International Ophthalmology

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Postoperative visual outcomes after bilateral Tecnis Symfony implantation. A Cumulative monocular visual acuities at different distances. Percentage of patients that achieved the distance-corrected logMAR VA at 4 m (distance), 63 cm (intermediate) and 40 cm (near) at 1 month after the implantation of Symfony IOL. B Uncorrected mean monocular and binocular visual acuities after 1-month postoperatively. Monocular and binocular corrected contrast sensitivity at 3 months in photopic (B) and mesopic (C) light conditions. CS, contrast sensitivity; VA, visual acuity
Mean monocular distance-corrected defocus curves at 6 months after bilateral Tecnis Symfony EDoF IOL implantation. Patients were classified into 3 uniform groups according to their pupil size in photopic and scotopic light conditions. Defocus curves are represented for each patient subgroup to show how the VA depends on pupil size. The limits of pupillary diameter for each subset were as follows: in photopic light conditions, small [1.69mm–3.14mm), medium [3.14mm–3.73mm), and large [3.73mm–5.82mm); in scotopic light conditions, small [2.73mm–4.97mm), medium [4.97mm–5.73mm), and large [5.73mm–7.42mm). VA, visual acuity
  • Galadriel Giménez-CalvoGaladriel Giménez-Calvo
  • Francisco de Asís Bartol-PuyalFrancisco de Asís Bartol-Puyal
  • Irene AltemirIrene Altemir
  • [...]
  • José Manuel LarrosaJosé Manuel Larrosa
Background To assess the influence of biometric measurements on the defocus curve after the implantation of enlarged depth-of-focus (EDoF) intraocular lens (IOL). Methods Patients who underwent cataract surgery with bilateral implantation of Tecnis Symfony IOL were enrolled. Preoperatively, axial length (AL), corneal keratometry (K), pupil size and corneal aberrations were measured. 1 month after surgery, distance, intermediate, and near visual acuities (VA) were recorded. At 3 months, monocular and binocular corrected contrast sensitivities under photopic and mesopic lighting conditions were measured with CSV-1000E test. At 6-months, the defocus curve between −5.00 to + 3.00 diopters (D) was assessed in steps of 0.50 D, and NEI-RQL-42 questionnaire was administered. Results One hundred thirty one eyes of 66 patients were included. Binocular logMAR VA better than 0.1 for intermediate vision was obtained in 90% of patients, whereas only 17.7% obtained that result in near vision. The rate of satisfaction was high (96%) and most of them (85.5%) had no or little difficulties in near vision. The mean amplitude of the defocus curve was 2.35D ± 0.73D, and smaller AL, smaller pupils, younger age, and male sex were associated with wider range of clear vision. Conclusions Tecnis Symfony IOL enables functional vision at all distances, but demographic variables and preoperative biometric measurements like AL and pupil size influence the postoperative amplitude of the defocus curve. These parameters could be used to predict the performance of EDoF IOLs.
The optical model of minimum limit of discernible change in spherical power
  • Zhen YiZhen Yi
  • Gao JieGao Jie
  • Cao KaiCao Kai
  • [...]
  • Dai YunDai Yun
Purpose The aim of this study was to deduce theoretically and verify the resolution limit of human eye to spherical lens change for more reasonable design of the trial lenses. Methods A total of 119 normal subjects with different myopia (not more than − 6D) were included. First, the resolution limit of discernible change in spherical power was derived based on the optical model. Then, the subjects were observed to see if they could perceive the changes in spherical power as per the resolution limit and compare the difference in the best-corrected visual acuity obtained with the resolution limit and interval of 0.25D. Results Assuming that the cone cell diameter is 3 μm and the pupil diameter of 4 mm, the theoretically resolution limit was 0.05D. When the diopter of spherical power was increased, the ratios of ability to perceive 0.05D spherical lens change were 98.3% and 96.7% in right and left eyes. When the diopter of spherical power was decreased, the ratios of ability to perceive 0.05D spherical lens change were 78.9% and 83.2% in right and left eyes. The best-corrected visual acuity obtained with the 0.05 D interval trial lens was significantly better than in the 0.25 D interval on both eyes (Right eye − 0.04 ± 0.07 vs − 0.02 ± 0.06, p < 0.001; Left eye − 0.07 ± 0.06 vs − 0.04 ± 0.06, t = 8.825, p < 0.001). Conclusion The resolution limit of human eye to spherical lens change was about 0.05D and the better corrected visual acuity can be obtained by adjusting the spherical power at an interval of 0.05D. Trial registration number: ChiCTR2100047074. Date of registration: 2021/6/7.
  • Manisha ChoudhariManisha Choudhari
  • Kritika NayakKritika Nayak
  • Noriaki NagaiNoriaki Nagai
  • [...]
  • Manju MisraManju Misra
Purpose The aim of the present study was to investigate increase in delivery of drug upon formulation as mucoadhesive microemulsion system and further to investigate possibility of any cytotoxic effects using such formulation. Material and methods Considering hydrophilic and small molecular nature of the drug, it was attempted to be formulated as microemulsion, by using pseudo ternary phase diagram method. Thus, three types of microemulsions were prepared; oil in water, water in oil type and chitosan-coated microemulsion. These microemulsions were characterized for several physicochemical properties like size, zeta potential, Polydispersity index, and compared for in vitro cell viability and ex vivo corneal irritation study. Results All three microemulsions were quite stable, transparent and homogenous systems. They showed similar drug release pattern, but highest ex vivo goat corneal permeation was observed with Chitosan coated microemulsion when compared with ganciclovir solution. Conclusion All microemulsions were found to be non-irritant in in vitro cell viability assay and ex vivo corneal irritation study, indicating the potential of using such systems for delivery of drug to eye.
  • Mohammed AljaroushaMohammed Aljarousha
  • Noor Ezailina BadarudinNoor Ezailina Badarudin
  • Mohd Zulfaezal Che AzeminMohd Zulfaezal Che Azemin
  • [...]
  • Muhammad Afzam Shah Abdul RahimMuhammad Afzam Shah Abdul Rahim
Purpose To develop an Arabic version of OSDI for the Gazan population. Methods A cross-sectional observational study was conducted using a convenience sample technique. The translation procedure included five stages: forward translation, revision of translation, backward translation, refinement of translation, and a final test of the pre-final version. The final sets of questionnaires were constructed using an online JotForm platform. The online platform was chosen to automatically calculate the questionnaire’s final overall score. Overall, 260 participants were instructed to fill out the English and the Arab-OSDI version twice to conduct the reliability of the translated version and repeatability evaluation. Results The mean age of the participants was 33.45 ± 11.74 years old. Cronbach’s alpha for all items was greater than 0.80, except for the “blurred vision” and “deteriorating vision” items (0.77 and 0.74, respectively). The mean overall score difference between the English-OSDI and Arab-OSDI was 0.86 based on the Bland–Altman chart. For repeatability, no significant difference in the overall scores between the two repeats of the Arab-OSDI (p = 0.632). The Arab-OSDI overall score (sessions 1 and 2) has a clinical difference (bias) of 0.21. Using the varimax rotation method, only three factors (ocular symptoms, vision-related function, and environmental triggers) had eigenvalues greater than one in the structure of the Arab-OSDI. Conclusion The Arab-OSDI is an appropriate, reliable, and repeatable tool for the determination of dry eye symptoms, ocular discomfort, and quality of life in the Gazan population. This version could remove the language barrier in answering OSDI items more easily.
Color contrast of corneal nerve density among three groups at 6 and 12 months following surgeries and comparison between each group and preoperative data. The line represents p < 0.05 between two blocks of color (nerve density in central cornea in three groups all decreased significantly compared with pre-operation, p value did not present in the figure). 1 represents the regional distribution; 2 shows color from cold to warm indicating density from low to high
Morphology of nerve fiber in patients with high myopia before surgery. 1–5, respectively, represent the nerves in central, nasal, temporal, upper and lower region of cornea. The branches of the central corneal nerve were intertwined into an irregular reticular structure
Six months postoperatively: 1–5, respectively, show nerve fibers in central, nasal, temporal, upper and lower region of cornea. a, b, c, respectively, represent SMILE, FS-LASIK and LASEK group. B3 shows no nerve passed through the epithelialized incision surface, but a large number of nerve fibers grew close to the edge of the incision. b2, b3 show the nasal and temporal incision presents a smooth curve during the recovery period, and the color of the surrounding white scar area was discriminably light
Twelve months postoperatively: 1–5, respectively, show nerve fibers in central, nasal, temporal, upper and lower region of cornea. a, b, c, respectively, represent SMILE, FS-LASIK and LASEK group. B3 and b5, respectively, show epithelialized and well-healed incisions. The density of the upper nerves was slightly higher than that of the lower nerves by naked eyes (b4, b5)
PurposeTo observe corneal nerve fibers and densitometry after small incision lenticule extraction (SMILE), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia.Methods This is a prospective, cross-sectional research study. Patients with high myopia (equivalent spherical lens: −6.00 and −11.00D) who underwent laser corneal refractive surgery were divided into three groups: SMILE, FS-LASIK and LASEK. Scheimpflug imaging of corneal nerves in five areas was observed by confocal microscopy before and 6, 12 months after surgery. Corneal densitometry was measured by Pentacam anterior segment analysis system.ResultsOverall, 59 patients were enrolled. The nerve density in the central area did not recover to the preoperative level in three groups until 12 months. The density and length of corneal nerves in central and lower area were better in the SMILE group 6 months postoperatively (p = 0.01), while nerve density did not differ significantly among three groups 12 months postoperatively (p = 0.18). Nerve fibers in central and temporal region were wider in LASEK than that in other two groups at 6- and 12-month follow-up. Corneal densitometry in the central 6 mm diameter was significantly higher in the LASEK group compared with other two groups 6 months postoperatively (p = 0.04). Twelve months postoperatively, corneal densitometry in range of all zone was lower in SMILE than in FS-LASIK and LASEK (p = 0.01, 0.03, 0.04).Conclusions Compared with FS-LASIK and LASEK, SMILE-treated eyes with high myopia had certain advantages in nerve density, length and nerve connection way and had better corneal transparency after operation.
The most frequently reported symptoms
Purpose To estimate the prevalence of computer vision syndrome (CVS) among university medical students in Riyadh, Saudi Arabia, after establishing remote learning during COVID-19 pandemic and to compare settings of electronic device usage and patterns of CVS protective measures applied by students before and during this pandemic. Methods This is an observational descriptive cross-sectional study which included 1st to 5th year medical students who were actively enrolled at the governmental colleges of medicine in Riyadh, Saudi Arabia, during the COVID-19 lockdown. The sample size was estimated to be 287 medical students. Participants were asked to volunteer and fill an electronic online questionnaire. Results A total of 300 medical students were included in this study. 94.0% reported at least one symptom of CVS, while 67% reported having more than three symptoms. The most frequently reported symptoms were musculoskeletal pain (84.3%), headache (71.1%) and dry eyes (68%). Thirty-eight percent of the students experienced more severe symptoms, while 48% experienced more frequent symptoms during the COVID-19 pandemic. Risk factors for having three or more symptoms were being a female (p < 0.001) and using electronic devices for longer periods (6.8 h ± 2.8) during COVID-19 lockdown (p < 0.001). Conclusion CVS prevalence during COVID-19 era among medical students is high. This necessitates increasing the awareness of CVS and its preventive measures.
