Frontiers in ophthalmology最新文献

Purpose: Evaluate the validity and reliability of saccadic reaction time (SRT)-based variables obtained using the novel eye-tracking device Bulbicam (BCAM) in differentiating early-to-moderate glaucoma (GLA) from healthy controls (HCs) and to identify potential biomarkers for GLA.

Methods: A controlled clinical study was conducted, involving 18 GLA-patients, and 18 age-matched HCs. Participants underwent BCAM's visual field (VF) test, which measures SRT at 58 symmetrically arranged locations with 6° spacing. Variables were analysed for group differences, within- and between-patient repeatability, and stability. To evaluate their potential as biomarkers, VF locations were aggregated into clusters, quadrants, hemifields, and whole VF analyses.

Results: Significant SRT differences (p ≤ 0.05) were observed between GLA and HC in 44 of 58 locations in the worst eye and 42 of 58 in the best eye. Eight out of ten clusters met the criteria for BCAM biomarkers having significant group differences, sufficient within- and between-patient repeatability, and adequate stability. All quadrants demonstrated excellent stability and repeatability thereby qualifying as biomarkers. Hemifield SRTs were reliable, however, the absolute difference between hemifields showed poor within-participant repeatability. The mean and standard deviation of SRT for the whole VF were identified as significant biomarkers with excellent stability.

Conclusions: The majority of SRT variables are capable of differentiate glaucomatous eyes from HC while maintaining sufficient reliability and stability for clinical application. 19 of 22 BCAM VF test variables were found to be potential GLA-biomarkers.

Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05449041.

Background: Congenital orbital teratoma is a rare neoplasm that typically presents as progressive, unilateral proptosis in an otherwise healthy newborn. Management includes prompt surgical excision, with guarded visual prognosis but excellent survival.

Case presentation: A 12-day-old healthy infant presented with progressive left eye swelling and proptosis. She was initially diagnosed with orbital cellulitis and treated with IV antibiotics. Magnetic resonance imaging (MRI) showed a 1.5x1.9x2.1 cm left intraconal mass with 9mm of proptosis and significant mass effect. The patient underwent left lateral orbitotomy for biopsy and excision of the mass. Histopathologic examination showed neutrophilic inflammation and granulation tissue with foci of gastrointestinal epithelium, cartilage, squamous epithelium, and ganglion cells, consistent with mature congenital teratoma. The postoperative course was uncomplicated and there is no sign of recurrence at 21 months of age.

Conclusion: Orbital teratoma should be suspected in a rapidly growing orbital mass in a newborn. Imaging showing characteristic findings should lead to prompt excisional biopsy. Tumor markers can be used to monitor for recurrence, which is rare.

Following extracapsular cataract extraction, residual lens epithelial cells (LECs) are induced to express pro-inflammatory genes within hours of surgery, then begin to proliferate while migrating to populate denuded areas of the lens capsule. If these cells reach the optical axis, they scatter light, resulting in visual disturbances that are clinically defined as Posterior capsular opacification (PCO). Historically, PCO occurred at high rates within weeks or months of surgery, but over the past 10-20 years, this "acute onset" PCO has become relatively rare following cataract surgery in adults, due to improved surgical techniques and the ability of square edge intraocular lens (IOL) implants to block residual LECs from reaching the visual axis. Despite this, PCO rates are still substantial by 5-10 years following cataract surgery, apparently due to the ability of these entrapped cells to escape their confinement at the capsular bag periphery. This review explores the mechanisms by which cataract surgery elicits acute phenotypic changes to LECs and explores how these changes may set the stage for late-onset PCO.

Purpose: To determine whether modulation of lens water content can alter the stiffness of the ex vivo bovine lens which have a similar stiffness profile to the presbyopic human lens.

