Therapeutic Advances in Ophthalmology最新文献

Background: Facial masks are essential for preventing respiratory infections, particularly among healthcare workers. However, prolonged mask use may lead to ocular surface disruption, known as mask-associated dry eye (MADE).

Objectives: To evaluate the impact of different types of disposable surgical masks on tear film parameters and corneal wavefront aberrations during an 8-h work shift.

Design: Randomized clinical trial.

Methods: Sixty healthcare personnel at Rajavithi Hospital were randomly assigned to three mask groups: Group 1 (earloop surgical mask; Medimask^®), Group 2 (earloop surgical mask with adhesive nose strip), and Group 3 (anti-fog earloop surgical mask; Welcare 3D Blue Line Anti-Fog Mask^®). Non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and conjunctival redness were assessed using the Oculus Keratograph^®5M. Corneal higher-order aberrations (HOAs) were measured using the GALILEI Dual Scheimpflug Analyzer before and after 8 h of mask wear.

Results: TMH decreased significantly in all groups: Group 1 from 201.13 ± 85.10 µm to 174.53 ± 42.01 µm (p = 0.003), Group 2 from 188.81 ± 59.55 µm to 164.61 ± 50.58 µm (p = 0.036), and Group 3 from 194.50 ± 58.29 µm to 166.25 ± 45.90 µm (p = 0.034). NIBUT showed slight, non-significant decreases: Group 1 (9.26 ± 4.47-8.35 ± 3.26 s), Group 2 (8.88 ± 3.79-8.20 ± 3.12 s), and Group 3 (9.14 ± 4.20-8.55 ± 3.74 s). Conjunctival redness increased significantly only in Group 1 (1.75 ± 0.47-1.98 ± 0.52, p = 0.048). HOAs were mostly unchanged, except for total HOAs at the 6 mm zone, which were higher in Group 3 (1.85 ± 1.20) than in Group 1 (1.14 ± 0.48) and Group 2 (1.28 ± 0.58; p = 0.012).

Conclusion: An 8-h shift of mask use reduced TMH across all groups and increased conjunctival redness in earloop surgical masks without adhesive. Although most optical aberrations remained unchanged, elevated HOAs in the anti-fog earloop surgical mask group may affect vision quality under mesopic conditions.

Thai clinical trials registry: TCTR 20230725002 (https://www.thaiclinicaltrials.org/show/TCTR20230725002).

This comprehensive review analyzes different types of intrastromal corneal ring segments (ICRS) used in the treatment of keratoconus, focusing on visual outcomes, complication rates, and patient selection criteria for INTACS, KeraRing, Ferrara Ring, MyoRing, and corneal allogenic intrastromal ring segments (CAIRS). We reviewed clinical studies, case reports, and long-term follow-ups to compare visual outcomes, corneal stability, and safety profiles of these ICRS types, with specific emphasis on parameters such as uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), keratometry (Kmax reduction), and complication rates, including migration, extrusion, and postoperative visual disturbances. Each type of ICRS exhibits distinct advantages, with efficacy varying according to disease severity and corneal irregularity. INTACS demonstrated reliable visual improvements for moderate keratoconus with minimal complication rates. KeraRing provided customizable options that significantly improved UDVA and CDVA in cases with irregular astigmatism, although segment migration was more common. The Ferrara Ring was highly effective in central keratoconus, offering substantial corneal flattening with a moderate risk of visual disturbances. MyoRing effectively reduced higher-order aberrations in advanced keratoconus but was associated with a higher reoperation rate. CAIRS, combined with corneal crosslinking, showed promising outcomes with enhanced biocompatibility and minimal complications, particularly for patients sensitive to synthetic materials. ICRS types offer tailored options for keratoconus management. INTACS remains effective for moderate cases, while KeraRing and Ferrara Ring are suitable for advanced stages, especially where customization and flattening are needed. MyoRing offers significant benefits for severe ectasia, and CAIRS presents a novel, biocompatible alternative. Optimizing outcomes and minimizing complications requires tailored selection based on patient-specific corneal characteristics and disease stage. Further comparative studies are needed to refine patient selection criteria and assess the long-term efficacy of each ICRS type.