The orbital area was automatically generated with the flood fill software tool (Mimics Research 22.0, Materialise, Belgium), then manually audited and refined with a digitizer (Intuos CTL6100, Wacom Co, Saitama Japan)
Bilateral stereographic conical-shaped orbits were reconstructed, and their volume was calculated automatically
Purpose This retrospective study aimed to analyze the relationship between the volume of the fractured and the normal orbit in patients with unilateral orbital fractures with and without indirect traumatic optic neuropathy (TON). Subjects Data of 25 patients with unilateral orbital fractures who underwent computer tomography between January 2016 and December 2020 were investigated. Emergency imaging was performed within 2 hours of arrival at the emergency room. The subjects were categorized into two groups: unilateral orbital fractures with and without TON. Methods and measures The assessment of TON was performed during a comprehensive ophthalmologic examination by an ophthalmologist. The stereographic orbit was reconstructed, and the volume was calculated. Other variables examined included age, sex, and cause of orbital trauma. The variables were compared using paired t-tests. Statistical significance was set at p < 0.05. Results The orbital volume of the non-fractured orbit was 27.50 ± 2.26 and 27.48 ± 2.64 cm³ in the groups with and without TON, respectively. The average volume of the fractured orbit in the TON group was 27.78 ± 2.56 cm³, and there was no significant volumetric difference between the fractured and non-fractured sides in this group. However, the average volume of the fractured orbit without TON was 28.76 ± 3.18 cm³, larger than that of the non-fractured orbit (p = 0.016). Conclusions Non-expansion of the fractured orbit was a risk factor for indirect TON in patients with unilateral orbital fractures. Volumetric analysis from primary imaging would expedite the diagnosis and treatment of TON, resulting in optimal outcomes.
Correlations between the corneal densitometry and corneal morphological parameters (A-K1, A-K2, A-Km, A-Kmax, ACE, PCE, CCT) obtained in the anterior 0–2 mm (A-K1, R² = 0.094, P = 0.001; A-K2, R² = 0.115, P = 0.000; A-Km, R² = 0.110, P = 0.00; A-Kmax, R² = 0.044, P = 0.03; ACE, R² = 0.050, P = 0.020; PCE, R² = 0.091, P = 0.001; CCT, R² = 0.112, P = 0.000)
Densitometry distribution from the anterior to the posterior layers over the annulus of 0–2 mm, 2–6 mm and 6–10 mm of a cornea in the KC eyes with Vogt’s striae
PurposeTo investigate corneal densitometry and correlations with corneal morphological parameters in patients with bilateral keratoconus (KC) with unilateral Vogt’s striae.Methods This prospective contralateral study enrolled 112 patients (224 eyes) with evident KC characteristics (corneal topography with asymmetric bow-tie pattern, inferior steepening), and at least one KC sign (conical protrusion of the cornea at the apex, corneal stromal thinning, Fleischer ring, Vogt’s striae) on slit-lamp examination. Corneal densitometry and morphological parameters were measured using Pentacam HR.ResultsThe mean age was 23.93 ± 6.81 years. Fifty-two (23.22%), 111 (49.55%), and 61 (27.23%) eyes were in mild, moderate, and severe groups, respectively. Corneal densitometry values of the anterior 0–2 mm and 2–6 mm, intermediate 0–2 mm and 2–6 mm, posterior 2–6 mm, and total cornea 2–6 mm were significantly higher in eyes with Vogt’s striae (P < 0.05), whereas those of the anterior 6–10 mm, posterior 0–2 mm, and total cornea 6–10 mm were significantly lower in eyes with Vogt’s striae (P < 0.05). Anterior 0–2 mm and total cornea 2–6 mm corneal densitometry values were positively correlated with anterior K1 (A-K1), K2 (A-K2), Km (A-Km), Kmax (A-Kmax), anterior corneal elevation, and posterior corneal elevation (P < 0.05), and negatively correlated with central corneal thickness and thinnest corneal thickness in eyes with Vogt’s striae (P < 0.05). A-K2, A-Km, and A-Kmax were significantly correlated with the densitometry values of the anterior 0–2 mm and intermediate 0–2 mm in eyes without Vogt’s striae (P < 0.05).Conclusion Vogt’s striae mainly occur on the anterior and intermediate layers during KC progression.
Objectives: To assess the relationship between orbital wall fractures connecting to paranasal sinuses (OWF-PNS) and SARS-CoV-2 ocular surface contamination (SARS-CoV-2-OSC) in asymptomatic COVID-19 patients. Methods: This was a prospective case–control study enrolling two asymptomatic COVID-19 patient cohorts with vs. without OWF-PNS in the case–control ratio of 1:4. All subjects were treated in a German level 1 trauma center during a one-year interval. The main predictor variable was the presence of OWF-PNS (case/control); cases with preoperative conjunctival positivity of SARS-CoV-2 were excluded to rule out the possibility of viral dissemination via the lacrimal gland and/or the nasolacrimal system. The main outcome variable was laboratory-confirmed SARS-CoV-2-OSC (yes/no). Descriptive and bivariate statistics were computed with a statistically significant P ≤ 0.05. Results: The samples comprised 11 cases and 44 controls (overall: 27.3% females; mean age, 52.7 ± 20.3 years [range, 19–85]). There was a significant association between OWF-PNS and SARS-CoV-2-OSC (P = 0.0001; odds ratio = 20.8; 95% confidence interval = 4.11–105.2; R-squared = 0.38; accuracy = 85.5%), regardless of orbital fracture location (orbital floor vs. medial wall versus both; P = 1.0). Conclusions: Asymptomatic COVID-19 patients with OWF-PNS are associated with a considerable and almost 21-fold increase in the risk of SARS-CoV-2-OSC, in comparison with those without facial fracture. This could suggest that OWF-PNS is the viral source, requiring particular attention during manipulation of ocular/orbital tissue to prevent viral transmission.
Analysis of contour changes of the brow with Bézier functions following frontalis contraction. Asymmetry of elevation was calculated as the difference between the medial and lateral areas outlined by the brow contours. CP is the position of each contour peak
Distributions of the contour peak position of the brows before (below) and after (above) frontalis position. Negative values indicate medial position
Relationship between laterality and asymmetry of brow elevation. The central continuous line indicates zero difference between the lateral and medial areas outlined in Fig. 1
Patterns of brow elevation. The Bezier lines show the difference in the left brow contours. Top: symmetric (the difference between the medial and lateral areas is 2.75%; CP motion is 0.86 mm; middle: medial asymmetric (asymmetry between the lateral and medial sectors is 13.6%; CP moved 2.6 mm in the medial direction). Bottom: lateral asymmetric. The lateral areas are 4.1% greater than the medial; the contour peak moved 3.0 mm laterally
Purpose To measure the changes of the eyebrow’s contour after frontalis muscle (FM) contraction. Methods Two consecutive pictures of the eyes and frontal region of 36 volunteers (15 men and 21 women) were obtained with the forehead relaxed and upon maximal frontalis muscle contraction. Bézier lines representing the brows’ contours, obtained with the ImageJ software, were graphically sampled with a resolution of 0.025 mm. The contours of the relaxed and elevated brows were compared regarding the position of the contour peak (CP), the degree of elevation of brow central point, and the medial and lateral areas outlined between the brow contours before and after frontalis contraction. The asymmetry of the brow contour after FM contraction was calculated by the Naeije formula as (Medial–Lateral)/(Medial + Lateral). A difference of 10% or less between the lateral and medial areas was taken as a cutoff value for symmetrical brow elevation. Results In 62 (86.1%) of the eyes, the location of the brow’s CP was lateral to the brow’s midpoint. When the brows were raised, the CP of 60% of the brows was displaced medially and 40% laterally. The motion of the CP with medial displacement (mean = 3.7 mm) was significantly larger than those displaced laterally (mean = 1.9 mm) decreasing the number of brows with lateral peaks from 62 (86.1%) to 54 (75%). No difference was observed between the mean elevation of the central point of the brow for males (7.9 mm (3.2 SD) and females (7.4 mm, 3.0 SD). In 58.3% of the sample, the positional change of the medial and lateral sectors of the brows was symmetrical, and among the 41.7% asymmetrical cases, the elevation of the medial side was higher than the lateral in 66.7% of the brows. Conclusions The brow changes during FM contraction concur well with the anatomic data of the FM shape. The contour of most brows is displaced toward the medial direction when the brow is elevated. The pattern of brow shape change is an indication of the FM anatomy and must be carefully analyzed before any procedure involving the FM, such as chemodenervation injections or frontalis slings for blepharoptosis correction.
Receiver operating curve of back keratoconus vertex (KVb) and front Baiocchi–Calossi–Versaci (BCVf) indices that remained in the reduced final regression model, for the discrimination between normal and keratoconus eyes
Purpose To evaluate the accuracy of different corneal parameters in detecting keratoconus using a dual Scheimpflug/Placido system (Sirius, CSO, Italy). Methods Sixty-eight eyes of 68 keratoconus patients and 77 eyes of 77 normal subjects were prospectively assessed in a diagnostic test study. The mean differences of the corneal parameters were compared using the independent t-test. The accuracy of curvature, elevation, pachymetry, and aberrometry indices, aqueous depth, and corneal volume in 10 mm was evaluated using the area under the curve (AUC), and the DeLong method was used for the comparison of AUCs. Multiple tests in a parallel manner and multiple logistic regression analysis were applied to determine the best predictor indices. Results All indices except aqueous depth and corneal volume were significantly different between the two groups (P < 0.001). Back keratoconus vertex (KVb) and front Baiocchi–Calossi–Versaci index (BCVf) had the highest sensitivity (for both 98.53%) followed by front symmetry index (SIf) (96.12%) and thinnest point of the cornea (88.24%) in elevation, aberrometry, curvature, and pachymetry parameters, respectively. The highest diagnostic ability was observed in KVb (AUC 0.993) and BCVf index (AUC 0.992) (DeLong > 0.05). Multiple test analysis showed a combination of indices with the highest accuracy that was similar to the performance of each one individually, and keratoconus was diagnosed correctly in 98.5% of the cases (R² = 93%). Conclusion The parameters extracted from Sirius can differentiate keratoconus from normal corneas with high accuracy without the need for complex computational algorithms. Elevation-based and combined aberrometry indices had the highest diagnostic power.
Corneal higher-order aberrations (HOAs) of the a anterior surface, b posterior surface, and c total cornea in Groups 1–3 and the control group
Receiver operating characteristic curves for anterior corneal aberrations
Receiver operating characteristic curves for posterior corneal aberrations
Receiver operating characteristic curves for total corneal aberrations
Purpose This study aimed to investigate the diagnostic value of corneal anterior, posterior, and total higher-order aberrations in keratoconic eyes. Methods We enrolled 94 patients (152 eyes) with mild keratoconus (Group 1), 64 patients (101 eyes) with moderate keratoconus (Group 2), and 32 patients (52 eyes) with advanced keratoconus (Group 3) according to the Amsler–Krumeich classification system; 99 healthy controls (197 normal eyes) were likewise enrolled. Anterior, posterior, and total corneal higher-order aberrations were assessed using a rotating Scheimpflug camera. The 3rd-order and 4th-order root-mean-square values were calculated for higher-order aberrations, including coma, spherical, and trefoil aberrations. Differences between keratoconic and normal eyes were analyzed using Kruskal–Wallis tests. Receiver operating characteristic curves were evaluated for the keratoconus and control groups. Results The differences in coma 90, coma, trefoil, and spherical aberrations, as well as 3rd-order and 4th-order root-mean-square values, were statistically significant between the keratoconus and control groups for all anterior, posterior, and corneal aberrations. The absolute values of these higher-order aberrations were higher in the keratoconus groups than in the control group and increased with keratoconus severity in Groups 1–3. Coma and 3rd-order RMS values showed excellent sensitivity and specificity for discriminating between normal and keratoconus eyes for all anterior, posterior, and corneal aberrations. Conclusion Coma aberrations and 3rd-order root-mean-square values may be valuable for diagnosing keratoconus. Combining these data with topography information may enable the effective and efficient detection of keratoconus in the future.
