Acta Ophthalmologica最新文献

Deep anterior lamellar keratoplasty (DALK) is a surgical procedure that involves replacing the anterior portion of the cornea with donor tissue while preserving the patient's endothelium. This technique has gained popularity in recent years as an alternative to traditional penetrating keratoplasty (PK) due to its potential advantages in terms of visual outcomes, graft survival and reduced risk of endothelial rejection.

The decision to perform DALK in keratoconus is based on various factors, including the keratometric readings, corneal thickness, corneal clarity and RGP tolerability.

Surgical technique plays a critical role in the success of DALK. Several approaches have been described to perform the DALKs; the big bubble technique is considered the most convenient for all surgeons. Other techniques were used according to the associated pathology.

This presentation is a quick journey into DALK indications and various techniques used in eyes with keratoconus.

Aims/Purpose: Report a rare case of salivary duct carcinoma (SDC) of the left parotid gland metastatic to the iris, ciliary body and choroid.

Methods: Data collection from clinical records.

Results: A 70-year-old woman with a history of stage IV SDC of the left parotid (pT2 cNx cM1) diagnosed in November 2020, treated with palliative chemotherapy with cisplatin since October 2021, presented to Ophthalmology department in Hospital de Santa Maria, Lisbon, Portugal in November 2021 due to a solid lesion in the anterior chamber and progressive declining vision of the left eye. Ultrasound biomicroscopy showed a 6.7x12.0x4.7mm cupuliform mass in the iris, with high reflectivity and heterogeneous internal structure, involving the ciliary body and displacing posteriorly the intraocular lens. Posterior segment ultrasound revealed a solid cupuliform lesion of the ocular wall, approximately 3 mm thick, with high reflectivity and a heterogeneous structure. The ultrasound characteristics were consistent with secondary intraocular lesion of the iris, ciliary body and choroid and orbital MRI supported this diagnosis. In December 2021, due to global systemic progression after three cycles of cisplatin, the patient was switched to 9 cycles of doxorubicin+cyclophosphamide, with apparent stabilization of the systemic disease. In September 2022, there was a significant reduction in the size of the iris metastasis, even though the posterior segment ultrasound demonstrated progression of the intraocular disease, now with multifocal choroidal metastasis in both eyes, associated with exudative detachment of the retina in the right eye. Due to multiple cerebral metastasis, the patient underwent holocranial radiotherapy 30 Gy/10 fractions, with ophthalmological findings being unchanged in October 2022. She underwent two more cycles of paclitaxel, which was suspended due to clinical deterioration. The patient died in December 2022, with a survival of 25 months (13 months since diagnosis of intraocular metastases).

Conclusions: The case reports a rare presentation of metastatic SDC to the eye.

Aims/Purpose: To assess the progression of diabetic retinopathy (DR) in pregnant women with pre-existing diabetes in the Birmingham and Solihull area and to evaluate adherence to recommended screening guidelines.

Methods: A retrospective review was conducted over 12 months (01/09/2022-31/08/2023) using data from the Diabetic Eye Screening Program (DESP) and hospital records (Medisoft, OCT, and retina images). The study included pregnant women with pre-existing diabetes who received maternity services at University Hospitals Birmingham (UHB) and were referred to DESP. Patients with gestational diabetes were excluded. Data collected included demographics, DR screening attendance, progression rates, and clinical outcomes.

Results: Out of 149 pregnant women with pre-existing diabetes, 54 (36.2%) were not referred for initial screening by 12 weeks due to late presentation and delayed diabetes status confirmation. Of the total, 88 (59%) missed the 12-week screening, 57 (40%) missed the 16-20 week screening, and 67 (48%) missed the 28-week screening. At 12 weeks, 27% were R0M0, 9% R1M0, 3% R1M1, and 1% R2M0/R2M1, with 8 referred to HES. At 16-20 weeks, 43% were R0M0, 16% R1M0, 1% R3SM0, and 1% were unable to assess, with 2 referred to HES. By 28 weeks, 37% were R0M0, 12% R1M0, 1% R3SM1, and 2% were still being graded, with 1 referred to HES. The study highlighted significant cases, including one patient who progressed to severe NPDR and required bilateral PRP and Ozurdex treatment, and another who developed DMO treated with Ozurdex.

Conclusions: Diabetic retinopathy progression during pregnancy remains a significant concern, with many patients missing critical screening appointments, leading to advanced DR stages and severe visual impairment. Despite adherence to screening guidelines, patient non-compliance and late referrals hinder effective management. Improved patient education and follow-up strategies are essential to enhance screening attendance and outcomes, thereby preventing severe DR progression during pregnancy. Further research is necessary to develop targeted interventions for better compliance and timely treatment.

Aims/Purpose: To evaluate the efficacy and safety of repeated low-level red-light (RLRL) therapy with customised orthokeratology (Ortho-K) for myopia control in Spanish children.

