initial density. Conclusions: Pars plana anterior surgery is a somewhat unfamiliar technique for anterior pole surgeons. But it is easy to learn and brings a decrease in the rate of damage to the corneal endothelium.

Purpose: To estimate the correlation between graft thickness as measured by anterior segment Optical Coherence Tomography and visual recovery after manual Descemet stripping endothelial keratoplasty. Design: Prospective observational study. Materials and methods: This prospective observational study included 25 patients with pseudophakic bullous keratopathy, who underwent DSEK. Visual acuity in LogMAR units and estimation of graft thickness measured by Anterior Segment Optical Coherence Tomography (AS-OCT) was carried out on postoperative day 1, 3rd month and 6th month. Correlation analysis was performed between graft thickness and postoperative visual acuity on postoperative day 1, 3rd month and 6th month. Results: The mean LogMAR visual acuity improved in all patients post DSEK - 1.47 (±0.48) to 0.75 (±0.38) LogMAR units. The average postoperative day 1 central corneal thickness was 724.96 µm (±77.59 µm), which decreased to mean central corneal thickness of 655.56 (±61.08 µm) on 3rd month and 633.48 (58.72) by the 6th month. Mean donor graft thickness on postoperative day 1, 3rd month and 6th month in this study was found to be 169.3 µm (±36.6 µm), 135.9 µm (±29.8 µm) and 127.5 µm (±31 µm) corresponding to a BCVA of 1.94, 0.86 and 0.75 LogMAR units respectively. On correlation analysis, thinner grafts were found to be associated with better postoperative BCVA especially on the 3rd and 6th month follow-up period. Conclusion: This study found that a higher proportion of thinner grafts achieved better postoperative visual rehabilitation and earlier stabilization of visual acuity.

Aim: To assess the role of Ocular Trauma Score (OTS) and Pediatric Penetrating Ocular Trauma Score (POTS) in predicting visual prognosis following ocular injury. Methods: 120 patients, aged 3 to 70 years, with ocular injury, presenting between August 2020 and 2021, who fulfilled the inclusion criteria, were classified using the Birmingham Eye Trauma Terminology System (BETTS). Data regarding age, sex, injury type, location, initial visual acuity, and treatment were recorded. Patients were evaluated using OTS and POTS, wherever applicable, to predict visual prognosis. Follow-up was done for 6 months post-treatment to compare the predicted and actual visual outcome. Results: 120 patients (96 males and 24 females) were included in the study. The mean age was 17.2 ± 14.7 years (range 3 to 70 years). 91.6% patients included were under the age of 40 years. Blunt trauma (n=62) was slightly more common. 80 patients (66.67%) reported to the hospital after 48 hours of injury. 34 patients (28.33%) had traumatic cataract alone and IOL implantation was done as a primary procedure. In 20 patients (16.67%), lens aspiration was done primarily, with secondary IOL implantation. Six months after the treatment, the BCVA in the open globe injury patients was 20/ 200 or better in 36 patients (75%) and 20/ 40 or better in 18 patients (37.5%). Amongst the closed globe injuries, 48 patients (66.67%), had a BCVA 20/ 200 or better, while 32 (44.44%) had a BCVA of 20/ 40 or better. Conclusion: OTS is a reliable predictor of final visual outcome, both in blunt and penetrating injuries. The POTS shows gross underestimation of final visual outcome. Abbreviations: BETTS = Birmingham Eye Trauma Terminology System, POTS = Pediatric Penetrating Ocular Trauma Score, OTS = Ocular Trauma Score, OGI = Open Globe Injury, HM = Hand Movement, NLP = No Light Perception, LP = Light Perception, CGI = Closed Globe Injury, VA = Visual Acuity, BCVA = Best Corrected Visual Acuity, IAP = Indian Academy of Pediatrics, IOL = Intraocular Lens, IGATES = International Globe and Adnexal Trauma Epidemiology Study, IOP = Intraocular Pressure, CART = Classification and Regression Tree, USA = United States of America.

