Seminars in Ophthalmology最新文献

Purpose: This study aims to present the therapeutic outcomes of benign eyelid margin tumors treated with laser ablation, offering an alternative approach to traditional shaving biopsy.

Methods: In all patients, tumors were eliminated through either laser ablation or shaving biopsy. Comparative analysis was conducted between two patient groups: the laser-assisted ablation group (Group 1) and the shaving excision surgery group (Group 2). A total of 66 patients with 67 benign eyelid margin tumors were retrospectively included in this study (2019-2023). Thity-four cases underwent laser ablation, and 33 cases were subjected to shaving excision biopsy. Postoperatively, histologic confirmation was obtained in 11 out of the 33 cases that underwent shaving excision.

Results: In Group 1, no functional or cosmetic complications were observed. The wound margin was clear after laser-assisted ablation in all cases. In Group 2, there was one instance of eyelid notching, loss of cilia, and two pigmentations. No wound infections were reported. The average wound epithelialization duration was 3.3 weeks in Group 1, significantly faster than 4.2 weeks in Group 2 (p < .01). The average lesion size was 3.0 × 2.9 mm in Group 1, significantly smaller than 3.5 × 3.4 mm in Group 2 (p < .05). No recurrences were observed during the follow-up period.

Conclusions: Laser ablation for small benign eyelid margin tumors may be a favorable alternative to shaving excision biopsy surgery. All patients were satisfied with the cosmetic result. There was no definitive postoperative or intraoperative complication during or after laser application.

Purpose: To report the clinical presentation, management, and outcomes of nodulo-ulcerative ocular surface squamous neoplasia (nuOSSN).

Methods: Retrospective interventional clinical cohort study of 27 patients from a quaternary ocular oncology center.

Results: Twenty-seven patients were diagnosed with nuOSSN during the six-year study period. The mean age at presentation was 53 years (median, 51 years; range, 25 to 81 years). Misdiagnosis was noted in 7 (26%) patients, and the mean lag time from symptom onset to presentation at our center was 14 months (median, 6 months; range, 1 to 96 months). The bulbar conjunctiva was the commonest epicenter (n = 19, 70%), and the temporal quadrant was most commonly involved (n = 13, 48%). The mean tumor diameter and thickness were 18 mm (median, 16 mm; range, 8 to 60 mm) and 3 mm (median, 2 mm; range, 1 to 5 mm), respectively. Corneal, limbal, and scleral thinning were seen in 15 (56%), 18 (67%), and 10 (37%) patients, respectively. Peripheral corneal opacification was seen in 18 (67%), and thickening around the area of scleral thinning was seen in 12 (44%) patients. Tumors belonged to the American Joint Committee for Cancer classification T2 (n = 2, 7%), T3 (n = 19, 70%), and T4 (n = 6, 22%) categories. Primary treatment (n = 19) included topical 1% 5-fluorouracil (5FU) eye drops (n = 1, 4%), excisional biopsy (n = 4, 14%), extended enucleation (n = 11, 41%), and orbital exenteration (n = 3, 11%). At a mean follow-up of 9 months (median, 3 months; range 1 to 46 months) in 19 patients who received treatment, the outcomes included local tumor recurrence in 2 patients (11%), tumor control in 16 (84%), globe salvage in 3 (16%), and lymph node metastasis in 2 patients (11%).

Conclusion: nuOSSN is an aggressive form of the disease that is frequently misdiagnosed due to the presence of corneoscleral thinning. Globe salvage rates are poor owing to the advanced stage of presentation.

Purpose: To help ophthalmologists and oncologists better understand the ocular irAEs secondary to PD-1 inhibitors , enabling early detection and management of ocular complications.Methods: We reviewed case reports and related literatures on ocular irAEs secondary to PD-1 inhibitors in PubMed, including a total of 70 case reports, summarizing and analyzing the specific conditions of these patients.Results: The most common malignant tumors were melanoma (n = 41; 58.6%) and lung cancer (n = 13; 18.6%). The main PD-1 inhibitors used were pembrolizumab (n = 38; 54.3%) and nivolumab (n = 28; 40%). They may result in various ocular complications, with the most common being uveitis (n = 35; 50%) and myasthenia gravis (n = 13; 18.57%). Adverse events concerning the cornea and the retina were reported in 8 cases each (11.43%). Neuro-ophthalmic adverse events were reported in 6 cases (8.57%). Most of these toxicities responded to topical and systemic steroids. Severe manifestations, however, may require temporary or permanent cessation of PD-1 inhibitors treatment.Conclusions: With the increasing use of PD-1 inhibitors, ophthalmologists need to remain sensitive to the clinical manifestations of adverse events to ensure timely diagnosis and management. To improve their quality of life and reduce mortality, oncologists and ophthalmologists should maintain close cooperation and implement multi-disciplinary treatment.

Purpose: To determine the impact of uveal melanoma thickness on patient survival from the date of presentation and at specific time intervals following metastasis-free survival.

Methods: In this retrospective cohort study, we evaluated data from 8034 consecutive uveal melanoma patients diagnosed at a tertiary care ocular oncology center between May 1972 and August 2007. The patients were categorized on the basis of tumor thickness (per each 1-mm increment) and evaluated for non-conditional survival (from date of presentation) and conditional survival (with 3-years, 5-years, and 10-years of metastasis-free survival) on the cumulative incidence of melanoma-related metastasis at 5-, 10-, 15-, 20-, 25- and 30-years.

