Romanian journal of ophthalmology最新文献

Sixth nerve palsy in children is a rare yet clinically significant condition that can result in strabismus and developmental complications. The acute onset of sixth nerve palsy can lead to esotropia, a sudden inward deviation of the eye due to impaired abduction. While most cases resolve spontaneously, botulinum toxin injection is gaining ground as a therapeutic intervention, particularly in pediatric patients with persistent or severe misalignment.

Objective: To evaluate the effectiveness of botulinum toxin injection in managing acute sixth nerve palsy in a 1-year-old child with esotropia. The therapeutic outcomes and a review of current evidence are discussed, focusing on the efficacy, safety, and timing of botulinum toxin therapy in pediatric sixth nerve palsy. Methods: We report the case of a 1-year-old child diagnosed with acute sixth nerve palsy and treated with botulinum toxin injection to the medial rectus muscle. Follow-up assessments were conducted at 1 week, 3 weeks, and 8 weeks to monitor ocular alignment and visual development. Results: At the one-week follow-up, esotropia decreased from 50 to 20 prism diopters, with moderate upper eyelid ptosis. At eight weeks, ocular alignment was normal, with mild residual ptosis and improvement in amblyopia.

Discussion: Sixth nerve palsy in children is uncommon but can arise from various underlying causes. In most cases, it resolves within a few months, but in severe or persistent cases, therapeutic interventions such as botulinum toxin injections can alleviate symptoms. The clinical case highlights that early intervention with botulinum toxin is a safe and effective method for improving ocular alignment.

Conclusion: Botulinum toxin injection effectively improved ocular alignment and facilitated amblyopia recovery in this pediatric case of sixth nerve palsy, supporting its use as a safe adjunctive treatment in early intervention.

Purpose: This study aimed to compare the safety and efficacy of toric intra ocular lens (IOL) implantation vs. opposite clear corneal incision (OCCI) during cataract surgery to correct preexisting corneal astigmatism in patients with age related cataract by comparing the postoperative residual astigmatism, the uncorrected distance visual acuity and the adverse effects following both the procedures.

Methods: A pilot prospective study was conducted at a tertiary hospital among patients undergoing cataract surgery over two years. A total of 150 eyes with pre-existing corneal astigmatism between 1 to 2.5 D were divided into two groups of 75 each by permuted block randomization. Group A underwent implantation of AcrySof Toric IOLSN6AT4 (Alcon Labs, Fort Worth, Tx), and Group B underwent implantation of normal non-toric aspheric AcrySof IOL SN60WF with OCCI on steep axis. Both groups were followed up for 24 weeks.

Results: In the OCCI Group, the difference between mean K1-K2 preoperative and 12 weeks postoperative (mean ± SD) of patients was 1.55 ± 0.17D. In the TORIC IOL Group, the difference between the mean K1-K2 preoperative and 12-week postoperative values (mean ± SD) for patients was 0.53 ± 0.11. The difference in mean K1-K2 pre-operatively and at 12 weeks was statistically significant for both groups (p < 0.0001). There was a significant reduction in corneal astigmatism in the OCCI group at 01 week.

Discussion: In our study, the difference in mean K1-K2 at 1 week between the two Groups was statistically significant (p < 0.0001), as OCCI acts directly on the corneal plane, whereas Toric IOLs reduce astigmatism at the lens plane without affecting corneal curvature. There was a significant reduction in corneal astigmatism in the OCCI group at 1 week. This reduction continued to stabilize at 12 weeks. The corneal astigmatism remained stable in the post-operative period in the Toric IOL group. The decrease in astigmatism was more significant in the toric IOL group than in the OCCI group.

Conclusions: These results demonstrate a similar efficacy of OCCI in reducing corneal astigmatism of up to 1.5 D compared to Toric IOLs. The uncorrected visual acuity was superior in the Toric IOL group. However, this difference was reduced significantly by 12 weeks.

