Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Objective: Uveitis are inflammatory disorders of various etiologies. The first-line etiological workup is currently poorly codified, and some patients undergo sequential investigations. However, what leads the clinician to perform subsequent exams and the relevance of such exams remain to be determined. The main objective of the study was to evaluate the relevance and modalities of a second-line workup of patients with uveitis.

Materials and methods: We performed a monocentric retrospective study in Nancy University Hospital. All adult patients who underwent an etiological workup in the Internal Medicine Department between January 2014 and December 2021 were included.

Results: Among the 247 patients included, 52 underwent a second-line workup, resulting in a modified diagnosis for 18 of them (34.6%), mainly sarcoidosis, intraocular lymphoma, and Crohn's disease. On multivariate analysis, a follow-up longer than 40 months and idiopathic uveitis were associated with the realization of a second-line workup (OR = 2.97 [1.58 - 5.61]; p = 0.001, and OR = 6.13 [2.3-16.1]; p < 0.01, respectively). The presence of synechia and ocular granuloma were associated with a modification of the diagnosis (OR = 8.03 [1.85-45.48]; p = 0.01, and OR = 5.14 [1.22-24.78]; p = 0.03, respectively).

Conclusion: The second-line workup is relevant in up to one-third of patients, mainly if presenting with a modification of ophthalmological examination, synechiae, and a granulomatous feature, and should focus on intraocular lymphoma, sarcoidosis, and Crohn's disease. Larger studies are needed to provide guidelines for second-line workup.

Many Indigenous Peoples are at risk of poor eye health outcomes due to the various financial, social, geographic, and cultural barriers faced when accessing care. Available literature indicates Indigenous populations across Canada suffer greater rates of eye diseases, including diabetic retinopathy, uveitis, and untreated refractive error, as well as their associated complications. However, many gaps within the current state of knowledge exist. Here, we review the available literature regarding the prevalence of eye disease among Indigenous populations in Canada, as well as previously trialed models of eye care delivery. Various models have been attempted to increase access to eye care for Indigenous communities, although several are focused on screening for diabetic retinopathy in northern populations, with many Indigenous Peoples remaining at risk for poor eye health and permanent vision loss. Failing to address the eye care needs of Indigenous communities will hinder the development of adequate solutions, leading to profound inequities, poor eye health outcomes, and greater vision loss among this population. Future research should seek to understand the root causes of why Indigenous communities have high rates of diabetes and associated ocular complications, including the roles of discrimination, colonialism, and mistrust toward the health care system.

Anterior uveitis presents a diagnostic challenge due to its wide array of etiologies and clinical manifestations. This narrative review aims to equip general ophthalmologists with a comprehensive understanding of anterior uveitis epidemiology, diagnosis, and treatment. Particular emphasis is placed on developing a tailored and stepwise strategy, rather than a one-size-fits-all approach, for the workup and treatment of anterior uveitis. Chest radiography and serologic testing for syphilis, human leukocyte antigen B27, and angiotensin-converting enzyme are appropriate routine investigations in cases of severe, bilateral, recurrent, or chronic anterior uveitis. Additional testing should be guided by clinical findings and regional epidemiology, especially when considering expensive and invasive modalities. Investigations that are obtained in the absence of clinical and epidemiologic orientation are of limited utility and incur significant costs to patients and health care systems. Most cases of anatomically isolated anterior uveitis resolve with topical corticosteroids, but some patients require escalation to systemic immunomodulatory therapy (IMT). IMT should be considered in patients who respond poorly to corticosteroids, develop side effects related to corticosteroids that limit their use, require high doses to maintain disease remission, or have concomitant systemic inflammatory disease. Comprehensive ophthalmologists should feel comfortable comanaging patients that require conventional disease-modifying antirheumatic drugs/antimetabolite therapy (i.e., methotrexate, azathioprine, and mycophenolate mofetil) with rheumatologists and providing guidance on ocular dosing. When uveitis quiescence cannot be achieved despite maximally tolerated antimetabolite therapy, patients should be referred to a uveitis specialist for consultation and consideration of IMT escalation. The timing of uveitis referral may depend on local factors specific to health care jurisdictions.

