Eye & Contact Lens-Science and Clinical Practice最新文献

Objective: To determine if scleral fittings that occur before corneal cross-linking (CXL) are still successful after the procedure.

Methods: This prospective study included seven patients with keratoconus or post-laser-assisted in situ keratomileusis (LASIK) corneal ectasia who were fitted with scleral lenses then underwent CXL. Four patients (six eyes) had keratoconus and three patients (five eyes) had post-LASIK ectasia. Topographic and refractive parameters, as well as uncorrected visual acuity, best spectacle-corrected visual acuity, and scleral lens-corrected visual acuity were collected preoperatively and compared with values 1 and 3 months postoperatively.

Results: Ten eyes had no significant change in refractive parameters from baseline to 3 months (P>0.05). Nine eyes had no significant change in Km (mean keratometry), K2 (steep keratometry), Kmax (maximal corneal curvature), or pachymetry from baseline to 3 months (P>0.05). On average, there was no significant difference regarding scleral lens or topographic measurements preoperatively versus postoperatively (P>0.05).

Conclusion: On average, no significant differences were observed between preoperative and postoperative corneal measurements or refractive correction. These findings suggest that scleral fittings could be introduced before CXL to expedite the process of lens prescription and future acquisition. Safe scleral lens use with a lens fit before surgery could resume 1 month postoperatively.

Objective: To compare endophthalmitis rates after cataract extraction in patients with different preoperative prophylaxis: double povidone-iodine preparation with topical antibiotics versus a control group.

Methods: All cases of postoperative endophthalmitis over the last 17 years were reviewed. Incidence rates of endophthalmitis for all cataract surgeries (current procedural terminology codes 66982 and 66984) performed by 26 surgeons were calculated. Cataract surgery combined with glaucoma and corneal procedures were excluded (1,347 surgeries). Incidence rates were compared for the study group (i.e., use of double povidone-iodine preparation) versus the control group. In the study group, two standard interventions were implemented: preoperative instillation of fluoroquinolone drops every 15 min for 1 hr and preoperative irrigation of conjunctival fornices and eyelashes with 10 cc of 5% povidone-iodine. In both the study and control group, povidone-iodine preparation was performed in the operating room, and postoperative fluoroquinolone drops were used.

Results: From January 2005 to May 2022, no cases of endophthalmitis were identified out of 7,611 cataract extractions performed by three surgeons who used the double povidone-iodine preparation. Seven new cases of endophthalmitis were identified in the control group during the same time (7 out of 9,876=0.07%). Two of these cases had combined cataract surgery with endoscopic cyclophotocoagulation, and five cases had cataract surgery alone. Individual surgeon rates of endophthalmitis ranged from 0% to 0.29%.

Conclusion: A double povidone-iodine preparation may provide more robust prophylaxis against postcataract extraction endophthalmitis than a single preparation.

Objectives: To evaluate scleral thickness of patients with keratoconus by anterior segment optical coherence tomography (AS-OCT).

Materials and methods: Fifty-two eyes of 42 patients with keratoconus (group 1) and 42 right eyes of 42 healthy individuals (group 2) were included. Scleral thickness measurements were taken with AS-OCT 6, 4, and 2 mm behind the scleral spur in four gaze positions: superior, inferior, temporal, and nasal. The data including central corneal thickness (CCT) by Pentacam from patients with keratoconus was also analyzed and its relationship with scleral thickness was evaluated.

Results: In group 1, mean scleral thickness from 6 mm posterior to scleral spur in superior, inferior, temporal, and nasal quadrants were 397±35.3 (320-482), 408±29.5 (341-467), 393±40.8 (297-469), and 403±35.8 (310-482) μm, respectively. In group 2, mean scleral thickness from 6 mm posterior to scleral spur in superior, inferior, temporal, and nasal quadrants were 440±42.2 (346-552), 461±33.9 (390-563), 451±46.6 (340-549) and 448±34.3 (350-521) μm, respectively. The mean scleral thickness in group 1 was significantly lower in all quadrants compared with group 2 (P<0.001). The mean CCT in group 1 was 478.22±87.55 (306-632) μm. Positive correlation was found between scleral thickness measurements taken at 4 mm (ϱ=0.312, P=0.037) and 2 mm (ϱ=0.308, P=0.039) posterior from the scleral spur in the inferior quadrant and CCT.

Conclusion: Scleral thickness was significantly lower in patients with keratoconus. Scleral thickness and CCT were positively correlated in inferior quadrant. Even though it is not yet known whether scleral changes are progressive or not, scleral thickness measurement may also find a place in the diagnosis and follow-up of patients with keratoconus in the future.

Abstract: The design of the prosthetic replacement of the ocular surface ecosystem (PROSE) device allows it to serve as a novel drug delivery system. In this article, we describe the off-label administration of amphotericin B and cenegermin by instillation in the PROSE device reservoir for the treatment of Candida keratitis in the setting of a persistent epithelial defect.

Purpose: We aimed to compare the answers given by ChatGPT, Bard, and Copilot and that obtained from the American Academy of Ophthalmology (AAO) website to patient-written questions related to keratoconus in terms of accuracy, understandability, actionability, and readability to find out whether chatbots can be used in patient education.

