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

Abstract: A 19-year-old male patient presented to our clinic with complaints of foreign-body sensation, pain, redness, tearing, and decreased vision in the right eye. One day prior, a bee struck his eye while he was riding a motorcycle. Biomicroscopic examination of the right eye showed periorbital edema, chemosis, ciliary injection, corneal edema with radiating Descemet folds, paracentral corneal infiltrate, and a brown needle-like foreign body resembling a bee stinger. Anterior segment optical coherence tomography (AS-OCT) confirmed corneal edema with Descemet folds, whereas in vivo confocal microscopy (IVCM) revealed multiple hyporeflective, round cyst-like structures within the superficial corneal epithelium, hyperreflective, round inflammatory cells around the subbasal nerves, a honeycomb pattern, and a hyperreflective, needle-like linear opacity in the stroma. The patient was treated with topical moxifloxacin 0.5%, dexamethasone 0.1%, and fluconazole 0.2% eye drops and oral moxifloxacin (400 mg) and cetirizine (10 mg) tablets. The patient's signs and symptoms improved significantly within 1 week. At the 18-month examination, the patient's vision was 20/20, with only a faint stromal opacity remaining. No stinger fragments were detected on biomicroscopic examination, AS-OCT, or IVCM examination. Anterior segment optical coherence tomography and IVCM are highly valuable for monitoring corneal edema, inflammation, cellular changes, and the embedded stinger within the cornea throughout the follow-up period.

Objectives: To evaluate the experiences of wearing scleral lenses while self-contained underwater breathing apparatus (SCUBA) diving in a large number of dives.

Methods: An anonymous online survey for diving scleral lens wearers worldwide was distributed. The data were collected between May 2019 and November 2022. The survey sought responses on participants' age and sex, SCUBA dive-related characteristics and scleral lens wear-related questions, and eye-related symptoms after the dive.

Results: A total of 67 scleral lens wearers completed the questionnaire (63% male). A median of 150 dives were performed while wearing the scleral lenses, with 26,360 dives in total. Seven participants experienced more redness, and five had less clear eyes after the dive. Two adverse events in 2 of 26,360 dives (0.007%) were reported by two participants. The scleral lens was more cloudy during diving in four subjects, two experienced a more cloudy scleral lens after diving, and the scleral lenses were more deposited after diving in three subjects. During seven dives of seven unique divers, a scleral lens was lost. After the dive, 10 divers experienced more tightness of the scleral lens on removal, whereas eight found them easier to remove.

Conclusions: Scleral lens wear while SCUBA diving seems to cause few complications and seems relatively safe.

Purpose: To investigate the vision improvement of corneal rigid gas permeable contact lenses (RGPCLs) in children with primary congenital glaucoma (PCG), compared with spectacles.

Methods: This cross-sectional analysis used baseline data from a randomized trial (CLEVR-PCG Study) investigating RGPCLs' impact on postoperative vision rehabilitation in children with PCG with controlled intraocular pressure from April 2022 to August 2023. The study included 51 eyes from 29 children aged 7.41±2.51 years. Refractive errors were corrected first with spectacles, then RGPCLs. Best spectacle-corrected visual acuity (BSCVA) and best RGPCL-corrected visual acuity (BCLVA) and contrast sensitivity function (CSF) were compared.

Results: BCLVA was better than BSCVA, and CSF with RGPCLs was better than with spectacles: BCLVA 0.30 (0.15, 0.52) LogMAR vs. BSCVA 0.40 (0.30, 0.70) LogMAR; area under the logarithm of the CSF (AULCSF) 0.68±0.38 vs. 0.51±0.33; CSF acuity 0.94±0.29 vs. 0.83±0.29 (all P<0.001). Multivariate linear regression showed greater myopic spherical equivalent (SER) associated with greater BCVA improvement (β=0.01, 95% CI: 0.004-0.02; P<0.001) and CSF acuity improvement (β=-0.01, 95% CI: -0.01 to -0.0005; P=0.036). Greater myopic SER (β=-0.01, 95% CI -0.02 to -0.004) and better BSCVA (β=-0.18, 95% CI: -0.32 to -0.04) associated with greater AULCSF improvement (P=0.007).

