PURPOSE: Identifying progression of keratoconus (KC) at an early stage remains a significant but important challenge, because it allows the treatment of patients before the disease affects their vision. This study aimed...PURPOSE: Identifying progression of keratoconus (KC) at an early stage remains a significant but important challenge, because it allows the treatment of patients before the disease affects their vision. This study aimed to analyze the risk factors for KC progression and the changes in CASIA-2 swept source OCT topography (SS-OCT Tomey, Japan) corneal parameters in progressive and nonprogressive KC. MATERIALS AND METHODS: This retrospective, single-center study was conducted at Bordeaux University Hospital, France, at the National Referral Center for Keratoconus (CRNK). One hundred thirty-four patients were retrospectively included and divided into two groups: progressive KC (n=59), requiring accelerated CXL, and stable KC (n=75). Demographic, clinical, and topographic data were recorded. RESULTS: At baseline, young age, a history of asthma, and severe KC were significantly associated with keratoconus progression (OR 2.50, 95% CI: 1.44-4.35; OR 2.80, 95% CI: 1.05-7.42; and 3.56, 95% CI: 1.54-8.19, respectively). CASIA Fourier high-order aberrations (CASIA HOA), Ectasia Screening Index (ESI), anterior maximal elevation, and posterior maximal elevation were the four variables that were significantly different between the progressive and nonprogressive groups. Keratometric Asymmetry Amplitude (KAA), SimKmax, Kapex ant, and CASIA spherical aberrations (CASIA AS) showed a greater magnitude of increase than the other parameters between the two consultations in the progressive group than in the nonprogressive group. CONCLUSION: In the future, developing a progression risk score that combines clinical criteria (age, asthma, and eye rubbing) with topographic variables (CASIA HOA, ESI, anterior maximal elevation, and posterior maximal elevation) may improve adaptation of the follow-up frequency for keratoconus patients. The four most promising CASIA parameters for monitoring keratoconus progression are KAA, Kapex, SimKmax, and CASIA AS; these variables could serve as potential warning signs of progression.
PURPOSE: To study Bowman's membrane lenticule as a novel surgical method for treatment in cases of peripheral ulcerative keratitis. METHOD: The study was a hospital-based, single center, prospective interventional study....PURPOSE: To study Bowman's membrane lenticule as a novel surgical method for treatment in cases of peripheral ulcerative keratitis. METHOD: The study was a hospital-based, single center, prospective interventional study. The study was evaluated in 30 eyes of 30 patients associated with peripheral ulcerative keratitis (PUK). For treatment, Bowman's membrane (BM) lenticule was tucked under the edges of the lesion after formation of recess around gutter. Best-corrected visual acuity (BCVA), mean epithelization time (MET), and corneal contour were measured and compared. RESULTS: The study enrolled a total of 30 eyes of 30 patients associated with PUK, out of which 19 were males and 11 females. The mean age of patients in the study was 50.80±10.85years. The mean BCVA changed from 0.311±0.202 decimal units preoperatively to 0.118±0.127 decimal units postoperatively, the MET was 2.30±0.530weeks and the mean corneal thickness changed from a preoperative value of 233.60±115.138 microns to 433.667±46.571 microns postoperatively. CONCLUSION: BM lenticule is a novel surgical technique which is very forcible and staunch method to treat patients suffering from PUK, including perforations. This treatment method adds to the thickness of the cornea reasonably sufficiently, reduces inflammation by acting as barrier between raw surface and inflammatory mediators, promotes nerve growth and reinforces healing process.
PURPOSE: To study the tomographic aspects of the macula in albinos and their correlation with visual acuity. PATIENTS AND METHOD: We conducted a case-control study including albinos (cases) and non-albinos (controls). Th...PURPOSE: To study the tomographic aspects of the macula in albinos and their correlation with visual acuity. PATIENTS AND METHOD: We conducted a case-control study including albinos (cases) and non-albinos (controls). They were age- and sex-matched. All subjects underwent an ophthalmological examination and spectral-domain macular OCT. Data were analyzed using SPSS version 22. The significance level was set at P<0.05. RESULTS: We included 50 albinos (cases) and 50 non-albinos (controls). The mean age was 25.84±9.02, and the sex ratio 0.5. The mean corrected visual acuity of the albino group was 0.63 logMAR. The mean foveal thickness was 281.16±10.55μm for cases and 196.86±19.14μm for controls (P<0.00001). The mean central macular thickness was 284.79±17.78μm and 256.17±17.78μm respectively in cases and controls (P<0.00001). The mean parafoveal thickness was 282.61±13.49μm in cases and 333.63±9.73μm in controls (P<0.00001). Corrected visual acuity was correlated with central macular thickness (r=-0.29; P=0.004) as well as to parafoveal thickness (r=-0.4; P<0.0001). VA was better with higher central macular or parafoveal thickness. All albinos had foveal hypoplasia. CONCLUSION: Albinos have foveal hypoplasia that is correlated with their visual acuity.
