Seminars in Ophthalmology最新文献

Purpose: This study aimed to determine the rate of retained metallic intraocular foreign bodies (IOFBs) following torsional phacoemulsification cataract surgery by an experienced surgeon and elucidate related surgical factors, particle origin theories from existing literature, and postoperative visual impact.

Methods: An observational study was conducted on 300 consecutive cases of cataract who underwent torsional phacoemulsification by a single surgeon using two-handed stop-and-chop technique. The incidence of retained IOFBs was observed and correlated with the surgical parameters and the density of cataract.

Results: Retained IOFBs were observed in 6 of 300 (2%) cases operated. These were significantly associated with higher cumulative dissipated energy and the density of cataract, but without impacting final vision.

Conclusion: Phacoemulsification retains inherent risks of metallic particle liberation from ultrasonically stressed instrumentation interacting within confined spaces. However, small retained IOFBs appear visually inconsequential over limited follow-up. Advances in technique, engineering design, and surgical quality control hold promise for further enhancing safety of the procedure.

Background: The anterior segment of the eye plays a crucial role in maintaining the normal intraocular pressure and vision. Developmental defects in the anterior segment structures lead to anterior segment dysgenesis (ASD) and primary congenital glaucoma (PCG), which share overlapping clinical features. Several genes have been mapped and characterized in ASD, some of which are also involved in other glaucoma phenotypes. PCG exhibits genetic heterogeneity like ASD, but the known genes do not account for the entire genetic basis of the disease. Considering the significant phenotypic and genotypic overlap between ASD and PCG, this article explores the possible involvements of ASD-associated genes in PCG pathogenesis.

Methods: A nonsystematic search in PubMed was performed using various combinations of keywords related to ASD, glaucoma, genetics, and molecular mechanisms, and articles published up until March 2024 were considered. Specifically, information pertaining to ASD-associated genes (FBN1, FOXE3, HMX1, LMX1B, MAF, OTX2, PAX6, PITX2, PITX3, PRDM5, PRSS56, RAX, SLC4A11, SOX2, TRIM44, VAX1, and WT1) was extracted, and their expressions were determined from the GTEx and EMBL-EBI Expression Atlas. Interactions of these genes were determined through the Ingenuity Pathway Analysis software.

Results: Most of the ASD-associated genes were found to be highly expressed in the early embryonic stages. Interactome analysis revealed that TRIM44, PAX6, WT1, SOX2, OTX2, PRDM5, and FBN1 interacted through the NFκB and Akt/PI3K pathways, either directly, or through interactions with other partners. FOXC1, PITX2, and HMX1 interacted through Wnt and Hedgehog signaling pathways. Both ASD and PCG present similar clinical features and harbor mutations in genes that are implicated in both these conditions. Collectively, we constructed a hypothetical model and proposed two parallel mechanisms comprising the defects in the anterior chamber angle and cell death in PCG pathogenesis.

Conclusions: Our findings suggest that complex interplay of these ASD-associated genes and their interactions could potentially result in defects in the anterior chamber angle and trabecular meshwork and induce cell death, resulting in PCG pathogenesis.

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.