Romanian journal of ophthalmology最新文献

Aims and objectives: The aim was to evaluate the reoperation rate in laser-assisted in situ keratomileusis surgery (LASIK) and to identify the underlying factors that necessitate retreatment.

Material and methods: A retrospective study was conducted at a tertiary eye-care centre in central India, which included 288 eyes that underwent LASIK between June 2020 and April 2023, with nine eyes of nine patients who underwent reoperation. Factors included were demographic data, type of reoperation, that is, flap striae correction by its re-lifting, correction of a dislodged corneal flap, clearing debris of diffuse lamellar keratitis, and treatment for over- or under-correction.

Results: Nine out of nine patients underwent reoperation of 288 eyes. The re-surgery rate in our study was 3.12%. Six patients were male, and three were female. The age group of patients was 21-30 years (±2). All patients were from urban areas. The reoperation included re-lifting a dislodged corneal flap (n=3, 1.04%), flap striae correction (n=2, 0.69%), clearing the debris of diffuse lamellar keratitis (n=2, 0.69%), and treatment for over (n=1, 0.35%), or under-correction (n=1,0.35 %).

Discussion: There was no significant gender difference in reoperation rates, although six of the nine cases involved males. This observation warrants further exploration into potential behavioral or occupational factors that might predispose males to flap-related complications.The retrospective design of this study and its reliance on data from a single surgeon may limit the generalizability of the findings. Multi-center studies with larger sample sizes could provide a more comprehensive understanding of reoperation rates and associated factors. Future research should also explore patient-reported outcomes and satisfaction scores to contextualize the clinical findings better.Advancements in refractive surgery techniques, such as the adoption of small incision lenticule extraction (SMILE), could also be evaluated for their impact on reoperation rates. Moreover, the role of artificial intelligence in refining patient selection and predicting surgical outcomes represents an exciting avenue for enhancing the safety and efficacy of LASIK procedures.

Conclusion: This study highlights key factors driving LASIK reoperations and emphasizes that addressing complications and leveraging emerging technologies can significantly improve patient outcomes and satisfaction.

Objective: Description of an unusual ectasia following corneal cross-linking (CXL) in a patient with keratoconus.

Methods: Clinical case report and review of the literature.

Results: We present a case of an unusual ectasia after corneal CXL in a patient with keratoconus.

Discussion: This case reports the first known occurrence of corneal ectasia following epi-off CXL, a procedure typically used to halt the progression of ectatic disorders such as keratoconus. Although the standard protocol was followed, subtle technical variations or postoperative healing factors could have contributed to the outcome.

Conclusions: This case underscores the need for ongoing vigilance in patient selection and follow-up in the context of CXL. The rare development of corneal ectasia post-CXL highlights a gap in our understanding of corneal biomechanics and the potential limitations of current diagnostic tools. More research is needed to refine patient screening methods and optimize treatment protocols to ensure the efficacy and safety of this widely used procedure.

Aim: This case presentation aims to present the use of amniotic membrane transplantation and the modified ring procedure performed through a 6 French aspiration catheter in the surgical treatment of a patient who developed symblepharon following SJS.

Methods: The clinical file and histopathology slides of this patient who underwent surgery due to semblaferon developed after Steven-Johnson syndrome in the left eye were examined.Results: A modified ring procedure performed with AMT and a French aspiration catheter was used in the surgical treatment of a patient with semblaferon who developed Stevens-Johnson syndrome in the left eye. Postoperatively, no significant sequelae were observed, and the patient showed a marked reduction in complaints. One month after treatment, the sembraferon ring was removed, and it was observed that the sembraferon did not recur.Discussion: SJS and TEN are rare but severe mucocutaneous reactions, most commonly triggered by medications. In the acute phase, the focus on managing systemic symptoms often leads to the neglect of ophthalmic complications, which may result in permanent ocular sequelae in the later stages. The findings underscore the critical importance of early diagnosis and treatment in preserving the ocular surface and preventing scar formation. However, when advanced complications such as symblepharon occur, surgical and supportive interventions-such as mucosal grafts, scleral lenses, amniotic membrane transplantation, and the use of symblepharon rings-may become necessary.

Conclusions: This case report demonstrates the effectiveness of the modified ring procedure using a 6 French aspiration tube and AMT in the surgical treatment of patients who developed symblepharon following SJS/TEN.The surgical technique was modeled after Kara's technique. All stages of the surgery were planned and performed by Dr. Ayça Küpeli Çınar.

Background: Chronic uveitis is a common vision-threatening condition that can lead to many complications and may not respond to conventional medical therapy. This case report aims to emphasize the need for a personalized approach to these challenging cases to reestablish visual function.

