Tabakci BN, Güler SD, Varan G
… +2 more, Aksöz P, Yildirim Y
Arq Bras Oftalmol
· 2025 · PMID 40699117
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PURPOSE: This study aimed to compare the effects of three different daily disposable contact lens materials on contrast sensitivity. METHODS: The participants were aged 18-45 years, with spherical equivalent refraction b...PURPOSE: This study aimed to compare the effects of three different daily disposable contact lens materials on contrast sensitivity. METHODS: The participants were aged 18-45 years, with spherical equivalent refraction between -0.50 D and -6.00 D, astigmatism below 0.75 D, and best contact lens-corrected visual acuity of 0.0 logMAR or better. Each patient was fitted binocularly with three daily disposable contact lenses made of different materials on three separate examination days. These materials were kalifilcon A, senofilcon A, and verofilcon A. The contrast sensitivity of each patient was recorded at spatial frequencies of 3, 6, 12, and 18 cycles per degree (cpd) under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions. RESULTS: The current study comprised 72 eyes of 34 female and two male patients. The mean age of the participants was 25.63 (± 0.80) years. Under photopic conditions, the participants' contrast sensitivity was significantly better with senofilcon A than with kalifilcon A at a frequency of 12 cpd (p=0.008). Under mesopic conditions, participants' contrast sensitivity was significantly higher with kalifilcon A than verofilcon A at 3 cpd (p=0.001), and with senofilcon A than verofilcon A at 12 cpd (p=0.004). The pre-lens non-invasive break-up times did not differ significantly between the three daily disposable contact lenses (p>0.05). CONCLUSION: In both photopic and mesopic lighting conditions, the participants in this study exhibited differences in contrast sensitivity when wearing three different daily disposable contact lens types, despite similar visual acuity and pre-lens tear film stability results in their clinical evaluations. These findings demonstrate the potential for subjective visual complaints arising from variations in the contrast sensitivity achieved by different daily disposable contact lenses.
Arq Bras Oftalmol
· 2025 · PMID 40699112
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Myopia is a significant risk factor for glaucoma and a growing public health problem worldwide. Detecting glaucomatous changes in highly myopic eyes is diagnostically challenging due to the abnormal appearance of the opt...Myopia is a significant risk factor for glaucoma and a growing public health problem worldwide. Detecting glaucomatous changes in highly myopic eyes is diagnostically challenging due to the abnormal appearance of the optic nerve head. These patients also have a greater biomechanical susceptibility to pressure-induced glaucomatous damage. Refractive surgery has become increasingly popular, and many candidates for refractive surgery are myopic. Therefore, we sought to review the aspects of patient evaluation in those who have undergone refractive surgery for myopia concerned with the detection and monitoring of glaucoma development. We identified several important elements of patient evaluation for glaucoma after refractive surgery. These included the need for both structural and functional assessments before and after surgery, and the importance of monitoring for postoperative biomechanical changes in the cornea and their impact on intraocular pressure. We conclude that, in patients who undergo refractive surgery for myopia, it is essential to assess for the presence of glaucoma, to identify staging, and to plan for long-term control of the disease, regardless of IOP.
