Romanian journal of ophthalmology最新文献

Purpose: To evaluate the impact of the pandemic on the intravitreal injection treatment routine for patients with neovascular age-related macular degeneration, regardless of lockdown periods.

Methods: We evaluated the data of intravitreal injections between March 2020 and June 1, 2021, which was the last day of official restrictions. We divided into two groups: a regular treatment group and a group that was interrupted for at least 3 months without excuse. The initial visual acuity at the beginning of the pandemic, the last visual acuity, the visual acuity after interruption, the central macular thickness, and the interruption time were recorded.

Results: A total of 156 patients' data were evaluated. There are forty-eight patients in the regular treatment group, 77 in the interruption group, and 31 in the discontinued group. The visual loss was significantly higher in the interruption group (respectively, -0.11 ± 0.19 vs. 0.03 ± 0.16, p<0.001). Central macular thickness changes were higher in the interruption group (respectively, 31.8 ± 5.7µm vs. 13.5 ± 4.6, p<0.001). The mean interruption time was 6.71 ± 2.45 months.

Discussion: Half of the patients in our study interrupted their treatment during the pandemic, and this interruption had a negative impact on their visual acuity and central macular thickness. In addition to COVID-19's own high mortality and morbidity, it also had adverse effects on patients who required regular follow-up and treatment.

Conclusion: Since interruptions in treatment negatively impact the prognosis of AMD, effective protocols that do not require frequent visits are necessary.

Purpose: This study investigates the impact of cataract surgery on the reliability and accuracy of iris recognition systems used for biometric identification.

Methods: We carried out a prospective observational study on patients undergoing cataract surgery via phacoemulsification. The study comprised 100 participants who underwent cataract surgery. We recorded preoperative iris scans using a standard biometric device (iris camera) and rescanned the same patients after surgery. Matching scores before and after surgery were analyzed to detect discrepancies. We examined the Hamming distance to evaluate changes in the iris pattern.

Results: The mean age of the study population was 64 ± 6.2 years (range, 52-74 years). The study population comprised 62 males and 38 females. Out of the total cases, 72 involved the right eye and 28 involved the left eye. The majority of patients presented within the current study presented with visual acuity between 6/18 and 3/60. We performed phacoemulsification and implanted foldable intraocular lenses in all cases. The study found no notable changes in iris pattern matching accuracy following uncomplicated cataract surgery. Postoperative images were matched with preoperative images in 95 patients, demonstrating that the surgery did not affect biometric reliability. The mean Hamming distance before and after surgery remained within the acceptable threshold for authentication, with 99% of cases successfully matched.

Discussion: The study supports the robustness of iris-based biometric systems under routine ophthalmic surgical conditions. This system's resilience to variations caused by cataract surgery demonstrates its robustness in practical sessions.

Conclusion: Cataract surgery, when performed without complications, does not impair the accuracy of iris-based biometric identification. These findings underscore the feasibility of using iris recognition systems in healthcare and security, even among patients undergoing ocular procedures.

Hidradenocarcinoma is a rare form of malignant adnexal tumor. This malignant tumor has been reported to metastasize to regional lymph nodes, and distant metastasis into structures like the orbit and extraocular muscle is uncommon. Orbital metastasis comprises about 10% of all orbital neoplasms. Common systemic malignancies contributing to orbital metastasis are breast cancer, prostate cancer, and skin malignancy, melanoma. We report the case of a middle-aged man with left axillary hidradenocarcinoma with an orbital metastatic lesion infiltrating the inferior rectus muscle with optic nerve involvement. This case report describes a rare presentation of orbital metastasis from an adnexal tumour.

Objective: To report a case of unilateral optic disc edema as a rare initial presentation of Vogt-Koyanagi-Harada (VKH) syndrome and emphasize the importance of early diagnosis using advanced imaging and cerebrospinal fluid analysis.