Objective: The purpose of this study was to assess the quality of vision of patients who have chosen orthokeratology, and to identify different incidents that occur in patients who used this type of therapy. Materials and methods: The study was conducted on a group of 10 patients who had a follow-up period of at least 4 years and presented regularly to ophthalmological check-ups. The clinical parameters that were analyzed are the following: ocular refraction before and after orthokeratology therapy, the appearance of corneal topography, the slit-lamp examination of the anterior segment of the eye, incidents determined by night contact lenses, as well as ocular comfort. Results: Issues produced by night lenses occurred in two cases due to deficient hygiene and care and in one case due to disruption of lens wear. Menicon lenses were used in 7 cases and Precilens lenses were used in 3 cases. The initial visual acuity without correction was between 0.02 and 0.7, and after orthokeratology 8 out of 10 patients had a visual acuity of 1. Conclusions: In our study, orthokeratology therapy demonstrated its efficiency in slowing myopia progression and no severe complication was observed during the follow-up period.

Objective: Our aim was to present a rare case of a middle-aged male patient, diagnosed with Graves' orbitopathy, which had an atypical rapid unilateral onset. Initially, the left eye presented exophthalmos, eyelid retraction, corneal ulceration, and pannus formation with an important vascular component due to corneal exposure. The same symptoms developed in the right eye within a short period of time. Methods: A 52-year-old man presented in our department with bilateral proptosis, decrease in visual acuity, and orbital pain, which developed initially in the left eye seven months before the right eye. Slit lamp examination revealed conjunctival hyperemia, purulent discharge, chemosis and inflammation of the caruncle in both eyes. The fluorescein eye stain test was positive due to corneal ulceration with the presence of cells and flare in anterior chamber in the RE (right eye). The LE (left eye) presented a corneal pannus. We documented the changes using a slit lamp biomicroscope, a fundus camera, orbital ultrasonography, and contrast CT (computer tomography) scans. Discussions: The severe Graves' ophthalmopathy represents a challenge both in active or inactive phase. Medical and surgical therapies should be taken into consideration in order to prevent the complications following corneal perforation or optic neuropathy. Also, ophthalmic, and systemic adverse reactions of systemic steroids used in the treatment of Graves' disease are important in the prognosis of the visual outcome. Conclusions: The management of Graves' ophthalmopathy is multidisciplinary and needs a very good therapy adherence in order to achieve a satisfactory prognosis and quality of life.

A 66-year-old North-East Indian male presented with bilateral eyelid swelling, ptosis, and bilateral submandibular gland enlargement. Dry skin on both arms was another peculiar complaint. Contrast enhanced CT scans revealed homogenously enhancing, diffusely enlarged lacrimal glands and blood investigations showed raised serum IgG4 levels. Histopathology from lacrimal gland biopsy showed lymphoplasmacytic infiltrates in storiform pattern. Immunohistochemistry showed 35% plasma cells positive for IgG4. A diagnosis of IgG4-related disease was made, due to supportive histopathology, immunohistochemistry, and serum IgG4 levels. The patient showed excellent response to systemic immunomodulators. Abbreviations: IgG4-RD = IgG4-related disease, CECT = Contrast-enhanced computed tomography, ACE = Angiotensin converting enzyme, IHC = Immunohistochemistry, HPF = high power field, IgG4-ROD = IgG4-related ophthalmic disease, ACR/ EULAR = American College of Rheumatology/ European League Against Rheumatism.