Objective/aim: To determine the incidence of steroid induced glaucoma and treatment characteristics in kidney transplant patients in a tertiary level multispecialty institution.

Methods: In this prospective cross-sectional study, the patients who underwent kidney transplant were enrolled and underwent comprehensive ophthalmological evaluation including intraocular pressure (IOP) measurement with Goldmann Applanation tonometry, visual field examination with Humphrey Field Analyzer, and gonioscopy. Cases with IOP > 21 mm Hg, visual field defect, and optic disc cupping > 0.7 or asymmetry of 0.2 or more were labeled as glaucoma, whereas IOP > 21 mm Hg with a normal visual field was designated as ocular hypertension (OHT).

Results: The mean age of patients was 39 ± 9 (range: 25-60) years. Out of 72 patients with kidney transplants, 7 (9.72%) patients were diagnosed with steroid-induced glaucoma, and 9 (12.5%) patients had ocular hypertension (OHT). Four (5.55%) patients underwent trabeculectomy to control IOP whereas 3 (4.16%) patients were controlled on anti-glaucoma medications. Best-corrected visual acuity < 6/9 was noted in 23 (31.94%) patients in at least one eye. The average follow-up was 30 months with interquartile range of 18-84 months. There was a significant association of cumulative dosage of steroid and development of cataract and OHT and glaucoma (P < 0.01).

Conclusion: Kidney transplant patients must be screened for glaucoma and other ocular abnormality and should be on routine ophthalmological follow-up due to the possibility of steroid induced glaucoma.

Objectives: To evaluate the agreement between Spectral-Domain Optical Coherence Tomography (AS-OCT) and Oculus Keratograph® 5M in measuring tear meniscus height (TMH) and to assess the impact of contact lens wear on these measurements. Materials and methods: TMH was measured in 54 healthy eyes using AS-OCT (3D OCT-1 Maestro, Topcon, Tokyo, Japan) and Oculus Keratograph® 5M (OCULUS Optikgeräte, Wetzlar, Germany), with and without contact lens wear. Bland-Altman analysis was used to assess agreement between the two devices. Delefilcon A, water-gradient, daily disposable contact lenses were used, and measurements were carried out after a 20-minute adaptation period.

Results: The means of TMH without the contact lenses were 0.21 ± 0.06 mm and 0.20 ± 0.05 mm obtained from AS-OCT and Oculus K5M, respectively, and these measurements were not statistically significant (t (53) = 0.99, p = 0.33). No significant differences were observed in TMH compared to contact lenses (t (53) = 1.52, p = 0.13). Agreement between measurements obtained by both the instruments was assessed using Bland-Altman analysis. The limits of agreement were within clinically acceptable ranges (0.10 mm - 0.15 mm), with no evidence of significant bias (t = -0.32, r = 0.22). The results obtained with contact lenses were also not statistically significant (t (53) = 1.52, p < 0.05).

Discussion: The present study compared tear meniscus height (TMH) measurements obtained from AS-OCT and Oculus K5M in subjects with and without contact lens wear. Both instruments showed good agreement, with AS-OCT consistently measuring slightly higher TMH values than Oculus K5M. The mean TMH values were similar to those of previous studies, indicating normal tear film in the subjects. Contact lens wear was found to reduce TMH slightly, but it returned to baseline after a short adaptation period. The Bland-Altman analysis confirmed good agreement between the two instruments, with most data points falling within the limits of agreement. These findings suggest that AS-OCT and Oculus K5M can be reliable tools for measuring TMH and can be used interchangeably for clinical practice.

Conclusion: AS-OCT and Oculus Keratograph® 5M showed comparable results in measuring TMH, suggesting potential interchangeability in clinical practice. Further validation in broader clinical settings and diverse subject groups may be warranted.

Purpose: This study examined patients with permanent legal blindness in one eye after a previous eye surgery and those with permanent legal blindness in one eye for non-surgical reasons. The objective of this study was to assess the occurrence of complications both during and after surgery in patients undergoing phacoemulsification for cataracts or vitreoretinal surgery for retinal detachment in the fellow eye.

