Frontiers in ophthalmology最新文献

Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder with ophthalmic manifestations occurring in 11% of cases. This report details the case of a 75-year-old woman presenting with orbital RDD characterized by right-sided proptosis and progressive vision loss, culminating in no light perception (NLP) for 8 months. Imaging studies revealed tumor involvement of the right ethmoid, maxillary, and sphenoid sinuses as well as the right orbit. Biopsy confirmed extranodal RDD. The patient underwent radiotherapy, which resulted in an improvement in the visual acuity to hand motion 3 months later. Subsequent orbital decompression surgery and tumor debulking were performed to address exophthalmos and worsening exposure keratopathy. Postoperatively, visual acuity improved to counting fingers at 6 in. in the first week and further to 20/800 seven months after surgery. Vision-threatening compressive optic neuropathy is a severe complication of orbital RDD; however, this case demonstrates its potential reversibility with a multidisciplinary therapeutic approach.

Background: Staphylococcal scalded skin syndrome (SSSS) is a rare but potentially life- threatening condition caused by exfoliative toxin-producing Staphylococcus aureus. Ocular involvement, although infrequently reported, may lead to vision-threatening complications if not promptly recognized.

Methods: The clinical history, findings, therapy, and outcome of two patients with SSSS exhibiting prominent ocular manifestations at disease onset were analyzed and reported. A comprehensive literature review was performed using PubMed/Medline, Embase, and Scopus incorporating search terms such as "Staphylococcal scalded skin syndrome," "eye," "eyelid," "conjunctival," "ocular manifestations," and "ocular adnexal."

Results: Two pediatric patients with SSSS were identified. Case 1: a 4-year-old boy with initial blepharitis progressing to periocular scaling, conjunctival inflammation, and corneal staining, confirmed as SSSS by clinical findings and microbiology. Case 2: a 38-month-old boy presenting with bilateral eyelid edema, periocular desquamation, and perioral lesions, with negative corneal staining. Both patients were treated with systemic antistaphylococcal antibiotics (including toxin-targeting regimens) and topical ocular therapy (fusidic acid gel and hypochlorous acid spray), resulting in rapid clinical improvement and complete resolution of ocular and cutaneous lesions. The literature review identified a single reported case of a healthy adult with purulent conjunctivitis as an initial manifestation of SSSS.

Conclusion: Although rare, ocular manifestations may serve as an early indicator of SSSS. Prompt ophthalmological evaluation and combined systemic and targeted topical therapy are essential to prevent ocular sequelae. Awareness of this condition among ophthalmologists and pediatricians is critical to prevent complications and potential permanent visual impairment.

Managing high hyperopia is notably challenging due to the unpredictability of refractive outcomes. Moreover, the technical difficulties of surgery in patients with smaller eyes, compounded by the limitations in available intraocular lens (IOL) powers in the United States, necessitate innovative approaches to achieve emmetropia. This case report discusses a novel approach using a light-adjustable lens (LAL) with a trifocal IOL to address these complexities and achieve spectacle independence. A 36-year-old man, who works as a military aircraft inspector and has high hyperopia and a history of left eye (OS) strabismic amblyopia, sought freedom from spectacles due to occupational demands. Pre-operative assessment showed severe uncorrected visual acuity and short axial lengths. Refractive lens exchange was performed bilaterally, utilizing a trifocal IOL combined with a light-adjustable lens OD and a high-powered monofocal lens OS. Post-operatively, significant improvement in visual acuity was observed, with heightened patient satisfaction. This case demonstrates the effectiveness of integrating a light-adjustable lens with a trifocal IOL to address high hyperopia in a less invasive manner and foster spectacle independence with patient satisfaction. Our approach offers promising implications for refractive surgery, highlighting the potential for tailored solutions in complex cases.

Purpose: To investigate the microbial profiles in the retina and RPE/choroid, and how they respond to retinal injury.

Methods: Adult C57BL/6J mice were subjected to retinal laser burns using a photocoagulator. One and 24h later, the retina and RPE/choroid were collected under strict sterile conditions and processed for 16S rRNA paired-end sequencing (2×250). The data were analyzed using R software, GraphPad Prism, OmicShare, and Wekemo Bioincloud.

Results: Microbiota were detected in the retina and RPE/choroid under normal physiological conditions. The alpha diversity was higher in the retina than in the RPE/choroid. All retinal microbiotas at the phylum level and 12 out of 14 at the genus level were shared with those of RPE/choroid. The top phyla were Firmicutes, Proteobacteria, and Actinobacteria. Retinal laser injury reduced the alpha diversity but did not affect beta diversity. In the RPE/choroid, the abundance of Actinomyces and Roseburia decreased, and the abundance of Lactobacillus increased significantly after laser injury. The abundance of Sphingomonas in the retina decreased, and the abundance of Faecalibacterium and Bifidobacterium increased (P<0.05) after laser injury in the retina. Faecalibacterium and Bifidobacterium are positively linked to Th17/IL-17 signaling and RIG-I-like receptor signaling pathways, as well as antigen processing and presentation.

Conclusions: The neuroretina and RPE/choroid have diverse microbiomes under normal conditions. Their richness and evenness are relatively stable in the retina compared to those in the RPE/choroid. Retinal laser injury enriches Faecalibacterium and Bifidobacterium in ocular tissues, and these microbiotas may participate in retinal wound healing through modulating inflammation.

The surgical technique of double optic capture involves capturing the optic of an intraocular lens implant through both an anterior and posterior capsular opening as a method to reduce secondary capsule opacity and membranes, while ensuring intraocular lens (IOL) centration. The techniques of performing this procedure is described as well as newer surgical modifications of the technique for both pediatric and adult cataract surgery. Future directions involving its use in routine adult cataract surgery as a method to prevent posterior capsule opacity are discussed.

