Pub Date : 2025-10-08DOI: 10.1016/j.jcjo.2025.09.002
Chrisha Faye Habaluyas, Muhammad Abumanhal, Mayari Ito, Yasuhiro Takahashi
Objective: To evaluate the efficacy and safety of a triamcinolone acetonide (TA) injection for upper eyelid retraction and excursion in patients with active thyroid eye disease (TED).
Design: A retrospective observational study.
Participants: Fifty-six eyelids of 42 patients with TED who had magnetic resonance imaging-confirmed inflammation of the levator palpebrae superioris (LPS), with or without lacrimal gland (LG) involvement.
Methods: Each patient received a transcutaneous injection of 1 mL of TA (40 mg/mL). Clinical outcomes included margin reflex distance-1 (MRD-1), upper eyelid excursion, Hertel exophthalmometry, and clinical activity score (CAS), recorded at baseline, 2 months, and 6 months postinjection. Intraocular pressure (IOP) and adverse events were monitored. Outcomes were compared between patients with inflammation localized in the LPS muscle (LPS group) and those with LPS inflammation, extending to the lacrimal gland (LPS-LG group).
Results: All variables improved by 2 months postinjection, and MRD-1 significantly decreased from 5.8 mm at baseline to 4.5 mm at 6 months (p < 0.001). Upper eyelid excursion improved from 12.8 mm to 14.5 mm (p < 0.001). Hertel exophthalmometric values were reduced (16.8 mm to 16.4 mm; p = 0.007). CAS decreased significantly from 1.7 to 0.1 (p < 0.001). No significant differences in treatment outcomes were observed between the LPS and LPS-LG groups. No cases of IOP elevation or post-procedural complications were observed.
Conclusions: A transcutaneous TA injection effectively improves upper eyelid retraction and excursion in active TED without significant adverse events.
目的：评价曲安奈德（TA）注射液治疗活动性甲状腺眼病（TED）患者上眼睑挛缩和偏移的疗效和安全性。设计：回顾性观察性研究。参与者：42例TED患者的56眼睑，磁共振成像证实提上睑肌（LPS）炎症，伴或不伴泪腺（LG）受累。方法：每例患者经皮注射TA 1ml （40mg /mL）。临床结果包括注射后基线、2个月和6个月记录的边缘反射距离-1 （MRD-1）、上眼睑偏移、Hertel验光和临床活动评分（CAS）。监测眼压（IOP）和不良事件。比较局限于LPS肌肉的炎症患者（LPS组）和延伸至泪腺的炎症患者（LPS- lg组）的结果。结果：注射后2个月，所有变量均得到改善，MRD-1从基线时的5.8 mm显著下降到6个月时的4.5 mm （p < 0.001）。上眼睑偏移从12.8 mm改善到14.5 mm （p < 0.001）。Hertel显眼值降低（16.8 mm至16.4 mm; p = 0.007）。CAS由1.7显著降低至0.1 （p < 0.001）。LPS组与LPS- lg组治疗结果无显著差异。没有观察到IOP升高或术后并发症。结论：经皮TA注射可有效改善活动性TED患者的上睑收缩和偏移，无明显不良反应。
{"title":"Effectiveness of triamcinolone acetonide injection for upper eyelid retraction and excursion in active thyroid eye disease.","authors":"Chrisha Faye Habaluyas, Muhammad Abumanhal, Mayari Ito, Yasuhiro Takahashi","doi":"10.1016/j.jcjo.2025.09.002","DOIUrl":"10.1016/j.jcjo.2025.09.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of a triamcinolone acetonide (TA) injection for upper eyelid retraction and excursion in patients with active thyroid eye disease (TED).</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Participants: </strong>Fifty-six eyelids of 42 patients with TED who had magnetic resonance imaging-confirmed inflammation of the levator palpebrae superioris (LPS), with or without lacrimal gland (LG) involvement.</p><p><strong>Methods: </strong>Each patient received a transcutaneous injection of 1 mL of TA (40 mg/mL). Clinical outcomes included margin reflex distance-1 (MRD-1), upper eyelid excursion, Hertel exophthalmometry, and clinical activity score (CAS), recorded at baseline, 2 months, and 6 months postinjection. Intraocular pressure (IOP) and adverse events were monitored. Outcomes were compared between patients with inflammation localized in the LPS muscle (LPS group) and those with LPS inflammation, extending to the lacrimal gland (LPS-LG group).</p><p><strong>Results: </strong>All variables improved by 2 months postinjection, and MRD-1 significantly decreased from 5.8 mm at baseline to 4.5 mm at 6 months (p < 0.001). Upper eyelid excursion improved from 12.8 mm to 14.5 mm (p < 0.001). Hertel exophthalmometric values were reduced (16.8 mm to 16.4 mm; p = 0.007). CAS decreased significantly from 1.7 to 0.1 (p < 0.001). No significant differences in treatment outcomes were observed between the LPS and LPS-LG groups. No cases of IOP elevation or post-procedural complications were observed.</p><p><strong>Conclusions: </strong>A transcutaneous TA injection effectively improves upper eyelid retraction and excursion in active TED without significant adverse events.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.02.011