Case presentation: A 29-year-old female patient, C.F., developed bilateral anterior uveitis of unknown origin that evolved into a chronic, refractory form. Topical, as well as systemic therapy, failed to control the inflammation, leading to complications in the form of cataract and secondary glaucoma. Surgical management involved Ahmed valve implantation in both eyes and pars plana vitrectomy.

Discussion: This particularly challenging case highlights the complex challenges in managing uveitis of unknown etiology, especially when complicated by secondary glaucoma. In young patients, progressive structural changes due to inflammation can rapidly lead to permanent vision loss. A combination of surgical procedures resulted in favorable anatomical and functional outcomes; however, long-term follow-ups remain essential to monitor for recurrent inflammation, intraocular pressure fluctuations, and other potential complications.

Conclusion: This case highlights the challenges and the need for a multidisciplinary approach in chronic, treatment-resistant uveitis with secondary complications.

Objective: Diabetic retinopathy (DR), a major diabetes complication, is the fifth leading cause of global blindness and moderate-to-severe visual impairment. DR is categorized into non-proliferative and proliferative forms, with the latter involving neovascularization. Adaptive optics (AO) imaging provides high-resolution, in vivo visualization of retinal microstructures, offering enhanced insight into disease pathology.

Methods: A comprehensive PubMed search was conducted for studies published before August 1, 2025, using the keywords "diabetic retinopathy" and "adaptive optics". The review focused on studies assessing cone photoreceptors, retinal vasculature, and clinical signs using AO imaging.

Results: Forty-two studies were included. Many examined cone photoreceptor integrity across DR stages, with or without diabetic macular edema (DME). AO imaging revealed microstructural changes, enabling the correlation of cone metrics with other imaging modalities, including optical coherence tomography angiography, electroretinography, microperimetry, and color vision tests. Several studies analyzed capillary-level vascular alterations and their association with DR severity and DME. Some works have integrated AO data with blood flow assessments using techniques such as laser speckle flowgraphy and AO scanning laser ophthalmoscopy. Lastly, several studies have identified clinical signs related to DR and described their features on AO imaging.

Discussion: Adaptive optics imaging reveals early and progressive alterations in photoreceptors, retinal microvasculature, and clinical signs such as microaneurysms and hard exudates in diabetic retinopathy, supporting its role as a valuable tool for understanding disease mechanisms and guiding early diagnosis and monitoring.

Conclusions: Adaptive optics is a valuable imaging tool that improves understanding of retinal microarchitecture in diabetic retinopathy. It aids diagnosis, monitoring, and prognosis by enabling detailed evaluation of cellular and vascular alterations.

Objective: To investigate the association between hypertensive retinopathy (HR) and components of the renin-angiotensin system (RAS), specifically angiotensin II (Ang II) and angiotensin-converting enzyme (ACE), as potential biomarkers for the diagnosis and prognosis of HR.

Methods: A total of 90 patients diagnosed primarily with hypertension were prospectively enrolled. HR was graded according to the Keith-Wagener-Barker classification into three severity groups. Paired serum and tear fluid samples were collected from each participant to measure Ang II and ACE levels, assessing both systemic and ocular changes. Statistical analyses included tests for normality and variance, as well as appropriate non-parametric methods. A p-value <0.05 was considered significant.

Results: Serum Ang II levels increased significantly with advancing stages of HR (p=0.039), showing a 42% rise in moderate HR compared to mild HR and an additional 18% increase in severe HR. Tear Ang II levels decreased markedly from mild to moderate HR (p=0.022) and from mild to severe HR (p=0.028). Serum ACE levels rose significantly as HR progressed (p=0.032), notably between mild and moderate HR (66% increase, p=0.009), whereas tear ACE levels showed no significant differences.

Discussion: Our findings showed that serum Ang II and ACE levels rise with HR severity, indicating systemic RAS activation, while tear Ang II decreases, suggesting altered local regulation. These contrasting trends reflect tissue-specific RAS activity and support the potential of Ang II as a biomarker for HR progression. The unchanged tear ACE levels imply limited ocular surface involvement. Overall, the data underscore RAS components' diagnostic relevance and therapeutic potential in hypertensive retinopathy.

Conclusion: These findings suggest that Ang II levels in serum (increasing) and tears (decreasing) correlate with HR severity, while ACE changes are significant only in serum. Further studies are warranted to elucidate the role of RAS in HR pathophysiology and to explore its potential as a therapeutic target in ocular disease.

Aim: To report the first case of orbital inflammation with concurrent anterior uveitis induced by oral Ibandronate, a bisphosphonate used for osteoporosis and other bone disorders.

