Romanian journal of ophthalmology最新文献

Purpose: This study aims to renew the management of viral epidemic conjunctivitis by introducing a one-time, low-concentration ocular surface povidone-iodine (LOS-pI) wash.

Methods: Among the 3,002 patients screened, 1,328 with acute conjunctivitis were categorized into two groups. Group A (664 patients) underwent a 1% betadine wash in addition to the standard treatment protocol (Eye Lubricant + Moxifloxacin 0.5% eyedrops), while Group B (664 patients) followed the standard protocol alone. In cases of membranous conjunctivitis, manual membrane removal was performed. Treatment responses were observed daily for three days, followed by weekly assessments for two additional weeks.

Results: Co-infection of adenovirus with enterovirus was found to be the main cause, often accompanied by staphylococcal superinfection. Group A showed complete resolution of conjunctival inflammation, with a remarkable 76.05% of patients experiencing improvement within an average of 2.6±0.51 days, in contrast to Group B's average of 7.5±1.1 days (p <0.05). Additionally, 13% of Group B patients with recalcitrant conjunctivitis significantly recovered following the 1% betadine wash. Complications (subconjunctival hemorrhage: 34.04%, superficial punctate keratitis: 6.02%) were more prevalent in Group B.

Discussion: The authors hypothesized that a single wash with betadine is sufficient to reduce disease duration and prevent secondary infections and complications. The core strength of our study lies in its substantial sample size. To our knowledge, no similar previous research has been conducted, on such a larger scale.

Conclusion: Viral conjunctivitis brings discomfort, work absenteeism, and financial burden. A single low-concentration betadine wash expedites recovery and reduces complications in acute infective conjunctivitis. This approach significantly enhances patient outcomes and alleviates the socioeconomic impact of the condition.

Objective: Phacoemulsification is the predominant method for cataract surgery, but complications like lens nuclei dislodgment into the vitreous cavity pose significant risks, including inflammation, glaucoma, retinal tears, and vision loss. Traditional management involves pars plana vitrectomy with phacofragmentation, which can increase the risk of retinal damage due to repulsive forces. This study tests whether the OZil phacoemulsification handpiece, employing torsional movement, offers a safer alternative by minimizing repulsive forces and reducing surgical duration compared to the traditional phacofragmatome.

Methods: This prospective study, conducted in a tertiary care hospital in eastern India from January to June 2023, enrolled 40 patients with nucleus dislocation during cataract surgery. Patients were randomized into Group 1 (traditional phacofragmatome) and Group 2 (OZil handpiece). Primary objectives included comparing the duration of surgery and intraoperative complications. Secondary objectives assessed postoperative best-corrected visual acuity (BCVA), surgical site safety, and cystoid macular edema (CME) incidence.

Results: Group 2 demonstrated significantly shorter surgical durations (110±2.54 seconds) compared to Group 1 (152±2.23 seconds, p < 0.001). The frequency of nucleus falls was considerably lower in Group 2 (p < 0.001). Postoperative BCVA and CME incidence showed no significant differences between groups. Multiple regression analysis confirmed the OZil handpiece significantly reduced surgical duration (β = -0.40, p < 0.001) without compromising safety.

Discussion: The OZil handpiece's rotational cutting mechanism offers a significant advantage in reducing surgical time while improving the followability of lens fragments, as compared to the traditional phacofragmatome. It addresses one of the key limitations of phacofragmentation by minimizing fragment displacement, where repulsive forces can complicate the procedure. Although both techniques showed similar safety profiles, the OZil handpiece's operational efficiency makes it a promising alternative for managing posteriorly displaced lens fragments in complex cases.

Conclusions: The OZil phacoemulsification handpiece significantly enhances surgical efficiency and safety in nucleus drop surgeries. Its integration into existing phacofragmatome systems can lead to major advancement in the ophthalmic surgical armamentarium, ensuring improved patient care.

Aim: The usefulness of the Inferior>Superior>Nasal>Temporal (ISNT) rule for the neuroretinal rim (NRR) has been widely used in differentiating normal eyes from glaucoma, but only a few studies have assessed whether this classical ISNT rule applies to the retinal nerve fibre layer (RNFL). This study aimed to determine the applicability of the ISNT rule for the peripapillary RNFL thickness in normal eyes using Spectral Domain Optical Coherence Tomography (SD-OCT) and assess if variants of the ISNT rule apply.

Methods: A cross-sectional study was conducted on 120 eyes of 62 healthy subjects who fulfilled the study criteria. Peripapillary RNFL thickness was measured by OCT scan and each eye's global, superior, temporal, nasal, and inferior quadrant thickness was noted. The values obtained were analyzed to determine the percentage of eyes obeying the ISNT rule and its variants.

