We compare the success rate and reoperation rate between adjustable suture (AS) and non-adjustable suture (NAS) in the treatment of strabismus in pediatric patients. We conducted a comprehensive search of scientific data...We compare the success rate and reoperation rate between adjustable suture (AS) and non-adjustable suture (NAS) in the treatment of strabismus in pediatric patients. We conducted a comprehensive search of scientific databases, including Pubmed, Medline, Embase, Web of Science, and the Cochrane Register of Controlled Trials prior to November 30, 2023., aiming to identify eligible studies for meta-analysis that compared AS versus NAS in patients with strabismus. The differences observed between AS and NAS were quantified as risk differences (RDs) and risk ratios (RRs) along with 95 % confidence intervals (CIs). The data on success rates and reoperation rates were pooled using fixed or random effects model according to the degree of heterogeneity between studies. Subgroup analyses were further performed in patients with exotropia and esotropia. Five studies with 8744 patients were included in this meta-analysis. The success rates observed in the AS group were markedly superior to those in the NAS group, with a RD of 0.17 (95 % CI, 0.11-0.24; P < 0.001) and a RR of 1.26 (95 % CI, 1.15-1.37; P < 0.001); however, there was no significant difference in the reoperation rates between the AS and NAS groups, with a RD of -0.04 (95 % CI, -0.10-0.02; P = 0.19) and a RR of 0.66 (95 % CI, 0.40-1.10; P = 0.11). In the subgroups of exotropia and esotropia, the effect of AS on prognosis was similar. We found that the AS technique can significantly improve the success rate of surgery in the early postoperative period. More evidence-based evidence is needed in the future to confirm whether there is an advantage in the long-term success rate of AS technique.
Cutibacterium acnes endophthalmitis is a subtle, indolent infection that typically follows cataract extraction with intraocular lens implantation. Ill-defined symptoms, false-negative cultures, and uncoordinated surgical...Cutibacterium acnes endophthalmitis is a subtle, indolent infection that typically follows cataract extraction with intraocular lens implantation. Ill-defined symptoms, false-negative cultures, and uncoordinated surgical interventions contribute to a prolonged disease course and poor visual outcomes. A comprehensive literature review spanning from 1986 to September, 2024, evaluated the management of C. acnes infections after intraocular surgeries. The primary outcome was improvement in best corrected visual acuity (BCVA). Secondary outcomes included BCVA, retreatments, follow-up duration, and complications stratified by primary surgical intervention. Of the 684 screened articles, 9 retrospective case series were included. Meta-analysis demonstrated significant visual improvement after surgeries (mean difference (MD): 0.62, 95 % CI: 0.15-1.09, p = 0.01). Pars plana vitrectomy (PPV) and PPV combined with IOL removal as first-line approaches yielded superior BCVA outcomes (MD: 0.70, 95 % CI 0.41-1.09, p < 0.00001). PPV-related treatments required fewer retreatments (Odds Ratio (OR): 8.85, 95 % CI: 3.29-23.83, p < 0.0001), but involved longer follow-up duration (MD: -6.53, 95 % CI: -9.57 to -3.49, p < 0.0001). Due to limited data, complications could not be analyzed. The findings suggest that PPV-related treatments significantly improve visual recovery and reduce recurrence rates, albeit with the need for extended follow-up.
We review the primary orbital, ocular, and adnexal rhabdomyosarcoma (RMS) spectrum of tumors and describe its clinicoradiological and histopathological features, molecular updates, management protocols, outcomes, and cha...We review the primary orbital, ocular, and adnexal rhabdomyosarcoma (RMS) spectrum of tumors and describe its clinicoradiological and histopathological features, molecular updates, management protocols, outcomes, and challenges. Despite being a favorable site, the prognosis remains dismal for cases of relapsing, refractory, and metastatic orbital RMS. A wide heterogeneity of data exists in terms of survival rates and treatment regimens spread across various geographic locations and age groups. Molecular cytogenetics is a crucial factor in both the diagnosis and effective management of RMS. Novel targeted therapy may play an integral role in avoiding treatment-related morbidity and mortality. Large-scale studies are warranted to formulate standardized regimens and uniformity, especially for advanced and metastatic cases.
