Journal of Ophthalmic and Vision Research
Volume:19 Issue: 4, Oct-Dec 2024

To evaluate the effects of topical insulin in patients with persistent corneal epithelial defects that are refractory to the standard treatment.

A retrospective, hospital-based, clinical study was performed on 17 eyes of 16 patients with different types of refractory persistent epithelial defects who were treated with topical insulin. The treatment was continued until the defect either was resolved or persisted after three months. Patients’ demographic information, etiology, comorbidities, and clinical data were reviewed. The rate of epithelial healing was considered as the primary outcome measure.

Neurotrophic keratitis was the most common cause of persistent epithelial defects (58.8%), and within this category, herpetic eye disease was the main comorbidity (44.4%). The mean follow-up time was 17.91 months. Eleven out of fifteen eyes (77.3%) had complete improvement and only one patient did not respond to the treatment. The mean time of reepithelization for the eyes with full recovery was 31.27 days (ranging from 6 to 61 days). The best-corrected visual acuity improved significantly after treatment (P < 0.005), and there were no reports of complications or side effects during the study period.

Our results suggest that topical insulin, due to its good safety profile, availability, and affordability, could be a good therapeutic alternative for persistent epithelial defects.

To compare rigid gas permeable (RGP) contact lens comfort in patients with keratoconus who underwent corneal cross-linking (CXL) versus those without CXL surgery.

This prospective study was carried out on 41 eyes (25 patients). Specifically, 21 eyes were assigned to the CXL group and 20 eyes to the non-CXL group. All of the patients were fitted with RGP lenses. The patients were also assessed one and three months after the initial RGP fitting. They were asked to grade themselves on a scale from 1 to 4 according to the frequency and intensity of ocular discomfort, vision fluctuation, and overall comfort with RGP lenses.

The mean age of participants was 24.5 ± 3.20 years. There was no significant difference in the intensity of fluctuations in vision (P = 0.30), frequency of discomfort (P = 0.29), and intensity of discomfort (P = 0.31) between the two groups during the one- and three-month follow-up interviews.

Based on the current study, there is no significant disparity in self-reported discomfort with RGP contact lenses between patients with keratoconus who have undergone corneal CXL and those who have not.

To evaluate the reproducibility and intra-eye similarity of the intraocular pressure (IOP) peaks induced by the water drinking test (WDT) in treated glaucoma patients.

This prospective cohort study evaluated 99 patients (198 eyes) who were treated for primary open-angle glaucoma. All patients underwent WDT in two consecutive visits with no change in their current therapy. The interval between the tests was 4 four to six months. The tests were administered at a similar time (4:00 PM ± 1 hour). The reproducibility of the time of the IOP peaks and the correlation between the peak time of both eyes during the two consecutive WDT sessions were assessed.

Of all IOP peaks, 59.6% and 71.7% occurred at the same time during the two WDT sessions in the right and left eyes, respectively. In the first and second WDT sessions, the agreements in IOP peak time between the right and left eyes were 60% and 63%, respectively.

The IOP peak time between the two consecutive WDT sessions was moderately reproducible, and there was a moderate agreement in the peak time between the two eyes. In light of these findings, clinicians should avoid performing simplified versions of WDT to evaluate IOP peaks.

This study aims to assess the incidence of serous choroidal detachment (SCD) in the second eye of patients undergoing bilateral trabeculectomy (BT) and evaluate its impact on the clinical outcomes and failure rate of trabeculectomy in the second-operated eyes.

This retrospective case–control study analyzed 90 eyes of 45 patients who underwent BT. Surgical success was defined as maintaining intraocular pressure (IOP) between 5 and 21 mmHg, requiring no additional glaucoma surgery, and exhibiting a visual acuity of at least light perception. Relevant patient data, such as age, glaucoma type, systemic diseases, preoperative and postoperative IOP, and complications, were extracted from medical records.

The mean age of patients was 59.8 ± 11.1 years. The five-year cumulative probability of success in the first- and second-operated eyes was 61.0% and 67.6%, respectively (log rank = 0.085, P = 0.77). Among the participants, 28.9% experienced SCD, and 76.9% of those who had SCD in the first-operated eye developed the same condition in the second eye as well (P < 0.001). In the first-operated eyes, the five-year cumulative probability of survival was 71.7% without SCD and 35.0% with SCD (log rank = 2.59, P = 0.107).

The occurrence of SCD in the first eye following trabeculectomy may indicate a predisposition to its development in the second eye during BT. Furthermore, the surgical success rate of the second-operated eye is comparable to the outcomes of the first eye undergoing BT.

To evaluate the serum levels of oxidative stress-related molecules in patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG) compared with healthy controls.

