Frontiers in ophthalmology最新文献

Background: Periocular motor neurotization is a surgical approach that can be indicated for the restoration of dynamic eyelid function in patients with facial nerve palsy. The orbicularis oculi muscle, responsible for eyelid closure, can be the target of a variety of re-innervation techniques, such as direct nerve transfers and muscle transpositions. This systematic review aims to map the existing evidence on direct neurotization techniques of the OOM, including nerve grafting, nerve transfers, and contralateral muscle transposition, and to describe their published effectiveness.

Methods: A systematic search of PubMed, Embase, and supplemental searching with citation chaining using google scholar to identify studies detailing periocular neurotization techniques. Studies were included if they reported clear outcomes such as restored blinking or eye closure, improved corneal protection, and enhanced eyelid symmetry.

Results: Of 857 screened studies, 6 met inclusion criteria, comprising 4 cohort studies, 1 case series, and 1 case report, with 106 patients eligible for detailed extraction. Direct neurotization of the OOM was associated with improvements in eye closure, blink reflex, and electromyographic data. Motor donor nerve selection was noted to affect outcomes significantly, with contralateral facial nerve branches yielding the highest blink improvement.

Conclusions: This review highlights the emerging role of direct neurotization techniques in reinnervating the orbicularis oculi muscle for appropriate patients with facial nerve palsy. Future high-quality studies are needed to establish clear indications, long-term efficacy, and comparative advantages of direct OOM neurotization in clinical practice.

Background: Optic neuritis (ON) is a common cause of visual loss in adults. It is commonly related to or occurs in the scenario of a demyelinating disease. Although treatment leads to visual recovery, diagnosis and treatment need to occur quickly, especially in lower-resource countries, where systems expect delays in care.

Purpose: The goal of this study was to examine health-system delays in ON diagnosis and treatment and their effects on visual recovery.

Methods: This retrospective review involved 100 cases of ON seen in a tertiary referral hospital from 2016 to 2023. Diagnosis was made of clinical features with confirmation by neuro-ophthalmological evaluation. MRI and visual evoked potentials (VEPs) were obtained if they were within reach. Visual recovery was defined as improvement of ≥3 Snellen lines at 3 months. Patients were given intravenous methylprednisolone (1 g/day for 3-5 days) and a tapered course of oral prednisolone. Delayed treatment was defined as the start of corticosteroids > 14 days after symptom onset, which was established for patients who did not start steroids on initial presentation. Logistic regression and ROC analysis were used to determine predictors of complete recovery.

Results: 58% of patients experienced delayed treatment and had lower rates of complete visual recovery (31.0% vs. 66.7%, p < 0.01). Delayed treatment (OR 0.45; 95% CI 0.21-0.89) and baseline poor BCVA independently predicted poor visual recovery.

Conclusion: In low-resource settings, the short-term visual outcomes of ON are worse with a delay in management. Prompt initiation of corticosteroids and improved referral pathways may aid in maximizing the recovery rate.

Purpose: The human ocular surface microbiome (OSM) plays a vital role in ocular health, infection prevention, and immune modulation. However, use of sequencing technology for researching the OSM is challenged by low sample biomass, high sample variability, and methodological inconsistencies. This review systematically evaluates existing literature on OSM research, identifying methodological challenges and proposing standardization strategies to enhance data quality, comparability, and clinical relevance.

Methods: A comprehensive analysis of peer-reviewed studies was conducted to assess methodologies used in sequencing-based OSM research, with focus on considerations in scope: sample size, selection, choice of eye, time frame, recruitment and enrollment criteria; sample collection and handling: sampling environment, topical anesthesia, sample collection tools and ocular region; sample preservation: temperature and use of buffers; and sample analysis: DNA extraction, quantification, and sequencing approach. Advantages and limitations of different approaches were identified, and best practices for standardization were explored.

Results: This review identified substantial variations in sample collection and processing methodologies, many of which are known to impact OSM composition. However, the influence of certain approaches remains unclear. Additionally, large reporting gaps were observed, as many studies failed to describe critical methodological elements, including specific sample handling procedures and sequencing parameters.

Conclusions: While sequencing technologies offer valuable insights, our findings highlight the need for further investigation of different methodological approaches to determine best practices and establish standardized methodological protocols, as well as the need for standardized reporting protocols in OSM research. These standards are essential for enhancing data reliability and translating findings into clinical applications.

