Seminars in Ophthalmology最新文献

Methods: A retrospective analysis of 44 TED patients (22 teprotumumab, 2023-2025 at Sheikh Shakhbout Medical City and 22 tocilizumab, 2018-2024 at Sheikh Khalifa Medical City) was conducted. Outcomes included proptosis reduction (Hertel exophthalmometry), clinical activity score (CAS) improvement, diplopia improvement, quality of life (QoL) improvement (TED-QOL), recurrence rates, and adverse events. Mann-Whitney U tests and chi-square/Fisher's exact tests were used (p < .05).

Results: Teprotumumab produced greater mean proptosis reduction (2.55 ± 1.01 mm vs 2.07 ± 1.07 mm, p = .04) and a larger mean CAS improvement (5.18 ± 1.99 vs 4.59 ± 1.82, p = .34). Diplopia improvement occurred in 78.6% vs 75.0% of patients (p = .82), while ≥1-grade improvement by Gorman criteria was achieved in 59.1% of each group (p = .61). Quality-of-life improvement averaged 4.2 ± 1.4 vs 3.4 ± 1.5 points (p = .18). Disease recurrence was lower with teprotumumab (4.5% vs 13.6%, p = .28). Adverse events occurred in 54.5% (teprotumumab) and 43.5% (tocilizumab) patients (p = .47), and were generally mild and reversible.

Conclusion: Teprotumumab and tocilizumab improved TED outcomes, with teprotumumab showing trends toward better proptosis reduction and lower recurrence. Larger studies are needed to confirm these findings.

Purpose: To differentiate the clinical features of fungal keratitis with predominantly deep stromal and endothelial (FSKE) involvement and HSV Endothelial Keratitis (HEK).

Methods: Medical records of patients diagnosed with FSKE or HEK between January 2019 and March 2024 were reviewed. We included cases presenting with predominant posterior stromal infiltrates and endothelial exudates that were later confirmed as fungal etiology by microbiology or confocal imaging. These were compared with confirmed HSV endothelial keratitis, diagnosed clinically and/or by PCR (Polymerase Chain Reaction).

Results: A total of 77 cases were included in the study, of which 45 were of FSKE and 32 of HEK. Hyphate edges, along with satellite lesions and the presence of hypopyon, are more commonly seen in fungal cases (66.6% (FSKE) vs. 3.1%, (HEK) OR = 62.0, p = .0001). Posterior stromal involvement was also significantly higher in fungal cases (46.6% vs. 8.8%, OR = 9.4, p = .001). Exudates over the endothelial surface (Endo-exudates) were defined as fluffy in cases with Fungal keratitis as opposed to HSV, where they were more of multiple dot-like (OR = 4.1, p = .005). An intact epithelium was more frequently noted in HEK (84.3% vs. 60% in FSKE, OR = 3.5, p = .02), with the presence of corneal oedema (46.8% vs. 13.3%, OR = 5.7, p = .001). Sampling of these endo-exudates revealed the presence of fungal filaments in 88.8% of fungal keratitis.

Conclusions: Hyphate edges, satellite lesions, hypopyon, fluffy endothelial exudates, and posterior stromal involvement strongly suggest fungal aetiology, whereas intact epithelium, corneal edema, and dot-like endothelial exudates favour HSV.

Purpose: The benefits of anti-tubercular therapy (ATT) in treating ocular tuberculosis (TB) are well documented. However, the optimal duration of ATT remains uncertain. We assessed the efficacy of 6-month ATT compared to 9-month therapy in preventing recurrent intraocular inflammation.

Design: Multi-center, open-label, non-inferiority, randomized controlled trial across three centers in India, Myanmar, and Thailand.

Methods: Patients aged $\ge$ 18 years with tubercular posterior uveitis (retinal vasculitis, serpiginous-like choroiditis [SLC] or multifocal choroiditis) were randomized to receive either 6- or 9-month ATT. Systemic corticosteroids were mandatory for SLC and, at the treating physician's discretion, for other phenotypes. The primary outcome measure was the non-recurrence of inflammation 1 year after ATT.

Results: Sixty-four patients (64.1% males, median age 38 years [22-70], 43.8% bilateral) were randomized across the three sites during the study period. Thirty patients were assigned to the 6-month arm and 34 to the 9-month arm. Both treatments demonstrated a high non-recurrence rate on intention-to-treat (ITT) analysis (0.94 [0.79-0.99] for 9-month [n = 32] and 0.85 [0.65-0.96] for 6-month treatment [n = 26]). The difference in proportion remained below the non-inferiority margin (0.16) for both the ITT (0.09 [84% CI -0.02 - 0.2]) and per-protocol (0.13 [84% CI 0.01 - 0.25]) analyses. In subgroup analysis, retinal vasculitis appeared to favor 6-month ATT, and SLC 9-months, with the confidence intervals not deviating on bootstrap resampling. No discontinuation due to drug toxicity was reported in either group.

Conclusion: Six-month ATT is non-inferior to 9-month ATT for treating tubercular posterior uveitis, though it may vary between the different clinical phenotypes.

Introduction: Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune condition characterized by recurrent conjunctival inflammation and progressive cicatrization, affecting nearly 70% of mucous membrane pemphigoid patients and potentially leading to blindness. Literature suggests an association between OCP and malignancy.

Methods: This case series reports on 10 clinically diagnosed OCP patients with solid malignancies seen at the Illinois Eye and Ear Infirmary between January 2019 and January 2025. In addition, a review of current literature on the association between OCP and cancer was conducted using MEDLINE and Google Scholar databases.

Results: Six patients had an OCP diagnosis before their cancer diagnosis, three had a cancer diagnosis prior to OCP diagnosis, and one had both simultaneously. Patients diagnosed with cancer after OCP experienced clinically worsening OCP, while those with prior cancer diagnosis had stable OCP.

Discussions: Given the potential association with malignancy, patients with OCP or cicatricial conjunctivitis should undergo thorough systemic histories, age-appropriate cancer screenings, and patient education within a multidisciplinary care model to optimize early screening and improve the ocular and overall health outcomes.