Romanian journal of ophthalmology最新文献

Purpose: To review and compare the current commercial solutions for transepithelial photorefractive keratectomy (TransPRK) offered by leading excimer laser manufacturers-SCHWIND eye-tech-solutions (AMARIS with SmartPulse), Alcon (WaveLight EX500), and Bausch + Lomb Technolas (TENEO 317), with a focus on technology, treatment protocols, and clinical outcomes.

Background: TransPRK, a no-touch surface ablation technique, eliminates mechanical or alcohol-based epithelial removal by using the excimer laser to ablate both epithelium and stromal tissue in a single step. This approach offers advantages, including lower epithelial trauma, reduced risk of infection, and faster epithelial healing. Industry innovation has significantly improved TransPRK outcomes through refined epithelial mapping, high-speed ablation, and advanced eye-tracking systems.All three platforms-SCHWIND AMARIS, WaveLight EX500, and Technolas TENEO-offer effective TransPRK capabilities, each with distinctive advantages. SCHWIND currently leads in terms of surface quality and early visual recovery due to SmartPulse Technology. WaveLight EX500 provides high-speed ablation and robust platform integration, while Technolas TENEO offers customizable epithelial profiles and a user-friendly interface.

Conclusion: In summary, modern TransPRK systems provide safe, effective, and increasingly customizable options for correcting myopia and astigmatism. The choice between platforms depends on a range of factors, including surgical goals, patient profile, available technology, and the surgeon's familiarity with the system. As laser platforms continue to evolve, further innovations in epithelial mapping, real-time ablation control, and surface smoothing may continue to enhance the outcomes and expand the indications for TransPRK.

Objective: Olfactory groove meningiomas (OGMs) are rare but serious tumours that can cause visual loss. Surgical treatment of such meningiomas is critical for the recovery of visual functions.

Methods: In this case report, a 62-year-old patient presented to our clinic with sudden visual loss in the right eye and underwent ophthalmological examination. Visual field (VF), retinal nerve fibre layer (RNFL) thickness test, and contrast-enhanced cranial and orbital magnetic resonance imaging (MRI) were performed. The patient was diagnosed with OGM compressing the optic chiasm and nerve, and was operated on by the neurosurgery department. Post-operative examinations were repeated, and the patient was followed up regularly.

Results: Evaluations revealed a significant improvement in the patient's visual functions, including visual acuity and visual field (VF). Postoperative RNFL-thickness tests showed minimum variation. Early surgical treatment of OGMs compressing the optic chiasm and the optic nerve resulted in significant improvements in visual acuity and visual field (VF).

Discussion: This case demonstrates that early surgical intervention in olfactory groove meningiomas can result in substantial improvements in visual acuity and visual fields, regardless of the initial severity of visual impairment. Even in cases with profoundly reduced vision, significant functional recovery is possible following timely decompression. Preoperative preservation of retinal nerve fiber layer (RNFL) thickness may serve as a favorable prognostic indicator for postoperative visual outcomes. The integration of MRI, VF, and OCT findings provides a comprehensive framework for diagnosis, treatment planning, and follow-up.

Conclusions: According to the literature, surgical intervention is efficacious in improving visual functions and emphasizes the importance of early surgical treatment for such cases.

Pseudo-Foster-Kennedy syndrome presents with optic disc swelling in one eye and optic atrophy in the other eye. It differs from the true Foster-Kennedy syndrome due to the absence of an intracranial mass. One of the most common causes of pseudo-Foster-Kennedy syndrome is sequential bilateral NAION. We present the case of a male patient who came to the emergency room in our clinic complaining of sudden vision loss in his right eye, headache, and hearing loss. The patient also had a diagnosis of high amblyopia in his left eye, where we also discovered an optic atrophy. We established the positive diagnosis of pseudo-Foster-Kennedy syndrome after a thorough anamnesis, ophthalmologic examination, and multiple investigations.

Matrix metalloproteinases are crucial proteolytic enzymes involved in the degradation and remodeling of the extracellular matrix within the ocular structures. Their expression and activity significantly influence aqueous humor dynamics and intraocular pressure in patients with glaucoma. Elevated intraocular pressure, a significant risk factor for glaucoma, is often associated with disturbed aqueous humor outflow. This review summarizes current findings on the role of matrix metalloproteinases in modulating aqueous humor and their potential as therapeutic targets in the treatment of glaucoma.

Objective: We report four unique neurological cases that initially presented with ophthalmological manifestations.

