Seminars in Ophthalmology最新文献

Purpose: To evaluate changes in intraocular pressure (IOP) in dominant and contralateral eyes following the dark room prone provocative test (DRPPT) in the study subjects with shallow anterior chamber.

Methods: This was a prospective, single-center, non-randomized controlled trial of 43 subjects (86 eyes) with shallow anterior chamber. The dominant eye was identified using the card-hole method. The study subjects underwent the DRPPT for one hour. Pre- and post-DRPPT IOP was measured using an I-Care tonometer, and pupillary parameters, including amplitude of constriction, peak constriction velocity, and peak re-dilation velocity, were also measured using the RAPDx® dynamic pupillometer.

Results: Significant increases in IOP were observed in both the dominant and contralateral eyes after DRPPT, compared to their respective pre-DRPPT IOP levels. (p < .01). Moreover, IOP variation before and after DRPPT was significantly greater in the dominant eye than in the contralateral eye (median 3.60 mmHg vs. 2.70 mmHg, p < .05). The dominant eyes exhibited a smaller amplitude of constriction (1.07 ± 0.35 mm vs 1.14 ± 0.34 mm, P < .05) and slower constriction velocity (3.71 ± 1.12 mm/s vs 3.78 ± 1.11 mm/s, P < .05) as compared to the contralateral eyes.

Conclusions: This study demonstrated that the dominant eye exhibited greater IOP changes after DRPPT than the contralateral eye. Additionally, it showed smaller pupil constriction and slower contraction, indicating a higher likelihood of pupil blockage in the dominant eye with shallow anterior chambers. This asymmetry partially explains the monocular onset of acute angle-closure attacks.

Purpose: To discuss comprehensively the varied complications after stent-less incisional or excisional minimally invasive glaucoma surgery (MIGS).

Method: A review of reported complications after stent-less MIGS procedures including gonioscopy-assisted transluminal trabeculotomy (GATT), bent needle goniectomy (BANG), Kahook-dual blade goniotomy, and microincisional trabeculectomy (MIT) published between 2014-2024, were analyzed and summarized.

Results: Apart from hyphema, peripheral anterior synechiae, and intraocular pressure spikes, other vision-threatening complications like cyclodialysis, Descemet's detachment, corneal edema, iridodilalysis, vitreous loss or vitreous hemorrhage can also occur intra- or postoperatively after any incisional or excisional MIGS procedures.

Conclusion: All possible complications are to be kept in mind during MIGS despite the procedures being minimally invasive. Adequate care should be taken during different stages of the surgery to avoid these complications.

Purposes: This meta-analysis aims to systematically analyze the efficacy of low-level red light (LRL) therapy for myopia control and prevention in children.

Methods: All the data were searched from the PubMed, EMBASE, and the Cochrane Library. The Cochrane Handbook was used to evaluate the quality of the included studies. Additionally, this meta-analysis was performed by using the Revman 5.4 software. Inclusion criteria was randomized controlled trials (RCTs), and the patient populations were younger than 18 years.

Results: Eight RCTs were included in this study. Compared with control group, LRL treatment could reduce the progression in spherical equivalent refractive (SER) for myopia children (MD, 0.49; 95% CI, 0.27 to 0.71; p < .00001). Also, less change in axial length (AL) and increase in subfoveal choroid thickness (SFCT) was shown in the LRL group for both myopia and premyopia children (MD, -0.24, 28.16; 95% CI, -0.32 to -0.17, 18.78 to 37.55; p < .00001, respectively).

Conclusion: Our meta-analysis shows that LRL therapy could delay the refraction progression of myopia children. It also could reduce progression in axial length and SFCT thinning in both myopia and premoypia children.

Introduction and primary objective: Pediatric rhegmatogenous retinal detachment (RRD) presents unique challenges in diagnosis and management. A thorough evaluation of family, medical, and ocular history is helpful, as systemic and genetic conditions can predispose children to RRD. Trauma, high myopia, and history of prematurity are also common risk factors. Examining young children in the outpatient setting may have limitations, but the yield can be maximized by modifying examination techniques and utilizing imaging technologies. In this manscript, the considerations for diagnosis and management of pediatric rhegmatogenous retinal detachment are outlined.

Conclusions: Primary scleral buckling is the treatment of choice for the vast majority of pediatric RRDs, as it offers a higher single surgery success rate in these young eyes with firmly adherent posterior hyaloid. Primary vitrectomy is not recommended due to this reason. Scleral buckling is the mainstay of pediatric RRD surgery, even in cases that may typically undergo vitrectomy in adults. Prophylactic treatment of the fellow eye may also be warranted in certain clinical scenarios. Understanding the unique challenges these patients face is important for early diagnosis, timely intervention, and tailored surgical strategies to optimize visual outcomes in this vulnerable patient population.

Purpose: To characterize the epidemiology of consumer product-related ocular injury in the United States (US) incarcerated population, and identify preventable causes.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for cases of eye injury from 2014 to 2023. Incarcerated cases were identified using the keywords "prison", "jail", "inmate", and "incarcerate". Year of injury, diagnosis, product code, and demographic information were gathered and compared between the incarcerated and general US populations using SPSS version 29 (IBM Corp.). A narrative analysis categorized cases of ocular trauma in the incarcerated by common causes of injury.

