Seminars in Ophthalmology最新文献

Purpose: Topical chloramphenicol is one of the most ubiquitous antibiotics used in ophthalmology and oculoplastic surgery globally. It shows broad-spectrum activity against a variety of different pathogenic organisms, is well tolerated on the ocular surface and displays excellent topical pharmacokinetics. Chloramphenicol has been available for purchase over the counter in the United Kingdom since 2005. Despite this, the largest health economy in the world, The United States has had a de-facto moratorium on its use for the past 30 years. In this review, we aim to evaluate topical chloramphenicol in ophthalmology and oculoplastic surgery and to determine whether its reputation within the US is warranted and justified.

Methods: We conducted a comprehensive literature review to evaluate the different facets of chloramphenicol, providing a detailed understanding of the drug, its historical context, the benefits and perceived risks, including safety concerns, and clinical perspectives of its use in clinical practice.

Results: The mechanism of chloramphenicol, the context around which the drug's use in the US declined, and the drug's evidence base and safety data, including published case reports of serious adverse events, were analysed. The perceived benefits of the drug, particularly in light of antimicrobial resistance and its economic impact, were reviewed. Finally, perspectives on its use in clinical practice in ophthalmology and associated allied specialities were presented.

Conclusion: Chloramphenicol and its topical application have been misunderstood for many decades, particularly in the United States. Its demise across the Atlantic was due to an overzealous response to a dubious association with a weak evidence base. Numerous authors have since validated the safety profile of the and its safety has been borne out. The benefits of chloramphenicol, an effective broad-spectrum agent with a positive cost differential in the era of anti-microbial resistance and fiscal tightening, cannot be understated. Its likely effectiveness as a therapeutic topical agent in ophthalmic surgery makes it a valuable tool in the ophthalmic anti-microbial armoury. We would encourage the reinstatement of this valuable yet misunderstood drug as a first-line agent for simple ophthalmic infections.

Purpose: Understanding the current role and efficacy of endocyclophotocoagulation (ECP) compared to ab-interno canaloplasty with or without trabeculotomy (OMNI), combined with cataract extraction and lens implantation (CEIOL), for the management of uveitic glaucoma (UG) is limited.

Methods: All UG patients ≥18 years old with ≥6 months of follow-up data (15.2 ± 5.9 months) after CEIOL combined with either ECP or OMNI from August 2019 to May 2022 at a single academic center were retrospectively reviewed [22 eyes of 15 patients (8 ECP, 14 OMNI)]. Surgical success was considered intraocular pressure (IOP) ≤21 mmHg and a reduction of baseline by ≥20% for two consecutive final visits without hypotony, additional surgery, or loss of light perception. Uveitic control was considered a <2-step increase in anterior chamber (AC) cell grade, <3+ AC cell grade, and no increase in steroid drop use at 3 months postoperatively. Secondary outcome measurements included postoperative change in IOP, glaucoma medications, best corrected visual acuity (VA), AC cell grade, and steroid drop frequency.

Results: Baseline ocular and preoperative characteristics of eyes (age, sex, laterality, uveitic location, systemic immunomodulating therapy, visual acuity, IOP, number of glaucoma medications, AC cell grade, and steroid drop frequency) did not significantly differ except for greater racial diversity in the ECP group. 62.5% eyes were surgically successful in the ECP group and 85.71% in the OMNI. Between-group analysis showed greater IOP reduction in the OMNI group (p < .05), but no difference in reduction of glaucoma medications (p = .33). No eyes displayed a two-step increase in or >3+ AC cell grade, however, 50% and 64.29%, respectively, increased steroid drop use. Between groups, no difference in the change of AC cell grade (p = .98) or steroid drop use (p = .84) was seen.

Conclusions: Both interventions improved visual acuity, IOP, and glaucoma medication use, however, OMNI was more successful at reducing IOP long term. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to underlying uveitis regardless of surgical approach.

Objective: To describe in detail the lacrimal drainage system anomalies and review of literature in patients with Goldenhar syndrome, Rubinstein-Taybi syndrome (RTS), and Ectodermal-Ectrodactyly-Clefting syndrome (EECS), their management and outcomes.

Methods: A retrospective chart review from January 2011-June 2023 of all cases presenting to the Dacryology clinic with Goldenhar syndrome, RTS, and EECS was obtained. Data collected included demographics, laterality, clinical presentations, proximal and distal lacrimal drainage anomalies, associated systemic features, management, and outcomes.

Results: Eight children with Goldenhar syndrome (n = 13), three with RTS (n = 5) and three with EECS (n = 5) presented with lacrimal drainage system involvement. Cases with Goldenhar syndrome showed male predominance (5/8), and the mean age at presentation was 14.75 months. Four cases had simple CNLDO, seven cases with complex CNLDO (4 - buried probe and 3 - atonic sacs) and a single neonate presented with bilateral dacryocele. Patients with RTS presented with mean age of 36.33 months with male predominance. Probing under endoscopic guidance explored the anatomy thoroughly and those with altered nasal anatomy increased the probability of complex CNLDO. Those with EECS (n = 5) presented with a greater involvement of proximal lacrimal drainage system compared with Goldenhar syndrome and RTS, including anomalies like punctal agenesis, incomplete punctal canalization (IPC), ectopic puncta, canalicular stenosis, and complex CNLDO.

Conclusions: A step-wise approach to assessing the proximal and lacrimal drainage system in those affected with craniofacial malformations and addressing them can result in satisfactory outcomes for the majority of patients.

Purpose: Blepharitis and lower eyelid ectropion are highly prevalent ocular conditions occurring in 37%-46% and 2-3% of the general adult population, respectively. Blepharitis has multifactorial origins and involves anterior and posterior types of eyelid inflammation. Lower eyelid ectropion results in ocular surface exposure, epiphora and chronic conjunctivitis. This study aims to investigate any possible association between both conditions.