Results: The ISNT rule for RNFL thickness was applicable for normal subjects in only 53.33% of cases. Removing the nasal quadrant from analysis increased the number of eyes obeying the IST rule to 71.66%. Further exclusion of the temporal quadrant showed almost the same results (75%) for the IS rule.

Conclusion: The ISNT rule for RNFL thickness could be validated in only 53.33% of normal individuals. Though documented as useful for NRR during ophthalmoscopy in glaucoma diagnosis, the ISNT rule did not apply to the quadrant values on RNFL on SD-OCT examination.

Introduction: The study hypothesizes that neural networks can be an effective tool for predicting treatment outcomes in patients with diabetic neovascular glaucoma (NVG), considering not only baseline intraocular pressure (IOP) values but also inflammation and intraocular microcirculation indicators.

Objective: To investigate the diagnostic significance of inflammation and intraocular blood circulation indicators in a neural network model predicting the effectiveness of transscleral cyclophotocoagulation (TSC CPC) treatment in patients with NVG of diabetic origin.

Methods: This retrospective cohort study included 127 patients (127 eyes; aged Me 65.0 years) with painful diabetic NVG and 20 healthy individuals (aged Me 61.5 years) as an immunological control. All patients underwent TSC CPC with a diode laser. Treatment success was defined as achieving an IOP level of ≤ 21 mmHg and maintaining or improving best-corrected visual acuity (BCVA) after 12 months of observation. Preoperative systemic immune-inflammation index (SII = platelets × [neutrophils/lymphocytes]) and systemic inflammation response index (SIRI = neutrophils × [monocytes/lymphocytes]) were calculated. We assessed the values of volumetric pulse blood filling, determined by the rheographic coefficient (RQ, 0/00), using the rheoophthalmography (ROG) method. Multiple regression analysis was used to conclude the significance of treatment efficacy based on initial clinical and laboratory indicators, followed by constructing a prediction model in the neural network.

Results: The development of the neural network model identified the most significant "input" parameters: SIRI (100%), RQ (85.7%), and SII (80.7%), which significantly influenced treatment success. The sensitivity of the neural network model was 100%, specificity was 30%, and the percentage of correctly predicted events during testing on the control group was 92.9%.

Conclusions: Neural network-based prediction of transscleral cyclophotocoagulation effectiveness for patients with diabetic neovascular glaucoma allows for a sufficiently accurate forecast of treatment success with a probability of 92.9%. We believe the in-time correction of systemic inflammation and intraocular blood circulation can significantly reduce intraocular pressure, preserve visual acuity, and improve the quality of life in patients with diabetic NVG after TSC CPC. Further research is required to support these findings.

Introduction: Neovascularization of the lens is a rare entity linked to lens-induced inflammation due to many causes like trauma. We describe a case managed using suprachoroidal triamcinolone, an anti-VEGF injection, in conjunction with cataract surgery and IOL implantation.

Patient and clinical findings: A male patient, 27, presented with a severe reduction in vision in his right eye (RE) accompanied by redness for one month. He also had a distant history of blunt trauma to the RE approximately eight years before. His vision in the RE was reduced to hand motion and 20/20 in the left eye. Examining the anterior segment in RE revealed lenticular neovascularization, irregular anterior capsular thickening, iris sphincter tear at the 12 o'clock position, and fine KPs, with iris pigment clumps on the anterior capsule.

Diagnosis treatment and results: To reduce vascularization and inflammation, the patient was treated with intravitreal Anti-VEGF and suprachoroidal triamcinolone by an innovative technique, along with cataract surgery, following which visual acuity improved to 20/20.

Conclusions and significance: In this exceptional case report, suprachoroidal TA has been used for the first time to treat ocular inflammation and vascularization in traumatic cataract with capsular neovascularization and lens-induced uveitis.

Objective: Retinal parasitism by worms is a rare clinical occurrence and may cause diagnostic and therapeutic challenges. We present a girl with unilateral involvement who was first diagnosed at the age of 10. Change in parasite appearance inside the lesion was recorded by optical coherence tomography (OCT) 14 years apart.

Methods: Case report.

Results: A 10-year-old girl was referred to our clinic with a presumptive diagnosis of a unilateral posterior pole mass. She had been examined at another institution for the left exotropia and decreased vision, without any accompanying systemic symptoms. Upon our examination, a subretinal lesion, of two disc diameters in size, was detected two disc diameters above the left optic disc, and a spiral-shaped, non-motile roundworm could be spotted inside the lesion. Adjacent chorioretinal atrophy and marked fibrosis surrounded the lesion, without any active inflammation. OCT sections through the lesion delineated the hyperreflective appearance of the spiraling roundworm. Fourteen years later, the worm inside the lesion had lost its spiraling form, and the remnants appeared as a coalesced whitish material inside the lesion on the OCT.

