Romanian journal of ophthalmology最新文献

Alport syndrome (AS) is a genetic disease characterized by hereditary nephritis, sensorineural hearing loss, and ocular anomalies. The most common ocular findings associated with AS include anterior lenticonus, retinal dot-fleck configuration, and corneal posterior polymorphism. Anterior lenticonus is 8 times more common in men with AS than in women. This case report evaluated the clinical and optical results obtained after phacoemulsification (PHACO) surgery and intraocular lens (IOL) implantation performed for bilateral anterior lenticonus due to AS. A 35-year-old male patient had complained of progressively decreasing vision for 10 years. The patient's ophthalmologic examination revealed bilateral anterior lenticonus and nuclear sclerosis. Continuous curvilinear capsulorhexis was applied in the anterior capsulorhexis method. Phacoemulsification surgery was performed using a high-viscoelastic material, starting the anterior capsulorhexis from the mid-periphery. The surgery was completed without anterior and posterior capsular rupture. Optimal postoperative refraction was achieved due to the IOL calculation performed using the traditional SRK-T formula. As a result, it has been shown that successful and uncomplicated results can be achieved with careful surgical technique and appropriate IOL selection in anterior lenticonus surgery due to AS.

Primary mucinous carcinoma (PMC) of the eyelid is an exceedingly rare malignancy that often presents as an innocuous, slow-growing lesion, leading to frequent misdiagnosis as a benign entity. This diagnostic challenge can lead to delayed treatment and potential recurrence. We report a unique case of PMC in a patient who presented with a clinically benign-appearing lesion, initially considered for differential diagnoses such as keratoacanthoma, epidermoid cyst, and pilomatrixoma. A diagnostic surprise emerged when histopathological evaluation confirmed PMC. Despite recommendations for wide local excision, the patient opted for observation due to concerns about postoperative morbidity. Over a two-year follow-up period, no recurrence was noted. This case highlights the deceptive presentation of PMC, the importance of histopathological confirmation, and the role of individualized patient management. A review of the literature further underscores the rarity of this entity and the necessity for long-term surveillance.

Purpose: To highlight serious adverse effects regarding intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, which is widely used for the treatment of retinal diseases, including two cases of post-injection endophthalmitis, one of which was complicated by rhegmatogenous retinal detachment, and one case of secondary cataract following a potentially unnecessary injection.

Methods: A retrospective analysis of three cases that developed complications after intravitreal anti-VEGF therapy.

Results: All cases resulted in a decline in best corrected visual acuity (BCVA) that required additional surgical procedures.

Discussion: While intravitreal anti-VEGF therapy has become the standard in the treatment of various retinal pathologies, it is not without risks. This case series presents significant adverse outcomes, emphasizing the potential for severe anatomical and functional consequences. As the global volume of anti-VEGF intravitreal injections increases, so must our commitment to patient safety, precision in diagnosis, and ethical decision making.

Conclusion: Although generally safe and commonly used in clinical practice, physicians must be aware of the risks of anti-VEGF therapy and must remain vigilant regarding patient selection and risk-benefit considerations.

Purpose: To evaluate the clinical performance of two monofocal aspheric intraocular lenses (IOLs) to determine their position in the capsular bag after implantation.

Methods: This retrospective study collates data from the medical records of patients who underwent cataract surgery and were implanted with two different hydrophobic aspheric monofocal IOLs. A total of 6 visit data were considered in the study, out of which four follow-up visits were on day 1, 7, 30, and 180 postoperatively. The investigational variables included IOL tilt and decentration, uncorrected and best corrected visual acuity (UCVA and BCVA), contrast sensitivity, manifest refraction, intraocular pressure, and posterior capsule opacification.

Results: A total of 85 subjects' medical records were screened. Nineteen subjects discontinued the study due to loss to follow-up. Thirty subjects' medical records were enrolled in the IOL 1 arm, and 36 subjects' medical records were enrolled in the IOL 2 arm. There were no statistically significant differences in vertical and horizontal IOL tilt and decentration results between IOL 1 arm and IOL 2 arm. Within-group analysis revealed a significant difference in BCVA at all visits from baseline for both the IOL 1 and IOL 2 arms. In the between-group analysis, there were no significant differences in BCVA at any visit between the IOL 1 and IOL 2 arms.

