Frontiers in ophthalmology最新文献

This case highlights an exceedingly rare presentation of secondary orbital melanoma and reviews the current literature on orbital melanoma. Case presentation: A 39-year-old man was referred to our clinic after acute-onset decreased vision and left upper eyelid ptosis. Outside-hospital magnetic resonance imaging (MRI) showed an enhancing left superior orbital apex mass. The patient was initially treated for presumed idiopathic orbital inflammation without improvement. An orbital biopsy was performed, and the pathology showed secondary malignant melanoma. A computed tomography (CT) chest scan showed likely pulmonary metastases. Upon further questioning, the patient reported a history of an incompletely excised pigmented forearm lesion. The patient was treated systemically with nivolumab and ipilimumab. Conclusions and importance: Despite its rarity, orbital melanoma should be considered in the differential diagnosis of patients with an orbital apex mass that does not respond to treatment for idiopathic orbital inflammation.

Purpose: To assess the effectiveness of Systane COMPLETE in reducing symptoms of ocular dryness and improving Meibomian Gland (MG) Score in subjects with mild to moderate dry eye disease (DED).

Methods: A prospective, interventional, single-center, single-arm study was conducted including cases of mild to moderate DED. Participants were prescribed a topical lipid-based combination of propylene glycol (PG) and hydroxypropyl guar (HPG) (Systane^® COMPLETE), administered four times daily for 30 days. Dry eye assessment parameters, Meibo score, and Ocular Surface Disease Index (OSDI) questionnaire responses were obtained before and after treatment.

Results: A total of 105 cases with mild to moderate DED were included in the study. Statistically significant improvements were observed in tear breakup time (TBUT) (p<0.0001), Schirmer's test (p<0.0001), lipid layer thickness (LLT) (p<0.0001), tear meniscus height (TMH) (p=0.0002), non-invasive breakup time (NIBUT) (p<0.0001), OSDI (p<0.0001), upper lid meibomian gland score (p=0.02), corneal staining score (p<0.0001). The change in Meibo score was not statistically significant (p=0.19).

Conclusion: A lipid-based nanoemulsion of PG-HPG helps in improving the objective parameters and symptoms of DED. Additionally, it may support improved meibomian gland function.

Background: Multiple myeloma (MM) is typically diagnosed based on systemic symptoms such as anemia or fatigue, or through imaging findings of bone lytic lesions. Neurologic manifestations as the initial presentation are rare. In this case, we report a patient diagnosed with MM after presenting with severe, unilateral vision loss.

Methods: A 67-year-old woman presented with a 5-day history of painless vision loss in her left eye. Her visual acuity was severely reduced to light perception, yet both the optic disc and retinal vessels appeared normal upon examination. Blood tests revealed no significant abnormalities except for anemia. Magnetic resonance imaging (MRI) revealed enhancement of the left optic nerve sheath, and bone marrow biopsy confirmed MM. High-dose steroid and subsequent chemotherapy led to significant visual improvement.

Conclusions: Unilateral optic perineuritis can be the first manifestation of MM, potentially caused by immune-mediated mechanisms or direct tumor cell infiltration near the optic nerve. Steroid not only contributed to symptom improvement but also may have played a role in partial remission of MM.

Introduction: Acanthamoeba is a ubiquitous protozoan pathogen that can cause a severe ocular infection, Acanthamoeba keratitis. Despite its high prevalence and potential contamination of contact lenses, the natural behavior of this parasite remains poorly understood. Therefore, we investigated Acanthamoeba trophozoite movement, rate of encystment, trophozoite size, and phylogenetic relationships between eight prevalent Acanthamoeba genotypes.

Methods: Acanthamoeba was seeded onto a plate with and without E. coli. After initial size measurements were recorded, images were taken using a microscope to create time-lapse videos over a 72-hour period. Amoeba trophozoite tracks were quantified for distance, displacement, and speed. Separately, Acanthamoeba cysts were generated naturally over the course of the study via nutrient deprivation in ¼ Ringer's over 72 hours. Wells were stained with calcofluor white to identify cysts and wells were quantified for rate of encystment and cyst size.

Results: Of the eight genotypes investigated, T7 and T18 possessed the largest trophozoite size while T5 was the smallest. T5 was consistently the fastest genotype over the 72-hour period in both the fed and starved conditions. Nutrient conditions did not show any consistent impact on the overall distance, speed, or encystment of any genotype within 72 hours. Finally, while some genotypes (T1, T11) demonstrated a relatively high percentage of encystment at the 24-, 48-, and 72-hour timepoints, the other genotypes demonstrated a relatively low encystment percentage at these same times.

Discussion: Overall, these results indicate that eight of the common genotypes of Acanthamoeba vary widely in terms of size, speed, rates of encystment, and response to nutritional state. From these, we can infer that Acanthamoeba keratitis prevention methods must be robust enough to counter amoeba in trophozoite or cyst form, and that amoeba should be expected to be able to traverse a wide variety of distances (for instance, across a contact lens or onto a corneal epithelium) in either a fed or starved nutritional state.

