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Keratoconus: exploring fundamentals and future perspectives - a comprehensive systematic review. 角膜塑形镜:探索基本原理和未来展望--全面系统综述。
IF 2.5 Pub Date : 2024-03-20 eCollection Date: 2024-01-01 DOI: 10.1177/25158414241232258
Sana Niazi, Zisis Gatzioufas, Farideh Doroodgar, Oliver Findl, Alireza Baradaran-Rafii, Jacob Liechty, Majid Moshirfar

Background: New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.

Objectives: This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.

Design: A multidimensional comprehensive systematic narrative review.

Data sources and methods: A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.

Results: Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.

Conclusion: The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.

Trial registration: The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.

背景:人工智能的新发展,尤其是在角膜病的早期检测和管理方面取得的可喜成果,在过去几十年中已有利地改变了角膜病的自然病史。人工智能在不同机器(如前节光学相干断层扫描和飞秒激光技术)中的应用提高了角膜病治疗方法(从隐形眼镜到角膜成形技术)的安全性、精确性、有效性和可预测性。这些植入人工智能的方案已经开始实施,眼科医生可以用最无创的方式治疗疾病:本研究全面描述了考虑机器学习策略的所有角膜病治疗方法:设计:多维度综合系统性综述:在五大电子数据库(PubMed、Scopus、Web of Science、Embase 和 Cochrane)中进行了全面检索,无语言、时间或研究类型限制。然后,根据主要网状关键词筛选标题和摘要,选出符合条件的文章。对于可能符合条件的文章,还对全文进行了审查:人工智能在角膜病诊断和临床管理方面大有可为,包括早期检测(尤其是亚临床病例)、术前筛查、角膜屈光手术后异位预测以及指导手术决策。大多数研究采用了一种单独的机器学习算法,而少数研究则评估了多种算法,这些算法评估了各种角膜病分期和管理策略之间的关联。最后但并非最不重要的一点是,人工智能在指导角膜内环节段植入角膜和预测手术结果方面被证明是有效的:机器学习模型在角膜病管理中的高效和广泛的临床应用,是未来改善角膜病患者视觉表现的潜在方法的重要目标:该文章已在PROSPERO(前瞻性注册系统综述的国际数据库)注册,ID为CRD42022319338。
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引用次数: 0
Early recurrence of macular schisis in X-linked retinoschisis treated with vitrectomy for rhegmatogenous retinal detachment under silicone oil: case report and brief literature review. 在硅油条件下对流变性视网膜脱离行玻璃体切割术治疗的 X 连锁视网膜裂孔症黄斑裂孔早期复发:病例报告和简要文献综述。
IF 2.5 Pub Date : 2024-02-24 eCollection Date: 2024-01-01 DOI: 10.1177/25158414241232261
Panagiotis Stavrakas, Foteini Tsapardoni, Efthymios Karmiris, Ioannis Iatropoulos, Konstantinos Kounas, Spyridon Lygeros, Vassilios Kozobolis, Demetrios G Vavvas

X-linked retinoschisis (XLRS) is an inherited retinal degeneration affecting males, characterized by splitting of the retinal layers. We herein present the outcomes of surgical treatment in a case of XLRS complicated by rhegmatogenous retinal detachment (RRD). A 22-year-old male presented to the emergency department due to decreased visual acuity and visual field defect in his left eye Oculus Sinister (OS) of 1 week duration. The patient reported an early onset retinal degeneration and decreased visual acuity in both eyes since childhood in his past ocular history. Upon presentation, best corrected visual acuity (BCVA) was 6/30 on the right eye Oculus Dexter (OD) and 6/120 OS. Fundus examination revealed areas of peripheral retinal schisis, and the characteristic spoke wheel pattern on the macula of both eyes. In OS, a temporal RRD involving the macula was identified. The patient underwent surgical treatment with pars plana vitrectomy with internal limiting membrane (ILM) peeling, endolaser, and silicone oil (SO) tamponade. BCVA in OS improved to 6/60 and schistic cavities resolution was observed in the immediate postoperative period. The patient's BCVA further improved to 6/19 at 1 month, as foveal anatomy showed relative improvement. However, there was a rapid reappearance of schisis spaces in the macular area at this point, which was also followed by progressive deterioration of foveal schisis by 3 months post-operatively. The resorption and recurrence of lamellar macular schisis changes after ILM peel and presence of SO, highlights that although XLRS findings can temporarily improve upon surgical intervention, the pathogenetic mechanisms contributing to disease phenotype remain to be elucidated.

