Taiwan Journal of Ophthalmology最新文献

Increasingly, patients desire spectacle independence postcataract surgery, for which multifocal intraocular lens (IOL) implantation is widely performed. However, multifocal IOLs have certain drawbacks: fixed focal change, increased photic phenomena, and unsuitability for use in aberrated eyes. Monovision is an option, but can only achieve fixed focal points as well. An alternative IOL that bridges the gap between providing an extended depth of focus (DOF) and decreasing induced aberrations is the IC-8 Apthera IOL, which utilizes small aperture technology to provide a continuous DOF with good near, intermediate and distance vision in eyes with up to 1.50D of preoperative astigmatism. Importantly, the IC-8 IOL has shown potential for use in aberrated eyes, demonstrating increased visual acuity at all distances, good contrast sensitivity, minimal photic phenomena, and high levels of spectacle independence in patients with corneal irregularities and higher order aberrations, especially postrefractive surgery. The IC-8 IOL has also been able to achieve good centration and positional stability, which is key for good visual outcomes and spectacle independence after surgery. This paper aims to bring together relevant literature to review the outcomes of IC-8 IOL.

Infectious uveitis remains a major cause of global visual morbidity, with significant geographic variability in its epidemiological patterns and clinical presentations. The Asia-Pacific region presents a unique model to study infectious uveitis, due to socioeconomic, environmental, and healthcare diversity within its populations. This narrative review explores the spectrum of infectious uveitides prevalent in the Asia-Pacific region, emphasizing diseases with high endemicity, emerging threats, and those posing notable diagnostic or therapeutic challenges. The review also highlights the critical importance of considering an infectious etiology in the differential diagnosis of uveitis, especially within, or travelers from endemic areas. The associated hosts, transmission vectors, and epidemiology of infectious uveitis, when combined with both the systemic and ocular phenotype can rationalize subsequent investigations and empiric therapy. Highly prevalent causes of infectious uveitis with typical ophthalmic manifestations are diagnosed utilizing consensus diagnostic criteria. However, regionally endemic and emerging diseases frequently present with overlapping clinical features, and their recognition requires the integration of epidemiologic insight with targeted diagnostics. Rare and novel uveitides are also addressed. Molecular diagnostics have transformed pathogen detection but remain inaccessible in many low-resource settings which may contribute to under-reporting. There has been increasing global and regional epidemiological surveillance of infection and seropositivity in both humans and reservoir hosts in the contemporary literature. However, interventional studies for the management of ophthalmic disease remain limited. This review underscores the evolving epidemiology of infectious uveitis in the Asia-Pacific and provides a comprehensive reference to inform clinical suspicion, directed diagnostic investigation, and public health planning.

Ocular tuberculosis (OTB) is one of the extrapulmonary manifestations caused by Mycobacterium tuberculosis (Mtb). If untreated, it can result in poor visual prognosis. Prompt diagnosis of OTB is met with challenges. The gold standard for the diagnosis of OTB is the direct demonstration of the Mtb in ocular tissues or ocular fluids either by Ziehl-Neelsen Stain, culture or molecular diagnostic techniques such as polymerase chain reaction. This is onerous owing to the paucibacillary nature of the disease, small quantity of samples, and low sensitivity and specificity of molecular diagnostic tests. Thus, one needs to rely on indirect evidences to make a diagnosis. Hence, most often, the diagnosis of OTB is presumed based on the geography the patient hails from and indirect laboratory evidences suggestive of TB. In this narrative review, we review clinical, laboratory, and radiology markers which aid in the diagnosis of OTB and outline the current concepts in the diagnosis of OTB.

