Romanian journal of ophthalmology最新文献

Purpose: To describe a case of recalcitrant fovea-involving macular folds developing after uncomplicated epiretinal membrane (ERM) peeling and causing intractable metamorphopsia.

Methods: Case report.

Results: A 22-year-old man with a stage 3 ERM, visual acuity (VA) of 20/100, and a history of scleral buckle underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. One week after surgery, VA dropped to 20/125 with worsened metamorphopsia. Ophthalmoscopy revealed a fovea-involving full-thickness macular fold, with photoreceptor outer segments in opposition. After 3 weeks of follow-up without improvement, PPV with induction of localized retinal detachment was performed, combined with retinal massage. Moreover, perfluorocarbon liquid (PFCL) was employed to stretch the retina. Nevertheless, the macular fold and metamorphopsia were unchanged, even one year after the first surgery.

Discussion: We hypothesize that, due to the highly contracted ERM, the retina may have separated from the RPE during peeling and folded over in the first postoperative days. Concurrently, incorrect patient positioning under air tamponade might have contributed to the vertical orientation of the fold.

Conclusion: Even if macular folds after ERM surgery are rare, prompt surgical treatment rather than watchful waiting should be considered to prevent permanent functional impairment.

Objective: Macular rupture following ocular trauma is an uncommon but significant complication that can lead to vision loss. Due to the scarcity of literature on treatment options for traumatic macular ruptures (TMR) in pediatric patients, this case report aims to provide scientific insight and share our positive experience in treating a pediatric TMR.

Materials and methods: A 6-year-old patient presented with reduced vision in the right eye following blunt trauma. Initial examination revealed hyphema, corneal edema, post-traumatic uveitis, and diminished visual acuity. Despite improvement in anterior segment findings, OCT confirmed a persistent full-thickness macular rupture three months post-injury, prompting surgical intervention.

Results: After three months of observation to allow spontaneous closure, the patient underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling using the inverted flap technique and SF6 gas tamponade. OCT showed a closed macular rupture three months after surgery with residual tissue reorganization, and visual acuity improved from 0.02 to 0.3. The surgical approach resulted in successful anatomical closure and moderate functional improvement.

Discussion: This case report highlights the successful management of a pediatric traumatic macular rupture (TMR) using pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. Despite the limited literature on the optimal treatment for TMR in children, the surgical approach described resulted in anatomic closure and functional improvement in the patient. The report emphasizes the importance of individualized treatment, considering both conservative and surgical options, particularly in cases where spontaneous closure is unlikely or delayed.

Conclusion: TMH management in pediatric patients poses unique challenges due to a lack of standardized treatment protocols. While conservative observation is acceptable in cases with a higher chance of spontaneous closure, surgical intervention should be considered for more significant or persistent ruptures.

Purpose: To compare dye-assisted epiretinal membrane (ERM) peeling using a standard operating microscope (SOM) with peeling without staining using either microscope-integrated optical coherence tomography (Mi-OCT) or a three-dimensional heads-up display (3D-HUD) platform.

Materials and methods: A prospective, randomized, and interventional pilot study. Patients requiring surgical intervention for ERM were randomized into group A (Mi-OCT), group B (3D-HUD), where dye was not used, and group C (dye-assisted peeling using SOM). Primary outcomes included the percentage of the eyes where complete ERM removal was possible without staining in groups A and B, intraoperative and postoperative complications, and best-corrected visual acuity (BCVA) at 3 months follow-up. Secondary outcomes included total surgical and ERM peel time.

Results: Complete ERM peeling was possible only in 80% (group A) and 70% (group B) without using dye. Postoperatively, no ERM recurrence was observed in groups A and B, except for one (10%) in group C. BCVA at 3 months improved significantly from baseline in all. The mean surgical and ERM peel time was considerably lesser in groups A and B than in group C.