X连锁视网膜裂孔症(XLRS)是一种遗传性视网膜变性,男性患者多见,其特点是视网膜层分裂。我们在此介绍一例XLRS并发流变性视网膜脱离(RRD)的手术治疗结果。一名 22 岁的男性因左眼视力下降和视野缺损(Oculus Sinister,OS)而到急诊科就诊,病程 1 周。患者称其过去的眼科病史中,双眼视网膜变性和视力下降自孩提时代就开始了。就诊时,他的右眼最佳矫正视力(BCVA)为 6/30,双眼最佳矫正视力(BCVA)为 6/120。眼底检查发现,双眼视网膜周围均有裂孔,黄斑部有特征性的辐状轮纹。在视网膜手术中,发现了累及黄斑的颞侧 RRD。患者接受了平面玻璃体旁切除术,并进行了内缘膜(ILM)剥离、内激光和硅油(SO)填塞等手术治疗。术后立即观察到OS的BCVA改善至6/60,裂孔消退。术后 1 个月,患者的 BCVA 进一步改善至 6/19,眼窝解剖结构也得到了相对改善。然而,此时黄斑区裂隙又迅速出现,术后 3 个月,眼窝裂隙也逐渐恶化。ILM剥离后片状黄斑裂孔变化的吸收和复发以及SO的存在,突出表明虽然XLRS结果在手术干预后可暂时改善,但导致疾病表型的致病机制仍有待阐明。
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引用次数: 0
Brown syndrome: a literature review. 布朗综合征:文献综述。
IF 2.5 Pub Date : 2024-02-22 eCollection Date: 2024-01-01 DOI: 10.1177/25158414231222118
Masoud Khorrami-Nejad, Elham Azizi, Farah Fareed Tarik, Mohamad Reza Akbari

The current data on various aspects of Brown syndrome are limited and sporadic. This review provides a coherent and comprehensive review of basic features, etiology, classification, differential diagnosis, and different management strategies of patients with Brown syndrome. In this topical review, PubMed, Scopus, and Google Scholar search engines were searched for papers, published between 1950 and January 2023 based on the keywords of this article. The related articles were collected, summarized, categorized, assessed, concluded, and presented. Brown syndrome is identified by restricted passive and active elevation of the eye in adduction. The condition is divided into congenital and acquired causes. The clinical features result from a restricted motion of the superior oblique tendon sheath through the trochlea while trying to look up in adduction. The newest explanation of the underlying pathophysiology has been explained as the presence of a fibrotic strand in the superior oblique muscle tendon with variable insertion sites which creates various elevation deficits seen in Brown syndrome. The most common clinical features include the presence of an abnormal head posture, V-pattern strabismus, and hypotropia in the primary position. Management of Brown syndrome includes watchful observation, surgical, and non-surgical procedures. Some cases might resolve spontaneously without any intervention; however, some acquired cases might require systemic and/or intra-trochlear steroid administration to treat the underlying causes. Surgical procedures such as superior oblique tenectomy and using a silicon tendon expander are indicated in the presence of hypotropia and significant abnormal head posture in the primary position.

目前有关布朗综合征各方面的数据有限,且多为零星数据。本综述对布朗综合征患者的基本特征、病因、分类、鉴别诊断和不同的管理策略进行了连贯而全面的综述。在这篇专题综述中,根据本文的关键词在 PubMed、Scopus 和 Google Scholar 搜索引擎中搜索了 1950 年至 2023 年 1 月间发表的论文。对相关文章进行了收集、汇总、分类、评估、总结和展示。布朗综合征可通过眼球内收时被动和主动抬高受限而确定。该病分为先天性和后天性两种原因。其临床特征是,当试图在外展时抬头时,上斜肌腱鞘通过踝关节的运动受限。对其潜在病理生理学的最新解释是,上斜肌肌腱中存在纤维化股,插入部位不一,从而造成布朗综合征中出现的各种抬高障碍。最常见的临床特征包括头部姿势异常、V 型斜视和原位肌张力低下。布朗综合征的治疗包括观察、手术和非手术治疗。有些病例可能无需任何干预即可自愈,但有些获得性病例可能需要全身和/或耳蜗内注射类固醇来治疗潜在的病因。手术治疗,如上斜腱膜切除术和使用硅肌腱扩张器,适用于存在低垂和主要体位头部姿势明显异常的病例。
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引用次数: 0
Effect of suprachoroidal triamcinolone on intraocular pressure: a systematic review and meta-analysis. 脉络膜上曲安奈德对眼压的影响:系统回顾和荟萃分析。
IF 2.5 Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1177/25158414241228671
Altamash Shahriyar Ghazanfar, Aly Hamza Khowaja, Haroon Tayyab

