BMC Ophthalmology最新文献

Background: Contrast sensitivity is an important measure of vision quality. Risk of falling injury is strongly associated with poor contrast sensitivity compared with poor near- and distance visual acuity. Since good visual acuity is not necessarily associated with good visual performance in the "real world" it is important to consider contrast sensitivity when prescribing corrective lenses. There is limited evidence on how refractive error and its correction affect contrast sensitivity in the study area. Therefore, this study is important to understand how refractive correction affects contrast sensitivity, which is important baseline information for prescribing refractive error correction.

Objective of this study: This study aimed to measure the mean difference in contrast sensitivity with and without corrective lenses in patients with refractive error.

Methods: Objective and subjective refractions were done for each patient, then Pelli- Robson contrast sensitivity was measured for them using computer based Pelli-Robson chart at 1 m. Pelli- Robson contrast sensitivity value (Log CS) with and without corrective lenses were recorded for each study participant. The collected data were checked for completeness and analyzed using SPSS 26. Descriptive analyses, independent sample t-tests, and one-way ANOVA were performed to compare CS means; the findings are presented using tables and pie charts. A P-value of ≤ 0.05 was used to indicate statistical significance.

Results: One hundred sixty-two patients attending refraction clinics participated in this study with response rate 98.19% of which 51.9% were male. The mean age of the participants was 34.28 ± 12.79 (SD). The mean contrast sensitivity increased from 1.29 ± 0.35 (SD) to1.51 ± 0.28 (SD) LogCS units with refractive correction (p = 0.000). There is no significant difference in contrast sensitivity between the types of refractive errors.

Conclusion and recommendation: Uncorrected refractive can affect contrast sensitivity; therefore, proper refractive correction is essential to improve visual acuity and contrast sensitivity.

Background: This case report describes a rare case of Coats disease in adult female patient with preserved vision after intravitreal Aflibercept injection and laser photocoagulation.

Case presentation: A female patient of Asian Palestinian descent, aged 20, exhibited a progressive and painless deterioration in the vision of her left eye over a period of two weeks. She exhibited no additional ocular symptoms. Prior to her presentation, she had no notable medical history and her vision was normal in both eyes. Inferotemporal telangiectasia, sausage-like blood vessels with perivascular sheathing in the peripheral fundus, extensive exudate involving the macula, severe macular edema, and localized inferotemporal exudative retinal detachment were observed upon examination of the posterior segment of her left eye. Following this, optical coherence tomography (OCT) identified subretinal exudate, intraretinal and subretinal fluid. After establishing the diagnosis of stage 3 Coats' disease, the patient was treated with intravitreal Aflibercept (Eylea) injections and sectoral laser photocagulation. The third injection resulted in the absence of intraretinal and subretinal fluid by OCT, but the subretinal exudate remained unresolved. One month subsequent to the previous injection, FFA guided sectoral laser photoagulation was applied to the inferiotemporal ischemic area. The patient was subsequently monitored monthly, and her vision improved. Five months after treatment, her vision has improved to 0.7 (6/8.7) and she has remained stable ever since. At present, the patient is undergoing routine outpatient follow-up.

Conclusion: Coats disease is an idiopathic, progressive disease that mostly affects male infants, yet adult cases have been documented. Our case and the existing body of literature indicate that adult individuals have a favorable visual prognosis in the small proportion of cases where this occurs. It appeared that the implementation of intravitreal therapies and increased use of lasers led to enhanced visual outcomes. It is recommended to perform lifelong follow-up to monitor for recurrences and complications.

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a condition in which tear ducts are blocked, leading to epiphora and dacryocystitis. This systematic review and meta-analysis aimed to measure the ability of transcanalicular dacryocystorhinostomy (TC-DCR) as an alternative approach to PANDO compared to traditional external dacryocystorhinostomy (EX-DCR).

Methods: Our search included Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL). We included only observational studies, randomized controlled trials (RCTs), and quasi-experimental studies that compared TC-DCR and EX-DCR. The outcomes measured were anatomical and functional success rates, intraoperative complications, postoperative complications, and surgical time. Statistically significant results were determined as a p value of less than 0.05; thus, a confidence interval of 95% was used. Dichotomous outcomes were reported via risk ratios (RR), whereas continuous outcomes were reported using standardized mean differences (SMD).