Koser E, Atik BK, Emul M
… +4 more, Ahmet S, Besek NK, Cubuk MO, Kirgiz A
Arq Bras Oftalmol
· 2025 · PMID 40699111
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PURPOSE: Posterior capsule rupture is defined as an intraoperative posterior capsule tear resulting in vitreous loss. This study aimed to analyze the clinical characteristics, preoperative risk factors, intraoperative ma...PURPOSE: Posterior capsule rupture is defined as an intraoperative posterior capsule tear resulting in vitreous loss. This study aimed to analyze the clinical characteristics, preoperative risk factors, intraoperative management strategies, and postoperative complications associated with posterior capsule rupture during phacoemulsification surgery. METHODS: This was a retrospective observational cohort study of the medical records for 25,224 phacoemulsification surgeries performed at our tertiary eye care center between 2017 and 2022. We collected and collated the demographic characteristics and clinical findings of the patients in our cohort. Intraoperative management strategies and postoperative outcomes over a 1-year followup period were also recorded. RESULTS: Posterior capsule rupture occurred in 351 eyes (351 patients), giving an overall posterior capsule rupture rate of 1.3%. The mean patient age was 68.6 ± 10.8 years. Pseudoexfoliation syndrome, mature cataracts, brown cataracts, and surgery performed by a resident were identified as risk factors for posterior capsule rupture (p<0.05 for each; the risk ratios were 2.70, 2.15, 2.44, 1.34, respectively). The most common intraoperative complications were dislocated lens fragments in the vitreous (8%) and iris damage (7.1%). The mean best-corrected visual acuity improved from 1.31 ± 0.84 (logMAR) postoperatively to 0.51 ± 0.56 at the end of the 1-year follow-up period (p<0.001). Corneal edema (55.6%) and elevated intraocular pressure (33.3%) were the most common early postoperative complications. Persistently elevated intraocular pressure (11.1%) and cystoid macular edema (5.1%) were the most common late postoperative complications. CONCLUSION: Posterior capsule rupture is a common complication of phacoemulsification surgery that requires prolonged postoperative follow-up and a multidisciplinary approach. Despite the increased incidence of complications when rupture occurs, appropriate intraoperative and postoperative management can lead to satisfactory visual outcomes.
Arq Bras Oftalmol
· 2025 · PMID 40699110
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PURPOSE: This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment. METHODS: In this comparative study, the epithelial c...PURPOSE: This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment. METHODS: In this comparative study, the epithelial closure rates and in vivo confocal biomicroscopy results of 26 patients with keratoconus who underwent subconjunctival injection of injectable platelet-rich fibrin near the limbus after epithelium-off corneal crosslinking treatment were compared with those of 25 patients who did not receive the injection of injectable platelet-rich fibrin. RESULTS: The average time to epithelial defect closure in the injectable platelet-rich fibrin group was 2.76 ± 0.90 days compared to 3.56 ± 0.86 days in the non-injectable platelet-rich fibrin group (p=0.003). At the end of the 1st month, the mean subbasal nerve plexus density was 1.26 ± 1.61 nerves/mm2 in the injectable platelet-rich fibrin group, whereas it was 0.72 ± 0.89 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the density increased to 3.42 ± 1.13 nerves/mm2 in the injectable platelet-rich fibrin group and 2.36 ± 1.15 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.002). Similarly, the anterior stromal keratocyte density at the end of the 1st month was 93.6 ± 33.5 cells/mm2 in the injectable platelet-rich fibrin group compared to 67.3 ± 26.4 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.001). By the end of the 3rd month, the density increased to 255.2 ± 45.7 cells/mm2 in the injectable platelet-rich fibrin group and 222.1 ± 43.6 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich fibrin group, one patient developed a sterile infiltrate at the end of the 1st week, whereas no complications were observed in the injectable platelet--rich fibrin group. CONCLUSION: Subconjunctival injectable platelet-rich fibrin application is an effective and safe method for corneal epithelial healing after crosslinking treatment.
