Acta Ophthalmologica最新文献

Aims/Purpose: The aim of this study was to explore the clinical characteristics, visual acuity (VA), and topographic patterns in patients who developed corneal ectasia (CE) following myopic laser vision correction (LVC).

Methods: We conducted a retrospective review of medical records for patients diagnosed with CE after laser vision correction between 2009 and 2023 at a tertiary hospital in Korea. We collected various data, including patient demographics, medical history, the type of refractive surgery and postoperative periods., VA at their initial and final visits, refractive errors, and topographic biometric data.

Results: In total, 36 eyes of 28 patients (13 females and 15 males) were included, and 8 (28.5%) cases were bilaterally involved. The most common type of surgery was LASIK (24 patients, 85.7%), while the remaining patients underwent LASEK (3 patients, 10.7%) or PRK (1 patient, 3.6%). In unilaterally involved eyes (20 eyes), VA, spherical equivalent (SE), and astigmatism of CE-affected eyes were significantly different from those of eyes with uninvolved eyes (all p < 0.001). In eyes with over 12 months of follow-up observation (12 eyes of 9 patients), no significant progression was noted in VA (p = 0.392), SE (p = 0.675), astigmatism (p = 0.737), and topographic parameters.

Conclusions: CE can develop even after comprehensive preoperative screening following LVC. This condition can significantly impact patients' quality of life by substantially reducing VA. Moreover, considering the spectrum of diseases that keratoconus represents, there is a possibility that CE may cease to progress after a certain age. Further investigations are required to understand the progression of CE concerning age in affected patients.

Aims/Purpose: To report on the impact of additional subconjunctival corticosteroid injections in a subsequent multimodal treatment of a challenging case of symblepharon following a Roper Hall Grade III chemical burn.

History and signs: A 42-year-old male patient was referred due to multiple failed treatment attempts for his corneal disease and severe symblepharon formation. The initial cause of the accident was a chemical burn on the right eye (OD) caused by potassium hydroxide. At the time of referral, extensive ocular surface damage was present with corneal vascularization, fibrovascular pannus, persistent central corneal ulcer, distichiasis, upper eyelid nasal entropion, and limbal stem cell deficiency (LSCD), with visual acuity reduced to finger counting.

Results: To treat this patient's condition, we adopted a multimodal three-step approach. The first step was to reconstruct the fornix, with additional preoperatively intensive topical therapy with autologous serum drops and antibiotic eye drops to reepithelialize the corneal ulcer. In the crucial postoperative period, we administered a subconjunctival injection of 0.5ml betamethasone and a week later 1ml triamcinolone to prevent recurrence of symblepharon. The healing process went well and there were no further signs of symblepharon recurrence three months later. To improve tissue modulation, we administered a subconjunctival injection of triamcinolone again to achieve a more lasting effect and planned step two, which included a limbal stem cell transplant and lastly a penetrating keratoplasty as the final step.

Conclusions: There are numerous therapeutic approaches to treat symblepharon, which are primarily based on surgical procedures and these remain an important cornerstone for the chances of recovery. In addition to surgical treatment, postoperative adjustment is also crucial for success. With our new approach we took action in the fibrosis formation process by administering early postoperative subconjunctival injections, this to achieve better bioavailability.

Aims/Purpose: Challenges in modeling rates of visual field (VF) progression relate to flooring effects and sensitivity to inclusion criteria like follow-up (FU) duration. We explored the relationship between VF progression and age, disease severity, and FU duration in primary open angle glaucoma (POAG).

Methods: Mean Deviation (MD) of 655 POAG eyes of 424 patients from the UZ Leuven Glaucoma Clinic with at least 5 VFs and 2 years of follow-up were used. Baseline severity was defined as Above 0 (≥0dB), mild ( < 0 and ≥-6dB), moderate ( < -6 and ≥-12dB), advanced ( < -12 and ≥-15dB), and severe ( < -15dB) disease. Linear mixed models and changepoint detection were used. Sensitivity analysis of modeled progression rates within each severity group was done by varying maximally included duration of FU.

Results: MD progression rates per year were -0.34dB (p < 0.001) for Above 0, -0.49dB (p < 0.001) for mild, -0.49dB (p < 0.001) for moderate, -0.26dB (p = 0.009) for advanced, and +0.1dB (p = 0.317) for severe POAG. Random effects correlation between baseline MD and progression rates was 0.36. The fixed effects for age and test related learning effect were non-significant (p = 0.65) and -0.21 (p = 0.004) respectively. The correlation between the implied slope and baseline age was -0.26. Changepoint analysis showed that group level progression estimates stabilized when minimum FU times were at least 2.17, 1.99, 2.18, and 4.56 years for mild, moderate, advanced and severe POAG respectively.

