Romanian journal of ophthalmology最新文献

Objective: To report on the surgical treatment of advanced keratoconus (KC) with stromal scarring in a young male patient with asymmetric disease progression complicated by an intraoperative microperforation of Descemet's membrane (DM) during deep anterior lamellar keratoplasty (DALK).

Methods: The surgical approach consisted of manual descemetic DALK (dDALK), further complicated with DM microperforation. Anterior segment ocular coherence tomography (AS-OCT) was used intraoperatively to locate the site and size of the tear. The surgeon decided not to convert to penetrating keratoplasty (PK), despite stromal scarring, significant ectasia, and variable corneal thickness, but rather to continue the dissection of the stromal bed with maximum precaution.

Results: Postoperatively, visual results improved and reached the best corrected visual acuity of 20/20. Choosing a proper graft dimension and reaching anatomical separation up to the DM were the keys to obtaining such a positive refractive outcome.

Discussions: DALK, the most advanced treatment for KC, was chosen as the ideal option for this young patient due to its advantages over PK: reduced rejection risk, fewer complications, quicker steroid tapering, and faster recovery. However, its steep learning curve remains a challenge for surgeons.

Conclusions: Despite manual DALK being a more challenging and time-consuming procedure than PK, careful dissection of the stromal bed and diligent assessment of the affected DM can provide a better and safer outcome for selected patients. Even if initial postoperative visual results are impressive, the surgeon must pay attention to the patient's future check-ups to swiftly correct any possible complications.

Purpose: To compare glaucoma suspects' 24-hour blood pressure pattern with healthy subjects and the Retinal Nerve Fibre Layer (RNFL) thickness among dippers and non-dippers.

Materials and methods: We included 100 patients diagnosed as glaucoma suspects in the study group and 100 age and gender-matched controls. Twenty-four-hour ambulatory blood pressure (BP) was measured using an automated BP monitoring device for mean systolic BP (SBP), mean diastolic BP (DBP), and mean arterial pressure (MAP). We classified patients into non-dippers, dippers, and overt dippers based on reduction in nocturnal MAP. Structural damage to the optic nerve head was studied by measuring the superior, inferior, and average RNFL thickness on Optical Coherence Tomography (OCT).

Results: Glaucoma suspects showed lower values of day, night, and mean SBP values but higher values of day, night, and mean DBP values when compared with controls, and these were statistically significant. ANOVA and Post Hoc test (Bonferroni) analysis among glaucoma suspects showed that overt dippers had statistically significant superior, inferior, and average RNFL thinning (average 86.20 ± 12.200 µm) as compared to non-dippers and dippers (average 105 ± 11.183 and 102.19 ± 9.582 µm respectively). Pearson's correlation, used to assess the relationship between the nocturnal dip in BP and average RNFL thickness, showed a negative correlation (r = -0.396, p < 0.001).

Discussion: Our study found a statistically significant decrease in systolic blood pressure day and night and an increase in diastolic blood pressure day and night in glaucoma suspects compared to normal. Mean arterial pressure did not show any significant difference, and the data obtained is comparable with previous studies. The corresponding retinal nerve fiber layer changes noted in dippers and non-dippers were also similar to those in the existing literature. This study, however, has a shortcoming of not including intraocular pressure-related nerve head changes.

Conclusion: Nocturnal BP reduction was associated with structural damage to the optic nerve head in glaucoma suspects, suggesting systemic vascular etiology in the damage progression. ABP monitoring can help detect those glaucoma suspects who are mainly likely to progress so that they can be on close follow-up.

Objective: To present a socioeconomic analysis of glaucoma patients regarding glaucoma treatment options.

Methods: This is a prospective, comparative cross-sectional study. One hundred twenty glaucoma patients were divided into three groups. In group one, 40 patients were treated with topical therapy; group two consisted of 40 patients who had previously undergone laser therapy for glaucoma treatment; and group three had 40 patients who had undergone glaucoma surgical therapy. Data were collected using questionnaires. The data obtained by the survey were entered into the database and analyzed in the statistical program "SPSS". The difference between the examined groups was analyzed using the "Mann-Whitney test", and the statistical significance of the difference was analyzed using the "Hi-square test".