Background: Triamcinolone acetonide is a synthetic corticosteroid with multiple ocular uses. Like other corticosteroids, it too is associated with ocular side effects such as increased intraocular pressure (IOP), glaucoma and cataracts. Suprachoroidal administration of triamcinolone is hoped to reduce the ocular side effects of the drug, especially rises in IOP. Our systematic review and meta-analysis aims to study this phenomenon.

Objectives: The purpose of this study was to evaluate the effect of suprachoroidal triamcinolone injections on IOP.

Design: Systematic review and meta-analysis.

Methods: We utilized the Medline, Scopus and Cochrane databases for this review. Studies published till June 2023, which fulfilled the eligibility criteria, were included. Studies in the English language with adult participants who were administered suprachoroidal triamcinolone without any concurrent intervention were included, whereas studies that did not report the mean and standard deviation for IOP were excluded. The outcome of interest was IOP at 1, 3 and 6 months post-suprachoroidal triamcinolone injection. IOP values from included studies were extracted onto Review Manager version 5.4 for analysis.

Results: Our search yielded 104 results, from which 22 papers were shortlisted for full-text screening. Finally, 12 studies were included in the analysis. Our analysis suggests a statistically significant increase in IOP in the first month after suprachoroidal triamcinolone injection but no significant differences at 3 and 6 months post-injection as compared to baseline.

Conclusion: Elevated IOP at 1 month post-injection must be considered when using suprachoroidal triamcinolone and adequate safety measures must be taken. However, the absence of a significant rise at 3 and 6 months post-injection indicates that this modality is safer than other existing drug delivery methods.

Trial registration: Registered with the Research Registry with the unique identifying number 'reviewregistry1656.' https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/648eefe65b6523002995eb21/.

背景:曲安奈德是一种人工合成的皮质类固醇,在眼部有多种用途。与其他皮质类固醇一样,它也与眼部副作用有关,如眼压升高、青光眼和白内障。人们希望通过在脉络膜上注射曲安奈德来减少该药物对眼睛的副作用,尤其是眼压的升高。我们的系统综述和荟萃分析旨在研究这一现象:本研究旨在评估脉络膜上腔注射曲安奈德对眼压的影响:系统综述和荟萃分析:方法:我们利用 Medline、Scopus 和 Cochrane 数据库进行综述。我们纳入了截至 2023 年 6 月发表的符合资格标准的研究。纳入的研究均为英语,且成年参与者均接受了脉络膜上曲安奈德治疗,未同时进行任何干预,而未报告眼压平均值和标准差的研究则被排除在外。研究结果为注射脉络膜上曲安奈德后 1、3 和 6 个月的眼压。将纳入研究的眼压值提取到 Review Manager 5.4 版进行分析:我们的搜索结果共产生 104 篇论文,从中筛选出 22 篇论文进行全文筛选。最后,12 项研究被纳入分析。我们的分析表明,在注射脉络膜上曲安奈德后的第一个月,眼压有统计学意义上的显著升高,但注射后 3 个月和 6 个月与基线相比没有显著差异:结论:在使用脉络膜上腔三苯氧胺时,必须考虑到注射后 1 个月的眼压升高,并采取适当的安全措施。不过,注射后 3 个月和 6 个月的眼压没有明显升高,表明这种方式比其他现有给药方法更安全:已在研究注册中心注册,唯一识别码为 "reviewregistry1656"。https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/648eefe65b6523002995eb21/。
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引用次数: 0
Factors influencing aqueous flare after cataract surgery and its evaluation with laser flare photometry. 影响白内障手术后眼球耀斑的因素及其激光耀斑测光评估。
IF 2.5 Pub Date : 2023-12-14 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231204111
Christopher Way, Andrew J Swampillai, Kin Sheng Lim, Mayank A Nanavaty

Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood-aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. It highlights the impact of preoperative pathological states such as uveitis and diabetes, intraoperative techniques, including efficient phacoemulsification and direct comparisons between postoperative anti-inflammatory regimes. There is a large interobserver variation in the subjective flare measurement after cataract surgery and the continued use of LFP amongst other objective, noninvasive measurements of intraocular inflammation, particularly in the further development of cataract surgery, is recommended.