Autosomal dominant optic atrophy (ADOA) is among the most prevalent inherited optic neuropathies with hallmark symptoms of bilateral, painless, progressive, and typically permanent vision loss over time. ADOA can affect patients' quality of life with debilitating visual symptoms, and there is a pressing need for effective therapeutics. In this paper, we review the current and future investigational therapies for ADOA, including the use of intravitreal injections of antisense oligonucleotides through Targeted Augmentation of Nuclear Gene Output (TANGO), CRISPR-based therapy, genetic editing, gene replacement approaches, and idebenone, a small-molecule mitochondrial modulator. Additionally, we review clinical trials for ADOA treatment and opportunities for future research on ADOA therapeutics, including the utilization of mitochondria-targeted peptides and antioxidants, NAD+ boosters/metabolic support, mitophagy and fission-fusion modulators, and cell-based regenerative therapy. The use of emerging technology to compensate for OPA1 protein haploinsufficiency provides new and vast avenues for the management of this otherwise vision-altering disease. Increased awareness of therapeutics for ADOA will allow for patient counseling regarding treatment access via clinical trials and for underscoring the importance of genetically testing family members, who may be incidentally identified with ADOA in a timely manner for newly available therapies. While patients with ADOA typically have poor visual prognoses, there are increasing promising therapies with the potential for preserving and improving visual function.

Introduction: Eye movement-based perimetry (EMP) is a promising, non-invasive approach for visual field assessment, particularly in pediatric populations where standard automated perimetry often fails. However, completion rates in prior pediatric EMP studies have ranged from 41 to 81%, and reasons for unsuccessful testing are seldom reported.

Objective: In this perspective article, we aim to highlight practical barriers and design gaps in EMP systems for children, with a focus on clinical use.

Observations: From our clinical experience with testing two commercially available EMP systems in children (21 patients with brain tumors and 19 age-matched controls), we observed recurring challenges, including poor ergonomic fit, inadequate calibration of eye tracker, and insufficient attention management strategies. These issues frequently led to data loss and incomplete tests, underscoring the gap between current technology and pediatric clinical needs. We outline solutions informed by technological development, vision science and clinical ophthalmology.

Conclusion: Pediatric testing experience must inform EMP design to ensure accessibility and reliability. Our observations highlight the need for clinician-engineer-scientist collaboration, with innovations likely to benefit not only children but also adults with similar testing challenges.

Purpose: Dry eye syndrome (DES) is characterized by tear film and ocular surface disruptions. Symptomatic DES, one of the most common ocular diseases, reduces the quality of life. This study aimed to evaluate the prevalence of and possible risk factors for DES in the Jazan region of Saudi Arabia.

Methods: This observational, cross-sectional study was conducted between October 2018 and May 2023. This study was conducted with 1061 participants using an online survey that included questions on sociodemographic characteristics, dry eye symptoms, possible factors related to dry eye, and chronic comorbidities. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI).

Results: The overall prevalence of dry eye symptoms was 59.9%, with 19.7% of the respondents having mild, 14.0% having moderate, and 26.2% having severe dry eye symptoms. A statistically significant difference in dry eye symptoms prevalence was observed between males and females (X² = 54.167; p = 0.000), with females (68.4%) being more commonly affected than males (52.2%). Moreover, Female participants were 1.78 times more likely to develop DES than males, and this association remained statistically significant after adjustment (OR = 1.78; 95% CI: 1.37-2.31). Smoking (p = 0.44), computer use (p = 0.87), and mobile phone use (p = 0.69), were not significantly associated with DES prevalence.

Conclusion: Dry eye symptoms are highly prevalent in Jazan Province, Saudi Arabia, affecting nearly 60% of the population. Female sex was a significant risk factor, while screen time and smoking were not. However, as the study relied on self-reported symptoms without objective clinical tests, the findings may not fully reflect disease prevalence. These results highlight the need for targeted screening and public health efforts in high-risk groups.

Purpose: The function of the eye lens, to fine focus light from different distances onto the retina to form a clear image, relies on tissue biomechanical properties, refractive index, shape, and transparency. Increased lens stiffness with age, especially of the center or nucleus, has long been hypothesized to lead to presbyopia, a loss of accommodative ability, and the need for reading glasses. The cellular and molecular mechanisms that determine lens biomechanical properties and change during age-related stiffening remain unclear. Little is known about the factors that regulate lens shape and growth, nucleus size, and refractive index. We previously showed that loss of EphA2, a receptor tyrosine kinase, or ephrin-A5, a ligand for Eph receptors, leads to changes in lens shape and resilience in 2-month-old mice. Surprisingly, the loss of EphA2 led to smaller and softer lens nuclei with no change in lens stiffness.

