Therapeutic Advances in Ophthalmology最新文献

Background: Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks.

Objective: Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon.

Methods: Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications.

Results: Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1-3) to 0.33 ± 0.53 (range 0-2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%).

Conclusion: When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision.

Background: Charles Bonnet syndrome (CBS) refers to the experience of visual hallucinations occurring secondary to sight loss. Although there is an increasing amount of research on this phenomenon, CBS remains a lesser-known outcome of visual impairment, with limited research into the impact on the patient.

Objectives: To explore the experiences and opinions of visually impaired military veterans with CBS regarding the impact of visual hallucinations.

Design: Semi-structured qualitative interviews.

Methods: Forty-six telephone interviews were conducted with members of Blind Veterans UK, a charity for visually impaired ex-service men and women. One-hundred and fifteen individuals at the charity with CBS were identified and invited to a semi-structured interview (participation rate - 40%). Qualitative data was transcribed and analysed using thematic analysis.

Results: Four overarching themes were identified: (1) impact of CBS (2) understanding and management of CBS (3) awareness of CBS (4) recommendations. Negative impact of CBS included feelings of fear, annoyance and disruptions to daily life and quality of life. Negative appraisal of CBS was not necessarily related to negative hallucination content. Participants expressed the value of increased awareness amongst patients and health care professionals. Knowledge and understanding of CBS provided reassurance and was considered an effective strategy to mitigate the negative impact of the condition.

Conclusion: Regardless of hallucination content, CBS has a substantial impact on the lives of people with visual impairment. Increased awareness and information can help to support individuals to manage their CBS more effectively. However, the findings from this study cannot be generalized to people without a military background so further research is required to understand and optimize support for military veterans and civilians with CBS.

Background: Charles Bonnet syndrome (CBS) refers to the presence of visual hallucinations experienced by people, without cognitive, or psychiatric deficits that are related to sight loss. This study surveyed younger adults (18-60 years) with visual impairments, to assess the impact of anxiety, depression, loneliness, and the COVID-19 lockdowns on their visual hallucinations.

Objectives: To examine the association between depression, anxiety, loneliness, the COVID-19 lockdowns, and visual hallucinations in younger adults with CBS.

Design: An online survey was used with an opportunistic sample of people with sight loss.

Methods: A survey assessed the frequency, duration, and valence of visual hallucinations using a five-point Likert scale, and assessed anxiety, depression, and loneliness using the Hospital Anxiety and Depression Scale and UCLA (University of California, Los Angeles) loneliness scale, respectively.

Results: Twenty-nine young adults (21 female), aged 22-59 years with vision loss from a range of causes, who experience visual hallucinations, were included in the survey. The majority (76%) of participants had experienced hallucinations within the past week, with 83% stating they occurred frequently or very frequently. For 59% of participants, the hallucinations were of short duration (<2 min), but 34% experienced them continuously. Hallucinations were regarded as being unpleasant by 34% of participants, while 59% rated them as being neutral. The incidence of depression and anxiety was high in the sample (48% and 65%, respectively), and 65% experienced loneliness. Participants with scores indicating anxiety or borderline anxiety had significantly more frequent hallucinations than other participants and a similar trend was found for depression. The COVID-19 lockdowns exacerbated hallucinations in 24% of cases, but for 68% they remained unchanged.

Conclusion: The study demonstrated that CBS is observed in people of all ages, with sight loss arising from a wide range of underlying causes. Depression, anxiety, and loneliness are observed in many cases of CBS. While there was some indication that high anxiety, and to some extent depression, was associated with frequent hallucinations, no other relationships were found between the psychosocial factors (depression, anxiety, and loneliness) and the frequency, duration, or valence of their visual hallucinations.

Background: Allergic conjunctivitis is a prevalent ocular condition characterized by inflammation of the conjunctiva due to hypersensitivity reactions to various allergens. Understanding its epidemiology and clinical characteristics is crucial for effective management and public health interventions.

Methods: This cross-sectional study investigated the prevalence, triggers, and associated factors of allergic conjunctivitis among residents of the Southern region of Saudi Arabia. Data were collected using a structured questionnaire administered through Google Forms. Statistical analysis was performed using IBM SPSS, including descriptive statistics and bivariable/multivariable analyses.

