bluuebunny/crossref_metadata_2025 huggingface dataset:
NATURAL COURSE AND CLASSIFICATION OF EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN-LIKE APPEARANCE
Authors: Romano Francesco , Cozzi Mariano , Monteduro Davide , Oldani Marta , Boon Camiel J. F. , Staurenghi Giovanni , Salvetti Anna Paola
Published: February 2023

Purpose:

To describe the imaging characteristics and topographic expansion of retinal pigment epithelium (RPE) and outer retinal atrophy in extensive macular atrophy with pseudodrusen-like appearance.

Methods:

Three-year, prospective, observational study. Nine patients with extensive macular atrophy with pseudodrusen-like appearance (17 eyes; 6 women) with no other ocular conditions were annually examined; one eye was excluded because of macular neovascularization. Best-corrected visual acuity measurement, fundus photographs, blue-light autofluorescence, and optical coherence tomography were performed at each visit. Formation of atrophy was analyzed on optical coherence tomography at foveal and extrafoveal areas following the Classification of Atrophy Meeting recommendations. Spatial enlargement throughout four sectors was assessed on blue-light autofluorescence after placing an Early Treatment for Diabetic Retinopathy Study grid centered on the foveola.

Results:

Mean age was 53.0 ± 2.1 years at baseline with a follow-up of 36.6 ± 0.7 months. Thinning of the outer nuclear layer and disruption of the ellipsoid zone initially appeared above areas of RPE–Bruch membrane separation and preceded RPE atrophy. Subfoveal fibrosis was seen in 65% of the eyes. Superior sector involvement was found in all patients at baseline and was significantly larger than the other sectors at any time point (P < 0.001). Best-corrected visual acuity declined from 68.0 ± 15.7 letters to 44.8 ± 14.9 letters during the follow-up and was significantly associated with subfoveal atrophy (P < 0.001) and fibrosis (P = 0.02).

Conclusion:

Our findings suggest that primary alterations in patients with extensive macular atrophy with pseudodrusen-like appearance are present at the outer segment–RPE interface, with the superior Early Treatment for Diabetic Retinopathy Study sector being the most vulnerable, which progresses to extensive atrophy of the RPE and outer retinal layers. Accordingly, we propose a three-stage disease classification.
ACUTE- AND DELAYED-ONSET ENDOPHTHALMITIS AFTER OPEN GLOBE INJURIES
Authors: Hudson Julia L. , Fan Jason C. , Smiddy William E. , Sridhar Jayanth , Yannuzzi Nicolas A. , Flynn Harry W.
Published: February 2023

Purpose:

The purpose of the study was to report the clinical features and best-corrected visual acuity outcomes in patients with acute- and delayed-onset endophthalmitis after open globe injuries.

Methods:

The study included a retrospective, comparative, consecutive case series of patients with endophthalmitis after open globe injury between January 2016 and October 2020 at the Bascom Palmer Eye Institute.

Results:

Acute-onset endophthalmitis accounted for 16 of 20 cases (80%), and all cases were diagnosed at the initial examination. Delayed-onset endophthalmitis cases, occurring more than 2 weeks after injury, accounted for 4 of 20 cases (20%) and were because of Zone 1 wound leaks and infections. Factors associated with endophthalmitis included presence of a retained intraocular foreign body (11/20 [55%]) and delay of presentation >24 hours (15/20 [75%]) (P < 0.001 and 0.002, respectively). The mean presenting best-corrected visual acuity was logMAR 1.64 (20/800), and the mean best-corrected visual acuity at the last follow-up was logMAR 1.22 (20/300).

Conclusion:

In patients with open globe injury–related endophthalmitis, visual acuity outcomes are generally poor. Despite intravitreal antibiotics at primary closure, delayed-onset endophthalmitis cases may develop in the setting of compromised Zone 1 wound integrity.
IDENTIFICATION OF PATHOGENS IN THE INTRAOCULAR FLUID SAMPLES OF PATIENTS WITH ENDOGENOUS ENDOPHTHALMITIS USING RAPID NANOPORE TARGETED SEQUENCING
Authors: Hao Xinlei , Wang Ming , Yuan Man , Zhang Rui , Jin Wei , Yang Anhuai
Published: February 2023

In Brief:

Nanopore targeted sequencing showed a higher positivity rate and a shorter turnaround time than did traditional culture in identifying pathogens in the intraocular fluid samples of patients with endogenous endophthalmitis.

Purpose:

To evaluate the feasibility of clinical application of nanopore targeted sequencing (NTS) for the identification of pathogens in patients with endogenous endophthalmitis, especially those with fungus-associated endophthalmitis.

Methods:

In this retrospective study, medical records and etiological results of 27 patients (34 eyes) with endogenous endophthalmitis were reviewed. The intraocular fluid samples were examined using both NTS and microbial culture. The results included the differences in detection time, positivity rate of pathogen detection, and positivity rate of fungus identification between two methods.