Methods: Bovine lenses cultured in isotonic artificial aqueous humor (AAH) were initially subjected to either MRI imaging using a clinical 3T scanner or a spin test to obtain baseline measurements of water content and shear modulus, respectively. Lenses were then exposed to either hypotonic or hypertonic stress to swell or shrink lenses, respectively, or isotonic AAH + ouabain or high extracellular potassium (AAH-High-K⁺) to inhibit lens water transport, for up to 4 hours before repeating the MRI scans and spin test.

Results: In isotonic AAH both free and total water was higher in the outer cortex of the lens relative the central lens nuclear region, but the shear modulus profile had the opposite profile being highest in the lens nucleus. Exposure to hypertonic AAH that shrinks the lens caused a loss of lens water and an increase in the shear modulus in the lens nucleus that served to steepen the shear modulus profile. In contrast, exposure to hypotonic-AAH to sweel the lens increased both free and total water content through all regions of the lens and caused a reversal of the shear modulus so that the nucleus of the lens became less stiff than the outer cortex. These effects of osmotic stress on the shear modulus profile were partially reversed upon the return of lenses to isotonic AAH. Inhibiting lens water transport under isotonic conditions caused more subtle increases in lens water content than seen with hypotonic challenge but still cause a similar softening of the nucleus but had no major effect on the shear modulus in the outer cortex of the bovine lens.

Conclusions: Our results demonstrate a link between lens water content and the stiffness of the nucleus of the bovine lens. This suggests that the modulation of lens water transport represents a novel strategy for the development of pharmacological interventions designed to restore accommodation in presbyopes by softening of the nucleus of the human lens.

The iridocorneal endothelial syndrome encompasses a spectrum of ocular disorders predominantly affecting one eye in young to middle-aged women, typically without a familial predisposition. The hallmark feature of iridocorneal endothelial syndrome is the migration of corneal endothelial cells towards the iridocorneal angle and onto the iris. This syndrome comprises three distinct clinical variations: progressive essential atrophy of the iris (including corectopia, iris atrophy, or iris hole), Chandler syndrome (characterized by corneal edema with mild to absent changes in the iris), and Cogan-Reese syndrome (manifesting as nodular pigmented lesions on the front surface of the iris). In cases involving corneal manifestations, such as corneal edema or decompensation, options like Descemet's stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty may be considered for optimal management. For instance, conditions affecting the iris, such as an iris cavity, multiple pupils, or photophobia, may make femtosecond-assisted keratopigmentation a treatment option. In cases of glaucoma secondary to iridocorneal endothelial syndrome, trabeculectomy with mitomycin C and the implantation of a glaucoma drainage device have been shown to reduce intraocular pressure effectively. At the same time, retrocorneal membrane interception-enhanced peripheral iridectomy has demonstrated significant efficacy.

We report the case of a 61-year-old patient with relapsing-remitting multiple sclerosis (RRMS) who developed asymptomatic macular edema (ME) after initiation of ozanimod, a sphingosine-1-phosphate receptor (S1PR) modulator. The patient had a history of completely resolved central serous choroidopathy (CSC) in the right eye. Following a recent clinical worsening and a new brain lesion, ozanimod was started after appropriate screening, including ophthalmological evaluation. Three months into treatment, an OCT performed as part of routine monitoring revealed ME in the contralateral (left) eye, despite the absence of visual symptoms. Ozanimod was discontinued, and ME progressively resolved over the subsequent 2 months. This case underscores the importance of ophthalmological monitoring even in asymptomatic patients, especially those with known risk factors such as prior retinal pathology. ME is a rare but recognized adverse event associated with all approved -imod therapies for MS, including ozanimod. Although the exact pathophysiology remains unclear, involvement of the inner blood-retina barrier via S1PR1 internalization has been hypothesized. Given ozanimod's long half-life and active metabolites, ME resolution may be delayed after drug withdrawal. This report highlights the relevance of interdisciplinary management and the utility of OCT in early detection of asymptomatic ocular adverse events during S1PR modulator therapy.

Purpose: To investigate the choroid in patients affected by pseudoxanthoma elasticum (PXE)-related retinopathy using the choroidal vascularity index (CVI).