Results: A total of 693 participants were recruited through convenience sampling via online platforms. Among the participants, 73.9% reported ocular symptoms, while 26.1% did not. Dust emerged as the most common trigger for ocular symptoms (32.9%), followed by eye drops/contact lenses (8.7%), animal dander (6.9%), and chemicals (5.8%). Notably, 39.7% reported experiencing ocular symptoms throughout the year. Despite the prevalence of ocular symptoms, only 26.7% consulted an ophthalmologist. Multivariable analysis revealed that gender and seasonal variation in symptoms were associated with allergic conjunctivitis diagnosis. Females showed a lower odds ratio (OR) of being diagnosed with allergic conjunctivitis compared to males (OR: 0.62, 95% CI: 0.29-1.31), and participants experiencing symptoms with no specific season had significantly lower odds of being diagnosed with allergic conjunctivitis (OR: 0.28, 95% CI: 0.11-0.72). A history of allergic rhinitis demonstrated a strong positive association with allergic conjunctivitis diagnosis (OR: 3.77, 95% CI: 1.83-7.75).

Conclusion: The study highlights the considerable burden of allergic conjunctivitis and the underutilization of healthcare services among affected individuals in the Southern region of Saudi Arabia. Tailored interventions and increased awareness are essential for effective management and mitigation of allergic conjunctivitis's impact on affected individuals and healthcare systems.

Background: Sjögren's syndrome is an autoimmune disease characterized by sicca symptoms and various extraglandular manifestations including vasculitis. Neurological involvement occurs frequently (Neuro-Sjögren) and often mimics immune neuropathies such as chronic inflammatory demyelinating polyneuropathy (CIDP).

Objectives: We aim to assess relevant differences in vessel density (VD) in Optical Coherence Tomography Angiography (OCTA) in those diseases to use it as an easily available diagnostic tool.

Design: Prospective, monocentric pilot-study.

Methods: OCTA (Heidelberg Engineering OCT SPECTRALIS) of the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus (DCP) of the retina was prospectively performed in Neuro-Sjögren, age-matched CIDP patients (n = 31, each), and healthy controls (n = 30). Vessel density (VD) and foveal avascular zone (FAZ) was measured with Erlangen Angio Tool.

Results: Significantly lower VD were found for the DCP and ICP in Neuro-Sjögren and CIDP patients compared to healthy controls (p = 0.0002 and <0.0001). When group comparison was age-adjusted, these differences were not found anymore. Different frequencies of "low" retinal blood flow in each layer comparing Neuro-Sjögren and CIDP patients were not found. FAZ revealed no significant differences between patients with Neuro-Sjögren, CIDP and healthy controls.

Conclusion: This study found no significant differences in VD or the foveal avascular zone between Neuro-Sjögren and CIDP patients using OCTA, suggesting that inflammatory vascular changes in the retina are uncommon in Neuro-Sjögren patients.

Background: Charles Bonnet syndrome (CBS) is a condition in which people with vision loss experience complex visual hallucinations. These complex visual hallucinations may be caused by increased excitability in the visual cortex that are present in some people with vision loss but not others.

Objectives: We aimed to evaluate the association between γ-aminobutyric acid (GABA) in the visual cortex and CBS. We also tested the relationship among visually evoked responses, functional connectivity, and CBS.

Design: This is a prospective, case-controlled, cross-sectional observational study.

Methods: We applied 3-Tesla magnetic resonance spectroscopy, as well as task-based and resting state (RS) connectivity functional magnetic resonance imaging in six participants with CBS and six controls without CBS. GABA+ was measured in the early visual cortex (EVC) and in the lateral occipital cortex (LOC). Participants also completed visual acuity and cognitive tests, and the North-East Visual Hallucinations Interview.

Results: The two groups were well-matched for age, gender, visual acuity and cognitive scores. There was no difference in GABA+ levels between groups in the visual cortex. Most participants showed the expected blood oxygenation level dependent (BOLD) activation to images of objects and the phase-scrambled control. Using a fixed effects analysis, we found that BOLD activation was greater in participants with CBS compared to controls. Analysis of RS connectivity with LOC and EVC showed little difference between groups. A fixed effects analysis showed a correlation between the extent of functional connectivity with LOC and hallucination strength.

Conclusion: Overall, our results provide no strong evidence for an association between GABAergic inhibition in the visual cortex and CBS. We only found subtle differences in visual function and connectivity between groups. These findings suggest that the neurochemistry and visual connectivity for people with Charles Bonnet hallucinations are comparable to a sight loss population. Differences between groups may emerge when investigating subtle and transient changes that occur at the time of visual hallucinations.

The glaucoma treatment paradigm is starting to change from a more reactive approach that relies on topical medications to a more proactive approach that leverages procedural interventions. This evolution toward interventional glaucoma has been enabled by a growing array of lower-risk minimally invasive procedures such as laser trabeculoplasty, minimally invasive glaucoma surgery, and procedural pharmaceuticals. A common feature of these glaucoma interventions-as with all glaucoma interventions-is the need for early, prompt, and accurate diagnosis. The present review summarizes new and upcoming developments in glaucoma diagnostics. These include technologies and techniques for home-based intraocular pressure measurement, novel visual field platforms, photography- and optical coherence tomography-based visualization, and artificial intelligence applications. They also include emerging technologies such as mitochondrial flavoprotein fluorescence imaging, detection of apoptosing retinal cells, collector channel visualization, and genetic testing. These diagnostic modalities have the potential to circumvent the limitations of traditional diagnostic methods. By increasing the frequency and feasibility of obtaining valuable glaucoma data with more rapid detection of disease and progression, these diagnostics may enable an interventional approach to glaucoma treatment for the betterment of patient care.

