Romanian journal of ophthalmology最新文献

Objectives: The objective of anti-VEGF (Vascular Endothelial Growth Factor) injections in the treatment of central serous chorioretinopathy (CSCR) is to help reduce fluid accumulation beneath the retina, promote resolution of retinal edema, and potentially prevent complications like permanent vision loss.The goal is to stabilize or improve vision by improving visual outcomes by reducing fluid and promoting retina reattachment.

Case presentation: A 43-year-old Caucasian male presented with painless, decreased vision in the left eye. The diagnosis of central serous chorioretinopathy was made. After the anti-VEGF injections, the results were good, beyond expectations, and the OCT aspect was maintained at 6 months within normal limits of the foveal affected area without recording extra vision loss.

Discussions: In CSCR, the retinal pigment epithelium (RPE) becomes compromised, causing fluid from the choroid to leak under the retina, leading to retinal or serous detachment of the macula. While the exact cause of CSCR is not fully understood, it is believed that the increased permeability of the choroidal vessels, often due to elevated VEGF levels, contributes to fluid leakage. The specific goals of using anti-VEGF injections in CSCR include reducing choroidal vascular leakage, promoting fluid reabsorption, and preventing recurrence or progression.

Conclusion: Anti-VEGF agents like aflibercept and ranibizumab are commonly used in treating CSCR, though their effectiveness can vary, and treatment regimens depend on individual patient response. Typically, anti-VEGF injections are administered via intravitreal injection into the eye, with repeat injections, if necessary, based on monitoring the patient's condition.

Cataracts are one of the leading causes of reversible blindness worldwide in the paediatric population. In general, paediatric cataracts significantly impact the child's visual development and their family, both emotionally and financially. However, certain developmental cataracts, like blue dot cataracts, are innocuous and will not cause visual morbidity. A sutural cataract involves the opacification of the anterior and posterior Y sutures, which can rarely affect vision. This is a case report of a 20-year-old male with vision loss, a rare association of blue dot cataract, sutural cataract, and significant astigmatism managed with uncomplicated phacoemulsification and Toric intra-ocular lens. Coexistence of blue dot cataracts with sutural cataracts is often rare, as is the presentation in the third decade of life with vision loss.

Objectives: The primary aim of this article is to present cystoid macular oedema as one of the side effects of Paclitaxel (Taxol) chemotherapy. Paclitaxel is used as a treatment option in patients with different types of solid carcinomas. The potential loss of vision, already altered by the disease, further compromises their quality of life, a contributing factor to overall psychological and mental decline.

Case presentation: A 69-year-old woman developed a drop in visual acuity that was painless, bilateral, and accompanied by wavy lines. This occurred six months after starting Paclitaxel chemotherapy for metastatic breast cancer. The diagnosis of cystoid macular oedema caused by Paclitaxel was made. The visual acuity significantly improved after Paclitaxel was discontinued, and the symptoms subsided.

Discussion: Paclitaxel is a chemotherapy drug used to treat various types of cancers and has been associated with cystoid macular oedema (CMO) in rare cases. CMO is thought to result from the disruption of the normal blood-retinal barrier. The specific mechanism remains incompletely understood, and multiple mechanisms have been postulated. In typical CMO, leakage from parafoveal capillaries is demonstrated on fluorescein angiograms in a classic petaloid pattern. However, in Taxane-Drug Induced CMO (TDICMO), there is no evidence of fluorescein leakage on angiography. TDICMO is a rare drug side effect of breast cancer treatment, described just 14 times in the English literature.

Conclusion: It is crucial to reiterate that if a patient undergoing Paclitaxel treatment experiences any vision changes, it is imperative to consult an ophthalmologist for a thorough evaluation and appropriate management. This step is essential for the patient's well-being and to ensure the best possible outcome.

Objective: To report demographic profile and clinical characteristics of acute anterior uveitis (AAU) after Photorefractive Keratectomy (PRK).

Materials and methods: This retrospective study reviewed records of all patients who underwent PRK to correct ametropia between July 2021 and June 2023. Patients who developed postoperative AAU were included for evaluation. Demographic details, preoperative ocular examination, intraoperative details, postoperative examination, time to onset of AAU, grading of cells, flare and pigments, time to heal, and final visual outcome were analyzed.