Case series: In the first case, a 36-year-old man came in with a left-sided headache and isolated third nerve palsy. Detailed investigations led to the discovery of a supraclinoid internal carotid artery aneurysm, necessitating prompt neurosurgical intervention. The second case featured a 74-year-old man with complete drooping of his right eyelid. The diagnosis of complete third nerve palsy led to further tests, which uncovered multiple myeloma. The third case involved a 19-year-old girl who had persistent double vision and bilateral ptosis. A collaborative effort between ophthalmologists and neurologists revealed Miller Fisher syndrome, which was successfully treated with intravenous immunoglobulins. Lastly, the fourth case described an 8-year-old girl who presented with optic neuritis. A thorough ophthalmological evaluation led to the diagnosis of Neuromyelitis Optica Spectrum Disorder, enabling early treatment and significant improvement.

Discussion: These cases highlight the crucial role of ophthalmologists in identifying severe systemic and neurological conditions through subtle ocular signs. Each diagnosis-from aneurysms to autoimmune and malignant disorders-was made possible by vigilant ophthalmic evaluation and timely interdisciplinary collaboration. These examples reinforce that the eye often provides the first clue to an underlying disease, and that early recognition by ophthalmologists can be critical to effective, and sometimes lifesaving, intervention.

Conclusion: These cases collectively emphasize the critical importance of detailed ocular evaluation in the early detection and management of a wide range of neurological and systemic conditions, highlighting how ocular symptoms can often be the first indication of more serious underlying health issues.

Aim: This study aimed to evaluate the effectiveness of statin therapy as an adjunctive treatment to anti-VEGF therapy in type 2 diabetic patients with non-proliferative diabetic retinopathy (NPDR) and clinically significant macular edema (CSME).

Materials and methods: In this prospective, randomized interventional study, patients were randomized into two groups: Group A received low-dose atorvastatin (10-20 mg), and Group B received high-dose atorvastatin (30-40 mg). All participants also received three loading doses of intravitreal ranibizumab (0.5 mg) at monthly intervals, followed by pro re nata treatment over a six-month period. Primary outcomes included the number of anti-VEGF injections required, best-corrected visual acuity (BCVA), and central macular thickness (CMT). Serum VEGF levels were measured at baseline and six months.

Results: The mean number of injections over six months was 3.4, with no significant difference between Group A (3.55) and Group B (3.33) (p = 0.24). Group A demonstrated substantial improvement in BCVA at both 3 and 6 months, accompanied by a notable reduction in CMT. In contrast, Group B's BCVA improvement was only significant at 3 months, with less consistent CMT reduction at 6 months. Serum VEGF levels decreased in Group A but increased in Group B, though these changes were not statistically significant.

Discussion: The findings suggest that low-dose atorvastatin, when used in conjunction with anti-VEGF therapy, may provide superior functional and anatomical outcomes in patients with CSME compared to high-dose statin therapy. The observed reduction in central macular thickness and improvement in visual acuity indicate a potential adjunctive benefit of statins, likely due to their pleiotropic effects, including anti-inflammatory and anti-angiogenic properties. Although the number of injections required was similar between the groups, the better response in the low-dose group highlights the need for further investigation into the dose-dependent effects of statins in managing diabetic macular edema.

Conclusions: Low-dose atorvastatin (10-20 mg) as an adjunct to anti-VEGF therapy resulted in better functional and anatomical outcomes in diabetic patients with CSME compared to high-dose atorvastatin. These findings suggest potential additional benefits of low-dose statins in managing patients with chronic subdural hematoma (CSME).

Background: Foster Kennedy syndrome is a neuro-ophthalmological disorder characterized by ipsilateral vision loss in one eye, followed by clinically significant papilledema in the opposite eye. The presence of mass lesions in the frontal lobe is primarily responsible for this syndrome. This case report further discusses symblepharon as an ocular manifestation of SJS.

Method: A case report.

Case report: We present a case of a 59-year-old female with a history of progressive headache, anosmia, mental status changes, and progressive poor vision. Ocular examination revealed disc pallor in her left eye with disc oedema in the contralateral eye. The patient was sent for computerized tomography (CT) and MRI, and the diagnosis of frontal lobe meningioma was confirmed. The surgical removal was performed, and the condition improved gradually.

Discussion: We present a case of Foster Kennedy Syndrome, a rare neurological sign characterized by optic atrophy (vision loss) in one eye and papilledema (swelling of the optic nerve) in the other eye, often associated with an intracranial mass (meningioma).

Conclusion: Presence of cranial fossa meningioma related to direct compression of a unilateral optic nerve, resulting in optic atrophy and might induce a rise in intracranial pressure, resulting in contralateral papilledema. This case presentation demonstrated that prompt and appropriate treatment was effective in gradually reducing the deterioration of symptoms associated with Foster Kennedy syndrome.

Aim: This study aims to evaluate various optical coherence tomography (OCT) parameters in patients diagnosed with amyotrophic lateral sclerosis (ALS).

