Romanian journal of ophthalmology最新文献

Aim: To evaluate the appropriateness and readability of the medical knowledge provided by ChatGPT-3.5 and Google Bard, artificial-intelligence-powered conversational search engines, regarding surgical treatment for glaucoma.

Methods: In this retrospective, cross-sectional study, 25 common questions related to the surgical management of glaucoma were asked on ChatGPT-3.5 and Google Bard. Glaucoma specialists graded the responses' appropriateness, and different scores assessed readability.

Results: Appropriate answers to the posed questions were obtained in 68% of the responses with Google Bard and 96% with ChatGPT-3.5. On average, the responses generated by Google Bard had a significantly lower proportion of sentences, having more than 30 and 20 syllables (23% and 52% respectively) compared to ChatGPT-3.5 (66% and 82% respectively), as noted by readability. Google Bard had significantly (p<0.0001) lower readability grade scores and significantly higher "Flesch Reading ease score", implying greater ease of readability amongst the answers generated by Google Bard.

Discussion: Many patients and their families turn to LLM chatbots for information, necessitating clear and accurate content. Assessments of online glaucoma information have shown variability in quality and readability, with institutional websites generally performing better than private ones. We found that ChatGPT-3.5, while precise, has lower readability than Google Bard, which is more accessible but less precise. For example, the Flesch Reading Ease Score was 57.6 for Google Bard and 22.6 for ChatGPT, indicating Google Bard's content is easier to read. Moreover, the Gunning Fog Index scores suggested that Google Bard's text is more suitable for a broader audience. ChatGPT's knowledge is limited to data up to 2021, whereas Google Bard, trained with real-time data, offers more current information. Further research is needed to evaluate these tools across various medical topics.

Conclusion: The answers generated by ChatGPT-3.5™ AI are more accurate than the ones given by Google Bard. However, comprehension of ChatGPT-3.5™ answers may be difficult for the public with glaucoma. This study emphasized the importance of verifying the accuracy and clarity of online information that glaucoma patients rely on to make informed decisions about their ocular health. This is an exciting new area for patient education and health literacy.

Purpose: To present a case of traumatic late macrostriae of Laser in situ keratomileusis (LASIK) flap managed by flap lifting, stretching, and polishing.

Material and method: A patient presented with a history of defective vision in his right eye following trauma with a rubber ball 10 days ago. He had undergone an uneventful LASIK surgery 4 years ago. Ocular examination showed visual acuity of 20/200, multiple parallel radiating folds in an undisplaced LASIK flap in the inferonasal quadrant, and sphincter tear. This case required an urgent surgical intervention. Epithelial debridement, flap lifting, gentle stretching, and irrigation were performed to smooth out the striae. A bandage contact lens was applied to ensure proper wound apposition.

Results: The postoperative period was without complications, and the patient achieved a final visual acuity of 20/20.

Discussions: The insufficient wound healing of the LASIK flap results in a cornea with compromised biomechanical strength. They remain susceptible to trauma for a long duration after surgery. Traumatic injury to these eyes can lead to late macrostriae formation, which results in visual deterioration. Cases of macrostriae presenting late require surgical debridement of epithelium, which keeps these folds fixed. It should be followed by flap irrigation and stretching to smooth these striae.

Conclusions: Since LASIK wound healing is always incomplete, it is crucial to inform patients about the potential risk of trauma. Any traumatic flap injury requires thorough examination and proper management of these cases results in excellent visual gain.

Aim: Google and various social media platforms have content on the therapeutic potential of nutritional supplements for glaucoma, but whether that information is evidence-based has not been analyzed. The current study explores such content for its quality.

Methodology: Criteria of search used were "glaucoma" and "vitamins" or "nutraceuticals" or "nutritional supplements". The first 30 search results on Google for every keyword combination were determined. The top 30 video results on Facebook Watch and YouTube for each keyword combination were selected. The initial 30 posts from Reddit and the top 30 Images on Google Images related to the keyword combination were also examined.

Results: Sixty-eight websites on Google, 75 Images from Google, 39 YouTube videos, 12 video results from Facebook Watch, and 19 posts from Reddit were identified and assessed for quality.The average Sandvik scores were 10.86 ± 2.6 (Google webpages), 10.08 ± 1.9 (YouTube videos), 10.62 ± 1.6 (Facebook Watch), and 10.26 ± 2.8 (Posts from Reddit). The average Risk Scores were 0.67 ± 0.9 (videos from YouTube), 0.49 ± 0.8 (webpages on Google), 0.33 ± 0.5 (videos from Facebook Watch), and 0.26 ± 0.5 (Reddit). The mean HON code scores were 5.15 ± 1.5 (YouTube), 6 ± 1.7 (Google webpages), 4.42 ± 1.1 (Facebook Watch), and 3.47 ± 1.8 (Reddit).