Results: There was a statistically significant difference in anatomical success (RR = 0.84, 95% CI 0.72-0.97; P = 0.02), favoring EX-DCR; functional success (RR = 0.87, 95% CI 0.78-0.97; P = 0.01), favoring EX-DCR; operative (OR) time (SMD = -2.42, 95% CI -2.92 - -1.91; P < 0.00001) favoring TC-DCR; and intraoperative complications (RR = 0.16, 95% CI 0.06-0.43; P = 0.0003), favoring TC-DCR. Moreover, the subgroup analysis comparing single-diode TC-DCR to EX-DCR revealed a statistically significant difference in terms of anatomical success and functional success; however, the comparison of multidiode TC-DCR to EX-DCR revealed no statistically significant difference.

Conclusions: More research should be conducted to compare the anatomical and functional success of muli-diode TC-DCR with EX-DCR because the analysis performed comparing them revealed no statistical significance.

Background: This study aims to detect Mycobacterium tuberculosis complex (MTBC) DNA in intraocular fluid from clinically suspected tuberculous uveitis patients using multiplex polymerase chain reaction (PCR) and investigate the diagnostic utility of multiplex PCR for tuberculous uveitis.

Methods: Primers targeting three specific genes (MPB64, CYP141, and IS6110) within the MTBC genome were designed. Multiplex PCR was conducted using DNA from the H37Rv strain as well as DNA extracted from fluids of confirmed tuberculosis patients to assess primer specificity and method feasibility. Intraocular fluid samples were collected during the initial visit for multiplex PCR detection of MTBC DNA. The results of multiplex PCR tests were correlated with intraocular fluid findings and clinical profiles of patients clinically diagnosed with tuberculous uveitis who underwent standard antituberculosis therapy.

Results: Multiplex PCR was employed to detect MTBC DNA in intraocular fluid samples from 15 patients clinically suspected of having tuberculous uveitis, with no amplification bands observed in the DNA lanes for the three target genes. T-cell spot test (T-SPOT) results were positive in 11 patients (100%), while purified protein derivative (PPD) tests were positive in 5 patients (45.5%). Abnormal chest CT findings were noted in 4 patients (36.4%), including one case of active pulmonary tuberculosis and three cases of inactive pulmonary tuberculosis. Retinal vasculitis was observed in 6 eyes (46.2%), panuveitis in 5 eyes (38.5%), and intermediate uveitis in 2 eyes (15.4%). The average duration of antituberculosis therapy administered to the 11 patients was 7.1 months (range: 6-10 months). The medium LogMAR Best Corrected Visual Acuity (BCVA) significantly improved at the last follow-up (Z=-2.371, P = 0.018).

Conclusions: Standard antituberculosis therapy demonstrated effectiveness in treating 11 patients clinically suspected of having tuberculous uveitis despite the absence of detectable MTBC DNA in intraocular fluid via multiplex PCR. Further investigation is warranted to elucidate the role of PCR in diagnosing ocular tuberculosis among Chinese individuals.

Background: One of the significant challenges that can arise during cataract surgery is the occurrence of posterior capsule rupture (PCR) and vitreous loss. It may result in different complications including cystoid macular edema, endophthalmitis, glaucoma, and considerably retinal detachment which consequently contributes to poor functional outcomes.

Methods: This study was a prospective double blinded randomized clinical trial including 42 patients with previous complicated cataract surgery including posterior capsular rupture and consequently vitreous loss that anterior vitrectomy was done for them. The patients were randomly categorized in to two groups by simple randomization. One group (25 patients) received sham laser and the other group (17 patients) received prophylactic 360° barrage laser 4 weeks after cataract surgery. After eighteen months, rate of retinal detachment was compared between two groups.