Methods: This single-site, randomised, parallel-group, non-blinded trial enrolled 26 children aged 10-13 years with myopia. A total of 26 children were enrolled, completing the 6-month follow-up in May 2024. Children were randomly assigned to either the RLRL combined with the Ortho-K or the Ortho-K-only group. The Ortho-K group was required to wear Ortho-K lenses for at least 8 hours per night. In addition to wearing Ortho-K lenses in the adjunct therapy group, daily RLRL therapy was administered twice a day for 3 minutes per session. The primary outcome was the axial length (AL) change measured at 6 months relative to baseline.

Results: Twenty-six children completed the study (11 in the RLRL + Ortho-K group and 15 in the Ortho-K group). After 6 months, the mean AL change was -0.06 mm (95% CI, -0.12 to 0.01 mm) in the RLRL +Ortho-K group, significantly lower than in the Ortho-K group (0.04 mm [-0.12 to 0.01 mm], p = 0.001). In the RLRL + Ortho-K group, 5 children (45.5%) achieved significant axial shortening (AL changes < = -0.05 mm). The mean change in macular thickness was 0.66 μm (95% CI, 0.05 to 1.28 μm) in the RLRL + Ortho-K group, significantly greater than in the Ortho-K group (0.08 μm [0.001 to 0.15 μm], p = 0.022). No severe adverse events were reported, such as vision loss, scotoma, functional visual loss, or structural damage on OCT scans. No significant corneal findings were observed.

Conclusions: Combining RLRL therapy with customised Ortho-K shows promise for controlling myopia progression in Spanish children. This approach may provide clinical benefits in managing myopia without severe adverse effects.

Aims/Purpose: Excessive levels of the intracellular second messengers Ca²⁺ and cAMP have been linked with photoreceptor cell death during retinal degeneration (RD). We investigated if a combination (TMB) of common clinical drugs; tamsulosin and metoprolol (alpha- and beta-adrenergic antagonists, Gq- and Gs-coupled, respectively), and bromocriptine (a D2-like dopamine-receptor agonist, Gi-coupled), that inhibit intracellular Ca²⁺ and cAMP signaling could be repurposed to mitigate RD.

Methods: Drug efficacy was tested in four distinct RD models: rd10, P23H, and Rpe65^−/− mice; and PDE6A^−/− dogs. The duration of the drug trials ranged from 1-wk to 7-months. Drug serum levels were measured by liquid chromatography-mass spectrometry (LC-MS). We used primarily photopic and scotopic electroretinography (ERG) and optical coherence tomography (OCT) to assess drug efficacy. Molecular biology methods such as immunohistochemistry, immunoblotting, and RNA-sequencing (bulk and single cell) were used to document therapeutic mechanisms, as well as to confirm therapeutic effects.

Results: Dietary TMB improved cone function and slowed cone degeneration in P23H mice. In rd10 mice, both rod and cone function were significantly improved by TMB; and cone degeneration was significantly slowed. In dark-reared rd10 mice, the drug efficacy was associated with decreased lipid peroxidation preceding the onset of cone degeneration. Dietary TMB improved retinal function and optomotor responses in Rpe65^−/− mice but did not halt rod or cone degeneration. Seven-month-long subcutaneous sustained infusion of TMB into PDE6A^−/− dogs led to higher cone counts at the end of the trial. TMB mitigated forskolin-induced cAMP activity in an ex vivo retina preparation.

Conclusions: Our results suggest that simultaneous inhibition of Gs- and Gq-coupled receptors and activation of Gi-coupled receptors by a combination of existing drugs is a viable therapeutic strategy for RD.

Purpose: Defocus Incorporated Multiple Segments (DIMS) lenses and atropine have proven standalone efficacy in controlling myopia progression in children. However, there is a scarcity of evidence of their efficacy when used in combination. This randomized controlled trial (RCT) aims to evaluate the efficacy of combination treatment using 0.025% atropine and DIMS spectacle lenses compared to 0.025% atropine and single vision (SV) lenses in slowing myopia progression in European myopic children.

Methods: RCT conducted on children aged 4-16 years with myopia between -1.00 and -6.00D and astigmatism ≤2.00D. Children were randomly assigned to the 0.025% atropine and SV lenses treatment group (group A) or 0.025% atropine and DIMS lenses treatment group (group B). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline, 6 and 12 months. Statistical analyses (Mann-Whitney U-test or Chi-squared test) were performed to test for significance between the two groups.

Results: 79 patients completed the 12 month-follow-up: n = 38 (48.1%) in group A (47.4% female), mean age 9.00 ± 2.74 years; n = 41 (51. 9%) in group B (46.3% female), mean age 9.68 ± 2.65 years. There was no significant association between group and sex (p = 0.93) or age difference between the groups (p = 0.26). At 12 months, mean AL ± SD change was 0.16 ± 0.13mm in group A and 0.09 ± 0.16mm in group B, mean difference 0.07 ± 0.02 mm (95%CI 0.03-0.12, p < 0.001). Mean SER ± SD progression was -0.16 ± 0.31D and -0.16 ± 0.36D in group A and B, respectively (p = 0.61). 39.5% of the children in Group B had no axial elongation over 12 months, compared to 14.5% of the children in group A (p < 0.001).