Discussion: Mi-OCT and 3D-HUD ensured complete ERM removal in 80% and 70% of cases, respectively, without dye, compared to 100% in the conventional group, with one recurrence. Both technologies reduced surgical and peeling time. Intraoperative OCT improved visualization and minimized unnecessary maneuvers, aligning with PIONEER and DISCOVER studies. BCVA improved significantly at three months across all groups, with no intergroup differences. Despite benefits, high costs and a learning curve limit widespread adoption. Our study's small sample size and short follow-up warrant further research to validate findings and assess long-term outcomes, including potential dye-related toxicity in conventional techniques.

Conclusion: Mi-OCT and 3D-HUD were associated with shorter surgical times and less need for staining. However, they had no added advantage over SOM at the three-month follow-up.

Purpose: To compare the refractive outcomes of phaco-trabeculectomy versus phacoemulsification.

Methods: This prospective observational study included 75 eyes, 42 eyes with cataract and glaucoma that underwent phaco-trabeculectomy, and 33 eyes with cataract that underwent phacoemulsification. The primary outcome measures were the assessment of mean prediction refractive error and absolute mean prediction refractive error, measured during biometry with a target refraction of more than -1 diopter.

Results: The mean age of the study population was 60.3 ± 4.5 years (SD) in the phaco trabeculectomy group (Group 1) and 64.24 ± 3.2 years (SD) in the phacoemulsification group (Group 2). The mean prediction error in group 1 was -0.21 + 0.88 diopters, and in group 2, it was -0.24 + 1.42 diopters, with absolute mean prediction errors of 0.72 + 0.68 diopters in group 1 and 0.71 + 0.97 diopters in group 2. A statistically significant shift in myopic and hyperopic prediction error was noted for 0 to 1 diopter, and a change above one diopter was not substantial.

Discussion: This discussion examines the challenges associated with refractive outcomes following combined cataract and glaucoma filtration surgery. The study found considerable variability in achieving the target refraction, with prediction errors generally within one diopter, consistent with other research. The study's limitations, including a short follow-up period and variations in surgical techniques, are acknowledged as possible factors that may contribute to refractive errors and astigmatism.

Conclusions: The predicted refractive errors in both groups were similar, with equal myopic and hyperopic shifts noted, and a statistically significant change was observed from 0 to 1 diopter.

Reputation is one of the most significant aspects of an organization. It plays a crucial role in Dentistry and Ophthalmology, significantly influencing the relationship between doctors and patients. Reputation management in these two fields is viewed as a strategic process through which dentists and ophthalmologists can establish patients' trust, thereby ensuring high-quality services and patient satisfaction. The study conducted in this paper aimed to analyze patients' opinions on how the reputation of medical offices and trust in ophthalmologists and dentists influence their decision to choose a particular office. The results showed that the doctors' professionalism and the quality of the equipment used are the most critical factors influencing patients' trust in ophthalmology and dental offices. Additionally, patients primarily evaluate the reputation of these practices based on their previous experiences or recommendations from family and friends.

Purpose: To assess the proportion of patients with dry eye syndrome and to examine the changes in conjunctival impression cytology (CIC) in all patients undergoing hematopoietic stem cell transplantation (HSCT) by employing CIC as a diagnostic tool for ocular graft vs. host disease (oGVHD).

Materials and methods: Every patient who received HSCT underwent a thorough ophthalmic examination, which included visual acuity, an assessment of dry eyes using objective tests such as Schirmer's I test, tear film break-up time, and subjective tests such as the Ocular Surface Disease Index (OSDI) questionnaire. Conjunctival impression cytology was conducted after that, following informed consent.