Objective: The purpose of this study was to quantitatively analyze and compare OCT characteristics of intraretinal hyper-reflective foci (IHRF) in eyes with diabetic retinopathy (DR) versus age-related macular degeneration (AMD).

Design: a retrospective observational study.

Participants: 54 treatment-naïve eyes (27 DR and 27 AMD).

Methods: The IHRF lesions in OCT B-scan were semi-automatically segmented. Mean reflectivity (MR), maximum diameter, circularity index (Cir), area, and the angle between the greatest linear dimension (GLD) and the horizontal were computed for each IHRF lesion. The presence and absence of a posterior shadow and the axial location were assessed. The MR was normalized using the vitreous and nerve fiber layer reflectance as dark and bright reference standards, respectively.

Results: A total of 1149 IHRF (1051 in DR and 98 in the AMD group) were identified, with a mean of 39 ± 36 lesions in DR eyes compared to only 4 ± 4 in AMD eyes (p < 0.001). The mean area of individual IHRF lesions was greater in DR eyes (1305 ± 1647 μm² vs 1031 ± 750 μm²; p = 0.016), but IHRF in AMD eyes had higher reflectivity (1.17 ± 0.14 vs 1.03 ± 0.17; p < 0.001). The angle of the GLD relative to the horizontal was greater in AMD eyes, indicating that IHRF in AMD eyes were more horizontally oriented. In AMD eyes, 88.8% of IHRF were located beneath the inner border of the outer nuclear layer (ONL), while in DR eyes, 56.9% were located there (p < 0.001).

Conclusions: IHRF lesions in eyes with DR and AMD demonstrate significant differences, with IHRF in DR eyes tending to be larger and less hyper-reflective compared to AMD eyes.

Ophthalmic rehabilitation refers to the multidisciplinary approach to restoring, maximizing, and preserving the visual function and quality of life for patients affected by ocular manifestations of cancer or its treatments. Besides its approach to low vision, ophthalmic rehabilitation also encompasses a series of reconstructive interventions to mitigate anatomic deficits that may interplay with visual impairment. A gamut of oncologic conditions may result in ocular disabilities, including primary intraocular tumours, secondary metastases, or adverse effects of systemic therapies such as chemotherapy, radiation, and surgery. Methods of ophthalmic rehabilitation are evolving constantly and involve the prescription of optical aids and adaptive technologies to enhance remaining vision, as well as supportive training and counselling to address psychosocial effects. Although studies in low vision have mostly covered aspects of rehabilitation in inherited and degenerative eye conditions, ophthalmic rehabilitation within the context of cancer carries specificities that have been poorly explored in the literature on ophthalmology and oncology. This review aims to build on the trends of low vision management, ocular oncology treatments, orbital reconstructive surgery, and visual therapy to revise the published rationale behind evaluating and managing patients facing debilitating ocular sequelae as the result of cancer.

Objective: Despite the widespread use of cyanoacrylate glue (CA) as an alternative for wound closure, its potential as a sole skin substitute material in periocular skin surgery remains unexplored. The primary objective was to determine the viability of CA as a sole skin substitute in periocular skin surgery after excision.

Design: Single-centre retrospective observational case series.

Methods: All patients were treated at the McGill University Health Centre from August 2023 to November 2023, where CA served as the sole skin substitute material after periocular skin excision.

Results: Three female and one male patient, with a mean age of 75 years, received treatment with CA after skin excision for both cancerous and benign skin lesions. Specifically, histopathology revealed 2 cases of basal cell carcinoma, 1 case of squamous cell carcinoma in situ, and 2 benign lesions. The skin defects after excision ranged from 4 × 3 mm to 15 × 30 mm. No complications were observed between CA graft insertion and final skin re-epithelization. Complete re-epithelization was achieved in all patients at final follow-up without evidence of excessive skin contraction.

Conclusions: This study presents a novel approach by using CA as a skin substitute material in periocular skin excisions. Its liquid form allows for easy application and conforms well to irregular wound surfaces. CA may offer economic advantages, including lower material cost and shorter surgical operating times, compared with traditional skin substitutes. Further research is needed to comprehensively evaluate CA's role as a skin substitute in periocular skin reconstruction.