Seminars in Ophthalmology最新文献

Purpose: To disclose that the lacrimal sac is classified within the orbital tissue.

Materials and methods: Ten orbits of 9 Japanese cadavers aged 64 to 85 years at death were included. The attachment site of the orbital septum in the medial canthal area was grossly dissected. The relationship between the orbital septum attachment site and the location of the lacrimal sac was examined.

Results: In the upper region, the orbital septum was attached to the most superior area of the lacrimal fossa and the medial canthal tendon. In the lower region, the septum was attached to the anterior lacrimal crest and the medial canthal tendon. In both the upper and lower regions, none of the septa attached to the posterior lacrimal crest. The lacrimal sac was situated behind the orbital septum.

Conclusion: The lacrimal sac, which is situated behind the orbital septum, is classified within the orbital tissue.

Objective: To evaluate dynamic magnetic resonance dacryocystography (MRDCG) in eyes with functional epiphora.

Methods: We included prospective eyes with epiphora if no alternative cause was found on clinical examination, were patent on syringing, had no obstruction or stenosis on DCG, and had an abnormal DSG. MRDCG was performed to qualitatively assess for block or patency and quantitatively measure tear transit time. We compared measurements to asymptomatic fellow eyes and to historical reference values from asymptomatic eyes.

Results: We included 26 symptomatic eyes of 19 patients (median age 63 years). There was a block on MRDCG in 18 (69%) eyes and patency in 8 (31%) eyes. The block occurred at the sac-nasolacrimal duct (NLD) junction in 9 (50%), proximal NLD in 5 (28%), mid-NLD in 1 (5.6%), and distal NLD in 1 (5.6%) eye(s). No contrast was observed in the lacrimal system in two eyes. For eyes patent on MRDCG, median times to the sac, NLD, inferior meatus, first 25%, and first 50% of the fundus-to-nose distance (FND) were 22, 54, 118, 34, and 84 s, respectively. Times to the sac, NLD, and to fill the first 25% and 50% of the FND were significantly longer than historical values from asymptomatic lacrimal systems (p = 0.017, 0.050, 0.035, 0.017, respectively).

Conclusion: MRDCG shows a high rate of block in functional epiphora. However, DSG and MRDCG results may not always correlate. The improved temporal resolution of this emerging modality may be advantageous in the critical first 2 min of tear transit.

Objective: To evaluate gender distribution in Canadian ophthalmology societies' leadership and to determine associations between gender, academic productivity, and institutional rank.

Methods: We identified members and assessed their gender composition using publicly available updated webpages. SCOPUS database was used to gather research metrics.

Results: In this study, data was collected from 12 Canadian ophthalmology societies, which included 277 executive committee members. Of these, 70.5% (196) were male and 29.1% (81) were female (p < .0001). Males were significantly more prevalent in presidential leadership roles (39 males vs. 23 females, p = .02), while females were more represented in other leadership categories (77 females vs. 61 males, p = .03). The Canadian Ophthalmological Society (COS) showed an upward trend in female representation from 19.2% in 2016 to 42.3% in 2021. Research productivity showed a positive correlation with society leadership rank, with a correlation coefficient of 0.732 for the m-index (p < .001) and 0.356 for the h-index (p < .05). Academic rank was also positively correlated with society leadership rank, with a correlation coefficient of 0.536 (p < .001). There was no significant difference in h-index (12.7 ± 1.0 for males vs. 13.8 ± 1.5 for females, p = .85) or number of publications (48.6 ± 5.1 for males vs. 60.0 ± 11.3 for females, p = .83) between male and female executive members, but females had a higher m-index (0.67 ± 0.05) compared to males (0.58 ± 0.03, p < .05). In academic rank, males were more likely to be associate professors (25% vs. 5% for females, p = .0001) or instructors (14.8% vs. 6.3% for females, p = .05), while a higher proportion of females held assistant professor positions (47.5% for females vs. 30.1% for males, p = .006).

Conclusion: In this study, we found that males were more prevalent in executive positions, particularly in presidential roles among Canadian ophthalmology societies. The gender distribution in leadership reflected the gender composition of practicing ophthalmologists in Canada. There was a positive correlation between research productivity and society rank, as well as academic position and society rank. Male and female executive members had similar h-index and number of publications, but females had a higher m-index. These findings highlight the need for continued efforts to address gender disparities in ophthalmology leadership.

Purpose: To evaluate the longitudinal change of cup to disc ratio (CDR) in premature infants with enlarged CDR and normal intraocular pressure (IOP).

Methods: This retrospective, observational study included 283 eyes of 283 premature infants at single center. Infants were divided into enlarged CDR and control groups. Data on demographics, gestational age (GA), birth weight (BW), vertical cup to disc ratio (vCDR), IOP, and corneal diameter were analyzed.