Results:

NTS and microbial culture enabled the detection of etiologic agents in 89.28% and 35.71% of the samples, respectively. The difference of positivity rate between these methods was statistically significant (P < 0.001). NTS also showed high sensitivity in both culture-positive and culture-negative samples (100% and 83.33%, respectively). Regarding culture-positive samples, the NTS results displayed a strong match with culture results. NTS showed a significantly higher positivity rate for fungal infection than did microbial culture (46.43% vs. 7.14%, P = 0.002). The average detection time of NTS was 1.11 ± 0.31 days, which was shorter than that of microbial culture (2.50 ± 0.58 days, Z = −4.686, P < 0.001). NTS technology facilitated an informed switch of intravitreal antimicrobial agents in 13 eyes.

Conclusion:

NTS, as a sensitive, specific, and timely complementary method, can be used along with traditional methods for the identification of pathogenic microorganisms in the intraocular fluid of patients with endogenous endophthalmitis.
INVERTED INTERNAL LIMITING MEMBRANE FLAP FOR SMALL-SIZED (<250 µm) FULL-THICKNESS MACULAR HOLE
Authors: Iuliano Lorenzo , Corbelli Eleonora , Bandello Francesco , Codenotti Marco
Published: February 2023

Purpose:

To compare the anatomical and functional outcome of small (<250 µm) and medium (250–400 µm) full-thickness macular holes (FTMHs) treated with internal limiting membrane (ILM) inverted flap (IF) or with the standard technique.

Methods:

Retrospective longitudinal analysis of successfully operated eyes with small or intermediate FTMH. Outcome measures were best-corrected visual acuity (BCVA), microperimetric sensitivity (with fixation stability), and restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) at 6 months.

Results:

Fifty small and 50 intermediate eyes with FTMH were included, half of each group (25) treated with the standard technique, half with IF. BCVA increased in every subgroup, similarly within the same stage regardless the technique. Small FTMH treated with IF disclosed inferior foveal sensitivity at 6 months (20.79 ± 0.48 dB) compared with the standard technique (21.51 ± 0.79 dB; P = 0.0035). At 1 month, inferior rates of ELM (24%) and EZ (24%) restoration were also found, compared with the standard technique (56% ELM P = 0.0420; 64% EZ P = 0.0095). At 6 months, ELM and EZ were similarly restored.

Conclusion:

The surgical repair of small FMTH with ILM IF seem to delay the foveal structural repair and to gain an inferior foveal sensitivity compared to the standard technique.
RETINOBLASTOMA ASSOCIATED WITH TOTAL EXUDATIVE RETINAL DETACHMENT
Authors: Ghose Neha , Agarwal Purva , Palkonda Vijay Anand Reddy , Kaliki Swathi
Published: February 2023

Purpose:

To study the clinical presentation, treatment, and outcomes of eyes presenting with retinoblastoma and total retinal detachment.

Methods:

A retrospective study of 50 eyes in 43 patients.

Results:

The mean age at presentation was 15 months (median, 9 months). Retinoblastoma-associated total retinal detachment was unilateral (n = 36; 84%) or bilateral (n = 7; 16%). The mean tumor basal diameter was 17 mm (median, 18 mm), and the mean tumor thickness was 13 mm (median, 12 mm). Associated features included subretinal seeds (n = 26; 52%), vitreous seeds (n = 13; 26%), and subretinal exudation (n = 4; 8%). Based on eighth edition of American Joint Committee on Cancer classification, the tumors were classified as cT2a (n = 19; 38%), cT2b (n = 28; 56%), or cT3c (n = 3; 6%). Primary treatment included intravenous (n = 48; 96%) or intraarterial chemotherapy (n = 2; 4%). Over a mean follow-up period of 30 months (median, 29 months; range, 7–62 months), retinal detachment resolved in 41 eyes (82%), tumor recurrence was noted in 39 eyes (78%), globe salvage was achieved in 35 eyes (70%), and one patient (2%) died due to metastasis.

Conclusion:

Relatively high tumor recurrence rate is noted in retinoblastoma presenting with total retinal detachment. With appropriate treatment, 70% of the globes can be salvaged.
CLINICAL CHARACTERISTICS AND SURGICAL PROGNOSIS OF IDIOPATHIC MACULAR HOLES WITH EPIRETINAL PROLIFERATION
Authors: Qi Biying , Yu Yanping , Yang Xiaohan , Zhang Ke , Wu Xijin , Wang Xinbo , Liu Wu
Published: February 2023

Purpose:

To investigate the clinical features and surgical outcomes of idiopathic macular holes with epiretinal proliferation (EP).

Methods:

This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for idiopathic macular holes. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity, and postoperative closure rate were compared between eyes with and without EP.

Results:

EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P < 0.001), and a larger base diameter (P = 0.014) than those without EP. In addition, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and a thicker central fovea (P = 0.012) at 1 month postoperatively and a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively.

Conclusion:

The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.
GOOD SYNDROME: CYTOMEGALOVIRUS RETINITIS CASE CHALLENGE
Authors: Baquero-Ospina Pablo , Cantu-Rosales Carolina , Concha-del-Rio Luz Elena
Published: February 2023

Purpose:

To describe cytomegalovirus retinitis in a patient with Good syndrome (hypogammaglobulinemia and thymoma), ocular progression despite treatment and fatal outcome.

