BMC Ophthalmology最新文献

Background: Circumscribed choroidal hemangioma (CCH) is a benign vascular hamartoma caused by congenital vascular malformation. And, central serous chorioretinopathy (CSCR) is a chorioretinal disease characterized by pachychoroid, RPE irregularities, and subretinal fluid (SRF) accumulation. Some literature has indicated a potential correlation between the occurrences of CCH and CSCR.

Case presentation: A 59-year-old man presented with blurred vision in his right eye for six months, with an unremarkable history. Multimodal imaging techniques including color fundus photography, fundus autofluorescence (FAF), B-scan ultrasonography (USG), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT), revealed the presence of CCH accompanying CSCR in the right eye. The patient received treatment with SML for CSCR, while no specific treatment was administered for CCH. The SRF was fully resolved one month after the treatment. At the 3- and 6-month follow-up, SRF resolved, and best-corrected visual acuity (BCVA) improved from 0.6 to 0.9 in the decimal format in the right eye, without notable changes in subfoveal choroidal thickness (SFCT) or the size of CCH.

Conclusion: This case reported the coexistence of CCH and CSCR in the right eye, both characterized by choroidal vascular abnormalities. Further research is necessary to determine the favorable effect of SML in patients with CSCR and concurrent CCH.

Purpose: To investigate the impact of secondhand smoke (SHS) exposure on myopia prevalence and risk among nonmyopic children in China.

Methods: This was a retrospective cohort study. A total of 232 children aged 5-10 years were included, with 128 exposed to SHS and 104 who were not. Baseline characteristics such as age, sex, height, weight, spherical equivalent refraction (SER), axial length (AL), average corneal K-reading (Ave-K), intraocular pressure (IOP), pupil diameter (PD) and subfoveal choroidal thickness (SFCT) were measured. Follow-up assessments at 3-, 6-, 9-, and 12-month visits were focused on changes in SER and AL. Behavioural and parental factors, including parental myopia status, parental education level, daily time spent on near work and outdoor activities were collected via questionnaires from medical records. Linear regression was applied to identify the factors that have a significant impact on axial elongation over 1 year.

Results: The mean spherical refraction myopic shift in the SHS group was - 0.64 ± 0.41 D/year, which was significantly greater than that in the control group (-0.47 ± 0.52 D/year) (P = 0.004). Children in the SHS group had significantly greater axial elongation than did children in the control group (0.26 ± 0.14 mm vs. 0.20 ± 0.13 mm, P = 0.002). Multivariate linear regression analysis revealed that SHS exposure (β = 0.053, P = 0.002), baseline SER (β = -0.054, P = 0.001) and parental myopia (β = 0.028, P = 0.036) were significant predictors of 12-month axial elongation.

Conclusions: This retrospective cohort study revealed that SHS exposure was associated with a greater likelihood of developing early-onset myopia. These findings indicate that eradicating SHS exposure is highly important for preventing myopia among children, especially in families with young children.

Background: This study compared the effectiveness of different ultrawide field fundus imaging systems (Clarus™ 500 and Optos^®) in diagnosing diabetic retinopathy (DR).

Methods: This was a prospective, multicentre study. Retinal photographs were captured at four eye centres utilizing both the Clarus™ 500 and Optos^® imaging systems. The image quality and the effective retinal area were compared. Then the consistency in diagnosing the severity of DR by two distinct imaging systems was compared according to three separate grading criteria (the International Council of Ophthalmology, the Early Treatment Diabetic Retinopathy Study [ETDRS] grading diagnostic criteria, and the Chinese Clinical Diagnosis and Treatment Guidelines for Diabetic Retinopathy [2014]) were analysed.

Results: A total of 113 patients, 201 eyes and 402 images were included in this study. 39 images were excluded due to the poor image quality and 363 images were finally analyzed. The Clarus™ imaging system demonstrated better image quality than the Optos^® imaging system (κ = 0.195). The mean effective retinal area was 490.03 ± 112.33 Disc area(DA) in the Clarus™ group and 410.41 ± 92.12 DA in the Optos^® group (P = 0.000). The κ values were 0.812 for ETDRS DR severity, 0.787 for ICO DR severity, and 0.790 for the Chinese guidelines, indicating substantial agreement between the two imaging systems. However, Clarus™ indicated higher DR severity than the Optos^® imaging system, with a higher detection rate of intraretinal microvascular abnormalities (IRMAs) and neovascularization.

Conclusion: Clarus^™ and Optos^® exhibit strong concordance in the identification of DR. Clarus^™ offers better image quality and IRMA recognition than Optos^® and better identifies patients who need treatment.

Purpose: To investigate the tomographic characteristics of corneas with excessive thickness and to explore their potential impact on the assessment of candidates for refractive surgery.

