Frontiers in ophthalmology最新文献

Orbital schwannomas are benign tumors that arise from Schwann cells in the peripheral nerves in the orbit. They typically present after the second decade of life given their slow growth and rarely before then. Diagnosis is based on clinical course and specific imaging modalities; however, the definitive diagnosis is by lesion biopsy. Surgical removal is typically curative. Herein we present the case of an 8-year-old boy with proptosis and diplopia where he exhibited the clinical findings of an orbital mass, however, the characteristic picture of orbital schwannoma was observed on imaging yet found within the inferior rectus muscle, a rare finding indeed.

Periorbital necrotizing fasciitis (NF) is a rare, vision-threatening soft tissue infection that requires rapid antimicrobial treatments to minimize devastating soft tissue destruction, and debridement of affected tissue results in extensive defects requiring various techniques of reconstruction. We herein describe a case of a 58-year-old male with periorbital NF who underwent eyelid repair with intact fish skin grafts. To our knowledge, this is the first case report of fish skin grafts being used in eyelid wound management after periorbital NF.

Purpose: The aim of this work was to track tangential traction of idiopathic epiretinal membrane from an initial assessment to the immediate post-operative phase using an enhanced version of the relaxation index (RI).

Methods: A retrospective analysis was conducted on 9 patients who underwent peeling surgery for idiopathic, symptomatic, and progressive epiretinal membrane. The RI assesses the displacement of vascular crossings in time from a fixed point, which is the retinal pigmented epithelium. This updated iteration integrates infrared images paired with OCT scans instead of OCTA.

Results: The study encompassed three timepoints: T1 (initial appointment), T2 (1 week pre-surgery), and Post (1 month post-surgery). T1 was 12± 9 months prior to surgery. A statistically significant difference (p<0.001) in RI was observed across all three timepoints; however, there was no significant correlation between RI and visual acuity (p>0.05).

Conclusion: The RI emerges as a comprehensive and direct parameter for objectively assessing and monitoring tangential traction in three dimensions across an extensive area of the posterior pole. Further streamlining of the process is necessary to integrate this feature into clinical practice effectively.

Purpose: The purpose of this study is to characterize orbital inflammatory disease (OID) in a primarily Black patient population, examining their demographics, presentations, workup, treatment, and outcome.

Methods: A retrospective study was performed from January 2005 to June 2022 at two academic institutions in Brooklyn, NY. Patients included met criteria for one of the following OID conditions: non-specific orbital inflammation; nonbacterial dacryoadenitis; Tolosa-Hunt; orbital myositis; definite, possible, or probable IgG4-related ophthalmic disease; and sclerosing orbital inflammation. Data reviewed included orbital inflammatory labs, imaging, pathology, and treatment. Treatment was considered successful if a patient had complete resolution of symptoms.

Results: Thirty-nine patients met criteria for this study. 35.9% were diagnosed with dacryoadenitis, 28.2% with NSOI, 12.8% with myositis, 5.1% with possible IgG-ROD, 7.7% with probable IgG4-ROD, 7.7% with Tolosa Hunt, and 2.6% with sclerosing OI. 91% were started on steroids; 12.8% required transition to steroid-sparing therapy. 85% had a successful outcome with a resolution of symptoms.

Conclusions: This study characterizes OID in a Black patient population and compares it to prior studies done on OID. Research on underrepresented patient populations is needed to understand differences in disease presentation and improve patient outcomes.

Purpose: This study aimed to compare the anterior chamber depth (ACD), anterior chamber volume (ACV), and iridocorneal angle (ICA) of the eyes of patients with non-arteritic anterior ischemic optic neuropathy (NAION) and normal eyes.

Methods: In this cross-sectional study, 28 patients with NAION who were admitted to our institution were examined. Central corneal thickness (CCT), ACV, ACD, and ICA of all eyes were measured using corneal topography (Sirius, CSO, Italy). Axial lengths (ALs) were measured using an IOL-Master 500 (Carl Zeiss, Meditec). The eyes of these patients were compared with the eyes of 29 healthy individuals of similar age and gender.

Results: The mean ALs of the eyes with NAION and those in the control group were not statistically different, measuring 22.95 ± 0.68 mm and 23.13 ± 0.80mm, respectively (p=0.651). While the average ACV was 137.93 ± 41.01 mm³ in the control group, it was significantly lower at 117.86 ± 22.23 mm³ in the patients with NAION (p=0.038). The mean ACD, ICA, and CCT values in the control and study groups were not statistically different, with 2.82 ± 0.57 mm and 2.64 ± 0.31 mm, 41.62 ± 6.99° and 40.14 ± 7.04°, and 542.48 ± 19.39µm and 544.68 ± 31.26 µm, respectively (p1 = 0.236, p2 = 0.693, and p3 = 0.959). No statistical differences were found between the eyes with NAION and their fellow eyes in terms of AL, CCT, ACD, ACV, and ICA (p>0.05).