Methods: Using coverslip compression and X-ray phase tomography, we investigated whether lens stiffness, resilience, morphometric changes, and gradient refractive index (GRIN) were altered in lenses from 4- and 8-month-old adult mice with disruption of Eph-ephrin signaling.

Results: Our data revealed no obvious changes in lens stiffness or resilience between control and ephrin-A5 knockout (KO or -/-) mice at 4 and 8 months of age. While there were no differences in lens resilience, EphA2^-/- lenses were stiffer than control lenses from 8-month-old mice. At all ages, EphA2 and ephrin-A5 KO lenses were more spherical in shape, and EphA2^-/- lens nuclei were smaller than controls. In 4- and 8-month-old mice, EphA2^-/- lenses were small. Measurement of GRIN in control and KO lenses revealed that EphA2^-/- lenses had decreased magnitudes of refractive index across the GRIN profile in all age groups.

Conclusions: These results suggest that, at least in mouse lenses, the size of the lens and nucleus does not affect whole tissue stiffness with age. Our work indicates that Eph-ephrin signaling influences lens shape and normal adult whole lens growth while EphA2 is needed for nuclear size and appropriate GRIN.

Background: Approximately 18% of patients with idiopathic intracranial hypertension (IIH) prove medically refractory, and eventually require a procedure to manage their condition. An additional 2% have fulminant disease and require an immediate procedure to preserve vision. Identifying a neuroradiologic marker to stratify IIH patients more likely to require a procedure would assist clinical management and outcomes. Here, the authors explore whether cerebellar tonsillar position is such a marker.

Methods: This was a retrospective, single-center cohort study of 180 consecutive patients with IIH in Canberra, Australia. Patient outcomes were classified as procedural intervention versus medical therapy alone. Cerebellar tonsillar position was measured relative to the foramen magnum to the nearest millimeter, as defined by the McRae line. The tonsillar position was classified as at or above the line, or lowered if below. Subsets of lowering were defined as "descent" (<3mm below), "ectopia" (3-5 mm below), or "Arnold-Chiari malformation" (>5 mm below). Two observers independently assessed the patients' initial neuroimaging, and a random sample of 20 was also assessed by a more senior radiologist. Measurement precision was assessed using intraclass correlation coefficients, and patient outcome was analyzed against tonsillar position using univariable penalized logistic regression modeling.

Results: 91% of patients were female. The tonsils were at or above the McRae line in 36% (65/180) of patients and lowered in 64% (115/180). In 7%, lowering amounted to Arnold-Chiari malformation (13/180). Among those who underwent a procedure, the average tonsillar position was 1.94mm below the foramen magnum, whereas in those not requiring a procedure, it was 0.80mm. Across the whole cohort, the average tonsillar position was 1.0mm below the McRae line. The position of the cerebellar tonsils across the whole cohort was only mildly correlated with the likelihood of a procedural outcome (p = 0.04). However, true Arnold-Chiari malformation was strongly associated with procedural intervention at 46% (6/13), compared with 18% (30/167) in those without the malformation, with a relative risk of 2.57 and risk difference of 28% (odds ratio 5.15, 95% CI 1.45-18.52, p = 0.01). There was high concordance between the two observers' measurements (0.89, 95% CI 0.81-0.93) and with the measurements obtained by the senior radiologist (0.97, 95% CI 0.93-0.99).

Conclusion: The presence of Arnold-Chiari malformation in patients with idiopathic intracranial hypertension is associated with an increased likelihood of requiring a procedure. Moreover, independent of procedural outcome, cerebellar tonsillar lowering occurs in IIH patients so frequently that it should be further investigated as a potential neuroradiologic "soft sign" of the disease.

Background: Hyperoxia induced by hyperbaric oxygen therapy (HBOT) may lead to retinal vasoconstriction and the generation of reactive oxygen species. This study aims to investigate the effects of a single session of HBOT on the healthy retina using full-field electroretinography (ffERG) and spectral-domain optical coherence tomography (SD-OCT).

Methods: Twenty patients diagnosed with either sensorineural hearing loss or avascular necrosis, all of whom had an indication for HBOT, were included in the study. A comprehensive ophthalmologic examination, along with ffERG and SD-OCT assessments of the retinal layers and choroid, were performed both before and within 24 hours after the first HBOT session.

Results: The mean age of the participants was 43.2 ± 11.4 years (range, 18-66 years). A statistically significant difference was observed only in the scotopic 0.01 ERG b-wave amplitude before and after HBOT (p = 0.029). The retinal pigment epithelium in the 3-mm nasal subfield of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid demonstrated a statistically significant thickening after the first HBOT session (p = 0.023).

Conclusion: A single session of HBOT induced an acute alteration in rod-bipolar cell function, as evidenced by impaired electrophysiological responses. Additional studies are necessary to clarify the duration and potential reversibility of the observed electrophysiological impairment.