Methods: Medical records of 37,692 consecutive patients examined at a single medical screening center between 2001-2020 were retrospectively analyzed.

Main outcome measures: The prevalence of lower eyelid ectropion and of blepharitis, a possible association between the two, and the relation of each to age and sex.

Results: A total of 35,670 patients were included. Ectropion was diagnosed in 69 patients (0.2%), and blepharitis in 4725 patients (13.2%). Male sex was more prevalent for each pathology (88.4% ectropion, and 85% blepharitis, p < .001). Older age was associated with each diagnosis (77.3 years for ectropion patients vs. 52.2 years for the general screened population and 60.5 years for blepharitis patients vs 52.2 years for the general screened population p < .001). The prevalence of ectropion was significantly higher in patients with coexisting blepharitis compared to those without (0.8% vs. 0.1%, respectively, p < .001).

Conclusions: Ectropion was significantly more prevalent in patients with blepharitis. Both conditions were associated with older age and male sex. This coexistence can aid in decision making of early surgical intervention of lower eyelid ectropion as well as the approach to medical treatment of blepharitis.

Purpose: Standardized data collection is needed to improve research for rare diseases. In this manuscript, we describe our experience establishing the Prospective Ocular Tumor Study (POTS).

Methods: The ongoing POTS captures all patients with an ocular tumor seen on the Ocular Oncology Service at Mayo Clinic Rochester and collects patient demographics, tumor features, treatment, and outcomes. This manuscript reports data collected from July 2019-July 2024.

Results: During a 5-year time period, 1,766 patients enrolled in the database, with 975 (55%) females, 1,732 (98%) white race, and mean age 61.5 years. The most frequent tumor types were choroidal melanoma (n = 610 [34%]), choroidal nevus (n = 575 [32%]), iris nevus (n = 95 [5.3%]), iris melanoma (n = 46 [2.6%]), and vitreoretinal lymphoma (n = 46 [2.6%]).

Conclusion: The POTS is a valuable source of detailed, longitudinal data on rare ocular tumors. Expanding standardized data collection across multiple centers will facilitate improved outcomes research in ocular oncology.

Objective: Ciliary body medulloepithelioma (CBME), a pediatric intraocular tumor with potential for locally aggressive behavior and metastasis, may present with a diverse spectrum of clinical and histopathologic features leading to diagnostic and management challenges. Examination of unusual CBME cases highlights challenges and modern diagnostic techniques which facilitate accurate diagnosis and guide management.

Methods: A retrospective clinicopathologic analysis of 6 patients with unusual clinical or pathologic features of CBME was performed.

Results: The mean duration of delay in accurate diagnosis was 5.7 years (SD: 8.2, median: 3, range: 0-22). All patients developed cataract, 4 (67%) were diagnosed with glaucoma, and 4 (67%) underwent surgery prior to accurate diagnosis. At initial presentation, only one patient with a known history of genetically confirmed DICER1 syndrome underwent appropriate imaging leading to a timely identification of a ciliary body mass and no delay in diagnosis. Following identification of intraocular mass, 4 (67%) patients underwent enucleation. Two patients (33%) underwent exenteration for extraocular extension of CBME. Initial histopathologic differential diagnosis included CBME, melanoma, adenoma or adenocarcinoma of the pigmented ciliary body epithelium, retinoblastoma, sarcoma, and malignant teratoma. Immunohistochemistry and genetic testing assisted in the diagnosis of CBME. Two patients (33%) had a germline DICER1 variant; this was known prior to CBME diagnosis in one patient and discovered after CBME diagnosis in the second patient.

Conclusion: This series highlights the unusual clinical and histopathologic features of CBME that contribute to delays in diagnosis. Modern aids including genetic testing, ancillary imaging studies, and immunohistochemistry facilitate a timely accurate diagnosis of CBME and guide management.

Purpose: To assess the practice patterns among the Indian Pediatric Glaucoma Society (IPGS) members in the management of children with primary congenital glaucoma (PCG).

Methods: An anonymous 74-question survey was administered online via Qualtrics (Qualtrics, Provo, Utah, USA) using a link sent by email to the 88 IPGS members. The questionnaire comprised five sections and was designed to gather information regarding respondent demographics and specialty training, clinic composition and volume, surgical practices and preferences, follow-up practices, and additional services. The survey was closed after 10 weeks. Data were analyzed using descriptive statistics and Chi-square tests. Statistical significance was set at p < .05.

Results: The response rate was 82%. Of the 71 respondents, 49 (69%) reported possessing glaucoma fellowship training that included specialist training in pediatric glaucoma. By comparison, 8 respondents (11%) reported possessing pediatric ophthalmology fellowship training that included specialist training in pediatric glaucoma, and this difference was statistically significant (69% vs. 11%; χ² = 47.37; p < .0001). The majority of the respondents were in ophthalmic institution-based practice (83%) and were located in South India (58%). In cases of hazy cornea, the most common surgery (95%) performed was combined trabeculotomy-trabeculectomy while goniotomy was most preferred (49%) in cases of clear cornea. Approximately, one-half of the respondents (56%) preferred to operate on each eye in separate sessions, whereas 46% preferred to operate on both eyes in the same session. One-half of the respondents (51%) preferred to use mitomycin-C in primary surgery. The most common challenges in providing care were patient-related, including delayed presentation, high travel costs, and low socioeconomic status.

Conclusions: Although a substantial consensus was found in most areas of management, a few areas, for example, use of MMC in primary surgery, showed diversity. The information gathered will enable glaucomatologists to compare their practices with those of their colleagues. In addition, this survey provides a baseline, allowing future trends in management to be determined.