Ali Alkhabbaz , Mohammad Karam , Marwa Al Ghafri , Adam Samet , Bryan Arthurs , Christian El-Haddad
<div><h3>Objective</h3><div>To compare the efficacy of levobupivacaine versus bupivacaine for peribulbar block in ophthalmic surgery.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Publications in MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) that compared levobupivacaine and bupivacaine for peribulbar block in ophthalmic surgery were screened for eligibility from inception through December 22, 2023. Our analyses were summarized by calculating mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous variables, using either fixed-effects or random-effects meta-analysis based on the level of heterogeneity.</div></div><div><h3>Results</h3><div>Eight randomized control trials enrolling 800 patients were identified in the English literature published between 1998 and 2023. There was no statistically significant difference in akinesia score at 2 minutes (MD = 0.17; <em>p</em> = 0.12) or 10 minutes postinjection (MD = 0.02; <em>p</em> = 0.89). Similarly, there was no statistically significant difference between the 2 groups in terms of time of onset of the anesthetic effect (MD = 0.38; <em>p</em> = 0.36), postoperative diplopia (OR = 0.62; <em>p</em> = 0.17), incidence of systemic hypotension (OR = 1.00; <em>p</em> = 1.00) or verbal pain scales during the block (MD = 0.04; <em>p</em> = 0.66), at the end of surgery (MD = −0.01; <em>p</em> = 0.94) or 4 hours postoperatively (MD = −0.00; <em>p</em> = 0.98).</div></div><div><h3>Conclusions</h3><div>As a result of conducting this meta-analysis, we conclude that there is no significant difference between levobupivacaine and bupivacaine in terms of akinesia score, time to onset of anesthetic effect, verbal pain scales, postoperative diplopia, or incidence of systemic hypotension.</div></div><div><h3>Objectif</h3><div>Comparer l’efficacité de la lévobupivacaïne à celle de la bupivacaïne pour réaliser une anesthésie péribulbaire en vue d’une chirurgie ophtalmologique.</div></div><div><h3>Méthodes</h3><div>On a procédé à une revue de synthèse systématique de même qu’à une méta-analyse conformément aux lignes directrices PRISMA (<em>Preferred Reporting Items for Systematic Reviews and Meta-Analyses</em>). On a vérifié l’admissibilité de tous les articles publiés dans MEDLINE, EMBASE, EMCARE, CINAHL et CENTRAL (<em>Cochrane Central Register of Controlled Trials</em>) comparant la lévobupivacaïne et la bupivacaïne dans l’anesthésie péribulbaire en vue d’une chirurgie ophtalmologique depuis la création des bases de données jusqu’au 22 décembre 2023. Nos analyses ont été résumées en calculant les différences moyennes (DM) pour variables continues et les rapports de cotes (RC) pour variables dichotomiques; on a eu recours à une méta-analyse à effets fixes ou à effets aléatoires selon le degré d’hétérogénéité de
{"title":"Levobupivacaine versus bupivacaine in peribulbar block for ophthalmic surgeries: a systematic review and meta-analysis","authors":"Ali Alkhabbaz , Mohammad Karam , Marwa Al Ghafri , Adam Samet , Bryan Arthurs , Christian El-Haddad","doi":"10.1016/j.jcjo.2025.02.011","DOIUrl":"10.1016/j.jcjo.2025.02.011","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the efficacy of levobupivacaine versus bupivacaine for peribulbar block in ophthalmic surgery.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Publications in MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) that compared levobupivacaine and bupivacaine for peribulbar block in ophthalmic surgery were screened for eligibility from inception through December 22, 2023. Our analyses were summarized by calculating mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous variables, using either fixed-effects or random-effects meta-analysis based on the level of heterogeneity.