Romanian journal of ophthalmology最新文献

Objective: Analysis of refractive errors and strabismus deviations following the visual screening of patients with the Welch Allyn Spot device. Material and Methods: This paper is a prospective cross-sectional study of 4281 patients examined with the Welch Allyn Spot device acquired by Lions Club Romania - District 124. The study was conducted between May 2019 and August 2021 and was performed with the help of Lions Club Romania. Results: In the present study, 4281 patients were evaluated and divided into 5 age groups (6-12 months, 12-36 months, 3-6 years, 6-20 years, and 20-100 years). The most frequent age group was 6-20 years, being identified in 51,97% of participants. We found that the most common refractive error was astigmatism, followed by hyperopia and myopia. Thus, (RE) the refractive errors found in the right eye were: astigmatism 93.23%, hyperopia 4.63%, and myopia 1.05%, and in the left eye (LE): astigmatism 90.40%, hyperopia 6.68%, and myopia 0.84%. Of all participants, 8.81% had horizontal strabismus, esotropia being found in the RE in 4.56% of the participants and the LE in 4.74% of them. Conclusions: The pediatric population was the most affected by astigmatism and esotropia. Abbreviations: RE = right eye, LE = left eye, SD = strabismus deviation.

Objective: To present a case of ocular toxoplasmosis. Materials and methods: A sixteen-year-old female patient presented to our clinic with complaints regarding decreased vision in her right eye (BCVA 0.5), starting five days before the exam. Her anamnestic data revealed a previous history of ocular toxoplasmosis in her left eye. OCT scans of the inner retina identified a huge cystic space, located posterior to the inner line, off the outer plexiform layer, with a small amount of hyperreflective foci. Other features of OCT included membranous-like structures on inner borders and elongation and splitting of the inner segment/outer segment junction. In later stages, beginning signs of retinitis and scaring could be observed. Results: The patient was treated with sulfamethoxazole/trimethoprim and prednisolone. After two weeks, total regression occurred and visual acuity and OCT remained stable for 6 months (BCVA 1.0). Discussion: Ocular toxoplasmosis can cause significant vision loss due to retinitis and scarring. Following treatment with sulfamethoxazole/trimethoprim and prednisolone, the patient's condition improved significantly and her visual acuity remained stable. Conclusion: On clinical examination and using OCT, rare morphological cystoid spaces (CS) can be identified as huge outer retina cysts (HORC), which are pathognomonic for posterior uveitis. Abbreviations: HORC = huge outer retinal cyst, OCT = optical coherence tomography, BCVA = best corrected visual acuity, CS = cyst space, OPL = outer plexiform layer, HRF = hyper reflective foci, RPE = retinal pigment epithelium, IS = inner segment, OS = outer segment, ERM = epiretinal membrane, PORT = punctate outer retinal toxoplasmosis, ELM = external limiting membrane.

The purpose of this study is to emphasize topical tacrolimus's role in treating anterior segment diseases in ophthalmology. The present study analyzed research papers and publications from international databases, including Pubmed, MedLine, Google Scholar, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Scopus to highlight the significance and advantages of topical application of tacrolimus and its efficacy in treating allergic eye disorders, immune-mediated diseases, and other ocular surface disorders. Tacrolimus and cyclosporine are the two most commonly used topical immunosuppressants in ophthalmology. Tacrolimus is a selective calcineurin inhibitor administered for the prevention and treatment of allograft rejection in solid organ transplant recipients and has a similar mechanism of action to cyclosporine. Management of immune-mediated inflammatory anterior segment requires intense immunosuppression and studies have shown that tacrolimus is ten to hundred times more effective than cyclosporine. Abbreviations: IL-2 = interleukin-2, FDA = Food and Drug Administration Agency, GvHD = graft versus host disease, (Ig)E = immunoglobulin E, SAC = seasonal conjunctivitis, PAC = perennial allergic conjunctivitis, VKC = vernal keratoconjunctivitis, AKC = allergic keratoconjunctivitis, GPC = giant papillary conjunctivitis, PKC = phyctenular keratoconjunctivitis, DED = dry eye disease, TBUT = tear break up time.