Results: In terms of gender, age, axial length, maturity, pseudophakia v/s aphakia, type of IOL and type of cataract surgery, there was no statistically significant difference between intervention and control groups. Distribution of RRD was clinically different between 2 groups (intervention and control group). In addition, there was a statistically significant difference between the rate of RRD in control group (non-laser patients) and normal population (0.08 vs. 0.0001). (P-value < 0.001).

Conclusion: Prophylactic barrage laser might be a useful intervention in eyes with posterior capsule rupture and vitreous loss during cataract surgery to prevent rhegmatogenous retinal detachment. However, further studies with larger sample sizes are indicated.

Trial registration: Iranian Clinical Trial Registry: IRCT20201120049450N2, Registered 13 Jul 2023, https://irct.behdasht.gov.ir .

Background: To analyze the demographic characteristics of retinopathy of prematurity (ROP) in China, attempting to propose optimized screening criteria and hopefully providing valuable information for future updates to the ROP guideline.

Methods: A multicenter, retrospective-cohort study was conducted. The study included infants born between January 1, 2018, and July 31, 2023, who underwent ROP screening and were diagnosed with ROP at seven screening centers in China. Examinations were carried out in accordance with the ROP guidelines in 2014: infants with a gestational age (GA)<32 weeks and/or birth weight (BW)<2000 g, or infants who were suspected to be at risk of ROP. ROP treatment followed the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. We utilized receiver operating characteristic (ROC) curves to determine the optimal predictive model, and conducted internal validation as well as compared the model to current standards.

Results: Among the 4770 infants diagnosed with ROP after fundus screening, 1330 (27.9%) infants received treatment. The mean GA at birth for all enrolled infants was 29.67 ± 2.45 weeks, with a mean BW of 1295.89 ± 403.64 g. This study proposed the optimization of guidelines to be ≤ 30 weeks of GA and ≤ 1600 g of BW, achieving a sensitivity of 99.4%, as high as the current standard, with an 18.0% reduction in screening requirements.

Conclusion: Considering the decrease in both GA and BW among the population requiring ROP treatment in China, it is imperative to contemplate updating the ROP screening guideline.

Background: Accurate localization of premacular hemorrhages (PMHs) is crucial as treatment strategies vary significantly based on whether the hemorrhage resides within the vitreous gel, subhyaloid space, or beneath the internal limiting membrane (ILM). This report outlines the clinical features, diagnostic findings, and treatment outcomes in a patient diagnosed with a PMH secondary to suspected Valsalva retinopathy.

Methods: This is a retrospective interventional case report.

Results: A 43-year-old healthy male presented with sudden vision loss in his left eye, reporting a visual acuity of 6/120 since the previous evening. Fundus examination revealed a PMH characterized by a "double-ring sign" accompanied by diffuse retinal hemorrhages. Optical coherence tomography confirmed that the hemorrhage was located in the sub-ILM space. The patient underwent two sessions of YAG laser membranotomy, utilizing energies of 2.5 mJ and 5 mJ, which successfully facilitated drainage of fresh hemorrhage from the sub-ILM space to the subhyaloid space and vitreous cavity. However, the presence of residual coagulated blood over the fovea resulted in persistent visual impairment, necessitating a subsequent pars plana vitrectomy (PPV). The PPV, in conjunction with internal limiting membrane peeling, effectively removed the remaining blood in front of the fovea and restored the visual acuity. By postoperative day 3, the patient experienced a significant improvement in visual acuity, measuring 6/8.

Conclusion: This case underscores the importance of thorough clinical examination and precise diagnostic techniques in the individualized management of PMHs, which is essential for achieving optimal visual outcomes.

Background: The aim of the present study was to compare the rates of change in Ganglion Cell- Inner Plexiform Layer (GCIPL) and Retinal Nerve Fiber Layer (RNFL) thickness, as measured by Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) program in control group, Primary Open Angle Glaucoma (POAG) and Pseudoexfoliation Glaucoma (PXG) eyes.

Methods: 60 POAG and 60 PXG patients and 30 control group patients were included in the study. Patients diagnosed with glaucoma were divided into two groups as mild (Mean deviation (MD) > -6.00) and moderate-severe (MD < -6.00). The average, superior and inferior quadrant thinning rates (expressed in micrometers per year) of GCIPL and RNFL in the OCT GPA program were compared between groups.