A Trichiatic lashes in the medial region of the right upper eyelid. B. One-year postoperative aspect after intermarginal split lamella with labial mucous membrane graft sealed with a fibrin sealant
Objective In the intermarginal split lamella with labial mucous membrane graft procedure to manage major trichiasis, the graft is usually sutured in the receptor bed using 6–0 polyglactin sutures. We aimed to compare the use of fibrin sealant to seal the graft to the receptor bed versus the conventional technique using sutures. Methods This is a retrospective comparative study of patients who underwent conventional intermarginal split lamella with labial mucous membrane graft or sutureless procedure using fibrin sealant (Tisseel, Baxter Healthcare Corp) between 2016 and 2021. Etiology of the trichiasis, procedure duration, postoperative discomfort and edema, complications, and follow-up period were extracted from these patients’ charts. Results Twenty-seven eyelids from 19 patients underwent the procedure: twelve patients underwent the sutureless procedure, while seven underwent the conventional procedure. Mean follow-up was 8.4 ± 2.9 months and 13.7 ± 6.5 months for the sutureless and conventional groups, respectively. Patients who underwent the sutureless procedure reported no postoperative foreign body sensation, while 71.4% of patients who underwent the conventional procedure reported some degree of ocular discomfort. In the sutureless group, operating time and postoperative edema were significantly reduced. Labial mucous membrane graft dehiscence was observed in one eyelid (8.3%) on the first postoperative day in the sutureless group. No dehiscence was observed in the conventional technique group. Conclusion The use of fibrin sealant showed to be a good alternative to conventional absorbable sutures. Advantages include expedited operating time, decreased postoperative discomfort, and expedite postoperative recovery.
Scatter plot of spherical equivalent (SE) values and laser spot numbers. The black line represents the regression line
Purpose To investigate the relationship between the development of corrected 1-year-old refraction values and risk factors in preterm infants who underwent laser photocoagulation (LPC) therapy for retinopathy of prematurity (ROP). Methods The ophthalmic examination findings of preterm neonates who had developed Type I ROP and received LPC therapy were evaluated retrospectively. The association between spherical equivalent (SE) values and clinical findings were analyzed by using multivariable linear regression analysis. Results The study included 157 eyes of 80 neonates with a mean birth week of 27.1 ± 2.2 weeks (23 to 32 weeks) and a mean birth weight of 995 ± 273 g (565 to 1760 g). The treatments were administered on an average of 36.8 ± 2.7 (32 to 45 weeks) postmenstrual age. LPC treatment was applied bilaterally to 77 of the 80 neonates included in the study, and unilaterally to 3 of them. The mean ± standard deviation of the SE value was 0.31 ± 1.89 diopters (D) (− 8.00 to 4.63 D) according to the results of the 1-year corrected age refraction examination. In univariate analysis, no significant association between GA, BW, and ROP zone and SE value, while the number of laser spots (ß = − 0.27 ± 0.00 D, p = 0.00) and stage 3 ROP (ß = − 0.29 ± 0.37 D, p = 0.00) were significantly associated with the SE value. In multivariable linear regression analysis, a significant association between number of laser spot, stage 3 ROP and SE value (ß = − 0.25 ± 0.00 D, p = 0.01 for number of laser spot, ß = − 0.28 ± 0.36 D, p = 0.00 for stage 3 ROP). Conclusion In conclusion, this study supports that stage of ROP and the number of laser spots count applied in photocoagulation treatment for ROP is significantly correlated with degree of myopia (p < 0.05).
The signal of axial length measurement derived from a standard time-domain optical coherence tomography-based biometer. A a single peak signal obtained from the normal eye; and B a double peak signal detected in an eye with epiretinal membrane
Postoperative predictive errors present as mean arithmetic error (ME) and mean absolute error (MAE) derived from IOL1, calculated from the first axial length signal (A) and IOL2, calculated from the second axial length signal (B)
Purpose To evaluate the accuracy of axial length (AL) measurement for intraocular lens (IOL) calculation in patients with cataract and epiretinal membrane (ERM). Methods This prospective, cross-sectional study was performed in cataract patients with ERM. All subjects were sent for standard optical biometry, prepared for cataract surgery. Signals of AL measurement were detected as double peaks and recorded as AL1 (first peak), and AL2 (second peak). The IOL power was calculated from AL1 and AL2, and reported as IOL1 and IOL2. The IOL2 was chosen for cataract surgery in all cases. Postoperative predictive errors were compared between IOL1 and IOL2. Results Thirty-seven eyes from 37 patients were included. Mean AL1 was significantly shorter than AL2 (23.13 ± 1.28 vs. 23.60 ± 1.34 mm, p < 0.001), resulting in higher power of IOL1 than IOL2 (mean difference was 1.53 ± 0.96 diopters, p < 0.001). At 3-months post-operation, twenty-nine eyes (78.4%) (95% CI 62.8%–88.6%) showed refractive error within ± 0.5 diopter and all eyes were within ± 1.0 diopter. Postoperative predictive errors including mean arithmetic error (ME) and mean absolute error (MAE) of IOL2 were significantly lower than those of IOL1 (ME: IOL1 vs. IOL2, −0.94 ± 0.91 vs. 0.08 ± 0.51; MAE: 0.97 ± 0.88 vs. 0.39 ± 0.33 diopter, all p < 0.001). Conclusions AL measurement in ERM can be detected as a double peak signal during biometric measurement. The IOL power calculated from the first and second peak signals is significantly different. However, the IOL power derived from the second peak signal provides better refractive outcomes. The results suggest that the second peak signal represents an accurate AL measurement.
Time (months) between primary Cataract Surgery and IOL dislocation
Time between primary Cataract Surgery and IOL dislocation according to the type of luxation
Time (months) between pars plana Vitrectomy and IOL dislocation (study group)
Kaplan–Meier curve. Patients with both -previous pars plana vitrectomy and PEX- are most likely to develop an IOL luxation at an early stage (group 4). In contrast, patients without this both risk factors are less likely for an IOL luxation (group 1)
Purpose The aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation. Methods A retrospective case–control study were all patients presented in the period 2012–2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included. Results 150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24–93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25–127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0–186 months). Conclusion Patients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.
Choroidal thickness measurement with EDI Spectral-Domain OCT. The measurements shown in the image are (from left to right): nasal (1000 μm), Subfoveal and temporal (1000 μm)
Box and whisker plot (The end of the boxes represent the first and third quartile, the middle line represent the median and the whiskers go from each quartile to the minimum and maximum) of the choroidal thickness in both groups. Choroidal thickness is significant greater in keratoconus eyes than healthy eyes in every measured location. N1000, Measurement undertaken at nasal (1000 μm); T1000, Measurement undertaken at temporal (1000 μm); S1000, Measurement undertaken at superior (1000 μm); I1000, Measurement undertaken at inferior (1000 μm). *P values represent the results of the U Mann–Whitney test
Purpose To analyze the choroidal thickness between patients with keratoconus undergoing cross-linking treatment and a healthy population, as well as to determine the factors that influence choroidal thickness. Methods This was an observational, analytical, case–control study that was conducted from February 2021 to June 2021. Choroidal thickness was measured at different locations, including the subfoveal, nasal (1000 μm), temporal (1000 μm), superior (1000 μm) and inferior (1000 μm) locations using a Spectral-domain optical coherence tomography with enhanced depth imaging, which allowed us to obtain horizontal and vertical B-scans centered on the fovea. Results This study included 21 patients with keratoconus (mean age, 21.86 ± 5.28 years) and 28 healthy patients (mean age, 24.21 ± 4.71 years). Choroidal thickness was significantly greater in patients with keratoconus than in healthy patients in each of the following measured locations: subfoveal (P < 0.001); nasal (1000 μm) (P < 0.001), temporal (1000 μm) (P < 0.001), superior (1000 μm) (P < 0.001) and inferior (1000 μm) (P < 0.001) locations. Variables such as age (ρ = − 0.09; P = 0.50) and refraction (ρ = 0.14; P = 0.34) were not found to be associated with choroidal thickness. In a stepwise multiple linear regression, the group was the single variable correlated with choroidal thickness (β = 0.88; P < 0.001). Conclusion Choroidal thickness is thicker in keratoconus patients treated with cross-linking than in the healthy population. This finding could be associated with inflammatory choroidal mechanisms in keratoconus patients, but more studies are needed. Age and refractive error do not seem to influence choroidal thickness.
Optical coherence tomography (OCT) showing a schematic representations of optic nerve head and macular measurements. In each scan of ONH (a), a horizontal reference line was drawn connecting the two terminations of Bruch's membrane. Starting from the deepest point of the cup, a vertical reference line was drawn, and two other vertical measurements were drawn at 100 μm and 200 μm distance. The average distance of the three measurements from the horizontal line was defined as “cup”. Distances from the same 3 points of the reference line to the anterior surface of the lamina cribrosa were also measured, and their average defined the LCD. PLT was considered as the difference between the cup and the LCD. On peripapillary scans, the CT was manually segmented and measured between the Bruch membrane hyperreflective line and the hyperreflective line of the inner surface of the sclera, by 3 measurements spaced 500 μm for each sector, both nasally and temporally. In horizontal macular scans (b), CT was measured using the same anatomical boundaries. The subfoveolar CT was measured along with 3 measurements, equidistant 500 μm each from the fovea, in the nasal and temporal sectors, respectively. Mean macular CT was defined as the average of these seven measurements. LCD Lamina cribrosa depth; PLT Pre-laminary tissue; CT Choroidal thickness
Linear correlation between age and variation of lamina cribrosa depth
Purpose The aim of this study is to investigate changes in choroidal and optic nerve morphological parameters following MicroShunt PreserFlo implantation. The secondary aim is to investigate how the structural changes relate to the decrease in intraocular pressure (IOP). Methods Prospective observational study on 15 eyes with glaucoma requiring MicroShunt implantation. Optical coherence tomography was used to measure macular choroidal thickness (MCT), peripapillary choroidal thickness (PCT), lamina cribrosa depth (LCD), cup depth and prelaminar tissue thickness (PLT), before and one day after surgery. Results were expressed in median and interquartile range (IQR) and correlated with IOP results. Results The IOP decreased from a median of 25 (IQR = 11) mmHg to 8 (IQR = 2) mmHg the day after surgery. Median MCT increased after MicroShunt implantation from 252.1 (IQR = 156.4) µm to a postoperative value of 318.1 (IQR = 166.6) µm (p < 0.001), with a median increase of + 87.7 µm (+ 26.4%). PCT increased from 157.2 (IQR = 109.1) µm before surgery to 206.0 (IQR = 136.1) µm after surgery (p < 0.001). Moreover, we found a significant post-operative decrease in cup depth (median reduction of − 29.3 µm, p < 0.001) and an increase in PLT (median increase of 27.3 µm, p = 0.028). On the other side, LCD reduction 24 h after surgery didn’t reach any statistical significance. Conclusion PreserFlo implantation determines retinal structural changes which appear similar to those caused by traditional filtering surgery, confirming the effectiveness of this device, meantime carrying a much smaller complications rate when compared to trabeculectomy.