Background: Charles Bonnet syndrome (CBS) is a condition characterised by the occurrence of vivid and complex visual hallucinations in individuals with visual impairment.

Objective: To explore the relationship between emotional distress and the perceived impact of CBS symptoms on participants' lives. We tested the hypothesis that heightened negative affect was associated with a more negative appraisal of CBS symptoms, increased self-reported loneliness, and poorer quality of life (QOL).

Design: Cross-sectional.

Methods: Participants recruited predominantly via vision-related charities rated their hallucinations and their impact on a Likert scale. Loneliness and negative affect were assessed with the Three-Item Loneliness Scale and Positive and Negative Affect Schedule. Health index (EQ-5D-3L) and vision-related QOL (VF-9) were also assessed. Correlation analysis and multi-variable regression determined the relation between survey responses.

Results: The majority of 126 respondents (81%) were aged 65+ years and 84% reported active CBS symptoms. Fifty-five percent of respondents rated impact of CBS as negative and no-one rated the impact as 'very pleasant'. A statistically significant correlation was found between impact of CBS and negative affect (p ⩽ 0.001; rho = -0.34) and impact of CBS and loneliness (p = 0.017; rho = -0.21). The relation between negative affect and CBS impact remained statistically significant when accounting for the impact of loneliness and the relationship between loneliness and CBS effect (p = 0.002, adj R ² = 0.1). A statistically significant correlation between loneliness and negative affect (p ⩽ 0.001; rho = 0.55) was also found.

Conclusion: Respondents experiencing negative emotions were more likely to perceive the impact of CBS symptoms as negative and report greater feelings of loneliness. Negative affect is an important consideration when assessing people with CBS.

Retinal hypoxia stands as a pivotal yet often underappreciated factor in the etiology and progression of many retinal disorders such as glaucoma, hypertensive retinopathy, diabetic retinopathy, retinal vein occlusions, and retinal artery occlusions. Current treatment methodologies fail to directly address the underlying pathophysiology of hypoxia and aim to improve ischemia through alternative methods. In this review, we discuss the critical role of retinal hypoxia in the pathogenesis of various retinal diseases and highlight the need for innovative therapeutic strategies that address the root cause of these conditions. As our understanding of retinal hypoxia continues to evolve, the emergence of new technologies holds the promise of more effective treatments, offering hope to patients at risk of vision loss.

This case series describes the aggregate rate of recovery in five consecutive subjects (six eyes) with retinal vein occlusion (RVO) who received l-methylfolate and other vitamins via Ocufolin^®, a medical food. Subjects were followed for 10-33 months by a single ophthalmologist. Ocufolin^® was prescribed at the time of diagnosis and subjects remained on the regimen throughout the time of observation. Examinations were performed in an un-masked fashion at 3-month intervals with recording of best corrected visual acuity (BCVA), average retinal nerve fiber layer (ARNFL) and central macular thickness (CMT), and fundus (examination of the retina, macula, optic nerve, and vessels) photography. Testing was done for vitamin deficiencies, vascular and coagulable risk factors, and methylenetetrahydrofolate reductase (MTHFR) polymorphisms. Vitamin deficiencies and vascular risk factors were found in all subjects, and all four tested subjects carried at least one MTHFR polymorphism. By the end of the study period BCVA in all subjects was 20/25 or better. Cystoid macular edema was identified and measured by optical coherence tomography (OCT). The percent change was calculated and plotted at 3-month intervals using the percent change in thickness from the time of diagnosis and percent change toward normative values for ARNFL and CMT. The total reduction in thickness of ARNFL and CMT from time of diagnosis was 44.19% and 30.27%, respectively. The comparison to normative data shows a reduction of ARNFL from 164.2% to 94% and CMT from 154.4% to 112.7% of normal thickness (100%). Plots showed the aggregate recovery was most rapid over the first 3 months and slowed over the next 3 months with most of the recovery taking place within 6 months of treatment. The rate of improvement in BCVA and resolution of retinal thickening was found to be better than predicted on historical grounds. No subjects progressed from nonischemic to ischemic RVO. Vitamin deficiencies, vascular risk factors, and genetic predisposition to oxidative stress were common in this RVO series. It appears that addressing these factors with Ocufolin^® had a salutary effect on recovery.