Discussion: Many patients who seek information online do not consult their physicians to verify the accuracy of their search results. Thus, with this changing trend, video and online medical content analysis has attracted interest. Search engines and social media platforms may serve as adjuncts for patient counseling in current care models by providing an online educational community. Compared to non-healthcare professionals, the healthcare professionals' information regarding nutraceuticals/nutritional supplements in glaucoma is of higher quality. Most HCPs do not recommend the use of dietary supplements as a complementary treatment for glaucoma, either because of inconclusive/insufficient data or due to contrasting studies that contradict each other. However, literature is building up with each passing day, to support nutritional supplementation as an integrative IOP-independent strategy for glaucoma management.

Conclusion: The information provided by healthcare professionals is superior to that offered by non-healthcare professionals. Most HCPs advise against the use of nutritional supplements as an adjunct therapy for glaucoma, either because of inconclusive data or due to contrasting studies that contradict each other.

Objective: To describe ocular hypertension cases after using a new aflibercept prefilled syringe and to assess the main characteristics of these eyes and their possible association with intraocular pressure (IOP) changes.

Methods: Case series. We reported all the cases of ocular hypertension following aflibercept prefilled syringes (PFS) treatment in our department between April 2021 and December 2023.

Results: A total of 4183 eyes were treated with aflibercept PSF. Thirteen transitory IOP elevations were observed immediately after injection (0.3%). Two eyes had an IOP between 30-35 mmHg, five eyes had an IOP between 36-55 mmHg and three eyes had an IOP > 56 mmHg. The mean IOP was 45.5 mmHg±11.33. Only six eyes needed anterior chamber paracentesis (37.5%). The other patients were treated conservatively (ocular massage and/or IOP-lowering drops). The mean IOP after treatment was 15.71 mmHg±7.20. Visual acuity improved after treatment in all the patients.

Discussion: Compared with other injectors, reports have indicated a higher incidence of moderate and severe IOP spikes with aflibercept PSF. The European Medicine Agency (EMA) has associated this significant increase with incorrect syringe handling, leading to higher injection volumes. Although plunger misalignment seems to play a role in the IOP spikes, some other characteristics of this new injector could play a role. Factors such as syringe diameter, plunger alignment, and injection force may contribute to this issue. The reason some authors found no significant differences in IOP elevation after IVI, with aflibercept PFS, could be due to variations in patient characteristics, which may also play an important role in post-IVI pressure changes.

Conclusions: Intraocular pressure spikes after aflibercept PFS can be explained by injector characteristics. The PFS of aflibercept has a domed plunger. Incorrect alignment between the base of the plunger and the black dosing line could cause an increase in the injected volume. Furthermore, the wider syringe diameter of aflibercept PFS could imply a larger injection force, increasing the risk of IOP elevation. Patient characteristics, such as previous VPP, axial length, or glaucoma history, may also play a role. Further studies are required to develop an ideal intravitreal syringe.

Objective: Intraoperative neuromonitoring (IONM) is nowadays a gold standard during brain tumor resections, but visual function mapping is less frequently performed in clinical practice. This article aims to report two transcortical brain tumor surgery cases affecting optic radiation, where the application of intraoperative visual evoked potentials (VEP) combined with tractography was beneficial to protect the patients' vision.

Methods: Two patients with brain tumors compressing the left posterior visual pathways underwent surgery under general anesthesia using IONM and VEP with neurologic improvement and preservation of vision.

Results: VEP is beneficial in the surgery of intra-axial lesions affecting the posterior visual pathways (optic radiation, visual cortex) and parasellar lesions involving the anterior visual pathways (chiasm). They can also be effectively combined with other mapping methods such as tractography.

Conclusions: According to our experience, IONM with VEPs and neuronavigation with tractography protect visual function in transcortical approaches to resecting tumors near the optic radiation and should be considered a standard monitoring method for such operations.

Aim: To compare the effectiveness of 0.5% and 0.25% proparacaine eye drops in providing topical anesthesia for routine ocular procedures.

Methodology: 137 patients (274 eyes) were included in this study. They were categorized into two groups. Group A patients received 0.5% and Group B received 0.25% proparacaine drops. A single surgeon performed all the procedures. Intraprocedural and postprocedural pain scores, surgeon comfort, supplemental anesthesia, and vital parameters, were noted.

Results: The mean age of the participants was 69.42 years (±12.05). An equal number of procedures were performed (n = 30) for applanation tonometry, lacrimal sac syringing, and A-scan biometry. The other procedures performed were removal of the conjunctiva (n = 5) and corneal foreign bodies (n = 16 per group), corneal scraping (n = 8 per group), and corneal suture removal (n = 18 per group).The mean visual analog pain score during the procedure was 6.9663 in Group A and 8.0803 in Group B (P = 0.66). The mean postprocedural pain score was not significant (P = 0.21). None of the patients required any additional anesthesia during or after the procedure. The average surgeon's experience was 0.152±0.507 in Group A and 0.111±0.402 in Group B (P = 0.07).In Group A, 133 of 137 patients (97.08%), and in Group B, 132 out of 137 patients (96.35%) preferred to use the same anesthetic for future procedures. None of the patients experienced a vasovagal attack or any change in vital parameters.