Scleral necrosis is a rare but severe complication caused by various etiologies. The main therapeutic approach is topical and systemic medical treatment. Surgical interventions may be indicated in unresponsive cases. These approaches, however, may fail to control the scleral necrosis. In addition, both medical and surgical treatment may lead to a number of ocular and systemic side effects, calling for noninvasive but effective treatment for the management of scleral necrosis. This review aims to summarize current studies investigating the role of topical erythropoietin in the treatment of scleral necrosis caused by various etiologies. Different electronic databases were extensively searched for relevant studies published until May 30, 2025, using the following keywords: "erythropoietin" AND "scleral necrosis" OR "necrotizing scleritis" OR "scleral ischemia." The primary outcomes assessed were the indication for topical erythropoietin administration, with secondary outcomes including the efficacy and ocular and systemic safety of treatment with this medication. Seven studies reported the outcomes of the administration of topical erythropoietin for the treatment of scleral necrosis. Of which, two were experimental studies, two were single case reports, including three eyes of two patients, two were case series, including 11 eyes of 11 patients, and one was a nonrandomized case-control study, including 11 eyes of nine patients. Etiologies for scleral necrosis were chemical burns in 15 eyes, thermal burn in one eye, surgically-induced scleral necrosis in six eyes, and systemic autoimmune diseases in three eyes. The necrotic lesions were improved in all eyes 9-90 days after the initiation of treatment with topical erythropoietin. Regarding ocular safety, two eyes developed granulation tissue, which resolved after the cessation of the treatment. Corneal vascularization was observed in 16 eyes with limbal stem cell deficiency due to chemical/thermal burns. No intraocular vascularization or systemic adverse reactions were observed during treatment with topical erythropoietin. Topical administration of erythropoietin can be safe and effective for the management of scleral necrosis caused by various etiologies. However, more studies, including randomized clinical trials, are needed to establish the role of topical erythropoietin in the treatment of this rare but sight-threatening complication.

In recent years, descemet stripping only (DSO) has emerged as an alternative to descemet membrane endothelial keratoplasty (DMEK) in certain patients with Fuchs endothelial dystrophy (FED). We herein report the 10-year follow-up of a 77-year-old male patient after bilateral DSO. The patient initially underwent DSO on the right eye for circumscribed cornea guttata. Three weeks after DSO, the best-corrected visual acuity (BCVA) already increased from 0.5 logarithm of the Minimum Angle of Resolution (logMAR) [Endothelial Cell Density (ECD) 1667/mm², Central Corneal Thickness (CCT) 583 µm] to 0.2 logMAR, and further improved to 0 logMAR 1 year after surgery (ECD 2213/mm², CCT 567 µm). This excellent visual acuity remained stable over the following 5 years (ECD 1696/mm², CCT 568 µm). Five years after the successful surgery on the right eye, DSO was also performed on the left eye by the same surgeon as FED progressed, with BCVA dropping to 0.5 logMAR (ECD unmeasurable, CCT 703 µm). However, this time, the treatment did not improve vision. Consequently, a DMEK was performed 7 months after DSO, which increased the BCVA to 0.1 logMAR. Ten years after successful DSO of the right eye, corneal guttata were observed, indicating de novo formation of a descemet membrane, and vision deteriorated again to 0.2 logMAR (ECD not measurable, CCT 641 µm). DMEK was also performed on the right eye ten years after successful DSO, which improved vision to 0.2 logMAR at one-year follow-up. This case suggests that DSO may be a temporary alternative to DMEK in FED, potentially providing excellent visual gain and good central endothelial cell density for nearly ten years. However, it may still fail due to long-term progression of the disease. It also highlights that the outcome may be limited by individual factors. Therefore, it is crucial to educate the patient about the limitations of DSO, both in short and long term. Nevertheless, if DSO fails, endothelial keratoplasty can still be successfully performed.

Background: Intravitreal injection (IVI) is a common practice in today's ophthalmology clinics. The pain that patients will experience after the application may be important in compliance with the treatment.

Objectives: This study aimed to investigate the correlation between various clinical characteristics of patients receiving IVI and corresponding visual analogue scale (VAS) scores (0: no pain to 10: severe pain).

Design: Single-centre, Prospective study.

Methods: A total of 313 participants (168 females, 145 males) with a mean age of 66.91 ± 9.67 years underwent IVI for diabetic retinopathy (DRP), retinal vein occlusion (RVO), or age-related macular degeneration (AMD). Eye examinations, including visual acuity and intraocular pressure measurements, were also conducted, and injection indications were determined based on dilated fundus examinations and spectral domain optical coherence tomography images. Following the injections, the researchers solicited VAS scores ranging from 0 to 10 (no pain to severe pain). The study explored the relationships between clinical characteristics, headache frequency, joint and muscle pain, analgesic use, surgical history, antidepressant use, vasovagal syncope, previous injections, and VAS score.

