Therapeutic Advances in Ophthalmology最新文献

Diabetic retinopathy and retinal vein occlusion represent two prevalent vision-threatening retinal diseases. Retinal laser therapy still plays an important role in treating these conditions, but its successful administration often requires referral to specialized centers and retina experts. It is, therefore, essential to develop a new treatment methodology that enables patients to benefit from the expertise of specialists from reference centers. For this purpose, we investigated the feasibility of teleguided photocoagulation conducted across continents to determine if different ophthalmologists can consensually devise and safely execute treatment plans remotely. Two patients from Italy (Europe) with diabetic retinopathy and one from Arizona (USA) with central retinal vein occlusion underwent retinal photocoagulation using Navilas^® 577s with remote teleguidance from the corresponding continental counterpart. The process included remote planning and execution, supported by an audio connection for real-time communication. Teletreatment success criteria included treatment plan completion, patient tolerance, remote connection stability, and technical quality. All treatments have been successfully performed with accurate spot application and no technical issues. Follow-ups at three weeks confirmed positive outcomes for each patient. Remote teleguided retinal photocoagulation appears feasible, offering a promising tool for global collaborations in retina care and potential benefits to regions with limited access to expert supervision.

Background: Selective laser trabeculoplasty (SLT) is an effective long-term option for the treatment of open-angle glaucoma.

Objectives: To investigate the real-world efficacy and safety of SLT with the Zeiss VISULAS green laser in medically treated primary open-angle glaucoma (POAG).

Design: Retrospective, single-center study.

Methods: POAG patients ⩾18 years of age on at least one antiglaucoma medication prior to the procedure, who underwent SLT with the Zeiss VISULAS green laser (Carl Zeiss Meditec, Jena, Germany). Medications were terminated or reinstated at subsequent follow-ups depending on the intraocular pressure (IOP) control. The primary efficacy outcome measures were mean reduction in glaucoma medications and mean reduction in IOP at 3, 6, and 12 months compared to baseline. Safety outcomes were intra- or post-procedural complications.

Results: One hundred fifty-six eyes of 156 patients, aged 66.5 ± 13.2 years, were recruited. The mean number of medications was reduced from 2.3 ± 1.0 at baseline to 0.8 ± 1.1 and 0.8 ± 1.2 at 3- and 6 months, respectively (p < 0.001). Despite the reduction of medications, the mean IOP (mmHg) was reduced from 16.6 ± 3.10 at baseline to 15.4 ± 3.82 at 3 months (n = 156) and 15.1 ± 3.30 at 6 months (n = 140) (p < 0.001). IOP reduction ⩾20% was observed in 28.8% of patients at 3 months and 27.9% of patients at 6 months. In the 12-month follow-up group (n = 22), mean medications and IOP (mmHg) at baseline were 2.3 ± 0.9 and 16.0 ± 2.80, respectively, which decreased to 0.9 ± 1.1 (p < 0.001) and 14.5 ± 1.92 (p = 0.103), respectively. At 3- and 6-month post-procedure, 59.6% of patients and 60% of patients, respectively, were medication-free compared to none at baseline. At 6 months, 69.3% of patients maintained IOP lower than or equal to pre-procedure IOP on fewer medications compared to baseline. No vision-threatening intra- or post-procedure complications were noted.

Conclusion: SLT with the Zeiss VISULAS green laser resulted in a clinically and statistically significant reduction in number of medications needed for IOP control. The procedure had a good safety profile similar to that described in the literature for SLT, with no vision-threatening complications.

Charles Bonnet syndrome (CBS) is a condition characterised by visual hallucinations of varying complexity on a background of vision loss. CBS research has gained popularity only in recent decades, despite evidence dating back to 1760. Knowledge of CBS among both the patient and professional populations unfortunately remains poor, and little is known of its underlying pathophysiology. CBS parallels two other better-known conditions that occur as a result of sensory loss: phantom limb syndrome (PLS) (aberrant sensation of the presence of a missing limb) and tinnitus (aberrant sensation of sound). As 'phantom' conditions, CBS, PLS and tinnitus share sensory loss as a precipitating factor, and, as subjective perceptual phenomena, face similar challenges to investigations. Thus far, these conditions have been studied separately from each other. This review aims to bridge the conceptual gap between CBS, PLS and tinnitus and seek common lessons between them. It considers the current knowledge base of CBS and explores the extent to which an understanding of PLS and tinnitus could provide valuable insights into the pathology of CBS (including the roles of cortical reorganisation, emotional and cognitive factors), and towards identifying effective potential management for CBS.

The integration of artificial intelligence (AI) in healthcare, particularly in the domain of facial processing tasks, has witnessed substantial growth in the 21st century. However, this requires sufficient appraisal for clinicians and researchers to adequately understand nomenclature and key concepts commonly used in this field. This article aims to elucidate the diverse applications of facial processing tasks, such as facial landmark extraction, face detection, face tracking, facial expression recognition and action unit detection, and their relevance to ophthalmology and other medical specialties. The keywords 'ophthalmology', 'facial artificial intelligence', 'facial recognition' and 'periorbital measurements' were used on PubMed and Ovid, between September 2012 and September 2022, to identify and screen for eligible articles. Studies reporting on human patients in ophthalmology, plastic, maxillofacial and cosmetic surgery with ocular lesions whose facial biometrics were processed by AI and written in the English language were included. A total of 291 and 513 articles were identified on PubMed and Ovid respectively. Twenty articles were included for analysis in this literature review after duplicates, inaccessible articles and articles without full manuscripts were excluded. Although fully automated algorithms can share the workload in healthcare systems and relieve strains on manpower, rigorous testing is crucial, followed by the challenges of convincing management bodies that it would work in reality, coupled with the costs of implementing specialised functional hardware and software. While patients have a valid concern that it would reduce physical contact with clinicians, it is important for clinicians not to replace clinical decision-making with AI alone.

Congenital aniridia is a rare genetic eye disorder often associated with PAX6 gene mutations, leading to complex ocular manifestations, including aniridia-associated keratopathy (AAK) and cataracts. The surgical management of cataracts in these patients is particularly challenging due to severe corneal opacities, which obscure key surgical steps such as capsulorhexis and phacoemulsification. This report presents two cases of congenital aniridia with severe AAK, in which chandelier retroillumination-assisted cataract surgery was employed. This technique, typically used in vitreous surgery, provided enhanced visualization of the lens through posterior segment illumination, facilitating successful cataract extraction and intraocular lens implantation. Both patients showed significant postoperative improvement in visual acuity. These cases demonstrate the feasibility and effectiveness of chandelier retroillumination-assisted cataract surgery in patients with congenital aniridia complicated by severe corneal opacity.

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.