PurposeTo evaluate reliability and global indices parameters from standard automated perimetry (SAP) in normal eyes undergoing phacoemulsification cataract surgery with implantation of trifocal or extended depth of focus intraocular lens (IOL).Methods Prospective study to evaluate the effect of trifocal IOL AcrySof IQ PanOptix® and extended depth of focus intraocular lens (EDOF) Tecnis Symfony® IOL implantation on visual field parameters. Patients underwent SAP pre- and postoperatively. Reliability indices (false negative rate—FN, false positive rate—FP), global indices (foveal sensitivity threshold, visual field index—VFI, standard pattern deviation—PSD, mean deviation MD) and test duration were analyzed.ResultsA total of 23 eyes from 13 patients were in the trifocal IOL group and a total of 22 eyes from 14 patients were in the EDOF group. The following results were obtained by analyzing pre- and postoperative SAP of EDOF IOL: the rate of change of FN was 1.95/1.41% (p = 0.61); FP 1.64/1.27 (p = 0.60); MD − 1.60/− 1.08 dB (p = 0.15); foveal sensitivity was 34.5/33.9 dB (p = 0.41); VFI 98.5/98.4% (p > 0.99); PSD 1.85/1.86 (p = 0.07); and for test duration 305.81/298.36 s (p = 0.35); all respectively. Analysis of pre- and postoperative parameters of trifocal IOL were the rates of change of FN 1.22/1.83% (p = 0.29); FP 1.65/1.48% (p = 0.95); MD − 1.55/− 1.37 dB (p = 0.19); foveal sensitivity 33.9/34.9 dB (p = 0.47); VFI 98.6/98.3% (p = 0.62); PSD 1.58/2.05 (p = 0.02); and test duration 297.17/298.57 s (p = 0.87); all respectively.Conclusion We identified a change in the PSD parameters in the trifocal IOL group. No other significant changes were identified in SAP parameters after implantation of trifocal AcrySof IQ PanOptix® and EDOF Tecnis Symfony® IOL. Longitudinal evaluation showed no changes in SAP after Trifocal and EDOF IOL implantation in normal subjects.
Purpose Within a population-based follow-up study, to examine the 10-year incidence of pseudoexfoliation syndrome (PEX), possible risk factors for PEX and its association with ocular aging of the cornea, lens and retina. Methods The baseline examination was conducted in 2006 on a random sample of 1,033 adult participants from Kaunas city (Lithuania) population of whom 631 had ophthalmic examination data at attendance of the 10-year follow-up in 2016. Detailed examination of the anterior and posterior segment of the eye was carried out. After diagnostic mydriasis PEX was diagnosed by the presence of typical grayish-white exfoliation material on the anterior capsule surface of the lens. The participants were divided to PEX and non-PEX groups. Results PEX prevalence increased from 9.8 to 34.2% from baseline to 10-year follow-up. Nuclear cataract was common both in the PEX group (66.7%) and in those without PEX (72.2%), but this difference did not reach statistically significantly increased risk of developing cataract in those with PEX (OR 1.2; p = 0.61). Central corneal thickness (CCT) was thinner in the PEX group (529 ± 34 μm) and in the oldest group (525 ± 36 μm) ( p < 0.001). Compared to baseline, corneal curvature (CC) became flatter in both groups (7.6 ± 0.27 vs 7.7 ± 0.26 mm; p < 0.001) during the follow-up, but the difference did not reach significance between groups. Corneal astigmatism was most commonly with-the-rule in both groups (37 (50.0%) vs 148 (68.5%); p > 0.05). Age, sex and PEX had no influence on age-related macular degeneration distribution. Conclusion The prevalence of PEX increased significantly with age in our population, with those with PEX having thinner and flatter corneae, but no difference in cataract and age-related macular degeneration characteristics.
Dynamic visual acuity test system
Visual acuity 3 months postoperatively
Dynamic visual acuity 3 months postoperatively
Purpose To compare binocular static visual acuity (SVA), stereopsis, contrast sensitivity (CS) and dynamic visual acuity (DVA) of 5 combinations of bifocal intraocular lenses (IOLs), trifocal IOLs and extended-depth-of-focus (EDOF) IOLs in age-related cataract patients. Methods Two hundred and ninety-two eyes of 146 patients who underwent cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University were involved. Subgroups included group MM (33patients, bilaterally bifocal IOL, ZMB00), group TT (31patients, bilaterally trifocal IOL, AT LISA tri839MP), group XX (34patients, bilaterally EDOF IOL, ZXR00), group MX (25patients, bifocal IOL, ZMB00 + EDOF IOL, ZXR00) and group TX (23patients, trifocal IOL, AT LISA tri839MP + EDOF IOL, ZXR00). The uncorrected SVAs (UDVA, UIVA and UNVA), uncorrected DVAs (UDDVA, UIDVA and UNDVA), near and distance stereopsis, and CS were assessed 3 months postoperatively. Results Subgroups of TT, XX, MX and TX showed better UIVA than MM (bP = 0.039, 0.021, 0.035 and 0.037, respectively). MX showed better UNVA than MM and TX (bP = 0.031 and 0.013, respectively). MX group had the optimal outcomes of both near and distance stereopsis. In the UDDVA, XX group and MX group showed better outcomes than TX group at 24 fps (frames per second) (bP = 0.019 and 0.023, respectively). XX group and MX group showed optimal outcomes at all speeds of UIDVA (P = 0.001, 0.005, 0.003 and 0.005, respectively). As the speed increased, the XX group and the MX group showed better UNDVA than the MM group and the TT group (P = 0.019, 0.002 and 0.003, respectively). Conclusions Mix-and-match implantation of bifocal IOLs and EDOF IOLs provides excellent and stable binocular visual outcomes including SVA, stereopsis and DVA in distant and near distances.
Background Artificial intelligence is developing rapidly, bringing increasing numbers of intelligent products into daily life. However, it has little progress in dry eye, which is a common disease and associated with meibomian gland dysfunction (MGD). Noninvasive infrared meibography, known as an effective diagnostic tool of MGD, allows for objective observation of meibomian glands. Thus, we discuss a deep learning method to measure and assess meibomian glands of meibography. Methods We used Mask R-CNN deep learning (DL) framework. A total of 1878 meibography images were collected and manually annotated by two licensed eyelid specialists with two classes: conjunctiva and meibomian glands. The annotated pictures were used to establish a DL model. An independent test dataset that contained 58 images was used to compare the accuracy and efficiency of the deep learning model with specialists. Results The DL model calculated the ratio of meibomian gland loss with precise values by achieving high accuracy in the identification of conjunctiva (validation loss < 0.35, mAP > 0.976) and meibomian glands (validation loss < 1.0, mAP > 0.92). The comparison between specialists’ annotation and the DL model evaluation showed that there is little difference between the gold standard and the model. Each image takes 480 ms for the model to evaluate, almost 21 times faster than specialists. Conclusions The DL model can improve the accuracy of meibography image evaluation, help specialists to grade the meibomian glands and save their time to some extent.
Flow chart of study selection process
Representative anterior segment photographs of the nine patients with moderate/severe NK. The picture a–i are consistent with the No. 1–9 patients in Table 3. a The central cornea shows a diffuse haze with a large epithelial defect with elevated rolled edges. bThe entire cornea is hazy with an epithelial defect with superficial and deep stromal vessels of limbus. c There is a large corneal epithelial defect with stromal opacities. The white, rolled margins of the defects is a typical sign of a non-healing epithelial defect. d Note the temporal persistent epithelial defect. The denuded surface appears dry, milky and hazy. e There is a large corneal epithelial defect with Descemet membrane folds. f Cornea epithelial defect with dense stromal infiltration on the centre cornea. It is surrounded by a slightly raised grey ring of proliferating epithelium. g Around the epithelial defect exists poorly adherent opaque and oedematous epithelium. h Superficial corneal ulcers located on the inferior side of the cornea. i A deep corneal ulcer with a small perforation was noticed, the perforation was inferior to the centre of the cornea and was 0.5 mm × 0.5 mm
Corneal confocal microscopy images showing a reduction in the sub-basal nerve plexus (white lines) in moderate/severe neurotrophic keratitis eyes (a, c) compared with contralateral unaffected eyes (b, d)
Purpose To analyse and quantify ocular surface parameters in patients with unilateral neurotrophic keratitis (NK) induced by trigeminal nerve injury post-neurosurgery. Methods The study included 26 unilateral NK patients who had undergone neurosurgery, and 20 matched normal controls. Demographic and clinical characteristics of all participants were collected and analysed. Slit-lamp examination, Cochet–Bonnet aesthesiometry, Keratograph 5 M, and LipiView interferometer were performed on both eyes of 17 mild NK patients. For nine moderate/severe NK patients, sub-basal nerve density was measured by in vivo confocal microscopy. Results Of the 26 patients, nine had acoustic neuroma, nine had trigeminal neuralgia, and eight had neoplasms. Facial nerve paralysis was observed in one of the 17 mild NK eyes (5.9%) and seven of the nine moderate/severe NK eyes (77.8%). Compared to contralateral and normal control eyes, 26 NK eyes showed significantly reduced sensitivity in five corneal regions ( P < 0.05). Corneal sensitivity in moderate/severe NK eyes was significantly lower than in mild NK eyes ( P < 0.05). Moderate/severe NK eyes had poor visual acuity, and their sub-basal nerve density was lower than that of the controls. The onset of the moderate/severe NK was from 0.5 to 24 months (median [Q1, Q3], 1 [0.5, 2.5] months) after neurosurgery. For the mild NK eyes, the number of total blinks, the first non-invasive tear breakup time (NITBUT) and average NITBUT were significantly lower than contralateral and normal control eyes ( P < 0.05), and the number of partial blinks and partial blinking rate were significantly higher than the other two control groups ( P < 0.05). Conclusions Patients with NK induced by trigeminal nerve injury following neurosurgery had decreased corneal sensitivity to various degrees accompanied by increased partial blinks and shortened NITBUT. The severity of NK is related to the severity of the corneal sensory impairment. Facial nerve paralysis can worsen the clinical progression of NK. Trial registration Chinese Clinical Trial Registry (ChiCTR2100044068, Date of Registration: March 9, 2021).
Purpose To study predisposing factors, clinical presentation and management strategies for Klebsiella keratitis. Methods A retrospective case review was performed on clinical records of culture-proven Klebsiella keratitis cases in a tertiary referral center over an 8-year period (from 2012 to 2020). Results Thirty eight episodes of culture-proven Klebsiella keratitis were identified in 37 patients. The mean age of the patients was 62.9 years (range, 24–101). Multiple predisposing factors were identified in 33 eyes including history of previous keratoplasty (n = 11) history of ocular trauma (n = 7), preexisting ocular surface disease (n = 7) and diabetes (n = 6). Corrected distance visual acuity (CDVA) at presentation was light perception (LP) in 16 patients, hand motion (HM) in 12, counting fingers (CF) at 50 cm in 5, CF at 1 m in 1, CF at 2 m in 2. One patient had a CDVA of 3/10. On initial examination Hypopyon was detected in 21 eyes. Descemet's membrane folds were present in 1 eye. Corneal thinning was identified in 20 eyes and perforation occurred in 4 patients. Corneal ulcer progressed to endophthalmitis in one patient. Microbiologic sensitivity testing showed that 89.5% isolates were sensitive to amikacin (34/38),88.9%sensitive to ceftazidime (32/36),94.4% were sensitive to gentamicin (34/36),97.2% sensitive to ciprofloxacin (35/36), and 100% to levofloxacin (26/26).Ultimately, one or more surgical procedures was needed in 21 patients. Conclusion Previous keratoplasty, history of ocular trauma, ocular surface disease and systemic disease such as diabetes are major risk factors for Klebsiella keratitis. In most of the patients, surgical and tectonic procedures were necessary to control the infection.