Background: Glaucoma is a leading cause of irreversible blindness worldwide. Predicting a patient's future clinical trajectory would help physicians personalize management. We present a novel approach for predicting patient visual field (VF) progression by combining Functional Principal Component Analysis (FPCA) with electronic health record (EHR) data.

Methods: We identified glaucoma patients using diagnosis codes who had >=3 VF tests. We developed a 2-stage modeling pipeline: 1) Patients were split 80:10:10 into train, validation, and test sets and classified as fast-progressors or slow-progressors. 2) FPCA was used to predict mean deviation (MD) trajectories over 10 years after the baseline year of VF exams, using the first 2 principal components. To make predictions, the model uses up to one year of baseline VF and EHR data as input, but can flexibly make predictions from as few as a single VF test.

Results: 15,764 VF tests belonging to 2,372 patients were included, of which 8.92% of eyes were fast progressors. On the held-out test set, predictions over 10 years of future MD trajectories using baseline VF and EHR clinical data yielded an R² of 0.646 and an RMSE of 3.67 for fast-progressors, and an R² of 0.728 and an RMSE of 3.09 for slow-progressors. Performance was higher when predicting over the near term (fast progressors: year 1 R² 0.920, RMSE 1.83; year 5 R² 0.515, RMSE 4.26; slow progressors: year 1 R² 0.918, RMSE 1.771; year 5 R² 0.717, RMSE 3.12).

Conclusion: A novel modeling approach combining FPCA with clinical data from EHR was able to model longitudinal clinical trajectories of glaucoma patients. This method is well-suited for modeling longitudinal healthcare data, handling sparse and irregular observation schedules with a varying number of inputs.

Dry eye disease (DED) is a common chronic ocular surface disorder that significantly impacts quality of life. Its pathogenesis involves disruption of immune regulatory mechanisms and ocular surface inflammation, which mutually reinforce each other in a vicious cycle. Conventional treatments, such as artificial tears and meibomian gland care, alleviate symptoms but often fail to control underlying inflammation. Anti-inflammatory therapy is therefore crucial. Traditional agents like corticosteroids provide rapid relief but carry risks with long-term use. Cyclosporine A, an immunosuppressant, offers unique advantages by inhibiting T-cell activation, reducing pro-inflammatory cytokines, enhancing tear secretion, and restoring the ocular surface. Clinical and experimental studies have consistently demonstrated its efficacy and safety in improving tear production, relieving symptoms, repairing ocular surface structures, and slowing disease progression. This review summarizes the mechanisms, recent clinical evidence, and future perspectives of topical cyclosporine A in DED treatment, providing a reference for rational clinical use and novel therapeutic development.

Background: Intermittent exotropia (IXT) is a common form of strabismus, often treated surgically to improve ocular alignment and binocular vision. This study compares the outcomes of two surgical techniques: bilateral lateral rectus recession (BLRR) and unilateral lateral rectus recession combined with medial rectus muscle resection (ULRRMMR), focusing on sensory eye alignment, stereopsis function, and binocular vision recovery.

Methods: This retrospective study included 306 children with intermittent exotropia, assigned to either the BLRR or ULRRMMR group. Participants were evaluated preoperatively and at 1-, 3-, and 12-months post-surgery for sensory alignment, stereopsis, binocular vision, and complications. Statistical analyses were conducted to compare the outcomes between the two groups.

Results: After surgery at one day, overcorrection was observed more frequently in the BLRR group (P = 0.02). A comparison of the two surgical approaches revealed that the BLRR group demonstrated significantly greater improvements in sensory eye alignment (P = 0.009). In contrast, the ULRRMMR group showed superior outcomes in terms of foveal stereopsis (P = 0.01), binocular vision recovery (P = 0.007), and achieving normal eye alignment (P < 0.001) at 12 months. Notably, there was no significant difference in the rate of complications or binocular vision recovery between the two groups at the 12-month follow-up (P = 0.822).

Conclusion: Both BLRR and ULRRMMR are effective treatments for intermittent exotropia, but the BLRR may be a more optimal choice for enhancing sensory alignment, while ULRRMMR technique offers superior recovery in terms of stereopsis, and binocular vision recovery.