Linaburg TJ, Pradeep T, Rinelli B
… +5 more, Chen Y, Chen Y, Ying GS, Briceño CA, Tamhankar M
Arq Bras Oftalmol
· 2025 · PMID 40699109
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PURPOSE: This study evaluated rates of thyroid eye disease-related eyelid surgeries, strabismus surgeries, and orbital decompressions in active thyroid eye disease patients treated with teprotumumab compared to those who...PURPOSE: This study evaluated rates of thyroid eye disease-related eyelid surgeries, strabismus surgeries, and orbital decompressions in active thyroid eye disease patients treated with teprotumumab compared to those who were not. METHODS: In this single-center longitudinal study, we compared patients with active thyroid eye disease evaluated from 02/01/2017 to 01/31/2020 (pre-teprotumumab era) with those seen from 02/01/2020 to 04/30/2023 (teprotumumab era). Patients from the pre-teprotumumab era who received corticosteroids and/or orbital radiation were compared with those in the teprotumumab era treated with teprotumumab, with or without corticosteroids and/or orbital radiation. The primary outcomes were rates of orbital decompressions, strabismus surgery, and eyelid surgery among patients with at least 6 months of follow-up. Orbital decompressions involving two or more walls were classified as severe. RESULTS: Of 486 records reviewed, 106 patients had active thyroid eye disease. Among them, 33 were from the pre-teprotumumab era; 22 received corticosteroids and/or orbital radiation, and 11 received no treatment. Seventy three patients were from the teprotumumab era; 37 received teprotumumab (with or without corticosteroids and/or orbital radiation), 10 received corticosteroids and/or orbital radiation alone, and 26 received no treatment. Demographics were comparable between groups. Orbital decompression was performed in 11 of 44 eyes (25.0%) in the pre-teprotumumab era treated with corticosteroids and/or orbital radiation (8 one-wall, 3 ≥two-wall), compared to 3 of 74 eyes (4.1%) in the teprotumumab era treated with teprotumumab with or without corticosteroids and/or orbital radiation (all one-wall). The overall rate of orbital decompressions and the rate of ≥two-wall decompressions were significantly lower in the teprotumumab era (p=0.02 and p=0.0496, respectively). There was no significant difference in one-wall decompressions between era (p=0.07). Rates of strabismus surgeries (27.3% vs. 13.5%, p=0.19) and eyelid surgeries (22.7% vs. 21.6%, p=0.92) did not significantly differ between the era. CONCLUSIONS: In patients with active thyroid eye disease, treatment with teprotumumab was associated with a significantly lower rate and severity of orbital decompressions compared to treatment with corticosteroids and/or orbital radiation alone. However, the rates of strabismus and eyelid surgeries remained similar between groups.
Arq Bras Oftalmol
· 2025 · PMID 40699108
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PURPOSE: Ptosis is characterized by drooping of the upper eyelid, often requiring surgical intervention for functional and aesthetic purposes. Müller's muscle conjunctival resection is a commonly utilized surgical techni...PURPOSE: Ptosis is characterized by drooping of the upper eyelid, often requiring surgical intervention for functional and aesthetic purposes. Müller's muscle conjunctival resection is a commonly utilized surgical technique to correct mild to moderate ptosis. This retrospective study aimed to evaluate the impact of Hering's law on the outcomes of unilateral Müller's muscle conjunctival resection surgery, particularly eyelid and brow symmetry. METHODS: Thirty patients with unilateral ptosis underwent Müller's muscle conjunctival resection. Preand postoperative assessments included ipsilateral and contralateral side margin-reflex distance and brow position, measured through digital image analysis. RESULTS: We found significant improvements in postoperative margin-reflex distance measurements in the ipsilateral eyelid but not in the contralateral eyelid, indicating minimal influence of Hering's law. Brow position showed a statistically significant increase on the contralateral side but not on the ipsilateral side. CONCLUSION: Müller's muscle conjunctival resection effectively restores symmetry in eyelid height and maintains brow symmetry. This is the first study to explore bilateral eyelid and brow symmetry after unilateral Müller's muscle conjunctival resection surgery for mild to moderate ptosis. Further research should be conducted to understand the long-term effects of Müller's muscle conjunctival resection on facial aesthetics, particularly in relation to brow position.