Conclusions: Older patients progress faster across severity levels and a significant learning effect is present when excluding patients with severe POAG. Excluding patients with a baseline MD above 0dB, the modeled average MD change is similar between mild and moderate POAG. Less progression is observed in advanced and no progression in severe POAG, consistent with the flooring effect. In mild and moderate POAG patients progression estimates converged after a minimum FU of at least 2 years.

Aims/Purpose: The aim of this study is to evaluate different approaches to investigate early alterations in tear biomolecular profiles induced by contact lens (CL) wear. This includes assessing the impact of CL wear on tear volume, osmolarity, and biomolecular composition using Raman spectroscopy.

Methods: Two participants of the same sex (male), age (23 years), and with a similar lifestyle wore different CLs for two hours. Ocular analysis was performed at three time points: before CL insertion, immediately after CL removal, and two hours post-removal. The analyses included tear meniscus height and osmolarity measurements. Tear samples were collected at each time point and analyzed using Raman spectroscopy.

Results: Tear volume and osmolarity remained unchanged throughout the study. Raman spectroscopy highlighted notable changes in the biomolecular profile of tears after CL wear, particularly in the 2700-3200 cm^-¹ spectral window.

Conclusions: Among the analyses performed, only Raman spectroscopy revealed significant changes. It highlighted alterations in the biomolecular profile of tears post-CL wear, particularly in the 2700-3200 cm^-¹ spectral window associated with C-H stretching. The ability of Raman spectroscopy to detect these subtle, subclinical changes underscores its value as a non-invasive tool for analyzing individual responses to CLs. Notably, Raman spectroscopy captures molecular-level alterations, which form the basis of changes in the physical and functional properties of the tear film, including those measured by tear meniscus height and osmolarity. These changes become detectable by traditional techniques only in a late stage, while molecular-level alterations can be detected earlier, providing an opportunity for proactive intervention and management.

Aims/Purpose: To report a unique presentation of pigment dispersion syndrome (PDS).

Methods: Observational case report.

Results: An 81-year-old woman presented to our department for a routine appointment. Relevant ophthalmologic history comprised prior bilateral cataract surgery in 2009 with single piece in-the-bag intraocular lens (IOL) implantation in right eye (RE) and sulcus implantation in the left eye (LE), due to capsular rupture. Upon examination, best corrected visual acuity was 10/10 in OD and OS. Intra-ocular pressure (IOP) was 9/9 mmHg; there was anisocoria, with OS > OD in photopic conditions. OS slit lamp examination showed IOL positioned in the sulcus, diffuse pigment deposition in the corneal endothelium and uneven extensive 360° iris transillumination defects. Gonioscopy revealed extensive angle pigment deposition in OS; colour fundus photographs displayed extensive retina pigment deposition, mainly in the peripapillary and perivascular areas. No glaucomatous cupping of the optic disc was observed. A diagnosis of left PDS was entertained; given the lack of vision complains, normal visual acuity, IOP, and no glaucomatous damage of the optic nerve, close monitoring of the patient was undertaken.

Conclusions: Pigment dispersion syndrome may arise from the iatrogenic damage to the iris of a single piece sulcus-placed IOL and typically presents with extensive pigment deposition in the structures of the anterior segment, along with iris transillumination defects. To our knowledge, this is the second report of PDS with pigment deposition in the posterior segment. Indeed, although rare, convection currents may carry pigment to the vitreous and retina, which justifies the unusual findings in this patient and warrants a complete ophthalmologic evaluation in such cases.

Aims/Purpose: The aim of this study was to investigate the effects of varying durations of optic nerve compression on retinal function and morphology in an adult DA/HanR rat with optic nerve crush model.

Methods: In the study, adult DA/HanR rats (4-8 mo) were divided into 5 experimental groups. Lateral canthotomy and lateral bulbar conjunctiva incision were performed to reach the area. The optic nerve was held 2-3 mm posterior to the globe with the help of calibrated forceps and compressed for four different periods of time: 10 seconds, 15 seconds, 30 seconds and 2 minutes. During the injury, retinal fundus observation of rats was checked with a 90-diopter fundus lens. To evaluate changes in vision after optic nerve damage, in vivo electrophysiological tests (VEP, EEG and ERG) with daylight stimulator, a light intensity of 500 μW/cm2, was studied. Changes in optic nerve and retina morphology after injury were evaluated by hematoxylin-eosin (H&E), TUNEL assay, immunofluorescence staining of gliosis and retina cell markers.