</div></div><div><h3>Results</h3><div>Eight randomized control trials enrolling 800 patients were identified in the English literature published between 1998 and 2023. There was no statistically significant difference in akinesia score at 2 minutes (MD = 0.17; <em>p</em> = 0.12) or 10 minutes postinjection (MD = 0.02; <em>p</em> = 0.89). Similarly, there was no statistically significant difference between the 2 groups in terms of time of onset of the anesthetic effect (MD = 0.38; <em>p</em> = 0.36), postoperative diplopia (OR = 0.62; <em>p</em> = 0.17), incidence of systemic hypotension (OR = 1.00; <em>p</em> = 1.00) or verbal pain scales during the block (MD = 0.04; <em>p</em> = 0.66), at the end of surgery (MD = −0.01; <em>p</em> = 0.94) or 4 hours postoperatively (MD = −0.00; <em>p</em> = 0.98).</div></div><div><h3>Conclusions</h3><div>As a result of conducting this meta-analysis, we conclude that there is no significant difference between levobupivacaine and bupivacaine in terms of akinesia score, time to onset of anesthetic effect, verbal pain scales, postoperative diplopia, or incidence of systemic hypotension.</div></div><div><h3>Objectif</h3><div>Comparer l’efficacité de la lévobupivacaïne à celle de la bupivacaïne pour réaliser une anesthésie péribulbaire en vue d’une chirurgie ophtalmologique.</div></div><div><h3>Méthodes</h3><div>On a procédé à une revue de synthèse systématique de même qu’à une méta-analyse conformément aux lignes directrices PRISMA (<em>Preferred Reporting Items for Systematic Reviews and Meta-Analyses</em>). On a vérifié l’admissibilité de tous les articles publiés dans MEDLINE, EMBASE, EMCARE, CINAHL et CENTRAL (<em>Cochrane Central Register of Controlled Trials</em>) comparant la lévobupivacaïne et la bupivacaïne dans l’anesthésie péribulbaire en vue d’une chirurgie ophtalmologique depuis la création des bases de données jusqu’au 22 décembre 2023. Nos analyses ont été résumées en calculant les différences moyennes (DM) pour variables continues et les rapports de cotes (RC) pour variables dichotomiques; on a eu recours à une méta-analyse à effets fixes ou à effets aléatoires selon le degré d’hétérogénéité de","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages e721-e729"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.02.017
Nishita T. Sheth , Irene T. Lee , Sandra S. Stinnett , Julie Woodward , Richard C. Allen , Christopher R. Dermarkarian
Objective
While ocular manifestations of facial nerve palsy, such as lagophthalmos are well known, there is limited knowledge on whether CN 7 palsy impacts globe positioning and its implications on symptoms and management. We hypothesize that CN 7 palsy is associated with ipsilateral exophthalmos.
Methods
A retrospective analysis of 500 patients diagnosed with facial nerve disorders, identified by ICD codes G51.0–G51.9, was conducted at a tertiary health care facility from January to November 2023. Patients were included if they had a diagnosis of unilateral facial nerve (CN 7) palsy and available computed tomography (CT) imaging after diagnosis. Patients under 18 years, those with bilateral CN 7 palsy, or with CT images of poor resolution were excluded. Axial position of the globe was measured on CT scans using 2 methods, both previously shown to correlate with Hertel exophthalmometry.
Results
Of the 500 charts reviewed, 55 patients met inclusion criteria. 55% (n = 30) of patients were male, and 58% (n = 32) had right-sided CN 7 palsy. The predominant etiology was acute Bell's palsy 76% (n = 42). CT measurements revealed a statistically significant relative exophthalmos on the side affected by CN 7 palsy, measuring an average of 0.89 mm (Method 1) and 0.92 mm (Method 2) (both methods p < .001).
Conclusions
Our study is the first to highlight changes in ocular globe position in CN 7 palsies. The observed exophthalmos highlights the importance of assessing globe position in ophthalmologic management of the disorder.