Kodali S, Steinberg Y, Parsikia A
… +1 more, Mbekeani JN
Arq Bras Oftalmol
· 2025 · PMID 40699107
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PURPOSE: To evaluate the changes in the rates and indications of eye removal procedures during the recent COVID-19 pandemic. METHODS: The medical records of all patients who underwent eye removal from 2007 to 2022 were r...PURPOSE: To evaluate the changes in the rates and indications of eye removal procedures during the recent COVID-19 pandemic. METHODS: The medical records of all patients who underwent eye removal from 2007 to 2022 were retrospectively reviewed. The patient demographic data and indications for surgery were collected. Data from two groups of patients (prepandemic surgery and postpandemic surgery) were compared. Statistical significance was set at p<0.05. RESULTS: Fifty-nine patients underwent enucleation (69%), evisceration (27%), or exenteration (3%). The mean (SD) age of the patients was 55.9 (19.4) years, and most (69%) of the patients were males. Most (47%) of the study population were Black. The common indications for eye removal were trauma (41%), painful blind eye (34%), and infection/inflammation (24%). The types of trauma were assault (55%), accidental (39%), and self-inflicted (6%). The mean (SD) monthly rates of eye removal increased from 0.25 (0.50) in the prepandemic period to 0.77 (0.91) during the pandemic (p<0.001). These increases were noted in both males (p=0.003) and females (p=0.001) and were the highest among Black patients [0.42 (0.76); p<0.001]. Among the indications of eye removal, painful blind eyes [0.35 (0.75); p<0.001] and ocular trauma [0.31 (0.47); p=0.051] exhibited the greatest increases following the pandemic. CONCLUSION: The rate of eye removal procedures increased during the recent pandemic. Although delayed care of chronic eye conditions may have contributed to the increased rates of painful blind eyes, the increased trauma-related eye removals may be attributed to the simultaneous spike in violent assaults in New York City.
David JPF, Rosa AAM, Scherer R
… +2 more, Teixeira CEC, Costa D
Arq Bras Oftalmol
· 2025 · PMID 40699106
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PURPOSE: Standard automated perimetry has been the standard method for measuring visual field changes for several years. It can measure an individual's ability to detect a light stimulus from a uniformly illuminated back...PURPOSE: Standard automated perimetry has been the standard method for measuring visual field changes for several years. It can measure an individual's ability to detect a light stimulus from a uniformly illuminated background. In the management of glaucoma, the primary objective of perimetry is the identification and quantification of visual field abnormalities. It also serves as a longitudinal evaluation for the detection of disease progression. The development of artificial intelligence--based models capable of interpreting tests could combine technological development with improved access to healthcare. METHODS: In this observational, cross-sectional, descriptive study, we used an artificial intelligence-based model [Inception V3] to interpret gray-scale crops from standard automated perimetry that were performed in an ophthalmology clinic in the Brazilian Amazon rainforest between January 2018 and December 2022. RESULTS: The study included 1,519 standard automated perimetry test results that were performed using Humphrey HFA-II-i-750 (Zeiss Meditech). The Subsequently, 70%, 10%, and 20% of the dataset were used for training, validation, and testing, respectively. The model achieved 80% (68.23%-88.9%) sensitivity and 94.64% (88.8%-98%) specificity for detecting altered perimetry results. Furthermore, the area under the receiver operating characteristic curve was 0.93. CONCLUSIONS: The integration of artificial intelligence in the diagnosis, screening, and monitoring of pathologies represents a paradigm shift in ophthalmology, enabling significant improvements in safety, efficiency, availability, and accessibility of treatment.
Arq Bras Oftalmol
· 2025 · PMID 40699105
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PURPOSE: This pilot study was conducted to investigate the presence of various bioactive compounds (copeptin, asprosin, and salusins) in the blood and tears of patients with glaucoma. METHODS: A total of 83 subjects, inc...PURPOSE: This pilot study was conducted to investigate the presence of various bioactive compounds (copeptin, asprosin, and salusins) in the blood and tears of patients with glaucoma. METHODS: A total of 83 subjects, including 28 patients with open-angle glaucoma, 28 patients with ocular hypertension, and 27 control volunteers, were enrolled in this study. The levels of salusin-α, salusin-β, copeptin, and asprosin in tears and venous blood samples were measured by enzyme linked immunosorbent assay (ELISA). RESULTS: Patients with open-angle glaucoma and those with ocular hypertension showed statistically significantly decreased levels of salusin-α and salusin-β in their blood and tears compared with those of control subjects (p<0.05), with the decrease being the most pronounced in patients with ocular hypertension (p<0.05). In contrast, the levels of copeptin and asprosin showed a statistically significant increase in both these patient groups compared with those of control subjects (p<0.05). There was a negative correlation between intraocular pressure and blood and tear salusins. CONCLUSIONS: Fluids from patients with open-angle glaucoma and ocular hypertension showed lower salusin levels. Patients with ocular hypertension had higher levels of copeptin and asprosin, but not those with open-angle glaucoma (except for asprosin, whose levels showed a slight but remarkable increase in plasma in patients with open-angle glaucoma). The pathogenesis of ocular hypertension and open-angle glaucoma may be significantly impacted by these biomarkers.