The semi-automated ImageJ tool is used to draw the borders of the total MG area (upper) and MG dropout area (lower) manually
SPEED scores of both groups declined with time, the improvements in LipiFlow group were statistically better than warm compress group at two- and three-month after post-treatment. P value differences between two groups are labeled above the line (*p < 0.05, **p < 0.01, ***p < 0.001)
Mean value of LLT in LipiFlow increased at every visit significantly compared with baseline (A), the rate of PB decreased steadily in LipiFlow group and the statistical changes were noted at 2 and 3 months (B), TBUT levels improved statistically significant with time in both groups (C), the CFS was statistically ameliorated at two- and three-month in LipiFlow group (D), mean value of SIT in LipiFlow group at 2 and 3 months improved. (*p < 0.05, **p < 0.01, ***p < 0.001)
Differences between two groups were labeled above the lines, MGS (A) and MGYLS numbers (B) showed statistical differences at two- and three-month. (*p < 0.05, **p < 0.01, ***p < 0.001)
Purpose Evaluate the efficacy and safety of LipiFlow® thermal pulsation treatment system compared with lid massage combined warm compress in Chinese patients with meibomian gland dysfunction (MGD). Methods Patients (n = 100 eyes, 50 subjects) diagnosed with MGD were recruited for this prospective, randomized, 3-month clinical trial. In Lipiflow group, patients (n = 50 eyes) received a single LipiFlow® thermal pulsation system treatment. In warm compress group, patients (n = 50 eyes) underwent warm compress daily for two weeks after an initial manual lid massage. Patients’ symptoms were evaluated using Standard Patient Evaluation for Eye Dryness (SPEED) questionnaire. Safety parameters included best-corrected visual acuity (BCVA), intraocular pressure (IOP) and objective parameters including meibomian glands yielding lipid secretion (MGYLS) number, meibomian glands secretion (MGS) score, lipid layer thickness (LLT), tear-film breakup time (TBUT), corneal fluorescein staining (CFS) were measured and presented from baseline and to 3 months post-treatment. Results Baseline parameters in both groups were comparable (p > 0.05). SPEED score and TBUT improved in two groups from baseline to 3 months. MGYLS number, MGS score, LLT improved in LipiFlow group and these improvements were maintained with no significant regression at 3 months. CFS showed significant improvement in warm compress group at 1 month compared with LipiFlow group. Moreover, the correlation analysis indicated LLT was positively correlated with TBUT, MGS score, and MGYLS number. Conclusion A single 12-min LipiFlow treatment is an effective therapy for MGD patients and can achieve improvements in symptoms alleviation and meibomian gland lipid secretion function lasting for at least 3 months.
Purpose In the present study, we aimed to investigate the positive rate of Demodex infection in patients with meibomian gland dysfunction (MGD) and to analyze its risk factors. Methods A total of 178 MGD patients admitted to the Jinan Second People’s Hospital from April 2020 to February 2021 were enrolled in the present study. All patients were examined for Demodex infection, and their medical history was collected. The positive rate of Demodex infection was calculated after the examination. The medical history, including age, eating habits, pet ownership, and so on, was collected. First, a univariate analysis was conducted to identify the factors associated with positive Demodex infection, and then, a multivariate comprehensive analysis was carried out to identify the main risk factors for positive Demodex infection. Results In the present study, the positive rate of Demodex infection in 178 MGD patients was 73.60%. The risk factors of Demodex infection in MGD patients were gender, pet ownership, toiletry sharing, and diabetes (all P ≤ 0.15). Age was one of the risk factors for infection [B = 0.105, OR 1.111 (95%CI 1.069–1.155), P = 0.000], and toiletry sharing was more likely to cause positive Demodex mite infection [B = 0.891, OR 2.439 (95%CI 1.066–5.577), P = 0.035]. The Demodex infection was not statistically associated with gender (P = 0.234), pet ownership (P = 1.141), and diabetes (P = 0.295). Conclusions The positive rate of Demodex infection was higher in MGD patients. The main risk factors affecting the positive rate of Demodex infection included age and toiletry sharing.
Nocardia infection on slit-lamp examination. Nocardia infection underwent pterygium excision (a, b, c), Nocardia infection followed conjunctival flap covering (d, e, f), Nocardia infection followed lamellar corneal transplantation (g, h)
Microbiological examinations of Nocardia infection. Smears on Gram’s stain, CFW, and Kinyoun staining illustrated thin branching filamentous organisms (a, b, c) (1000 × magnification). Blood and chocolate agar plate showed tiny chalky-white colonies of Nocardia at the site of inoculation (d, e). Nocardia in Nutrient broth (f)
Confocal microscope images of Nocardia. Demonstrate small, slender, beaded filamentous structures in two cases. (a, b) (800 × magnification) (arrows)
Nocardia recurrence. Nocardia infection on superior conjunctiva 20 days followed PKP (a). Infectious lesion resection was performed (b). Nocardia infection on superior conjunctiva 15 days following resection (c). Resection was performed again (d). Scleritis and endophthalmitis recurred (e). Nocardia infection after eviscerated (f)
Objective To investigate the clinical characteristics and treatment outcomes of Nocardia infection after ocular surface surgery. Methods This is a retrospective study. Eight cases of culture-proven Nocardia infection, which developed within 1 month after ocular surface surgery were included. Demographics and clinical history of patients were investigated. Results There were 8 eyes (2 left and 6 right) of 8 patients (5 males and 3 females), aged 27–65, with a median age of 52.9 years. Three cases underwent pterygium excision, three were subjected to conjunctival flap covering, and two were treated with lamellar corneal transplantation. The time interval between previous surgery and the onset of symptoms varied from 7 to 28 days (mean = 20.5 ± 7.13 days). All the cases presented grey-white infiltrates at the surgical incision site while appearing with six corneal ulcers and two conjunctival ulcers. Filaments of Nocardia were founded by confocal microscopy in two of the five cases. All responded poorly to medical therapy. Seven of the eight cases were treated with reoperation. Nocardia infection recurred in three cases after reoperation, and one was eviscerated. Conclusions Surgical trauma is a risk factor for ocular Nocardia infection. Nocardia infection should be suspected when secondary infection occurs in a surgical incision with an atypical clinical presentation. The use of corticosteroids may influence the efficacy of drugs. Complete removal of lesions may lower the recurrence of Nocardia infection with poor drug treatment effects.
Background To describe the incidence and factors predicting visual outcome in patients with infectious endophthalmitis following intravitreal anti-VEGF injection. Methods Retrospective, single-site, cohort study. Patients with acute endophthalmitis within 6 weeks of intravitreal anti-VEGF injection who were referred to our practice after inciting injection or were injected by us between January 2010 and July 2017 were included. All patients received intravitreal antibiotics with either vitreous/anterior chamber tap (TAP) or pars plana vitrectomy. Visual outcomes pre/post treatment, baseline variables (age, gender, ocular disease) and cultures results were studied. Results Seventy eyes of 69 patients were included. Presenting VA was the strongest factor associated with final visual outcome after adjusting for other variables including culture status and baseline VA (p = .0002). Cultures were positive in 62.8% of eyes and were associated with worse visual outcome (p = .0087). Growth of Streptococcus or microorganisms other than coagulase negative Staphylococci (CNS) was also associated with worse prognosis, regardless of baseline and presenting VA (p = .0002). The crude incidence of post-injection endophthalmitis was 0.028% in our practice (40 eyes in 143,628 injections) during the study time. No significant difference was found between pre-filled bevacizumab versus ranibizumab or aflibercept drawn from a vial. Conclusions In a large, single center, retrospective study, the incidence of acute endophthalmitis post anti-VEGF injection was relatively low. Worse visual acuity at presentation of endophthalmitis and growth of Streptococcus or organisms other than CNS were associated with the worst visual outcomes.
Location and degree (stenosis or block) of pre-sac obstruction based on lacrimal syringing/probing in the clinic. NA obstruction location and/or degree not available
Purpose To determine the diagnostic value of 'soft stops' encountered during lacrimal syringing and probing. Methods Single-center retrospective review. Adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to April 2021 were reviewed. Cases with evidence of soft stop encountered during lacrimal syringing/probing were included, and patients with possible canaliculitis or a history of lacrimal surgery were excluded. Findings of syringing/probing consistent with pre-sac obstruction were correlated with dacryocystography (DCG) and surgical findings. Results 53 (10.2%) canalicular systems had soft stops on syringing/probing and were included in the analysis. The mean age of the patients was 63.8 ± 15.6 (range 28–87) years, and 27 (65.9%) were females. Intraoperative examination findings were available for 27 of 30 cases that underwent lacrimal surgery and DCG was available for 40 systems. Pre-sac obstruction found on syringing/probing was confirmed in 40% and 37% of cases on DCG and surgery, respectively. The correlation between syringing/probing and DCG was stronger for canalicular than for common canalicular location ( p = 0.016). Canalicular stenosis on syringing/probing manifested as pre-sac abnormality on DCG in 5/7 (71.4%) compared to 0/6 common canalicular stenosis cases ( p = 0.021). Based on the surgical findings, the false-positive rate of a soft stop on syringing/probing was highest for common canalicular ‘stenosis’ (100%) and lowest for canalicular ‘block’ (45.5%; p = 0.093). Findings of pre-sac obstructions on DCG were confirmed in 85.7% of the cases intraoperatively ( p = 0.035 compared to syringing/probing alone). Conclusions Soft stops on probing showed poor correlation with DCG and surgical findings, particularly in common canalicular location.
Tear meniscus height (TMH) before and after surgery. Mean TMH was significantly decreased at one month and 2 months after surgery and at the final observation, compared to the preoperative mean TMH (*p < 0.05)
Tear meniscus area (TMA) before and after surgery. Mean TMA was significantly decreased at one month and 2 months after surgery and at the final observation, compared to the preoperative mean TMA (*p < 0.05)
Higher-order aberrations (HOAs) before and after surgery. Mean HOAs was significantly decreased at 2 months after surgery and at the final observation, compared to the preoperative mean HOAs (*p < 0.05)
Scatterplots showing correlations between the change (Δ; preoperative minus postoperative) in higher-order aberrations (HOAs) and Δ in tear meniscus height (TMH). There was a significant correlation between ΔHOAs and ΔTMH (Pearson correlation coefficient: r = 0.3476, p = 0.0241)
Scatterplots showing correlations between Δ in higher-order aberrations (HOAs) and Δ in tear meniscus area (TMA). There was a significant correlation between ΔHOAs and ΔTMA (Pearson correlation coefficient: r = 0.3653, p = 0.0174)
PurposeTo analyze the relationship between tear meniscus dimensions and higher-order aberrations (HOAs) in patients with lacrimal passage obstruction using anterior segment optical coherence tomography (AS-OCT).Methods This study was a retrospective observational study of 71 eyes of 49 patients with lacrimal passage obstruction. These patients received sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) at Toyama University Hospital between August 2020 and October 2021. Using AS-OCT, tear meniscus height (TMH), tear meniscus area (TMA), and total corneal HOAs values were measured before and after surgery.ResultsSurgical success was achieved in 69 eyes (97.1%). At the final observation, 62 eyes showed lacrimal patency (89.8%). The preoperative TMH, TMA, and HOAs values were 1.55 ± 0.96 mm, 0.11 ± 0.14 mm2, and 0.37 ± 0.27 µm, respectively, and the final postoperative TMH, TMA, and HOAs values were 0.97 ± 0.74 mm (p < 0.0001), 0.06 ± 0.11 mm2 (p = 0.02), and 0.29 ± 0.16 µm (p = 0.001), respectively. The results showed a significant improvement. The changes in HOAs before and after surgery were positively correlated with the changes in TMH (r = 0.3476, p = 0.0241) and TMA (r = 0.3653, p = 0.0174).ConclusionSG-BCI for lacrimal passage obstruction resulted in a significant decrease in measured HOAs. The decrease in HOAs was correlated with decreases in tear meniscus dimensions.
