Taiwan Journal of Ophthalmology最新文献

The purpose is to highlight the surgical modifications that are undertaken for a safe cataract surgery when associated with anterior segment dysmorphology. Surgical modifications that are undertaken in a case of congenital cataract complicated with congenital anterior segment dysmorphology such as microcornea, congenital corneal opacity, aniridia, anterior and posterior lenticonus of the lens, and persistent fetal vasculature are described. Careful preoperative assessment is crucial to anticipate and plan for intraoperative and postoperative challenges that may arise during cataract surgery in the presence of anterior segment dysmorphology. Surgical adjustments in cataract surgery when associated with anterior segment dysmorphology should be tailored to each individual case and the surgeon's expertise.

Purpose: This study aimed to evaluate serum cystatin C as a potential biomarker for diabetic retinopathy (DR) in a rural Indian population, addressing the urgent need for effective screening tools amidst rising diabetes prevalence.

Materials and methods: A cross-sectional study recruited 112 patients with diabetes mellitus from Sambalpur, Odisha, India, categorized into groups with and without DR. Serum cystatin C levels were measured alongside clinical and demographic parameters, using established diagnostic methods.

Results: Patients with DR exhibited significantly higher serum cystatin C levels compared to those without DR (mean: 0.99 ± 0.50 mg/L vs. 0.80 ± 0.36 mg/L, P = 0.027). Adjusted analysis showed a notable association between higher cystatin C tertiles and DR (adjusted odd's ratio: 7.65, 95% confidence interval: 1.49-39.08, P = 0.01), highlighting its potential as an independent predictor.

Conclusion: Elevated serum cystatin C levels were strongly associated with the presence of DR, suggesting its utility as a biomarker for early identification and risk stratification in diabetic patients. Integration of cystatin C measurement into routine clinical practice may enhance DR screening and management strategies, offering potential benefits in reducing vision loss and improving patient outcomes. This study underscores the need for further longitudinal research to validate these findings and elucidate the temporal relationship between cystatin C levels and DR progression.

Purpose: This study aimed to investigate optical coherence tomography (OCT) characteristics in hydroxychloroquine (HCQ) retinopathy and their correlation with visual acuity among Taiwanese patients.

Materials and methods: We retrospectively recruited patients undergoing long-term HCQ treatment who had received examinations of best-corrected visual acuity and OCT scans. We observed disruptions in the ellipsoid zone (EZ) and retinal pigment epithelium (RPE) across different retinal regions. Principal component analysis (PCA) was employed to identify the most significant factors associated with visual deterioration.

Results: Among the 120 eyes included in the study, HCQ retinopathy was present in 42 eyes (35.0%). In patients with mild-to-moderate retinopathy, the pericentral pattern was predominant (75.0%), whereas no parafoveal pattern was observed. Serial examinations revealed that lesions typically progressed from pericentral to parafoveal and foveal regions. EZ disruption was observed in all affected cases, most frequently at the pericentral region (100%), followed by the perifoveal (87.4%), parafoveal (72.1%), and foveal (43.2%) regions. RPE disruption was noted in 59.5% of cases, with the highest prevalence at the pericentral (53.2%) and perifoveal (52.3%) regions, followed by the parafoveal (33.3%) and foveal (28.8%) regions. PCA identified RPE disruption at the fovea and parafoveal regions as the most strongly correlated factors for visual deterioration.

Conclusions: In Taiwanese patients, HCQ retinopathy predominantly manifests with pericentral lesions, while isolated parafoveal lesions are rare as an initial presentation. RPE disruption, rather than EZ disruption, appears to be the primary determinant for visual deterioration in this population.

Open-globe injury (OGI), referring to the full-thickness violation of the eye wall, is a severe consequence of ocular trauma which can lead to permanent vision loss. Here, we review the current literature on pediatric OGI including a focused review of studies published in the past 10 years. Scoring systems for final visual prognosis, important aspects of clinical examination, and imaging at the point of care are discussed. We furthermore provide an overview of primary and secondary surgical management of the initial OGI and sequelae. Amblyopia management differentiates pediatric from adult visual rehabilitation following OGI, and we discuss the current state-of-the-art approaches for the prevention of vision loss.

Myopia has become a globally prevalent ocular disease. The choroid plays a vital role in myopia, and its changes tend to occur earlier than those of the retina and long-term variations in eye growth. Abnormal axial growth is an intrinsic characteristic of myopia, accompanied by ocular biomechanical changes that result in chorioretinal atrophy, thinning, and other complications particularly in the choroidal vasculature. Recent advancements in imaging technologies have provided deeper insights into these changes. This article explores key findings related to the choroid vascular index in myopia patients.

Purpose: Optic disc size measurement is essential for determining landmarks, lesions, and distances of the retina. Due to the size variability in nature and when measured with different instruments, newer methods to compare sizes between different instruments are needed. We aimed to determine the comparability of slit lamp, fundus photography, and optical coherence tomography (OCT) measurements of optic disc size after correcting for both ocular and instrument magnification.

