Romanian journal of ophthalmology最新文献

Purpose: To report the hastened recovery of two nonresponding fungal corneal ulcer cases after using intrastromal injections of autologous buffy coat (a component of blood rich in leucocytes) as an adjuvant to topical antifungal therapy.

Methods: Microbiologically proven non-responding cases (>2 weeks of treatment) of fungal corneal ulcers who visited the cornea specialty clinic of our hospital were explained the disease and adjuvant intrastromal autologous buffy coat treatment, which would be repeated if effective. Then, well-informed and written consent was obtained from the patients for the treatment. The study adhered to the tenets of the Declaration of Helsinki. An in vitro experiment was also carried out to prove the hypothesis by growing fungi on a donor button and injecting it with the buffy coat of a healthy volunteer.

Results: The study showed immediate positive outcomes, with patients showing faster lesion resolution with decreasing lesion size, resolving hypopyon, and complete clinical recovery in both cases in less than seven days.

Discussion: Intrastromal autologous buffy coat shows promise as an adjunct therapy for difficult fungal corneal ulcers, enhancing local immunity and healing. This approach may reduce treatment time and risks, though further studies are needed to confirm these findings.

Conclusion: Intrastromal buffy coat for recalcitrant fungal ulcers is a promising treatment modality as it provides both local immunity and growth and repair stimulus to the diseased cornea. However, a long-term randomized control trial is needed to evaluate the results further.

Purpose: Accelerated Collagen Crosslinking (A-CXL) is widely used worldwide as an effective treatment for keratoconus due to its efficiency and rapidity. This paper aims to identify relevant changes in visual acuity parameters and topographic measurements before and six months after treatment.

Methods: A total of 30 eyes from 20 patients who underwent A-CXL between May 2021 and June 2023 and had at least six months of follow-up were analyzed retrospectively. Comparisons between uncorrected visual acuity, best corrected visual acuity, spherical and cylinder diopters, and topographic measurements like Kmax, SIf, SIb, KVf, KVb, BCVf, BCVb, TCT, and CCT were made before and six months after surgery.

Results: After the accelerated Collagen crosslinking (A-CXL), BCVA improved, cylinder diopters and Kmax values were reduced, and central corneal thickness (CCT) and thinnest corneal thickness (TCT) were elevated.

Discussion: The study has shown results comparable with other studies regarding the heterogeneity of the group study, good outcomes in measuring the corneal central thickness and thinnest corneal thickness, and good evolution of the refraction and visual acuity. Regarding the specific topography markers, like SIf/SIb, KVf/KVb, BCVf/BCVb, and K_max, minor differences were observed at 6 months follow-up and were not considered statistically relevant. Other studies show a better correlation at 1-year check-ups and similar results at 6-month follow-ups.

Conclusion: This method's main benefits are its brief duration and minimum intrusion, improvement of visual acuity, and the possibility of reintervention for better outcomes.

Objective: This case report describes a rare presentation of the Mizuo phenomenon in a vitamin A deficiency-associated patient.

Methods: A 38-year-old male presented with nyctalopia for 10 years and a fresh onset of dry eyes. He was a known case of alcoholic liver disease with cirrhosis and Oguchi disease. Anterior segment evaluation revealed moderate dry eyes, and fundus examination revealed metallic sheen OU, the latter extinguished after dark adaptation via a modified patch test suggestive of the Mizuo Nakamura phenomenon. Multimodal imaging modalities like SD-OCT, short-wave autofluorescence, and electrophysiological tests were performed. Findings suggested a diagnosis other than Oguchi's disease. The gene panel comprising SAG and GRK1 mutations was negative for Oguchi. Serum vitamin A levels were significantly low (0.03 mg/l). The patient was started on topical lubricants and oral vitamin A supplements and counseled to abstain from alcohol.

Results: SD-OCT demonstrated thinning of the ellipsoid region with multiple hyperreflective excrescences in outer retinal layers colocalized with hyperautofluorescent flecks on short-wave autofluorescence. ERG was normal bilaterally. An electrooculogram showed a significantly decreased Arden ratio of OU. After controlled oral Vitamin A supplementation, the patient's serum Vitamin A levels remained low (0.06 mg/l).

Conclusion: This case is rare and likely the first reported presentation of the Mizuo phenomenon in a vitamin A deficiency-associated patient with normal ERG and abnormal EOG. Increasing choice for weight loss diet and bariatric surgeries Vitamin A deficiency is also expected to affect developed countries. Modified patch tests make diagnosis easier and earlier. More extensive studies are needed to correlate levels of Vitamin A with the natural course of the Mizuo phenomenon and substantiate multimodal imaging findings.