Results: Average GCIPL thinning rates were -0.23 ± 0.21 μm/year in the control group, -0.64 ± 0.54 μm/year in POAG patients, and -1.06 ± 1.16 μm/year in PXG patients (ANOVA, p < 0.001). Average RNFL thinning rates were -0.33 ± 0.44 μm/year in the control group, -0.86 ± 0.73 μm/year in POAG patients, and -1.33 ± 1.4 μm/year in PXG patients (ANOVA, p < 0.001).

Conclusions: The rates of GCIPL and RNFL thinning were highest in patients with PXG. We found that the glaucoma stage did not affect the rate of RNFL and GCIPL thinning.

Background: To investigate the association between obesity and orbital fat expansion in proptosis of thyroid eye disease.

Methods: This observational study retrospectively enrolled 87 participants who received orbital fat decompression surgery for thyroid eye disease. Primary outcome measures included average body mass index (BMI) and the proportion of the study sample with overweight and obesity, compared with the general Taiwanese population. Secondary outcome measures included the association of obesity with proptosis severity, removed fat volume, and thyroid status.

Results: The average BMI (25.59 ± 4.36 kg/m²) of the study sample was significantly higher than that in the general population of Taiwan (24.5 kg/m²; P = 0.012). Participants with overweight (19.52 ± 3.52 mm) and obesity (21.25 ± 3.76 mm) exhibited significantly more severe proptosis than participants without overweight (18.05 ± 3.37 mm) and without obesity (18.09 ± 3.02 mm; P = 0.029 and P < 0.001, respectively). In addition, a significantly greater orbital fat volume was removed from the group with obesity (4.61 ± 1.17 ml) versus that without obesity (3.57 ± 1.12 ml; P = 0.021). A positive correlation between BMI and removed fat volume was noted (correlation coefficient = 0.291, P = 0.005). BMI was an independent factor predicting both proptosis severity (P < 0.001) and removed orbital fat volume (P = 0.02).

Conclusions: Obesity is associated with orbital fat expansion and consequently more severe proptosis in thyroid eye disease. Weight control may be a potential strategy to prevent thyroid-associated exophthalmos.

Background: Prostaglandin analogs are first-line treatments for open-angle glaucoma due to their proven efficacy in reducing intraocular pressure. Despite their topical administration, systemic adverse drug Events (ADEs) have been reported. This study investigates the systemic ADEs associated with topical prostaglandin analogs using the United States Food and Drug Administration (USFDA) Adverse Drug Event Reporting System (AERS) database.

Methods: The USFDA AERS database was queried for reports on prostaglandin analogs from March 2004 to March 2024 in this retrospective pharmacovigilance study. Data were deduplicated and analyzed using disproportionality analysis with both frequentist and Bayesian approaches. Reports on systemic ADEs where topical prostaglandin analogs were the primary suspect were included. Statistical analysis was performed using descriptive statistics and the chi-square test for categorical variables.

Results: A total of 30,853 reports were analyzed, predominantly involving latanoprost and bimatoprost, with most patients being elderly and female. In general, hypersensitivity reactions were the most common systemic adverse events reported with prostaglandin analogs. Varied systemic adverse events were observed within the class as latanoprost was linked to conditions like angina pectoris, atrial tachycardia and Meniere's disease, bimatoprost to lentigo maligna melanoma, and tafluprost to labyrinthitis and skin discoloration. Notably, tafluprost had a significantly higher occurrence of death compared to other prostaglandin analogs, yet the causal relationship has not been established for this association due to unavailability of critical data on temporality and potential confounders including concomitant diseases/drugs and severity of the disease.

Conclusion: Prostaglandin analogs are associated with systemic ADEs, particularly in elderly and female patients. The most reported systemic adverse event was hypersensitivity reactions for the class and cardiac events for latanoprost. Tafluprost was observed with higher mortality statistically, yet causal relationship could not be established in the absence of details on the potential confounders. The findings emphasize the need for continuous monitoring of adverse reactions, and consideration of patient-specific factors when prescribing these medications.