PurposeVascular endothelial growth factor receptors (VEGFRs) have been demonstrated to play a critical role in ischemic retinal diseases, as VEGFRs mediate hypoxia-induced neovascularization. Not only hypoxia, ischemia also induces the deficiency of glucose, yet its effects on VEGFR signal and neovascularization have seldom been studied. Bioinformatics analysis predicted that VEGFRs may be regulated by O-GlcNAcylation, while glucose deficiency influences the O-GlcNAcylation.Methods In this study, we treated human retinal microvascular endothelial cells with low glucose (LG) alone or in combination with low oxygen (oxygen and glucose deprivation, OGD). Cell viability and apoptosis rate were used to evaluate cell growth characters.ResultsLG (2.8 mmol/L) treatment induced mRNA and protein levels of VEGFR1, 2, 3 even in the presence of the protein synthesis inhibitor, cycloheximide (CHX), suggesting that the increase in VEGFR proteins is partially associated with post-translational modifications. Immunoprecipitation analysis showed that O-GlcNAc level was decreased by LG in both VEGFR1, 2, but a de-O-GlcNAc glycosylase inhibitor restored the O-GlcNAc levels. This inhibitor also abolished the LG-induced increase in VEGFR2 protein, whereas this effect was not disappeared in the presence of the proteasome inhibitor, MG132. Similar results were also observed under OGD condition. VEGFR2 knockdown more significantly retarded the growth of hRMECs and HUVECs than VEGFR1, 3 knockdown under LG and OGD conditions.ConclusionsA relatively low glucose suppressed O-GlcNAcylation in VEGFR2, whereby inhibiting its proteasome degradation; up-regulated VEGFR2 promoted the proliferation of vascular endothelial cells under ischemic condition.
Neural network structure
Training results of Beijing Tongren Hospital's medical records
Training results of Beijing eye study
PurposeTo investigate the effect of comprehensive factor analysis on the relationship between glaucoma assessment and combined parameters including trans-laminar cribrosa pressure difference (TLCPD) and fractional pressure reserve (FPR).Methods The clinical data of 1029 patients with 15 indicators from the medical records of Beijing Tongren Hospital and 600 cases with 1322 indicators from Beijing Eye Research were collected. The doc2vec method was used to vectorize. The multivariate imputation by chained equations (MICE) method was used to interpolate. The original data combined with TLCPD, combined with FPR, and not combined parameters were respectively applied to train the neural network based on VGG16 and autoencoder to predict glaucoma and to evaluate the effect of combined parameters.ResultsThe accuracy rates used to classify the glaucoma of the two sets reach over 0.90, and the precision rates reach 0.70 and 0.80 respectively. After using TLCPD and FPR for the autoencoder method, the accuracy rates are both close to 1.0, and the precision rates are 0.90 and 0.70 respectively.Conclusion Using the combined parameters of FPR and TLCPD can effectively improve the diagnosis and prediction of glaucoma. Compared with TLCPD, FPR is more suitable for improving the effect of neural network for glaucoma classification.
Representation of the different refractive surgery techniques available to correct refractive errors following DALK
PurposeThe main objective of this work is to present an updated review of the different surgical procedures for the correction of residual refractive errors following deep anterior lamellar keratoplasty (DALK) surgery.MethodsA review of the literature was conducted using PubMed, Web of Science, and Scopus databases. The search was conducted in January 2022 and was limited to articles published in peer-reviewed journals. The information extracted from each publication included sample size, mean follow-up time, pre- and post-operative uncorrected (UDVA) and corrected distance visual acuity (CDVA), pre- and post-operative refraction and spherical equivalent (SE), safety and efficacy indexes and complications.ResultsResidual ametropias, mainly high astigmatism and myopia, and the resulting anisometropia are likely to occur following DALK. They become a limiting factor and may lead to unsatisfactory visual restoration, therefore affecting patients’ quality of vision and life. Alternative surgical interventions may be required to treat this residual ametropia, such as corneal refractive surgery or intraocular lens implantation. A total of 47 relevant articles were studied in detail. Different refractive surgery techniques have been shown to be effective and safe for the correction of ametropia following the DALK procedure and to improve the patient’s quality of vision, although more research is needed to confirm long-term results.Conclusion The final refractive technique will depend on different factors, such as the amount of ametropia, the condition of the cornea or the patient’s individual needs, economics, and occupational demands.
Prototype with adaptation of two polarizing filters (black arrows) on the slit lamp, perpendicular to each other. The light is vertically polarized at its source (blue curves). Then, the superficial layer of the skin reflects the vertically polarized light; another part of the light penetrates deeply and looses the vertical polarization (merged blue and red curves, respectively). Finally, the second lens filters the superficial brightening that was vertically polarized. The remaining light from deeper layers is horizontally polarized (red curves)
Fitzpatrick skin phototype distribution
Nasal corner lesion assessed by slit lamp without cross polarization (a), by portable dermatoscope (b), and by slit lamp with cross polarization (c). Reflections are observed by the stratum corneum (black arrows) in image A, while in images B and C the following structures are better defined: microhemorrhages (yellow arrows) and micro-ulcerations (green arrows), hypopigmented central area without structures (red arrows), with peripheral areas with a pink-milky background (yellow circle) with bright white structures (green circle) and absence of a pigmented network. The findings are suggestive of basal cell carcinoma (BCC), which was posteriorly confirmed as a solid BCC by anatomopathological evaluation
Lesion in the lower eyelid evaluated by slit lamp without cross polarization (a), by portable dermatoscope (b), and by slit lamp with cross polarization (c). Reflections are observed through the stratum corneum in image A, while in images B and C the following structures are better defined: comma vessels (yellow arrows), globules (green arrows), dots (red arrows) and homogeneous brownish area (yellow circle). The findings are suggestive of intradermal melanocytic nevus, which was posteriorly confirmed by anatomopathological evaluation
Lesion in the eyebrow region evaluated by slit lamp without cross polarization (a), by portable dermatoscope (b), and by slit lamp with cross polarization (c). Superficial brightening is observed through the stratum corneum (black arrows) in image A, while in images B and C the following structures are better defined: comedo-like openings (yellow arrows), keratin scales (yellow circles), dark gray globules (green circles), without other criteria for melanocytic lesion (pigmented network, stretch marks). The findings are suggestive of seborrheic keratosis, which was posteriorly confirmed by anatomopathological evaluation
PurposeDermoscopy is a complementary examination of skin lesions, which allows the observation of anatomical features invisible to the naked eye. Its use increases the diagnostic accuracy of skin tumors. The development of polarized dermoscopy allowed the observation of deeper skin structures, without the need of skin contact. The purpose of this study was to present a low-cost prototype through the adaptation of polarized lenses on a slit lamp in order to assess anatomical aspects invisible to conventional biomicroscopy in eyelid lesions.Methods Twenty two eyelid lesions were documented using a prototype, compound of two polarizing filters, orthogonal to each other, adapted to a slit lamp with an integrated digital camera. Images of the eyelid lesions were also obtained with non-polarized biomicroscopy and with a portable dermatoscope, and were compared regarding anatomical aspects.ResultsAnatomical structures imperceptible to conventional ophthalmic examination were evidenced using the polarized lenses, demonstrating that this tool can be useful to the ophthalmologist when assessing eyelid lesions. We have obtained high-quality images of the lesions. The slit lamp provided higher magnification, better focus control and easier assessment of eyelid lesions than the portable dermatoscope.Conclusion Ophthalmologists already use the slit lamp in their practice. The adaptation of polarized lenses to this device is a cost-effective, fast and non-invasive method that permits to improve the diagnostic accuracy of eyelid lesions, evidencing anatomical structures imperceptible to conventional ophthalmic examination.
Demonstration of hAMT surgery as an adjuvant treatment in ulcerative microbial keratitis. Total corneal ulcerative keratitis, melting (A) and fluorescein staining (B) was observed in slit lamp examination. hAMT was performed (C). An absolute recovery response (D, E) was achieved
Illustration of Acanthamoeba keratitis case. Slit lamp examination (A) and fluorescein staining (B) of 28-year-old female who wore soft contact lenses, revealed a central stromal infiltrate with hypopyon. hAMT was performed (C). Then, epithelialization was completed (D) and was negative for fluorescein staining (E)
Illustration of recurrent herpes infection on the graft of a patient with a previous history of PKP (A, B). Central corneal ulcerative keratitis, melting (A) and fluorescein staining (B) was observed in slit lamp examination. hAMT was performed (C). A total recovery response (D, E) was attained
A 59-year-old male patient had an organic-based trauma, suffered from keratitis caused by Fusarium solani. At presentation, a central dense stromal infiltrate was noted (A, B). hAMT was performed (C). After patient underwent two therapeutic keratoplasty surgery, the infection was under control (D, E)
Purpose To evaluate the effectiveness of cryopreserved human amniotic membrane transplantation (hAMT) in patients with infectious ulcerative keratitis. Methods A retrospective cohort study based on medical records of patients who underwent hAMT procedure over a 2-year period (2020–2021) was conducted at Ege University Hospital, Turkey. Cryopreserved hAM was used. Best corrected visual acuity (BCVA) was measured with the Snellen chart. Detailed ophthalmological examination was performed at all visits. Treatment success was defined as complete healing including disappearance of corneal infiltrates, epithelial defect closure, reduction in anterior segment reaction. Results A total of 13 eyes of 12 patients were diagnosed with ulcerative keratitis between 2020 and 2021. hAMT was performed in severe keratitis patients in which corneal infiltrates extending to middle to deep stromal and patients with neurotrophic component, in other words, having trouble for wound healing. The mean age was 60.9 ± 18.7 years, and 66.6% of the patients were male. Average ulcer horizontal diameter was 9.7 ± 2.8 mm. A single-layer human amniotic membrane (hAM) was transplanted 92.3% of eyes. Overlay technique was used in all patients for hAMT. The mean residence time of the amniotic membrane on the ocular surface was 14.1 ± 10.2 days. The mean time from the first presentation to the hAM transplantation was 9.7 ± 6.8 days. The average hospitalization time of all patients was 15 ± 12.1 days, pre-hAMT was 10.2 ± 7.3 days and post-hAMT was 4.8 ± 9.1 days. The mean follow-up time was 3 months. Recovery response was positive in 76.9%. Average healing time was 32.1 ± 14.04 days. Conclusions hAMT was effective in the treatment of infectious ulcerative keratitis by accelerating and supporting wound healing. Performing hAM transplantation at the early stages of the disease and prolonged residence of membrane on the ocular surface increase the success of the treatment and moreover shortens hospitalization time.
Main molecular mechanisms of cell pyroptosis: The classical pyroptosis pathway activates caspase-1 via NLPR3 inflammatory vesicles and the non-classical pyroptosis pathway directly activates caspase-4/5/11, both by cleaving the key protein GSDMD to produce two-terminal fragments, GSDMD-C and GSDMD-N. Immediately after production, GSDMD-N translocates to the inner leaflet of the plasma membrane and binds to phospholipids, inducing pore formation and eventually leading to membrane lysis and the release of a large number of inflammatory factors such as IL-1βand IL-18 as well as some cellular contents, while GSDMD-C inhibits this activity of GSDMD-N
Purpose Pyroptosis is a newly discovered form of programmed pro-inflammatory cell death. The main signaling pathways include the classical scorch death pathway that depends on NLRP3 inflammatory vesicles and other activation caspase-1 and the non-classical scorch death pathway that depends on caspase-4 /5/11. The substrate of all inflammatory caspases is GSDMD; a large number of studies have confirmed that pyroptosis is associated with certain infectious diseases, atherosclerotic diseases, metabolic diseases, and aseptic inflammatory diseases of important organs. In recent years, pyroptosis has been studied partially in the ocular field. So, this article reviews the recent literature intending to help readers understand the main mechanisms of cellular scorch death and the progress of GSDMD-mediated cellular scorch death in retinal vascular inflammatory diseases. Method A detailed review of the literature related to pyroptosis and inflammatory diseases of the retinal vasculature is presented. The following 6 electronic databases were searched: CNKI, Wanfang, VIP, PubMed, The Cochrane Library, and Embase Databases, and the search period was from the database to May 2022. The main search keywords include “Pyroptosis,” “ GSDMD,” “Retinal Vascular Inflammatory Disease,” “Diabetic retinopathy,” “Retinal vasculitis.” The discovery of pyroptosis, the main molecular mechanisms, key proteins, and their pathogenesis and therapeutic prospects in retinal vasculitis diseases are extensively studied and summarized. Result The mechanisms of gasdermin D-mediated pyroptosis are elaborated and analyzed, with particular emphasis on their key role and potential in the pathogenesis and treatment of inflammatory retinal vascular lesions. Conclusion Gasdermin D-mediated pyroptosis is a well-studied form of programmed pro-inflammatory cell death, which has a bidirectional regulatory effect on a variety of immune and inflammatory diseases. The literature reveals that pyroptosis is closely related to the pathogenesis of retinal vascular inflammatory diseases, and it may be an important therapeutic target for diabetic retinopathy and other retinal vasculitis eye diseases in the future.
