Clinical ophthalmology (Auckland, N.Z.)最新文献

Purpose: Ocular cysticercosis, caused by Taenia solium larvae, presents significant public health challenges, especially in regions with poor sanitation. Traditional imaging techniques often fail to detect anterior segment cysticercosis accurately, necessitating the exploration of more advanced diagnostic modalities like Ultrasound Biomicroscopy (UBM).

Patients and methods: A retrospective observational analysis was conducted on 18 eyes from 14 patients with cysticercosis involving the anterior segment. UBM imaging was performed using a Sonomed VuMax HD ultrasound biomicroscopy machine with a 50 MHz probe.

Results: In the study, 18 eyes from 18 patients were analyzed, revealing 12 cases of conjunctival cysticercosis, 4 of anterior chamber cysticercosis, and 2 of iris cysticercosis. Patients averaged 37.89 (± 16.2) years, with a male predominance. Conjunctival cysts appeared as clear masses, occasionally eliciting inflammatory reactions. Iris involvement caused thinning near the angle, while anterior chamber cysts could displace the lens, leading to iris bombe in some instances.

Conclusion: UBM emerges as a valuable diagnostic tool for anterior segment cysticercosis, providing detailed imaging superior to traditional methods. Its cost-effectiveness and accessibility make it particularly valuable, especially in resource-constrained settings. Future research should focus on validating UBM's diagnostic accuracy and exploring its role in monitoring disease progression and treatment response.

Purpose: Corneal cystine accumulation results in photophobia and affects patients' quality of life. We assessed the efficacy and safety of cysteamine 0.55% solution in Japanese cystinosis patients with corneal cystine crystals for 52 weeks.

Patients and methods: This was a Phase III, open-label, single-arm study conducted in Japan (jRCT2021200029; registered on 07/12/2020). Patients with white blood cell cystine levels >1 nmol/half-cystine/mg protein or presence of corneal cystine crystal deposits identified by slit-lamp biomicroscopy were included. The primary endpoint was assessed as the in vivo confocal microscopy (IVCM) total score of 7 corneal layers. Visual acuity, photophobia and safety (adverse events [AEs]) endpoints were also evaluated.

Results: Six patients (four males and two females) were included. The mean age (standard deviation [SD]) of the patients was 29.0 (10.30) years, with a mean treatment duration of 13.7 (0.52) months. Although the acquisition of the IVCM total score was limited, an overall downward trend was observed in IVCM scores for each layer of the cornea. A decrease in the average of smoothed intensity was observed in four out of six patients at Week 16. Most patients reported at least 1-step improvement in physician and patient-reported photophobia assessment. Thirty-three AEs were reported in five patients (83.3%). Three patients (50.0%) reported eye and general disorders and administration site conditions. Tingling sensation was the most frequently reported local adverse drug reaction. No serious AEs or deaths were reported.

Conclusion: Cysteamine eye drops were efficacious and well tolerated in the Japanese cystinosis patients with corneal cystine crystals.

Purpose: To evaluate visual and anatomical outcomes following a switch from intravitreal Aflibercept (IVI AFL) (T1) to biosimilar Ranibizumab (B-RBZ) (T2) in patients with diabetic macular edema (DME).

Methods: This was a multicenter observational study, analysing medical records of consecutive, treatment-naïve centre-involving DME patients having a baseline visual acuity (VA) of ≥55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. DME patients, having received monthly loading doses of IVI AFL(T1) and responsive to it, who subsequently shifted to B-RBZ(T2) motivated by financial constraints rather than a lack of efficacy to IVI AFL were identified.