Methods: A retrospective study included 62 patients (group 1) with legal blindness in one eye, compared to 62 control patients (group 2) undergoing similar surgeries. Complications, history of complex surgery leading to legal blindness, and demographic characteristics were analyzed.

Results: In group 1, the complication rate was significantly higher in patients who underwent both phacoemulsification and vitreoretinal surgeries than in group 2 (p < 0.05). In group 1, complications developed during surgery in the other eye in 28.1% of the patients whose permanent legal blindness stemmed from a complication in the previous surgery. In contrast, complications arose in the surgery of the other eye in 10% of patients whose permanent legal blindness did not result from any complications in the previous surgery. A statistically significant difference was observed between the two groups (P < 0.05).

Discussion: In our study, if the cause of eye loss in patients with permanent legal blindness in one eye was a surgical complication, the possibility of complications during surgery in the other eye was high. Surgery can be planned at higher visual acuity levels in a patient who has lost one eye for reasons other than surgery. In patients who have lost one eye due to previous surgery, surgery for the other can be planned at lower visual acuity levels.

Conclusion: This is the first report to compare the rate of complications during and after surgery in patients with pre-existing permanent legal blindness in one eye who underwent cataract surgery and vitreoretinal surgery in the other.

Cataract is the leading cause of treatable blindness worldwide, and cataract surgery complications leading to blindness are a common cause of preventable blindness. All surgeons aim to obtain a good pupil dilation intra-operatively to ease the surgery. The small pupil is often challenging and contributes to intra and post-operative complications. Phacoemulsification, though, has many options to tackle small pupil. The same options cannot be employed in small incision cataract surgery, especially using mechanical pupil expanders. Small incision cataract surgery is very commonly performed in developing countries. The authors describe a case series of small pupil cataracts managed successfully without the use of any secondary aids to cause pupil dilatation and explain the techniques employed to manage small pupil while performing Small incision cataract surgery. With correct techniques, operative complications of small pupil can be minimized, and small incision cataract surgery is still a helpful option, especially in resource-limited settings, to provide an excellent visual recovery.

We report a problematic case of solitary fibrous tumor of the orbit in an anemic patient who presented with painless, progressive outward protrusion of the right eye. Magnetic resonance imaging (MRI) orbit and brain with contrast showed a well-defined intraconal lesion in the superomedial aspect of the right orbit. The lesion was excised using a vertical eyelid split orbitotomy with minimal blood loss. Histopathological and immunohistochemical examination showed the features of a solitary fibrous tumor. This case highlighted that with careful surgical planning, total removal of a large vascular tumor could be done with less bleeding, especially in an anemic patient in whom an iota of hemorrhage was life-threatening.

Objective: Present the diagnosis and therapeutic approach in a patient with pseudoxanthoma elasticum and ocular involvement.

Case report: A 46-year-old patient presented for progressive loss of vision and metamorphopsias in the left eye. The ophthalmological examination showed angioid streaks and secondary choroidal neovascularization. The dermatologist performed an incisional biopsy of a skin area in the right axilla that showed white-yellow, discrete streaks. Histopathological examination confirmed the diagnosis of pseudoxanthoma elasticum. It was decided to start intravitreal injections with aflibercept. Three injections were made in the left eye with subsequent visual acuity improvement.

Discussion: Angioid streaks are a rare retinal condition, and pseudoxanthoma elasticum is the most common association. Other systemic conditions are Ehlers-Danlos syndrome, Paget's disease, and hemoglobinopathies. Definite diagnosis requires skin lesions or calcified elastic fibers on pathological examination and angioid streaks of the retina. Choroidal neovascularization is a frequent complication and leads to vision loss. Intravitreal inhibitors of vascular endothelial growth factor are currently the first line of treatment.

Conclusions: Pseudoxanthoma elasticum has numerous systemic manifestations and requires a multidisciplinary team to be monitored and treated.