Duane Retraction Syndrome (DRS) and Monocular Elevation Deficiency (MED) are two distinct congenital strabismus entities that have not been reported simultaneously until now. Thirty percent of individuals with DRS present with various congenital ocular and non-ocular anomalies. A 16-year-old girl presented with right eye ptosis and ocular deviation since birth. The patient's hypotropia increased in the upward gaze. She also exhibited small-angle exotropia in the primary position, along with the limitation of both abduction and adduction. The patient had globe retraction and increased ptosis in adduction. Strabismus manifestation in the patient was consistent with concurrent type III DRS and MED in the right eye.

Background: Stevens-Johnson syndrome (SJS) is a life-threatening condition resulting from a severe reaction to the use of certain drugs, with the highest incidence found in children. It manifests as a triad of skin, orifice, and ocular mucosa lesions. Ocular manifestations most commonly involve the conjunctiva and eyelids. This case report further discusses symblepharon as an ocular manifestation of SJS.

Method: A case report.

Case report: A 10-year-old boy came with decreased vision and an inability to produce tears. On examination, pseudomembranous conjunctivitis was found in both eyes, granulation tissue in the right eye, and erosion of the corneal epithelium in the left eye. The posterior segment could not be assessed due to symblepharon. It was known that the patient previously experienced SJS in early 2023. Symblepharectomy was carried out with the indication of separate adhesions caused by symblepharon.

Discussion: Symblepharon is a rare, severe ocular manifestation of SJS (Stevens-Johnson syndrome). Previous studies found that severe ocular occurred in around 4% and 11.1% of cases. This happened because of ongoing chronic inflammation due to SJS. Symblepharon is an adhesion of eyelids and bulbar conjunctiva, which can harm the eye because it can cause cicatricial then disruption of the tear film meniscus, limit eye mobility, and cause visual disturbances.

Conclusion: Symblepharon occurs due to prolonged inflammation, which can structurally and functionally disrupt the eye. Early discovery of symblepharon, especially in severe manifestations of SJS, can help prevent further damage to the eye.

Purpose: To gain epidemiological insights by investigating the age, risk factors, and clinical features of individuals affected by the conjunctivitis outbreak.

Methods: The study was conducted at various ophthalmic centers, involving participants with clinical symptoms of acute conjunctivitis within one week from 15 June 2024 to 15 July 2024. Demographic information, clinical features, signs, and symptoms were recorded and analyzed using SPSS version 21.0 and MedCalc software.

Results: The study included 920 patients (1722 eyes), 56% males and 44% females, and most cases were bilateral (94%). Among the affected groups, hospital staff (43%) were the most affected, followed by school-going children (31%), those in direct contact with infected individuals (17%), or others (11%). The median age of onset was 26 years, with a range spanning from 2 to 76 years. The age group most affected was 19-49 years (52%), followed by <18 years (34%) and the elderly group (14%). The most common and first symptom was foreign body sensation (92%), and additional symptoms included ocular itching (81%) and watering (80%). The most prevalent signs were conjunctival congestion (99%), follicles (96%), subconjunctival bleeding (43%), eyelid swelling (51%), chemosis (39%), and pre-auricular lymph node enlargement (6%). Corneal involvement was not observed.

Discussions: Acute Epidemic Conjunctivitis (AEC) outbreaks have significant implications for public health, particularly regarding healthcare resource utilization, economic burden, and disruption of daily life. Timely identification, effective communication, and coordinated response strategies are essential to managing AEC outbreaks and preventing their escalation.

Conclusion: This study provides crucial insights into epidemic conjunctivitis in North Central India. The study findings can guide targeted interventions and healthcare resource allocation to manage the outbreak effectively.

Objective: To evaluate the adherence rate of diabetic subjects to the retinopathy screening program and to identify the characteristics associated with non-compliance to regular screening.

Methods: A cross-sectional study involving 240 patients with diabetes who attended outpatient non-ophthalmology clinics at four tertiary university hospitals between March 2020 and March 2021 was conducted. A validated questionnaire collected data that included socio-demographic variables, characteristics of diabetes, diabetes-related complications and comorbidities, knowledge and attitudes toward DR and its screening, and barriers to DR screening. Univariate and multivariate logistic regression was employed to identify the factors associated with adherence to the annual diabetic eye examination. Adherence was defined as a history of the dilated ophthalmic exam in the past year and subsequent follow-ups recommended by the ophthalmologist.