Introduction: The eye lens is a sophisticated optical element that provides the eye with both refractive power and transparency as well as the ability to change focus. The latter function diminishes with age as the lens becomes less able to change its shape. The changes with age in lens structure affect its function as a transparent refractive element but much remains misunderstood.

Methods: The review considers the optical parameters of the lens, its gradient of refractive index, and how this may be formed and altered with growth and ageing. The review is structured around three axioms that relate to the creation of the refractive index, the explanation for the lens paradox, and the changes in the structural proteins and how these may be linked to opacification.

Results/discussion: It is accepted that the structure/function relationship in the eye lens is explained by the distribution of its proteins forming a gradient of refractive index that provides a high level of image quality to the eye. Delving deeper into explanations for the gradient index creation, the lens paradox and the state of proteins in situ in lenses with cataract, gives reason for doubt. The axioms described indicate which areas require revisiting the literature, reconsideration of accepted thinking, and further experimental investigations.

Purpose: This study aimed to characterize the presentation, treatment, and outcomes of preseptal and orbital cellulitis in patients with and without cancer, to help guide management of these infections.

Methods: A retrospective cohort study was conducted at a tertiary care center to identify adults who presented from 2007 to 2022 with orbital and preseptal cellulitis. Patients with cancer were defined as patients actively receiving chemotherapy or in remission but on immunosuppressants at the time of their orbital infection care. Their demographics, presentation, management, and follow-up characteristics were recorded. Management variables included data on antibiotics, antifungals, and systemic steroids administered.

Results: Of the 183 patients presenting with orbital cellulitis, 15 (8.2%) had active cancer while of the 130 patients with preseptal cellulitis, 8 (6.2%) had cancer (p = 0.661). Patients with cancer who were found to have preseptal cellulitis were more likely to have head and neck cancer than those who had orbital cellulitis (50.0 versus 0%, p = 0.008). In the orbital cellulitis cohort, the management of patients with and without cancer differed in antifungal and corticosteroid therapy. Compared to patients without cancer, patients with cancer received a higher antifungal rate (46.7% versus 10.1%, p = 0.001) and were started on steroids a median of 2 days later (3.0 versus 1.0 day after admission date, p = 0.007). Both cohorts had similar readmission rates (20.0% in cancer and 11.3% in non-cancer cohort, p = 0.397) and eye exam findings at follow-up. Patients with and without cancer in the preseptal cellulitis cohorts were similar in all characteristics assessed.

Conclusions: Patients with cancer presenting with orbital cellulitis have a higher rate of antifungal administration and are started on systemic steroids later compared to patients without cancer, although they have similar eye exam outcomes and readmission rates. Patients with cancer are not at an increased risk of preseptal cellulitis and are managed similarly to patients without cancer.

Orbital masses include a diverse spectrum of benign, malignant, inflammatory, and vascular lesions in pediatric and adult patients. Accurately diagnosing the type of lesion is critical, as management strategies differ significantly. Advanced imaging is therefore essential, and computed tomography (CT) is central to orbital evaluation. We reviewed the literature to synthesize evidence on CT features across common orbital pathologies and correlated imaging with clinical presentation to emphasize diagnostic relevance. CT characteristics are summarized for vascular lesions (cavernous venous malformation, lymphatic malformation), inflammatory conditions (orbital myositis, dacryoadenitis), benign lesions (dermoid cyst, pleomorphic adenoma), and malignant lesions (lacrimal gland lymphoma, adenoid cystic carcinoma, rhabdomyosarcoma). We present characteristic patterns of location, morphology, enhancement, and bone change, with practical discriminators and common pitfalls to aid differentiation. When used alongside clinical context, CT remains a preferred modality in many clinical settings due to its rapid acquisition, wide availability, and reliable depiction of bone and calcifications. It supports accurate diagnosis and informed management decisions in time-critical settings. This review provides a structured reference for interpreting CT findings across a wide range of orbital disease.

Orbital arteriovenous fistulas are exceedingly rare and present a unique challenge due to difficulties with access. We report a case of a patient with an acute progressive direct orbital arteriovenous fistula causing orbital compartment syndrome and compressive optic neuropathy. He underwent medial orbital decompression followed immediately by direct cannulation of the vascular anomaly, through which two separate fistulas were embolized under fluoroscopic guidance.