BMC Ophthalmology最新文献

Background: Fungal keratitis can develop after plant injury or after prolonged glucocorticoid use. Typical manifestations include corneal infiltrates, satellite lesions, plaques, and an immune ring. Some cases exhibit atypical signs, requiring reliance on etiological examination. Notably, fungi previously deemed nonpathogenic to humans can cause keratitis with rare clinical manifestations. This report details the clinical signs and successful treatment outcomes of keratitis caused by Phaeoisaria sp.

Case presentation: A 51-year-old man visited the ophthalmology clinic with ongoing eye pain and a history of corneal iron foreign body removal two months earlier. Examination revealed a brownish ulcer with clear borders, swelling, and redness, indicating the presence of rust. Although the initial cultures were negative, a rare fungus called Phaeoisaria sp. was eventually identified as causative agent. The patient completed six weeks of antifungal treatment and showed no signs of recurrence at the 7-month follow-up visit.

Conclusions: Patients with a history of corneal foreign bodies should also be informed of the possibility of atypical corneal fungal infection.

Background: To compare structural and vascular parameters between advanced pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG).

Methods: One hundred and six eyes of 81 patients were enrolled in this cross-sectional study. All patients underwent complete ophthalmic examination and measurement of the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). The vessel densities (VD) in the peripapillary and macular area were also determined using optical coherence tomography angiography (OCTA). A linear mixed model was used for the comparison of the structural and vascular parameters between groups with adjustment for type of glaucoma, age, sex, intraocular pressure (IOP), and mean deviation (MD) of the visual field C24-2.

Results: The patients in the PXG group were significantly older (68.06 ± 10.6 vs. 61.24 ± 15.23, p = 0.01) and had worse MD in the visual field C24-2 (-24.83 ± 6.18 vs. -22.37 ± 5.94, p = 0.04). Sex and IOP were comparable between groups (p > 0.05). Perippaillry RNFL and GCC thickness were not different between groups (p > 0.05). The PXG eyes showed lower VD in the average peripapillary area (32.67 ± 7.78 vs. 37.75 ± 8.87, p = 0.027) and nasal (37.45 ± 9.74 vs. 42.15 ± 7.36, p = 0.026) and inferior (38.09 ± 8.27 vs. 42.71 ± 9.13, p = 0.041) quadrants of parafovea.

Conclusion: The advanced PXG and POAG eyes have comparable structural defects in the peripapillary and inner macula while the PXG eyes may have more vascular deterioration, especially in the macula.

Background: The aim of the study was to investigate the quantitative differences between severe stage 3 and stage 4A retinopathy of prematurity (ROP) by evaluating the pre-treatment fundus photographs.

Methods: Thirty-three eyes with clinical diagnosed as severe stage 3 were classified as severe stage 3 group. Twenty-two eyes with retinal detachment without foveal involvement were classified as stage 4A group. Quantitative measurements were performed on pre-treatment 130 degree fundus photographs.

Results: In the severe Stage 3 group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 18 eyes (55%), in 5 eyes (15%), and in none of the eyes, respectively. In the stage 4A group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 21 eyes (96%), in 22(100%) eyes, and in 17 eyes (77%), respectively. Dragging and vertical tractional bands were higher in the Stage 4A group than in the severe stage 3 group (p = 0.000). Disc-to-fovea distance, the width of the fibrous membranes, the total area of the fibrous membranes, total retinoschisis, and detachment areas were significantly higher in the stage 4A group than in the severe stage 3 group (respectively, p = 0.000,p = 0.006, p = 0.024,p = 0.000).

Conclusions: Fibrous membranes and tractional bands can be detected in severe stage 3 ROP, but the width and the total area of the fibrous membranes and total retinoschisis-detachment area were found to be higher in stage 4A eyes. The dragging of the posterior pole can be an important diagnostic indicator for the diagnosis of stage 4A. Therefore this finding may be a simple auxiliary finding for diagnosis and prognosis of stage 4A ROP.

Objective: To assess refractive and visual outcomes of a spherical Implantable Collamer Lens (ICL) followed by planned postoperative adjunctive laser-assisted in situ keratomileusis (LASIK) in the treatment of high compound hyperopic astigmatism.