Results: The participants had an average age of 59 ± 14.2 years, and 53% were females. The average duration of diabetes was 108 ± 89.62 months. Based on the last ophthalmic examination, 50.8% of patients were non-adherent to the suggested DR screening guidelines. A history of smoking (p-value=0.013, 95%CI for OR: 1.21-5.10), lower education levels (p-value=0.045, 95%CI for OR: 1.02-3.82), and not clarifying the necessity of ophthalmic examination by primary physicians (p-value < 0.001, 95%CI for OR: 2.19-12.35) were significantly associated with non-adherence. Among non-adherent subjects, 38% reported fear of the COVID-19 pandemic, 21.3% cited the lack of information regarding DR screening, 10.7% cited lack of access to the ophthalmologist, 5.7% cited financial problems, and 10.7% noted a lack of support from family and friends as the main reason for non-attendance to the annual eye care.

Discussions: This study revealed a non-compliance rate with DR screening guidelines that surpasses pre-pandemic figures. Although younger participants demonstrated a higher likelihood of recent eye care, this correlation lost significance in multivariate analysis, potentially reflecting education and technology utilization disparities. Despite uniform insurance coverage, socioeconomic factors, such as transportation challenges, may impede adherence. Furthermore, individuals informed by healthcare providers about the necessity of eye exams exhibited greater compliance; however, many newly diagnosed patients remained unaware of the risks associated with DR. The COVID-19 pandemic emerged as a prominent barrier, with numerous patients citing it as a reason for their non-compliance due to disruptions in clinical care.

Conclusions: Half of the diabetic subjects attending tertiary hospitals for non-ophthalmic complaints were non-adherent to recommended retinopathy screening. Lower education, smoking, and unawareness of the necessity of ann

Introduction: To evaluate the performance of ChatGPT-4.0 and ChatGPT-3.5 in answering multiple-choice questions in OphthoQuestions (www.ophthoquestions.com), a popular question preparation bank, and to compare the performance of GPT-4.0 and GPT-3.5.

Methods: In January 2024, using a personal account on OphthoQuestions (www.ophthoquestions.com), 520 questions were selected from 4,551 OphthoQuestions. These 520 questions were created by randomly selecting 40 questions from each of 13 ophthalmology subspecialties. GPT-3.5 and GPT-4.0 were asked to answer these same 520 questions.

Results: ChatGPT-4.0 and ChatGPT-3.5 answered 408 questions (78.46%) 95% CI [70,88%] and 333 questions (64.15%) 95% CI [53,74%] of 520 questions correctly, respectively. GPT-4.0 answered significantly more questions correctly than GPT-3.5 (p= 0.0195). ChatGPT-4.0 showed a statistically significant difference compared to ChatGPT-3.5 in giving correct answers in all subgroup analyses (p<0.05).

Discussions: This study gives an encouraging new proof of ChatGPT's ability to manage complex clinical and medical data, focusing on the development and consistency of artificial intelligence algorithms. The statistically significant success of GPT-4.0 over GPT-3.5 in this study should be examined in light of future algorithm advances, particularly in online tests, which will increase progressively as the use of artificial intelligence poses an increasing danger to test integrity. Protocols such as required proctoring should be considered. In the following years, ChatGPT's clinical management and decision-making expertise should be supplemented by more research indicating that it may be a beneficial resource for ophthalmologists and other medical professionals seeking information and guidance on challenging cases.

Conclusions: GPT-4.0 was found to give more and more consistent answers than GPT 3.5 on a multiple-choice ophthalmology question bank. ChatGPT has shown significant differences between algorithms in accuracy and repeatability when handling questions related to eye diseases. This study shows that new artificial intelligence algorithms are promising. More data is needed to use artificial intelligence language models in medical applications.

Objective: To report a case of atypical delayed-onset endophthalmitis following intravitreal dexamethasone (DEX) implantation, managed successfully without implant removal.

Case presentation: A 72-year-old Asian woman with recurrent macular edema due to central retinal vein occlusion (CRVO) received an intravitreal DEX implant. Two weeks post-injection, she experienced blurred vision but no pain or redness. Best-corrected visual acuity (BCVA) had dropped to hand movements near the face (HMCF). Examination revealed 3+ anterior chamber cells and a 1.5 mm hypopyon, with significant vitreous haze obscuring retinal details. A diagnosis of acute endophthalmitis was made. Initial treatment with intravitreal vancomycin and ceftazidime was followed by pars plana vitrectomy (PPV) without implant removal. Microbiological tests were negative, and vision improved significantly, with BCVA returning to 6/12 after two weeks.

Discussion: Endophthalmitis following DEX implantation is rare, and its management is not well-defined. While implant removal is often recommended, favorable outcomes can be achieved without it. The negative culture results and atypical presentation suggested a possible non-infectious etiology. Intraocular steroids may obscure typical signs of infection.

Conclusion: Atypical delayed-onset endophthalmitis following DEX implantation can be successfully treated with prompt vitrectomy and intravitreal antibiotics without implant removal, underscoring the need for individualized management in such cases.