Conclusions: Combination treatment with 0.025% atropine and DIMS spectacle lenses is more effective in controlling axial elongation than 0.025% atropine with SV lenses in European children. The differences in SER between the groups were not significant. The AL increase in group B was less than that previously reported with DIMS lenses alone in Asian and European children over 12 months, suggesting that other factors, such as pupil size, may enhance the DIMS lens efficacy in controlling axial elongation.

Congenital aniridia is a rare, panocular disease with PAX6 haploinsufficiency in 90% of the cases. In addition to PAX6, other factors appear to play a role in aniridia associated keratopathy (AAK) development. FOXC1, DSG1, FOSL2 and FABP5 are genes that are crucial for eye development, differentiation of limbal stem cells and for the regulation of lipid metabolism in epithelial cells. Recent data also indicate the importance of microRNA 204-5p and microRNA 138-5p in AAK. The Lagali AAK classification well describes the progressive nature of AAK, from a mild peripheral to a central corneal vascularization with corneal pannus formation. Ocular surface inflammation, as much as previous ocular surgery seem to have a role in AAK progression. Nevertheless, the corneal endothelium might possess slightly better quantitative reserves in congenital aniridia, than in healthy subjects and corneal endothelial deposition seems to be independent from the developmental abnormalities but may be related to up to date undescribed endothelial inflammatory or metabolic changes.

Aims/Purpose: The purpose of this study was to evaluate the refractive predictability of the sutureless scleral fixation Carlevale intraocular lens (IOL) for the correction of aphakia in the absence of capsular support.

Methods: Retrospective cohort study. Consecutive patients implanted with Carlevale IOL between February 2020 and February 2024, with a minimum follow-up of 3 months, were included. Exclusion criteria included use of toric IOLs and absence of postoperative refraction due to a severely limited visual acuity or lack of cooperation. The clinical data were acquired from the patients' records. Primary outcome was the postoperative spherical equivalent deviation (PSED) in relation to the preoperative refractive target. Secondary outcomes included the best corrected visual acuity (BCVA), surgically induced astigmatism (SIA), and postoperative complications.

Results: A total of 44 eyes were implanted with the Carlevale IOL in the study period. Of these, 30 met the inclusion criteria and were included in the statistical analysis. The mean follow-up time was 18.3 ± 11.7 months, and the mean age at the time of surgery was 70.93 ± 16.28 years. The most common surgical indications were aphakia after complicated cataract surgery (40%, n = 12), IOL dislocation (33.3%, n = 10), and aphakia after trauma (20%, n = 6). The PSED was -0.62 ± 1.51 diopters, with no statistically significant difference between surgical indication groups (p = 0.606). BCVA showed a statistically significant increase from 1.52 ± 0.88 to 0.42 ± 0.41 logMAR (p < 0.001). The trauma group had worse BCVA results (p = 0.013). The SIA was 1.14 ± 1.93 diopters. Regarding postoperative complications, the most common were transient ocular hypertension (20%), bleeding (hyphema or hemovitreous; 13.3%), and cystoid macular edema (6.6%).

Conclusions: The Carlevale IOL is a valuable option in our arsenal for managing aphakic eyes with no capsular support. It appears to provide acceptable predictability in refractive outcomes, with low astigmatism and few associated complications.

Aims/Purpose: Infants with congenital mobility visual impairment or blindness (MVI/B) walking delays are due to exposure and insufficient contact with their environment. Assistive safety devices provide contact and protection. ^[1,^2] Our study measured foot motility/gait in pediatric patients with a MVI/B to quantify the benefits of wearing a Pediatric Belt Cane.

Methods: Videos of fifty pediatric patients (Mean age = 26 mos, SD = 10.8) with a MVI/B Before and After were analyzed using the MediaPipe platform to perform gait analysis. Subsequent analyses included linear regression analysis and data smoothing to calculate metrics for foot mobility, approximate speed, step frequency, and estimated step lengths. T-test analysis was performed to calculate the significance of differences in gait analyses.

Results: Patients utilizing Pediatric Belt Canes showed significant percent increase in foot mobility (p < .05), percent improvement in approximate speed (p < .05), percent reduction in step frequency (p < .05), and percent increase in step length (p < .05).

Conclusions: Pediatric Belt Canes lead to marked, quantifiable improvements in walking for children with a MVI/B, supporting the conclusion that assistive safety devices are a medical necessity in the care and management of all children with a MVI/B (e.g., lack visual preview). Further work increasing the choice of assistive devices is warranted for sport, blind children with motor impairments, etc.

References: 1. Chong, P., Enzenauer, R., Ambrose-Zaken, G. Comparative video gait analysis of assistance for cortically visually impaired Children. International Council of Ophthalmology, WOC, August 17, 2024, Vancouver. 2. Chong, P. Comparative video gait analysis of assistance for mobility visually impaired Children. AAPOS, April 8, 2024, Austin, TX.