尽管现代白内障手术已日臻完善,但术后炎症仍是全球视力发病率的一个重要因素。激光耀斑光度法(LFP)可以客观地量化眼内炎症和血-水屏障破坏的代用指标。本综述概述了 LFP 在评估白内障术后炎症方面的作用。它强调了葡萄膜炎和糖尿病等术前病理状态、术中技术(包括高效的超声乳化)以及术后抗炎方案之间直接比较的影响。白内障手术后主观耀斑测量的观察者间差异很大,建议继续使用 LFP 和其他客观、无创的眼内炎症测量方法,特别是在白内障手术的进一步发展中。
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引用次数: 0
Central contrast sensitivity perimetry discriminates between glaucomatous and non-glaucomatous eyes. 中央对比敏感度视野法区分青光眼和非青光眼眼睛。
IF 2.5 Pub Date : 2023-10-30 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231208284
Emmanuel Kwasi Abu, Carl Halladay Abraham, Albert Kofi Dadzie, Enyam Amewuho Morny, Michael Ntodie, Stephen Ocansey, Samuel Abokyi, Andrew Owusu-Ansah, Naa Adjeley Addo, Michael Williams, Asantewaa Aboagye-McCarthy, Godfred Sakyi-Badu, Paa Kwesi Fynn Hope, Peter Osei-Wusu Adueming

Background: Glaucoma is an optic neuropathy which causes irreversible vision loss. Standard perimetry, which is essential for glaucoma diagnosis, can only detect glaucomatous visual filed loss when considerable structural damage has occurred. Contrast sensitivity is one of the visual function tests that is reduced in eyes with glaucoma. It is known to be affected in pre-perimetric stages of glaucoma.

Objective: The objective of this study was to investigate the discriminating ability of central contrast sensitivity perimetry in eyes with and without glaucoma.

Design: The study employed a cross-sectional study design.

Methods: The study participants were made of two groups; eyes diagnosed with glaucoma by an ophthalmologist based on visual field test and optical coherence tomography (OCT) and age- and sex-matched controls who were declared free from glaucoma. Static contrast sensitivity (CS) was measured in the central 10° of visual field using a custom psychophysical test.

Results: There were 45 eyes with glaucoma and 45 age- and sex-matched controls in this study. The static CS in the glaucoma group was significantly reduced in 9 out of the 13 tested locations in the central 10° of the visual field. The mean static CS at 5°, 10°, superior hemifield and inferior hemifield were all significantly reduced in the glaucoma patients compared to the controls.

Conclusion: Static CS measurement is a sensitive approach that can be utilized to aid in the detection of glaucoma. The use of static CS can be adopted in the development of a cost-effective yet sensitive screening tool for the detection of glaucoma.

背景:青光眼是一种导致不可逆视力丧失的视神经病变。标准视野对青光眼诊断至关重要,只有在发生相当大的结构损伤时,才能检测到青光眼的视野损失。对比敏感度是青光眼患者视觉功能测试中降低的一种。众所周知,它在青光眼术前阶段受到影响。目的:本研究的目的是探讨中心对比敏感度视野法对青光眼和非青光眼患者的鉴别能力。设计:本研究采用横断面研究设计。方法:研究参与者分为两组;眼科医生根据视野测试和光学相干断层扫描(OCT)诊断为青光眼的眼睛,以及年龄和性别匹配的对照组,他们被宣布没有青光眼。静态对比敏感度(CS)是使用自定义心理物理测试在中心10°视野中测量的。结果:本研究共有45眼青光眼患者和45名年龄和性别匹配的对照组。青光眼组的静态CS在视野中心10°的13个测试位置中的9个位置显著降低。与对照组相比,青光眼患者在5°、10°、上半视野和下半视野的平均静态CS均显著降低。结论:静态CS测量是一种灵敏的方法,可用于青光眼的检测。静态CS的使用可以用于开发一种成本效益高但敏感的青光眼检测筛查工具。
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引用次数: 0
Efficacy of pneumatic retinopexy in young adults with rhegmatogenous retinal detachment. 气动视网膜固定术治疗年轻成人孔源性视网膜脱离的疗效。
IF 2.5 Pub Date : 2023-10-30 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231208279
Zeynep İpekli, Seren Pehlivanoğlu, Özgür Artunay

Background: In young adults with rhegmatogenous retinal detachment, pneumatic retinopexy can be a cost-effective and minimally invasive highly effective method in suitable cases.