PurposeTo compare the surgical outcomes of tarsofrontalis sling surgery using silicon rod versus supramaximal levator resection in patients of unilateral congenital ptosis with poor levator function (≤ 4 mm).Materials and Methods This randomized control study was conducted over a period of 18 months. 44 patients were enrolled in the study group. The study population was randomly divided into two groups (22 in each group). In Group A, congenital ptosis was treated with tarsofrontalis sling surgery using silicon rod and supramaximal levator resection was done in the group B. Follow-up examination was done at postoperative day 1, one week, 1 month, 6 months and 12 months. Surgical outcome measures were change in marginal reflex distance-1 (MRD 1), vertical palpebral fissure height (VPFH) and inter-eyelid difference of margin reflex distance 1 and complications in two groups.ResultsThe mean age of patients in group A was 7.25 ± 6.10 years ranging from 1–18 years and mean age of patients in group B was 5.64 ± 2.44 years ranging from 3 to 11 years. Good surgical outcome was obtained in 73–77% of both groups. MRD1and VPFH increased significantly after surgery from baseline in both the groups (p value < 0.001). Inter-eyelid MRD 1 difference also improved significantly in both groups following ptosis surgery. Conclusion Both supramaximal levator resection and tarsofrontalis sling surgery are equally effective in cases of unilateral ptosis patients with poor levator function and should be part of the surgical armamentarium for treating congenital ptosis.
Illustrates the development of visual acuity (logMAR) over the course of follow-up as a box-plot
PurposeEndophthalmitis is a severe inflammation following surgery or endogenous spread of pathogens. Besides clinical signs and symptoms, standardized ultrasound might help to confirm the diagnosis. Thus, we analyzed 172 cases of endophthalmitis for pathogens, visual acuity (VA) and the predictive value of standardized ultrasound.Methods Retrospective analysis of patients treated with pars-plana-vitrectomy for endophthalmitis at the University Eye Hospital was performed. Sex, age, VA at presentation, first day after surgery, four weeks postoperatively, and at last follow-up, as well as pathogen culture, and presence of standardized ultrasound before vitrectomy were recorded. Mann–Whitney U and Chi-square tests were used for groupwise comparisons.ResultsA total of 172 patients (male = 47.7%) with a median age of 76 years (IQR 65–82 years) treated for endophthalmitis (exogenous = 85.5%) were included. Median follow-up time was 65 days (IQR 12–274 days). Visual acuity at presentation was 2.30 logMAR (IQR 2.70–2.30 logMAR); it increased to 1.00 logMAR (1.4–0.40 logMAR) at last follow-up. A total of 79 patients (45.9%) underwent standardized ultrasound before vitrectomy. Patients with positive ultrasound criteria had a significantly decreased VA at presentation (p = 0.034). Positive microbiological cultures for Streptococcus spp. and Enterococcus faecalis were associated with decreased VA (p = 0.028) at last follow-up.Conclusion Standardized ultrasound is an easy and robust tool in the diagnosis of endophthalmitis. Positive criteria are significantly associated with decreased VA at presentation. The recovery of VA depends on pathogens and is significantly worse for certain species (Streptococcus spp., Enterococcus faecalis).
IntroductionTo compare the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAID), corticosteroid (CS), and a combination of both drugs to prevent cystoid macular edema (CME) after cataract surgery.Methods We searched Pubmed, Cochrane Library, and Embase electronic databases to assess the relevant randomized controlled trials (RCTs) up to 28 April 2021. Network meta-analysis was registered on PROSPERO (CRD42020182520).ResultsTwenty-four RCTs were included in this review. The NSAID and combination of both drugs were significantly reduced the risk of developing CME than CS alone in non-diabetics and mix populations. In the ranking profiles, the combination therapy showed a significant advantage over the single drugs and was less likely to develop CME. Diclofenac was the most likely to reduce the odds of developing CME compared with bromfenac and nepafenac. Dexamethasone was the most likely to reduce the odds of developing CME compared with betamethasone and fluorometholone.ConclusionNSAID combination with CS has significantly reduced the risk of developing CME postoperatively than the single drug. Diclofenac was superior to bromfenac and nepafenac in preventing CME. Dexamethasone was superior to betamethasone and fluorometholone in preventing CME.
Flow diagram of articles selection
Quality assessment of the eligible studies according to the modified QUADAS-2
The overall percentage of refractive prediction error within ± 0.5 D and ± 1.0 D of the included formulae (HQ: Hoffer Q; H1: Holladay I; H2: Holladay II; BUII: Barrett Universal II; D: diopter)
Forest plots of the percentage of eyes with refractive prediction error in ± 0.5 D when comparing Barrett Universal II with SRK/T (A), Hoffer Q (B), Holladay I (C), Holladay II (D), Haigis (E), Olsen (F), T2 (G), EVO (H), Kane (I), H-RBF (J), LSF (K)
Forest plots of the percentage of eyes with refractive prediction error in ± 1.0 D when comparing Barrett Universal II with SRK/T (A), Hoffer Q (B), Holladay I (C), Holladay II (D), Haigis (E), Olsen (F), T2 (G), EVO (H), Kane (I), H-RBF (J), LSF (K)
Purpose To compare the accuracy of the new-generation intraocular lens power calculation formulae in axial myopic eyes. Methods Four databases, PubMed, Web of Science, EMBASE and Cochrane library, were searched to select relevant studies published between Apr 11, 2011, and Apr 11, 2021. Axial myopic eyes were defined as an axial length more than 24.5 mm. There are 13 formulae to participate in the final comparison (SRK/T, Hoffer Q, Holladay I, Holladay II, Haigis for traditional formulae, Barrett Universal II, Olsen, T2, VRF, EVO, Kane, Hill-RBF, LSF for the new-generation formulae). The primary outcomes were the percentage of eyes with a refractive prediction error in ± 0.5D and ± 1.0D. Results A total of 2273 eyes in 15 studies were enrolled in the final meta-analysis. Overall, the new-generation formulae showed a relatively more accurate outcome in comparison with traditional formulae. The percentage of eyes with a predictive refraction error in ± 0.5D (± 1.0D) of Kane, EVO and LSF was higher than 80% (95%), which was only significantly different from Hoffer Q (all P < 0.05). Moreover, another two new-generation formulae, Barrett Universal II and Olsen, had higher percentages than SRK/T, Hoffer Q, Holladay I and Haigis for eyes with predictive refraction error in ± 0.5D and ± 1.0D (all P < 0.05). In ± 0.5D group, Hill-RBF was better than SRK/T ( P = 0.02), and Holladay I was better than EVO ( P = 0.03) and LSF ( P = 0.009), and Hoffer Q had a lower percentage than EVO, Kane, Hill-RBF and LSF ( P = 0.007, 0.004, 0.002, 0.03, respectively). Barrett Universal II was better than T2 ( P = 0.02), and Hill-RBF was better than SRK/T ( P = 0.009). No significant difference was found in other pairwise comparison. Conclusion The new-generation formula is more accurate in intraocular lens power calculation for axial myopic eyes in comparison with the third- or fourth-generation formula.
A Right monocular elevation deficit with esotropia of 20PD with a right hypotropia of 35-40PD, managed with right medial rectus recession 5.5–>3 mm, right inferior rectus recession 5–>3 mm, and left superior rectus recession 6–>3 mm; all 3 muscles on adjustable sutures [–> (adjusted to)]. B Postoperative appearance at last follow-up
A An 18-year-old lady with an esotropia of 83 PD and a “V” pattern of 12 PD. B Orthotropic with pattern collapse after Bimedial recessions of 7 mm and left lateral rectus resection of 4 mm and left inferior oblique myectomy
Purpose Strabismus, whether congenital or acquired, is a common visual and cosmetic problem, especially for the young. Adjustable suture strabismus surgery is not in vogue in our country. This technique gives the surgeon a second attempt to provide a better outcome for the patients. Our objective was to assess the long-term success of adjustable strabismus surgery in terms of postoperative alignment. Methods We carried out a prospective study utilizing the fornix approach for adjustable strabismus surgery, in mainly horizontal, but also vertical strabismus in adults and cooperative children, to enhance the postoperative outcomes. The patient characteristics, preoperative deviation, type and pattern of strabismus, were evaluated and analyzed. The postoperative alignment was evaluated at 1 year and beyond, to assess the success of this adjustable surgery. Results This study recruited 50 adults and children with a female predominance of 39 (78%); and with the mean age being 18.34 ± 9.88 years. Exotropia was the primary diagnosis in the majority with 21 (42%) cases; with purely horizontal strabismus in 23 (46%) cases. The mean preoperative horizontal deviation was 48.76 ± 20.35 prism diopters (PD) and the mean postoperative horizontal deviation was 2.73 ± 3.63 PD. The mean preoperative vertical deviation was 4.8 ± 8.54 PD whereas the mean postoperative vertical deviation was 0.86 ± 1.73 PD. The Wilcoxon Signed Ranks test analyzed the difference between the two which was statistically significant (p = 0.000). Surgical success, defined as postoperative horizontal alignment within ≤ 10 PD of orthotropia at the end of one year or more of follow-up after surgery, was achieved in 49 (98%) cases. The average follow-up was 21.47 ± 8.7 months. Conclusion Adjustable strabismus surgery has very good long-term outcomes in terms of postoperative alignment and patient satisfaction.
A The Glaucoma Staging System 2 (GSS 2) scoring, B A GSS 2 score calculated as “Stage 0” in a participant in the healthy group C A GSS 2 score calculated as “Stage 1” in a participant in the aortic regurgitation group. *The horizontal red line in figures B and C shows the pattern standard deviation, and the vertical line shows the mean deviation. The intersection of the two parameters (red arrow) indicates the GSS 2 score
The staging results performed according to the Glaucoma Staging System 2 (GSS 2) between the healthy group and the aortic regurgitation (AR) group
PurposeTo examine whether there is a relationship between ocular pulse amplitude (OPA), intraocular pressure (IOP), and visual field (VF) deterioration among the patients diagnosed with aortic regurgitation (AR).Methods Twenty-nine patients (average age of 62.06 ± 13.27 years) with AR diagnosis without glaucoma history as AR group and 32 healthy participants (average age 63.81 ± 6.42 years) as control group were included in the study. Routine ophthalmologic examination including VF test [mean deviation (MD), pattern standard deviation (PSD) and VF index (VFI) values were recorded], diurnal IOP and OPA measurements with Pascal dynamic contour tonometry (DCT) was conducted on the patients. VF deficits were classified by Glaucoma Staging System 2 (GSS 2) score.ResultsSixteen (50.0%) of 32 healthy subjects and 14 (48.3%) of 29 AR patients were female (p = 1.000). The measurement conducted at 15:30 among the diurnal IOP measurements performed with the Pascal DCT was found to be statistically significantly higher in the AR group (p = 0.009). While the MD and PSD values of the group diagnosed with AR were determined to be statistically significantly high, the VFI value was found to be significantly low. When the healthy cases and the patients diagnosed with AR were compared, it was observed that there was a statistically significant positive correlation in terms of the significant GSS 2 stage (p < 0.001).Conclusion Although there was no significant increase in IOP, VF deficits were detected in patients with AR. These VF pathologies may be due to the ocular perfusion disorder in AR. However, additional comprehensive studies that also examine perfusion are needed to further confirm this.
