Seminars in Ophthalmology最新文献

Aim: To carry out an exhaustive bibliometric analysis of the existing literature on endoscopic dacryocystorhinostomy (DCR), with a view to comparing this with the trend in external DCR.

Methods: A total of 1,230 publications on endoscopic DCR and 1,036 on external DCR were retrieved from the Web of Science databases and analyzed. Data on publication types, indexing categories, journal and publisher contributions, temporal trends, authorship networks, frequently used keywords, and country-level contributions were evaluated. Co-authorship and keyword co-occurrence networks were visualized to identify collaboration patterns and thematic focuses. Citation metrics, including the top 100 most-cited publications, were also assessed.

Results: Original articles accounted for over 85% of the publications in both endoscopic and external DCR literature. The research is predominantly concentrated in ophthalmology (44.4%) and otorhinolaryngology (32.1%) for endoscopic DCR, with most publications indexed in the Science Citation Index Expanded (77.3%). The number of endoscopic DCR publications peaked in 2020, while external DCR peaked in 2015. Ali Mohammad Javed emerged as the most prolific author with 78 publications, and the co-authorship network revealed strong interdisciplinary collaborations. India led the publication output for both endoscopic (16.9%) and external (15.7%) DCR, followed by the United States and Turkey. Frequently used keywords such as "dacryocystorhinostomy" and "epiphora" highlighted the primary clinical focus.

Conclusion: The bibliometric analysis highlights the increasing trend in publications over the last decade, indicating an escalating interest in minimally invasive methods, with endoscopic DCR being a prominent approach for the management of nasolacrimal duct obstruction. Key contributors, impactful journals, and strong collaborations drive innovation in the field. However, research gaps remain in patient-reported metrics, and contributions from underrepresented regions. Addressing these areas through international and multidisciplinary efforts will advance the field further.

Purpose: The US Food and Drug Administration (USFDA) granted the miltefosine orphan drug designation in 2016 for treating Acanthamoeba keratitis. This study evaluates miltefosine's in vitro efficacy against clinical isolates of Acanthamoeba from patients with keratitis and its safety profile in human corneal epithelial cell line to rationalize its localized ocular application.

Methods: Acanthamoeba spp. isolated from corneal scrapings of keratitis patients (n = 17) were cultured axenically, genotyped, and tested for miltefosine's minimal cysticidal and trophozoicidal concentrations (MCC and MTC) by microbroth dilution method. Safer concentrations of miltefosine were determined using human corneal epithelial (HCE) cells at four incubation points. Trophozoites and cysts of one of the isolates, A. castellanii, were challenged on confluent monolayers of HCE in the presence and absence of miltefosine for 24 h. Cytopathic effects were evaluated using microscopic analysis.

Results: The majority of Acanthamoeba isolates tested were T4 genotypes (94.11%). MTC₉₀ and MCC₉₀ of miltefosine were 0.125 and 4 mg/mL, respectively. Miltefosine was found safe on HCE at 0.0625 and 0.125 mg/mL for 4 and 0.25 h, respectively. Microscopical findings showed that A. castellanii trophozoites destroyed the cellular structures of HCE within 24 h without miltefosine. Drug pre-treatment prevented the initiation of infection at both the tested concentrations (0.0625 and 0.125 mg/mL) upto 24 h.

Conclusion: Miltefosine was effective against Acanthamoeba trophozoites and cysts in vitro with >30-fold higher cidal concentration for cysts compared to trophozoites. An effective trophozoicidal concentration of miltefosine (0.125 mg/mL), found to be safe for HCEs, suggests its potential utility as an adjunct treatment for Acanthamoeba keratitis.

Purpose: To assess the clinical features of ocular adverse events in patients receiving BRAF/MEK inhibitor therapy.

Methods: In this retrospective study, 65 patients were treated with BRAF/MEK inhibitors (dabrafenib/trametinib or encorafenib/binimetinib).

Results: Of the 65 patients, 28 had malignant melanoma and 37 had non-melanoma malignancies. Bilateral MEK-associated retinopathy was observed in nine cases; none experienced vision loss due to MEK-associated retinopathy. Uveitis was diagnosed in four patients (6.1%), three of whom presented with Vogt-Koyanagi-Harada (VKH)-like uveitis. All VKH-like uveitis cases were observed in patients with melanoma and their incidences were significantly higher in these patients than in those without melanoma (p = .04). Treatment with corticosteroids resulted in either resolution or control of symptoms in all cases of VKH-like uveitis, enabling continuation of BRAF/MEK inhibitor therapy.

Conclusion: VKH-like uveitis was found to be significantly more frequent in patients with melanoma than in those with other malignancies.

Purpose: Persistent corneal epithelial defects (PCEDs) following pars plana vitrectomy (PPV) represent a significant clinical challenge, potentially leading to corneal scarring, vision loss, and other severe complications. This review aims to summarize the prevalence, associated risk factors, and management strategies for PCEDs in the context of PPV, providing evidence-based guidance for clinicians.

Methods: A comprehensive systematic review was conducted using PubMed and Embase databases, identifying English-language studies addressing PCEDs after PPV.

Results: The prevalence of PCEDs post-PPV varied widely, from 0% to 78.37%, influenced by intrinsic factors such as diabetes mellitus, which impairs corneal nerve function and healing, and extrinsic factors like intraoperative tamponade with C3F8. Management strategies ranged from conservative options like bandage contact lenses to advanced treatments like topical insulin.