Objectives: To evaluate the role of pneumatic retinopexy in the treatment of young adults with rhegmatogenous retinal detachment (RRD) and the factors that may affect the success of pneumatic retinopexy.

Design: Retrospective study.

Methods: The study included 67 eyes of 67 patients aged between 21 and 40 who underwent pneumatic retinopexy (PR) between January 2015 and June 2021 for primary RRD. We retrospectively analyzed the prognostic factors that may affect the success of PR, such as preoperative age, best corrected visual acuity, tear site, lens condition, and axial length.

Results: PR was successful in 61.2% of the patients, whereas 38.8% required secondary surgery. Between the group that had a single surgery (Group 1) and the group that required secondary surgery (Group 2) the tear location, axial length, and volumes of gases used were statistically different (p = 0.04, p < 0.001, and p = 0.02, respectively). There was a significant difference in visual acuity before and after surgery in the group that was successful with a single surgery (Friedman χ2 = 40.051, p < 0.001). There was no significant difference between the two groups in terms of intraocular pressure (p > 0.05), and glaucoma was not observed in the postoperative period.

Conclusion: Since it is a minimally invasive and cost-effective method that provides rapid visual rehabilitation, it can be considered as first-line therapy in young adults who are suitable for PR.

背景:在患有孔源性视网膜脱离的年轻人中,在合适的情况下,气动视网膜固定术是一种成本效益高、微创高效的方法。目的:评价气动视网膜固定术在年轻成人孔源性视网膜脱离(RRD)治疗中的作用,以及可能影响气动视网膜修复成功的因素。设计:回顾性研究。方法:该研究包括67名年龄在21岁至40岁之间的患者的67只眼睛,这些患者在2015年1月至2021年6月期间接受了气动视网膜固定术(PR)治疗原发性RRD。我们回顾性分析了可能影响PR成功的预后因素,如术前年龄、最佳矫正视力、撕裂部位、晶状体状况和轴长。结果:61.2%的患者PR成功,38.8%的患者需要二次手术。在单次手术组(第1组)和需要二次手术的组(第2组)之间,撕裂位置、轴向长度和使用的气体体积在统计学上有差异(p = 0.04,p p = 分别为0.02)。在单次手术成功的组中,手术前后的视力有显著差异(Friedmanχ2 = 40.051,p p > 0.05),术后未观察到青光眼。结论:由于它是一种微创且成本效益高的方法,可以提供快速的视觉康复,因此可以作为适合PR的年轻人的一线治疗。
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引用次数: 0
Management of post-keratoplasty ametropia. 角膜移植术后屈光不正的治疗。
IF 2.5 Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231204717
Niloufar Bineshfar, Azin Tahvildari, Sepehr Feizi

Even after a successful corneal transplant, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. Refractive errors can be caused by recipient pathology and corneal thickness, as well as intraoperative factors such as donor-host discrepancy, recipient's eccentric trephination, vitreous length, wound apposition, technique of suturing, and suture material. Also, wound healing and the interim between keratoplasty and suture removal contribute to astigmatism. Lamellar keratoplasty outperforms penetrating keratoplasty in terms of endothelial cell loss and endothelial graft rejection, yet the risk of developing refractive errors is comparable. Nonsurgical interventions such as spectacles and lenses fail to provide desirable vision in cases with high astigmatism and corneal irregularity. When these limitations are encountered, surgical interventions including incisional keratotomy, wedge resection, laser refractive surgeries, intracorneal segments, and intraocular lens implantation are employed. However, occasionally, none of these approaches deliver the desired effects, leading to the need for a repeat keratoplasty.