Materials and methods: In this prospective, observational study, optic disc size was measured by slit-lamp biomicroscopy, fundus photography, and OCT. Instrument and ocular magnification was calculated, and the measured size was corrected for both using the Littman formula. The corrected values were analyzed using Bland-Altman plots and intra-class correlation (ICC) for agreeability and correlation, respectively. Linear regression analysis was conducted to estimate the systematic errors and interconvertibility in cases of high correlation.

Results: Fifty-six eyes were included for the analysis. Uncorrected and corrected values for each method had excellent correlation and agreeability (ICC absolute agreement >0.75, P < 0.01). Among magnification corrected values, slit lamp and OCT had excellent correlation and agreement (ICC consistency = 0.846, confidence interval 0.75-0.91, P < 0.01). This pair had R ² = 0.73 on linear regression (P < 0.01). Linear regression formulas for interconverting uncorrected and corrected values for the three methods had variable accuracy (R ² from 0.47 to 0.66).

Conclusion: Uncorrected values of different methods for disc size measurement cannot be compared directly; they need ocular and instrument magnification correction. Among the three methods compared, the best interconvertible pairs of measurement were magnification corrected slit lamp and OCT values.

Purpose: The purpose of the study was to study the efficacy of oral cyclophosphamide monotherapy in advanced resistant ocular cicatricial pemphigoid (OCP).

Materials and methods: This retrospective case series examines patients diagnosed with advanced resistant OCP at a uveitis tertiary care center who were treated with oral cyclophosphamide therapy.

Results: Seventeen patients were included in this study. The average age of the participants was 74.3 ± 10.3 years, ranging from 60 to 99 years. The gender distribution was 8 females to 9 males. Oral cyclophosphamide-induced remission in 7 patients (41.1%) and was prematurely discontinued in 10 patients (58.9%), with 7 (63.7%) citing ineffectiveness and 3 (36.3%) experiencing side effects as reasons for discontinuation. The average therapy dose of cyclophosphamide administered was 116.1 ± 47.5 mg. The average duration required for the induction of remission was 150 ± 128 days. The overall therapy duration averaged 306 ± 189 days. Conducting univariate logistic regression with generalized estimating equations (GEEs) on variables did not reveal statistically significant differences between the two groups (responsive and nonresponsive to oral cyclophosphamide therapy), except for the maximum dose of oral cyclophosphamide therapy (P = 0.007).

Conclusion: The prognosis of advanced OCP in patients is unlikely to be altered by the stepladder approach and step-up strategy. While oral cyclophosphamide can be efficacious for remission induction in resistant and aggressive OCP cases, a step-down strategy employing less potent agents with safer side effect profiles should be contemplated for subsequent treatment.

As we move toward an era in which there will be treatment options for geographic atrophy (GA) secondary to age-related macular degeneration, the need to accurately understand and interpret multimodal imaging (MMI) for the condition is paramount. This review discusses the evolution of MMI in GA and how it has led to a greater understanding of different phenotypes and risk factors for progression. These advancements have allowed novel imaging biomarkers to be used as end points in large interventional studies exploring new therapies for GA treatment. Due to differences in drug approval timing, ophthalmologists in some jurisdictions are already treating patients with complement inhibiting intravitreal therapies and using MMI to guide management. Cementing knowledge of how GA appears on MMI and evolves over time will be vital for best practice as these interventions become more widely available.

This report describes a patient with polypoidal choroidal vasculopathy (PCV) with fovea-involving retinal pigment epithelium (RPE) tear that showed tissue remodeling with a good visual outcome. Imaging over the patient's clinical course from 2019 was reviewed. A 74-year-old female presented with left submacular hemorrhage and a large multi-lobular pigment epithelial detachment. Left eye vision was 6/19 at the presentation. Indocyanine green angiography (ICGA) revealed underlying PCV. One month after initiation of intravitreal aflibercept (IVA, Bayer), she developed fresh subretinal hemorrhage. An RPE tear of 1 disc area in size, centered over the fovea was diagnosed. The torn RPE edge was scrolled up temporal to the fovea on spectral-domain optical coherence tomography (SD-OCT), with hypertransmission into the choroid observed over the area of RPE loss. Left eye vision after the RPE tear was 6/15. Over the next 2 months, the subretinal hemorrhage resolved following further IVA. At month 3, fundus autofluorescence (FAF) demonstrated hypo-autofluorescence while fundus fluorescein angiography (FFA) and ICGA showed a window defect corresponding to the area of RPE tear. On SD-OCT, there was a faint hyper-reflective layer where one might expect the RPE layer to be. Serial SD-OCT scans over 5 years revealed increasing prominence of the hyperreflective layer between the ellipsoid zone and Bruch's membrane. FAF remained hypo-autofluorescent. At the last review, the patient retained 6/9 vision. We report a case of fovea-involving RPE tear documented with multimodal imaging with good visual outcome, which is atypical. Serial OCT suggests tissue remodeling may explain the functional preservation.