Sarcoidosis is a chronic multisystemic disease, which can be rarely associated with autoimmune disorders, such as antiphospholipid syndrome (APS). Although amaurosis fugax is an uncommon complication, its presentation can unmask a carotid artery dissection (CAD) in these diseases. In addition, central serous chorioretinopathy (CSC) has been related to vascular disorders too. We presented a case of a Caucasian middle-aged man, who developed CAD symptoms, such as amaurosis fugax in the right eye (RE) and headache. His medical history included arterial hypertension, hypothyroidism, and Lofgren's syndrome. On examination, retinal pigment epithelium (RPE) atrophy and subretinal fluid (SRF) in the macular area of the RE were observed. These findings were confirmed by optical coherence tomography (OCT), which also revealed an increase in choroidal thickness. However, these differed significantly from the contralateral eye. These clinical symptoms and imaging findings suggested a CSC in the RE, but not all clinical processes were justified. Subsequently, a CT angiography was performed and confirmed a significant occlusion in the right internal carotid artery and progressive sharpening of the lumen with an intimal flap due to a carotid dissection. In addition, the laboratory results were compatible with antiphospholipid syndrome (APS). To the authors' knowledge, the patient returned to the ED due to an anterior uveitis and he is currently asymptomatic with Cemidon and Adalimumab treatment. We described for the first time a case of carotid dissection and central serous chorioretinopathy in the context of two autoimmune-based pathologies, such as sarcoidosis and antiphospholipid syndrome. Abbreviations: APS = Antiphospholipid syndrome, BCVA = Best-corrected visual acuity, CAD = Carotid artery dissection, CNV = Choroidal neovascular membrane, CSC = Central serous chorioretinopathy, CT = Computed tomography, ED = Emergency Department, ICAD = Internal carotid artery dissection, LE = Left eye, OCT = Optical coherence tomography, RAPD = Relative afferent pupillary defect, RPE = Retinal pigment epithelium, RE = Right eye, SRF = Subretinal fluid.

Objective: Orbital myositis is a rare clinical condition that involves idiopathic inflammation mostly of extraocular muscles. The purpose of this study was to present a diagnostic and treatment plan of orbital myositis. Methods: A 60-year-old female presented with decreased visual acuity on her left eye, ocular hypertension, restricted and painful left abduction, diplopia, swollen eyelids, and orbital discomfort. MRI, as well as ultrasound, showed enlargement in width of medial rectus muscle. After other diagnoses were excluded, the diagnosis of left orbital myositis was established. Results: She was started on systemic corticosteroid treatment, but each time the steroid dose was tapered she experienced a relapse. Immunosuppressive therapy was introduced and the steroid dose was gradually tapered and excluded. One year after immunosuppressive therapy, the clinical findings improved. Conclusion: The diagnosis of orbital myositis requires detailed examination, laboratory testing and MRI scans of the orbits in order to exclude other diseases with similar clinical findings. The first line treatment option is systemic corticosteroid therapy with additional immunosuppressive therapy if needed. Abbreviations: MRI = magnetic resonance imaging, BCVA = best corrected visual acuity, ENT = ear, nose, throat specialist, CBC = complete blood count, WBC = white blood cell, ESR = erythrocyte sedimentation rate, CRP = C reactive protein, HM = hand motion, TED = thyroid eye disease, SLE = systemic lupus erythematosus, ECG = electrocardiogram, CT = computed tomography.

Objective: To compare the number of surge events and efficacy of phacoemulsification using a near-physiological intraocular pressure (IOP) setting and a standard IOP setting. Materials and methods: The surgical data of patients who underwent phacoemulsification with IOL implantation using the CENTURION Vision System's Active Fluidics setting and Active Sentry Handpiece (Alcon Laboratories, USA) were analyzed. Results: The study included 181 patients (204 eyes). In Group 1, the IOP was set at 20 mmHg (n=102, 50%), and in Group 2, the IOP was set at 60 mmHg (n=102, 50%). Total case time was significantly lower (p=.036) in Group 1 (0:03:17.20 ± 0:00:34.55 vs. 0:03:28.71 ± 0:00:43.03). There was no statistically significant difference between the mean cumulative dissipated energy (CDE) (7.06 ± 3.20 vs. 7.59 ± 3.26) and mean ultrasound (UJS) time (0:00:36 ± 0:00:12 vs. 0:00:38 ± 0:00:13) between the two groups (p=0.24 and p=0.31, respectively). Active sentry (AS) engaged less often (p<0.001) in Group 1. There was no statistically significant correlation between the CDE and AS activation in Group 1 (p=0.96). A strong statistically significant correlation between the CDE and AS activation (p<0.0001, r=0.61, CI (0.47 to 0.72)) was observed in group 2. Conclusion: During phacoemulsification, surge events are more likely to occur when operating at high IOP settings. Abbreviations: LIPMICS = low infusion pressure microincision cataract surgery, IOP = intraocular pressure, CDE = cumulative dissipated energy, UJS = mean ultrasound time, AS = Active sentry, LOCS = Lens Opacities Classification System, NO = nuclear opalescence, AFR = aspiration flow rate.