Methods:

A 71-year-old woman with unilateral panuveitis of unknown cause and a history of thymoma resection was referred to the clinic. Visual acuity was 20/100 in her right eye and light perception in her left eye. In slit-lamp examination, the right eye had inferior, fine, pigmented keratic precipitates, 2+ anterior chamber cells, cataract, and 2+ vitreous cells, with no fundus detail and normal ocular ultrasound results. Left eye presented a white cataract, chronic hypotony, and increased choroidal thickness with calcifications. Laboratory evaluations showed normal or negative results for common causes of infection and inflammation. Prednisolone acetate eye drops were started, with improvement of AC inflammation. Cataract surgery was performed, reaching visual acuity of 20/30. Two years later, visual acuity had decreased and 2+ vitritis and retinitis were found. On clinical suspicion of masquerade syndrome, a vitrectomy biopsy was performed; pathologic assessments reported no data on ocular lymphoma. Leukopenia and lymphopenia were found: immunoglobulin levels, CD4 count, and viral load revealed systemic immunosuppression. The aqueous tap was positive for cytomegalovirus. Oral valganciclovir and intravitreal ganciclovir were initiated.

Results:

In a patient with previous resection of thymoma and hypogammaglobulinemia, final diagnosis was Good syndrome, with cytomegalovirus retinitis being secondary to immunosuppression. Despite treatment, cytomegalovirus retinitis progressed and systemic deterioration resulted in mortal outcome.

Conclusion:

Good syndrome is an extremely rare disease, and association with cytomegalovirus retinitis is uncommon. To the authors’ knowledge, only 14 cases exist in the literature.
Acute syphilitic necrotizing retinitis associated with placoid chorioretinitis in an immunocompetent patient.
Authors: Kreps Elke O. , Jasim Haneen , Mamtora Sunil , Dick Andrew D.
Published: February 2023

Purpose:

We report an atypical case of combined acute syphilitic necrotizing retinitis and a contiguous acute syphilitic posterior placoid chorioretinitis (ASPPC) in an HIV-negative, immunocompetent patient.

Method:

Observational case report.

Results:

A 56-year-old male presented with a one-week history of pain and blurred vision in the left eye. He also complained of left-sided hearing loss for several months. Ocular examination demonstrated a unilateral panuveitis with a yellowish placoid macular lesion involving the outer retina contiguous with an ovoid area of full-thickness retinitis extending temporally. Vitreal polymerase chain reaction (PCR) analysis for HSV, CMV, VZV and T. gondii were negative but syphilis serology was reported as positive. An MRI of the head revealed bilateral enhancement along the facial nerves, more marked on the left side, consistent with syphilitic involvement. He was treated as neurosyphilis with a 14-day course of systemic procaine penicillin and oral probenecid. Oral prednisolone (1 mg/kg/day) was commenced 24 hours prior to initiating antibiotics to prevent Jarisch-Herxheimer reaction and treat his panuveitis.

Conclusion:

To our knowledge, this is the first report of combined syphilitic necrotizing retinitis and ASPPC occurring in continuity in the same eye. This case highlights the diversity of possible presentations of ocular syphilis, even in HIV-negative immunocompetent patients.
Three-year Follow-up of Progressive Chorioretinal Atrophy in Atypical Alagille Syndrome: a Case Report
Authors: Umemura Kyohei , Fujita Kyoko , Kamei Motohiro
Published: February 2023

Purpose:

To report a case of atypical Alagille syndrome (ALGS) with progressive chorioretinal atrophy.

Methods:

Case report

Results:

A 42-year-old Japanese man presented with atypical ALGS. At the first visit, funduscopy revealed anterior circumferential chorioretinal atrophy in peripheral retina and in peripapillary region with posterior pole sparing in both eyes. Fundus autofluorescence (FAF) showed hypoautofluorescence in the peripheral and peripapillary regions, but normal findings in the macular region. After follow-up for three years, hypopigmentated area with well visualized large choroidal vessels extended to mid-peripheral region. On FAF images, hypoautofluorescence newly appeared in macular region in both eyes. Perivascular hypoautofluorescence and granular hyperautofluorescence scattering within the posterior pole were also observed. BCVA deteriorated and concentric visual field contraction worsened progressively.

Conclusion:

ALGS is known to have many ophthalmic manifestations, most of which are stable with minimal threat to vision. In the present case, chorioretinal atrophy progressed during three-year follow-up, suggesting that progression of chorioretinal atrophy with vision loss may occur over time in ALGS.
Five-year follow-up of a spontaneously progressive retinal racemose hemangioma
Authors: Xu Yu , Luo Lifu , Yang Bo , Xiao Jun
Published: February 2023

Purpose:

To report the progression of a patient with retinal racemose hemangioma after five years of follow-up.

Methods:

Observational case report.

Results:

A 14-year-old girl was diagnosed with an isolated retinal racemose hemangioma with retinal arteriovenous malformation in the posterior pole of the left eye fundus. At the fifth year of follow-up, a spontaneous enlargement of the previously normal vessel was found above the original lesion. The patient’s vision remained stable and no complication was observed.