Methods: Assessment of BCVA was done using Snellen charts, and subjective refraction was done to achieve a BCVA for distance and near. Measurement of intraocular pressure (IOP) was done with Goldman applanation tonometry. Stereoscopic fundus examination was performed using a 90D lens to assess the status of the optic nerve and retina, ruling out any ocular pathology. The patients were then subjected to OCT scanning to measure optic nerve head and macular parameters. Optical coherence tomography was performed using CIRRUS™ HD OCT (500-21822) (version 8.0.0.518) (Carl Zeiss Meditec, Dublin, CA, USA). The analyzed area was centered manually, and the absence of segmentation errors was confirmed for each scan.

Results: RE Avg RNFL and LE Avg RNFL showed weak correlations with ALSFRS, indicated by Pearson Correlation coefficients of 0.073 and -0.026, respectively. The p-values (0.637 and 0.86) suggested that these correlations were not statistically significant. RE Avg GCL and LE Avg GCL, on the other hand, exhibited moderate positive correlations with ALSFRS scores, with correlation coefficients of 0.337 (RE) and 0.389 (LE). These correlations were statistically significant, as indicated by p-values of 0.021 and 0.006, respectively, suggesting a substantial association between GCL thickness and ALS functional outcomes.

Discussion: All patients in our study were clinically diagnosed cases of ALS, as per the El Escorial criteria. Age group-wise analysis showed statistically significant thinning overall as well as quadrant-wise RNFL parameters in patients less than 50 years compared to age-matched controls, indicating that the pathological process occurring in larger motor neurons in ALS might also be happening in smaller sensory neurons of the retina, causing thinning, which was not due to age-related process. Although GCIPL thinning was occurring in our cases, though statistically not significant compared to control, the significant positive correlation observed between GCIPL and ALS functional outcome and between RNFL and GCIPL measurements highlighted the fact that though the axonal degeneration in retinal neurons might not be translating to the same extent in ganglion cells in ALS, the subtle thinning of GCIPL correlated strongly with functional disability in patients with ALS, implying better functional scores with higher values of GCIPL parameters.

Conclusion: In summary, GCL measurements in both eyes showed a notable relationship with ALSFRS, whereas RNFL did not appear to correlate significantly.

Objective: Our objective was to assess retinal microcirculation and photoreceptor parameters in both healthy individuals and patients with vascular retinal diseases using adaptive optics ophthalmoscopy. This technology enhances optical system resolution to 2 µm by correcting wavefront aberrations, revolutionizing in vivo studies of ocular structures.

Materials and methods: Our study examined the clinical applications of adaptive optics in both healthy individuals and patients with vascular retinal diseases, including nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and macular telangiectasia (MacTel) type 2.

Results: In our study, we observed a higher wall-to-lumen ratio (WLR) value in our patient with proliferative diabetic retinopathy compared to our healthy volunteer. Additionally, we found a positive correlation between WLR and the severity of diabetic retinopathy. Furthermore, cone density was lower in all quadrants of our patient with proliferative diabetic retinopathy. For our patient diagnosed with MacTel type 2, the cone mosaic appeared irregular and blurred, with notable cone loss, especially on the temporal side of the macula, consistent with the typical location of MacTel type 2 lesions.

Discussion: Adaptive optics imaging assesses retinal changes in vascular diseases despite acquisition challenges. The obtained images aid in tracking the progression of diabetic retinopathy and detecting early changes of MacTel Type 2. Our study highlights both vascular and photoreceptor changes, quantifying these parameters to enhance the understanding of these vascular diseases.

Conclusions: Adaptive optics imaging is an advanced technique that provides high-resolution visualization of the microstructure of retinal vasculature and photoreceptors. This technology enhances our understanding of both healthy and vascular retinal conditions, aiding in diagnosis, monitoring, and prognosis.

Ciliary body melanoma is a rare and aggressive ocular tumor that often presents with nonspecific symptoms, leading to delayed diagnosis. This report presents the case of a 43-year-old male with a history of ischemic heart disease who presented with diminished vision in the left eye, initially attributed to a cataract. Despite prior evaluation, no sign of malignancy was detected, and the patient was advised to proceed with cataract surgery. The patient visited our center for a second opinion, where a comprehensive evaluation identified a large ciliary body melanoma extending into the anterior chamber. Management was challenging due to the patient's cardiac condition, as anticoagulant therapy could not be discontinued. Enucleation was performed to mitigate the high risk of hematogenous metastasis associated with the tumor's rich vasculature, ciliary body contraction, and potential extension through emissary canals. Histopathology confirmed the diagnosis of spindle cell melanoma. This case highlights the diagnostic complexities of ciliary body melanoma, which can masquerade as a common condition like cataract, emphasizing the need for vigilance in atypical presentations and the importance of thorough evaluation to avoid misdiagnosis. It also underscores the challenges in managing such tumors in patients with significant systemic comorbidities, requiring a multidisciplinary approach for optimal outcomes.