Taiwan Journal of Ophthalmology最新文献

Purpose: To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on the regression of hyperreflective dots (HRDs) in patients with branch retinal vein occlusion (BRVO).

Materials and methods: Thirty-seven eyes with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three Groups according to intravitreal treatments. Group 1 consisted of 12 eyes who received only IVD, Group 2 consisted of 10 eyes who received only IVR, and Group 3 consisted of 15 eyes who received both IVD and IVR. The number of HRDs and best-corrected visual acuity (BCVA) were compared between the Groups through the follow-up time.

Results: The mean number of HRDs in inner and outer retinal layers was significantly decreased in Group 1 and Group 3 (For Group 1; P < 0.001, P = 0.001, for Group 3; P < 0.001, P < 0.001). At the 1^st year, the number of HRDs in inner and outer retinal layers was significantly lower in Group 1 and Group 3 than Group 2 (All P < 0.05). The BCVA was higher in Group 3 than Group 2 at 1^st year (P = 0.048).

Conclusion: The HRDs should be considered inflammatory markers in the follow-up of CME in BRVO.

Purpose: To measure the pupillary dynamics and accommodative response in individuals with mild traumatic brain injury (mTBI) as compared to age-matched controls.

Materials and methods: This prospective comparative study was carried out at the neuro-optometry clinic of a tertiary eye care hospital. Sixty-three subjects with a history of mTBI and ninety age-matched controls were enrolled in this study. Subjects in the age range of 18-35 years were included in the study. A comprehensive neuro-optometric assessment was performed followed by pupillary dynamics and accommodation response measurements using NeurOptics® pupillary light reflex™-3000 and Grand-Seiko WAM-5500 binocular accommodation auto ref/keratometer | shigiya machinery works LTD.

Results: A statistically significant difference was noticed for constriction percentage (%): 32.73 ± 9.20 versus 39.93 ± 7.36 (P < 0.001), average constriction velocity (mm/s): 2.24 ± 0.85 versus 2.62 ± 0.68 (P = 0.002), maximum constriction velocity (mm/s): 3.82 ± 1.33 versus 4.42 ± 0.93 (P = 0.004) and T75 (recovery period to 75% of the baseline pupillary diameter in sec): 1.38 ± 0.36 versus 2.0 ± 0.82 (P < 0.001) in mTBI compared to age-matched controls. A statistically significant difference was noted for accommodative response (in D) as well as in the sample as compared to age-matched controls: -1.12 ± 0.64 versus - 1.39 ± 0.47 (P < 0.001).

Conclusion: Pupillary constriction velocities and accommodative response are significantly affected in mTBI. These findings have important clinical implications in being able to understand the visual symptoms following an mTBI.

Myopia as an uncorrected visual impairment is recognized as a global public health issue with an increasing burden on health-care systems. Moreover, high myopia increases one's risk of developing pathologic myopia, which can lead to irreversible visual impairment. Thus, increased resources are needed for the early identification of complications, timely intervention to prevent myopia progression, and treatment of complications. Emerging artificial intelligence (AI) and digital technologies may have the potential to tackle these unmet needs through automated detection for screening and risk stratification, individualized prediction, and prognostication of myopia progression. AI applications in myopia for children and adults have been developed for the detection, diagnosis, and prediction of progression. Novel AI technologies, including multimodal AI, explainable AI, federated learning, automated machine learning, and blockchain, may further improve prediction performance, safety, accessibility, and also circumvent concerns of explainability. Digital technology advancements include digital therapeutics, self-monitoring devices, virtual reality or augmented reality technology, and wearable devices - which provide possible avenues for monitoring myopia progression and control. However, there are challenges in the implementation of these technologies, which include requirements for specific infrastructure and resources, demonstrating clinically acceptable performance and safety of data management. Nonetheless, this remains an evolving field with the potential to address the growing global burden of myopia.

Purpose: This study used contrast sensitivity (CS) and optical coherence tomography (OCT) to assess the functional and structural alterations of the macula and the optic nerve head (ONH) in diabetic patients with no retinopathy and those with mild nonproliferative diabetic retinopathy (NPDR).

Materials and methods: In this study, 40 eyes of 20 diabetic patients with no diabetic retinopathy (DR), 40 eyes of 20 diabetic patients with mild NPDR, and 36 eyes of 18 healthy individuals were examined. Best-corrected visual acuity (VA) and CS were performed using early treatment DR study charts and the Pelli-Robson chart, respectively. The macula and ONH were evaluated using OCT, which provided data on the entire retina, inner retinal layer, outer retinal layer, retinal nerve fiber layer (RNFL), and the macula zone-ellipsoid zone-retinal pigment epithelium layer.

Results: VA and CS were significantly different between the three groups (P < 0.001). The entire thickness of the retina and the internal thickness of the retina in the 3-6 mm subfields of the macular region, as well as the thickness of the ganglion cell layer + inner plexiform layer (GCL + IPL) and GCL + IPL + RNFLs, differed significantly across the groups (P < 0.013).