Conclusion: RGPCLs immediately improved vision in children with PCG. These findings suggest that RGPCLs are potentially useful for visual rehabilitation in this population.

Purpose: To examine the impact of an accelerated cross-linking (A-CXL) protocol on retinal microvascularization in the treatment of keratoconus using optical coherence tomography-angiography (OCT-A).

Methods: The trial included 49 eyes receiving A-CXL therapy for keratoconus. Retinal and optic nerve head parameters were evaluated using OCT-A. OCT-A measurements were conducted preoperatively and at 1 week, 1 month, and 6 months postoperatively.

Results: Forty-nine keratoconus patients undergoing A-CXL were evaluated. Superficial capillary plexus vessel density (SCP-VD) showed significant decreases in the foveal and parafoveal regions at 1 week and 1 month. Although most SCP-VD parameters showed a trend toward recovery by 6 months, some quadrants remained below baseline. Deep capillary plexus vessel density (DCP-VD) showed significant reductions across all quadrants in the foveal, parafoveal, and perifoveal regions at 1 week (P<0.05 for all), and several of these changes persisted through 6 months. Central macular thickness (CMT) decreased at all time points (P<0.05). Persistent reductions in parafoveal DCP-VD, retinal deep capillary blood flow area, CMT, and choriocapillaris blood flow area were still evident at the final follow-up (P<0.05 for all).

Conclusion: In keratoconic eyes successfully treated with A-CXL, significant changes in the vascular density of both the superficial and deep retinal plexuses were observed in the early postoperative period. Although alterations in the superficial plexus seemed to be mostly reversible, sustained changes in deep retinal microcirculation and perfusion parameters suggest a more prolonged and possibly subclinical effect of A-CXL on the outer retina.

Abstract: Neurotrophic keratopathy (NK) is a serious condition that can lead to significant visual morbidity. One of the greatest challenges of treating NK is that there are a wide variety of underlying conditions that affect the corneal nerves, and the root cause of the NK for any given individual is necessary in order to provide the best possibility of treatment success. NK is noted to be frequently caused by herpetic disease, including herpes zoster ophthalmicus (HZO), and studies have demonstrated that the risk of developing NK increases with recurrences of HZO. As such, vaccination to prevent HZO, as well as suppressive valacyclovir to reduce the chance of multiple recurrences of HZO in individuals who have had HZO, can decrease the risk of NK from HZO as well as the subsequent vision loss. These preventative therapies are therefore highly recommended.

Abstract: The intraepithelial corneal nerves are a dense collection of sensory axons that consist of the intraepithelial basal nerves and intraepithelial nerve terminals. The plasma membranes of corneal epithelial cells ensheathe the nerves providing them mechanical support. The nerves, in turn, release trophic factors that nourish the epithelial cells. The corneal nerves grow continuously, and homeostasis is maintained by the diurnally regulated shedding the terminals. In response to injury, severed fragments of sensory axons and terminals along with their mitochondria are internalized by corneal epithelial cells. Some of these axonal mitochondria function metabolically within the corneal epithelium. The health of the corneal epithelium during homeostasis and in response to injury depends on the health of its sensory nerves, and the stability of the sensory nerves depends on the insulation and support provided by the corneal epithelial cells. This mini review describes the unique features of the corneal epithelium and its sensory nerves, highlights their importance, and summarizes how their nomenclature is evolving to reflect recent research findings.

Objective: This study aimed to evaluate the short-term visual performance and subjective satisfaction of a dual-focus soft contact lens (DF-SCL) compared with a single-vision soft contact lens (SV-SCL) in myopic Chinese children over one month of daily wear.

Methods: Myopic children aged 8 to 14 years first underwent baseline testing with SV-SCL (Proclear), followed by DF-SCL (MiSight). They then continued wearing DF-SCL for one month. Distance and near high-contrast visual acuity (d-HCVA, n-HCVA), contrast sensitivity function, the Subjective Acceptability Questionnaire, and visual performance questionnaire were assessed at four visits: SV-baseline, MiSight (MS)-baseline, MS-1 week, and MS-1 month.