Results: Out of 120 patients, 65 were females, and 56 were males with a mean age of 55,6 ± 11,9 years with a range of 24-83 years. Based on the type of treatment, on average, the youngest were patients in group 2 (51.2 ± 8.3 years, range 31-66 years), followed by group 3 (55.2 ± 12.6 years, range 29-82 years), and the oldest were patients in group 1 (60.3 ± 12.6 years, range 24-83 years). Statistical analysis using the "Man-Whitney U" test showed that there was a statistically significant difference in the average age by type of treatment (p < 0.05). Other socioeconomic factors did not show statistically significant differences among groups.

Discussion: Our study highlighted the interplay between socioeconomic factors and treatment choices in glaucoma management. Younger, more informed patients were more likely to opt for newer therapies like laser treatment, while older patients often relied on traditional methods. Identifying these patterns is crucial for tailoring screening programs, optimizing treatment protocols, and improving overall patient outcomes.

Conclusion: Our study demonstrates few socioeconomic differences between patients in different types of glaucoma treatment.

Aim: Completing circular uniform anterior capsulorhexis in intumescent white cataracts is challenging for all cataract surgeons. Numerous techniques have been described to get a circular capsulorhexis and prevent perpendicular linear tears in the anterior capsule.

Methods: 570 cases of white total cataracts were selected for this retrospective clinical study. In this technique of Star CanVac rhexis, the anterior lens capsule was nicked using a 26 G cystotome, and multiple centripetal tears were made in the center to create a small star-shaped opening. A vacuum was used to develop capsulorhexis, and a 25 G flat tip cannula attached to a 5 ml syringe half filled with balanced salt solution (BSS) was used to build capsulorhexis. The piston of the 5 ml syringe was withdrawn to create a vacuum to hold the free capsular flap. It was then directed circularly to get a round capsulorhexis. Oozing liquefied cortex was aspirated simultaneously with the same cannula.

Results: This technique was successfully executed in 564 eyes. Six eyes had anterior capsular tears, 2 of which extended into the posterior capsule.

Discussion: Intumescent cataracts often complicate the rhexis procedure due to increased lens volume and pressure. Over time, different methods have been refined to handle the pressure variation between the anterior chamber and the intralenticular area, such as mini-rhexis, double rhexis, sewing needle capsulotomy, and phaco capsulotomy. The primary goal of these procedures is to first reduce the elevated intralenticular pressure. Star CanVac capsulotomy facilitates equal pressure between the anterior chamber and the lenticular compartment, effectively reducing the risk of accidental capsular tears. Advantages of this approach include completing rhexis in one step, removing the liquefied cortex simultaneously, and relying on easily accessible instruments.

Conclusion: Star CanVac capsulorhexis is an effective, safe, and alternative technique to conventional capsulorhexis in total white cataracts.

Orbital pseudotumor is nonspecific orbital inflammation (NSOI). It is a benign, non-infectious, space-occupying inflammatory lesion of the orbit. NSOI can affect various tissues in the orbit, such as the lacrimal gland and extraocular muscles. The most common classification is based on clinical presentation. Bacteria, viruses, fungi, or parasites can cause infectious orbital inflammation. It is a diagnosis of exclusion after ruling out inflammatory, infectious, and neoplastic causes. We present a case of a male in his sixties who presented with progressive pain, swelling, blurry vision, and forward protrusion of his right eye. He had no history of trauma or recent illness. His general physical and systemic examination was within normal limits. His ocular examination showed eyelid edema, erythema, eccentric proptosis, and a mature cataract in his right eye. His left eye showed a lenticular opacity. CT orbit revealed a homogenous isodense lesion observed without any globe distortion. A diagnosis of orbital pseudotumor was made. The patient was treated with oral corticosteroids, and an excision biopsy was done, resulting in symptomatic improvement and regression of inflammation at follow-up. In complex cases of inflammatory orbital pseudotumor, particularly those with granulomatous inflammation, some initial success has occurred with monoclonal antibodies against tumor necrosis factor (TNF)-alpha or with lymphocyte depletion using rituximab. Our patient, however, responded well to an excision biopsy and a course of oral steroids.

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.