Methods: In this prospective, multi-center, multi-surgeon, single-arm trial, eyes with ≥ 3.50 D hyperopia and ≥ 2.00 D of astigmatism underwent surgery receiving a spherical Implantable Collamer Lens (ICL) followed by a planned adjunctive LASIK postoperatively. Outcomes measures included postoperative uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, spherical (SEQ) and defocus equivalent (DEQ), efficacy index, safety index, and astigmatism vector analyses.

Results: 48 eyes had a mean sphere of 6.18 ± 1.35 D and mean cylinder of 2.69 ± 0.89 D preoperatively. After ICL and LASIK, 94% of eyes achieved a UDVA within 1 line of preoperative CDVA. Efficacy and safety indices were 0.94 ± 0.13 and 1.00 ± 0.13, respectively. We obtained near-to-emmetropia SEQ postoperatively (mean - 0.03 ± 0.43D), and the scatterplot of attempted versus achieved refractive correction revealed a predictable procedure (R² = 0.89). 93.8% and 100% of eyes achieved target SEQ within 0.75 and 1.00 D. 87.5% and 100% of eyes were within 0.50 and 0.75 D of intended plano cylinder.

Conclusion: Spherical ICL with postoperative adjunctive LASIK was safe with good early visual and refractive outcomes. The combined modality is a promising approach to treating high compound hyperopic astigmatism where toric hyperopic ICL is not available.

Trial registration: This trial was retrospectively registered on ClinicalTrials.gov with the trial registration number NCT06742541.

Background: Congenital cytomegalovirus (CMV) infections are associated with eye manifestations, especially in patients with systemic disease. However, there are no ophthalmic screening guidelines for infants with congenital CMV.

Methods: Retrospective review of pediatric patients (< 18 years old, 2010-2023) with a diagnosis of congenital CMV and at least 1 eye examination. Gestational age at birth, systemic findings, and ophthalmic findings at initial and final eye examinations were collected.

Results: Seventy-two patients (47% male) with congenital CMV underwent initial eye examination at 2.1 ± 2.9 years of age (median 0.3 years). Thirty-one patients (43%) only had one eye examination while 41 patients had follow-up (1 month-19 years). Fifty-two patients (72%) had systemic findings, most commonly hearing loss (50%), neurologic abnormalities (39%), and developmental delay (38%). Patients born < 36 weeks gestation (n = 15) had a higher rate of systemic findings, neurologic abnormalities, developmental delay, and intrauterine growth restriction compared to full-term patients. Twenty-four (33%) patients had ocular findings and all also had systemic manifestations. Strabismus (26%) and optic nerve abnormalities (17%) were most common. Only 2 patients (3%) were diagnosed with retinitis, which was detected at initial examination.

Conclusions: One-third of patients with congenital CMV had ocular findings in conjunction with systemic manifestations. Retinitis was rare and detected on initial eye examination. While initial screening for retinitis is important, patients with systemic sequelae of congenital CMV are at risk for other eye manifestations and require continued follow-up.

Background: Endothelin is a potent vasoconstrictor and contributes to the regulation of vascular perfusion. Aberrant endothelin-1 (ET-1) levels in aqueous humor have been reported across a variety of vascular diseases of the eye, including glaucoma. These findings suggest that dysregulation of ET-1 production may contribute to glaucoma pathophysiology. In this study, aqueous humor from patients undergoing ocular surgery was assayed for ET-1 abundance and related to the presence of glaucoma.

Patients: Open angle glaucoma patients (n=62 total) from the ophthalmology clinics of the University of Iowa Hospitals and Clinics were enrolled in this study and organized into three distinct cohorts based on their diagnostic criteria, including those with primary open angle glaucoma (POAG, n=25 patients), normal tension glaucoma (NTG, n=17 patients), exfoliation glaucoma (XFG, n=8 patients), and normal controls (n=12 patients).