Aim and objectives: Visual dysfunction in diabetes mellitus (DM) is multifactorial and can be due to vascular disease, and metabolic abnormalities that can affect the retina, optic nerve, and visual pathways. Visual evoked potential (VEP) is an electrophysiological test that can quantify the functional integrity of the visual pathways from the retina via the optic nerves, and optic tracts to the visual cortices. In this study, we aimed to investigate the visual pathway dysfunction among diabetics without retinopathy compared with healthy controls and to look for any correlation with diabetic neuropathy, duration of diabetes, or HbA1c level. Methods: The study included 75 diabetic patients and 75 age and sex-matched controls. VEPs were recorded using the pattern reversal stimulation method on the Medtronic EMG EP machine, and P100 latency and N75-P100 amplitude were recorded in both diabetic patients and healthy controls. Results: Mean P100 latency was significantly prolonged and N75-P100 amplitude significantly reduced among diabetic cases compared to healthy controls (p < 0.001). Among diabetics with peripheral neuropathy, P100 latency was significantly prolonged and N75-P100 amplitude was significantly reduced compared to diabetics without peripheral neuropathy. A significant positive correlation of VEP P100 latency (p < 0.001) and a negative correlation with N75-P100 amplitude (p < 0.001) with duration of disease were also found. Conclusion: VEP changes are observed in diabetics before the development of retinopathy or peripheral neuropathy indicating optic pathway dysfunction, which precedes the development of these complications. Early preclinical visual pathway dysfunction can warrant taking the necessary measures to reduce diabetic complications. Abbreviations: DM = Diabetes Mellitus, VEP = Visual Evoked Potential, HbA1c = Hemoglobin A1 c, MRI = Magnetic Resonance Imaging, EEG = Electroencephalography, P100 = Positive wave peak at latency 100 ms (millisecond), N75 = Negative wave peak at latency 75 ms (millisecond), N145 = Negative wave peak at latency 145 ms (millisecond), OCT = Optical coherence tomography, PRVEP = Pattern Reversal Visual Evoked Potential, NCS = Nerve Conduction Study, SSR = Sympathetic Skin Response, IL1 = Interleukin-1, LIF = Leukemia inhibitory factor, CNTF = Ciliary neurotrophic factor, TNF alpha = Tumor necrosis factor-alpha, TGF-beta = Transforming growth factor-beta.

Aim: To report a case of cytomegalovirus (CMV) neuroretinitis observed in an immunocompetent patient. Materials and methods: The patient presented with a complaint of diminution of vision in both eyes (BE) and had a traumatic cataract in the right eye (RE). Fundus examination of the left eye (LE) revealed an active white, fluffy lesion with an overlying retinal hemorrhage patch with a macular star. The diagnosis of CMV neuroretinitis was established, and the patient commenced treatment with valganciclovir. Results: The patient exhibited no underlying risk factors. Subsequently, a positive response to oral valganciclovir treatment was observed. Discussion: Cytomegalovirus (CMV) neuroretinitis is typically associated with immunocompromised individuals, such as those with HIV/AIDS. The patient's presentation with a traumatic cataract in the right eye and a distinctive fundus appearance in the left eye posed a diagnostic challenge. The absence of common risk factors for CMV infection necessitated a thorough examination and consideration of rare infectious etiologies. The positive response to valganciclovir reinforces its efficacy in managing CMV-related ocular conditions. This case emphasized the necessity for ophthalmologists to maintain a high index of suspicion for CMV and other unusual pathogens when faced with neuroretinitis in patients who do not present with typical systemic immunosuppressive conditions. Early diagnosis and appropriate antiviral therapy prevent potential complications and preserve vision in such atypical presentations. Conclusion: This case underscores the importance of considering rare infectious agents in immunocompetent patients when encountering neuroretinitis, particularly in the absence of typical symptoms or signs of the disease. Abbreviations: CMV = Cytomegalovirus, BE = Both eyes, RE = Right eye, LE = Left eye, CBC = Complete Blood Count, ESR = Erythrocyte Sedimentation Rate, VDRL = Venereal Disease Research Laboratory, FTA-ABS = Fluorescent Treponemal Antibody Absorption, PPD = Purified Protein Derivative, ANA = Anti-Nuclear Antibodies, RF = Rheumatoid Factor, ACE = Anti Converting Enzyme, Ig G = Immunoglobulin G, HSV = Herpes simplex virus.