PURPOSE: We aimed to evaluate the anterior segment parameters and refractive changes after Gonioscopy-Assisted Transluminal Trabeculotomy (GATT). MATERIALS AND METHODS: This retrospective, cross-sectional, observational...PURPOSE: We aimed to evaluate the anterior segment parameters and refractive changes after Gonioscopy-Assisted Transluminal Trabeculotomy (GATT). MATERIALS AND METHODS: This retrospective, cross-sectional, observational study included 21 eyes of 19 patients with open-angle glaucoma who underwent at least 180° GATT between February 2022 and January 2024. The anterior segment parameters obtained using Sirius corneal topography (CSO, Italy) were retrospectively reviewed for the preoperative period and the 3rd postoperative month. RESULTS: Among the study population, fourteen eyes were diagnosed with primary open-angle glaucoma, six with pseudoexfoliative glaucoma, and one with pigmentary glaucoma. Compared to the preoperative period, the postoperative intraocular pressure (IOP) and the number of antiglaucomatous drugs (NAGD) used were significantly lower (23 [15-35] mmHg vs. 14 [7-19] mmHg, P<0.001; 4 [1-4] vs. 0 [0-3], P<0.001, respectively). Compared to the preoperative period, there were significant increases in the postoperative anterior chamber angle (ACA) (38 [27-55]° vs. 52 [35-62]°, P<0.001), anterior chamber depth (ACD) (2.67 [1.93-3.82] mm vs. 3.36 [2.7-4.25] mm, P<0.001), and anterior chamber volume (ACV) (111 [87-208] mm vs. 155 [110-252] mm, P=0.001). No significant differences were detected in K1, K2, spherical equivalent (SE), best-corrected visual acuity (BCVA), or central corneal thickness (CCT) before and after GATT (P>0.05). CONCLUSION: In our study, a decrease in IOP and the NAGD used, as well as an increase in ACA, ACD, and ACV, were observed after GATT compared to the preoperative period. The lack of changes in K1, K2, SE, BCVA, and CCT suggests that the surgery may be advantageous in these aspects.
PURPOSE: To evaluate the accuracy in terms of thickness of LASIK flaps created using the ELITA femtosecond laser (Johnson and Johnson Surgical Vision, Inc) compared to the intended thickness. METHODS: This retrospective,...PURPOSE: To evaluate the accuracy in terms of thickness of LASIK flaps created using the ELITA femtosecond laser (Johnson and Johnson Surgical Vision, Inc) compared to the intended thickness. METHODS: This retrospective, single-center study was conducted at the Institut Noemie de Rothschild (Paris, France) in patients eligible for bilateral LASIK surgery. The ELITA femtosecond laser was used to create all flaps, with an intended thickness of 110μm or 120μm. Flap thickness was measured manually by using images from two Optical Coherence Tomography (OCT) devices: Anterion (Heidelberg Engineering), which uses a "Swept Source" technology, and Avanti (Optovue), which uses "Spectral Domain" technology. For each patient, two flap thickness measurements were obtained from the horizontal Anterion B-scan. Additionally, two Avanti scans, one horizontal and one vertical, were acquired per patient, with two flap thickness measurements recorded from each scan. Postoperative refractive and visual outcomes were also evaluated. RESULTS: 30 eyes of 15 patients were included. 66.6% were female. The mean age of the patients was 31.4 years (range: 25 to 45 years). 48 Anterion measurements were obtained: mean flap thickness was 124.9±12.3μm (range 101 to 157μm). 120 Avanti measurements were obtained: mean flap thickness was 115.1±7.7μm (range 92 to 132μm). The mean deviations between the achieved and attempted flap thickness were 8.38±9μm by Anterion measurements and 6.67μm±4.72μm by Avanti measurements. The mean postoperative spherical equivalent was 0.05±0.43 diopters. The mean uncorrected visual acuity (UCVA) was 0.99 (LogMar). No intraoperative or postoperative complications occurred. CONCLUSION: The ELITA femtosecond laser provides accurate and consistent LASIK flap thickness with excellent visual outcomes and no reported complications.
