BMC Ophthalmology最新文献

Background: To evaluate anatomical and functional outcomes after vitrectomy with inverted internal limiting membrane flap technique combined with scleral buckling for eyes with rhegmatogenous retinal detachment and a coexisting macular hole.

Methods: Eleven consecutive patients of primary rhegmatogenous retinal detachment with a coexisting macular hole who underwent vitrectomy with internal limiting membrane flap technique combined with scleral buckling surgery between September 2014 and September 2023 were evaluated retrospectively. The main outcome measurements were the retinal reattachment rate, macular hole closure rate, and final postoperative best-corrected visual acuity.

Results: The primary retinal reattachment rate and macular hole closure rate were 100% (11/11) after initial surgery. Six patients required secondary surgery to improve vision, including cataract surgery in four patients, combined cataract surgery and silicone oil removal in one patient, and combined epiretinal membrane peeling and silicone oil removal in one patient. Visual acuity improved from 2.45 ± 0.52 logMAR preoperatively to 0.9 ± 0.26 logMAR finally (P = 0.002). However, only one patient (1/11; 9%) demonstrated microstructural recovery on optical coherence tomography (OCT) images.

Conclusion: Vitrectomy with internal limiting membrane technique combined with scleral buckling achieves favorable anatomical reattachment and macular hole closure rates. The final visual outcomes improve after sequential surgeries. However, as confirmed on OCT, the microstructures did not recover in most cases.

Purpose: To compare outcomes of phacoemulsification combined with a Kahook Dual Blade (KDB) goniotomy in eyes with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Methods: This retrospective comparative study was conducted in a tertiary medical center. Sixty eyes of 60 patients (27 with POAG, 33 with PXG) underwent phacoemulsification combined with a KDB goniotomy. Intraocular pressure (IOP), number of medications used, best corrected visual acuity preoperatively and at 1 day, 1 week and 1, 3, 6 and12 months postoperatively, surgical success, and surgical complications were reviewed. If IOP reduction was >%30 or postoperative IOP < 18 mmHg, the procedure was considered as surgical success.

Results: The mean IOP reduced from 26.4 ± 5.9 mmHg at baseline to 17.9 ± 6.1mmHg at 12 months for POAG (p < 0.01) and from 27.1 ± 7.9 at baseline to 15.1 ± 2.3 mmHg at 12 months for PXG (p < 0.01). Medication use reduced from 3.4 ± 0.9 to 2.0 ± 1.3 for POAG (p < 0.01) and from 3.7 ± 0.5 to 1.8 ± 1.3 for PXG (p < 0.01) at 12 months. Mean IOP was significantly lower in PXG than POAG at week 1 and months 1, 3, 6 and 12 (all p < 0.05). Surgical success rate was 74% for POAG and 84% for PXG (p = 0.30) at 12 months. No vision-threatening complications occurred.

Conclusion: KDB goniotomy combined with cataract surgery was safe and effectively reduced the IOP and drug burden in patients with POAG and PXG. In the first year, significantly lower IOPs were noted in PXG compared with POAG.

Purpose: LHON leads to gradual, painless, and permanent vision loss in both eyes, often associated with central scotomas. As the condition progresses, there is a decline in visual function, accompanied by noticeable structural alterations. This study focused on evaluating the clinical characteristics of patients with differing LHON stages, with a specific emphasis on optical coherence tomography (OCT) imaging results.

Methods: This analysis included 22 individuals with LHON. Patients underwent thorough clinical ophthalmologic assessments, including SD-OCT, Visual evoked potentials, and perimetry. When LHON was suspected, blood samples were obtained to test for the three major mitochondrial mutations (G1178A, T14484C, G3460A), with further sequencing to identify additional known mutations. The data were subsequently examined through descriptive statistical methods.

