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

Objectives: This systematic review aims to evaluate loteprednol etabonate's efficacy and safety in reducing post-cataract pain and inflammation.

Methods: A literature search was conducted to identify randomized controlled trials comparing loteprednol etabonate and placebo for post-cataract pain and inflammation. The primary outcome was the proportion of patients with complete resolution of anterior chamber inflammation (ACI) and grade zero pain. The quality of the studies was assessed using the RoB 2 tool, and a meta-analysis was performed using RevMan 5 software.

Results: This systematic review identified eight clinical trials (n=3,332 patients) fulfilling research criteria. Meta-analysis results showed that loteprednol etabonate significantly improved ACI resolution compared with placebo at 8, 15, and 18 days postoperatively (RR=2.25, 2.11, and 2.06, respectively, with a P value <0.00001). Loteprednol etabonate also increased the likelihood of achieving no pain (RR=1.54, 1.66, 1.70, and 1.92, respectively, with a P value <0.00001) and reduced the need for rescue therapy (RR=0.47, P <0.00001) while maintaining no change in IOP after 3, 15, and 18 days.

Conclusion: Loteprednol etabonate demonstrates significant efficacy in alleviating pain and inflammation post-cataract surgery, with notable advantages in safety, including minimal impact on intraocular pressure and reduced adverse events.

Objective: To evaluate refractive and topographic outcomes following photorefractive keratectomy (PRK) with 75% angle kappa (P-Dist) compensation in myopic eyes.

Methods: This retrospective study included 127 right eyes of patients with myopia and/or myopic astigmatism, who underwent wavefront-optimized PRK, incorporating 75% P-Dist compensation. Visual, refractive, topographic, aberrometric, and point-spread function (PSF) measurements were recorded preoperatively and at 1, 3, and 6 months postoperatively.

Results: The mean P-Dist was 232.13±121.78 μm (range: 31.69-769.84 μm). Eyes were grouped by mean P-Dist: group-1 (<232.13 μm, small-angle kappa, n=67) and group-2 (>232.13 μm, large-angle kappa, n=60). Preoperative P-Dist correlated with root-mean-square of higher-order aberrations (RMS-HOAs) (r=0.24, P =0.01) and coma (r=0.381, P <0.001). Group-2 had higher preoperative coma ( P =0.001). At 6 months, the percentage of eyes within ±0.50 diopters (D) spherical equivalent and≤0.50 D astigmatism, visual acuity, asphericity, mean pupil power, HOAs, and PSF were similar between the groups ( P >0.05 for all). No correlation was found between preoperative P-Dist and postoperative HOAs or PSF changes ( P >0.05 for all).

Conclusions: PRK with 75% angle kappa compensation yields comparable refractive and topographical outcomes in myopic eyes with small- and large-angle kappa. In eyes with a significant angle kappa, aligning ablation with P-Dist may not induce additional corneal refractive or topographical changes.

Abstract: This review examines how gaps within the Food and Drug Administration's|Food and Drug Administration (FDA) regulatory oversight, manufacturing standards, and bottle design requirements contributed to over-the-counter (OTC) eye drop contamination and subsequent product recalls. We also discuss recent growth in the number of patients with dry eye diseases and explosion of electronic commerce (e-commerce) retailers that has created new channels for the widespread circulation of unsafe eye drops. Considering the ongoing FDA recalls, we outline actionable strategies for providers and patients and the role that advocacy organizations play in closing the gaps in OTC eye drop safety.

Abstract: A 59-year-old male contact lens wearer was admitted to the intensive care unit for COVID-19 pneumonia. As contact lenses were not removed during admission, the patient developed bilateral corneal abscesses, leading to evisceration of the left eye. Complete corneal melting was observed in the right eye, which was preserved with a therapeutic scleral lens filled with moxifloxacin until donor tissue was available for a sclerokeratoplasty combined with amniotic membrane transplantation. In the second procedure consisting of phacoemulsification, capsular bag implantation of the intraocular lens was not possible, and flanged intrascleral fixation was performed. Long-term graft survival has been achieved with systemic and topical immunosuppression.

Objectives: This study aimed to estimate direct and indirect economic costs associated with Acanthamoeba keratitis and explore variations in individual and healthcare characteristics.