Methods: PXE patients and controls were recruited at the Eye Clinic in Florence. High-resolution imaging optical coherence tomography (OCT) scans (12 × 9 mm) of 32 PXE patients and 20 age-matched controls were examined. Images were binarized using the ImageJ software, and subfoveal choroidal thickness (SFCT), luminal area (LA), stromal area (SA), total choroidal area (TCA), and CVI were measured.

Results: Sixty-four eyes of 32 PXE patients (mean age 45.65 ± 16.12; range 14-69) and 40 eyes of 20 controls (mean age 47.3 ± 13.7; range 18-71) were included in the study. SFCT was significantly lower in PXE patients compared to controls. The LA, SA, and TCA of the PXE patients were significantly reduced in comparison with those obtained for controls (p = 0.012, p < 0.001, and p = 0.001, respectively). On the contrary, the CVI did not significantly differ between patients and controls (p = 0.744). In young subjects, differences regarding SFCT, LA, SA, TCA, and CVI were not detected between PXE patients and healthy controls (p = 0.170, p = 0.990, p = 0.264, p = 0.351, and p = 0.487, respectively).

Conclusion: In PXE-related retinopathy, choroidal impairment appears progressive with age, and there is a simultaneous, proportional impairment of both the stromal and vascular components of the choroid.

Introduction: Intraocular pressure (IOP) elevation during dialysis has been observed in patients with glaucoma. This is thought to result from rapid shifts in plasma osmolality, leading to fluid movement into the anterior chamber, a phenomenon referred to as ocular dialysis disequilibrium. This case highlights a patient with advanced pseudoexfoliation glaucoma who developed recurrent, symptomatic IOP spikes during dialysis, posing management challenges.

Methods: Case report.

Results: A 65-year-old male with advanced pseudoexfoliation glaucoma experienced recurrent left eye pain and vision loss during hemodialysis, with IOP spikes up to mid 50s (mmHg), requiring early dialysis termination. Medical management including topical drops, oral acetazolamide, and dialysis modifications failed to adequately control IOP. The patient later underwent Ahmed glaucoma valve implantation which stabilized IOP (8-13 mmHg), eliminated dialysis-related pain, and allowed return to standard dialysis sessions. At 6 months, visual acuity was 20/80 + 2 OS with IOP well controlled on topical therapy.

Conclusion: This case demonstrates that ocular dialysis disequilibrium can cause symptomatic IOP spikes in glaucoma patients and may be unresponsive to medical therapy alone. Surgical intervention may be necessary for long-term IOP control. Early recognition and interdisciplinary coordination between ophthalmology and nephrology is critical to prevent irreversible vision loss.

Myelin oligodendrocyte glycoprotein-associated optic neuritis (MOG-ON) is a sight-threatening demyelinating disorder that can present with various ocular manifestations. Here, we describe a unique case of bilateral MOG-ON with unilateral retinal hemorrhages and Roth spots. We present the case of a 48-year-old man with acute-onset painful, severe vision loss in both eyes. Initial fundoscopic examination revealed bilateral optic nerve edema with unilateral retinal hemorrhages and Roth spots. Imaging was notable for perineural enhancement along both optic nerves. Serological testing revealed elevated MOG antibodies. The patient was treated with high-dose intravenous steroids followed by plasmapheresis, which resulted in substantial clinical improvement. We conducted a literature review of all available studies published before March 30, 2025, using PubMed, including the keywords "myelin oligodendrocyte glycoprotein-associated optic neuritis," "myelin oligodendrocyte glycoprotein," "optic neuritis," "Roth spots," and "retinal hemorrhage." We found that this is the first reported case in a male patient-and only the third reported case overall-of retinal hemorrhages and Roth spots occurring in the context of MOG-ON. While retinal hemorrhage and Roth spots have not historically been associated with MOG-ON, recognizing the spectrum of fundoscopic findings is crucial for the early diagnosis and management of this potentially sight-threatening disease.