{"title":"Relative exophthalmos in facial nerve palsy","authors":"Nishita T. Sheth , Irene T. Lee , Sandra S. Stinnett , Julie Woodward , Richard C. Allen , Christopher R. Dermarkarian","doi":"10.1016/j.jcjo.2025.02.017","DOIUrl":"10.1016/j.jcjo.2025.02.017","url":null,"abstract":"<div><h3>Objective</h3><div><span>While ocular manifestations of facial nerve palsy, such as </span>lagophthalmos<span> are well known, there is limited knowledge on whether CN 7 palsy impacts globe positioning and its implications on symptoms and management. We hypothesize that CN 7 palsy is associated with ipsilateral exophthalmos.</span></div></div><div><h3>Methods</h3><div><span><span><span>A retrospective analysis of 500 patients diagnosed with facial nerve disorders, identified by </span>ICD codes G51.0–G51.9, was conducted at a tertiary </span>health care facility from January to November 2023. Patients were included if they had a diagnosis of unilateral facial nerve (CN 7) palsy and available </span>computed tomography (CT) imaging after diagnosis. Patients under 18 years, those with bilateral CN 7 palsy, or with CT images of poor resolution were excluded. Axial position of the globe was measured on CT scans using 2 methods, both previously shown to correlate with Hertel exophthalmometry.</div></div><div><h3>Results</h3><div><span>Of the 500 charts reviewed, 55 patients met inclusion criteria. 55% (n = 30) of patients were male, and 58% (n = 32) had right-sided CN 7 palsy. The predominant etiology was acute Bell's palsy 76% (n = 42). CT measurements revealed a statistically significant relative exophthalmos on the side affected by CN 7 palsy, measuring an average of 0.89 mm (Method 1) and 0.92 mm (Method 2) (both methods </span><em>p</em> < .001).</div></div><div><h3>Conclusions</h3><div>Our study is the first to highlight changes in ocular globe position in CN 7 palsies. The observed exophthalmos highlights the importance of assessing globe position in ophthalmologic management of the disorder.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages e667-e671"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.03.014
Burak Mergen , Ali Ceylan , Fahri Onur Aydin , Petek Aksöz Bolat , Burcin Kepez Yildiz , Yusuf Yildirim
Objective
To evaluate the initial clinical outcomes of a small-incision lenticule extraction (SMILE)-derived lenticule patch graft for the management of corneal defects.
Methods
Patients who underwent SMILE-derived lenticule patch graft implantation with sutures between 2016 and 2020 at 2 different tertiary-care referral hospitals were evaluated retrospectively. The etiology, logarithm of the minimum angle of resolution (logMAR)-equivalent best corrected visual acuity (BCVA), and globe integrity were evaluated. Additional surgical interventions and secondary surgeries were recorded. The follow-up duration was 1 year.
Results
Sixteen eyes of 16 patients (9 females and 7 males) were included in the study. The mean age of the patients was 48.9 ± 19.6 (range: 24–80) years. The most common underlying etiologies were neurotrophic keratitis (18.7%), penetrating injuries (18.7%), and corneal melting due to inflammatory or rheumatological disorders (18.7%). The etiology was unknown in 4 patients (25.0%). Anatomic success in terms of corneal integrity was achieved in all 16 eyes after the procedure. The mean logMAR BCVA was 1.9 ± 0.8 before the surgery and 1.2 ± 0.7 after the surgery. In 3 patients, amniotic membrane transplantation was performed together with a lenticule patch. After the procedure, penetrating keratoplasty was performed in 4 patients (25.0%) to improve their BCVA.
Conclusions
Lenticule patch application to treat corneal defects secondary to various corneal pathologies is effective and reliable for preserving eye integrity. This method is particularly advantageous for patients unable to undergo a cornea transplant under emergency conditions until cornea donor tissue becomes available.
{"title":"A pilot study on SMILE-derived lenticule patch implantation: stromal augmentation for various corneal pathologies","authors":"Burak Mergen , Ali Ceylan , Fahri Onur Aydin , Petek Aksöz Bolat , Burcin Kepez Yildiz , Yusuf Yildirim","doi":"10.1016/j.jcjo.2025.03.014","DOIUrl":"10.1016/j.jcjo.2025.03.014","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the initial clinical outcomes of a small-incision lenticule extraction (SMILE)-derived lenticule patch graft for the management of corneal defects.</div></div><div><h3>Methods</h3><div>Patients who underwent SMILE-derived lenticule patch graft implantation with sutures between 2016 and 2020 at 2 different tertiary-care referral hospitals were evaluated retrospectively. The etiology, logarithm of the minimum angle of resolution (logMAR)-equivalent best corrected visual acuity (BCVA), and globe integrity were evaluated. Additional surgical interventions and secondary surgeries were recorded. The follow-up duration was 1 year.</div></div><div><h3>Results</h3><div><span>Sixteen eyes of 16 patients (9 females and 7 males) were included in the study. The mean age of the patients was 48.9 ± 19.6 (range: 24–80) years. The most common underlying etiologies were neurotrophic keratitis (18.7%), penetrating injuries (18.7%), and corneal melting due to inflammatory or rheumatological disorders (18.7%). The etiology was unknown in 4 patients (25.0%). Anatomic success in terms of corneal integrity was achieved in all 16 eyes after the procedure. The mean logMAR BCVA was 1.9 ± 0.8 before the surgery and 1.2 ± 0.7 after the surgery. In 3 patients, </span>amniotic membrane<span> transplantation was performed together with a lenticule patch. After the procedure, penetrating keratoplasty was performed in 4 patients (25.0%) to improve their BCVA.</span></div></div><div><h3>Conclusions</h3><div><span>Lenticule patch application to treat corneal defects secondary to various corneal pathologies is effective and reliable for preserving eye integrity. This method is particularly advantageous for patients unable to undergo a </span>cornea transplant under emergency conditions until cornea donor tissue becomes available.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages 272-278"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.03.008
Wei Sim , Jack Mouhanna , Danah Albreiki
Objective
To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) arterial injury on temporal artery biopsy (TAB).