Methods: One hundred and two eyes from 102 patients with the thinnest pachymetry (TP) < 500 μm, 100 eyes from 100 patients with TP ranging from 500 to 580 μm, and 102 eyes from 102 subjects with TP ≥ 580 μm were included. Pentacam ectasia indices were compared among these different groups.

Results: When compared to eyes with TP between 500 and 580 μm, significantly higher values in anterior radius of curvature (ARC), anterior corneal astigmatism (KAp), back elevation at the thinnest pachymetry (BE), deviation of normality of the back elevation (Db), and a more negative Q value for the back surface (Qback) were observed in eyes with TP ≥ 580 μm (Mann-Whitney U test: P < 0.001). No significant differences were observed in the indices for the anterior cornea (Mann-Whitney U test: index of height decentration, P = 0.348; inferior-superior value, P = 0.334; keratoconus percentage index, P = 0.077; deviation of normality of the front elevation, P = 0.891). The proportion of abnormalities was highest in eyes with TP ≥ 580 μm for BE (16.7%, Chi-square test: P < 0.001) and Db (20.6%, Chi-square test: P = 0.001).

Conclusions: The tomography of thick corneas reveals greater BE and Db, as well as a more negative Qback while no significant disparities emerged in the anterior corneal indices.

Purpose: To predict the surgical planning based on early-obtained computed tomography (CT) images of orbital medial wall fractures.

Methods: Early orbital medial wall fractures CT images were selected for retrospective study. The binocular proptosis, fracture area, and binocular interrectus distance were measured on a PACS workstation with line segment and irregular area measurement tools of the system. Medial rectus changes and intraorbital pneumatosis were observed. According to the obtained results, the cases were grouped, and the correlation analysis was carried out.

Results: 104 cases were divided into 6 groups by detailed classification of the characteristics. For cases with a relatively complete muscle cone structure, the difference in binocular proptosis was significantly correlated with the difference in binocular interrectus distance (P < 0.05), with a fitting linear regression equation of Y= -0.165 + 0.478*X (Y is binocular proptosis difference, X is binocular interrectus distance difference).

Conclusion: Within the limitations of the study, based on early-obtained CT images of orbital medial wall fractures, detailed classification of the characteristics can predict clinical surgical planning. And restoring normal interrectus distance may be the key to restoring proptosis.

Background: This study aims to assess the surgical outcomes of lateral rectus muscle paralysis patients who received superior rectus transposition (SRT) surgery or SRT with augmented suture (SRTA).

Methods: This case series study enrolled 11 lateral rectus muscle paralysis patients who underwent SRT or SRTA from April 2014 to June 2022 at Wuhan Bright Eye Hospital. Preoperative and postoperative assessments included the following parameters: (1) eye position in primary gaze; (2) ocular motility; (3) presence of diplopia; and (4) compensatory head positioning.

Results: Six cases received SRT, and 5 cases received SRTA. Preoperative esodeviation showed a mean angle of + 57.27 ± 9.62 prism diopters (PD), and the angle reduced to + 7.45 ± 2.70, + 6.36 ± 2.67, and + 3.09 ± 3.34 PD at 1 month, 6 months, and 12 months, respectively. At postoperative 12 months, 10 out of 11 cases achieved a significant reduction in internal oblique deviation, resulting in the elimination of abnormal head positioning and initial eye position diplopia. The range of motion of the affected eye was also improved by the surgical procedure, significantly enhancing the external rotation compared to preoperative values. No significant vertical or torsional strabismus was observed after surgery. Stable eye positions and remarkable treatment outcomes were revealed by follow-up evaluations conducted between 12 and 18 months postoperatively.

Conclusions: Internal rectus migration combined with transposition of the superior rectus muscle may be feasible for treating lateral rectus muscle paralysis. The eye position, abduction function, and binocular vision function were improved in patients who received SRT or SRTA.

Background: Nodular fasciitis (NF), also known as pseudosarcoma fasciitis, is defined as a benign, self-limiting, vascular, or fibrovascular proliferation. It is commonly found on the trunk and upper extremities. NF is rarely found in the orbit and periorbital regions, with only a few case studies reported since it was initially described by Font et al. in 1966. NF usually presents as a rapidly growing solitary tumor and is often mistaken for a sarcoma due to its high cellularity and increased mitotic activity.

Case presentation: We present a case of NF in a 41-year-old Saudi man with a 1-year history of a gradually enlarging left medial subbrow mass in the left eye. The mass was not associated with pain, visual disturbances, double vision, or a history of trauma. An external ophthalmic examination revealed a firm, oval mass over the nasal aspect of the superior orbital rim of the left eye. The mass was non-tender, measured 1 × 2 cm in diameter, and fixed to deep tissues. Computed tomography (CT) with contrast revealed a well-demarcated left para-orbital soft tissue round lesion with peripheral enhancement occupying the nasal aspect of the superior orbital rim above the inner canthus. Debulking and incisional biopsies were performed, and the histopathological findings were consistent with those of NF.