Methods: Aqueous humor was collected intraoperatively from patients undergoing surgeries for glaucoma (including minimally invasive glaucoma surgeries, trabeculectomy, or glaucoma drainage device implantation) for samples in the glaucoma cohorts and cataract extraction for those in the control cohort. Aqueous humor was assayed by ELISA to measure and compare ET-1 abundance between the glaucoma cohorts and control cohort. ET-1 levels were also analyzed with linear regression to control for the covariates of age and sex.

Results: ET-1 was significantly elevated in the aqueous humor of patients in the POAG (mean ± SD: 7.8 ± 5.1 pg/mL; p = 0.002) and NTG cohorts (6.1 ± 3.0 pg/mL; p = 0.030) compared to the control (4.0 ± 1.9 pg/mL). No significant difference in aqueous ET-1 was detected in the XFG cohort (6.2 ± 4.5 pg/mL; p = 0.230) compared to the control. Significantly higher ET-1 levels were detected in a merged grouping of all glaucoma cohorts (POAG, NTG, XFG) relative to controls (p = 0.021). Analysis of covariance indicated neither age nor sex was associated with ET-1 level (p = 0.60 and p = 0.27), respectively. Controlling for age and sex had minimal influence on the comparison of ET-1 levels in the POAG versus control cohort (p = 0.018) and nominal influence on the comparisons between the NTG (p = 0.089) or XFG cohort (p = 0.15) relative to the control.

Conclusions: Elevated ET-1 in aqueous humor was associated with POAG and NTG compared to controls amongst cohorts of patients at the University of Iowa. These data suggest that dysregulation of vascular perfusion may have a role in the pathophysiology of POAG. The analyses of NTG and XFG samples were limited by the relatively small sample sizes.

Background: To report a case of intraocular inflammation (IOI) after intravitreal injection of aflibercept 8 mg for treatment-refractory neovascular age-related macular degeneration.

Case presentation: An 80-year-old man with diabetes mellitus had neovascular age-related macular degeneration refractory to treatment with aflibercept 2 mg. Despite ten injections of faricimab, the exudation remained, and we switched to brolucizumab, which resulted in a mild IOI. The IOI improved with only topical steroids, and we switched back to aflibercept 2 mg for the exudation. However, the exudation remained, and we decided to switch to aflibercept 8 mg after careful discussion with the patient. Two weeks later, he experienced minor ocular pain and photophobia. One month later, although a dry macula was achieved, severe visual impairment occurred due to anterior chamber inflammation, retinal vasculitis, and retinal vascular occlusion. We diagnosed the severe IOI following aflibercept 8 mg and immediately started steroid eye drops and a sub-Tenon injection of triamcinolone acetonide. Although the inflammation resolved, his visual acuity did not improve.

Conclusions: This case demonstrated a potential dose-dependent inflammatory response following aflibercept 8 mg, which did not occur with aflibercept 2 mg in patients with a history of intraocular inflammation.

Purpose: To compare the anatomical and visual outcomes in eyes with submacular hemorrhage (SMH) treated with a combination of ranibizumab (RBZ) either innovator or biosimilar (Razumab) and intravitreal perfluoropropane gas (C₃F₈).

Methods: Treatment naïve neovascular age related macular degeneration (n-AMD) patients with SMH were retrospectively analyzed. Patients received either innovator or biosimilar RBZ (3 loading doses followed by pro re nata regimen) and single injection of intravitreal C₃F₈. Optical coherence tomography (OCT) was performed at baseline, 1, 3 and 6 months. Changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at 6 months. P value ≤ 0.05 was considered statistically significant.

Results: A total of 67 eyes (35 and 32 eyes in innovator and biosimilar group respectively) were analyzed. BCVA improved from 1.15 ± 0.19 to 0.51 ± 0.23 logarithm of minimum angle of resolution (logMAR) in innovator RBZ group (p < 0.001) and from 1.17 ± 0.15 to 0.53 ± 0.20 logMAR in biosimilar RBZ group (p < 0.001). Similarly, mean CMT showed significant reduction in both groups at 6 months (innovator RBZ: 609.5 ± 50.1 μm to 254.3 ± 20.3 μm, p < 0.001; biosimilar RBZ: 602.3 ± 58.9 μm to 251.8 ± 22.3 μm, p < 0.001). Intergroup comparisons between innovator and biosimilar RBZ showed no differences in either BCVA or CMT at all time points (all p values > 0.05). Mean number of intravitreal injections was marginally higher in innovator group compared to biosimilar RBZ (4.37 ± 0.49 vs. 4.22 ± 0.42; p = 0.18).