Discussion: The present study aimed to establish equivalence between two concentrations of proparacaine hydrochloride in which false positive and false negative errors were expected. This is the inherent challenge in the equivalence and inferiority trials. To mitigate these risks, the present study was carefully designed with specific statistical methods, sample size calculation, and rigorous methodology. Nevertheless, it is crucial to recognize that the risk of false positive errors remains, and the results should be interpreted with this in mind.

Conclusion: These findings indicated that 0.25% proparacaine is a viable alternative to the standard 0.5% concentration in routine ophthalmic procedures, with the potential for improved patient comfort.

Aim: To evaluate the efficacy of anti-angiogenic agent Bevacizumab in central retinal venous occlusion treatment.

Objectives: To determine the efficacy of Bevacizumab and ophthalmological parameters such as best corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography (OCT) in central retinal venous occlusion in patients aged less than 30.

Methods: This is a prospective, interventional study, done on 25 eyes of 25 patients aged 30 years and below with central retinal venous occlusion, who received intravitreal Bevacizumab injections for three consecutive months. The mean change in best corrected visual acuity (BCVA), and central macular thickness (CMT) measured by optical coherence tomography were compared and correlated at baseline after 3 months and 6 months follow-up.

Results: The mean best corrected visual acuity and the central macular thickness on OCT improved significantly from 1.08±0.29 and 454.80±114.5µm at baseline to 0.77±0.32 logMAR units and 339.7±82.5µm after 6 months follow up.

Conclusion: The current study showed that intravitreal Bevacizumab at a dose of 1.25 mg and with strict control of systemic contributory parameters seemed to improve BCVA and CMT and macular edema measured at baseline to 3 months and 6 months follow-up after three consecutive monthly injections.

Background: Ocular surface disorder (OSD) is a vexed eye problem and a diagnostic conundrum. Diagnosis has traditionally depended upon symptoms and tests like Schirmer's, TBUT, staining with dyes, and tear meniscus height. Schirmer's test is the most popular. However, the test strips irritate with reflex tearing - producing false high results. Matrix Metalloproteinase 9 (MMP) in the tear is believed to be expressed by stressed epithelial cells of the corneal surface - a key pathology in dry eye disease. This study attempts to compare the results of Schirmer's test and MMP-9 so that the test can individually or severally add to a more definite diagnosis of dry eye disease.

Materials and methods: 100 eyes of 50 symptomatic patients underwent MMP-9 estimation and were divided into two groups (MMP-9+ve and MMP-9-ve). They were then sub-grouped as per DEWS-2007 based on Schirmer test levels and Ocular Symptomatology Score (OSS). The two groups were compared for severity of dry eye based on Schirmer's test and OSS.

Results: Mean Schirmer's value was 12.85 (SD 7.07) for MMP-9+ve and 19.18 (SD 8.94) for MMP-9-ve patients. 80% of patients with severe dry eye and 55.6% of moderate dry eye patients were positive for MMP-9. 85% of the MMP-9 patients had OSS values of 2 or 3.

Discussion: A higher OSDI and positive MMP-9 were shown to be correlated in a statistically remarkable way (p<0.001). The OSDI values of 0-12 for 3/44 (6.8%) positive results, 13-22 for 2/8 (25%) positive results, 23-32 for 4/14 (28.6%) positive results, and 33-100 for 13/35 (37.1%) positive results all showed an increase in MMP-9 positivity along with a rise in the subjective severity of the illness.

Conclusion: MMP-9 compares well with Schirmer's values and DED categories based on Schirmer's. The result pointed towards the usefulness of this test in diagnosing patients who may have not yet manifested symptoms.

Purpose: This article aims to highlight if the central macular retina suffers changes after cataract surgery, and to evaluate the eventually discovered changes regarding persistence.

Material and method: This retrospective study, which lasted over three years (2021-2023), included patients who underwent cataract surgery performed by one surgeon. Spectral-domain optical coherence tomography (SD-OCT) imaging assessed macular changes and measured the central macular thickness.

Results: A total of 240 eyes with diagnosed senile cataract were included in this study. The mean age was 66 years ± 4 years. Preoperative central foveal thickness was 210 ± 27.3 µm, the postoperative thickness on day 1 was 234.3 ± 40.2 µm, at 6 months 230.5 ± 35.2 µm, and the 1-year follow-up 229.2 ± 30.3 µm.

Discussion: Macular changes after cataract surgery are easily confirmed by SD-OCT. The evaluation and monitoring of macular changes can be done by using central macular thickness assessment.

Conclusions: The study provides data from a Romanian pool of patients. The values correlated well with those from similar studies of SD-OCT examinations, but differences were still observed, as there were different devices for performing SD-OCTs.