Results: The mean VAS score was 4.77 ± 2.90. While DRP and RVO had similar VAS scores (4.95 ± 2.98 and 5.22 ± 2.70, respectively), the AMD group had significantly lower scores (4.09 ± 2.64). Compared with nonusers, antidepressant users had significantly greater VAS scores (5.79 ± 3.43) (4.52 ± 2.70) (p < 0.05). Patients with a history of syncope had significantly greater VAS scores (p < 0.05). In patients reporting monthly headaches, a positive correlation was found between headache frequency and VAS score (r = 0.23, p < 0.01).

Conclusion: For individuals experiencing daily headaches, inquiries about vasovagal syncope and antidepressant use may be beneficial, considering the potential association of these symptoms with higher VAS scores after IVIs.

We report the first case of concurrent iridocorneal endothelial (ICE) syndrome and keratoconus, treated successfully with Descemet's membrane endothelial keratoplasty (DMEK). A 60-year-old male presented with gradual visual deterioration in his left eye over 4 years. Best corrected visual acuity was 1.1 LogMar, with corneal stromal oedema. Hypertonic saline and systemic acyclovir provided no improvement. Further examination revealed peripheral anterior synechiae and possible ICE syndrome. Combined cataract surgery and adapted DMEK were performed, using right eye data for intraocular lens calculation. Postoperative histopathology confirmed ICE syndrome. Two months postoperatively, vision improved to 0.54 LogMar, with normal intraocular pressure and optical coherence tomography. Ten months later, unaided visual acuity reached 0.4 LogMar, with no significant changes observed in regular follow-ups. The patient remains satisfied with his vision. This case highlights the rare association of keratoconus with Chandler Syndrome and the first report of such a case where DMEK was used as management. The diagnosis of ICE syndrome complicates treatment, however, despite the challenges, DMEK demonstrated promising results for ICE-related corneal oedema in a patient with concurrent keratoconus, offering improved visual acuity and no complications.

Scleritis is a rare, potentially sight-threatening, painful eye disease. Based on its anatomical involvement, it can be categorized as anterior and posterior scleritis. There are several possible causes, among which infectious and noninfectious origins should be considered. From the therapeutic aspect, it is important to clarify the infectious origin, to provide target treatment, or to identify the possible underlying autoimmune disease. Corticosteroid therapy is considered to be the basis for the stepwise treatment of scleritis. In this article, we describe the management of three patients (investigations, stepwise approach of therapy, and treatment difficulties) who developed three different types of scleritis: anterior non-necrotizing scleritis, anterior necrotizing scleritis, and scleromalacia perforans. The differential diagnosis of scleritis and its management after diagnosis pose difficulties in clinical practice. In general, the therapeutic approach is based on the principle of early and individualized treatment, which depends on the nature and severity of the patient's inflammatory eye disease and the presence or absence of associated systemic diseases.

Purpose: To report the practices and outcomes of ophthalmic evaluations for pentosan polysulfate sodium (PPS) maculopathy at a single institution.

Methods: This study was conducted on patients of Massachusetts Eye and Ear who had documented PPS exposure and an ophthalmic encounter from 2019 through 2022. The main outcomes were examination components performed and identification of PPS maculopathy. Image analysis confirmed findings.

Results: Thirty-seven patients were included. Of the initial encounters, optical coherence tomography (OCT) was documented for 29 (78.4%) patients, fundus autofluorescence (FAF) for 13 (35.1%), and color fundus photography (CFP) for 12 (32.4%). Four cases (10.8%) of PPS maculopathy were observed. Mean (range) duration of exposure was 17 (15-20), and mean (range) cumulative exposure was 2418 (2190-2628) mg. Maculopathy did not occur until after 15 years of exposure and greater than 2000 mg of cumulative exposure. Three cases (8.1%) of PPS maculopathy were evaluated following drug cessation over a mean of 18.3 months. Two cases (5.4%) of PPS maculopathy progression post-cessation over durations of 1.1 and 4.3 years were described.

Conclusion: We found inadequate imaging and documentation of OCT, CFP, and FAF to evaluate for toxicity in patients with a history of current or past PPS exposure. This study contributes four cases of PPS maculopathy to the growing literature reporting the phenotypic spectrum of toxicity, including two cases of maculopathy progression following drug cessation. There is a need for evaluations post-cessation due to possible progression of maculopathy, so patients are not treated inappropriately for differential diagnoses.