PURPOSE: This study aims to evaluate the clinical outcomes of patients with refractory neurotrophic keratitis (NK) who were unresponsive to standard therapies and treated with topical insulin. METHODS: In this prospectiv...PURPOSE: This study aims to evaluate the clinical outcomes of patients with refractory neurotrophic keratitis (NK) who were unresponsive to standard therapies and treated with topical insulin. METHODS: In this prospective analysis, 16 eyes with stage 2 or 3 NK were treated with topical insulin. These patients had been refractory to standard medical treatment. Informed consent was obtained from patients before starting treatment. Each patient applied topical insulin drops (10 units/1mL) six times a day, along with prophylactic fluoroquinolone drops. Treatment was continued until the persistent NK resolved, and anterior segment photos were taken regularly. RESULTS: The study included 16 eyes of 15 patients with a mean age of 59 years. Initial visual acuity was poor, averaging 1.7 log MAR. Topical insulin treatment led to significant improvements: 75% of patients showed improved visual acuity with a mean gain of 0.5 log MAR. The mean healing time for ulcers was 12.3 days, with a healing rate of 93.75%. No complications or side effects were reported. CONCLUSIONS: Several studies have explored the use of topical insulin in treating neurotrophic corneal ulcers, employing various concentrations. Our study is the first to use a concentration of 10IU/mL. Our findings suggest that topical insulin therapy could be an effective treatment for refractory neurotrophic keratitis (NK) due to its high efficacy, accessibility, and low cost. While our study may have identified an optimal insulin concentration, further research with larger sample sizes is needed, including investigations into other causes of refractory corneal ulcers.
INTRODUCTION: The surgical procedure of combined resection and resection of the same muscle (CRR) has been proposed thus far for overactive muscles. We recently published our short-term results with this technique used i...INTRODUCTION: The surgical procedure of combined resection and resection of the same muscle (CRR) has been proposed thus far for overactive muscles. We recently published our short-term results with this technique used in esotropia and in exotropia. We present the long-term results of these two series. METHODS: CRR consists of a large recession, which decreases the active and passive force of the muscle and greatly reduces the arc of contact, like posterior fixation sutures. The risk of overcorrection and muscle underaction are limited by combining a muscle resection adjusted according to the Quantified Passive Duction Test. We describe in detail the method of action, as well as the surgical technique and titration according to the muscle and the type of strabismus. RESULTS: In purely constant esotropia, the technique was compared to posterior fixation sutures on the medial rectus. While equally effective at 6 months, we observe greater stability at 5 years with CRR (90% success vs. 55% with posterior fixation sutures). For exotropia, in 100 cases of exotropia operated with CRR of the lateral rectus, our results with more than 2 years of follow-up are superior to those usually obtained, with 83% success on alternating cover test and 100% improvement of Newcastle Control Scores. CONCLUSION: In view of these encouraging results, we believe that this technique, which elegantly allows treatment of the tonic and anatomic aspects of comitant strabismus in a single, simple, surgical procedure, should be included in our surgical therapeutic arsenal for comitant strabismus.
INTRODUCTION: Clinical practice guidelines (CPGs) are crucial for providing evidence-based recommendations to improve patient care. Over the past 30 years, CPG development has progressed, particularly in addressing varia...INTRODUCTION: Clinical practice guidelines (CPGs) are crucial for providing evidence-based recommendations to improve patient care. Over the past 30 years, CPG development has progressed, particularly in addressing variations in care. However, significant disparities remain, especially in low- and middle-income countries. This systematic review aims to evaluate the methodological quality of cataract-related CPGs published between 2000 and 2023 by using the AGREE II instrument. METHODS: A comprehensive search identified 11 CPGs meeting eligibility criteria, assessed across six domains: Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence. RESULTS: CPGs from the United States, National Institute for Health and Care Excellence (NICE), and Peru showed high scores in Rigor of Development and Scope and Purpose domains. Conversely, guidelines from Asia, Chile, and Mexico were not recommended due to deficiencies across multiple domains. Applicability emerged as the weakest domain across all CPGs, indicating challenges in translating guidelines into practice. CONCLUSIONS: These findings highlight variability in CPG quality, emphasizing the need for ongoing improvements, particularly in Stakeholder Involvement and Applicability domains. Continued efforts to enhance methodological rigor and practical applicability are crucial for improving quality of care in cataract management.