Results: This study included 24 eyes from 12 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT), with a mean age of 31.4 ± 11.06 years. Dry eye disease was observed in 28.8% of the cases. Based on the symptoms, 16 eyes (66.67%) were diagnosed with oGVHD. The Ocular Surface Disease Index (OSDI) indicated mild symptoms in 4 eyes (16.67%), moderate symptoms in 11 eyes (45.33%), and severe symptoms in 1 eye (4.17%) in individuals with ocular GVHD. In contrast, 93.55% of eyes without oGVHD exhibited mild symptoms, while 6.71% showed moderate symptoms (p = 0.002).Objective assessments indicated that Schirmer's I score was ≤ 5 mm in 50% of the eyes (n = 12), and tear film breakup time was less than 5 seconds (3.85 ± 2.18 seconds) in 29.17% of eyes with oGVHD (p = 0.05). The conjunctival impression cytology (CIC) was abnormal in 9 eyes (37.5%, p = 0.05), revealing changes in cell morphology, such as decreased goblet cell density, reduced cytoplasmic mucin, and inflammatory cells. The average goblet cell density was measured at 190.63 ± 81.00 cells/mm² in 6 eyes (p = 0.05), showing a correlation with the time since HSCT; specifically, when the interval from HSCT to CIC assessment was 40.67 ± 5.01 months, the goblet cell density significantly decreased to 181.00 ± 76.62 (p = 0.04).Changes in morphology were observed in 8 eyes with oGVHD (91.7%) compared to 2 eyes without oGVHD (16.67%), with abnormal CIC results in 66.67% of cases (p = 0.02).

Discussion: This study highlights the significant prevalence of dry eye disease (DED) and ocular surface alterations in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly in those diagnosed with ocular graft-versus-host disease (oGVHD). The findings align with previous research, indicating that oGVHD is a leading cause of post-HSCT ocular morbidity, with symptoms ranging from mild irritation to severe ocular surface damage. The significantly higher Ocular Surface Disease Index (OSDI) scores, reduced Schirmer's I test values, and shorter tear film breakup times (TBUT) in oGVHD patients corroborate established diagnostic criteria for severe tear dysfunction. Moreover,

Background: This study aimed to assess a dermal filler's safety, efficacy, and outcome for inducing temporary mechanical ptosis of the upper eyelid in patients with facial nerve palsy with exposure keratopathy.

Methods: A prospective interventional study was conducted on 13 patients with facial nerve palsy with various levels of lagophthalmos and exposure keratopathy. A total of 0.3 ml of dermal filler (Juvéderm Ultra Plus XC, Allergan, USA) was injected subdermally over the pretarsus area of the upper lid to induce mechanical ptosis. Post-dermal filler implantation patients were followed up for a reduction in the amount of lagophthalmos and adverse effects.

Results: Out of 13 patients exposed to keratopathy due to facial nerve palsy, two were females, and eleven were males, with a mean age of 54+/-6.5 years and House Brackmann severity grades IV and V. The preinjection average lagophthalmos was 5.5 mm, and it decreased to an average of 0.8 mm postinjection at 1 week of follow-up, which was maintained at 12 weeks and 24 weeks of follow-up. No adverse side effects were observed during the 24-week follow-up.Discussion: This study highlights the effectiveness and safety of hyaluronic acid-based dermal fillers in treating lagophthalmos and exposure keratopathy caused by facial nerve palsy. A single 0.3 ml injection in the pretarsal region successfully induced mechanical ptosis, significantly reducing lagophthalmos and protecting the cornea, with results sustained for 24 weeks and no adverse effects. Offering a minimally invasive, cost-effective alternative to traditional surgical methods, dermal fillers show promise, particularly in early-stage management. Despite a small sample size and limited follow-up, these findings pave the way for future research to refine dosing and assess long-term efficacy.

Conclusions: Absorbable dermal filler implants are an easy and effective method for inducing mechanical ptosis and protecting the cornea in patients with exposure keratopathy due to facial nerve palsy.

Objective: To evaluate the relationship between optical coherence tomography angiography (OCTA) findings and axial length (AL) in eyes with high myopia.

Materials and methods: A total of 122 eyes from 78 patients were included. Seventy-five eyes with an AL ranging between 26.00 and 27.49 mm comprised Group 1, and 47 with an AL of ≥ 27.50 mm comprised Group 2. Spectral-domain OCT was performed to measure the central macular thickness, subfoveal choroidal thickness (SCT) and swept-source OCTA was utilized to obtain the data on foveal avascular zone (FAZ) and vascular density (VD) values at the superficial and deep capillary plexuses (SCP and DCP), outer retina (OuR), and choriocapillaris (CC) segments.