Conclusions:

Retinal racemose hemangioma was once considered stable and non-progressive, but progression and expansion of the lesion may also occur, so long-term follow-up is necessary.
PARACENTRAL ACUTE MIDDLE MACULOPATHY (PAMM) IN GIANT CELL ARTERITIS
Authors: Pellegrini Francesco , Mairot Kevin , Cuna Alessandra , Lee Andrew G
Published: February 2023

Purpose:

To describe a representative case and review the literature on paracentral acute middle maculopathy (PAMM) and giant cell arteritis (GCA).

Methods:

A review of the English language ophthalmic literature was performed using the search terms of PAMM, giant cell arteritis, and temporal arteritis.

Results:

We describe a 72-year-old woman with PAMM as the presenting ophthalmic manifestation of GCA with a review the prior cases from the literature. We found a total of 26 cases of PAMM in GCA. In 19 out of 26 cases PAMM was associated with no other fundus abnormalities and was only seen on multimodal imaging including OCT.

Conclusion:

PAMM can cause acute paracentral visual loss and GCA should be suspected in all cases of PAMM of the elderly, even when isolated and not associated with constitutional symptoms of GCA.
Sub-tenon’s vancomycin injection for subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis: a case report and literature review.
Authors: Rowe Lucas W. , McVeigh Luke G. , Hajrasouliha Amir R.
Published: February 2023

Purpose:

To report the use of a sub-tenon’s vancomycin injection for treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus (MRSA) endogenous endophthalmitis (EE).

Methods:

A 17-year-old male developed EE with subretinal abscess in his right eye secondary to MRSA bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with intravenous vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a sub-tenon’s vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses.

Results:

On presentation, exam revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to macula with subretinal fluid inferotemporally involving macula. Four days post-intravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the sub-tenon’s space with no complications during the procedure or during his post-operative recovery. At seven days post-injection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess.

Conclusion:

We present the first successful case of sub-tenon’s vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that sub-tenon’s injection of antibiotics is a safe and effective non-surgical management option for bacterial subretinal abscesses.
Outcomes of Conventional 8.0-mm Versus Large 9.0-mm Diameter Deep Anterior Lamellar Keratoplasty for Keratoconus
Authors: Lucisano Andrea , Lionetti Giovanna , Yu Angeli Christy , Giannaccare Giuseppe , D'Angelo Sergio , Busin Massimo , Scorcia Vincenzo
Published: February 2023

Purpose:

The purpose of the study was to compare the clinical outcomes of large 9.0-mm diameter and conventional 8.0-mm big-bubble deep anterior lamellar keratoplasty (DALK).

Methods:

In this comparative, retrospective interventional case series, medical records of 124 cases of large 9.0-mm diameter DALK from January 2017 to December 2019 and 133 conventional 8.0-mm DALK from January 2014 to December 2016 performed by a single surgeon for the indication of keratoconus were reviewed. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), and postoperative complication rates.

Results:

Postoperative logarithm of the minimum angle of resolution BSCVA did not significantly differ between 9.0-mm and 8.0-mm DALK at any time points. Although the cumulative percentage of eyes achieving Snellen BSCVA of 20/40 or better was comparable between groups (9.0-mm DALK: 93%, 8.0-mm DALK: 90%, P = 0.571), the cumulative percentage of eyes achieving 20/20 or better (9.0-mm DALK: 44%, 8.0-mm DALK: 26%, P = 0.01) and 20/25 or better (9.0-mm DALK: 74%, 8.0-mm DALK: 59%, P = 0.03) was significantly higher in the 9.0-mm DALK group. RA was significantly lower in the 9.0-mm DALK group compared with the 8.0-mm DALK group during all time points (P < 0.001). The percentage of eyes with RA less than or equal to 4.0 D was significantly lower in the 9.0-mm DALK patients (90%) compared with in 8.0-mm DALK group (72%) (P = 0.002). Postoperative complication rates were similar between groups.

Conclusions:

Compared with conventional 8.0-mm DALK, large 9.0-mm DALK can provide superior visual outcomes at higher levels of Snellen BSCVA and significantly lower degrees of astigmatism without an increased risk of immune rejection and graft failure.
Femtosecond Laser Capsulotomy in Previous Radial Keratotomy
Authors: Friehmann Asaf , Assia Ehud I.
Published: February 2023

Purpose:

The aim of this study was to describe clinical experience using femtosecond laser-assisted anterior capsulotomy in eyes with previous radial keratotomy.

Methods:

Eyes of patients with previous radial keratotomy and cataract-related vision impairment who underwent phacoemulsification and intraocular lens implantation were retrospectively reviewed. Eyes with any vision impairment cause other than cataract or previous radial keratotomy were excluded.

Results:

Sixteen postradial keratotomy eyes were included. In 5 patients, manual anterior capsulectomy was successfully performed. Six eyes underwent femtosecond laser capsulotomy using routine parameters (incision depth 500 μm and 4 μJ power), of which in 3 eyes capsulotomies were complete, whereas in the other 3 eyes incomplete capsulotomy was evident. In 3 patients, both incision depth and power parameters were doubled (incision depth 1000 μm and 8 μJ power), whereas in 2 patients, only the pulse energy was doubled (8 μJ power) and in all 6 cases, the capsulotomy was successfully completed. At the last follow-up, all capsulotomies were intact without radial tears, and the intraocular lenses were stable and central.