Results: The clinical characteristics of 22 individuals (median age 33, range 9-68) were examined. All participants carried a mutation linked to LHON. The most prevalent mutation was G11778A (55%), followed by G3460A (23%), T14484C (14%), with one instance each of the rare G13042A and C3461T mutations. Fourteen participants experienced acute vision loss (average duration: 5.2 ± 5 months), while eight had chronic LHON. There was no significant difference in visual acuity (VA, logMAR) between the two groups (0.9 vs. 0.9, p = 0.91). However, chronic patients exhibited significantly reduced the retinal nerve fiber layer (RNFL), especially in the temporal region (32 μm vs. 56 μm, p < 0.0001), but not in the nasal region. Ganglion cell layer (GCL) thickness was also notably thinner in the temporal area for chronic patients compared to those with acute LHON (22 μm vs. 28 μm, p = 0.04). Linear regression analysis showed correlations between RNFL and GCL and visual acuity (R² = 0.18, p = 0.007 and R² = 0.1, p = 0.05).

Conclusion: In our analysis, we observed an unusual pattern in the genetic mutations, with G3460A being the second most frequent, rather than T14484C, which may be attributed to the limited sample size. 14 patients experienced acute or subacute vision loss, while eight were assessed for chronic disease. Those with chronic LHON demonstrated significantly thinner GCL and RNFL. These results underscore the importance of accelerating both diagnosis and treatment to facilitate prompt intervention for patients.

Objective: To evaluate the anatomical and functional outcomes of our novel surgery (a three-step approach) and the conventional inverted internal limiting membrane flap technique (IFT) in treating large full-thickness macular holes (FTMHs).

Methods: This was a retrospective, consecutive, nonrandomized comparative study of patients who underwent either the novel surgery (n = 27, Group A) or IFT (n = 27, Group B). The main outcomes of MH closure rates and the best corrected visual acuity (BCVA) at 1-, 3-, and 6-month follow-up were compared between the two groups.

Results: At 6 months postoperatively, MH closure was achieved in 24/27 patients in Group A and 22/27 patients in Group B (88.89% vs. 81.48%, P = 0.704) with U-shaped closure rates being significantly higher in Group A (P = 0.029). The average BCVA at month 6 was 0.69 ± 0.38 (LogMAR) in Group A and 0.91 ± 0.39 in Group B (P = 0.015) with the improvement in BCVA being significantly higher in Group A (0.50 ± 0.59 vs. 0.31 ± 0.59, P = 0.045). The recovery rates of ELM were significantly higher in Group A (P = 0.026).

Conclusions: Our three-step approach greatly improves anatomical and functional outcomes compared with IFT. This novel surgery has a dominant advantage in earlier and higher ultimate closure rate, U-type closure rate, and ELM recovery rate, and more importantly, better recovery of BCVA.

Background: To analyze the clinical features and prognosis of orbital melanoma.

Design: Retrospective observational case series.

Methods: A retrospective analysis of the electronic medical records, histopathology, imaging examinations, and follow-up information of 37 patients with orbital melanoma.

Results: The most common primary site was the conjunctiva, with half of the patients presenting with orbital involvement at the initial visit. The most common symptoms were globe displacement due to intraorbital mass, causing swelling of the eyelids and blurred vision. All patients underwent mass excision surgery. Rates of intraorbital soft tissue infiltration, nerve invasion, and bone destruction were 48.6%, 18.9%, and 13.5%, respectively. Five patients (13.5%) have distant metastases to the liver, bones, lungs, skin, and parotid lymph nodes. The Median Survival Time of the 13 deceased patients was 132 ± 24.88 months, with a 5-year survival rate of 78.4%±7.3%. The presence of nerve invasion showed a significant correlation with prognosis (P = 0.047 < 0.05), while age, gender, eye involvement, bone destruction, and intraorbital soft tissue infiltration showed no significant correlation with prognosis (P > 0.05). The expression of Ki-67 was negatively correlated with patient survival time and rate, where higher Ki-67 expression was associated with shorter survival time (r²=-0.267, r²=-0.067).

Conclusions: Treatment strategies for orbital melanoma should consider the tumor's invasive characteristics and Ki-67 expression levels to optimize treatment outcomes and improve patient survival rates. Furthermore, due to the significant impact of nerve involvement on prognosis, it is recommended that clinical focus on this factor be enhanced.

