Romanian journal of ophthalmology最新文献

Objective: To evaluate the efficacy of SF₆ versus C₃F₈ gas tamponade for large idiopathic macular holes.

Materials and methods: The study included 60 eyes with large macular holes managed with pars plana vitrectomy, inverted internal limiting membrane flap, and gas tamponade with either SF₆ group (30 eyes of 30 patients) or C₃F₈ group (30 eyes of 30 patients). Based on minimal linear diameter (MLD), subjects were further classified into two groups: large (400 - <600 μm) or very large (>600 μm); compared for anatomical closure, improvement in best corrected visual acuity, and development of complications.

Results: Both groups were comparable in baseline features of age, sex, etiology, and size of hole, with significantly larger MLD (708.2 ± 154.62 vs. 622.6 ± 114.08 μm; p=0.017) and a poorer macular hole index (0.36 ± 0.06 vs 0.31 ± 0.04; p=0.003) in the SF₆ group. Macular hole closure was achieved in all eyes in the C₃F₈ group and 29 of 30 eyes in the SF₆ group. Significant improvement was observed in vision in both groups from baseline at six months post-surgery. Cataract development/progression was observed in one patient in both groups, with no significant increase in intraocular pressure. In sub-groups of very large macular holes, despite significantly larger MLD and poorer macular hole index in the SF₆ group, structural and functional outcomes were comparable to C₃F₈.

Discussion: The management of large macular holes is a critical challenge as these conditions can severely impair central vision and quality of life for affected patients. Surgical intervention using tamponade agents is a standard approach to promote hole closure and retinal healing. Both SF₆ and C₃F₈ have demonstrated effectiveness in promoting macular hole closure. While the evidence is somewhat mixed, several studies indicate that SF₆ may be associated with quicker visual recovery in the early postoperative period. However, the long-term visual outcomes are often comparable between the two agents. In the present study, we compared the efficacy of both these tamponade agents for large and very large idiopathic macular holes.

Conclusions: Both SF₆ and C₃F₈ tamponades are equally effective in the treatment of large macular holes. However, despite poorer pre-operative prognostic factors like larger MLD and macular hole index, the efficacy and safety of SF₆ gas tamponade are comparable to C₃F₈ tamponade.

Objectives: Cataract surgery in patients with microcornea and ocular coloboma poses unique surgical and postoperative challenges. The presence of a small corneal diameter, abnormal ocular anatomy, and the risk of postoperative complications require a highly individualized approach. This case highlights the difficulties encountered in biometry measurement and the development of capsular contraction syndrome following phacoemulsification surgery.

Case report: A 38-year-old male with bilateral ocular coloboma, microcornea, and nystagmus presented with progressive vision loss. Phacoemulsification with intraocular lens (IOL) implantation was performed in the right eye. Preoperative planning included keratometry by corneal topography and axial length confirmation with both optical and ultrasonic biometry. Despite meticulous planning, a postoperative refractive error and rapid anterior capsular fibrosis developed. Although neodymium: YAG capsulotomy was recommended, the patient declined the intervention.

Discussion: In eyes with microcornea and coloboma, accurate biometry is often hindered by structural abnormalities, increasing the risk of refractive surprises. Additionally, the risk of intraoperative complications such as capsulorhexis extension, zonular dialysis, or vitreous prolapse is heightened. Postoperatively, capsular contraction syndrome may develop rapidly, especially if subcapsular epithelial cells are not adequately removed. This case emphasizes the need for careful intraoperative management and vigilant postoperative monitoring.

Conclusion: Cataract surgery in patients with microcornea and coloboma requires thorough preoperative assessment, surgical expertise, and tailored postoperative care. Awareness of potential complications such as biometric inaccuracy and capsular contraction is essential to optimize outcomes in these complex cases.

Purpose: This study aimed to evaluate the stability of post-lens tear film (PoLTF) and pre-lens tear film (PLTF) in three different silicone hydrogel contact lenses (CLs) using optical coherence tomography (OCT) and multifunctional topography.

Materials and methods: A total of 158 participants were assigned to three groups based on the CL material: Group 1 (Lotrafilcon B), Group 2 (Senofilcon A), and Group 3 (Samfilcon A). Non-invasive average break-up time (NIAvgBUT) of the PLTF was measured after a few hours of lens wear during the first visit and after 2-4 weeks of continued use in the second visit. PoLTF thickness was assessed in five corneal quadrants using OCT, measured both indirectly and manually.

Results: The mean participant age was 21.9±5.0 years. The NIAvgBUT of the PLTF was significantly higher at the first visit than at the second visit (9.5±2.9 s vs. 8.3±2.1 s, p=0.0001). Similarly, the PoLTF thickness in the central corneal area showed a significant reduction after 2-4 weeks of lens wear (p=0.001).

Discussion: Our results emphasize the clinical importance of monitoring both pre-lens and post-lens tear film parameters during routine follow-up visits. By integrating OCT-based measurements into daily practice, clinicians may identify early tear film instability and prevent contact lens intolerance. This is particularly relevant for younger patients who are at risk of long-term ocular surface changes due to extended lens wear.