Case presentation: We present the case of a 23-year-old male who initially presented with unilateral optic disc edema, retro-orbital pain, and headache, progressing to bilateral involvement with serous retinal detachments. Advanced imaging, including fundus fluorescein angiography (FFA), Indocyanine green angiography (ICG), and Enhanced depth imaging-Optical coherence tomography (EDI-OCT), revealed hallmark findings of VKH, such as choroidal granulomas and increased choroidal thickness. Cerebrospinal fluid analysis confirmed pleocytosis and melanin-laden macrophages, which helped to establish the diagnosis. The patient was treated with high-dose intravenous corticosteroids and azathioprine, with significant improvement.

Discussion: VKH progresses through prodromal, acute uveitic, chronic, and recurrent phases. Although typically presenting with panuveitis, isolated optic disc edema as an initial sign is rare. Early diagnosis requires multimodal imaging and cerebrospinal fluid analysis to differentiate VKH from other inflammatory and infectious aetiologies.

Conclusion: This case highlights the importance of considering VKH in patients presenting with disc edema, whether unilateral or bilateral, particularly when accompanied by vitreous cells. Advanced ocular imaging and thorough systemic evaluation are critical for early diagnosis. Prompt treatment can prevent progression to chronic disease and irreversible vision loss.

Purpose: To summarize current knowledge on the clinical features, diagnosis, and treatment of ocular toxoplasmosis, with emphasis on alternatives for sulfonamide-allergic patients.

Materials and methods: A comprehensive PubMed search (1908-2021) was conducted using terms like Toxoplasma gondii, ocular toxoplasmosis, posterior uveitis, and retinochoroiditis. Priority was given to studies published after 2000, particularly those from 2010 onwards. Google Scholar, as well as English and Spanish sources, were also utilized.

Results: Ocular toxoplasmosis is the most common infectious form of posterior uveitis worldwide, typically presenting as necrotizing retinochoroiditis with associated vitreomacular adhesion and vitritis. Diagnosis is mainly clinical, supported by serology (IgG/IgM) and PCR of intraocular fluids when needed. Standard treatment includes systemic antiparasitic agents (e.g., pyrimethamine with sulfadiazine or trimethoprim-sulfamethoxazole) plus corticosteroids. In patients with sulfonamide allergies, alternatives such as pyrimethamine with clindamycin or azithromycin, or intravitreal clindamycin with dexamethasone, are effective. Recent studies show comparable outcomes with these regimens. Prompt treatment of active disease helps reduce retinal damage.

Discussion: Recent evidence supports the efficacy and safety of non-sulfonamide regimens and intravitreal therapies in managing ocular toxoplasmosis. These options are particularly valuable for patients with contraindications to standard treatments. Advances in imaging and molecular diagnostics have also enhanced early recognition and tailored management of the disease, contributing to improved visual outcomes.

Conclusion: Advances in diagnostic tools (PCR, intraocular antibody detection) and alternative therapies have improved outcomes in ocular toxoplasmosis, including in patients who are intolerant to sulfonamides. Clindamycin-based or intravitreal approaches offer effective, safe options. Further research is needed to refine treatment protocols, prevent recurrences, and clarify disease pathogenesis.

Background and objectives: Microvascular changes induced by diabetes mellitus (DM) are the primary cause of diabetic retinopathy (DR) and choroidopathy. There is a lack of evidence linking diabetic retinopathy (DR) to changes in choroidal thickness (CT), so we designed this study to investigate this relationship. The choroidal thickness of DM patients, with or without DR, was compared to that of controls (subjects without diabetes) using spectral domain optical coherence tomography (SD-OCT).

Materials and methods: We recruited 132 participants for a prospective observational study. Choroidal thickness at five points: subfoveal and at 500 and 1000 µm, both temporally and nasally to the fovea, was measured. OCT measurements, insulin use, lipid profiles, age, gender, fundus examination, and glycaemic control were recorded. The inferential and descriptive statistics were applied.

Results: When compared to DM patients without DR, CT showed a trend toward lower values; however, only CT at 1000 μm temporal to the fovea (300.25 ± 65.37 μm in control group 1, 304.82 ± 76.71 μm in group 2, and 271.84 ± 65.07 μm in DR group 3) reached statistical significance (p = 0.05). Each diabetic subgroup did not differ in sub-foveal choroidal thickness (SFCT) (p = 0.586). Patients without DME (289.53 ± 63.86 μm) and those with DME (289.83 ± 100.99 μm) had comparable SFCTs (p = 0.992).