Results: This study included 57 participants (mean age: 54.23 ± 6.91 years), with 80.7% male patients. VA improved during T1, from 61.4 ± 11.74 ETDRS letters at baseline to 72.7 ± 8.05 ETDRS letters (mean change: +11.2 letters, 95% CI: 9.1 to 13.4; p < 0.001). During T2, VA declined slightly over 12 months with a mean VA of 69.9 ± 3.78 ETDRS letters at the 12-month mark (+8.5 letters from baseline; p < 0.001). Mean central macular thickness (CMT) during T1 reduced from 411.9 ± 34.62 μm at baseline to 279.3 ± 9.96 μm (mean change: -132.6 μm, 95% CI: -142.2 to -122.9 μm; p < 0.001). CMT remained stable over the 12-month follow-up period, with minimal fluctuations. Subretinal fluid (SRF) and intra retinal fluid (IRF) were present in 84.2% and 91.2% of eyes, respectively, decreasing to 5.3% and 7.0% at the time of switch (p < 0.001). In T2 phase, 22.8% and 21.1% exhibited SRF and IRF, respectively, at the end of the study.

Conclusion: Transitioning to biosimilar Ranibizumab (Razumab) after initial treatment with aflibercept in patients with DME preserved visual and anatomical benefits over a 12-month period, with only minor variations in SRF and IRF. These results underscore the efficacy of biosimilar Ranibizumab as a cost-effective option for managing DME.

Purpose: To evaluate the efficacy of 0.2% and 0.4% pilocarpine HCl (CSF-1) for the treatment of presbyopia and to determine the contributions of pilocarpine HCl and diclofenac sodium on the efficacy of fixed-dose combination (FDC) formulations.

Patients and methods: This was a Phase 2b, multicenter, randomized, double-masked, parallel-group clinical trial. Adults (45-64 years) with presbyopia were randomized 1:1:1 to 3 arms (Pilo arm: pilocarpine HCl; Pilo-Diclo FDC arm: pilocarpine HCl with 0.006% diclofenac sodium; Control arm: 0.006% diclofenac sodium). Participants in Pilo and Pilo-Diclo FDC arms received 0.2% pilocarpine HCl (0.2% Pilo or 0.2% Pilo FDC, respectively) from days 1-8, and 0.4% pilocarpine HCl (CSF-1 or CSF-1-FDC, respectively) from days 8-15. Primary efficacy endpoint was achievement of ≥3-line (15-letter) gain in mesopic, monocular distance-corrected near visual acuity (DCNVA) at 40 cm, 1 hour post-treatment of the study eye on days 8 and 15 in the per protocol (PP) population. Safety endpoints were assessed.

Results: One hundred and sixty-six participants were randomized (intent-to-treat, N = 166; PP, n = 160). There were no statistical differences between 0.2% Pilo or 0.2% Pilo FDC versus Control at 1 hour post-treatment on day 8. On day 15, 43.1% and 46.9% of participants receiving CSF-1-FDC (0.4% Pilo FDC) or CSF-1 (0.4% Pilo), respectively, achieved ≥3-line gain at 1 hour post-treatment in mesopic DCNVA compared with 16.1% of Control group in the PP population, meeting the primary endpoint (P = 0.0015 and P = 0.0002, respectively). All formulations were well tolerated.

Conclusion: CSF-1 demonstrated significant improvements in mesopic DCNVA and favorable safety. Pilocarpine HCl as a single active ingredient, at the concentration of 0.4% (CSF-1), provided a transient, therapeutic effect for presbyopia.

Purpose: The purpose of the study was to assess the pattern of spheroidal degeneration of cornea (SDC) and its association with other eye diseases at the anterior segment clinic (ASC) in Menelik II Tertiary Referral Hospital.

Methods: A hospital-based prospective descriptive study was conducted at ASC, in Menelik II Tertiary Referral Hospital, from May 2021 to September 2022. All enrolled patients meeting the inclusion criteria were selected and assessed with a structured questionnaire. Descriptive analysis was used to describe the study variables in terms of frequency and percentage. The results were presented using tables and figures.

Results: Out of 62 cases of SDC, 48 (77.4%) were male and 14 (22.6%) were female. It was more prevalent in the age groups of 60-69 and 70-79. Most respondents had outdoor activity (91.9%). A total of 24.2% of patients were found to have Stage I; 35.5% were found to have Stage II; and 40.3% were in Stage III. Posterior subcapsular cataract (PSC) was found in 10 (16.1%) SDC cases, post-trachomatous corneal opacity (CO) in 10 (16.1%) SDC cases, and non-trachomatous CO in 8 (12.9%) SDC cases, but none of them had an association with SDC.