Background: We described two cases of lacrimal drainage pathway disease-associated keratopathy (LDAK) wherein lacrimal irrigation tests revealed no abnormalities, and there were few signs and symptoms suggestive of lacrimal drainage pathway disease.

Case presentation: Case 1 involved a 66-year-old woman with Sjögren's syndrome who presented with corneal perforation in her left eye. Slit-lamp examination revealed a non-infiltrative corneal ulcer and perforation in the inferior peripheral cornea. LDAK was suspected; however, there were minimal signs of lacrimal drainage pathway disease. Despite treatment with contact lenses and topical steroids, there was no improvement. Dacryoendoscopy was performed, revealing multiple concretions within the canaliculus. LDAK caused by lacrimal canaliculitis was confirmed, and the corneal ulcer rapidly re-epithelialized after removing the concretions. Case 2 involved a 78-year-old woman with Sjögren's syndrome who presented with epiphora in her right eye. Slit-lamp examination revealed two non-infiltrative ulcers in the inferior cornea, one of which had perforated. LDAK was suspected, but there were minimal signs of lacrimal drainage pathway disease. Dacryoendoscopy was performed, revealing concretions within the lacrimal sac and confirming chronic dacryocystitis. After removing the concretions, the corneal ulcer rapidly re-epithelialized.

Conclusions: We encountered two cases of LDAK that presented with minimal signs of lacrimal drainage pathway disease. When LDAK is suspected, dacryoendoscopy is a valuable tool for diagnosing lacrimal drainage pathway disease and removing concretions.

Background: Anti-vascular endothelial growth factor (VEGF) drugs are the first-line treatment option for DME management. However, part of DME was refractory to anti-VEGF medicine. With promotion of imaging technology, various retinal morphological characteristics are considered to be related to the prognosis of DME treatment. This study aimed to identify reliable predictive baseline morphological characteristics for refractory diabetic macular edema.

Methods: This retrospective study was to investigate refractory diabetic macular edema and were followed up for 6 months post-treatment. According to the treatment results, the cohort was divided into refractory or improved group. Baseline morphological characteristics were evaluated and analyzed using optical coherence tomography.

Results: Serous retinal detachment (63% vs. 25%, P < 0.05) and foveal eversion (77.8% vs. 41.7%, P < 0.05) are more common morphological characteristics in refractory DME than improved group. Binary logistic regression analysis showed average thickness of serous retinal detachment can predict the risk of refractory DME (OR = 1.052, 95% CI 1.005-1.102, P = 0.030). The area under the receiver operating characteristic curves for serous retinal detachment thickness was 0.922 (95% confidence interval 0.713-0.992).

Conclusion: Patients with refractory diabetic macular edema exhibited an increased incidence of baseline morphological characteristics, including serous retinal detachment and foveal eversion. The thickness of serous retinal detachment can serve as reliable quantitative biomarker, with diabetic macular edema displaying a serous retinal detachment thickness > 162 μm having a potential to become refractory in this study. This finding may promote early detection of refractory diabetic macular edema.

Background: This study aimed to investigate the outcomes of gonioscopy-assisted transluminal trabeculectomy (GATT) surgery in patients with Fuchs' uveitis syndrome (FUS) related glaucoma.

Case presentation: The clinical and surgical records of 4 FUS patients who underwent GATT surgery between 2021 and 2023 were retrospectively reviewed. The preoperative process, clinical course under medical treatment, postoperative clinical course, intraocular pressures (IOP), glaucoma medication requirements, need for additional surgeries, visual outcomes, and surgical success results were evaluated for each patient GATT surgery was performed as the first intervention for glaucoma control in FUS patients under 50 years of age with IOP above 20 mm Hg despite multiple different medications. The average follow-up period after GATT surgery was 12 months. Despite reaching the maximum level of antiglaucomatous treatment in any of the patients, the target IOP was not achieved. On average, 6 months later, mitomycin-C trabeculectomy (MMC-trab) was performed as a conventional surgical option in three of the patients, and diode laser cyclophotocoagulation was applied to one patient with poor visual prognosis.