Inherited retinal diseases (IRDs) are genetic disorders characterized by progressive photoreceptor function loss, often leading to significant visual impairment. Uveitis has been increasingly recognized in the clinical c...Inherited retinal diseases (IRDs) are genetic disorders characterized by progressive photoreceptor function loss, often leading to significant visual impairment. Uveitis has been increasingly recognized in the clinical course of some IRDs. Despite advances in understanding the genetic causes and pathophysiology of IRDs, gaps remain in understanding the roles of inflammation and autoimmunity in IRD and IRD-associated uveitis. This review discusses IRD-associated uveitis, including anterior, intermediate, posterior, and panuveitis, as well as complications such as cystoid macular edema and retinal vasculitis. In patients with IRD-associated uveitis, mutations affecting protein function in cilia or photoreceptor outer segments suggest a universal autoimmune mechanism triggered by the immunogenicity of shedding photoreceptor discs. Notably, in patients where uveitis is the initial sign, CRB1 mutations are often implicated, likely due to the compromised blood-retina barrier function or alterations in the external limiting membrane. Other mechanisms leading to uveitis preceding IRD diagnosis include ALPK1 mutations, which activate the proinflammatory NF-κB pathway, CAPN5 mutations, which lead to dysfunction of the innate and adaptive immune systems, and VCAN1 mutations, which elicit immunogenicity due to irregularities in vitreous modeling. Understanding these mechanisms could enhance the development of innovative treatments that target personalized inflammation pathways in IRDs.
Microcystic macular edema (MME) is the presence of small cystoid abnormalities localized in the inner nuclear layer of the retina. First identified in the context of multiple sclerosis, successive reports highlighted the...Microcystic macular edema (MME) is the presence of small cystoid abnormalities localized in the inner nuclear layer of the retina. First identified in the context of multiple sclerosis, successive reports highlighted the presence of microcystic changes in several optic nerve conditions, such as neuromyelitis optica, optic atrophy from several etiologies, medical retinal diseases such as age-related macular degeneration and diabetic retinopathy, and in the postoperative period after epiretinal membrane peeling. Generally, these cysts are not associated with vascular leakage, unlike the more conventional types of macular edema from vascular origin. A number of theories have been proposed to explain these findings: the suspect of neuronal loss as causative finding made the hypothesis of retrograde trans-synaptic degeneration likely, more recently flanked by theories including the presence of vitreomacular traction and Müller cells dysfunction. We gather all the insights regarding the pathogenesis, epidemiology and functional impact of MME.
Glaucoma in retinopathy of prematurity (ROP) is a challenge. It is typically secondary, though it may be associated with primary congenital glaucoma. Secondary causes are multifactorial, with mechanisms and severity pote...Glaucoma in retinopathy of prematurity (ROP) is a challenge. It is typically secondary, though it may be associated with primary congenital glaucoma. Secondary causes are multifactorial, with mechanisms and severity potentially linked to the stage of ROP, time of presentation, or interventions for its treatment. Anecdotal reports of glaucoma following anti-vascular endothelial growth factor injection exist, but conclusive evidence is lacking. The most important cause of glaucoma in ROP is secondary angle closure in patients with stage 5 ROP. Clinical features such as corneal clouding and increased corneal diameters are clues to diagnosing glaucoma; however, glaucoma may present much later in life as well, therefore, life-long follow-up of these patients is essential. Appropriate control of intraocular pressure (IOP) becomes imperative in infants with ROP as these eyes tend to enlarge quickly with raised IOP. Management strategies consist of medical therapy, angle-based surgery, filtration surgery, glaucoma drainage devices and cyclo-ablation. The choice of therapy is individualized according to the age, presentation of glaucoma, and visual potential. We review the epidemiology, etiology, natural history, risk factors, clinical features, investigations, differential diagnosis, management and outcomes of glaucoma in ROP.
There has been limited success in both measuring and modifying episcleral venous pressure (EVP) in clinical practice. Understanding the potential role of EVP in the management of glaucoma for different patients may allow...There has been limited success in both measuring and modifying episcleral venous pressure (EVP) in clinical practice. Understanding the potential role of EVP in the management of glaucoma for different patients may allow for more individualized treatment approaches. To explore the clinical implications of lowering EVP, an international group of 9 glaucoma experts (the ENGAGE Global Expert Working Group) convened to bridge the gap between the current literature and evidence with clinical opinion and best practices. This review summarizes insights from the group on the effect of current medical therapies on EVP and its potential impact. It also discusses unmet investigational needs to enhance the understanding of EVP, as well as the challenges associated with the measurement and treatment of EVP. Regardless of the relatively modest EVP reductions achieved with current treatments, EVP lowering may have clinical significance in patients with glaucoma, particularly those with low intraocular pressure (IOP). Those who might benefit include patients with elevated EVP; normal-tension glaucoma; undergoing trabecular meshwork bypass surgery, goniotomy, or selective laser trabeculoplasty; or requiring additional IOP lowering to the low teens or with a lower-than-usual target IOP.