Conclusion: Between May 2021 and September 2022, sixty-two cases of SDC were found at the ASC in Menelik II Tertiary Referral Hospital. The data showed a preponderance of SDC in males and older subjects. Stage III and primary types are the leading presentations. It was observed predominantly in individuals who spent most of their time outdoors. Pterygium, corneal opacity, pseudoexfoliation (PXF), PSC, and glaucoma were noted; however, none of these had a significant association with SDC.

Purpose: To assess the long-term outcomes of transepithelial iontophoresis cross-linking (I-CXL) for early keratoconus with high visual acuity under the age of 25.

Methods: This retrospective study was conducted at the Department of Ophthalmology, Humanitas San Pio X, Milan, Italy, on data collected between 2015 and 2020. Patients diagnosed with early keratoconus and under the age of 25 who underwent to I-CXL were retrospectively reviewed and included in the study if they fulfilled the following criteria: high visual acuity (LogMAR ≤ 0.2) before I-CXL and the fact that the fellow, most advanced eye, had been treated with epithelium off CXL (S-CXL). Corrected distance visual acuity (CDVA), spherical equivalent refraction, thinnest corneal thickness, corneal topography and tomography were assessed at baseline and at least 24 months of follow-up, using Pentacam. Statistical analysis was performed with STATA SE version 17.

Results: Twenty patients with a mean age of 18.5 ± 3.75 months were included. The median follow-up time was 24 months. The statistical analysis showed no significant change over time in CDVA, maximum keratometry and A, B, C values of the Belin Progression Display. Mean baseline CDVA was 0.03 ± 0.07 logMAR, whereas at 24-month was 0.01 ± 0.04. Mean spherical equivalent was -1.29 ± 1.38D at baseline and -1.05 ± 1.51D after 24 months. Preoperative maximum keratometry was 48.35 ± 4.95 D and 48.56 ± 4.96 D after the 2 years of follow-up. Mean baseline A value was 7.13 ± 1.66 mm and 24-month postoperative was 7.43 ± 0.48 mm. Average B value was 5.87 ± 0.55 mm prior to surgery, while it was 5.83 ± 0.60 mm after the last follow-up. Mean baseline and 24-month thinnest point were 498.9 ± 34.29 µm and 500.10 ± 33.45 µm respectively. None of the patients showed a progression of keratoconus.

Conclusion: I-CXL may be considered as a beneficial treatment option for young patients with less advanced keratoconus, although further consensus on patient selection criteria is needed.

Purpose: Macular edema is a known complication following complicated retinal detachment repair with silicone oil (SiO) tamponade. Limited previous research has not led to a consensus regarding the safety and efficacy of intra-SiO injections. Consequently, we aim to present our case series study on intra-SiO injections for postoperative macular edema.

Methods: A retrospective, single-center, case series study of eight eyes that developed macular edema postoperatively following complicated retinal detachment repair surgery with SiO tamponade, were treated with different forms of intravitreal injections such as steroids or anti-vascular endothelial growth factor (VEGF). The main outcome measures included visual acuity (VA), central subfield macular thickness (CSMT), and the type and number of injections.

Results: The mean age (±SD) of the patients was 64.75±8.9 years. The mean follow-up period (±SD) was 3.1±2.2 years. The mean (±SD) number of injections was 8.25±7.24. Mean (±SD) VA (in LogMAR) and CSMT before injections were 1.7±0.8 and 488±104 μm, respectively. At the last follow-up visit, the mean (±SD) VA and CSMT were 1.4±0.7 (p-value=0.45) and 396±184 μm (p-value=0.11), respectively. Overall, patients showed a partial response without a significant worsening of the macular edema and VA. No complications were reported following repetitive intravitreal injections.

Conclusion: Macular edema in silicone oil-filled eyes may be safely and effectively treated with intravitreal injections to halt its deterioration and preserve vision, especially when SiO removal is not anticipated in the foreseeable future.