Conclusions:

Radial corneal scars after previous radial keratotomy may interfere with femtosecond laser-assisted anterior capsulotomy using routine parameters. Surgeons should be alert and ready to convert to manual anterior capsulectomy. Modification of the laser parameters may overcome this potential complication.
High Prevalence of Demodex Infestation is Associated With Poor Blood Glucose Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study in the Guangzhou Diabetic Eye Study
Authors: Zhang Nuan , Wen Kuiyao , Liu Yan , Huang Wenyong , Liang Xiaoling , Liang Lingyi
Published: February 2023

Purpose:

The aim of this study was to investigate the association between type 2 diabetes mellitus (T2DM) and ocular Demodex mite infection.

Method:

About 381 patients with T2DM from nearby communities were enrolled, and 163 age-matched and sex-matched nondiabetic patients from the cataract clinic were included as the control group. All subjects underwent personal history and demographic data collection, ocular examination, and lash sampling, followed by microscopic identification and counting of Demodex mites. Binocular fundus photography was performed for diabetic patients. Statistical correlation between ocular Demodex infestation and T2DM and blood glucose control status was performed.

Results:

The Demodex mite infestation rate (62.5% vs. 44.8%, P < 0.001) and count [3 (0–12) vs. 2 (0–9.6), P = 0.01], especially of Demodex brevis (18.9% vs. 4.9%, P < 0.001) [0 (0–1) vs. 0 (0–0), P < 0.001], were significantly higher in the T2DM patient group than that in the control group. The ratio of Demodex brevis to Demodex folliculorum in the T2DM patient group was significantly higher than that in the control group (1:3 vs. 1:9, P < 0.001). Diabetic patients presented with more cylindrical dandruff (55.1% vs. 39.3%, P = 0.001). Ocular Demodex infestation was strongly associated with poor blood glucose control (HbA1c > 7%) (odds ratio = 1.82; 95% confidence interval, 1.12–2.94; P = 0.2) and female sex (odds ratio = 1.69, 95% confidence interval, 1.08–2.65, P = 0.02). No association was found between Demodex infestation and the severity of diabetic retinopathy.

Conclusions:

Patients with T2DM, especially those with poor blood glucose control, tend to have a higher prevalence of ocular Demodex infestation, suggesting that high blood glucose is a risk factor for demodicosis.
Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Disease Severity
Authors: Vasiliauskaite Indre , Kocaba Viridiana , van Dijk Korine , Baydoun Lamis , Lanser Charlotte , Lee Demi , Jager Martine J. , Melles Gerrit R. J. , Oellerich Silke
Published: February 2023

Purpose:

The aim of this study was to evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after Descemet membrane endothelial keratoplasty (DMEK) based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity.

Methods:

The cohort in this retrospective study included 750 eyes that underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3–4) and 440 eyes (68%) had advanced FECD (Krachmer grade 5–6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival.

Results:

The mean 10-year BCVA was 0.08 ± 0.28 logMAR (n = 96), and the BCVA remained stable between 5 and 10 years postoperatively (all P > 0.05). The mean ECL at 5 and 10 years was 56% ± 17% (n = 460) and 66% ± 14% (n = 96), respectively (P < 0.05). The 10-year graft survival rate for the total cohort was 0.85 (95% confidence interval, 0.82–0.89). BCVA and ECD differed at 1 to 5 years between eyes with different surgical indications (all P < 0.05), and FECD eyes had higher graft survival compared with BK eyes (0.90 vs. 0.60, P = 0.001). Moderate FECD eyes had better BCVA, ECD, and graft survival outcomes than advanced FECD eyes (all P < 0.05). Minor graft detachment (P = 0.04) and lower donor ECD (P = 0.01) were related to lower 10-year ECD.

Conclusions:

Long-term outcomes and graft survival after DMEK were better in FECD eyes than BK eyes and were also related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent long-term outcomes.
Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus
Authors: Grentzelos Michael A. , Liakopoulos Dimitrios A. , Kankariya Vardhaman P. , Siganos Charalambos S. , Tsilimbaris Miltiadis K. , Pallikaris Ioannis G. , Kymionis George D.
Published: February 2023

Purpose:

The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus.

Methods:

In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively.

Results:

Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 (P < 0.001) and 0.06 ± 0.12 (P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from −5.39 ± 3.89 diopters (D) preoperatively to −2.29 ± 2.65 D (P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from −4.70 ± 2.86 D preoperatively to −3.55 ± 2.45 D (P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up (P > 0.05).