Results: A total of 38 subjects (19 female, 19 male; mean age 10.75±1.13 years; mean spherical equivalent refraction, -1.81±0.69 D) completed the study. At baseline, d-HCVA was significantly better with SV-SCL (-0.05±0.06 logMAR) than with DF-SCL (-0.02±0.04 logMAR, P =0.03), while n-HCVA showed no significant difference ( P =0.27) between with SV-SCL (-0.03±0.05 logMAR) and DF-SCL (-0.01±0.04 logMAR). After one week of DF-SCL wear, n-HCVA improved significantly (-0.04±0.06 logMAR, P =0.04) compared with MS-baseline. After one month of DF-SCL wear, d-HCVA (-0.03±0.06 logMAR, P =0.55) and n-HCVA (-0.05±0.07 logMAR, P =0.48) were comparable with SV-baseline. The contrast sensitivity with DF-SCL improved at 12 and 18cpd after one week of DF-SCL wear compared with MS-baseline. In the questionnaire, overall satisfaction significantly improved at the 1-month visit ( P <0.001) compared with MS-baseline, and visual symptoms of paracentral and peripheral blurry vision alleviated after a week of wearing ( P =0.009).

Conclusion: Myopic Chinese children demonstrated good visual quality and high subjective satisfaction over one month of DF-SCL wear, despite a slight initial decline in visual performance compared with SV-SCL.

Objective: To identify systemic conditions associated with dry eye disease (DED) symptoms, signs, and their discordance in a clinically diagnosed DED cohort.

Methods: In this prospective cross-sectional study, participants with DED were assessed for systemic conditions through self-reported history, health records, and specialist referrals. Dry eye disease symptom and sign scores were transformed to a 0 to 1 scale using linear transformation. A discord score (symptom score-sign score) was calculated. Associations between systemic conditions and DED parameters were analyzed using linear regression.

Results: The study included 371 DED participants (mean age: 52.9±14.0 years; 226 women). No significant correlation was observed between signs and symptoms (Spearman rho = -0.08; P=0.08). Increasing age (β = -0.005; P<0.001) and longer DED duration (β = -0.003; P<0.001) were associated with higher signs than symptoms. Atopy, chronic gastrointestinal disorders, psychological disorders, and hormonal replacement therapy use were associated with more severe DED symptoms than signs (all P≤0.03). Female sex, graft-versus-host disease, Sjögren disease, and rheumatoid arthritis were associated with more severe DED signs and a symptom-sign discordance (all P≤0.04).

Conclusion: Systemic conditions significantly affect how DED presents and may cause symptom-sign mismatch, highlighting the need for thorough systemic history and evaluation in DED.

Purpose: To evaluate the diagnostic and management practices of optometrists in Trinidad and Tobago (T&T) for keratoconus (KC), and to identify barriers affecting clinical care.

Methods: A cross-sectional survey was conducted between July and December 2023 among registered optometrists in T&T using a validated questionnaire. Data were collected on diagnostic approaches, treatment strategies, referral behaviors, and perceived challenges. Descriptive statistics and chi-square tests were used for analysis, with significance set at P <0.05.

Results: Of the 108 respondents, 57.4% were women and 50.0% identified as Indo-Trinidadian. While 64.8% reported diagnosing at least five KC cases annually, only 17.6% had access to corneal topography. Most practitioners (78.7%) relied on clinical examination and patient-reported symptoms for the diagnosis of KC. Rigid gas permeable (RGP) lenses were seldomly used for KC management, as 66.7% reported they did not fit RGP lenses, with cost identified as the main barrier (53.7%) to RGP use. Only 36.1% reported co-managing KC cases with ophthalmologists. Regression analysis revealed that Optometrists with ≥5 years of experience were significantly more likely to diagnose KC more frequently compared to those with less than 5 years of practice experience (OR: 4.74; 95% CI: 1.99-11.31; P = 0.001).

Conclusions: Optometrists in T&T play a crucial role in KC care despite resource limitations. The development of national guidelines is urgently needed to standardize diagnosis, management, and referral pathways.