Results: Records of 390 patients who underwent PRK during the study period were reviewed. Of these, 16 (29 eyes, b/l:13 patients, u/l: 3 patients) presented with AAU following PRK. The mean age of patients was 27.43 + 4.53 years (range 22-32 years), with a mean spherical equivalent of -3.18 + 2.16 (range -2 to -7 D). Mean ablation depth was 55.13 + 28.10 mm (range 27-105 mm), and mean duration of excimer laser ablation was 11.27 + 8.31 seconds (range 3-36 seconds). The mean onset time of AAU post-surgery was 27.8 + 10.9 days (range 7-47 days). Most eyes (75.86%, n=22) had a moderate-intense grade of inflammation, while 82.75% (n=24) of the eyes had significant pigment dispersion. The mean healing time was 57.43 + 27.87 days (33-106 days). The median follow-up duration was 12 months (range 6-18 months). The incidence of AAU post-PRK in our study was 4.1%.

Discussion: This study's incidence of post-PRK acute anterior uveitis (AAU) was 4.1%, aligning with previous reports of rare but significant inflammatory responses following PRK. The mean onset at 27.8 days suggested a delayed immune-mediated reaction rather than an immediate post-surgical response. While most cases had mild-to-moderate inflammation, a subset experienced severe reactions and ocular hypertension, reinforcing the need for close monitoring. The absence of systemic associations and posterior segment involvement suggested the role of a localized immune response. Despite the prolonged resolution time, all eyes achieved a final CDVA of 0 LogMAR, indicating favorable long-term outcomes with timely intervention and management.

Conclusion: Anterior uveitis following PRK is infrequent. While it presents with marked anterior chamber reaction and pigment dispersion, the inflammation is often well-controlled with topical steroids. It does not affect the final visual outcome.

Mucormycosis is an aggressive, life-threatening fungal infection predominantly affecting immunocompromised individuals. It typically manifests as rhino-orbital or rhino-cerebral disease. However, rarely, its initial presentation may closely resemble an innocuous condition like acute dacryocystitis, which is prone to result in higher morbidity rates. Herein, we report a case of a 52-year-old diabetic patient who presented with symptoms suggestive of acute dacryocystitis. Broad-spectrum antibiotics were started, but the patient did not improve with therapy. Further investigations, including imaging and biopsy, unraveled invasive mucormycosis. Prompt surgical debridement and antifungal therapy were initiated, but the delayed diagnosis culminated in significant orbital involvement. A high index of clinical suspicion is warranted for mucormycosis in patients with risk factors such as diabetes or immunosuppression who present with dacryocystitis and are unresponsive to standard treatment. Early diagnosis and aggressive intervention play a pivotal role in improving patient outcomes in this condition.

Objective: To investigate the occurrence and characteristics of the "Fern-like pattern" (FLP) on ultra-wide field fluorescein angiography (UWFA) across a variety of uveitic conditions, challenging the traditional association of FLP primarily with Behçet's disease (BD).

Methods: This observational study at a tertiary care centre in India analysed the UWFA images of 23 eyes from 12 patients diagnosed with BD, tubercular vasculitis, intermediate uveitis, Vogt‒Koyanagi‒Harada (VKH) syndrome, or exudative retinal detachment. Clinical and imaging data were reviewed to assess the presence and implications of FLP in these conditions.

Results: The study included 12 patients: 8 males (66.67%) and four females (33.33%). The distribution was: 3 with BD, 4 with tubercular vasculitis, 3 with intermediate uveitis, 1 with VKH syndrome, and 1 with exudative retinal detachment. The average age was 29.58 ± 11.35 years. Anterior segment examination revealed significantly more hypopyon, cells, and posterior synechiae in BD patients. Posterior segment examination showed choroiditis exclusively in non-Behçet's patients and considerably increased vitritis in BD patients. Disc hyperfluorescence and neovascularization were substantially more common in BD patients.

Discussion: Our study is the first to comprehensively assess the presence of FLP on UWFA across both BD and non-BD uveitic conditions, demonstrating its occurrence in TB vasculitis, VKH syndrome, and intermediate uveitis. While traditionally linked to BD, FLP signifies retinal capillary leakage and inflammation, necessitating careful differential diagnosis. We observed optic disc hyperfluorescence predominantly in BD, underscoring its role as a potential disease activity marker requiring aggressive immunosuppression. Notably, FLP was identified in exudative retinal detachment and VKH, suggesting shared inflammatory mechanisms across conditions. These findings broaden the clinical relevance of FLP in uveitis and highlight the need for further studies to explore its diagnostic and prognostic significance.