Conclusion: In diabetic subjects with no retinopathy, the reduced thickness of the GCL + IPLs is possibly indicative of early neurodegenerative changes in the inner retina. Furthermore, in the diabetic groups, a decrease in CS was observed compared to the control group.

Purpose: In recent years, there has been a significant shift from this destructive procedure to a reconstructive procedure such as anterior lamellar recession (ALR) and bilamellar tarsal rotation (BLTR). The aim is to report the outcomes and success rates of ALR compared to BLTR in patients with upper lid cicatricial trichiasis.

Materials and methods: Our study is a prospective, interventional, comparative study that was conducted at the Ophthalmology Department of Al-Azhar University Hospital, New Damietta, Egypt. Our study was conducted on 62 eyes of 45 consecutive patients suffering from upper lid cicatricial trichiasis that required surgical intervention (17 patients were bilateral and 28 were unilateral). Thirty-three of them were treated by ALR (group 1), and 29 of them by BLTR (group 2). All statistical analysis was performed using the SPSS version 26.

Results: As regards the immediate postoperative correction, we found that adequate correction was significantly higher in the ALR group at all follow-up periods (P < 0.05). However, the overcorrection and undercorrection were significantly higher in the BLTR group (P < 0.05). Compared to the ALR group, the BLTR group saw a greater undercorrection at 1, 3, and 6 months (9.3%% vs. 0%; P = 0.048, 18.6% vs. 1.8%%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, respectively).

Conclusion: ALR is better than BLTR in the treatment of upper lid cicatricial trichiasis.

Iris mammillations are distinctive uniform nipple-like elevations that cover the anterior surface of the iris partially or totally. It is a rare finding and may coexist with other ocular and extraocular manifestations. Optic nerve pit (ONP), also known as optic disc pit (ODP) or optic hole, is a congenital defect resulting from the failure of fetal fissure closure during the embryonic development. It belongs to the congenital cavitary anomalies spectrum. This case presents a 19-year-old female patient who complained of a gradual decrease in visual acuity in both eyes for 4 years. Slit-lamp and fundus examinations revealed iris mammillations and ODP in the left eye. Corneal topography revealed bilateral keratoconus, which was managed with cross-linking. Iris mammillations and ODP are poorly understood ocular anomalies that are not reported frequently and have never been reported previously both combined with keratoconus. Thus, ophthalmologists should be aware of these conditions, their differential diagnosis, and their possible association with other disorders. This is the first reported case of the combined coexistence of iris mammillations and ODP with keratoconus.

Osteopetrosis (OS) is a rare heritable disorder characterized by osteoclast dysfunction and increased bone density on radiography. Optic nerve osseous compression is the most frequent ocular complication of OS, with nystagmus, strabismus, ptosis, proptosis, and lagophthalmos occurring less frequently. However, it is uncommon for patients to have neurological or ocular symptoms at initial presentation. Herein, we present the case of a 3-year-old girl with the initial presentation of ocular symptoms who was confirmed to have OS through genetic testing. She was born full-term and found to have nystagmus since the age of 1 year. Her best-corrected visual acuity was 1.2/60 for both eyes. Exotropia of the left eye and bilateral small-amplitude pendular nystagmus were also noted. Color fundoscopy revealed a tessellated fundus and pale discs with cup-to-disc ratios of 0.5-0.6. Magnetic resonance imaging revealed bilateral optic canal stenosis and optic nerve atrophy. Whole-exome sequencing revealed a biallelic chloride voltage-gated channel 7 mutation, c.2297T > C (p.Leu766Pro) and c.1577G > A (p.Arg526Gln), and autosomal recessive OS was diagnosed. The patient is currently being evaluated for possible hematopoietic stem cell transplantation. We suggest that OS should be considered a differential diagnosis for unexplained nystagmus and optic nerve atrophy.

Purpose: We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.

Materials and methods: This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.

Results: The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage (P = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).

Conclusion: Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.

Bleb leakage is a notorious complication of glaucoma filtration surgery which increases the risk of sight-threatening conditions. A 25-year-old female with severe bilateral juvenile open-angle glaucoma was treated for blebitis and exogenous endophthalmitis secondary to chronic bleb leak after undergoing XEN implantation, followed by multiple rounds of bleb needling, and augmented trabeculectomy. In the right eye, visual acuity was hand movement with cataract, intraocular pressure was 6 mmHg and the bleb was large, highly elevated from 10 to 1 o'clock, avascular, thin wall, and cystic with leaking points. Combined surgery of low-setting phacoemulsification and amniotic membrane transplantation without excising and manipulating the bleb was performed in the same setting. At postoperative 1 month, 6 months, and 1 year, her right vision had improved to 6/24, and the intraocular pressure was 12-14 mmHg, and the bleb leakage had resolved. This successful treatment was accomplished by maintaining the bleb's viability, preventing additional injury, and promoting wound healing.