Methods: Twenty patient-written questions obtained from the AAO website related to keratoconus were asked to ChatGPT, Bard, and Copilot. Two ophthalmologists independently assessed the answers obtained from chatbots and the AAO website in terms of accuracy, understandability, and actionability according to the Structure of Observed Learning Outcome taxonomy, Patient Education Materials Assessment Tool-Understandability, and Patient Education Materials Assessment Tool-Actionability tests, respectively. The answers were also compared for readability according to the Flesch Reading Ease scores obtained through the website.

Results: Bard had significantly higher scores compared with ChatGPT-3.5, Copilot, and AAO website according to Structure of Observed Learning Outcome taxonomy and Patient Education Materials Assessment Tool-Understandability (P<0.001 for each), whereas there was no significant difference between the other groups. Bard and ChatGPT achieved significantly higher scores than the AAO website according to the Patient Education Materials Assessment Tool-Actionability scale (P=0.001). The AAO website achieved significantly higher scores than the Bard on the Flesch Reading Ease scale, whereas there was no significant difference between the other groups (P=0.017).

Conclusion: Chatbots are promising to provide accurate, understandable, and actionable answers. Chatbots can be a valuable aid in the education of patients with keratoconus under clinician supervision. In this way, unnecessary hospital visits can be prevented, and the burden on the health care system can be alleviated, while patient awareness can be raised.

Objectives: This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being.

Methods: Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted.

Results: Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures (P<0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions (P<0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies.

Conclusion: Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.

Objectives: To assess the quality of life in Japanese patients with Fuchs endothelial corneal dystrophy (FECD) using The National Eye Institute Visual Function Questionnaire.

Methods: Here, 34 patients with FECD (FECD group) and 13 healthy individuals (control group) completed the National Eye Institute Visual Function Questionnaire Japanese version by interview format. The association between dominant eye corrected distance visual acuity and composite score (component 11) or subscales in the FECD group was evaluated using Spearman rank correlation coefficient.

Results: The average age was 65.8±11.9 and 60.1±7.9 years in the FECD and control groups, respectively. Corrected distance visual acuity was significantly lower in the FECD group (0.021±0.21 logarithm of the minimum angle of resolution) than in the control group (-0.61±0.055 logarithm of the minimum angle of resolution) (P<0.0001). Composite scores were significantly lower in the FECD group (77.6±11.0) than in the control group (89.2±7.0) (P=0.0006). All subscale scores were lower in the FECD group, particularly for distance vision and mental health (81.4±13.1 and 84.0±15.6, respectively) than in the control group (90.7±12.0 and 95.7±5.7) (P=0.022 and P=0.0046, respectively). Corrected distance visual acuity in the dominant eye did not significantly correlate with composite scores or subscales in the FECD group.

Conclusions: Quality of life is lower in patients with FECD than in healthy individuals, particularly regarding distance vision and mental health.

Objective: This study aimed to document the treatment success of eyelid hygiene with liposomal suspension using new diagnostic tools and to determine whether additional lipid substitution provided measurable benefits in meibomian gland dysfunction.

Methods: A single-center controlled, partially single masked study was conducted. Group A used eyelid hygiene only, whereas group B additionally applied a liposomal eye spray. Subjective perception using the Ocular Surface Disease Index (OSDI) questionnaire, measurement of tear film osmolarity, noninvasive tear film break-up time, assessment of the lipid layer, meibography, inspection of lid margins, assessment of the meibomian glands, and measurement of matrix-metallopeptidase-9 were collected at baseline and after 12 weeks.

Results: Eighty-two patients were included and randomized into two groups. Both groups showed a decrease in OSDI score (P<0.001), an increase in lipid layer thickness (P<0.001), significant improvement in the degree of loss of meibomian glands (P<0.001), in the damage pattern of the eyelid margins (P<0.001), in the quality of meibomian gland secretion, and in matrix-metallopeptidase-9 after 12 weeks.

Conclusions: Our study confirms the success of treatment with eyelid hygiene measures using a liposomal suspension. The additional benefit of lipid substitution was not significant after 12 weeks of treatment.

Objectives: To evaluate demographic, socioeconomic, and clinical factors associated with nonadherence with initial follow-up after a diagnosis of infectious keratitis.

Methods: A retrospective chart review of patients aged 18 to 60 years who were diagnosed with infectious keratitis at the Wills Eye Hospital Emergency Room from March 2019 to September 2019 was conducted. The primary outcome was nonadherence with initial follow-up recommendation and included patients who did not follow-up in the time frame requested by the diagnosing physician and those who were lost to follow-up.

Results: Two hundred and seventeen patients were included with a mean age of 39.0±11.6 years, and 38.2% of patients were nonadherent. Patients who identified as non-Hispanic White were more likely to be nonadherent compared with Hispanic White patients (odds ratio [OR]=5.00, 95% confidence interval [CI]: 1.27-20.00, P=0.021). Additional variables associated with nonadherence included lower income (OR=0.92, 95% CI: 0.85-0.99, P=0.020) and government versus private insurance (OR=2.13, 95% CI: 1.09-4.15, P=0.027). Among clinical variables, patients not cultured at the initial evaluation were more likely to be nonadherent (OR=2.54, 95% CI: 1.36-4.77, P=0.004).

Conclusions: Race, income, insurance, and corneal culturing had associations with follow-up nonadherence. Identifying barriers to follow-up for infectious keratitis may have important implications in preventing vision loss and other complications.