Discussion: When comparing diabetic patients with and without diabetic retinopathy to healthy controls, there are differences in CT (increased, decreased, or no change). The atrophy and dropout of the choriocapillaris in eyes with diabetic retinopathy may be the cause of the decrease in CT in DR patients that our study revealed.

Conclusion: DR patients showed a statistically significant decrease in CT at the 1000 μm temporal to fovea choroidal subregion compared to DM patients without DR. These results suggest that diabetes induces pathological changes in the choroid, resulting in retinopathy.

Background and objective: The cornea is the outermost transparent layer of the eye. Various anatomical and physiological factors, such as a healthy functioning monolayer of corneal endothelial cells, play an essential role in maintaining corneal transparency. Conditions or events that cause endothelial loss beyond the threshold result in loss of corneal transparency. The present study aimed to evaluate the short-term effects of intravitreal anti-VEGF injections on the corneal endothelium using non-contact specular microscopy in patients undergoing anti-VEGF injections for various retinal diseases.

Materials and methods: This prospective cohort study included 47 eyes of 47 treatment-naïve patients who received intravitreal anti-VEGF injections for various retinal diseases. Using a non-contact specular microscope, pre-injection parameters, including ECD, cell count, CV, and hexagonality, were compared with those on post-injection days 1, 1st week, 1st month, and 3rd month. A statistically significant result was defined as a "p" value of less than 0.05 using the appropriate test of significance.

Results: Early morphological changes in endothelial cells were indicated by a significant increase in the mean value of the coefficient of variation of the area of endothelial cells in the first week (p < 0.001) and the first month (p < 0.027) of the post-injection period. However, at the follow-up examination 30 days later, no noticeable change in the patient's ECD, cell count, or hexagonal shape could be detected under the specular microscope.

Discussion: This prospective cohort study evaluated the effects of intravitreal anti-VEGF injections on corneal endothelial morphology in 47 treatment-naïve, non-diabetic patients with various retinal conditions. While endothelial cell count, density, and hexagonality remained stable, a transient increase in polymegathism was observed at both day 7- and one-month post-injection. No differences were found between phakic and pseudophakic eyes or between different anti-VEGF agents (Aflibercept vs. Ranibizumab).

Conclusion: Intravitreal anti-VEGF injections were found to induce morphological alterations in corneal endothelial cells during the first week and first month following injection, as evidenced by an increase in the coefficient of variation. However, these endothelial changes are subtle and do not typically translate into clinical concerns.

Orbital venous lymphatic malformations or lymphangiomas are choristomas of the orbit. Common in the pediatric population, the lesion is notorious for spreading into various anatomical spaces due to its infiltrative nature. Additionally, the vascular nature poses challenges to complete removal. Hemorrhages are not uncommon in the lesion, which may result in permanently compromised ocular function. Medical management involves injecting sclerosant into the cystic areas of the lesion, resulting in shrinkage and collapse, followed by total excision, which is the most suitable treatment option. The authors present a series of cases in which lymphangiomas have been completely excised using this minimal manipulative approach.

Topical treatment remains the first-line therapeutic approach for glaucoma, primarily aimed at reducing intraocular pressure (IOP), which is currently the only modifiable risk factor for the disease. However, while topical medications are effective in lowering IOP, they are also associated with a range of adverse effects. This study evaluated the short-term side effects of various topical glaucoma medications in Wistar rats with experimentally induced intraocular hypertension. A glaucoma model was established using saline solution and viscoelastic pre-filled syringes, followed by the application of different topical anti-glaucomatous agents to assess both efficacy and potential side effects. Five groups of Wistar rats were utilized: four groups received other treatments, while the fifth group served as a control, with no therapy administered. The rats were monitored for 21 days following the induction of elevated intraocular pressure (IOP) and the commencement of treatment. Preliminary results suggested that the number of drops administered per day might have a more significant impact on the outcomes than the presence or absence of preservatives in the eye drops.