We evaluate the administration protocols, diagnostic utility, and safety of oral fluorescein angiography (OFA) in pediatric ophthalmological diseases, with a secondary objective of comparing OFA to intravenous fluorescei...We evaluate the administration protocols, diagnostic utility, and safety of oral fluorescein angiography (OFA) in pediatric ophthalmological diseases, with a secondary objective of comparing OFA to intravenous fluorescein angiography (IVFA) in terms of image quality and clinical utility. A comprehensive search of PubMed, Embase, and Web of Science was conducted, focusing on studies involving pediatric patients. Fifteen studies were included, with 11 assessing the utility and safety of OFA and 4 comparing it to IVFA. These studies covered 581 eyes from 464 patients. The most common dosing protocol for OFA involved 25 mg/kg of 10 % fluorescein dye, with various dilution solutions and fasting requirements enhancing image quality. Adverse effects were minimal, with mild reactions such as itching or nausea observed in 0.019 % of patients. OFA demonstrated good diagnostic value across various pathologies, including retinal vasculopathies, uveitis, disc edema, and Coats disease. OFA is a feasible imaging modality that is a less invasive and better-tolerated alternative to IVFA in the pediatric population, providing high-quality diagnostic images with fewer adverse effects. Our review highlights the need for standardized administration protocols and further research into optimizing dosing and ingestion techniques to enhance image quality and diagnostic utility.
Age-related macular degeneration (AMD) is a leading cause of visual impairment in the aging population. Evidence showing the presence of cellular senescence in retinal pigment epithelium (RPE) of patients with AMD is gro...Age-related macular degeneration (AMD) is a leading cause of visual impairment in the aging population. Evidence showing the presence of cellular senescence in retinal pigment epithelium (RPE) of patients with AMD is growing. Senescent RPE play a pivotal role in its pathogenesis. The senescent RPE suffers from structural and functional alterations and disruption of the surrounding microenvironment due to the development of the senescence-associated secretory phenotype, which contributes to metabolic dysfunctions and inflammatory responses in the retina. Senotherapeutics, including senolytics, senomorphics and others, are novel treatments targeting senescent cells and are promising treatments for AMD. As senotherapeutic targets are being developed, it is promising that the burden of AMD could be decreased.
Dynamic reconstructive techniques of the eyelid in facial nerve palsy aim to restore or replace spontaneous and voluntary movement. These may include transfer and graft techniques of nerve and muscle. The role of these p...Dynamic reconstructive techniques of the eyelid in facial nerve palsy aim to restore or replace spontaneous and voluntary movement. These may include transfer and graft techniques of nerve and muscle. The role of these procedures from an ophthalmic and oculoplastic perspective is yet to be established. We conducted a literature review of studies of periocular dynamic reanimation and their methodology, and the findings were critically appraised. Common weaknesses were identified, such as a lack of robust assessment of the ocular surface, failure to differentiate effortful closure from spontaneous blink, and inability to control for potential confounding variables.
Exposure keratopathy (EK) is an underestimated ocular surface disorder that involves multiple underlying pathophysiologic mechanisms. It results from an exposed cornea due to different causes of eyelid insufficiency or b...Exposure keratopathy (EK) is an underestimated ocular surface disorder that involves multiple underlying pathophysiologic mechanisms. It results from an exposed cornea due to different causes of eyelid insufficiency or blinking dysfunction, ocular globe protrusion, a negative orbital vector, and diverse contributing factors leading to impaired ocular surface homeostasis and the potential for vision loss. EK can be congenital, acquired, or induced, and various risk factors predispose patients to corneal exposure. These causes can be grouped into those related to proptosis and eyelid malformations, malfunctioning, or acquired deformity. If detected early, EK offers a range of effective treatment options. The superficial punctate keratitis and dryness of the cornea's lower third can be successfully treated at the initial stages; however, if left untreated, EK can progress to extensive epithelial erosion, persistent epithelial defects, stromal melting, vascularization, squamous metaplasia, and opportunistic infections, leading to significant visual loss. Different and varied treatment modalities, including medical and surgical, are available for patients with EK, depending on the disease stage, the underlying mechanism, and the cause. We examine the risk factors, causes, and range of pathologies associated with EK. Exploring the mechanisms that contribute to the development of the disorder's clinical manifestations provides valuable insights that can help clinicians detect and diagnose the disease promptly and plan appropriate targeted treatments.
Cocaine, a prevalent drug of abuse, is associated with numerous systemic health complications, including significant ocular manifestations. These ocular effects range from mild to severe, with the potential for irreversi...Cocaine, a prevalent drug of abuse, is associated with numerous systemic health complications, including significant ocular manifestations. These ocular effects range from mild to severe, with the potential for irreversible vision loss. Despite the extensive documentation of cocaine's systemic effects, the literature still lacks a focused review of its ocular manifestations. We methodically explore the epidemiology, pathophysiology, clinical presentations, diagnostic challenges, and therapeutic approaches related to cocaine-associated ocular manifestations. By categorizing the findings based on the anatomical location and type of pathology-orbital, corneal, retinal, neuro-ophthalmic, glaucoma-related, and uveal manifestations-we aim to provide a detailed overview that aids in early diagnosis and effective management of ocular disease secondary to cocaine use. Our review highlights the importance of awareness among clinicians, showcasing the wide range of ocular pathology to improve patient outcomes and prevent long-term ocular damage after cocaine abuse.