Cytomegalovirus (CMV) anterior uveitis (AU), a significant cause of intraocular inflammation, is increasingly recognized in immunocompetent individuals, often leading to visual morbidity if not promptly addressed. The diagnosis of CMV AU is challenging, owing to its variable clinical manifestations, which can overlap with other forms of AU. CMV AU should be suspected in corticosteroid-recalcitrant inflammatory ocular hypertensive syndrome or corneal endotheliitis with coin-shaped keratic precipitates (KPs). CMV AU differs from herpes simplex virus and varicella-zoster virus AU with milder symptoms, less ciliary injection, smaller KPs, higher intraocular pressure (IOP), and diffuse iris atrophy. Aqueous humor analysis, specifically polymerase chain reaction (PCR), is the gold standard for diagnosis, detecting viral DNA, and quantifying disease severity. While highly effective, PCR can yield false negatives with low viral loads. Clinical judgment remains crucial, alongside PCR results. Early diagnosis and targeted antiviral treatment are key to preserving visual function and preventing complications, such as glaucoma and keratopathy. CMV AU treatment aims to control inflammation, reduce viral activity, and prevent complications. Antiviral therapy is crucial, with topical ganciclovir (GCV) gel often first line. Oral valganciclovir is used for systemic treatment, especially in severe cases. Intravitreal GCV may be used in severe cases, often followed by systemic therapy, but its role remains suspicious. Corticosteroids should only be used with antiviral therapy. Topical corticosteroids manage inflammation and are tapered over time. IOP management is also essential, potentially requiring surgery. Treatment duration varies, and long-term maintenance may be necessary. More research is needed to standardize treatment protocols and further understand the pathogenesis and immunopathogenesis of CMV anterior uveitis.

Purpose: Rhegmatogenous retinal detachments (RRD) are the most common and sight-threatening complication of acute retinal necrosis (ARN). This study aims to analyze the clinical characteristics, treatment outcomes, and factors influencing RRD outcomes in ARN patients.

Materials and methods: A retrospective review of ARN and ARN-related RRD cases diagnosed between 2014 and 2023 at a tertiary eye institute in South India was conducted. Data on demographics, clinical presentation, quadrant involvement, visual acuity, treatment modalities, outcomes, and RRD recurrence patterns were analyzed.

Results: Among 322 ARN patients, RRD was observed in 111 eyes (27.32%) of 88 patients, with a mean age of 38 years and a male predominance (63%). HIV positivity was noted in 11.38%. Despite prophylactic photocoagulation in 17 eyes, RRD developed in 15 eyes within 2 months to 2 years. Silicone oil tamponade was used during primary surgical intervention, with 1000 cc in 77 eyes and 5000 cc in 34 eyes. RRD recurrence occurred in 42.6%. Multivariate analysis revealed significant associations between RRD recurrence and factors such as RRD at presentation or extensive retinitis involvement (over 50% of quadrants affected). Among the patients with recurrent RRD, roughly half (50%, n = 18) had involvement of over 50% retinal quadrants by ARN, and over half (71.42%, n = 35) presented with RD initially.

Conclusion: This study underscores the high prevalence of RRD in ARN. Retinal detachment at initial presentation and retinitis involving more than two quadrants were significant risk factors for RRD recurrence. Prophylactic laser photocoagulation did not prevent RRD occurrence.

Purpose: The purpose of this study was to evaluate the utility of baseline interferon (IFN)-inducible gene expression as a prognostic biomarker for Anti-tubercular therapy (ATT) response in patients with undetermined cause of uveitis who tested positive for QuantiFERON-TB Gold (QFT-positive uveitis).

Methods: This prospective cohort study included 17 QFT-positive uveitis patients at a tertiary uveitis center in Indonesia. Baseline and week 2 peripheral blood transcripts were evaluated through real time-quantitative polymerase chain reaction to assess the expression of 10 IFN-inducible genes (IRF7, IFIT2, STAT1, IL1B, MyD88, TLR8, FCGR1B, GBP1, UBE2L6, and SERPING1). Patients were stratified into clusters based on gene expression patterns. The primary outcome was complete resolution of uveitis at 6 months.

Results: Hierarchical clustering revealed two distinct groups. Patients with higher baseline expression of IFN genes (Cluster 2) were more likely to achieve complete uveitis resolution after ATT compared to those with lower expression levels (Cluster 1) (80% vs. 43%). Using a previously established IFN gene signature score (IGSS) cutoff (≥5.61), 82% of high-scoring patients showed complete resolution, compared to only 33% in the low-scoring group (P = 0.046). However, week 2 gene expression changes did not correlate with treatment response, indicating limited utility in monitoring disease activity or predicting long-term outcomes.

Conclusion: Baseline, but not week 2, peripheral blood IFN-inducible gene expression may serve as a prognostic biomarker for stratifying QFT-positive uveitis patients through prediction of their response to treatment. Patients with higher baseline IGSS are more likely to require ATT to achieve uveitis resolution at 6-month follow-up.

Purpose: To comprehensively review the epidemiology, clinical features, causative pathogens, primary infection sites, and mortality of endogenous endophthalmitis (EE).