Objective: Assessment of the utility of smartphone fundoscopy in diagnosing posterior pole pathologies. Methods: An iPhone 12 and a 20D Volk lens were used for smartphone fundoscopy. Patients needing bedside consultation were examined with direct ophthalmoscopy and smartphone fundoscopy. Some patients were examined with this technique after slit lamp examination. Results: Over one year 23 bedside fundus examinations were performed and 2 papilledema were diagnosed. After initial slit lamp examination, photos of various pathologies were taken: age-related macular degeneration, branch retinal artery occlusion, arterial embolus, branch retinal vein occlusion, non-arteritic anterior ischemic optic neuropathy, myelinated retinal nerve fiber layer, choroidal naevus. Discussion: With the 20D lens, the image is overturned, magnified 3,13X, and the field of view is 46°. The utility was demonstrated in literature by teaching students this technique and using it in screening for retinopathy of prematurity. The weighted retinal irradiance was measured in two studies. It was 4,6 mW/cm2 in one and from 0,58 to 2,30 mW/cm2 in the other, within safe limits. Conclusions: Smartphone fundoscopy is a fast, accessible, and safe technique for fundus examinations. Other departments could use it for the diagnosis of papilledema.

Aim: To describe the case of a patient with Marfan syndrome who had bilateral superonasal lens subluxation. Method: The case of a male patient, aged 18, who complained of having impaired vision in both eyes (BE) since he was a toddler, was presented. On examination of the patient, features suggestive of Marfan syndrome were revealed, as well as bilateral intraocular lens subluxation. Results: The patient was refracted and glasses were recommended, which improved his vision. The patient was referred to the cardiology, orthopedic, and dental departments for a multidisciplinary approach to prevent complications and further management. Discussion: Lens subluxation is frequently presented as a primary clinical manifestation of Marfan syndrome. It can vary from asymptomatic, which is seen only after pupillary dilation, to significant subluxation, in which the equator of the lens in the pupillary axis causes diplopia or decreased vision. Conclusion: This case underscored the importance of considering the rare feature of Marfan syndrome.

Introduction: Management of patients living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) still represents a challenge for doctors in various medical fields. The presence of co-infections, with different degrees of immune system impairment, raises the need for a multi-disciplinary approach to the PLWHA. Methods: In this paper, we present three cases of PLWHA with various ophthalmological conditions, who were admitted to "Prof. Dr. Matei Balș" National Institute for Infectious Diseases (INBIMB). Three of them were late presenters, recently diagnosed with AIDS. All three were in immuno-virological failure. The ophthalmic conditions were either related to the HIV infection, or the result of other complications. Discussion: The diversity and complexity of ocular involvement in PLWHA were deeply linked to the patient's immunological status at the ophthalmological evaluation moment. Thus, antiretroviral therapy (ART) played an important immune status recovery role. Encountered ocular conditions vary, some being directly caused by the presence of the virus, and the others were the result of opportunistic infections (cytomegalovirus, Varicella virus) or other co-infections (Treponema pallidum). Neurological conditions disturbing the natural defense mechanism, prolonged hospital stay, and exposure to multiple antibiotic regimens are risk factors for difficult-to-treat eye infections with multidrug-resistant bacteria. Some ocular conditions can be the reason that leads to HIV infection diagnosis, while others can appear during the time, especially in patients with low ART adherence. The prognostic is conditioned by the early recognition and correct management of the disease and the immunological status recovery under ART. Conclusions: Correct and early diagnosis of HIV-related eye conditions is mandatory to establish the most appropriate medical management to obtain an increase in the quality of life of the patient. Abbreviations: HIV = Human Immunodeficiency Virus, AIDS = Acquired Immunodeficiency Syndrome, ART = Antiretroviral Therapy.