Design
Single-centre, retrospective cohort study.
Participants
One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.
Methods
Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.
Results
Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (p = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (p = 0.050) and with earlier relapse rates (p = 0.007). Aortitis (HR 7.96; p = 0.007) and jaw claudication (HR 5.08; p = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (p = 0.044 and p = 0.047, respectively) and were associated with disease relapses on univariable analysis (p = 0.044 and p = 0.047, respectively) but not on multivariable analysis.
Conclusions
The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.
{"title":"Risk factors associated with disease relapse in healing/healed arterial injury and biopsy-proven giant cell arteritis","authors":"Wei Sim , Jack Mouhanna , Danah Albreiki","doi":"10.1016/j.jcjo.2025.03.008","DOIUrl":"10.1016/j.jcjo.2025.03.008","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) </span>arterial injury on temporal </span>artery biopsy (TAB).</div></div><div><h3>Design</h3><div>Single-centre, retrospective cohort study.</div></div><div><h3>Participants</h3><div>One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.</div></div><div><h3>Methods</h3><div>Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.</div></div><div><h3>Results</h3><div>Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (<em>p</em><span> = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (</span><em>p</em> = 0.050) and with earlier relapse rates (<em>p</em> = 0.007). Aortitis (HR 7.96; <em>p</em><span> = 0.007) and jaw claudication (HR 5.08; </span><em>p</em><span> = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (</span><em>p</em> = 0.044 and <em>p</em> = 0.047, respectively) and were associated with disease relapses on univariable analysis (<em>p</em> = 0.044 and <em>p</em> = 0.047, respectively) but not on multivariable analysis.</div></div><div><h3>Conclusions</h3><div>The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages 279-283"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.03.019
Meira Fogel Levin , Giuseppe Querques , Riccardo Sacconi , Jason M.L. Miller , Mark W. Johnson , Alexandra Miere , Eric Souied , Anne Kunkler , Nicolas A. Yannuzzi , Adrian T. Fung , K. Bailey Freund , Tommaso Bacci , Prithvi Ramtohul , Lawrence Yannuzzi , SriniVas R. Sadda , Caroline R. Baumal , Panos Christakis , R. Rishi Gupta , Michael Ip , Ahmad Santina , David Sarraf
Objective
To characterize the clinical and multimodal imaging features of central bouquet hemorrhage (CBH) with Henle fiber layer (HFL) involvement in highly myopic eyes, and to investigate the relationships between hemorrhage characteristics, reabsorption time, and visual outcomes.
Methods
Multicenter, retrospective analysis of highly myopic eyes with CBH involving the HFL, confirmed by optical coherence tomography (OCT).
Results
Eighteen eyes from 18 subjects were included for analysis. The mean age of the cohort was 39 ± 13.7 years (range: 17–69) and 61% of subjects were female. Mean refractive error was −14.8 ± 3.14 diopters (range: −9 D to −22 D). All eyes demonstrated a combined CBH with HFL component, while a subretinal component was present in 83.3% of cases. Myopic choroidal neovascularization (CNV) was excluded in all eyes using optical coherence tomography angiography (OCTA) or dye-based angiography (fluorescein or indocyanine green). No correlation was observed between hemorrhage size and visual outcomes or reabsorption time. Hemorrhage cleared after a mean of 2.63 months, and the radial HFL hemorrhage component resolved first. All eyes showed improvement in visual acuity from baseline. Persistent OCT alternations after resolution of hemorrhage included ellipsoid zone disruption (88.9%) and hyperreflective changes in HFL (77.8%). Anti-VEGF injections were administered to 6 eyes (33.3%) and did not correlate with a significant visual or anatomical benefit.
Conclusion
CBH with HFL involvement in high myopia was associated with significantly improved visual outcomes from baseline but structural alterations can persist after clinical resolution. The size of the hemorrhage did not correlate with resorption time, and anti-VEGF treatment did not affect outcome. These findings provide new insights into the natural history and management of nonneovascular CBH in highly myopic eyes.