Conclusion: Differences in anterior segment morphology were observed in eyes with NAION compared to healthy eyes. Decreased ACV may be a risk factor for NAION.

Introduction: Artificial intelligence (AI) shows promise in ophthalmology, but its potential in tertiary care settings in Latin America remains understudied. We present a Mexican AI-powered screening tool and evaluate it against first-year ophthalmology residents in a tertiary care setting in Mexico City.

Methods: We analyzed data from 435 adult patients undergoing their first ophthalmic evaluation using an AI-based platform and first-year ophthalmology residents. The platform employs an Inception V3-based multi-output classification model with 512 × 512 input resolution to capture small lesions when detecting retinal disease. To evaluate glaucoma suspects, the system uses U-Net models that segment the optic disc and cup to calculate cup-to-disc ratio (CDR) from their vertical heights. The AI and resident evaluations were compared with expert annotations for retinal disease, CDR measurements, and glaucoma suspect classification. In addition, we evaluated a synergistic approach combining AI and resident assessments.

Results: For glaucoma suspect classification, AI outperformed residents in accuracy (88.6% vs. 82.9%, p = 0.016), sensitivity (63.0% vs. 50.0%, p = 0.116), and specificity (94.5% vs. 90.5%, p = 0.062). The synergistic approach achieved a higher sensitivity (80.4%) than ophthalmic residents alone or AI alone (p < 0.001). AI's CDR estimates showed lower mean absolute error (0.056 vs. 0.105, p < 0.001) and higher correlation with expert measurements (r = 0.728 vs. r = 0.538). In the retinal disease assessment, AI demonstrated higher sensitivity (90.1% vs. 63.0% for medium/high risk, p < 0.001) and specificity (95.8% vs. 90.4%, p < 0.001). Furthermore, differences between AI and residents were statistically significant across all metrics. The synergistic approach achieved the highest sensitivity for retinal disease (92.6% for medium/high risk, 100% for high risk).

Discussion: AI outperformed first-year residents in key ophthalmic assessments. The synergistic use of AI and resident assessments showed potential for optimizing diagnostic accuracy, highlighting the value of AI as a supportive tool in ophthalmic practice, especially for early career clinicians.

Objective: To assess the effectiveness and safety of oral propranolol for the treatment of ocular adnexal infantile hemangiomas.

Patients and methods: retrospective observational cohort study. Propranolol was administered at an initial oral dose of 1 mg/kg and subsequently increased to 2 mg/kg for 1 year. Outcomes were evaluated by comparing pre- and post-treatment clinical findings, contrast-enhanced ultrasound (CEUS) findings and/or orbital magnetic resonance imaging findings from baseline to 3, 6, 9, 12, 24, and 48 weeks. Regression was graded as follows: satisfactory when 90% and above of the baseline lesion volume and extension decreased, acceptable when 50 to 90%, mediocre when 30 to 50%, poor less than 30%.

Results: Twenty-four patients were included in this study. The mean age at presentation was 4 ± 1 week. Sixteen (71%) patients were females and 7 (29%) were males. The mean follow-up duration was 18 ± 3 months. Therapy was started for of 23/24 patients at 5 weeks old, of 1/24 started at 9 weeks of age. The median age was 5,16 weeks. Sixteen patients (66%) had satisfactory resolution between 3 and 6 weeks, 5 (20%) after 9 weeks, and 3 (12%) after 12 weeks. One patient (5%) had a mediocre response after 24 weeks. One patient withdrew from therapy because of hypoglycemia, which was successfully managed as an outpatient. No significant adverse reactions, such as bradycardia, hypotension, bronchospasm, or congestive heart failure, were detected in this cohort.

Conclusion: This study indicates that the real-life use of oral propranolol for infantile hemangioma yields a high success rate with a lower morbidity than previously reported, particularly when managed by a proficient and multidisciplinary team.

Tuberculum sellae meningioma (TSM) is an uncommon tumor among all intracranial meningiomas. As these tumors grow, they compress the surrounding structures, including the optic nerves and the pituitary gland. Ocular motor nerve palsy (OMNP) can occur as an isolated mononeuropathy or as part of multiple cranial nerve palsies. The role of corticosteroids in the management of OMNP has not been fully studied in the literature. In this report, we present a case of a previously well middle-aged woman who presented with severe headache and isolated OMNP on examination. MRI of the brain showed a small TSM that extends into the right optic canal. In our case, we noted the expedient and complete recovery of isolated OMNP within a few days following treatment with dexamethasone. This case report is on an isolated OMNP associated with TSM, which has not been previously reported. In addition, it highlights the role of corticosteroids in achieving rapid recovery from OMNP.