Conclusions:

Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.
Human MPox (Monkeypox) Virus Membranous Keratoconjunctivitis With Transient Corneal Hypoesthesia and Late Symblepharon Formation: A Novel Case and Clinical Implications
Authors: Uner Ogul E. , Hubbard Donald C. , Torres-Quinones Carlos , Pegany Roma , Huang Lingling , Ponsetto Momoko K. , Fletcher Miles , Sikka Monica K. , Nanji Afshan , Redd Travis K. , Stutzman Richard D. , Chamberlain Winston , Kim Donna H.
Published: February 2023

Purpose:

The aim of this study was to describe a case of corneal involvement as an early manifestation of ocular disease in the 2022 human mpox (monkeypox) virus outbreak.

Methods:

This is a single case report with longitudinal care.

Results:

A 47-year-old immunocompetent man presented with viral conjunctivitis before development of skin lesions or systemic symptoms. Subsequently, he developed membranous keratoconjunctivitis and a corneal epithelial defect. Orthopoxvirus-positive polymerase chain reaction test from his ocular surface was positive. The epithelial defect did not heal with conservative treatment but was successfully treated with amniotic membrane transplantation over 8 days. Reduced corneal sensation was noted after epithelial healing, and polymerase chain reaction from the ocular surface remained positive at 17 days from symptom onset, with slowly recovering conjunctivitis at 21 days. Continued membrane formation required repeated removal but significantly improved with topical corticosteroid treatment after epithelial healing by 29 days of symptom onset. Corneal sensation normalized by 87 days from symptom onset at which time symblepharon were noted but PCR testing from the ocular surface was negative.

Conclusions:

Early corneal involvement of human monkeypox virus is possible. Transient corneal hypoesthesia may be due to acute inflammation. Chronic inflammatory changes can result in symblepharon. These findings have potential implications in patient care and corneal donation.
Prevalence of Meibomian Gland Atrophy in Patients Undergoing Cataract Surgery
Authors: Yeu Elizabeth , Koetting Cecelia , Calvelli Hannah
Published: February 2023

Purpose:

The aim of this study was to determine the prevalence of meibomian gland (MG) atrophy in a US-based population of patients presenting for cataract surgery.

Methods:

In this retrospective study, case records of 391 patients aged 50 years or older, who had undergone a preoperative cataract surgery workup with meibography, were included. The amount of atrophy in the lower eyelid was graded as described by Arita et al (grade 0 = no atrophy, grade 1 = 1%-33% atrophy, grade 2 = 34%-66% atrophy, and grade 3 = >66% atrophy), and the prevalence of MG atrophy was determined. Associations between MG atrophy and demography, comorbidities, and risk factors were evaluated.

Results:

Overall, 95.1% of patients (372/391) had MG atrophy ≥grade 1, with 50.4% (197/391) having grade 1, 25.8% (101/391) grade 2, and 18.9% (74/391) grade 3. MG atrophy had a statistically significant correlation with MG expressibility (R = 0.22; P = 0.001), but not with meibum grade (R = 0.103; P = 0.123) and telangiectasia (R = 0.014; P = 0.787). The prevalence of MG atrophy (≥grade 1) was comparable among patients who had previously been diagnosed with dry eye disease (DED) versus those who had not; however, the severity of MG atrophy was higher in patients with previous DED diagnosis (grade 2/3: 59% vs. 30.9%). Among patients with no previous history of DED, 18% (35/194) had moderate and 13% (25/194) had severe MG atrophy.

Conclusions:

MG atrophy is common in patients presenting for cataract surgery evaluation, indicating potential underdiagnosis. Routine use of meibography during preoperative screening in cataract surgery patients may facilitate more timely and effective diagnosis and treatment.
Novel Application of Conjunctival Anterior Segment Optical Coherence Tomography Angiography to Assess Ocular Redness
Authors: Binotti William W. , Nosé Ricardo M. , Pondelis Nicholas J. , Jamali Arsia , Kataguiri Paula , Akhlaq Anam , Kenyon Kenneth R. , Hamrah Pedram
Published: February 2023

Purpose:

The aim of this study was to determine anterior segment optical coherence tomography angiography (AS-OCTA) parameters to assess ocular redness severity.

Methods:

AS-OCTA analyses of 60 eyes of 40 patients were grouped according to ocular redness stages using the 5-category validated bulbar redness scale in a cross-sectional retrospective study (groups 1–5). A subset of patients with slit-lamp photographs, total 35 eyes of 23 patients, were assessed with 10-category validated bulbar redness scale for comparison. AS-OCTA images of nasal and temporal bulbar conjunctiva were analyzed. Vessel density (VD) represented the blood flow pixels by the total pixels of image (%); vessel diameter index represented the VD by the skeletonized density; fractal dimension, measured with the box-count method, represented the vessel branching complexity. Averaged nasal and temporal parameters for each eye were correlated to validated bulbar redness scales.

Results:

There was no statistical difference between groups for age (P = 0.118), sex (P = 0.501), eye laterality (OD/OS; P = 0.111), or location (nasal/temporal; P = 0.932). In the 5-category scale, VD significantly increased from group 1 to 2 (31.5 ± 1.9% and 33.4 ± 2.2%, P = 0.023), 2 to 3 (36.0 ± 3.5%, P < 0.001), and 4 to 5 (40.2 ± 2.9 and 46.5 ± 2.8, P < 0.001). The correlations were 0.805 (P < 0.001) and 0.893 (P < 0.001) for the 5-category and 10-category scales, respectively. Vessel diameter index showed a significant increase from 1 to 2 (2.90 ± 0.17 and 3.00 ± 0.15; P = 0.004) and 4 to 5 (2.92 ± 0.31 and 3.33 ± 0.08; P = 0.001). The correlations were 0.550 (P < 0.001) and 0.625 (P < 0.001) for the respective scales. The fractal dimension showed no significant differences between subsequent groups. The correlations were 0.445 (P < 0.001) and 0.583 (P < 0.001), respectively.