{"title":"Central bouquet hemorrhage with Henle fiber layer extension in myopic eyes","authors":"Meira Fogel Levin , Giuseppe Querques , Riccardo Sacconi , Jason M.L. Miller , Mark W. Johnson , Alexandra Miere , Eric Souied , Anne Kunkler , Nicolas A. Yannuzzi , Adrian T. Fung , K. Bailey Freund , Tommaso Bacci , Prithvi Ramtohul , Lawrence Yannuzzi , SriniVas R. Sadda , Caroline R. Baumal , Panos Christakis , R. Rishi Gupta , Michael Ip , Ahmad Santina , David Sarraf","doi":"10.1016/j.jcjo.2025.03.019","DOIUrl":"10.1016/j.jcjo.2025.03.019","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the clinical and multimodal imaging features of central bouquet hemorrhage (CBH) with Henle fiber layer (HFL) involvement in highly myopic eyes, and to investigate the relationships between hemorrhage characteristics, reabsorption time, and visual outcomes.</div></div><div><h3>Methods</h3><div>Multicenter, retrospective analysis of highly myopic eyes with CBH involving the HFL, confirmed by optical coherence tomography (OCT).</div></div><div><h3>Results</h3><div><span>Eighteen eyes from 18 subjects were included for analysis. The mean age of the cohort was 39 ± 13.7 years (range: 17–69) and 61% of subjects were female. Mean refractive error<span> was −14.8 ± 3.14 diopters (range: −9 D to −22 D). All eyes demonstrated a combined CBH with HFL component, while a subretinal component was present in 83.3% of cases. Myopic choroidal neovascularization (CNV) was excluded in all eyes using </span></span>optical coherence tomography angiography<span> (OCTA) or dye-based angiography (fluorescein or indocyanine green). No correlation was observed between hemorrhage size and visual outcomes or reabsorption time. Hemorrhage cleared after a mean of 2.63 months, and the radial HFL hemorrhage component resolved first. All eyes showed improvement in visual acuity from baseline. Persistent OCT alternations after resolution of hemorrhage included ellipsoid zone disruption (88.9%) and hyperreflective changes in HFL (77.8%). Anti-VEGF injections were administered to 6 eyes (33.3%) and did not correlate with a significant visual or anatomical benefit.</span></div></div><div><h3>Conclusion</h3><div>CBH with HFL involvement in high myopia was associated with significantly improved visual outcomes from baseline but structural alterations can persist after clinical resolution. The size of the hemorrhage did not correlate with resorption time, and anti-VEGF treatment did not affect outcome. These findings provide new insights into the natural history and management of nonneovascular CBH in highly myopic eyes.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages 289-296"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.03.018
Anna Schuh, Medea Ettl, Siegfried Priglinger, Elisabeth M. Messmer, Andreas Ohlmann, Christoph Hintschich
<div><h3>Objective</h3><div>Analyzing characteristics of ocular surface squamous cell neoplasia (OSSN) at first diagnosis and potential risk factors for aggressive growth behaviour.</div></div><div><h3>Design</h3><div>Retrospective.</div></div><div><h3>Methods</h3><div>Including patients with first diagnosis of OSSN at a tertiary center from 2013 until 2022. Cases were analyzed regarding demographics, clinical findings, and histopathological findings, including Ki-67 expression.</div></div><div><h3>Results</h3><div>A total of 153 patients with first diagnosis of histopathological confirmed OSSN were included. Mean age was 72 years (36–98), with a slight male predominance (66%; <em>n</em> = 101). Most patients had invasive squamous cell carcinoma (SCC; 45.8%, 70), followed by carcinoma in situ (CIS; 37.9%, 58) and epithelial dysplasia (ED; 16.3%, 25). Duration of symptoms varied significantly: ED 6 months (0–36), CIS 1.5 (0–48), SCC 3 (0–36) (<em>p</em> = 0.048). 44.3% (51/115) of cases were previously misdiagnosed, and, therefore, inadequately treated. Orbital involvement was observed in 8.5% (13), intraocular in 1.3% (2), metastasis in 2.7% (4) at initial diagnosis. Ki-67 labeling index (LI) varied significantly across subtypes: ED 35% (2–87%), CIS 45% (11–85%), SCC 50% (18–93%) (<em>p</em> = 0.007) and was higher with involvement of the caruncle, lower fornix, lower eyelid margin, or tarsus (<em>p</em> = 0.023). Patients with globe or orbit invasion had significantly longer median symptom duration (6 months (0–48) vs 2 (0–48); <em>p</em> = 0.01). Patients with metastasis exhibited significantly higher Ki-67 LI (<em>p</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>Our study found extended time intervals from first symptoms to first correct diagnosis correlate with higher risk for advanced SCC. Further, elevated Ki-67 LI correlated with more invasive tumor entities, such as SCC and CIS, and indicate an increased risk of metastasis.