Discussion: Tilt and decentration of IOL may occur secondary to complicated cataract surgery or following uneventful phacoemulsification. IOL tilt up to 2-3 degrees and decentration of 0.2-0.3 mm are common and not clinically significant. Larger amounts of decentration and tilt deteriorate the optical performance of the IOLs, subsequently affecting the patients' vision.

Conclusion: IOL vertical and horizontal tilt and decentration found in the current study are within the limits reported in the literature. The position of these two lenses in the capsular bag remains very stable at day 180 after implantation.

Purpose: To evaluate the combination therapy of sustained-release dexamethasone implant (DI) with/without prompt laser in patients with macular edema secondary to BRVO.

Methods: Forty eyes of 40 patients with BRVO were randomized into two groups. Group 1 received a single dose of intravitreal injection of DI, and Group 2 received a single dose of DI followed by prompt laser treatment on the 7th day. Primarily, outcome measures noted at 3, 6, 9, and 12 months' follow-up were improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome measures were change in intraocular pressure (IOP), color vision (CV), and contrast sensitivity (CS).

Results: Mean age of patients in Groups 1 and 2 was 60.30 + 11.59 years and 52.30 + 10.86, respectively. Mean BCVA (logMAR units) in Groups 1 vs. 2 was 0.72 vs. 0.67 at baseline (p=0.286), 0.38 vs. 0.34 at 3 months (p=0.99), 0.29 vs. 0.36 at 6 months (p=0.006), 0.23 vs. 0.36 at 9 months (p=0.001), and 0.19 vs. 0.38 at 12 months (p=0.001), respectively. Mean CMT (μ) in Groups 1 and 2 was 519.5 and 491.1 at baseline (p=0.33), 285.8 and 334.2 at 3 months (p=0.035), 343.1 and 328.9 at 6 months (p=0.294), 309.6 and 328.7 at 9 months (p=0.009), and 283.4 and 316.42 at 12 months (p=0.231), respectively. CS and CV were significantly better in Group 1 as compared to Group 2 at 12 months, while IOP was similar.

Discussion: Our study demonstrated that prompt addition of laser therapy to sustained-release dexamethasone implant did not confer additional benefit in BRVO-related macular edema and might, in fact, compromise long-term visual outcomes. While both groups showed comparable early improvement, monotherapy with dexamethasone resulted in superior BCVA, color vision, and contrast sensitivity at 12 months. These findings suggested that concurrent use of steroids and prompt laser might interfere with retinal healing. Differences in outcomes compared to earlier studies might relate to the timing of laser application, as deferred laser appears to be more effective. Larger trials with longer follow-up are warranted to confirm these observations.

Conclusion: Combination therapy of laser with intravitreal sustained-release DI leads to poorer visual outcomes and may indicate a negative impact of steroid therapy on healing.

We report a case of a young patient in his mid-20s who underwent retinal detachment surgery four years before. The patient was lost to follow-up for 4 years. At present, the patient presented to our centre with loss of vision in the operated eye. Examination revealed an oil-filled globe with no signs of oil emulsification. Instead, the oil had lost its transparency and had become opacified. The oil sample was removed and subjected to Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric analysis (TGA), and mass spectrometry analysis to ascertain the cause of oil opacification.

Vitamin D plays a crucial role in ocular health, particularly in the function and protection of the retina. This fat-soluble vitamin is synthesized in the skin in response to UVB radiation and can also be obtained from dietary sources. Research indicates that vitamin D has neuroprotective properties, which are essential for retinal cell survival and function. The active form of vitamin D, calcitriol, has been shown to modulate inflammation and oxidative stress in retinal tissues, thus potentially preventing retinal degeneration diseases such as age-related macular degeneration (AMD) and diabetic retinopathy. Furthermore, vitamin D receptors are expressed in various retinal cells, suggesting that vitamin D directly influences retinal physiology. Deficiency in vitamin D has been associated with an increased risk of chronic eye diseases, emphasizing the importance of maintaining adequate vitamin D levels for preserving retinal health. Ongoing studies are needed to elucidate further the molecular mechanisms underlying the protective effects of vitamin D on the retina and to explore its therapeutic potential in retinal disorders.