Arq Bras Oftalmol
· 2025 · PMID 40699104
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PURPOSE: This study aimed to evaluate the influence of intrastromal corneal ring segment implants on the intraocular pressure measurements using Goldmann applanation tonometry, rebound tonometry, and noncontact tonometry...PURPOSE: This study aimed to evaluate the influence of intrastromal corneal ring segment implants on the intraocular pressure measurements using Goldmann applanation tonometry, rebound tonometry, and noncontact tonometry in keratoconic corneas and analyze the intertonometer agreement. METHODS: We enrolled 74 eyes in this observational and prospective study. Each participant had a complete eye examination, corneal analysis with Scheimpflug Tomography (Pentacam®), and intraocular pressure evaluation with Goldmann applanation tonometry, rebound tonometry, and noncontact tonometry, before and after intrastromal corneal ring segment implantation (on postoperative days 1, 7, 45, and 90). Intertonometer agreement was assessed using Bland-Altman analysis. RESULTS: The mean age was 29.9 ± 10.2 years, and 47 (63.5%) eyes had keratoconus grade II. Intraocular pressures were higher for noncontact tonometry preoperatively and on 90 postoperative day (mean ± SD: 12.4 ± 2.2 and 12.1 ± 2.2 mmHg, respectively), followed by Goldmann applanation tonometry (11.1 ± 3.0 and 11.2 ± 2.7 mmHg, respectively), and were lower for rebound tonometry (9.7 ± 3.4 and 9.4 ± 3.2 mmHg, respectively). The variation from the Goldmann tonometry on 7 postoperative day to the baseline (p=0.022) and that of noncontact tonometry on 90 postoperative day to the baseline (p=0.021) were statistically significant. The rebound tonometry underestimated intraocular pressure when compared with the Goldmann applanation tonometry by a mean of 1.47 ± 5.19 mmHg. Noncontact tonometry, when compared with Goldmann applanation tonometry, overestimated intraocular pressure by a mean of 1.23 ± 4.15 mmHg. CONCLUSION: Despite statistically significant differences between some postoperative periods, the intraocular pressure measurement differences may not be clinically relevant.
Akgun Z, Kiyat P, Sarikaya I
… +2 more, Yilmaz U, Selver OB
Arq Bras Oftalmol
· 2025 · PMID 40699103
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PURPOSE: This study aimed to evaluate the relationship between the objective severity of dry eye disease subjective symptoms, and corneal sensitivity. METHODS: The study included 62 eyes from 31 healthy volunteers and 15...PURPOSE: This study aimed to evaluate the relationship between the objective severity of dry eye disease subjective symptoms, and corneal sensitivity. METHODS: The study included 62 eyes from 31 healthy volunteers and 150 eyes from 75 patients diagnosed with dry eye disease . Participants underwent the Schirmer I test, tear break-up time assessment, and corneal staining evaluation using the Oxford Scale. Subjective symptoms were assessed through the Ocular Surface Disease Index questionnaire and a modified Ocular Surface Pain Score questionnaire. Corneal sensitivity was measured in five corneal regions using a Cochet-Bonnet esthesiometer. Dry eye disease severity was graded from 1 to 5 based on the Oxford Scale. Comparative analyses were performed. RESULTS: Schirmer I and tear break-up time values were significantly lower in the DED group, while Ocular Surface Disease Index and Ocular Surface Pain Score were significantly higher (p<0.001 for all). Corneal sensitivity in all quadrants was significantly lower in DED patients (p<0.001 for all). A strong correlation was observed between the Ocular Surface Pain Score and the Ocular Surface Disease Index (r=0.983, p<0.001). Central corneal sensitivity exhibited a moderate positive correlation with Schirmer I and tear break-up time (p<0.001, r=0.583 and 0.657, respectively) and a moderate negative correlation with Ocular Surface Disease Index and Ocular Surface Pain Score (p<0.001, r=0.625 and -0.631, respectively). Disease severity progression was associated with increased Ocular Surface Disease Index and Ocular Surface Pain Score, but no statistically significant difference was found between Grades 3 and 5. Similarly, corneal sensitivity decreased with advancing disease severity, yet no significant difference was observed between Grades 4 and 5. CONCLUSION: Corneal sensitivity decreases in dry eye disease and is negatively correlated with disease severity. Subjective symptoms increase with disease progression and show a positive correlation with severity. The absence of significant differences between the advanced stages suggests that neuropathic mechanisms and subbasal nerve plexus deterioration play a role in chronic and late-stage dry eye disease.