Results: Between 2014 and 2023, there were an estimated 1,644,841 cases of consumer-product related ocular injury the US, with 2683 cases occurring in the incarcerated. A higher percentage of ocular injury cases in the incarcerated involved African American individuals (43.42% vs. 17.18%), males (92.22% vs 68.54%), alcohol use (4.11% vs. 0.64%), drug use (3.91% vs. 0.82%), and hospitalization (4.96% vs. 1.39%). Contusions were less common in the incarcerated population (27.21% vs. 41.31%), while foreign body injuries were more common (24.38% vs. 18.75%). Penal labor, including cleaning (13.74%), welding (8.25%), yardwork (5.92%), and power grinding (5.72%), accounted for 36.36% of injuries. 26.50% of injuries were sports-related, with basketball involved in 16.82%.

Conclusions: The epidemiology of ocular injury in the incarcerated differs from the general US population. Penal labor and sports-related ocular injury represent a majority of cases, underscoring the need for protective eyewear.

Background: Metastatic retinoblastoma remains a significant challenge in pediatric oncology, with stark disparities in survival outcomes between high-income countries (HICs) and low-income countries (LICs). Delayed diagnosis and treatment, driven by socioeconomic factors and limitations in healthcare systems, contribute to poorer outcomes in LICs. Histopathological characteristics, including high-risk pathology factors (HRPFs) and the extent of ocular tumor invasion, are critical for predicting metastatic risk and guiding treatment strategies.

Methods: This review examines the role of clinical, histopathological, and molecular characteristics in assessing metastatic risk in retinoblastoma. Literature on HRPFs, tumor invasion, and molecular subtypes was analyzed to understand their impact on risk stratification and therapy optimization, particularly in resource-limited settings.

Results: Retinoblastoma is increasingly recognized as a heterogeneous disease with at least two distinct molecular subtypes. High-risk cases frequently exhibit genetic alterations that underscore the need to incorporate molecular profiling into risk assessment. Current adjuvant therapy approaches, however, vary widely, and debates persist regarding their necessity based on tumor characteristics. Integrated strategies that combine clinical, histopathological, and molecular data show promise in improving management and survival outcomes.

Conclusions: Addressing the disparities in metastatic retinoblastoma outcomes requires a multifaceted approach. By integrating clinical, histopathological, and molecular insights, management strategies can be optimized to improve survival, particularly in resource-limited settings where challenges are most pronounced.

Purpose: Trilateral retinoblastoma (TRB), intracranial neoplasm in heritable retinoblastoma patients, is a very rare fatal disease. Many ocular oncology centers conduct routine screening of retinoblastoma patients by brain imaging. Nevertheless, there is a debate regarding its ability to prolong TRB patients' survival and the number-needed-to-treat. We recommend baseline screening brain imaging in bilateral retinoblastoma patients, followed by imaging according to clinical need. We aim to see if this screening schedule has an impact on patients' survival.

Methods: In a retrospective observational study, we reviewed the medical records of patients diagnosed with bilateral retinoblastoma at a tertiary medical center ocular oncology unit between 1.7.1986 and 1.2.2020, who had at least 36 months follow-up or retinoblastoma-related death. We collected data on patients' demographics, clinical features, systemic evaluation, treatment, follow-up, and outcome.

Results: The analysis included 109 patients, 60 males and 49 females, diagnosed with bilateral retinoblastoma at a median age of 7.0 months (range 0.43-70.5 months). Germline mutation was found in 43 patients (39.4%) and somatic mutation in 15 patients (13.8%). Genetic status was not recorded in 51 patients (46.8%). Fifty-eight patients (53.0%) underwent baseline brain imaging (MRI in 42 patients and CT scan in 16 patients), in all of whom it was within normal limits. During a median follow-up of 138 months (range 19-787 months), 35 children had follow-up brain imaging (MRI in 25 patients and CT in 10 patients). One patient developed symptomatic TRB during follow-up, and is alive and disease-free (0.9%, Cl:0.02%-5.6%). Looking at survival, six patients (5.5%) developed metastatic disease, and eight patients (7.3%) expired, in all of whom death was retinoblastoma-related.

Conclusions: Due to TRB rarity, routine screening by baseline brain MRI may be sufficient, avoiding anesthesia, expenses, distress, and unnecessary interventions, without a significant impact on patients' survival. Nevertheless, due to TRB fatality and treatment morbidity, periodic brain MRI until age 3 is a legitimate option.

Purpose: To examine propranolol efficacy in treating diffuse (DCH) and circumscribed choroidal hemangiomas (CCH) and controlling intraocular pressure (IOP) in patients with Sturge-Weber syndrome (SWS).

Methods: A SWS patient case treated with propranolol for DCH is presented. Following PRISMA guidelines, we also performed a systematic review using PubMed/Web of Science, analyzing 14 studies detailing propranolol treatment outcomes for DCH, CCH, and IOP control in SWS. Demographic, clinical, treatment, and outcome data were extracted and statistically analyzed. Fisher's exact test was used to compare findings such as retinal detachment rates.

Results: We reviewed patients treated with propranolol, including 8 DCH, 18 CCH, and 16 SWS cases of IOP control. Retinal detachment rates were significantly higher in DCH compared to CCH cases. Post-propranolol, 73% of DCH and CCH cases showed subretinal fluid improvement, and in SWS patients, 94% had IOP reduction.

Conclusion: This study underscores the potential utility of propranolol beyond its traditional use in cutaneous hemangioma for treatment of CCH/DCH and IOP control.