Objectives: To present the case of a premenopausal woman with long-standing type 1 diabetes mellitus and diabetic retinopathy, in whom severe vitamin D deficiency was associated with poor metabolic control and depressive symptoms, and whose ocular and systemic condition spectacularly improved after vitamin D supplementation.

Material and methods: We describe the clinical history, laboratory findings, and ophthalmological assessments of a 42-year-old woman from an urban area of Dobrogea, Romania. The patient had a 28-year history of type 1 diabetes mellitus complicated with proliferative diabetic retinopathy, early-stage chronic kidney disease, and diabetic polyneuropathy. Initial laboratory evaluation indicated severe vitamin D deficiency (8 ng/mL), marked glycemic variability (documented by continuous glucose monitoring), and microalbuminuria.

Results: Following six months of vitamin D supplementation, serum levels increased to 40 ng/mL, depressive symptoms improved, and the patient became more adherent to nutritional therapy. Ophthalmological follow-up: Optical Coherence Tomography (OCT) retinal findings showed stabilization of retinal neovascularization.

Discussion: The distinctiveness of this case arises from the coexistence of multiple risk factors, including long-duration type 1 diabetes with microvascular involvement, pronounced vitamin D deficiency despite favorable sun exposure conditions, premenopausal status under HRT, and retinal changes objectively documented before and after supplementation.

Conclusions: This case supports the hypothesis that vitamin D may have a protective role against retinal neovascularization in diabetic retinopathy, possibly by reducing inflammation and angiogenesis trend, and indirectly by improving metabolic control.

Objective: Refractive management in keratoconus is a challenging task. The study aimed to evaluate the results of Toric Implantable Phakic Contact Lenses in providing visual rehabilitation for patients with stable keratoconus after one year of primary procedures, including collagen cross-linking, topo-guided photorefractive keratectomy, and intracorneal ring segments.

Methods: This retrospective cross-sectional interventional study was conducted at a tertiary eye care hospital in South India. Sixty-four patients with 86 eyes were included, and all of them received Toric Implantable Phakic Contact Lens (TIPCL) implantation. All patients were subsequently divided into three subgroups: collagen cross-linking (CXL), intracorneal ring segments (INTACS+CXL), and Topographically Guided photorefractive keratectomy (TGPRK+CXL). Patients were followed up regularly for a period of one year.

Results: We included data from 64 patients with 86 eyes, with an average age of 30.67 ± 7.96 years. Reduction in the mean spherical equivalent, sphere, and cylinder values was observed across all three subgroups, and the results were statistically significant. There was considerable improvement in uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BDVA). At the end of one year, 75.3% of eyes achieved UDVA improvement of more than 3 lines. The average safety index was 0.77, and the efficacy index was 1.20.

Discussion: TIPCL implantation proved to be a safe and effective option for correcting residual refractive error in keratoconus patients after stabilization procedures. Our results align with previous reports on phakic IOLs, demonstrating comparable safety and efficacy indices. The study emphasizes the importance of careful patient selection, as outcomes are strongly influenced by baseline refraction, corneal irregularity, and disease stability. While complications such as lens rotation, shallow anterior chamber, and cataract were rare, they emphasize the need for meticulous surgical planning and postoperative monitoring. Compared with existing literature, this is among the first studies to analyze outcomes across three stabilization subgroups, underscoring TIPCL as a viable, reversible option for patients with stable keratoconus.

Conclusion: The implantation of Toric Implantable Phakic Contact Lens (TIPCL) is a valuable option for visual rehabilitation in keratoconus patients.

Choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) represents a significant global cause of visual impairment. Contemporary therapeutic approaches for neovascular AMD focus on inducing regression of CNV by inhibiting critical growth factors involved in angiogenesis. For nearly two decades, vascular endothelial growth factor (VEGF) has been the principal therapeutic target, with multiple intravitreally administered agents developed to achieve anatomical restoration and improved visual outcomes through sustained dosing.