即使在成功的角膜移植后,患者也会出现严重的屈光不正,阻碍了他们的康复和满意度。屈光不正可能由接受者的病理学和角膜厚度,以及术中因素引起,如供体-宿主差异、接受者的偏心钻孔、玻璃体长度、伤口贴壁、缝合技术和缝合材料。此外,伤口愈合以及角膜移植术和缝线去除之间的过渡也会导致散光。在内皮细胞损失和内皮移植物排斥反应方面,薄层角膜移植术优于穿透性角膜移植术,但发生屈光不正的风险相当。在高度散光和角膜不规则的情况下,眼镜和镜片等非手术干预措施无法提供理想的视力。当遇到这些限制时,可以采用外科干预措施,包括切口角膜切开术、楔形切除术、激光屈光手术、角膜内段和人工晶状体植入术。然而,偶尔,这些方法都没有达到预期的效果,导致需要重复进行角膜移植。
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引用次数: 0
The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness. 非体外循环冠状动脉搭桥术对脉络膜下厚度、神经节细胞复合体和视网膜神经纤维层厚度的影响。
IF 2.5 Pub Date : 2023-10-11 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231204106
Nesime Setge Tıskaoğlu, Alper Yazıcı, Abdulkadir Ercan, Kübra Tınç

Background: Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes.

Objectives: To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer.

Design: Prospective, longitudinal study.

Methods: Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed.

Results: A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values.

Conclusion: Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.

背景:心脏手术与眼部不良事件有关。非体外循环冠状动脉搭桥手术避免了体外循环中出现的全身炎症反应,在末端器官功能障碍和神经系统结果方面优于体外循环。目的:确定非体外循环冠状动脉搭桥术对脉络膜厚度、神经节细胞复合体和视网膜神经纤维层的影响。设计:前瞻性纵向研究。方法:对接受非体外循环手术的患者在术前和术后1小时进行检查 第6周 手术后数周。记录脉络膜厚度、神经节细胞复合体和视网膜神经纤维层的测量结果,并评估非体外循环冠状动脉搭桥术对这些参数的影响。结果:本研究共纳入44例44眼患者。从252.84开始,凹下脉络膜厚度有统计学意义的增加 ± 56.24 µm至273.82 ± 39.76 1时为µm 周和301.97 ± 44.83 µm,6 非体外循环冠状动脉搭桥术后数周(p = 0.044;p ⩽ 0.001)。神经节细胞复合体和视网膜神经纤维测量显示与术前值相比没有显著差异。结论:非体外循环冠状动脉搭桥术对神经节细胞复合体和视网膜神经纤维的测量没有负面影响。非体外循环手术后,脉络膜下厚度显著增加,这可能对高危患者或已有受脉络膜影响的眼部疾病的患者有利。
{"title":"The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness.","authors":"Nesime Setge Tıskaoğlu,&nbsp;Alper Yazıcı,&nbsp;Abdulkadir Ercan,&nbsp;Kübra Tınç","doi":"10.1177/25158414231204106","DOIUrl":"10.1177/25158414231204106","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes.</p><p><strong>Objectives: </strong>To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer.</p><p><strong>Design: </strong>Prospective, longitudinal study.</p><p><strong>Methods: </strong>Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed.</p><p><strong>Results: </strong>A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (<i>p</i> = 0.044; <i>p</i> ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values.</p><p><strong>Conclusion: </strong>Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/dc/10.1177_25158414231204106.PMC10571675.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review. 新冠肺炎-MOGAD相关视神经炎的潜在诱因:病例报告和文献综述。
IF 2.5 Pub Date : 2023-10-06 eCollection Date: 2023-01-01 DOI: 10.1177/25158414231199541
Ankit Bhardwaj, Hara Prasad Mishra, Ayush Goel, Ashi Gupta

SARS-CoV-2 affects the nervous system directly by neurotoxic action, by binding to angiotensin-converting enzyme-2 (ACE2) receptors or indirectly by inducing cytokine storm leading to disruption of the blood-brain barrier, immunological mediation, increasing blood coagulation and as a trigger for autoimmune-mediated demyelinating injuries in the central nervous system. In COVID-19 neuro-ophthalmological manifestations are not so common. Optic neuritis is the result of optic nerve inflammation and has varied causes. In many patients, signs of inflammation are not visible on the fundus, and it usually manifests as papillitis-anterior neuritis, retrobulbar neuritis or visible optic nerve oedema. We are reporting a case of a middle-aged adult diagnosed with myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis of the right eye post-COVID-19 disease. Routine biochemical and haematological investigations, including electrolytes and hepatic and renal functions, were normal. In cerebrospinal fluid (CSF) - glucose 63.8 mg/dL, protein 39.1 mg/dL and ADA - 1 µ/L. No oligoclonal bands of immunoglobulin G (IgG) were seen on high-resolution electrophoresis. Serum Anti-MOG-antibodies were positive. A gadolinium-contrast magnetic resonance imaging (MRI) of the brain and orbits shows post-contrast enhancement in the superior aspect of the right intraconal soft tissue. The right optic nerve appears bulky and heterogeneous with peripheral post-contrast enhancement along its entire length suggestive of neuritis. A diagnosis of MOG antibody-positive optic neuritis was made, and the patient was treated with an injection of Methylprednisolone with intravenous immunoglobulin. Each day, the evaluation of the right eye showed remarkable improvement from finger counting to 6/6 vision. The patient was discharged on the 9th day of admission. We can conclude that early diagnosis was essential for improving the long-term outcome of the patient.

