Therapeutic Advances in Ophthalmology最新文献

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.

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.

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.

Background: Extended depth-of-focus (EDOF) intraocular lenses (IOLs) provide a continuous range of uncorrected vision at different distances.

Objective: To assess visual acuity, refractive outcomes, and patient satisfaction after cataract surgery using the LuxSmart EDOF IOL (Bausch+Lomb).

Design: A two-center, prospective observational clinical study.

Methods: This study includes patients who have undergone bilateral phacoemulsification with bilateral implantation of the LuxSmart EDOF IOL, with the aim of achieving emmetropia. Visual acuity (VA) and subjective refraction were obtained in all patients preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective measures were obtained using the Catquest-9SF questionnaire and the Patient-Reported Spectacle Independence Questionnaire (PRSIQ). Contrast sensitivity and a glare assessment were undertaken postoperatively. Safety outcomes were additionally assessed.

Results: Sixty eyes from thirty patients were recruited for this study. The mean spherical equivalent was 1.04 ± 1.67 D preoperatively and -0.30 ± 0.46 D at 6 months. Monocular uncorrected distance VA was 0.57 ± 0.32 (logMAR) preoperatively and 0.09 ± 0.12 (logMAR) at 6 months. Mean 6-month monocular uncorrected VA was 0.11 ± 0.13, 0.12 ± 0.15, and 0.31 ± 0.15 (logMAR) at 80, 66, and 40 cm, respectively. More than 90% of patients were either fairly or very satisfied with their vision. There was one case of suspected vitreomacular traction postoperatively.

Conclusion: The LuxSmart EDOF IOL offers good refractive, VA, and safety outcomes. The single elongated focal point designed to enhance the DOF shows good results for VA and patient satisfaction.

The coronavirus disease-19 (COVID-19) infection may remain asymptomatic or may have several different presentations. Although this disease primarily affects the respiratory system, systemic manifestations affecting the gastrointestinal, cardiovascular, neurological, otorhinolaryngologic, and ophthalmic systems have been reported. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. In the current narrative review, we report the ophthalmic manifestations of COVID-19 in the pediatric age cohort. We performed a comprehensive literature search for the publications on ophthalmic manifestations of COVID-19 in children between 1 March 2020 and 1 January 2022 and compiled the ophthalmic manifestations of this entity among the pediatric population. Conjunctivitis is the most common ophthalmic manifestation in children and can develop at any stage of the disease. Ophthalmic manifestations are seen more commonly in children with severe systemic disease. Long-term and indirect consequence of the COVID-19 disease is the rise of myopia among children. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. Pediatricians, as well as ophthalmologists, must keep observing all children with COVID-19 closely for ophthalmic signs.

Background: Diabetic retinopathy, a common microvascular complication of diabetes mellitus, is one of the leading causes of vision loss worldwide. Although some oral drugs have been suggested to affect the risk of diabetic retinopathy, systematic evaluation about the associations between medications and diabetic retinopathy is still absent.

Objective: To comprehensively investigate associations of systemic medications with incident clinically significant diabetic retinopathy (CSDR).

Design: Population-based cohort study.

Methods: From 2006 to 2009, more than 26 000 participants residing in New South Wales were enrolled in the 45 and Up study. Diabetic participants with self-reported physician diagnosis or records of anti-diabetic medication prescriptions were finally included in the current analysis. CSDR was defined as diabetic retinopathy cases requiring retinal photocoagulation recorded in the Medicare Benefits Schedule database from 2006 to 2016. Prescriptions of systemic medication from 5 years to 30 days prior to CSDR were retrieved from the Pharmaceutical Benefits Scheme. The study participants were equally split into training and testing datasets. Logistic regression analyses were performed for the association between each of systemic medication and CSDR in the training dataset. After controlling the false discovery rate (FDR), significant associations were further validated in the testing dataset.