Conclusion: A significant decrease in PLTF stability (NIAvgBUT) and PoLTF thickness in the central corneal area was observed after 2-4 weeks of CL use. These findings suggest that prolonged CL wear affects tear film stability and surface wettability, highlighting the importance of monitoring these changes over time.

Aim: To compare the inflammation and hypoxia-related parameters in the first 24-hour complete blood count (CBC) and arterial blood gas (ABG) analysis among infants diagnosed with retinopathy of prematurity (ROP), those requiring treatment for ROP, and those without any stage of ROP.

Methods: Three hundred and thirty infants screened for ROP with CBC, ABG analysis, and albumin results in the first 24 hours after delivery were included. In addition to individual cell counts on CBC and hypoxia indicators in ABG analysis, systemic immuno-inflammatory index (SII), systemic inflammatory response index (SIRI), pan-immune inflammation value (PIV), and hemoglobin, albumin, lymphocyte, and platelet (HALP) values were calculated and compared between the study groups.

Results: No significant differences were observed in SII, SIRI, PIV, and HALP scores among any groups, whether for ROP diagnosis or treatment requirement. Multivariate analysis showed significant differences in red blood cell count (RBC) (p=0.001), hemoglobin (HGB) (p=0.001), mean corpuscular volume (p<0.001), and mean corpuscular hemoglobin concentration (p<0.001) between infants with and without ROP. RBC (p=0.001) and HGB (p=0.002) also significantly differed between neonates needing treatment and those not, but were not independent predictors of treatment necessity in the multivariate analysis. No significant differences in ABG parameters were found among the groups for either ROP diagnosis or treatment need.

Discussion: This study contributes to the literature by being the first to evaluate emerging inflammatory indices such as SIRI, PIV, and HALP in the context of ROP, demonstrating that these parameters from the initial blood draw do not provide predictive value. While erythrocyte-related markers showed some associations, they were not independent predictors of treatment need, highlighting the importance of cautious interpretation of early hematologic findings. These results underscore that the very first blood sample may reflect transitional neonatal physiology more than disease-specific mechanisms, and they encourage future studies to explore longitudinal sampling for more reliable biomarkers.

Conclusion: The novel inflammatory markers, SII, SIRI, PIV, and HALP score, obtained from blood tests within the first 24 hours of neonatal life, do not appear to be predictive of ROP development or the need for treatment.

We present a rare case of a middle-aged female diagnosed with Glanzmann Thrombasthenia who developed panophthalmitis following platelet transfusion. The patient presented with acute vision loss, proptosis, and ocular pain in the right eye following a platelet transfusion. Imaging confirmed panophthalmitis, while cultures were inconclusive. The patient was treated with intravenous and fortified topical antibiotics along with platelet transfusions. Despite aggressive management, the right eye progressed to phthisis bulbi. Systemic infection was controlled, and ocular pain and swelling significantly reduced. The patient was managed with systemic and fortified topical antibiotics under the care of a multidisciplinary team, including ophthalmologists, hematologists, and infectious disease specialists. This report highlights the diagnostic challenges, management dilemmas, and the importance of an interdisciplinary approach in managing infectious complications in patients with inherited platelet function disorders.

Objective: To report the diagnosis and therapeutic approach in the case of a patient with conjunctival lymphoma.

Case presentation: A 54-year-old caucasian female presented to the hospital with a painless conjunctival mass in the right eye of at least three months duration. The ophthalmological examination showed a "salmon patch" conjunctival lesion in the inferior fornix. An incisional biopsy of the conjunctival lesion was performed, and the histopathological examination confirmed the diagnosis of extranodal marginal zone B-cell conjunctival lymphoma. The CT scan showed no systemic involvement. It was decided to start radiotherapy with brachytherapy.

Discussion: Conjunctival lymphoma is a rare ocular malignancy arising from polyclonal proliferation of lymphocytes. The most common subtype is extranodal marginal zone B-cell lymphoma (EMZL), followed by diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and T-cell lymphoma (TL). Clinical manifestations are non-specific; they usually present as a unilateral or bilateral painless, salmon-pink conjunctival lesion, often without systemic symptoms. Definite diagnosis requires conjunctival biopsy and relies on histopathology and immunohistochemistry, with molecular profiling playing an increasing role in risk stratification. Treatment strategies include: radiotherapy, immunotherapy (Interferon-α2b, Rituximab), chemotherapy, and antibiotherapy. Prognosis is generally favorable, with high survival rates, especially in localized cases.

Conclusions: Conjunctival lymphoma can be easily overlooked during a routine examination; therefore, a thorough clinical evaluation, advanced imaging, histopathological, and immunohistochemical analysis are essential for appropriate management. Systemic staging and an interdisciplinary approach involving ophthalmology, medical oncology, and radiation oncology are necessary for optimal treatment planning and outcome.