严重急性呼吸系统综合征冠状病毒2型通过神经毒性作用、与血管紧张素转化酶-2(ACE2)受体结合或间接通过诱导细胞因子风暴影响神经系统,从而破坏血脑屏障、免疫介导、增加血液凝固,并引发自身免疫介导的中枢神经系统脱髓鞘损伤。在新冠肺炎中,神经眼科表现并不常见。视神经炎是视神经炎症的结果,其病因多种多样。在许多患者中,眼底看不到炎症迹象,通常表现为乳头炎性前神经炎、球后神经炎或可见的视神经水肿。我们报告了一例中年人被诊断为新冠肺炎后右眼髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性视神经炎的病例。常规生化和血液学检查,包括电解质和肝肾功能,均正常。脑脊液(CSF)-葡萄糖63.8 mg/dL,蛋白质39.1 mg/dL和ADA-1 µ/L。在高分辨率电泳上未发现免疫球蛋白G(IgG)的寡克隆带。血清抗MOG抗体阳性。大脑和眼眶的钆造影磁共振成像(MRI)显示,右侧脑内软组织的上表面有造影后增强。右侧视神经体积庞大且不均匀,沿其整个长度的外周造影后增强提示神经炎。诊断为MOG抗体阳性的视神经炎,并对患者进行注射甲基泼尼松和静脉注射免疫球蛋白的治疗。每天,对右眼的评估都显示出从手指计数到6/6视力的显著改善。患者于入院第9天出院。我们可以得出结论,早期诊断对于改善患者的长期预后至关重要。
{"title":"COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review.","authors":"Ankit Bhardwaj,&nbsp;Hara Prasad Mishra,&nbsp;Ayush Goel,&nbsp;Ashi Gupta","doi":"10.1177/25158414231199541","DOIUrl":"10.1177/25158414231199541","url":null,"abstract":"<p><p>SARS-CoV-2 affects the nervous system directly by neurotoxic action, by binding to angiotensin-converting enzyme-2 (ACE2) receptors or indirectly by inducing cytokine storm leading to disruption of the blood-brain barrier, immunological mediation, increasing blood coagulation and as a trigger for autoimmune-mediated demyelinating injuries in the central nervous system. In COVID-19 neuro-ophthalmological manifestations are not so common. Optic neuritis is the result of optic nerve inflammation and has varied causes. In many patients, signs of inflammation are not visible on the fundus, and it usually manifests as papillitis-anterior neuritis, retrobulbar neuritis or visible optic nerve oedema. We are reporting a case of a middle-aged adult diagnosed with myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis of the right eye post-COVID-19 disease. Routine biochemical and haematological investigations, including electrolytes and hepatic and renal functions, were normal. In cerebrospinal fluid (CSF) - glucose 63.8 mg/dL, protein 39.1 mg/dL and ADA - 1 µ/L. No oligoclonal bands of immunoglobulin G (IgG) were seen on high-resolution electrophoresis. Serum Anti-MOG-antibodies were positive. A gadolinium-contrast magnetic resonance imaging (MRI) of the brain and orbits shows post-contrast enhancement in the superior aspect of the right intraconal soft tissue. The right optic nerve appears bulky and heterogeneous with peripheral post-contrast enhancement along its entire length suggestive of neuritis. A diagnosis of MOG antibody-positive optic neuritis was made, and the patient was treated with an injection of Methylprednisolone with intravenous immunoglobulin. Each day, the evaluation of the right eye showed remarkable improvement from finger counting to 6/6 vision. The patient was discharged on the 9th day of admission. We can conclude that early diagnosis was essential for improving the long-term outcome of the patient.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/b1/10.1177_25158414231199541.PMC10559697.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41148395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Therapeutic Advances in Ophthalmology
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