Introduction: Ocular involvement in human immunodeficiency virus (HIV) infected and treatment-experienced patients is a significant concern, despite the advancements in antiretroviral therapy (ART) medication. The extended life expectancy of HIV patients has altered the spectrum of HIV-associated ocular diseases, ranging from minor issues to severe vision impairment or blindness. Therefore, understanding these complications becomes crucial in providing comprehensive medical care and quality of life improvement. HIV patients on multiple ARTs can experience various ocular disorders due to the complexity of their treatment regimens, drug toxicities, immune reconstitution, and opportunistic infections. Most worthy to consider are: cytomegalovirus (CMV) retinitis, immune recovery uveitis (IRU), keratoconjunctivitis sicca (dry eye syndrome), and HIV-associated neuroretinal disorders. Materials and methods: A retrospective clinical investigation was conducted on HIV/AIDS-infected patients from January 1, 2013, to December 31, 2023. The study included 62 patients over 18 years, who tested HIV-positive via enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot (WB), with assessments of HIV plasma viral load (VL) and CD4+ T cell counts (CD4). Data collected included demographics, pathological histories, clinical characteristics, blood tests, assessments for opportunistic infections, patient staging, antiretroviral therapy initiation, and disease prognosis. Results: The study found that of most patients, 37 were aged 30-39 (59.7%), with 59.7% males and 40.3% females. Most had been living with HIV for 10-19 years (35.5%). Initial CD4 counts were < 200 cells/mm3 in 46.8% of patients, which improved to 19.3% when the study was done. CMV retinitis prevalence decreased from 46.8% initially to 35.5% despite ART. Other conditions included ocular toxoplasmosis (3.22%), tuberculosis-related uveitis (1,6%), keratoconjunctivitis sicca (19.3%), and HIV retinopathy (29%). Notably, 62.1% of CMV retinitis patients experienced significant visual acuity reduction. Oral valganciclovir was beneficial for patients with CMV disease affecting multiple sites and effective for both induction and maintenance therapy of CMV retinitis. Conclusions: Managing ocular complications in HIV-experienced patients requires a multidisciplinary approach with regular ophthalmologic evaluations, prompt treatment of infections, and continuous monitoring of ART effectiveness. Early detection and intervention are crucial for preserving vision and improving outcomes. The study highlighted the importance of constant monitoring even after viral suppression. Abbreviations: HIV = Human immunodeficiency virus, ART = antiretroviral therapy, CMV = cytomegalovirus, IRU = immune recovery uveitis, ELISA = enzyme-linked immunosorbent assay, WB = Western Blot, VL = viral load, CD4 = CD4+ T cells.

Aim: To compare corneal parameters in diabetics versus age-group-matched non-diabetics; also, to correlate these parameters with the duration of diabetes, glycated haemoglobin (HbA1c) levels, and severity levels of diabetic retinopathy (DR). Materials and methods: A comparative study was conducted at a tertiary eye-care center from January 2020 to December 2020. Two-hundred patients (400 eyes) with type-2 diabetes (100) and age-sex-matched non-diabetics (100) were included. Corneal morphological parameters like central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CoV), hexagonality (6A), and average cell area were recorded by specular microscopy. These parameters were correlated with the duration of diabetes, severity of disease based upon fasting blood glucose levels, HbA1c, and grade of DR. Mean and standard deviation were calculated, and regular distribution of continuous data was tested using independent sample t-test and ANOVA. Results: Mean ECD (2447.32 ± 269.89/mm2), 6A (45.03 ± 6.71%), and IOP (15.47 ± 2.02 mmHg) changed in diabetic cases and were significantly low in diabetics, whereas, mean average cell area (413 ± 50.19 mm2), standard deviation (167.05 ± 77.91), CCT (525.81 ± 36.69) and CoV (39.84 ± 15.59%), were significantly high in diabetics. Mean CCT had insignificant variation. Subgroup analysis within diabetics showed a statistically significant reduction of ECD, cell count, and 6A with increased duration of diabetes, poor glycaemic control, and raised HbA1c. Discussion: The corneal endothelial analysis is vital in daily clinical practice and provides valuable evidence concerning the viability of corneal endothelium in various intraocular surgeries. Uncontrolled DM harms the cornea with 70% of diabetics resulting in complications like keratopathy. The study highlighted that the increased duration of diabetes raised HbA1c, and poor glycemic control negatively affected corneal morphology. Our study showed a definite reduction in ECD and 6A in diabetics compared to non-diabetics. Conclusion: A definite reduction in the corneal endothelial counts, cell density, and hexagonality was found in type-2 diabetics compared to non-diabetics. Abbreviations: DM = Diabetes Mellitus, CCT = central corneal thickness, ECC = endothelial cell counts, ECD = endothelial cell density, CoV = coefficient of variance, 6A = hexagonality, DR = Diabetic retinopathy, SD = Standard of deviation, IOP = Intraocular pressure.