</div></div><div><h3>Objectif</h3><div>Analyser les caractéristiques du carcinome épidermoïde de la surface oculaire (CESO) lors du diagnostic initial de même que les facteurs de risque éventuels d’une croissance agressive.</div></div><div><h3>Nature</h3><div>Étude rétrospective.</div></div><div><h3>Méthodes</h3><div>Patients ayant reçu un diagnostic initial de CESO dans un centre de soins tertiaires entre 2013 et 2022. On a procédé à l’analyse des données démographiques, des observations cliniques et des caractéristiques histopathologiques, notamment l’expression de la protéine Ki-67.</div></div><div><h3>Résultats</h3><div>Au total, on a retenu 153 patients dont le diagnostic initial de CESO a été confirmé par histopathologie. L’âge moyen était de 72 ans (36-98 ans), et le nombre d’hommes était légèrement plus élevé (66 %; n = 101). La plupart des patients présentaient une forme invasive de cancer épidermoïde (CE; 45,8 %; 70), un carcinome in situ (CIS; 37,9 %; 58) ou une dysplasie épithéliale (DE; 16,3 %; 25)
{"title":"Ocular surface squamous cell neoplasia: risk factors for aggressive growth behaviour and the role of Ki-67","authors":"Anna Schuh, Medea Ettl, Siegfried Priglinger, Elisabeth M. Messmer, Andreas Ohlmann, Christoph Hintschich","doi":"10.1016/j.jcjo.2025.03.018","DOIUrl":"10.1016/j.jcjo.2025.03.018","url":null,"abstract":"<div><h3>Objective</h3><div>Analyzing characteristics of ocular surface squamous cell neoplasia (OSSN) at first diagnosis and potential risk factors for aggressive growth behaviour.</div></div><div><h3>Design</h3><div>Retrospective.</div></div><div><h3>Methods</h3><div>Including patients with first diagnosis of OSSN at a tertiary center from 2013 until 2022. Cases were analyzed regarding demographics, clinical findings, and histopathological findings, including Ki-67 expression.</div></div><div><h3>Results</h3><div>A total of 153 patients with first diagnosis of histopathological confirmed OSSN were included. Mean age was 72 years (36–98), with a slight male predominance (66%; <em>n</em> = 101). Most patients had invasive squamous cell carcinoma (SCC; 45.8%, 70), followed by carcinoma in situ (CIS; 37.9%, 58) and epithelial dysplasia (ED; 16.3%, 25). Duration of symptoms varied significantly: ED 6 months (0–36), CIS 1.5 (0–48), SCC 3 (0–36) (<em>p</em> = 0.048). 44.3% (51/115) of cases were previously misdiagnosed, and, therefore, inadequately treated. Orbital involvement was observed in 8.5% (13), intraocular in 1.3% (2), metastasis in 2.7% (4) at initial diagnosis. Ki-67 labeling index (LI) varied significantly across subtypes: ED 35% (2–87%), CIS 45% (11–85%), SCC 50% (18–93%) (<em>p</em> = 0.007) and was higher with involvement of the caruncle, lower fornix, lower eyelid margin, or tarsus (<em>p</em> = 0.023). Patients with globe or orbit invasion had significantly longer median symptom duration (6 months (0–48) vs 2 (0–48); <em>p</em> = 0.01). Patients with metastasis exhibited significantly higher Ki-67 LI (<em>p</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>Our study found extended time intervals from first symptoms to first correct diagnosis correlate with higher risk for advanced SCC. Further, elevated Ki-67 LI correlated with more invasive tumor entities, such as SCC and CIS, and indicate an increased risk of metastasis.</div></div><div><h3>Objectif</h3><div>Analyser les caractéristiques du carcinome épidermoïde de la surface oculaire (CESO) lors du diagnostic initial de même que les facteurs de risque éventuels d’une croissance agressive.</div></div><div><h3>Nature</h3><div>Étude rétrospective.</div></div><div><h3>Méthodes</h3><div>Patients ayant reçu un diagnostic initial de CESO dans un centre de soins tertiaires entre 2013 et 2022. On a procédé à l’analyse des données démographiques, des observations cliniques et des caractéristiques histopathologiques, notamment l’expression de la protéine Ki-67.</div></div><div><h3>Résultats</h3><div>Au total, on a retenu 153 patients dont le diagnostic initial de CESO a été confirmé par histopathologie. L’âge moyen était de 72 ans (36-98 ans), et le nombre d’hommes était légèrement plus élevé (66 %; n = 101). La plupart des patients présentaient une forme invasive de cancer épidermoïde (CE; 45,8 %; 70), un carcinome in situ (CIS; 37,9 %; 58) ou une dysplasie épithéliale (DE; 16,3 %; 25)","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages e738-e743"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.04.002
Joshua Bierbrier , Stephanie Baxter , Davin Johnson
Objective
To compare the perioperative complication rates of cataract surgeries performed at a hospital and an independent health facility (IHF) in Ontario following governmental funding changes affecting for-profit private clinics.