PURPOSE: To determine the accuracy of various biomechanical parameters, including the updated version of the stress-strain index (SSIv2), the Corvis Biomechanical Factor (CBiF), and the Chinese Corvis Biomechanical Index...PURPOSE: To determine the accuracy of various biomechanical parameters, including the updated version of the stress-strain index (SSIv2), the Corvis Biomechanical Factor (CBiF), and the Chinese Corvis Biomechanical Index (cCBI), in differentiating between normal corneas and keratoconus at different stages in a North African population. METHODS: This prospective observational case-control study included three groups: the normal group (100 eyes), moderate keratoconus group (KC grade 1: 56 eyes), and severe keratoconus group (KC Grade 2: 51 eyes). Each eye underwent Corvis ST examination to determine the stiffness parameter at first applanation (SP-A1), Ambrósio relational thickness (ARTh), integrated inverse radius (IIR), velocity at first applanation (velocity A1), biomechanical-corrected IOP (bIOP), tomographic and biomechanical index (TBI), CBI, and the new parameters SSIv2, CBiF, and cCBI. Comparison of biomechanical parameters between groups was performed using ANOVA or Kruskal-Wallis tests (with P<0.05). The performance of these parameters was evaluated using ROC (Receiver Operating Characteristic) curves by determining AUCs (Area Under the Curve), which were compared using DeLong's test. RESULTS: Before and after correction for age, central corneal thickness, and bIOP, most biomechanical parameters were significantly different among the three groups (P<0.05). The TBI had the highest diagnostic accuracy (AUC=0.997) in detecting keratoconus, followed by the CBI (0.975), ARTh (0.948), and IIR (0.939). The CBI and ARTh presented the highest efficacy in differentiating between keratoconus severities (AUC=0.861 and 0.850, respectively). CBiF and cCBI showed excellent ability to diagnose keratoconus (AUC=0.937 and 0.933, respectively). SSIv2 demonstrated good potential (AUC=0.796) for detecting keratoconus. CONCLUSION: In a North African population, the TBI best distinguished keratoconus eyes from normal eyes, followed by the CBI and ARTh. CBiF, cCBI, and SSIv2 demonstrated excellent performance, albeit less so.
PURPOSE: We aimed to describe three cases of childhood cyclic esotropia and report the outcomes of botulinum toxin type A (BTA) treatment. MATERIALS AND METHODS: Three children with cyclic esotropia manifesting in a 48-h...PURPOSE: We aimed to describe three cases of childhood cyclic esotropia and report the outcomes of botulinum toxin type A (BTA) treatment. MATERIALS AND METHODS: Three children with cyclic esotropia manifesting in a 48-hour cycle were included in the study. BTA (5 IU) was injected into the medial rectus muscles. RESULTS: The first patient was a 9-year-old boy with esodeviation (55-50 PD at near and distance) beginning after phacoemulsification surgery for juvenile cataracts. Injection of BTA resulted in breaking the cycle, and a second BTA injection was performed for residual deviation. During the 6-year follow-up, he remained orthophoric with a stereoacuity of 40arcseconds. The second patient was a 9-year-old girl with latent nystagmus and anisometric amblyopia. She experienced diplopia and esotropia (65-45 PD at near and distance). After two BTA injections and 8 years of follow-up, she remained stable with a stereo acuity of 800 arcseconds. The third patient was a 5-year-old boy with a history of falls and right esotropia (40 PD at near and distance). Following a single BTA injection, he was found to be orthophoric with a 4-year follow-up. CONCLUSIONS: Based on our cases, BTA injection was found to be an effective method for achieving long-term orthotropia. After breaking the cycle with the first BTA injection, recurrent injections may be useful for residual deviations. We believe that BTA injection should be considered the first-line treatment for cyclic esotropia.