Conclusions:

Conjunctival AS-OCTA VD was the most reliable parameter to assess ocular redness.
Assistive applications of artificial intelligence in ophthalmology
Authors: Hubbard Donald C. , Cox Parker , Redd Travis K.
Published: February 2023

Purpose of review

Assistive (nonautonomous) artificial intelligence (AI) models designed to support (rather than function independently of) clinicians have received increasing attention in medicine. This review aims to highlight several recent developments in these models over the past year and their ophthalmic implications.

Recent findings

Artificial intelligence models with a diverse range of applications in ophthalmology have been reported in the literature over the past year. Many of these systems have reported high performance in detection, classification, prognostication, and/or monitoring of retinal, glaucomatous, anterior segment, and other ocular pathologies.

Over the past year, developments in AI have been made that have implications affecting ophthalmic surgical training and refractive outcomes after cataract surgery, therapeutic monitoring of disease, disease classification, and prognostication. Many of these recently developed models have obtained encouraging results and have the potential to serve as powerful clinical decision-making tools pending further external validation and evaluation of their generalizability.
Risk Factors for Hyphema Following Kahook Dual Blade Goniotomy Combined With Phacoemulsification
Authors: Pratte Eli L. , Ramachandran Maya , Landreneau James R. , An Jella A.
Published: February 2023

Précis:

Hyphema development after Kahook Dual Blade (KDB) excisional goniotomy was significantly associated with postoperative day 1 intraocular pressure (IOP) ≤12 mm Hg, male sex, and narrow iridocorneal angles, but not with continuation of anticoagulation or antiplatelet therapy.

Purpose:

To identify risk factors of hyphema development after KDB goniotomy combined with phacoemulsification.

Methods:

In all, 202 eyes in 145 patients who received a KDB goniotomy combined with phacoemulsification between February 21, 2017 and February 18, 2020 were evaluated for preoperative factors that were predictive of postoperative hyphema. Hyphema was defined as the development of ≥1 mm layered blood in the anterior chamber. The primary outcome was the association between various preoperative factors and the development of postoperative hyphema. Binomial logistic regression was used to analyze risk factors of hyphema development while controlling for other variables.

Results:

Hyphema occurred in 8.4% (17/202) of patients on day 1 after KDB goniotomy combined with phacoemulsification. Male sex (P=0.008), angle closure glaucoma (P=0.036), and postoperative day 1 IOP ≤12 mm Hg (P=0.049) were significantly correlated with hyphema development while controlling for other variables. Preoperative anticoagulation and antiplatelet therapy had no association with hyphema development (P=0.538).

Conclusions:

Postoperative hyphema was associated with male sex, narrow iridocorneal angles, and a postoperative day 1 IOP lower than typical episcleral venous pressure when controlling for other variables. Preoperative anticoagulation or antiplatelet therapy was not associated with developing postoperative hyphema in this study; however, further investigation is needed before recommendations can be made.
Optical Coherence Tomography Angiography of the Retinal Circulation Following Trabeculectomy for Glaucoma
Authors: Hong Ji Wook , Sung Kyung Rim , Shin Joong Won
Published: February 2023

Précis:

Despite successful trabeculectomy, eyes with similar levels of peripapillary and macular vessel densities but with worse preoperative visual field mean deviations may experience functional and vascular decline after surgery.

Purpose:

To evaluate the retinal microcirculation change after trabeculectomy according to glaucoma severity using optical coherence tomography angiography (OCTA).

Methods:

We enrolled 59 eyes of primary open angle glaucoma patients who underwent trabeculectomy. The eyes were categorized into 3 groups by preoperative visual field (VF) mean deviation (MD), group 1: MD>−12.0 dB, group 2: MD −12.0 to −20.0 dB, and group 3: MD <−20.0 dB. OCTA was performed preoperatively and 1 year after trabeculectomy. The differences in the radial peripapillary capillary vessel density (pVD) and macular VD between preoperative and postoperative assessment were analyzed and compared in each group. Factors associated with the VD change after trabeculecomy were determined using linear regression analysis.

Results:

Mean postoperative IOP and IOP reduction did not differ among the 3 groups after trabeculectomy. Preoperative pVD (37.2 vs. 36.6%, P=1.00) and macular VD (39.0 vs. 38.4%, P=1.00) did not differ between groups 1 and 2. Group 1 and 3 showed no changes in VD parameters after trabeculectomy (all, P>0.05). However, group 2 showed statistically significant decreases in pVD (36.6 vs. 32.9%, P<0.001) and macular VD (38.4 vs. 36.0%, P=0.010) after trabeculectomy. The reduction of pVD was associated with a decrease of IOP (Coefficient (β); 0.14, P=0.032) and VF MD (β; 0.15, P=0.0116) in group 2, respectively.