Design
Retrospective chart review.
Participants
All patients receiving publicly funded elective cataract surgery in Kingston, Ontario, between January 1, 2023, and December 31, 2023.
Methods
Electronic medical records were assessed for 3 cataract surgery complications: posterior capsular rupture (PCR), retinal tear/detachment, and endophthalmitis. Age, eye, lens type (spheric, aspheric, premium), intraoperative complication, and postoperative complications were recorded for each chart. Differences between clinical settings were evaluated using Fisher’s Exact and χ2 tests (p < 0.05).
Results
A total of 3190 (hospital: 1741; IHF: 1449) charts were reviewed. The hospital had a significantly higher rate of PCRs (1.44% vs 0.21%; p < 0.01). Retinal tears/detachments occurred in 5 hospital cases (0.29%) and none at the IHF, while 2 endophthalmitis cases were reported at the IHF (0.14%) and none at the hospital (both p > 0.05). Lens use patterns significantly differed, with more premium and aspheric lenses used at the IHF and more spheric lenses at the hospital.
Conclusions
Complication rates at both sites were similar and within expected ranges. Differences in PCR rates may be explained by a tendency to perform more complicated surgeries at the hospital. The findings suggest that cataract surgery at both clinical settings is safe.
{"title":"Comparing the rate of cataract surgery complications between a hospital and an independent health facility","authors":"Joshua Bierbrier , Stephanie Baxter , Davin Johnson","doi":"10.1016/j.jcjo.2025.04.002","DOIUrl":"10.1016/j.jcjo.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the perioperative complication rates of cataract surgeries performed at a hospital and an independent health facility (IHF) in Ontario following governmental funding changes affecting for-profit private clinics.</div></div><div><h3>Design</h3><div>Retrospective chart review.</div></div><div><h3>Participants</h3><div>All patients receiving publicly funded elective cataract surgery in Kingston, Ontario, between January 1, 2023, and December 31, 2023.</div></div><div><h3>Methods</h3><div>Electronic medical records were assessed for 3 cataract surgery complications: posterior capsular rupture (PCR), retinal tear/detachment, and endophthalmitis. Age, eye, lens type (spheric, aspheric, premium), intraoperative complication, and postoperative complications were recorded for each chart. Differences between clinical settings were evaluated using Fisher’s Exact and χ<sup>2</sup> tests (<em>p</em> < 0.05).</div></div><div><h3>Results</h3><div>A total of 3190 (hospital: 1741; IHF: 1449) charts were reviewed. The hospital had a significantly higher rate of PCRs (1.44% vs 0.21%; <em>p</em> < 0.01). Retinal tears/detachments occurred in 5 hospital cases (0.29%) and none at the IHF, while 2 endophthalmitis cases were reported at the IHF (0.14%) and none at the hospital (both <em>p</em> > 0.05). Lens use patterns significantly differed, with more premium and aspheric lenses used at the IHF and more spheric lenses at the hospital.</div></div><div><h3>Conclusions</h3><div>Complication rates at both sites were similar and within expected ranges. Differences in PCR rates may be explained by a tendency to perform more complicated surgeries at the hospital. The findings suggest that cataract surgery at both clinical settings is safe.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages 267-271"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jcjo.2025.05.001
Amy Basilious , Rachel L. McInnis , Verena R. Juncal
{"title":"Presumed ocular tuberculosis presenting as a pigmentary retinopathy","authors":"Amy Basilious , Rachel L. McInnis , Verena R. Juncal","doi":"10.1016/j.jcjo.2025.05.001","DOIUrl":"10.1016/j.jcjo.2025.05.001","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 5","pages":"Pages e794-e797"},"PeriodicalIF":2.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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