Material and methods: A 55-year-old female, with a history of diabetes and hypertension, developed bilateral eye pain, redness, and photophobia two days after taking oral Ibandronate for a thoracic spine fracture. Examination revealed reduced visual acuity, anterior uveitis at presentation, and bilateral proptosis two days later. The imaging revealed diffuse bilateral orbital inflammation.

Results: After discontinuing the drug, the patient was treated with intravenous methylprednisolone, leading to significant improvement in ocular symptoms.

Discussion: Bisphosphonates, including Ibandronate, can cause ocular adverse effects such as uveitis and orbital inflammation. The pathophysiology is linked to immune modulation via gamma T-cell activation. Most cases respond to discontinuation of drug and steroid administration. The risk-benefit ratio of steroid administration has to be weighed, as it can worsen osteoporosis. Early detection and timely discontinuation of the drug can avoid sight-threatening complications.

Conclusion: This case underscores the importance of early recognition and prompt management of ocular complications, particularly as the use of bisphosphonates continues to increase.

Purpose: To report a 53-year-old woman with a traumatic phacocele after blunt eye trauma.

Methods: In this case, a comprehensive ophthalmological examination, computed tomography (CT), eye ultrasonography, optical coherence tomography (OCT), as well as eye and orofacial surgeries, were performed. The surgery was divided into three different stages: a revision of the wound, maxillofacial surgery, and a 25G pars plana vitrectomy with retropupillary Artisan IOL implantation.

Results: During the latest examination, occurring one and a half months after the incident, the patient presented with a best-corrected visual acuity (BCVA) of 20/70 in the left eye.

Discussion: Phacocele is a rare consequence of blunt ocular trauma, most commonly observed in elderly patients after a fall, with the lens dislocated in the superonasal quadrant. Prompt surgical management is essential, although long-term visual results may be affected by postoperative complications.

Conclusion: Phacocele, defined as the displacement of the crystalline lens into the subconjunctival space, is a rare complication that may arise from blunt eye trauma. Due to its infrequency, there is limited literature and documented cases available. As demonstrated in this case, the patient exhibited significant improvement in best-corrected visual acuity (BCVA) following surgical interventions in the eye.

Topical treatments remain the primary therapeutic strategy for glaucoma, with the primary objective of reducing intraocular pressure (IOP), the only modifiable risk factor for the disease. While these medications are effective in lowering IOP, they are also associated with a variety of potential adverse effects. This study aims to compare the effects of various topical antiglaucoma medications on the ocular surface in patients with open-angle glaucoma or intraocular hypertension. Patients were classified based on their treatment type and assessed using the Schirmer test, tear break-up time (TBUT), and fluorescein staining. The monitoring period spanned from February 2019 to September 2024. Preliminary results suggested that the daily number of drops administered may have a more significant impact on outcomes than the presence or absence of preservatives in the eye drops.

Objectives: Keratoconus (KC) is a bilateral, progressive corneal ectasia that involves corneal thinning and a decrease in visual acuity. Stopping the progression of keratoconus can be achieved through various photooxidative crosslinking (CXL) methods. The objective of this study was to compare two protocols of epi-off corneal crosslinking-the standard and the accelerated protocol-in terms of efficacy after a one-year follow-up.

Methods: 41 eyes with progressive keratoconus were treated with corneal crosslinking, either using the accelerated (Acc-CXL) or standard protocol (Std-CXL). The following parameters were monitored: refraction, corneal diopter power on topographic maps (Kmax and Kmin), corneal thickness (CCT), resistance factor (CRF), hysteresis, and the depth of the demarcation line. All measurements were repeated 12 months after the intervention.

Results: The progression of keratoconus was halted in 20 eyes using the accelerated method and in 21 eyes using the standard procedure. Both methods resulted in a statistically significant regression of the spherical equivalent, Kmax, and an increase in CCT and CRF, without substantial differences in efficacy. The demarcation line was highlighted on average at a depth of 278.9 ± 31.71 micrometres for the Acc-CXL group and 280.42 ± 47.85 micrometres for the Std-CXL group. It was correlated with the initial topographical values.

Discussion: The evaluation of patients revealed no progression of keratoconus following the procedure. Approximately 40% of the cases in the accelerated protocol group and 38.09% of the cases in the standard protocol group have maintained the parameters at a constant level. In comparison, approximately 60% of the cases have shown improvements. An Australian registry revealed that both CXL protocols are safe and effective; however, the standard procedure leads to improved visual acuity, a more significant flattening of the steepest meridian, and a higher chance of an effect greater than one diopter power.

Conclusions: Corneal crosslinking (CXL) was effective in halting the progression of keratoconus using both methods. Accelerated CXL is faster and more comfortable for patients, with similar efficiency to standard CXL.