Results: For the entire cohort, Non-conditional incidence of metastasis at 5-, 10-, 15-, and 30-years was 8%, 11%, 12%, and 12%. Conditional cumulative incidence of metastasis with 5-year and 10-year metastasis-free survival revealed 30-year incidence of metastasis at 10% and 8%, respectively. The multivariate Cox regression analysis showed that each 1-mm increase in tumor thickness was associated with a significant (p < .05) increase in the risk of metastasis [HR: 1.08 (95% CI: 1.05-1.11) for non-conditional survival, HR: 1.07 (95% CI: 1.03-1.11) for 3-year metastasis-free survival, HR: 1.09 (95% CI: 1.03-1.15) for 5-year metastasis-free survival, and HR: 1.17 (95% CI: 1.05-1.30) for 10-year metastasis-free survival].

Conclusion: In this study, we emphasize that increasing the thickness of uveal melanoma at presentation demonstrates a poorer ultimate prognosis. However, those with longer metastasis-free intervals were found to have a lower risk of ultimate metastatic disease, highlighting the importance of conditional and non-conditional survival.

Aim: Regular screening of large number of people with diabetes for diabetic retinopathy (DR) with the support of available human resources alone is a global challenge. Digital health innovation is a boon in screening for DR. Multiple artificial intelligence (AI)-based deep learning (DL) algorithms have shown promise for accurate diagnosis of referable DR (RDR). The aim of this review is to evaluate the use of AI for DR screening and the various currently available automated DR detection algorithms.

Methods: We reviewed articles published up to May 15th 2024, on the use of AI for DR by searching PubMed, Medline, Embase, Scopus, and Google Scholar using keywords like diabetic retinopathy, retinal imaging, teleophthalmology, automated detection, artificial intelligence, deep learning and fundus photography.

Results: This narrative review, traces the advent of AI and its use in digital health, the key concepts in AI and DL algorithm development for diagnosis of DR, some crucial AI algorithms that have been validated for detection of DR and the benefits and challenges of use of AI in detection and management of DR. While there are many approved AI algorithms that are in use globally for DR detection, IDx-DR, EyeArt, and AEYE Diagnostic Screening (AEYE-DS) are the algorithms that have been approved so far by USFDA for automated DR screening.

Conclusion: AI has revolutionized screening of DR by enabling early automated detection. Continuous advances in AI technology, combined with high-quality retinal imaging, can lead to early diagnosis of sight-threatening DR, appropriate referrals, and better outcomes.

Background: Susac syndrome is a rare autoimmune microangiopathy that affects the small vessels of the retina, brain, and inner ear, leading to a characteristic triad of encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss. The syndrome often presents diagnostic challenges due to its overlapping symptoms with other conditions. Immunosuppressive therapies remain the cornerstone of treatment.

Methods: A retrospective review of the literature from PubMed (1998-2024).

Results: Special emphasis is placed on the role of ophthalmologists, who play a pivotal role in the diagnostic process. This article provides a comprehensive overview of the disease, focusing on the pathogenesis, clinical presentation, diagnostic process, and treatment approaches.

Conclusion: By highlighting the role of ophthalmologists in recognizing and managing Susac Syndrome, this review underscores the importance of a multidisciplinary approach to improve outcomes in this complex, multisystem disease.

Purpose: To assess the tear film parameters associated with photophobia in dry eye disease (DED).

Methods: Three hundred seventy-four patients with DED (mean age, 42.2 ± 12.8 years) had their tear film and OSDI scores evaluated using Oculus keratograph 5 M (TMH, NIBUT, Meibography), Lipiview interferometer (LLT), and TearLab osmolarity system. Photophobia scoring from OSDI sheets was used to calculate the odds ratio via multivariate logistic regression analysis. Data from the eye with severely affected NIBUT was used.

Results: Of 374, 127 had aqueous deficient dry eye disease (ADDE), and 247 had evaporative DED. The mean age, female sex, Schirmer I, TMH, NIBUT, LLT, and tear osmolarity values in patients with photophobia versus no or mild photophobia were 42.2. vs. 40.9 years, 42% vs. 40%, 11.6 vs. 10.5 mm, 0.27 vs. 0.29 mm, 4.6 vs. 4.7s, 60.3 vs. 60.9 nm and 305 vs. 307 mOsm/L, respectively. Multivariate analysis revealed no tear film parameters predictive of photophobia in evaporative DED, whereas tear osmolarity had a weak negative association with photophobia (odds ratio of 0.96, 95% C.I, 0.92-1, p = .04) in ADDE patients.

Conclusion: Tear film parameters do not predict the presence or absence of photophobia in DED except for a weak inverse association with tear osmolarity in ADDE. This suggests the role of central sensitization in regulating photophobia in DED patients.

Purpose: Electric scooters (e-scooters) have rapidly become a mainstream method of transportation in the U.S. but there is consequently limited data on their safety profile. This study evaluates ophthalmic injuries related to e-scooters compared to non-motorized scooters and off-road vehicles (ORV).

Methods: This retrospective study uses the National Electronic Injury Surveillance System (2014 to 2023). Ocular injury profiles associated with conventional scooters, e-scooters, and off-road vehicles were included.

Results: E-scooter ocular injuries rose by 1950% between 2014 and 2023. E-scooter riders were 4.3 times more likely to sustain orbital fractures and 2.7 times more likely to be hospitalized than non-motorized scooter riders. ORV and e-scooter riders had comparable injury and hospitalization patterns. Alcohol use and lack of helmet use were significant contributors to injury severity.

Conclusions and relevance: Injury patterns and hospitalization rates in e-scooter accidents resemble those of ORV incidents. Findings highlight the need for public health interventions to reduce the burden of e-scooter-related injuries.