Results: The 10-year incidence of CSDR was 3.9% (n = 404). A total of 26 systemic medications were found to be positively associated with CSDR, among which 15 were validated by the testing dataset. Additional adjustments for pertinent comorbidities suggested that isosorbide mononitrate (ISMN) (OR: 1.87, 95%CI: 1.00-3.48), calcitriol (OR: 4.08, 95% CI: 2.02-8.24), three insulins and analogues (e.g., intermediate-acting human insulin, OR: 4.28, 95% CI: 1.69-10.8), five anti-hypertensive medications (e.g., furosemide, OR: 2.53, 95% CI: 1.77-3.61), fenofibrate (OR: 1.96, 95% CI: 1.36-2.82) and clopidogrel (OR: 1.72, 95% CI: 1.15-2.58) were independently associated with CSDR.

Conclusion: This study investigated the association of a full spectrum of systemic medications with incident CSDR. ISMN, calcitriol, clopidogrel, a few subtypes of insulin, anti-hypertensive and cholesterol-lowering medications were found to be associated with incident CSDR.

Background: Amiodarone is widely used for heart arrhytmia. Previous studies have suggested the possibility of optic neuropathy with the chronic use of this drug.

Objectives: To identify structural or functional changes in the retina and optic nerve in patients on chronic amiodarone therapy without visual complaints.

Methods: This observational study included 15 eyes of 15 patients with cardiac arrythmia on chronic amiodarone treatment and 15 healthy matched subjects as a control group. All subjects underwent electrophysiological tests [pattern visual evoked potential (PVEP), pattern electroretinogram (PERG), multifocal electroretinogram (mfERG), and optical coherence tomography (OCT) and angiography (OCTA)].

Results: There were no statistically significant differences between the two groups regarding the PVEP, PERG, and the mfERG parameters. Macular and optic nerve head OCT and OCTA have not shown statistically significant differences except for the morphological parameters of the optic disc (p = 0.008 for the horizontal and p = 0.013 for vertical cup/disc ratio and p = 0.045 for rim area).

Conclusion: Patients on chronic amiodarone therapy have not shown evident structural or functional changes in the retinal or optic nerve as demonstrated by electrophysiological tests, OCT, and OCTA results compared to controls.

Background: Corneal cross-linking (CXL) is a safe and effective procedure for slowing keratectasia progression in eyes with a corneal thickness of at least 400 µm. Limited research has evaluated the safety and efficacy of epi-off CXL in corneas thinner than 400 µm.

Objective: To evaluate the safety and efficacy of CXL to slow keratectasia progression in eyes with <400 µm preoperative corneal thickness.

Design: Retrospective chart review.

Methods: This retrospective chart review included 37 eyes who underwent epi-off, iso-osmolar riboflavin corneal CXL with a preoperative thinnest point of the cornea <400 µm and had at least 6-12 months of follow-up. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity (BCVA), thinnest point of the cornea, flat keratometry, steep keratometry, maximum keratometry (K_max), need for penetrating keratoplasty, and cases of endothelial failure were recorded. Data were collected at baseline and months 3, 6, 9, and 12 post-CXL.

Results: Following cross-linking, 18 eyes (47%) had improved BCVA, 13 (35%) had an unchanged BCVA, and 6 eyes (16%) had a worse BCVA (p = 0.05). The mean postoperative BCVA was 20/81 (0.61 LogMAR) compared to 20/121 (0.78 LogMAR) preoperatively (p = 0.06). K_max decreased an average of 1.1 D at 3-month (p = 0.53) and 3.4 D at the furthest follow-up (p = 0.10). At the farthest follow-up, 22.7% of eyes had >1 D of K_max steepening. No patients required keratoplasty and there were no cases of endothelial failure in the follow-up period.

Conclusion: This research supports the safety and efficacy of epi-off, iso-osmolar CXL in eyes with <400 μm baseline corneal thickness with no patients requiring penetrating or endothelial keratoplasty, a trend toward improvement in BCVA, and K_max flattening. In the future, prospective studies would be helpful to confirm these findings.