Taiwan Journal of Ophthalmology最新文献

Purpose: To study the role of polymerase chain reaction (PCR) in viral anterior uveitis with secondary glaucoma.

Materials and methods: This was a retrospective cohort study in which aqueous humor from 28 eyes of 23 patients with viral uveitis and secondary glaucoma from 2008 to 2024 was sent for real-time/nested PCR. The clinical features of the patients were analyzed (P < 0.05 statistically significant).

Results: The median age at uveitis onset was 45 years. Secondary open-angle glaucoma was found in 23 out of 28 eyes, 82.1%. The median intraocular pressure (IOP) reduced significantly from baseline, 18.5 to 14 mmHg at the final visit (P = 0.01). Maximum IOP was 60 mmHg. PCR was positive in 57.1% of eyes, mostly for varicella-zoster virus (32.1%), followed by Cytomegalovirus (CMV) (17.8%) and herpes simplex virus (10.7%). Valacyclovir was used to treat 50% of eyes. CMV was treated with valganciclovir (10.7% eyes). Antiglaucoma and anti-inflammatory medications were reduced significantly from initiation (P < 0.001).

Conclusion: PCR enables timely and accurate detection of virus causing anterior uveitis and helps salvage vision in secondary glaucoma with appropriate antiviral therapy.

Ocular infections, particularly intraocular infections, face challenges due to low sample volumes and their paucibacillary nature (low pathogen load) compared to other anatomical sites. This often leads to culture-negative cases, complicating the identification of the causative pathogen. Intraocular sample collection is mainly invasive and difficult to repeat. Ocular microbiology diagnostics require specialized expertise developed over years of experience, along with effective communication between clinicians and microbiologists, to ensure accurate pathogen diagnosis. This review offers an overview of ocular microbiology practices employing both conventional and molecular techniques for pathogen identification, including unusual pathogens primarily affecting the eye, antimicrobial susceptibility testing, result interpretation, emerging diagnostic techniques, challenges in intraocular sample processing, troubleshooting strategies, serological approaches, and basic operating room sterility assessments in eye care institutions. The review aims to assist both ophthalmologists and microbiologists in their daily practice of ocular microbiology diagnostics.

This study highlights the significant ocular complications associated with human immunodeficiency virus (HIV), particularly its impact on the retina. Historically, HIV infection frequently resulted in severe retinal infections, such as Cytomegalovirus retinitis. However, with the widespread adoption of highly active antiretroviral therapy, the prevalence of these infections has significantly declined. Despite this progress, unresolved challenges in treatment approaches remain. In addition, HIV is known to cause nonopportunistic ocular conditions, such as optic neuropathy, immune recovery uveitis, and HIV-associated retinopathy, which require further clinical attention. In addition, we conducted an in-depth discussion on the phenomenon of early senescence in HIV patients. With the widespread adoption of optical coherence tomography angiography, this technology has enabled us to detect subtle changes associated with early senescence at an earlier stage. In this review, we conducted an extensive literature search to consolidate current evidence on the ophthalmic manifestations of HIV, particularly among patients in Taiwan. By synthesizing this information, we aim to highlight areas for improvement in clinical practice and offer insights into optimizing care for HIV patients with ocular complications.

Klebsiella pneumoniae (K. pneumoniae) represents a frequent cause of endogenous endophthalmitis in East Asia but remains an uncommon cause of endogenous endophthalmitis in the United States. Recent reports have characterized the emergence of hypervirulent K. pneumoniae strains, which are now thought to be the predominant cause of endogenous K. pneumoniae endophthalmitis. We document four cases of endogenous Klebsiella endophthalmitis in Los Angeles County from 2022 to 2024, including two cases confirmed secondary to a hypervirulent strain. The first two cases occurred in diabetic females with associated renal abscesses. While both patients were initially treated with systemic and intravitreal antibiotics, they ultimately required evisceration or enucleation. The third case occurred in a 54-year-old diabetic male, who presented with panophthalmitis of the left eye, subsequently found to have multiple hepatic abscesses. Our final case occurred in a 47-year-old diabetic male with bilateral endogenous endophthalmitis and disseminated cerebral, pulmonary, and hepatic abscesses consistent with K. pneumoniae invasive syndrome. Both the latter two patients were treated with intravitreal and systemic antibiotics, followed by vitrectomy. These cases underscore the importance of recognizing endogenous Klebsiella endophthalmitis as a potential complication in diabetic patients and its association with both hepatic and renal abscesses, as prompt systemic workup may facilitate timely diagnosis and intervention.

Purpureocillium lilacinum (PL) is an infrequent cause of fungal keratitis. Treatment of PL keratitis is complicated by delayed diagnosis, resistance to topical antifungal treatments, and the frequent need for surgical intervention. We report a case of PL keratitis in a patient with a significant history of methamphetamine use who initially presented with a persistent corneal epithelial defect in the right eye and associated exuberant intraocular inflammation as evidenced by a hemorrhagic hypopyon. Despite an extended treatment course with multiple antimicrobial agents, including topical and systemic voriconazole, the patient ultimately underwent penetrating keratoplasty for corneal perforation. Our case represents the first documented instance of PL keratitis in a methamphetamine user, highlighting their increased vulnerability to infectious, including fungal, keratitis. It also demonstrates the challenging and often protracted clinical course of PL keratitis, which often requires both aggressive medical and surgical interventions.

