Seminars in Ophthalmology最新文献

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.

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.