Seminars in Ophthalmology最新文献

Purpose: To investigate the efficacy and safety of brolucizumab in diabetic macular edema (DME) and diabetic retinopathy (DR).

Methods: In this systematic review and meta-analysis, an electronic search was done to acquire all articles describing brolucizumab use in patients with DME and DR. The review was prospectively registered on PROSPERO (CRD42022382625). Collected articles were filtered through two stages by independent reviewers. Data were extracted from the included articles and then analyzed accordingly.

Results: Brolucizumab induced significant improvement in best-corrected visual acuity and was either better or non-inferior to other types of anti-VEGF (MD -0.64 mu, 95% CI [-1.15, -0.13], P = .01); the same observation was noted with regards to central subfield macular thickness (CSMT) (MD -138.6 mu, 95% CI [-151.9, -125.3], P = .00001). Brolucizumab was reported to be relatively safe for use in diabetic patients, with few adverse events observed, with a higher frequency of adverse events in relation to the 3 mg dose compared to the 6 mg dose.

Conclusion: Brolucizumab is a new drug that has potential advantages in efficacy over other anti-VEGF agents in the treatment of DME and DR. It showed significant improvement in BCVA and CSMT with the possibility of a lower dosing schedule compared to other agents. Although observed in low frequency, sight-threatening adverse effects appear to occur more frequently compared to other anti-VEGF agents. The main observed adverse event was retinal vasculitis which was seen more commonly with the 3 mg dose versus the 6 mg dose.

The prognosis of 11,778 mitochondrial mutations in Leber hereditary optic neuropathy (LHON) is poor. Patients with favorable outcomes (visual acuity better than 20/100) who could be observed for more than 6 months were analyzed. Among 74 patients (57 male, 17 female), 6 (8.1%) showed improvement in visual acuity of 20/100 or higher. The patients with favorable outcomes have better visual acuity at nadir (logMAR 0.98 ± 0.69 in the favorable patients and logMAR 2.32 ± 0.93 in the unfavorable patients, p = .003). Among the favorable group, four patients (36, 32, 19, and 7 years of age at onset) took idebenone within 6 months of onset. However, fifty-one percent of the patients with unfavorable outcomes took idebenone (p = .008). Although the age at onset in the favorable patients is relatively younger than that of the unfavorable patients (20.3 ± 10.8 versus 28.8 ± 12.8 years), a significant difference was not found (p = .138). In conclusion, better visual acuity in nadir and administration of idebenone may affect vision recovery.

Aim: To report a case series on canaliculocoele and to review the existing literature.

Methods and materials: A retrospective analysis of the case records of all patients diagnosed with canaliculocoele between January 1^st, 2018, and December 31^st, 2019, was conducted. Only histopathologically proven cases of canaliculocoele with a minimum follow-up of 6 weeks were included.

Results: Five cases of canaliculocoele that presented over 2 years were included. The mean age was 58.8 ± 9.63 years, with a female preponderance. The mean duration of symptoms was 22.2 ± 22.71 months. All patients had medial cystic swelling, either at the upper or lower lid. Four patients had gross stenosis of the punctum, while the punctum was absent in one patient. Ultrasound biomicroscopy showed canalicular cystic distension with intra-lesional hyper-reflective echoes. All patients were managed with a complete cystectomy, except for one where a marsupialization was done. Adjunctive mini-Monoka intubation was done in two patients. The histopathological diagnosis of all cases was consistent with canaliculocoele. The mean follow-up was 3.82 ± 2.77 months.

Conclusion: Canaliculocoele is mostly unilateral and seen in middle-aged women. A good clinical evaluation supported by diagnostic imaging along with an affirmative histopathology can confirm the diagnosis.