Results: Of the 283 patients, 38 (13.4%) and 245 (86.6%) were in the enlarged CDR and control groups, respectively. In the enlarged CDR group, the vCDR and baseline IOP was 0.63 ± 0.12 and 12.7 ± 2.2 mmHg, respectively. In the control group, the vCDR and baseline IOP was 0.18 ± 0.05 and 10.9 ± 1.7 mmHg, respectively. The IOP at a GA of 40 weeks and at 1 and 2 years of age were significantly lower than that at baseline. The differences in vCDR between baseline and each follow-up visit were not significant. vCDR was negatively correlated with GA and BW; however, these correlations were not significant.

Conclusions: The vCDR did not significantly change up to age of 2 years of age in premature infants with enlarged CDR and normal IOP. However, close follow-up is needed until other reliable glaucoma examinations, such as optical coherence tomography and visual fields, can be possible.

Methods: This pilot clinical trial included 10 eyes of 10 patients with idiopathic MH, where PPV along with ILMP was done. Fibrin glue was used as a tamponade, and no postoperative positioning was given to any patient. The primary outcome measure was successful anatomical closure of the MH. The secondary outcome measures were postoperative improvement in best-corrected visual acuity (BCVA) and any complications of the procedure.

Results: The median age of patients was 62.5 years. Eight eyes were pseudophakic and two were phakic. The mean basal diameter of the MH was 1193 microns. The mean minimal linear diameter was 652 microns. Successful anatomic closure of MH was achieved in eight cases. The median BCVA improved from a Snellen equivalent of 20/100 preoperatively to 20/60 at 1 month postoperatively. The median follow-up period was 4 months.

Conclusion: The findings of this study suggest that the use of fibrin glue can be useful in patients where postoperative positioning is difficult.

Purpose: This review analyzed the top 100 most-cited thyroid eye disease (TED) papers.

Methods: In November 2022, Scopus was searched for the most highly cited TED works since inception. For each paper, journal of origin and impact factor, corresponding author country and specialty affiliation, citation count, publication year, database-affirmed study funding, and open-access status were extracted.

Results: A total of 76 primary and 24 secondary articles were published between 1969 and 2021 across 29 journals, with a median (range) of 186.5 (133-930) citations. The most cited journal was Journal of Clinical Endocrinology and Metabolism (25 articles; 5126 citations). The most cited article was 'Graves' ophthalmopathy' (Bahn 2010; New England Journal of Medicine; 930 citations). Articles hailed from 10 countries, with most from the United States (38 articles; 9194 citations). Endocrinology (n = 59) and ophthalmology (n = 26) were the most common corresponding authors. Nineteen first authors contributed multiple articles. Only journal impact factor was significantly associated with citation count (p = .0002; ρ = 0.45).

Conclusion: A variety of medical disciplines, Western countries, and study personnel contributed to highly cited thyroid eye disease research. Thus, this research area is not exceedingly informed by any singular perspective. Further, it can be interpreted with increased confidence for their generalizability of results to patients globally.

Purpose: Intravenous and intra-arterial thrombolytic strategies have been used to treat central retinal artery occlusion (CRAO); however, previous meta-analyses evaluated the efficacy of these two thrombolytic strategies separately but did not compare them. This network meta-analysis aimed to evaluate the comparative efficacy and safety of different thrombolytic methods for treating CRAO.

Methods: We searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfangdata to identify relevant studies published before 1 January 2023. We used the "network" command in STATA 14.0 software to perform network meta-analysis. In addition, we calculated the surface under the cumulative ranking (SUCRA) to rank all currently available thrombolytic strategies.

Results: We included 12 studies in the final data analysis. Results suggested that, compared with standard treatment (ST), intravenous tissue plasminogen activator (IVtPA) (OR, 5.78; 95% CI, 2.07 to 16.11) and intra-arterial urokinase (IAUK) (OR, 2.78; 95% CI, 1.10 to 7.02) and intra-arterial tPA (IAtPA) (OR, 2.45; 95% CI, 1.04 to 5.77) achieved better visual improvement. The differences in visual improvement among IVtPA, IAUK, and IAtPA are insignificant. Furthermore, compared with ST, administration of IVtPA within 4.5 hours of CRAO onset (OR, 8.87; 95% CI, 3.35 to 23.48) rather than administration after 4.5 hours of onset (OR, 3.09; 95% CI, 0.81 to 11.70) achieved better visual improvement. In addition, compared to ST, all available thrombolytic strategies we evaluated were associated with a higher risk of adverse events, but these strategies did not differ. Based on the results of SUCRA, IVtPA had the highest ranking probability in visual improvement (91.9%) but had a relatively lower ranking probability of adverse events (60.1%).

Conclusion: Both intravenous and intra-arterial thrombolytic strategies are effective for treating CRAO, but SUCRA results show that IVtPA may be the optimal strategy for treating CRAO. Furthermore, based on the results of subgroup analysis, we further speculate that IVtPA injection within 4.5 hours of the onset of CRAO should be the optimal thrombolytic option for treating CRAO. However, due to the limitations of all eligible studies, more studies are still required in the future to validate our findings.

Objective: To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery.

Design: Retrospective Cohort study.

Participants: The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up.

Methods: Retrospective review of strabismus operation patients' medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management.

Results: Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003).

Conclusion: Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.