Treatment-naive patients with no known systemic diseases and with OHT and POAG diagnosis were recruited for the study. Also, age- and gender-matched healthy volunteers with no ocular and systemic diseases were included as controls. None of the participants were under any topical or systemic treatment or vitamin/antioxidant supplements. Smokers were excluded from the study. Serum levels of total antioxidant capacity (TAC), ascorbic acid, protein carbonyls (PCs), advanced glycation end products (AGEs), neuronal pentraxin 2 (NPTX2), and 𝛽-amyloid precursor protein(A𝛽) were analyzed.

A total of 90 patients (30 in each group) were included in the study. There was no statistically significant difference between the study groups in terms of age and gender distribution. Serum levels of TAC (1.47 ± 0.11 mmole/L) were significantly higher in patients with OHT compared to controls (1.40 ± 0.11 mmole/L) and patients with POAG (1.30 ± 0.08 mmole/L) (P < 0.05). However, there was no significant difference between the study groups in terms of serum levels of ascorbic acid, PCs, AGEs, NPTX2, and A𝛽.

Serum levels of TAC were significantly higher in patients with OHT. This elevated level might contribute to the protection of the optic nerve even in the presence of increased intraocular pressure.

To evaluate choroidal structure and vasculature in eyes following scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) compared with fellow eyes and control eyes.

This retrospective observational study was performed on 84 eyes: 32 eyes in the study group consisting of patients who had undergone SB due to RRD, 32 fellow eyes of the same patients, and 20 normal control eyes. Choroidal structures and optical coherence tomography angiography (OCTA) parameters were measured and compared among the three study groups.

In the study group, the mean total choroidal area (0.6816 ± 0.03188 mm2) was comparable to the fellow eyes (0.7199 ± 0.03056 mm2) and the control group (0.7154 ± 0.17160 mm2). Mean outer luminal area was significantly lower in the study group (0.4089 ± 0.00442 mm2) than in the fellow eyes (0.4437 ± 0.00701 mm2) and the control group (0.4475 ± 0.00442 mm2) (P = 0.042, and 0.047, respectively). The choroidal vascularity index (CVI) and OCTA parameters were not significantly different in eyes with prior SB compared to the fellow eyes and the control group.

SB does not significantly affect CVI, choroidal vasculature, and OCTA parameters.

To examine the natural adaptive course of ocular motor system in unilateral abducens nerve palsy while addressing the scarce literature on saccade dynamics and natural adaptation.

Binocular horizontal eye movements were recorded from 18 healthy adults and 21 adults with unilateral abducens nerve palsy during the acute and chronic phases. Dynamics of the paretic and non-paretic eyes were compared, and the non-paretic eye dynamics were correlated with the respective prism diopters. Non-parametric tests were used for statistical comparisons.

The paretic eye, compared to the non-paretic eye, presented a slightly lower saccadic gain and velocity/amplitude ratio and a higher duration/amplitude ratio. The nonparetic eye, compared to healthy controls, showed consistent amplitude gain (>1) and a tendency for a higher duration/amplitude ratio. In the acute phase, when the non-paretic eye was covered, the paretic eye’s amplitude ratio was lower and the duration/amplitude ratio decreased significantly. In the acute phase, a greater degree of esotropia in the paretic eye was associated with a lower amplitude gain and duration/amplitude ratio in the nonparetic eye.

During adaptation in abducens nerve palsy, the saccade duration of the paretic eye increased, and a similar tendency was observed in the non-paretic eye. This finding likely reflects a change in the “pulse-step” pattern and may be related to plastic changes in central structures, such as the cerebellum, that support learning processes.

To investigate the surgical outcomes of three different types of inferior oblique muscle weakening procedures in patients with mild hypertropia due to unilateral superior oblique muscle palsy.

We reviewed surgical data of patients aged >30 years with unilateral superior oblique palsy. The patients were categorized into three groups in terms of the surgical procedure: inferior oblique myectomy (IOM), inferior oblique recession (IOR), and inferior oblique disinsertion (IOD). Patients with preoperative hypertropia of 6 to 10 prism diopters (PD) were selected as mild cases for further comparison. Demographic data, preoperative and postoperative deviations in the primary position, contralateral gaze, contralateral elevation gaze, and ipsilateral tilt were considered for analysis. Complete success was defined as achieving postoperative orthotropia in addition to the resolution of diplopia and head tilt.

A total of 82 patients with an average age of 11.8 years were included in this study. The male-to-female ratio was 1.27, and the most common cause of palsy was congenital (89%). Fifty-six patients were treated with IOM, thirteen with IOR, and thirteen with IOD. The mean hypertropia correction was significantly better in the IOM group (9.1 PD) than in the IOR (7.1 PD) and IOD (7.5 PD) groups. Complete success was achieved in 80.3% of the IOM group, 69.2% of the IOR group, and 84.6% of the IOD group. The reoperation rate was 1.7% in the IOM group and 7.6% in the IOR group.

Compared to IOR and IOD procedures, IOM was more effective in correcting hypertropia in patients with inferior oblique muscle overaction and mild hypertropia secondary to unilateral superior oblique palsy.