Conclusions: In FUS, which causes low-grade inflammation, has a low likelihood of synechial formation, and relatively affects a younger age group, GATT surgery, a minimally invasive glaucoma surgery (MIGS) method, was considered a good alternative as an initial surgical option. However, it was observed that the surgical success was limited.

Clinical relevance: In recent years, the concept of hyperopia reserve, defined as a physiological hyperopic refractive status preceding emmetropia and myopia, has gained increasing attention. and raised awareness about myopia. This concept has become of interest to both parents and practitioners.

Background: To report the distribution of refractive errors and ocular biometry in a large scale of preschool children in Beijing, in North China. The distribution of hyperopia reserve and its associated factors were also further investigated.

Methods: This study presents baseline data from Beijing Hyperopia Reserve Research (BHRR), which enrolled 2109 preschool children from 22 randomly selected kindergartens. Cycloplegic refraction was performed for all children. Hyperopia reserve was defined as a spherical equivalent refractive error (SER) greater than zero. Parents completed a questionnaire about the severity of refractive status (normal; mild myopia <-3D; moderate myopia ≥-3D and ≤-6D; high myopia >-6D) and their children's indoor and outdoor activity times.

Results: The mean SER was + 1.11 ± 0.97D, and the mean axial length was 22.25 + 0.73 mm in all preschool children. The overall prevalence of myopia was 3.7%, with age-specific rates of 2.8%, 3.8%, 3.8%, and 5.2%, respectively. A total of 1932 children (91.6%) had hyperopia reserve, yet only 24.1% of children had age-adjusted normal hyperopia reserve. Regression analysis showed that maintaining hyperopia reserve was associated with sex (boy as reference, OR = 1.7, P = 0.005), mild myopic group parents (Father: OR = 1.7, P = 0.003; Mother: OR = 2.2, P < 0.001), increased outdoor activity time (OR = 1.3, P = 0.031) and reduced study time (OR = 0.8, P = 0.025).

Conclusions: The present study provided a comprehensive database on the refractive status and ocular biometry of preschool children aged 3-6 years in Beijing, North China. Although most children maintained hyperopia reserve, the majority had age-adjusted hyperopia reserve deficiencies. Early intervention, particularly for children with parents exhibiting severe myopia may be warranted.

Background: Herein, we developed a new index called the drawbridge index to predict surgical outcomes and assessed its value in guiding surgical decision-making for large macular holes (MHs) with diameters of 400-550 μm.

Methods: A total of 48 eyes with large MHs (diameters of 400 to 550 μm), which had undergone vitrectomy with internal limiting membrane (ILM) peeling, were included and retrospectively analyzed. Based on optical coherence tomography images, base diameter, minimum linear diameter, the macular hole index (MHI), diameter hole index (DHI), and traction hole index (THI) were measured and calculated. The drawbridge index was calculated using the software ImageJ. It was determined by calculating the sum of the arm lengths extending from the break point of the outer plexiform layer (OPL) to the retinal pigment epithelium (RPE) on both sides of the macular hole, as well as the sum of the lengths from the starting point of the distorted OPL to the RPE in the vertical direction, and the difference between them then dividing by base diameter. The effectiveness of these predictive indices in prognosing "closed" versus "not closed" outcomes, and their correlation with outcome indicators, including best-corrected visual acuity, central foveal thickness, and ellipsoid zone defect length, was assessed. Furthermore, the area under the receiver operating characteristic curve (AUC) and a cutoff value were calculated for the drawbridge index. In the second part, a total of 21 patients were enrolled in the validation group, and the drawbridge index was utilized to guide surgical decisions for the ILM techniques.

Results: Significant differences were observed between the "closed" and "not closed" groups using the drawbridge index (P < 0.05). The drawbridge index was significantly correlated with postoperative best-corrected visual acuity, ellipsoid zone defect, and central foveal thickness. It exhibited an AUC value of 0.92, and the cutoff value of 1.03 demonstrated a sensitivity of 87.50% and a specificity of 80.00%. Assisted by the drawbridge index, a 100% closure rate was achieved in patients in the validation group.

Conclusion: The drawbridge index may be reliable and useful for making surgical decisions regarding ILM manipulation for large MHs.