Ciliary madarosis, characterized by the partial or complete loss of eyelashes, has limited treatment options, especially in pediatric cases. Prostaglandin analogues, primarily used in glaucoma treatment, have shown poten...Ciliary madarosis, characterized by the partial or complete loss of eyelashes, has limited treatment options, especially in pediatric cases. Prostaglandin analogues, primarily used in glaucoma treatment, have shown potential as a novel approach for promoting eyelash regrowth due to their hypertrichotic effects. We report the case of a 5-year-old boy presenting with isolated eyelash loss on the right upper eyelid. Following unremarkable systemic and ophthalmologic evaluations, the child was treated with nightly latanoprost 0.005% eye drops applied to the eyelid margin. After three months, eyelash regrowth was observed, with no adverse effects. This case highlights the potential of latanoprost as a viable treatment for pediatric ciliary madarosis. Further research is warranted to establish guidelines for its off-label use in eyelash loss.
PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) complicated by a stroke, leading to the diagnoses of lupus anticoagulant and hypercysteinemia. METHODS: Case report. RESULTS...PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) complicated by a stroke, leading to the diagnoses of lupus anticoagulant and hypercysteinemia. METHODS: Case report. RESULTS: A 28-year-old man complained of blurry vision and red eyes. On exam, his visual acuity was 20/25 in both eyes. Slit lamp examination demonstrated anterior uveitis, vitritis and multifocal, yellowish, subretinal, placoid lesions within the posterior pole. On fundus fluorescein angiography (FFA), the placoid lesions appeared hypofluorescent in the early phases and became hyperfluorescent in the late frames. On indocyanine green angiography (ICGA), hypofluorescent spots were present across all phases of the exam. Spectral-domain optical coherence tomography (SDOCT) demonstrated disruption of the outer retinal and ellipsoid zone. These features were consistent with the diagnosis of APMPPE. A uveitis work-up was unremarkable. Treatment with dexamethasone eye drops was initiated. Eight weeks after initial presentation, the patient was admitted on the neurology service for an acute episode of right-sided weakness as well as dysarthria. Magnetic resonance imaging (MRI) showed a small subacute infarct in the left posterior limb of the internal capsule and a small aneurysm of the right middle cerebral artery. An extensive laboratory work-up revealed hypercysteinemia with lupus anticoagulant detected by diluted Russell Viper Venom Time (dRVVT). The patient was started on anticoagulant medication and a statin. His symptoms improved, and the neurological examination was normal at a follow-up visit three months later. CONCLUSION: APMPPE is a well-established disease, and neurological complications are rare. Cerebral vasculitis and strokes are the most commonly reported neurological lesions. The search for antiphospholipid syndrome and hypercysteinemia in the first-line work-up of APMPPE should be considered.
INTRODUCTION: We study data and prognostic factors in a population of 37 patients with acute retinal necrosis. PATIENTS AND METHODS: 37 immunocompetent patients aged 16 to 88 years with unilateral or bilateral acute reti...INTRODUCTION: We study data and prognostic factors in a population of 37 patients with acute retinal necrosis. PATIENTS AND METHODS: 37 immunocompetent patients aged 16 to 88 years with unilateral or bilateral acute retinal necrosis, diagnosed clinically and virologically at Lille University Hospital and Dunkirk Hospital were included. RESULTS: The initial visual acuity was significantly associated with the location of the area of retinal necrosis. Conversely, we found no statistically significant relationship between diagnostic delay and initial visual acuity. Moreover, 70% of patients had a retinal detachment during follow-up, and 50% of retinal detachments occurred within 90 days of diagnosis. DISCUSSION: We found no statistically significant relationship between diagnostic delay and initial visual acuity, whereas the latter is dependent upon the location of the area of necrosis, although we would intuitively expect the centripetal progression of the necrosis to associate a delay in diagnosis with greater damage. Initial visual acuity appears to be a major prognostic factor. CONCLUSION: Acute retinal necrosis is a rare and serious pathology, the visual prognosis of which appears to be primarily related to the area of initial necrosis and initial visual acuity.