Conclusion:

Following successful trabeculectomy surgery for uncontrolled glaucoma with similar IOP reduction, glaucoma eyes with advanced visual field loss showed reduced pVD and macular VD measured by OCT-A. These findings may be relevant to disease progression.
Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey
Authors: Lee Moon Hyung , Kim Hong Kyu , Kim Sung Soo
Published: February 2023

Précis:

Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR).

Purpose:

To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008–2012).

Materials and Methods:

Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6.

Results:

Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high (P<0.001, P<0.001, and P<0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 (P<0.001, P=0.006, P=0.005, P<0.001).

Conclusions:

In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.
Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes
Authors: Waldner Derek M. , Chaban Yuri , Penny Michael D. , Al-Ani Abdullah , Belkin Avner , Ahmed Iqbal Ike K. , Schlenker Matthew B. , Gooi Patrick
Published: February 2023

Précis:

Analysis of efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental gonioscopy-assisted transluminal trabeculectomy showed no significant difference between approaches, with novel risk factors for failure identified.

Purpose:

Compare the efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental suture gonioscopy-assisted transluminal trabeculotomy (GATT).

Design:

Multicenter, retrospective interventional cohort study of 297 eyes of 243 glaucomatous patients, which underwent superior or inferior 180-degree suture hemi-GATT surgery combined with phacoemulsification at one of 3 Canadian ophthalmological surgical centres in Calgary, Alberta or Toronto, Ontario

Main Outcome Measures:

The primary outcome measure was the hazard ratio (HR) of failure for the “primary success” criteria. “Primary success” was defined as an intraocular pressure (IOP) <18 mm Hg and either 1) IOP reduced by ≥20% from baseline on the same number of IOP-lowering medications or 2) IOP ≤ baseline on fewer medications. Secondary outcome measures included HRs of failure for alternative criteria (“complete success”, “qualified success” and “20% IOP reduction”), cross-sectional analysis, and Cox proportional hazard analysis for risk factors associated with increased failure for the complete cohort.

Results:

Baseline characteristics were similar between groups. The crude and adjusted HR of failure for the “primary success” criteria for superior surgeries relative to inferior surgeries were 1.27 (95% CI = 0.86–1.88) and 1.50 (95% CI = 0.91–2.46), with no statistically significant difference between approaches. Of the secondary criteria, there was statistical significance in favor of inferior surgeries only for crude analysis of the “20% reduction” criteria (1.40/1.27 (95% CI = 1.01–1.92). Increased risk of failure by the “primary success” measure for either intervention was seen with primary open angle glaucoma, advanced disease, and age below 70 years. There were no significant differences in the frequency of postoperative complications between cohorts, which were present in 72 superior (44.4%) and 67 inferior (49.6%; P value = 0.41) eyes; mostly early postoperative hyphema, iritis, and corneal edema.

Conclusions:

This retrospective study showed no difference in inferior versus superior 180 degrees of hemi-GATT/phacoemulsification cataract surgeries through the majority of analyses. Nonmodifiable factors including glaucoma type, advanced disease, and younger age were associated with a significantly higher risk of failure in this cohort. Further study is warranted.
Torque Teno Virus in Nasopharyngeal Aspirate of Children With Viral Respiratory Infections
Authors: del Rosal Teresa , García-García Mª Luz , Casas Inmaculada , Iglesias-Caballero María , Pozo Francisco , Alcolea Sonia , Bravo Blanca , Rodrigo-Muñoz José M. , del Pozo Victoria , Calvo Cristina
Published: February 2023

Background:

Torque teno virus (TTV) is a ubiquitous anellovirus responsible for persistent infections and is considered a marker of immune function. The role of TTV as a facilitator of respiratory infections (RIs) is unknown.

Objectives:

Our aim was to estimate, in a prospective study, the prevalence of TTV in the nasopharyngeal aspirate (NPA) of hospitalized children <5 years old, with RIs and correlate them with outcomes and immune response.

Patients and Methods:

NPA was taken for testing of 16 respiratory viruses by reverse transcription-polymerase chain reaction (PCR), TTV PCR, and immunologic study.

Results:

Sixty hospitalized children with an RI were included. A total of 51/60 patients had positive common respiratory viral (CRV) identification. A total of 23/60 (38.3%) children were TTV+ in NPA. TTV+ patients had other CRVs in 100% of cases versus 78.3% in TTV− (P = 0.029). The TTV+ patients tended to be older, have fever, and to need pediatric intensive care unit admission more often than TTV− patients. Abnormal chest radiograph was more frequent in the TTV+ patients, odds ratios 2.6 (95% CI: 1.3–5.2). The genetic expression of filaggrin (involved in epithelial barrier integrity) was lower in TTV+ patients; however, the levels of filaggrin in the NPA were increased.

Conclusions:

TTV infection is common in children with RI and could be associated with abnormal imaging in radiograph, greater severity and an alteration in filaggrin gene expression and protein release.