Results: It was observed that the response to light was reduced in both the retina (ERG) and visual cortex (VEP-EEG) in the damaged eyes compared to the control group. Retina cell survival showed decrease in injured groups by TUNEL assay. In immunofluorescence staining, an increase in the severity of gliosis with activation of the microglia and Müller cells in the retina and optic nerve depending on the duration of damage was shown by the expressions of GFAP, Glutamine Synthetase and Vimentin. It was observed that the expression of the neural marker NeuN and the photoreceptor marker Rhodopsin decreased upon injury.

Conclusions: Our study provided preliminary results to further optic nerve regeneration studies to select optimum time points for improve axonal healing in retina and optic nerve injuries.

Funding Information: This work is supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under Grant ARDEB-121S762

Aims/Purpose: Myopic children are increasingly prescribed soft multifocal contact lenses to slow the progression of myopia. Their impact on central and peripheral vision is not fully understood beyond visual acuity, a measurement that is not sensitive enough to detect small changes in visual performance caused by increased higher-order aberrations and scattered light. The aim of this study was to investigate up to what extent Dual-focus (DF) contact lenses, designed for myopia control, affect flicker modulation sensitivity (FMS) measured in central vision and near periphery across photopic and mesopic light levels.

Methods: Right eyes of twenty-five myopic and non-presbyopic young adults were fitted with two soft contact lens designs, a DF with addition power of +2.00 D located in the near periphery and a single-vision (SV) contact lens of the same material and parameters, in random order. 30 minutes after contact lens insertion, photopic and mesopic FMS were measured foveally (0 degrees) and at four near peripheral locations selected diagonally away from fixation at an eccentricity of 5 degrees in each of the four quadrants to produce a measure of overall peripheral FMS.

Results: The mean visual acuity did not vary significantly between the DF and SV contact lenses. Mean central fovea FMS were 0.12 log units worse in the DF than the SV contact lens, under both photopic (p < 0.001) and mesopic (p = 0.001) luminance conditions. Mean peripheral FMS were 0.04 log units worse with the DF contact lens than SV contact lens, under both photopic (p = 0.002) and mesopic (p = 0.048) light levels.

Conclusions: DF contact lenses designed for myopia control reduced FMS compared to SV contact lenses, with the reduction being greater for central fovea FMS than for near periphery FMS, for both photopic and mesopic luminance conditions. The blurred background noise created by the peripheral power of DF contact lenses is likely to influence both central and peripheral vision.

Aims/Purpose: To report a patient who developed dysthyroid optic neuropathy post thyroidectomy

Methods: Patient who came to the Eye OPD with diminution of vision post thyroidectomy procedure was evaluated

Results: A 57-year-old female who had Grave's ophthalmopathy detected 8 months ago, vision 6/6 B/E came to the EYE OPD with sudden exacerbation of symptoms for the past 4 days. She had undergone total thyroidectomy 8 days ago. Her visual acuity was 6/24 both eyes and Color vision was impaired in the both the eyes, left eye more than right eye. On ocular examination there was upper lid retraction both the eyes with scleral show. There was fullness of B/E lower lids with lid lag B/E. EOM were mildly restricted in B/E and pupils were sluggishly reacting B/E, rest anterior segment: WNL. Patient was pharmacologically dilated for fundus examination and both eyes disc pallor was noted.

CECT Orbits was performed which showed significant enlargement and prominence of bilateral extraocular muscles, predominantly inferior and medial rectus (left eye > right). Vertical Barrett's Index of left eye > 60% suggestive of significant optic nerve impingement of left eye. Thyroid tests performed showed profound hypothyroidism with FT4 1.9 pg/ml, TSH: 41 microU/ml.

Euthyroid state was rapidly restored with thyroxine and T3 supplements and optic neuropathy was treated with oral steroids. Patient was kept on regular follow up and dysthyroid optic neuropathy improved significantly with restoration of normal visual acuity.

Conclusions: Dysthyroid optic neuropathy may be precipitated post thyroidectomy in patients developing hypothyroidism suggesting that euthyroid state must be maintained and prompt treatment with steroids of graves ophthalmopathy can restore normal visual acuity.