Representative cases of type 3 MNV eyes and fellow eyes with multimodal imaging. A–D The case of a 70-year-old male patient with type 3 MNV in the right eye and GA in the fellow eye. Optical coherence tomography shows intraretinal exudation (A) and fluorescein and indocyanine angiography show focal hyperfluorescence (B). The fellow eye shows diffuse complete retinal pigment epithelium and outer retinal atrophy (C) and hypo-autofluorescence on fundus autofluorecence imaging (D). E-H The case of a 78-year-old female patient with type 3 MNV in the right eye and no GA in the fellow eye. Optical coherence tomography shows intraretinal exudation and pigment epithelial detachment (E) and fluorescein and indocyanine angiography show focal hyperfluorescence (F). The fellow eye shows no signs of retinal pigment epithelium, outer retinal atrophy (G), or focal hyper-autofluorescence on fundus autofluorescence imaging (H).
PurposeWe sought to investigate the clinical features of eyes with unilateral type 3 macular neovascularization (MNV) according to the degenerative features of fellow eyes. Methods We retrospectively reviewed 55 patients with unilateral type 3 MNV and identified degenerative features including geographic atrophy (GA) in fellow eyes using multimodal imaging. Then, the clinical features of eyes with type 3 MNV at baseline and during follow-up with anti-vascular endothelial growth factor treatment and an as-needed regimen were compared according to the degenerative features of fellow eyes.ResultsEighteen patients (32.7%) had GA in fellow eyes; initial disease manifestations of type 3 MNV eyes including stage, best-corrected visual acuity, and choroidal thickness (CT) did not vary between groups (all P > 0.05). During follow-up, a rate of complete fluid resolution after three monthly loading injections was not associated with GA in fellow eyes (P = 0.703), while a lower rate of early recurrence within 3 months after loading treatment was associated with thinner CT in type 3 MNV eyes and GA over one disc area in fellow eyes (P = 0.025 and P = 0.021).Conclusion Degenerative features of fellow eyes in patients with unilateral type 3 MNV may be associated with the clinical characteristics of affected eyes.
The average number of ocular attacks per year before and after the initiation of infliximab treatment for up to14 years. The number represents the mean number of ocular attacks and continued to decrease
The change in the average BOS24 for individual ocular attacks per year before and after the initiation of IFX treatment for up to 14 years. The patients' ocular attack scores continued to decrease
The LogMAR converted from best-corrected visual acuity (BCVA) before IFX treatment and at 5 years (a, n = 24) or 10 years (b, n = 14) after the initiation of the treatment
Objectives To evaluate long-term outcomes of infliximab (IFX) treatment in patients with Behçet's disease (BD)-associated uveitis.Patients and methodsWe retrospectively analyzed the cases of patients with BD-associated uveitis treated with IFX for > 5 years. We compared the numbers of ocular inflammatory attacks, ocular disease activities, and visual acuity before and after the initiation of IFX treatment.ResultsThe 24 patients were 20 men and 4 women. Their mean age at the initiation of IFX treatment was 37.3 ± 9.2 years. The mean term from the initiation of IFX treatment was 10.3 ± 2.4 years. The average number of ocular inflammatory attacks was 5.4 ± 2.1 per 12 months before the IFX treatment and significantly lower at 0.83 ± 0.96 per 12 months after the initiation of IFX treatment (p < 0.05). We used a scoring system for BD-associated uveitis named the Behçet's disease ocular attack score 24 (BOS24) to estimate the changes in ocular disease activities between before and after initiation of IFX treatment. The average score decreased significantly from 7.58 ± 2.77 to 2.55 ± 2.74 after the initiation of IFX treatment (p < 0.05). Even after > 5 years of the treatment, both the number of ocular attacks and the BOS24 score kept decreasing. The visual acuity in 42 of 48 eyes (24 patients) was improved or maintained.ConclusionsIFX was effective for controlling ocular inflammatory attacks and diminishing ocular disease activities in patients with BD-associated uveitis, and it maintained the patients' visual acuity.
Frequencies and percentages of videos containing specific content, including risk factors, interventions, and consequences of DME
Purpose Diabetic macular edema (DME) is a vision-threatening complication of diabetes mellitus due to increased vascular permeability. Patients are increasingly using YouTube videos to educate themselves about DME. This study analyzes the content and quality of YouTube videos about DME. Methods Videos were searched in December 2021 for “diabetic macular edema." The first 100 videos sorted by both relevance and view count were reviewed (n = 200). Quantitative metrics and content were collected. Two reviewers assessed videos using the JAMA (0–4), modified DISCERN (1–5), and Global Quality Scale (GQS, 1–5). Videos were sorted into author groups: 1 (academic institutions/organizations), 2 (private practices/organizations), and 3 (independent users; ophthalmologist users noted). Statistical analyses were deemed significant at a = 0.05. Results One hundred four videos were included after applying exclusion criteria. Overall mean + standard deviations were 2.25 ± 0.83 (JAMA), 3.47 ± 0.55 (DISCERN), and 3.95 ± 0.95 (GQS). 51.9% of videos stated a definition, 32.7% mentioned screening, and 50% mentioned any DME risk factor. Healthcare professional-targeted videos had higher JAMA and DISCERN scores than patient-targeted videos (p < 0.05). Videos using ophthalmologists had higher JAMA and DISCERN scores than those lacking their presence (p < 0.05). JAMA scores significantly varied between author groups; within group 3, ophthalmologist-authored videos had higher DISCERN scores (p < 0.05). Conclusion Videos without ophthalmologists or targeted toward patients had poor quality and content coverage. The rising prevalence of diabetes, coupled with increased internet use for acquiring medical information, creates a strong need for high-quality information about DME.
Distribution (males vs females) of tennis-related ocular injuries in various age groups between 2000 and 2019 (A), with detailed distribution in the subgroups of 0–20 year cohort (B)
Estimated number of tennis-related ocular injuries in the US over the 20 years of study duration, 2000 and 2019 with trendline
Estimated rate (injuries per million persons) of tennis-related ocular injuries for the entire US population versus US tennis players between 2000 and 2019
PurposeTo characterize trends in ocular tennis injuries over the last 20 years.Methods The National Electronic Injury Surveillance System was utilized to characterize tennis-related eye injuries in a nationally representative sample of emergency department visits. Data were divided into 5 age groups, and various demographic information was obtained.ResultsApproximately 16,000 tennis-related ocular injuries were identified with males being affected nearly 2:1 compared to females. The youngest age group (0–20) had the greatest proportion of injuries, with most injuries in boys 11–15 years old. Injuries occurred most often during the spring season. Most patients were treated and released from the ED. Of those patients who were hospitalized, one-third had an open globe injury.Conclusions The overall number of injuries trended downward during the timespan of the study. Although most patients did not experience serious visual consequences, the greatest proportion of ocular tennis injuries occurred in the pediatric age group in whom the risk of amblyopia is high. Primary care providers and tennis regulatory bodies should consider recommending eye safety sports goggles in children to mitigate the potential for significant visual morbidity.
The distribution of prediction errors for four formulas in each group. The tops of the bars represent the mean prediction errors, and the whiskers represent the standard deviations. P values were calculated using the one-sample t test; values < 0.05 were considered statistically significant. *: P < 0.05. **: P < 0.01. ***: P < 0.001. Note that hyperopic prediction errors are indicated by positive values. (Barrett II = Barrett Universal II)
Percentage of eyes within ± 0.25D, ± 0.50D and ± 1.00D of the target refraction for each formula in each group (Barrett II = Barrett Universal II)
PurposeHyperopic surprises tend to occur in axial myopic eyes and other factors including corneal curvature have rarely been analyzed in cataract surgery, especially in eyes with long axial length (≥ 26.0 mm). Thus, the purpose of our study was to evaluate the influence of keratometry on four different formulas (SRK/T, Barrett Universal II, Haigis and Olsen) in intraocular lens (IOL) power calculation for long eyes.Methods Retrospective case series. A total of 180 eyes with axial length (AL) ≥ 26.0 mm were divided into 3 keratometry (K) groups: K ≤ 42.0 D (Flat), K ≥ 46.0 D (Steep), 42.0 < K < 46.0 D (Average), and all the eyes were underwent phacoemulsification cataract surgery with Rayner (Hove, UK) 920H IOL implantation. Prediction errors (PE) were compared between different formulas to assess the accuracy of different formulas. Multiple regression analysis was performed to investigate factors associated with the PE.ResultsThe mean absolute error was higher for all evaluated formulas in Steep group (ranging from 0.66 D to 1.02 D) than the Flat (0.34 D to 0.67 D) and Average groups (0.40 D to 0.74D). The median absolute errors predicted by Olsen formula were significantly lower than that predicted by Haigis formula (0.42 D versus 0.85 D in Steep and 0.29 D versus 0.69 D in Average) in Steep and Average groups (P = 0.012, P < 0.001, respectively). And the Olsen formula demonstrated equal accuracy to the Barrett II formula in Flat and Average groups. The predictability of the SRK/T formula was affected by the AL and K, while the predictability of Olsen and Haigis formulas was affected by the AL only.Conclusions Steep cornea has more influence on the accuracy of IOL power calculation than the other corneal shape in long eyes. Overall, both the Olsen and Barrett Universal II formulas are recommended in long eyes with unusual keratometry.
AimTo analyze the top 100 most cited papers related to amblyopia.MethodsA bibliographic search in the Institute for Scientific Information Web of Knowledge across 55 years was performed.ResultsEighty-nine of the 100 papers were published in first-quartile journals. Half (50) of the senior authors were from the USA. Most papers dealt with clinical science (72) and included original research (84). Forty-two of the articles related to all three types of amblyopia (refractive, strabismic and deprivation). Thirty-four related to both strabismic and refractive amblyopia. Around two-thirds of the papers dealt with treatment (34) and pathophysiology (30). Almost a quarter (23%) of the papers were multicenter studies. Nearly half (48) of the papers were published between 2000 and 2010. The Pediatric Eye Disease Investigator Group (PEDIG) published the highest number of studies (11), which dealt more with treatment (p = 0.01) and had higher average number of citations per years (p = 0.05). A larger number of articles on the treatment of amblyopia are newer (p = 0.01). There was no correlation between the time of their publication and the number of citations (p = 0.68, r = 0.042).Conclusions Half of the papers were published between 2000 and 2010 and were spearheaded by PEDIG. Most papers dealt with treatment and pathophysiology. This study provides an important historical perspective, emphasizing the need for additional research to better understand this preventable and curable childhood vision impairment.
Top-cited authors
Carl P Herbort
  • Centre for Ophthalomic Specialised care and University of Lausanne
Ilknur Tugal-Tutkun
  • Istanbul University
Moncef Khairallah
  • University of Monastir
Piergiorgio Neri
  • Cleveland Clinic Abu Dhabi
Francesco Pichi
  • Cleveland Clinic Abu Dhabi