Conclusion: Biosimilar RBZ may act as a viable alternative to innovator RBZ to treat SMH with comparable anatomical and visual outcomes at 6 months.

Background: The principal objective of our study is to evaluate the characteristics of babies with type 1 ROP, screening practices and treatment trends in a tertiary care centre in Pakistan.

Methods: This prospective study at Mayo Hospital, Lahore (July 2022-July 2024), included 89 preterm infants with type 1 ROP, selected using non-probability sampling. Infants were categorized based on international (GA < 32weeks or BW < 1500 g) and local screening criteria (GA < 35 weeks or BW < 2000 g), and treatment outcomes were evaluated across three groups: Anti-VEGF, combination therapy (Anti-VEGF followed by laser), and laser therapy. Statistical analysis was performed using SPSS version 27.0, significance was set at p < 0.05.

Results: Out of 355 infants screened, 89 (25.1%) met the inclusion criteria for type 1 ROP. The cohort included 55 males (61.8%) and 34 females (38.2%), with a mean gestational age of 31.31 weeks and a mean birth weight of 1602.25 g. Zone 1 ROP was found in 36% of cases, associated with lower birth weight (P = 0.029) and earlier gestational age (P = 0.037), while Zone 2 ROP, found in 64%, was linked to higher birth weight and later gestational age. Zone 1 infants were more likely to receive anti-VEGF or combination therapy, whereas Zone 2 infants predominantly received laser therapy (p < 0.000). Preterm infants (born before 32 weeks) mostly received Anti-VEGF or combination therapy, while those with higher birth weights primarily received laser therapy (p < 0.010). Among the treated babies, 63 (70.8%) met international screening criteria and were more likely to have Zone 1 ROP and receive Anti-VEGF or combination therapy. Conversely, 26 (29.2%) did not meet these criteria, had predominantly Zone 2 ROP and were more likely to receive laser therapy (p = 0.007).

Conclusion: International screening criteria effectively identify severe type 1 ROP cases, particularly Zone 1, which often require Anti-VEGF therapy. Local criteria capture additional cases, predominantly Zone 2, which are more likely to need laser treatment. These findings highlight the need for tailored screening and treatment approaches to improve ROP management and outcomes for preterm infants.

Background: Herpes simplex keratitis (HSK) is a recurrent inflammatory disease of cornea primarily initiated by type I herpes simplex virus infection of corneal epithelium. However, early diagnosis of HSK remains challenging due to the lack of specific biomarkers. This study aims to identify biomarkers for HSK through tear metabolomics analysis between HSK and healthy individuals.

Methods: We conducted a cross-sectional study enrolling 33 participants. Tear samples were collected from one eye of 18 HSK patients and 15 healthy volunteers using Schirmer-strips. Tear metabolomic profiling was performed using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS). Metabolites were quantified and matched against entries in the human metabolome database (HMDB) and small molecule pathway database (SMPDB) to identify metabolites and metabolic pathways, respectively. Metabolic differences between HSK and control group were determined using multivariate statistical analysis.

Results: A total of 329 metabolites were identified, of which 18 were significantly altered in HSK patients. Notably, 12 metabolites were significantly increased, and 6 were significantly decreased in HSK patients. The changed metabolites were enriched in these pathways: arginine and proline metabolism, phospholipid biosynthesis, alpha linolenic acid and linoleic acid metabolism, retinol metabolism. To assess the potential utility of tear biomarkers, a predictive model was developed combining 4 metabolites (AUC = 0.998 [95%CI: 0.975, 1]): D-proline, linoelaidic acid, plantagonine, and phosphorylcholine.

Conclusions: Our study establishes that HSK has a distinctive metabolomic profile, with 4 key elements maybe emerging as potential biomarkers for diagnostic purposes. These findings may provide novel insights into early and rapid diagnosis of HSK.