Aim: Myopia is a growing endemic, especially in the young age groups (E3: 47.2% in 25-29 years old), which is projected to affect up to a staggering 50% of the world's population in the following decades. Transepithelial photorefractive keratomileusis is a novel single-laser refractive surgery that offers advantages in simplicity and corneal biomechanics.

Methods: The study reported Trans-PRK results on 71 patients (a total of 137 eyes) with myopia and myopic astigmatism.

Results: Mean uncorrected visual acuity at 6 months was 0.02054 logMAR (0.9689 decimal) and at 1 year, 0.02 logMAR (0.9683 decimal); both values were superior to preoperative corrected visual acuity (CDVA). No statistical difference was found between 1 or more months postoperative UCVA and preoperative CDVA (p=0.848-0.723). The efficacy index was over 90% at 1 month and onwards. The safety index was 97% at 1 week and closer to 100% at later follow-up. Cumulative VA 20/20 was achieved in 82.6-89.2% of patients, and 20/25 in 94.2-95.1% of patients. Spherical refraction was +0.13 from plano at 1 month and -0.13 at 6 months; -0.17 at 1 year. Spherical equivalent accuracy was within ±1 D in 87.2% to 95.1% of patients. Vectorial correction index (ideal 1) indicated slight initial overcorrection at 1.19 at 1 month, 1.1 at 6 months, and an almost ideal 1.01 at 1 year; difference vector measured 0.11-0.19D.

Discussion: The study reported excellent results using Trans-PRK for the treatment of myopia, as measured by cumulative postoperative uncorrected distance visual acuity, with refractive results aligning with those of comparable studies. Vectorial astigmatism correction was excellent, especially at the 1-year postoperative follow-up, approaching the ideal value. Thus, Trans-PRK offers the expected high-quality correction while presenting biomechanical and simplicity advantages over comparable techniques.

Conclusions: Trans-PRK achieved excellent refractive results, a safe profile, and nearly ideal vectorial correction at later follow-up.

This open prospective study aimed to evaluate the dynamics of progression of early and intermediate age-related macular degeneration (AMD) against the background of continuous use of the nutraceutical formula AREDS2, which includes omega-3 polyunsaturated fatty acids (PUFAs), vitamin D, resveratrol, and photobiomodulation (PBM), over a 5-year follow-up in patients from Ukraine and Moldova. Examining 126,400 patients, 163 patients (304 eyes) with early and intermediate stages of AMD were treated (5-year follow-up). Patients were divided into two groups. Patients in the 1st group (149 eyes) were prescribed a nutraceutical formula based on AREDS2 with omega-3 PUFAs, vitamin D, and resveratrol (Nutrof®Forte 1 capsule once a day continuously). The second group (155 eyes) included patients who irregularly took various vitamin-antioxidant complexes. All patients underwent PBM every 6 months. The five-year prevalence of early and intermediate AMD was estimated using data from leading ophthalmological centers in Ukraine (Odesa - 7.1%, Kharkiv - 6.6%) and Moldova (6.3%). AMD progression in the multivariate Cox regression model over five years showed a 3.24-fold reduction in relative risk (95% CI: 2.15-4.79, p=0.000) for patients with early and intermediate AMD who regularly took the recommended nutraceutical (compared to those who irregularly took various vitamin-antioxidant complexes). Patients with early and intermediate AMD are recommended to undergo courses of PBM every six months. Additionally, it is crucial to address cardiovascular issues and consistently use the AREDS2 nutraceutical formula. Adherence to these recommendations can reduce the likelihood of disease progression by at least 3.24 times over the next 5 years.

Ampiginous choroiditis is a disease that includes features of both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. This article presents two patients who were diagnosed with ampiginous choroiditis in our clinic. A 28-year-old female patient presented to our clinic with blurred vision that had persisted for 2 weeks. Her best corrected visual acuity (BCVA) was 20/20. Her medical history included a COVID-19 infection about 1 month before. Fundoscopic examination revealed multiple grayish-yellow lesions with irregular borders and pseudopodial extensions, involving the posterior poles of both eyes diffusely. Fundus findings and multimodal imaging, including optical coherence tomography, fundus autofluorescence imaging, and fundus fluorescein angiography, indicated ampiginous choroiditis. The patient was treated with oral steroids and azathioprine. The second patient was a 34-year-old male under follow-up in the neurology clinic, with a diagnosis of transverse myelitis, who was referred to us for an ophthalmologic consultation. The patient had a COVID-19 infection a few weeks prior. The patient had no visual symptoms in our first examination, and his BCVA was 20/20. Fundus examination and multimodal imaging were associated with ampiginous choroiditis. The patient's ongoing treatment was initiated by neurology, including oral steroids and azathioprine therapy. This treatment regimen was continued, and follow-up was conducted. In conclusion, these two cases suggest that the SARS-CoV-2 virus may serve as an immunogenic trigger for the development or reactivation of ocular inflammatory diseases in individuals predisposed to white dot syndromes.