Boas FSV, Costa ACP, Rolim-de-Moura C
… +1 more, Gracitelli CPB
Arq Bras Oftalmol
· 2025 · PMID 40699102
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PURPOSE: This study aims to describe the technique, feasibility, efficacy, and safety of 360° trabeculotomy ab externo with double access for the treatment of congenital glaucoma. METHODS: This paper provides a detailed...PURPOSE: This study aims to describe the technique, feasibility, efficacy, and safety of 360° trabeculotomy ab externo with double access for the treatment of congenital glaucoma. METHODS: This paper provides a detailed description of the 360° trabeculotomy ab externo with double access used to treat pediatric glaucoma. The postoperative outcomes of six eyes from six patients who underwent this procedure for primary and secondary congenital glaucoma are also reported. RESULTS: Six eyes from six patients were included in this study. The median age of the patients at the time of surgery was 1.25 yr (range: 0.27-5.41 yr). The mean preoperative intraocular pressure was 25 ± 5.87 mmHg (range: 18-35 mmHg). At baseline, the mean number of hypotensive eye drop medications used was 2 ± 0.63. Postoperatively, the mean intraocular pressure decreased to 10 ± 2.20 mmHg (range: 9-14 mmHg), and none of the patients required hypotensive eye drops. The most common postoperative complication was hyphema, observed in one case on the first postoperative day; however, it resolved within 7 days. CONCLUSIONS: The 360° trabeculotomy ab externo with double access is a valuable addition to the surgical options for pediatric glaucoma. This technique facilitates a complete 360° ab externo opening of the trabecular meshwork while enhancing surgical safety.
Andrade AL, Faria TP, Meneghim RLFS
… +4 more, Hashimoto M, Jorge EN, Schellini SA, Jorge EC
Arq Bras Oftalmol
· 2025 · PMID 40699101
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PURPOSE: This study aimed to evaluate abnormalities in the retinal nerve fiber layer and ganglion cell layer in patients with thyroid-associated orbitopathy using optical coherence tomography and to examine their relatio...PURPOSE: This study aimed to evaluate abnormalities in the retinal nerve fiber layer and ganglion cell layer in patients with thyroid-associated orbitopathy using optical coherence tomography and to examine their relationship with disease severity. METHODS: A cross-sectional study was conducted involving 74 participants, comprising 45 individuals with thyroid-associated orbitopathy and 29 healthy controls. All subjects underwent a comprehensive ophthalmological examination and optical coherence tomography using the Cirrus HD-OCT. The clinical activity score and the European Group on Graves' Orbitopathy severity were also evaluated. RESULTS: In the thyroid-associated orbitopathy group, the mean peripapillary retinal nerve fiber layer thickness was significantly reduced in the temporal quadrant (p<0.05). No significant differences were found in ganglion cell layer thickness across all sectors when compared with the control group. Besides, a significant correlation was observed between orbitopathy severity and decreased mean peripapillary retinal nerve fiber layer thickness (p<0.001). CONCLUSION: Optical coherence tomography may serve as a useful tool for identifying changes in the retinal nerve fiber layer and ganglion cell layer in patients with thyroid-associated orbitopathy, including in the inactive phase and prior to the clinical manifestation of dysthyroid optic neuropathy. It may be a helpful adjunct in monitoring disease progression.