Results: While no significant differences were found in terms of the mean superficial-FAZ and deep-FAZ areas (p=0.284 and p=0.952, respectively), there were significant differences between the groups in terms of the mean foveal VD in the SCP (p=0.001), the mean total VD (p=0.045) and foveal VD in the DCP (p<0.001), the mean foveal VD (p=0.019) and superior parafoveal VD in the OuR (p=0.008), the mean total (p=0.005), temporal parafoveal (p=0.034), inferior parafoveal (p=0.029), and nasal parafoveal VDs in the CC segments (p=0.005).

Discussion: The findings of the present study highlight the complex interplay between axial elongation and retinal microvasculature, suggesting that factors beyond mechanical stretching may contribute to these alterations. The variability in the existing literature on this topic arises from inconsistencies in the definition of high myopia, the use of different OCTA devices, and heterogeneous study populations. By including eyes with myopic maculopathy and employing axial length-based classification, this study provides a broad representation of high myopia. However, its retrospective design, single-center setting, and monoracial cohort represent limitations. Future large-scale, prospective studies involving diverse populations are needed to elucidate further the pathophysiology of high myopia and its impact on retinal and choroidal microcirculation.

Conclusions: Our study revealed that high-myopic eyes with longer ALs exhibited increased total VD in the DCP and increased foveal VD in the SCP, DCP, and OuR segments, while they showed decreased total VD and temporal, inferior, and nasal parafoveal VDs in the CC segment compared to high-myopic eyes with shorter ALs.

Purpose: This review explores modern therapeutic options for the dry form of age-related macular degeneration (AMD), a condition representing one of the most significant challenges in ophthalmology due to its progressive nature and lack of effective treatment. The study discusses innovative approaches, evaluates available methods, and examines the potential of emerging technologies to improve patients' quality of life.

Methods: A comprehensive review of current literature was conducted, being focused on therapies for dry AMD, including classical methods such as AREDS/AREDS2 supplementation, molecularly targeted drugs, gene therapy, cell transplants, tissue engineering, nanotechnology, and light-based therapies. Emerging tools leveraging artificial intelligence for personalized treatment and predictive modeling were also evaluated.

Results: AREDS/AREDS2 therapies effectively slow disease progression but cannot reverse retinal damage. Advances include molecularly targeted therapies (Pegcetacoplan, Avacincaptad Pegol) that reduce inflammation, gene therapy (HMR59) protecting RPE cells, and mitochondria-targeted drugs (SS-31) mitigating oxidative stress. Using scaffolds, nanoparticles, tissue engineering, and nanotechnology enhances RPE regeneration and drug delivery. Light-based therapies (LLLT, adaptive phototherapy) improve mitochondrial function, while AI aids in predicting disease progression and personalizing treatment.

Conclusions: Modern therapeutic approaches for dry AMD provide promising avenues to slow disease progression and protect vision. However, further clinical trials are needed to optimize these strategies, assess long-term outcomes, and expand patient access to effective treatments. These advancements have the potential to significantly improve the quality of life for individuals affected by dry AMD.

Neuroretinitis is an inflammatory type of optic nerve damage evidenced by the appearance of papillary edema. It also involves inflammation of the retinal layers, as evidenced by the thickening of these layers and the presence of intra- and subretinal fluid. Chorioretinitis is a condition in which inflammation of the posterior component of the uvea, the choroid, leads to further damage to the retina, causing it to become inflamed. The most common causes of neuroretinitis and chorioretinitis in the pediatric population are represented by infectious etiologies. Most cases of neuroretinitis in children are caused by cat scratch disease, which is typically attributed to the bacterium Borrelia burgdorferi. We present the case of a 10-year-old child who presented to our service complaining of a sudden decrease in vision and the appearance of a central scotoma two days before he was referred to our service. Our first diagnosis was of optic neuritis, based on the presence of objective papillary edema on fundus examination. Subsequently, the appearance of chorioretinal foci completely changed the diagnosis and treatment in this case.