Purpose: To assess ocular higher-order aberrations (HOAs) following ray trace guided laser in situ keratomileusis (LASIK).

Methods: Retrospective review at a single-site ophthalmology practice. Two hundred and fifty eyes of 250 patients with myopia and astigmatism undergoing ray trace LASIK were randomly reviewed (Wavelight Plus, Alcon). The InnovEyes Sightmap (Alcon) diagnostic device was used for whole-eye wavefront aberrometry, tomography, and biometry assessment preoperatively and 3 months post-operatively. Ocular HOA, ablation decentration, intraoperative pupil size, and pupil tracking were assessed. Intraoperative eye tracking of x and y coordinates were separately averaged to calculate mean and standard deviation of movement along the x-axis and y-axis to assess eye movement.

Results: Total HOA RMS (n = 250 eyes) increased marginally from 0.306 ±0.102 to 0.371 ±0.135 (p < 0.001) post-operatively. Spherical aberration decreased (0.092 ±0.112 to 0.056 ±0.125, p < 0.001). There was no significant difference in preoperative to postoperative vertical coma under -3D SEQ and horizontal coma under 2D SEQ. In eyes with 4D or more myopia treatment, post-operative vertical and horizontal coma was moderately correlated with the product of ablation depth and vertical and horizontal decentration (R² 0.51, p < 0.001, R²=0.34, p < 0.001, respectively). Multivariate analysis further showed this was correlated to eye movement.

Conclusion: Ray trace LASIK results in a minimal increase in total ocular HOA which is statistically but not clinically significant. Spherical aberration decreases. In larger treatments, there is an increase in coma which correlates with vertical and horizontal decentration of ablation, likely due to eye movement during surgery.

Purpose: Validate a novel approach for assessing residual astigmatism's impact on visual acuity in pseudophakic patients using defocus curves and spherical equivalent compensation.

Materials and methods: Thirteen patients over 40 with cataracts and normal ophthalmological examinations were enrolled in a prospective, non-randomized cohort study. The defocus curve method was employed, wherein visual acuity was measured with spherical lenses ranging from -2.50 to +2.50 diopters in 0.5 diopter increments based on subjective refraction. Cylindrical lenses (+1, +2, and +3 diopters) were introduced at each spherical diopter's 90° and 180° axes. Curves' results were compared at each defocus point to assess the impact of astigmatism. The Kruskal-Wallis test was used to determine if astigmatism significantly affected visual acuity post-phacoemulsification surgery with intraocular lens implantation.

Results: Significant p-values were observed only for defocus curve points of -0.5, 0, +0.5, and +1, indicating rejection of the hypothesis of no difference between the 90° and 180° groups at these points. Although statistical significance was not achieved, the against-the-rule (ATR) group was inclined toward improved near and intermediate visual acuity. In contrast, the with-the-rule (WTR) group tended to enhance distance visual acuity and myopic tolerance.

Conclusion: This novel methodology is both reproducible and valuable. It offers potential insight into residual astigmatism tolerance in pseudophakic patients. Its application may aid in surgical planning and intraocular lens decision-making.

Glaucoma treatment is beginning to undergo an evolution, moving away from topical medication-based therapies toward more proactive minimally invasive interventions. This shift towards an "interventional glaucoma" treatment paradigm has been shown to benefit patients, providers, and society. A key component of effectively implementing this approach is education about the importance of glaucoma diagnosis and treatment, as well as the various treatment modalities available. Such education is relevant not only for patient but also patients' support networks, ophthalmologists, optometrists, third-party payers, and policy-makers. Education can occur both within and outside the clinical setting. The present article provides an overview of the diverse educational methods available for glaucoma patients, including those based on patient-provider interactions and those based on internet and printed material. Examples of the former could include general and specific verbal instruction, motivational interviewing, or community-based educational workshops, while examples of the latter could include office-based movies or printed materials, virtual reality headset educational videos, artificial intelligence-assisted education, or self-directed internet videos and articles. By empowering patients with knowledge and an up-to-date awareness of treatment options, effective education can be a valuable part of making an interventional glaucoma treatment paradigm possible.