Conclusion: PCEDs after PPV are multifactorial and demand individualized management. Advanced therapies, particularly serum-based treatments, and topical insulin, show promising outcomes. Further prospective research is warranted to refine these treatments.

Background: Conjunctival melanoma (CM) is a rare and potentially aggressive malignancy of the ocular surface with high rates of local recurrence and metastasis. The objective of this report was to evaluate the yield of diagnostic staging tests in patients with conjunctival melanoma.

Methods: 81 consecutive patients with invasive conjunctival melanoma treated by the senior author over the course of 23 years were included. All imaging studies at baseline and during the follow up were reviewed. We also reviewed the yield of sentinel lymph node biopsy (SLNB) in patients who had this procedure as part of their baseline staging.

Results: We found an overall nodal metastatic rate of 16% and distant metastatic rate of 26%. The SLNB positivity rate was 23.1% (6 out of 26 patients).Eight out of 81 (10%) patients with CM had brain metastasis as identified on routine brain magnetic resonance imaging.

Conclusions: More than a third of patients with nodal metastasis and most patients with distant metastasis, including 100% of patients with brain metastasis, were detected to have metastatic disease during the follow-up period, highlighting the importance of continued surveillance imaging. Twelve of 20 patients with distant metastasis (57%) never had nodal metastasis, highlighting the importance of continued surveillance for distant metastasis even with a negative SLNB result.

Purpose: To develop CT-based machine learning radiomics models used for the diagnosis of dysthyroid optic neuropathy (DON).

Materials and methods: This is a retrospective study included 57 patients (114 orbits) diagnosed with thyroid-associated ophthalmopathy (TAO) at the Beijing Tongren Hospital between December 2019 and June 2023. CT scans, medical history, examination results, and clinical data of the participants were collected. DON was diagnosed based on clinical manifestations and examinations. The DON orbits and non-DON orbits were then divided into a training set and a test set at a ratio of approximately 7:3. The 3D slicer software was used to identify the volumes of interest (VOI). Radiomics features were extracted using the Pyradiomics and selected by t-test and least absolute shrinkage and selection operator (LASSO) regression algorithm with 10-fold cross-validation. Machine-learning models, including random forest (RF) model, support vector machine (SVM) model, and logistic regression (LR) model were built and validated by receiver operating characteristic (ROC) curves, area under the curves (AUC) and confusion matrix-related data. The net benefit of the models is shown by the decision curve analysis (DCA).

Results: We extracted 107 features from the imaging data, representing various image information of the optic nerve and surrounding orbital tissues. Using the LASSO method, we identified the five most informative features. The AUC ranged from 0.77 to 0.80 in the training set and the AUC of the RF, SVM and LR models based on the features were 0.86, 0.80 and 0.83 in the test set, respectively. The DeLong test showed there was no significant difference between the three models (RF model vs SVM model: p = .92; RF model vs LR model: p = .94; SVM model vs LR model: p = .98) and the models showed optimal clinical efficacy in DCA.

Conclusions: The CT-based machine learning radiomics analysis exhibited excellent ability to diagnose DON and may enhance diagnostic convenience.

Background: Long-term follow-up is essential for retinoblastoma survivors, as treatment-related sequelae can emerge years after therapy.

Methods: This case series reviews 67 eyes treated with periocular and/or intravitreal chemotherapy from 2005 through 2020.

Results: Periocular chemotherapy was associated with orbital fibrosis in 79.1% of cases, with risk increasing concomitantly with the number of injections. Cataracts developed in 19.4% of eyes, with 10 out of 13 requiring cataract extraction. Other complications included chronic conjunctivitis and limbal stem cell deficiency (3% each), while strabismus was observed in 29.9% of which 7.5% underwent strabismus surgery. Comparative analyses of periocular and anterior segment complications from other retrospective studies are included to contextualize our findings.

Conclusions: Understanding these long-term sequelae is crucial for appropriately following and managing retinoblastoma survivors who were treated during this era. We highlight the importance of vigilant surveillance as treatment protocols continue to evolve.

Purpose: Keratoconus is a bilateral asymmetrical degeneration in the cornea. It is associated with local thinning in the cornea leading to visual problems such as myopia and astigmatism. Several treatments, such as lenses and keratoplasty surgeries, were utilized to treat this condition. In this study, we aim to compare deep anterior lamellar keratoplasty (DALK) to penetrating keratoplasty (PK).

Methods: We registered our study protocol on PROSPERO (CRD42024559427). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to June 2024. Using STATA 17, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). A P-value ≤.05 is considered as statistically significant.

Results: The meta-analysis included a total of 47 studies with a total number of 27,018 eyes. There was no significant difference between PK and DALK in terms of best-corrected visual acuity (BCVA) at 1 year (Hedge's g: 0.03 with 95% CI [-0.13, 0.19], p = .71). PK was associated with a lower risk of graft failure than DALK (log RR: -0.41 with 95% CI [-0.74, -0.08], p = .01). PK was associated with a higher risk of graft rejection than DALK (log RR: 0.85 with 95% CI [0.35, 1.35], p < .001). There was no significant difference between PK and DALK in terms of corneal astigmatism at 1 year (Hedge's g: 0.03 with 95% CI [-0.24, 0.31], p = .82).

Conclusion: The visual outcomes such as BCVA, astigmatism, and spherical equivalent refraction, of PK and DALK are comparable. However, PK was associated with a higher risk of complications and rejection episodes, but, a lower risk of graft failure.