We performed a comprehensive systematic review and network meta-analysis (NMA) to assess the efficacy of pharmacological agents for the treatment of proliferative vitreoretinopathy (PVR) following retinal detachment (RD)...We performed a comprehensive systematic review and network meta-analysis (NMA) to assess the efficacy of pharmacological agents for the treatment of proliferative vitreoretinopathy (PVR) following retinal detachment (RD) surgery. A systematic search was performed across PubMed, Scopus, Web of Science, and Embase. Randomized and non-randomized controlled trials and comparative observational studies evaluating the effect of pharmacological agents in a clinical setting were included. The primary outcome was retinal reattachment rate, and secondary outcomes were PVR recurrence, reoperation, intraocular pressure (IOP), epiretinal membrane (ERM), and macular edema. A total of 23 studies with 1749 eyes were included. Twelve different drugs or drug combinations were assessed. The NMA was performed for retinal reattachment, PVR recurrence, and reoperation rate outcomes. Among the pharmacological agents analyzed, adjunctive therapy with 13-cis-retinoic acid (13-cis-RA) demonstrated a statistically significant improvement in retinal reattachment rates (RR=1.36, 95 % CI: 1-1.84) and a reduction in reoperation rates (RR=0.23, 95 % CI: 0.07-0.69) compared to the control group, while none of the other drugs had statistically significant results. Additionally, adjunctive therapy did not yield significant improvements in IOP, ERM, or macular edema, except for a reduction in macular edema associated with dexamethasone in one study. This systematic review and NMA indicate that most pharmacological agents could not significantly improve retinal reattachment, reduce PVR recurrence, or lower reoperation rates following RD surgery. 13-cis-RA was the only drug that showed a significant impact on lowering retinal detachment and reoperation rates. Further high-quality clinical trials are warranted to confirm these findings.
In recent years, with the rapid development of artificial intelligence (AI) technology, large language models (LLMs), as powerful tools, are expected to transform traditional medical practices and improve medical efficie...In recent years, with the rapid development of artificial intelligence (AI) technology, large language models (LLMs), as powerful tools, are expected to transform traditional medical practices and improve medical efficiency and quality. In the field of ophthalmology, LLMs not only assist doctors in diagnosing eye diseases, optimizing treatment recommendations, improving medical record-writing efficiency, and providing educational training support, but also offer strong support for ophthalmic researchers in data processing and innovative research. LLMs, however, face numerous challenges in clinical applications, such as knowledge boundaries, AI hallucinations, and data privacy protection. We summarize the progress of LLM applications in the field of ophthalmology and highlight the challenges, providing references for their future use in clinical practice.
An 89-year-old man presented with acute and painless loss of vision in his left eye. He denied constitutional symptoms. Visual acuity was light perception with pallid optic disc edema. Neurological work-up and serologica...An 89-year-old man presented with acute and painless loss of vision in his left eye. He denied constitutional symptoms. Visual acuity was light perception with pallid optic disc edema. Neurological work-up and serological inflammatory markers were normal. Due to the clinical suspicion for giant cell arteritis (GCA), he was started on corticosteroid therapy and bilateral temporal artery biopsies (TABs) were performed. Histopathology of the left temporal artery ipsilateral to the visual loss was negative for arteritis, while the contralateral temporal artery was positive for arteritis. The diagnostic evaluation of GCA and value of unilateral versus bilateral TABs is discussed.
We examine the role of social media in ophthalmology, focusing on its impact on patient education, professional networking, and practice promotion. An English language, PubMed search from 2019 to 2024 was performed using...We examine the role of social media in ophthalmology, focusing on its impact on patient education, professional networking, and practice promotion. An English language, PubMed search from 2019 to 2024 was performed using the search terms: "social media" and "ophthalmology" on PubMed. An analysis based on the existing usage patterns and impact/effect of social media platforms in ophthalmology was performed and is described. Fifty-five papers were included in the review. Social media enhance patient engagement and education with varying content quality. Platforms like X and YouTube have the potential to offer valuable educational content, while Instagram and TikTok foster interactive user engagement. Despite these benefits, misinformation, patient confidentiality, and time commitment remain a considerable issue. Social media provide substantial advantages for ophthalmologists, but requires careful management to address the spread of inaccurate information and ensure content quality.