To assess the efficiency and safety of pilocarpine eye drop 1.25% analogue (IRPilo) in comparison with its original brand-name drug (Vuity).

In this non-randomized comparative study, 75 patients with presbyopia aged 40 to 60 years were enrolled. The right eyes of these patients received either IR-Pilo (n = 45) or Vuity (n = 30) and their contralateral eyes served as controls. Refractive errors, distance best-corrected visual acuity (BCVA), near vision, amplitude of accommodation, pupil size, and intraocular pressure (IOP) were measured before and 1 to 2 hours after instillation of the eye drop.

The mean refractive error was stable, except for a small myopic shift in the Vuity group. There was no significant change in distance BCVA. Near vision improved significantly in both intervention groups (P < 0.001) with preference for IR-Pilo (4 vs 2.3). Furthermore, a higher amplitude of accommodation and pupil constriction occurred after instillation of both drops, with a higher effect associated with IR-Pilo. However, IOP did not change significantly post intervention.

IR-Pilo and Vuity eye drops had comparable results; both were effective and led to stable distance vision and improved near vision. Both ophthalmic drugs were safe and none of them were associated with significant adverse effects.

Microbial keratitis (MK) is a sight-threatening ocular disease that needs rapid diagnosis and treatment to prevent more serious outcomes. The broad-spectrum topical antimicrobial treatment is currently the main pharmacological approach for MK management, yet its efficacy is increasingly challenged by evolving antimicrobial resistance, including multidrug resistance. Also, the ocular surface presents numerous challenges for standard topical drug delivery. The failure and ineffectiveness of current therapies have necessitated the development of novel therapeutic strategies to manage MK. With advances in nanotechnology in the biomedical field, various nanomaterials can be employed to control MK. The primary determinants of nanoparticles’ vast range of applications are their size, surface properties, and chemical makeup, which also happen to be the same elements that give rise to their poisonous and dangerous effects. In this study, we provide a perspective on the contact lens-associated corneal illnesses such as MK and explore how nanotechnology might help address this significant clinical issue. In addition, safety and toxicological concerns about the increasingly widespread use of contact lenses are also discussed.

Retinal artery occlusion (RAO) is a well-characterized ischemic ophthalmic event that may result in sudden and devastating vision loss. The etiology of RAO may vary including both arteritic and non-arteritic causes and the location of the lesion can extend from the ophthalmic artery to the branches of the central retinal artery. Given this variable causes of RAO, the clinical presentation and extent of vision loss may also differ from case to case, necessitating a prompt and thorough evaluation, including a full stroke work up. While there is currently no widely accepted standard for the treatment of RAO, there are several proposed methods that have been or are currently being investigated through retrospective studies and prospective trials. The current article aims to provide a review of the pathophysiology, clinical presentation, and management of RAO in addition to presenting a systematic review of recently published studies on treatment options for RAO.

To report the coincidence of acute retinal necrosis (ARN) syndrome following acute meningoencephalitis and presumed coronavirus disease 2019 (COVID-19) in an immunocompetent patient.

Case Report: 

A 58-year-old female presented to our emergency department with sudden unilateral visual loss following a recent hospitalization for viral meningoencephalitis. Magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcription polymerase chain reaction (RTPCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient. Ophthalmic examination revealed severe ocular inflammation and yellowish patches of necrotizing retinitis in the right eye, compatible with the diagnosis of ARN. The result of aqueous humor PCR was positive for varicella zoster virus (VZV). The patient received a single intravitreal ganciclovir injection and 10 days of intravenous ganciclovir, followed by oral acyclovir. The patient underwent COVID-19 screening tests: while the chest CT scan showed features highly suggestive of COVID-19, the RT-PCR was negative on two occasions. Two months later, best-corrected visual acuity improved to 20/70 in the right eye, the anterior chamber reaction and keratic precipitates resolved, and the vitreous haze decreased significantly.

A case of VZV-induced ARN following acute meningoencephalitis was observed in association with presumed COVID-19. This could be an incidental finding during the COVID-19 pandemic; however, it could also suggest that COVID-19 might trigger ARN in cases with latent herpes family viruses.

To report a case of tubercular choroiditis that was initially treated for multifocal choroiditis.

Case Report: 

A 54-year-old female patient diagnosed with multifocal choroiditis was referred to the clinic while undergoing treatment with systemic prednisone and methotrexate. The presenting visual acuity was 20/100 in the right eye and finger counting at 1 meter in the left eye. Further investigation by repeated tuberculin skin test and QuantiFERON-TB Gold test revealed tuberculosis as the probable cause of choroiditis. The patient was started on a four-drug antituberculosis regimen. Six months later, the vision improved significantly to 20/30 in the right eye and finger counting at 6 meters in the left eye, with no remaining cellular reaction.

Tuberculosis should be considered in the differential diagnosis of multifocal choroiditis, and it is vital to perform careful history taking and thorough examinations.