Conclusion: The study confirms that FLP on UWFA is not exclusive to BD and appears in other uveitic conditions. Clinical signs such as hypopyon and disc hyperfluorescence indicate BD, whereas choroiditis is more common in non-Behçet's uveitis. These findings highlight the importance of precise clinical and imaging assessments to distinguish between different uveitic conditions for accurate diagnosis and effective treatment.

Objective: This report describes a case of bilateral central serous chorioretinopathy linked to cosmetic minoxidil use in an adolescent girl, highlighting clinical findings, progression, and implications for practice.Materials and methods: Case report.

Results: A 14-year-old girl with no significant medical history reported several weeks of blurred vision in both eyes. She had been using 2% topical minoxidil on her eyebrows and eyelashes without a prescription for the past 6 months. The initial examination revealed that the best-corrected visual acuity (BCVA) was 20/80 in the right eye and 20/25 in the left eye, with no abnormalities noted in the anterior segment. Fundus evaluation and OCT confirmed bilateral serous retinal detachment. Given the patient's unsupervised minoxidil use, a causal link to central serous chorioretinopathy (CSC) was suspected. After discontinuing the drug, the subretinal fluid (SRF) resolved, and visual acuity fully recovered within three months, supporting the association between minoxidil and choroidal neovascularization (CNV), not CSC.

Discussion: Topical minoxidil has been widely used due to its vasodilatory, anti-inflammatory, anti-androgenic, and trichogenic properties, primarily through its induction of the Wnt/β-catenin signaling pathway. Despite its benefits, adverse effects such as hypotension, pruritus, and hypertrichosis are common, and isolated reports have linked its use to CSC, with symptoms typically resolving after discontinuation of the drug in most case studies. Proposed mechanisms for this association include systemic absorption leading to increased choroidal vascular permeability and disruption of retinal homeostasis. To our knowledge, this is the first reported case in the literature of bilateral CSC linked to cosmetic minoxidil use in an adolescent girl, with complete resorption of SRF and recovery of visual acuity following discontinuation of the drug.

Conclusion: CSC linked to topical minoxidil use is rare and requires early detection for prompt discontinuation and recovery. Further research is needed to confirm this link, understand the underlying mechanisms, and develop more effective treatments.

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

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: Our study underlined 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 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 diabetic retinopathy progression and detecting early MacTel Type 2 changes. Our study highlighted vascular and photoreceptor changes, quantifying these parameters to enhance 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 healthy and vascular retinal conditions, aiding diagnosis, monitoring, and prognosis.

Objective: This study aims to evaluate higher-order aberrations (HOAs) pre- and post-cataract surgery using advanced technologies to achieve an acceptable best-corrected visual outcome in favor of patients.

Methods: This prospective, observational study involves 200 adult patients (aged 40 years or older) undergoing cataract surgery. All these patients have been evaluated before and after cataract surgery.The study involved comprehensive measurements of higher-order aberrations (HOAs) using both Scheimpflug imaging (Sirius system) and ray-tracing technology (iTrace). These measurements were taken preoperatively and at specific postoperative time points (7 days, 1 month, and 2 months). Various parameters were analyzed, including the root mean square (RMS) of total HOAs and specific corneal HOAs. Patients were followed up for 2 months postoperatively.

Results: We found no significant differences between the S and I methods at any time point for lower-order aberration (LOA). The S method generally measured higher LOA values than the I method. Significant differences were observed between the S and I methods at all time points for HOA. The S method consistently measured higher HOA values. The S method showed small but significant changes over time, while the I method showed no significant changes.

Discussion: This study provides comprehensive insights into the changes in corneal curvature and higher-order aberrations following modern cataract surgery. The findings suggested that while small changes occur in corneal properties, these have minimal impact on visual outcomes. The significant improvement in vision appears to be primarily driven by replacing the cataractous lens with an IOL, particularly in reducing total ocular aberrations.

Conclusion: Our study highlighted a significant reduction in total ocular higher-order aberrations (HOAs), particularly spherical aberrations. This reduction is a key factor in improving visual quality after cataract surgery. This reduction is primarily attributed to replacing the cataractous lens with an IOL rather than to changes in corneal optics.