Methods: Patients treated at Moorfields Eye Hospital, UK, between January 2011 and August 2014 were surveyed. Patients were included if they had a confirmed diagnosis and wore contact lenses. Direct costs included healthcare expenses, whereas indirect costs encompassed lost wages for patients and caregivers. The Mann-Whitney U test and generalized linear models were used to analyze cost data and their associated factors, with P <0.05 being considered statistically significant.

Results: A total of 73 patients were included, with a mean age of 39.3 years (19-81); 40 patients (54.8%) were female, and 41 (56.2%) had good outcomes. Median direct, indirect, and total costs were £2,966.5 (IQR £5,553.2), £1,776.0 (IQR £3,223.3), and £6,678.6 (IQR £17,268.4), respectively. Higher direct costs were independently associated with multiple medical visits ( P <0.001), steroids before antiamoeba therapy ( P =0.042), and keratoplasty ( P <0.001).

Conclusions: The cost of managing Acanthamoeba keratitis is substantial. Future research should focus on optimizing treatment strategies and improving patient outcomes to help alleviate the financial burden on patients and healthcare systems.

Abstract: Gram-negative diplobacilli Moraxella, commonly found on skin and mucous membranes, rarely cause ocular infections, except for Moraxella nonliquefaciens , associated with severe endophthalmitis. We present the case of a patient with common variable immunodeficiency (CVID) who developed bilateral ulcers due to M. nonliquefaciens without local predisposing factors. This case underscores the relevance of considering M. nonliquefaciens as an important ocular pathogen, even in the absence of local predisposition. This case presents a 42-year-old woman with a history of viral conjunctivitis and common variable immunodeficiency presented with pain and blurred vision in her left eye. She was diagnosed with infectious keratitis caused by M. nonliquefaciens , treated with fortified antibiotic eye drops and cycloplegics. Subsequently, she developed similar symptoms in her right eye, also caused by the same microorganism. After several weeks of treatment, both eyes showed improvement, allowing for continued treatment with topical corticosteroids and antibiotics. Two months later, her visual acuity significantly improved, with clear corneas and paracentral leukomas in both eyes. In conclusion, patients with CVID undergoing intravenous immunoglobulin (IVIG) therapy may develop severe ocular infections, even by uncommon microorganisms such as M. nonliquefaciens . Although IVIG therapy is essential for managing CVID, susceptibility to ocular infections may persist due to deficiencies in local immune response, especially in the tear film. It is crucial to consider this risk when treating patients with CVID for proper management and prevention of ocular complications.

Abstract: Scleral lenses have been shown to provide improved visual acuity and ocular surface protection in patients with corneal irregularities and ocular surface disease. However, scleral lens (SL) wear may lead to anterior ocular pathology owing to metabolic or mechanical stress. Most reports of SL-related complications have described microbial keratitis or hypoxia-related issues. There is limited literature describing complications caused by mechanical interactions, such as suction between the SL and ocular surface. This case report describes a patient with long-standing keratoconjunctivitis and keratoconus who developed intracorneal hemorrhage within 4 hr of completing application and removal training on the first day of SL wear.

Purpose: To identify the causal relationship between the gut microbiota and cataracts using a two-sample Mendelian randomization (MR) approach.

Methods: Genetic instrumental variables for gut microbiota were derived from a genome-wide association study (GWAS) of 18,340 participants. The aggregated statistics for cataracts, which involved 8,890 cases and 454,120 controls, were also obtained from GWAS. In addition, the inverse variance weighted method served as the primary analysis. Moreover, the weighted median method, MR-Egger regression, and MR Multieffect residual and outlier tests were performed to test the robustness of our results.

Results: Ultimately, we found a suggestive association between five bacterial traits and cataract risk: the ChristensenellaceaeR.7 group ( P =0.00175, odds ratio [OR]=0.995, 95% confidence interval [CI]: 0.991-0.998), Sellimonas ( P =0.0309, OR=0.998, 95% CI: 0.997-1.000), and Eubacterium ruminantium group ( P =0.0498, OR=0.998, 95% CI: 0.997-1.000) were negatively correlated with cataract, whereas Eggerthella ( P =0.0157, OR=1.002, 95% CI: 1.000-1.005) and Odoribacter ( P =0.0471, OR=1.004, 95% CI: 1.000-1.007) were positively associated with cataract. Heterogeneity was not observed in any of the five bacteria.

Conclusions: Our analysis provides evidence supporting a potential causal relationship between the gut microbiota and cataract risk. However, more research is needed to further elaborate on how gut microbiota affects cataract development.