Introduction: To report the management of a long-standing, large hyphema following vitrectomy with silicone oil tamponade using multiple anterior chamber paracentesis (ACP) or washout (ACW).

Case presentation: A 50-year-old woman presented with blurred vision attributed to polypoidal choroidal vasculopathy and vitreous hemorrhage. Vitrectomy with silicone oil tamponade and lens extraction were performed. A persistent large hyphema and elevated intraocular pressure were detected postoperatively. ACP and ACW were performed five and two times, respectively. The hyphema faded, and the elevated IOP decreased to the normal range within 2 months. The cornea was clear, and corneal blood staining was not observed.

Conclusions: Multiple ACPs and ACWs are necessary and effective for the treatment of long-standing large hyphema.

Rhino-orbital cerebral mucormycosis (ROCM) is a rare, but potentially fatal opportunistic infection due to a fungus of the Mucorales sp. that involves infiltration of the sinuses, orbits, and central nervous system. Orbital exenteration (OE) is reserved for severe cases refractory to initial antifungal treatment and endoscopic sinus debridement, though there is currently no consensus on the ideal timing of OE and its impact on infection progression and survival. In this case series, we present three cases of similar, extensive ROCM that were candidates for OE after initial medical and surgical management with variable outcomes. We discuss that undergoing OE does not necessarily correlate with survival after ROCM infection and that the decision to proceed with exenteration should be personalized based on the status of a patient's comorbidities and the nature and extent of infectious spread. Globe-sparing OE may serve as a viable alternative for patients with localized, late-stage infection or reversible ROCM risk factors given vision preservation and less postoperative disfigurement with possibly comparable efficacy.

Purpose: To investigate the potential protective effects of taurine supplementation against retinal degeneration in an animal model of mild dry age-related macular degeneration (AMD).

Methods: To test the effects of a taurine supplement in mild dry AMD, sodium iodate (NaIO₃)-induced retinal degeneration model was used. Two administration methods, intraperitoneal (IP) and intravenous (IV), were used to deliver NaIO₃ in pigmented Long Evans rats to generate mild and severe dry AMD, respectively. Structural abnormalities were evaluated in vivo using near-infrared (IR) reflectance fundus imaging and optical coherence tomography (OCT). Using the slow progressive mild AMD model, we investigated the neuroprotective effects of oral taurine supplementation (1.5% w/v in drinking water) against NaIO₃-induced retinal degeneration over 20 weeks. In addition, a human Retinal Pigment Epithelium (RPE, hTERT-RPE1) cell culture model was used to directly assess taurine's ability to protect against NaIO₃-related oxidative stress.

Results: The high-dose IV model (80 mg/kg) exhibited extensive and severe retinal damage, with ONL thinning by 64.2% and total retinal thickness (TRT) by 47.6%, predominantly in the peripapillary region. In contrast, the lower-dose IP model (50 mg/kg) displayed milder, more gradual deterioration (outer nuclear layer (ONL) thinning by 19.4% and TRT by 11.5%). Oral taurine supplementation significantly preserved ONL and TRT in vivo and supported RPE-1 cell survival, proliferation, and motility, under NaIO₃ conditions.

Conclusion: Taurine supplementation provided significant structural protection against NaIO₃-induced damage both in vivo and in cell culture, demonstrating its potential as a therapeutic candidate for mitigating mild dry AMD progression.

Purpose: Graves' orbitopathy (GO) is the most common extra-thyroidal manifestation of Graves' disease (GD). Clinical disease activity and severity stage at the time of diagnosis are commonly used to determine the optimal treatment. There are still controversies regarding the "gold standard" for establishing disease activity. Although the clinical activity score (CAS) is the best evaluated parameter and therefore widely used, it lacks the ability to predict disease progression in all patients and response to anti-inflammatory treatment. Additional predictors are needed to select the optimal treatment for each patient.

Methods: We conducted a comprehensive review of the literature on activity assessment in GO.

Results: A large variety of parameters are used in studies to assess disease activity, most common clinical activity/severity scores, orbital imaging techniques, and serum biomarkers. CAS remains the best validated way for activity scoring. Other promising parameters, including specific MRI sequences (short tau inversion recovery, T2 mapping, and diffusion-weighted imaging sequences) and serological biomarkers [thyroid-stimulating immunoglobulin (TSI)/thyroid-stimulating hormone (TSH)-binding inhibitor immunoglobulin (TBII)], are starting to prove their utility in quantifying disease activity and in predicting the outcome of GO. TBII and TSI measurements' cutoff values for prognostic statements are available for almost all routine test systems and should be used more systematically as biomarkers for GO.

Conclusions: CAS is still considered the gold standard for assessing disease activity. Applied alone, CAS fails to predict disease progression in all patients. The future assessment is probably a combination of clinical, serological, and imaging measurements. The selection of treatment should be tailored to the manifestations and main treatment effects of the available drugs. Future studies will need to determine which parameters provide the best predictions for each drug class.

Ophthalmomyiasis is an uncommon parasitic infestation of the human eye caused by dipteran larvae, most frequently Oestrus ovis. It is rarely reported in temperate countries such as Bulgaria. We present a case of external ophthalmomyiasis in a 35-year-old urban resident, with no livestock exposure, caused by O. ovis. Larvae were morphologically identified after extraction. Approximately 30 motile larvae were mechanically removed over several days. Microscopy confirmed first-instar O. ovis larvae. Treatment included systemic and topical antibiotics, anti-inflammatory agents, and eye irrigation, resulting in complete recovery. This case of ophthalmomyiasis demonstrated that infestation can occur among urban residents without direct contact with livestock. Early recognition and mechanical removal are essential to prevent ocular damage.