Purpose: The purpose of this study was to compare the rate of detection of diabetic retinopathy (DR) lesions and the agreement for grading DR severity between swept-source optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) and establish the utility of OCTA as a noninvasive alternative to FFA.

Materials and methods: 116 eyes of 60 DR patients underwent OCTA with a 12 m × 12 mm acquisition protocol centered at the fovea followed by FFA. For each imaging technique, the presence or absence of DR lesions including microaneurysms, intraretinal microvascular abnormalities (IRMAs), new vessels on the disc (NVD), new vessels elsewhere (NVE), and nonperfusion areas (NPAs) was recorded. Statistical analysis was performed using IBM SPSS.22 using the McNemar test.

Results: The detection rates were comparable in OCTA versus FFA for most DR lesions (P > 0.05) except microaneurysms (90 eyes, 77.6% in OCTA vs. 115 eyes, 99.1% in FFA). OCTA detected NPAs better than FFA (91 eyes, 78.5% vs. 78 eyes, 67.2%). There was an excellent agreement for the identification of IRMA (κ =0.791), NVD (κ =0.938), and NVE (κ =0.942); good agreement for the identification of NPA (κ =0.635) and poor agreement for microaneurysms (κ =0.058) identification. Overall, agreement in grading of DR severity between OCTA and FFA was good (κ =0.687).

Conclusion: OCTA serves as a noninvasive, rapid imaging modality for evaluating retinal vascular changes in DR and can be the sole imaging modality in specific situations such as pregnancy, nephropathy, and in patients with uncontrolled diabetes and hypertension. OCTA is noninferior to FFA, and both modalities should be utilized as complementary imaging modalities to maximize their respective advantages and improve treatment outcomes.

We report a rare presentation of Rosai-Dorfman disease (RDD) as scleritis transforming to a nodule in a female with multisystem inflammatory syndrome following COVID-19 infection. A 54-year-old female presented to us first in August 2022 with redness and slight discomfort in both eyes of 2 weeks' duration. She had a history of multisystem inflammatory syndrome post-COVID-19 infection. Although she presented with scleritis (oculus uterque), it continued to persist with a course of oral and topical steroids. Laboratory investigations including autoimmune profile were negative. Only QuantiFERON-TB Gold test was positive. High-resolution computed tomography showed a few subcentimeter enlarged mediastinal lymph nodes and a cluster of enlarged cervical lymph nodes. Biopsy showed chronic granulomatous inflammation with no caseation, negative for Mycobacterium tuberculosis. Over a year, this transformed to a scleral nodule. Excision biopsy confirmed RDD disease. Whole body positron emission tomography-computerized tomography confirmed no active lesions elsewhere. She was started on methotrexate. At 1-year follow-up, there was no recurrence.

Purpose: This study aimed to investigate the correlation between ONSD measured by USG and opening cerebrospinal fluid (CSF) pressure in cases of IIH.

Materials and methods: This study employed a prospective observational design. It included 47 patients diagnosed with IIH. ONSD was measured using USG while opening CSF pressure was measured using LP. The study analyzed the correlation between ONSD, CSF opening pressure, and other variables.

Results: The study discovered a significant positive association between the measurements of right and left ONSD. However, the ONSD and opening CSF pressure were not significantly correlated. The axial length showed a negative correlation with ONSD. The study determined that an ONSD cutoff value of 5.67 mm was optimal for the prediction of high ICP.

Conclusion: The investigation concluded that there is no significant relationship between ONSD distension and opening CSF pressure in IIH cases, suggesting that USG may not be reliable for estimating ICP. Frisen classification may have limited application in patients with chronic papilledema.

Purpose: The purpose of the study was to compare two antivascular endothelial growth factor (anti-VEGF) agents (aflibercept and ranibizumab) with a corticosteroid implant (Ozurdex), administered as intravitreal injections to patients with persistent diabetic macular edema (DME) not responding to bevacizumab.

Materials and methods: We conducted a retrospective study of 60 patients comprising men and women aged 18 and above who suffered from DME showing a suboptimal response after three intravitreal injections of bevacizumab and were referred to the ophthalmology department between January 2013 and June 2018. The following data were collected before therapy initiation and 1 month following three injections of anti-VEGF agents or steroids: age, sex, lens status, visual acuity (VA), intraocular pressure (IOP), and central foveal thickness (CFT).

Results: One month following the third injection of anti-VEGF or steroid, VA and CFT were significantly improved; neither one of the injected medications showed clinical benefit over the others. However, IOP was increased after treatment with steroids compared to the other injections.

Conclusion: Resistance to anti-VEGF occurs in a substantial proportion of patients with DME. Few studies compare the efficacy of anti-VEGF agents and steroid therapy as second-line treatment for DME to determine the best treatment strategy. Injections of the examined drugs provide a similar clinical benefit. The increase in IOP following steroid injections compared to anti-VEGF agents is well known and has been previously described. It should be well considered before selecting second-line treatment.