INTRODUCTION: This study aimed to evaluate the efficacy and safety of weekly adalimumab (Q1 week) in children with chronic non-infectious uveitis following an inadequate response to biweekly adalimumab (Q2 weeks). METHOD...INTRODUCTION: This study aimed to evaluate the efficacy and safety of weekly adalimumab (Q1 week) in children with chronic non-infectious uveitis following an inadequate response to biweekly adalimumab (Q2 weeks). METHODS: This retrospective, single-center study was conducted in the ophthalmology department of a tertiary center in Marseille, France, and included all patients under 16 years of age with chronic non-infectious uveitis requiring adalimumab dose escalation from Q2 weeks to Q1 week from January 2015 to April 2024. RESULTS: Seventeen eyes of ten patients were included: six with juvenile idiopathic arthritis, one with idiopathic non-granulomatous anterior uveitis, two with idiopathic granulomatous panuveitis, and one with Vogt-Koyanagi-Harada disease. Eighty percent of patients exhibited active inflammation prior to initiating adalimumab Q1 week, while 80% demonstrated no active anterior inflammation at last follow-up (P=0.041). The mean dose of topical corticosteroids and oral corticosteroids was reduced by the conclusion of follow-up compared to the time of adalimumab dose escalation to Q1 week (7.5mg/day versus 3.9mg/day, P=0.059). The adalimumab dose escalation to Q1 week allowed for complete withdrawal of oral corticosteroids in five out of the seven patients treated with oral corticosteroids (P=0.074). No adverse effects from the adalimumab were reported during the follow-up period. CONCLUSION: Escalation to adalimumab Q1 week in children with chronic non-infectious uveitis demonstrated promising efficacy, with a substantial proportion of patients achieving complete resolution of active inflammation.
Olazaran Gamboa L, Jiménez Alonso A, Heras Mulero H
… +10 more, Fanlo Mateo P, Gangoitia Gorrotxategi N, Salmerón Garmendia I, López Arbués S, Galarza López A, Argüelles AS, Reyzabal Ereño I, Elso Echeverría B, Uriarte Terán M, Ochoa Tejada L
PURPOSE: To report and present imaging of a case of reversal of optic disc cupping following filtering surgery in juvenile glaucoma. OBSERVATION: A 22-year-old woman visited our emergency department complaining of blurre...PURPOSE: To report and present imaging of a case of reversal of optic disc cupping following filtering surgery in juvenile glaucoma. OBSERVATION: A 22-year-old woman visited our emergency department complaining of blurred vision in her right eye for two weeks associated with bilateral ocular pain. Her medical history included bilateral juvenile glaucoma treated since 2018, occurring in the context of a significant family history of glaucoma. On initial examination, intraocular pressure was 43mmHg in both eyes. Fundus examination showed bilateral optic disc cupping. Humphrey perimetry revealed advanced glaucomatous scotomas surrounding fixation. Filtering surgeries were performed: a deep non-perforating sclerectomy for the right eye followed by a trabeculectomy for the left. Transient hypotony retinopathy occurred in both eyes. Intraocular pressure reduction was followed by a reversal of the optic disc cupping. This morphologic recovery was not associated with improvement in other structural parameters such as retinal nerve fiber layer or ganglion cell complex thickness or perimetric functional indices. CONCLUSION AND IMPORTANCE: This is a rare case of reversal of optic disc cupping in an adult. This case highlights the dynamic sclerolaminar movements involved in the pathogenesis of glaucoma and raises the question of the consequences of these kinetics.