Materials and methods: A retrospective review was conducted on patients diagnosed with EE at National Taiwan University Hospital between 2014 and 2024. Clinical data, including patient demographics, underlying systemic diseases, identified pathogens, infection sources, and outcomes, were analyzed.

Results: Ninety-nine eyes from 91 patients with EE were enrolled. The majority of cases were bacterial (61.5%), followed by fungal infections (27.5%). A small number of cases had no documented pathogens. Bilateral involvement was more frequent in fungal cases. Among patients with endogenous bacterial endophthalmitis (EBE), Klebsiella pneumoniae was the most common causative pathogen, typically originating from liver abscesses. Diabetes mellitus (DM) was the most frequently associated systemic disease. In endogenous fungal endophthalmitis (EFE), Candida albicans was the predominant pathogen. Patients with EFE had a higher prevalence of bilateral involvement and increased mortality. Overall, the visual prognosis for EE patients was poor, regardless of the causative pathogen. Generalized estimating equations analysis identified female sex (P = 0.014), EFE (P < 0.001), bilateral involvement (P < 0.001), and DM (P = 0.014) as risk factors for mortality in EE.

Conclusion: EE remains a vision-threatening condition. K. pneumoniae, frequently associated with liver abscesses, is the leading cause of EBE. C. albicans is the most common pathogen in EFE. However, patients with bilateral EFE have a higher mortality rate. Overall, final visual outcomes were generally poor, with many patients experiencing severe vision impairment despite treatment.

Purpose: The purpose of this study was to investigate corneal endothelial changes following common clinical endothelial injury scenarios in order to uncover mechanisms underlying unexplained chronic corneal endothelial wound healing.

Materials and methods: This cross-sectional study included patients with endothelial injuries from three common scenarios: postcataract surgery, corneal dystrophies, and penetrating injuries. Noncontact specular microscopy was used to capture images from five distinct corneal regions. Endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (HEX) were assessed. All endothelial photographs were also reviewed. Statistical analysis was performed to compare injured and noninjured eyes.

Results: Seventy-seven patients were enrolled, with a mean age of 64 years (48 females, 29 males). The mean central ECD was 2138.91 ± 869.34 cells/mm² in postcataract surgery eyes, 1999.48 ± 763.91 cells/mm² in endothelial dystrophy eyes, and 1854.86 ± 551.85 cells/mm² in trauma cases. While most parameters showed no significant differences, postcataract surgery eyes exhibited a significant increase in CV value in the upper and temporal regions (P < 0.05). Unexpectedly, stochastic single-cell loss was observed in 42.86% of patients, continuing up to two years postinjury. This loss was significantly higher compared to uninjured eyes (P = 0.00005), suggesting that excessive single-cell loss occurs well beyond the expected wound healing period.

Conclusion: We identified accelerated stochastic single-cell loss in the corneal endothelium following primary injuries, persisting well beyond the expected wound healing period, a phenomenon that has not been previously highlighted. This finding offers a potential explanation for the chronic endothelial cell loss following a primary injury.

Uveitis sometimes causes severe inflammation and significant loss of visual function. However, the cause is unknown in approximately 50% of cases, and the pathogenesis of the disease is also unknown in many cases. Intraocular fluid is rich in biological substances such as DNA/RNA, cytokines, antibodies, proteins, and metabolites and analysis of intraocular fluid is important for identifying biomarkers and understanding the pathogenesis of uveitis. For example, comprehensive polymerase chain reaction test of intraocular fluid has enabled rapid diagnosis of infectious uveitis. In addition, a combination of histopathological examination of intraocular fluid, cytokine measurement, flow cytometry, and genetic assessments has increased the efficiency of diagnosis of intraocular malignant lymphoma. In recent years, omics analysis such as metabolomics, proteomics, and transcriptomics has been actively conducted in the medical field, and there are scattered reports of intraocular fluid analysis in uveitis. Moreover, research and practical application of artificial intelligence (AI) is also progressing rapidly in the medical field. In the field of ophthalmology, many studies introducing AI have been reported, and a small number of machine learning studies using intraocular fluid have also been reported. In this review, we searched PubMed for previous reports on intraocular fluid analysis in uveitis and aim to introduce the analysis of intraocular fluid in uveitis, including the results of our comprehensive genetic analysis of cytomegalovirus in the eye.