Discussion: Although rare, retinal parasitism by worms presents significant diagnostic challenges due to its atypical presentation and the potential for misdiagnosis. In this case, the initial presentation of a subretinal lesion containing a spiral-shaped roundworm was notable for its lack of associated systemic symptoms and the absence of active inflammation, often seen in more common ocular infections. The long-term follow-up, using OCT, provided valuable insights into the infection's natural course, showing the gradual degeneration and transformation of the parasite into a coalesced whitish material, over 14 years. This case underlines the importance of longitudinal imaging in understanding the progression of such unusual retinal conditions and the need for awareness of parasitic infections as a differential diagnosis in similar clinical scenarios.

Conclusions: The present case demonstrates the natural evolution of the inactive subretinal worm by OCT and color fundus images.

Introduction: Intra-ocular lens (IOL) calcification is a rare yet serious complication, presenting as clouding within the optics of IOL and necessitating IOL exchange.

Patient and clinical findings: In this case, a 77-year-old male experienced gradual vision loss in his left eye (LE) over four years post-cataract surgery a decade before. His best corrected visual acuity (BCVA) was 3/60 in the LE, with the anterior segment displaying a clear cornea but an opacified IOL within the capsular bag. Ultrasound biomicroscopy (UBM) revealed hyperechoic reflections from the IOL in the LE. ImageJ software used on UBM images indicated a significant difference in optical density (OD) compared to the right eye (RE).

Results: The patient was diagnosed with IOL calcification in LE, and underwent anterior vitrectomy and IOL exchange with sulcus-placed IOL with optic capture in the capsular bag, resulting in an improved visual acuity of 6/18. Microscopic examination of explanted IOL revealed whitish calcium carbonate crystal deposits on the IOL, which were visible under polarized light.

Conclusions and significance: The innovative use of polarized light and ImageJ software can be used in resource-constraint settings to confirm the diagnosis in such cases. Based on ImageJ on the UBM image, OD can pick up even subtle changes in the optical clarity of the IOL optic preoperatively.

Objective: To investigate the clinical characteristics, associated systemic features, and management outcomes of patients with limbal dermoids diagnosed with Goldenhar syndrome.

Methods: This case series included patients from the eye outpatient department, diagnosed with Goldenhar syndrome based on systemic evaluation. Demographic data, ophthalmological assessments, and systemic evaluations were recorded. Various surgical interventions were employed based on the extent of limbal dermoids, and postoperative follow-up spanned one year.

Results: Seven patients (nine eyes) were included, with a mean age of 7.71±4.15 years. Limbal dermoids were bilateral in two patients and unilateral in five. Grade 1 and grade 2 limbal dermoids were observed. The mean BCVA was 0.50±0.11 (logMAR), and astigmatism was present in six patients. Systemic features of Goldenhar syndrome included vertebral anomalies, ear abnormalities, facial anomalies, and lower limb deformity. Surgical interventions varied, with simple excision, lamellar keratoplasty, and amniotic membrane transplantation utilized. Postoperatively, corneal scar formation occurred in all simple excision cases.

Conclusion: This case series underscores the rarity of limbal dermoids in the context of Goldenhar syndrome and the importance of early surgical intervention in managing these cases. By sharing our experiences and outcomes, we hope to contribute to the broader understanding of this condition and its optimal treatment.

Adult-onset Coats disease is an uncommon and vision-threatening disease characterized by the development of abnormal blood vessels in the retina. Coats' disease commonly affects children in the first decade of life, but very rarely manifests in adults after the third decade of life, or who characteristically present with unilateral vision loss. Despite being a sight-threatening disease, the etiology remains inconclusive and various genetic and vascular abnormalities are implicated. Diagnosis relies on ophthalmologic examination, fundus photography, fluorescein angiography, and optical coherence tomography. Treatment modalities include laser photocoagulation, intravitreal injections of anti-vascular endothelial growth factor agents, and, in advanced cases, surgical interventions are needed and the treatment is aimed at avoiding complications like retinal detachment and neovascular glaucoma, which were comparatively rare in adult-onset Coats' disease. Despite therapeutic advancements, the prognosis varies, with some patients experiencing significant visual impairment. This review outlines the clinical features, diagnosis, management, and prognosis of adult-onset Coats' disease, underscoring the importance of early detection and intervention in optimizing visual outcomes.

A 64-year-old male was referred for complaints of blood in tears and bloody discharge of unknown cause in the left eye. The patient was a chronic bandage contact lens (BCL) user. He had no history of recent trauma. A blood-stained BCL was present on the cornea in the left eye, which was removed. The ocular surface was dry with vascularization of the cornea. Double eversion of the upper eyelid with a Desmarre's retractor revealed a pyogenic granuloma with large papillae on the forniceal conjunctiva and a folded BCL hidden in the fornix. The folded BCL was carefully removed from the "upper fornix trap" and topical steroid eyedrops were prescribed.