Conclusions: NF is a rare benign tumor that infrequently presents in the periorbital region. It lacks distinctive features for a definitive diagnosis and should be suspected when imaging results are inconclusive. Management typically involves complete local excision or debulking.

Background: Age-related macular degeneration (AMD) is a major cause of vision loss worldwide. This study aimed to assess risk factors for wet AMD by two methods: assessing risk factors measured in the Scottish Heart Health Extended Cohort (SHHEC), and to systematically review the literature.

Methods: Eighteen thousand one hundred seven volunteers were recruited to SHHEC between 1984-1995, with risk factor data collected on recruitment. Hospital records were linked to study data up to 2017 and survival analysis was used to analyse risk factors and wet AMD. Literature published between 2000-2023 was searched for studies assessing risk factors for wet AMD, resulting in 5,503 papers. Following review, 7 studies were included in the systematic review.

Results: Within the SHHEC data, 231 cases of wet AMD were reported. Increasing age (Hazard Ratio (HR) 10.51; 99% Confidence Interval (CI) 4.78-23.11) and smoking (HR 1.67; 99% CI 1.17-2.38) were significantly associated with an increased risk of wet AMD. Increased dietary intake of vitamin K (HR 0.56; 99% CI 0.34-0.94) was associated with a decreased risk of wet AMD. According to a systematic review, smoking, high Body mass index, heavy alcohol intake, increased systolic blood pressure, increased pulse pressure, and high levels of C-reactive protein and serum triglycerides in the blood may be associated with an increased risk of wet AMD. However, the studies provide mixed evidence and no conclusive results.

Conclusion: We have demonstrated that increasing age and smoking are high-risk factors for the development of wet AMD, while vitamin K is associated with a reduced risk of wet AMD.

Background: Amblyopia is associated with structural differences in ocular biometrics, but existing studies often lack long-term follow-ups. This study compares three-year changes in ocular biometric components in amblyopic and non-amblyopic eyes.

Methods: In this prospective cohort, study data were collected in 2015 and 2018 in Shahroud, northeast Iran. The sample comprised 4968 primary students (9935 eyes), including 4931 non-amblyopic students (9893 eyes) and 37 students with amblyopia (42 eyes). Axial length, keratometry, central corneal thickness, lens thickness, pupil diameter, anterior chamber depth, lens power and vitreous chamber depth were measured using Lenstar LS900. Multilevel mixed-effects regression models were used to determine any association between variables.

Results: The mean age of children without and with amblyopia at baseline were 9.7 ± 1.7 and 9.9 ± 1.5 years, respectively. The mean axial elongation in amblyopic and non-amblyopic groups over three years was 0.37 (95% CI: 0.34-0.40) and 0.33 mm (95% CI: 0.31-0.34), respectively (p < 0.001). Amblyopic eyes showed greater axial elongation than non-amblyopic eyes (p < 0.001). Anterior chamber depth was constant in amblyopic eyes while it decreased in non-amblyopic eyes by 0.13 mm. Vitreous chamber depth increased significantly in both groups, with a greater increase observed in the amblyopic eyes (0.36 vs. 0.28 mm) (p < 0.001). Flat and steep keratometry increased significantly in amblyopic eyes (p < 0.001), while it was constant in non-amblyopic eyes. Lens power decreased significantly in both groups (p < 0.001). The increase in the axial length and vitreous chamber depth in the amblyopic eye was greater than in the non-amblyopic eyes (p < 0.001). The spherical equivalent change in both groups was - 0.31 D.

Conclusions: Amblyopia was associated with significant changes in key biometric parameters, offering valuable insight into the structural alterations underlying the condition.

Background: Brown-McLean Syndrome is a rare clinical condition typically presenting as localized edema involving a 2-3 mm peripheral area of the cornea, which often has undergone intraocular surgery.

Case report: We present a unique case of unilateral Brown-McLean Syndrome (BMS) with concurrent keratoconus in an 18-year-old male patient. The individual sought medical attention due to poor vision in the right eye, which had been unnoticed for a month. Notably, there was no history of ocular surgery or trauma, and the patient did not suffer from any systemic diseases. Clinical examination revealed peripheral corneal edema, extending 2-4 mm from the limbus, exclusively affecting the right eye. Corneal topography indicated the presence of keratoconus, which was an incidental finding during the investigation.

Conclusions: This case underscores the importance of considering BMS in the differential diagnosis of peripheral corneal edema even in the absence of ocular surgery or trauma. The potential relationship between BMS and keratoconus is explored, suggesting that long-term edema and degeneration of the peripheral cornea could alter its biomechanical properties, leading to deformation and keratoconus. Thorough clinical evaluation and long-term follow-up are crucial in managing such patients.