OBJECTIVE: To evaluate the clinical efficacy of intraoperative corneal releasing incisions for astigmatism correction in Catalys White Lux femtosecond laser-assisted cataract surgery and to compare the differences betwee...OBJECTIVE: To evaluate the clinical efficacy of intraoperative corneal releasing incisions for astigmatism correction in Catalys White Lux femtosecond laser-assisted cataract surgery and to compare the differences between intrastromal releasing incisions and anterior penetrating releasing incisions. METHODS: In this prospective study, 39 patients (39 eyes) with cataracts and corneal astigmatism of 0.75 D or greater were enrolled. Patients were randomly assigned to two groups based on the depth of the corneal releasing incision: Group A (intrastromal releasing incisions, with a depth of 60%) and Group B (anterior penetrating releasing incisions, with a depth of 80%). Visual acuity, correction of corneal astigmatism, and endothelial damage were compared between the two groups before and after surgery. Additionally, regression analyses were conducted on factors potentially affecting astigmatism correction, including age, corneal endothelium, and incision depth. RESULTS: All 39 patients (39 eyes) underwent successful surgery, with no adverse events such as corneal edema, perforation, or incision or intraocular infection occurring during or after the procedure. Postoperative uncorrected visual acuity improved significantly in both groups, with no statistically significant difference between them (P>0.05). Astigmatism was corrected in all cases, with Group A showing more pronounced and earlier stabilization, although this difference was not statistically significant (P>0.05). Endothelial damage was observed in all eyes; however, there was no significant difference between the groups at 1 week postoperatively (P>0.05). At 1 month and 3 months postoperatively, a significant difference was noted (P<0.05), with Group B exhibiting greater corneal damage than Group A. Logistic regression analysis indicated no significant correlation between patient age, corneal endothelium, and the success rate of astigmatism correction. CONCLUSION: Catalys White Lux femtosecond laser-assisted cataract surgery with concurrent corneal releasing incisions for astigmatism correction is a safe and effective procedure. The intrastromal incision yields more stable postoperative outcomes and results in less corneal damage compared to the anterior penetrating incision.
PURPOSE: Digital heads-up three-dimensional (3D) visualization systems are now familiar in vitreoretinal surgery, with reported better technical and similar patient outcomes compared to conventional microscopes. Here, we...PURPOSE: Digital heads-up three-dimensional (3D) visualization systems are now familiar in vitreoretinal surgery, with reported better technical and similar patient outcomes compared to conventional microscopes. Here, we compared the efficacy and safety of two different 3D systems. METHODS: A retrospective, single-center, cohort study of adults having undergone vitrectomy for treatment of rhegmatogenous retinal detachment (RRD), idiopathic epiretinal membrane (ERM), or macular hole (MH). Consecutive vitreoretinal surgeries were performed by the same surgeon using the NGENUITY system (3D-N group) or the ARTEVO 800 system (3D-A group) between April 2021 and November 2023 in our tertiary ophthalmology department (Toulouse University Hospital, France). The primary outcomes were 6-month retinal detachment (RD) recurrence rate, 3-month MH closure rate, and change in central macular thickness (CMT) at 3 months for ERMs. RESULTS: Two hundred and two surgeries on 202 eyes were included. Surgeries performed were for RRD (n=91/202; 45%), idiopathic ERM (n=82/202; 41%), or MH (n=29/202; 14%). Inclusion was n=121/202(60%) eyes in the 3D-N group and n=81/202(40%) eyes in the 3D-A group. Comparing 3D-N versus 3D-A groups, we found no significant differences in 6-month RD recurrence rate (17% versus 21%; P=0.62), MH closure rate (92% versus 88%; P=1.0), or decrease in CMT at 3 months (-79.5±69.1 versus -68.5±81.2μm; P=0.34). Subgroup analysis according to eyes operated for RRD, idiopathic ERM, or MH showed no significant differences in mean 3-month gains in best-corrected visual acuity, surgery duration, or 3-month post-operative complications between systems used. CONCLUSION: The two 3D systems were comparable in terms of short-term anatomical and functional outcomes.
PURPOSE: To compare the diagnostic reasoning and case-based problem-solving abilities of ChatGPT o3-mini-high and DeepSeek-R1 in ophthalmological cases with text-based questions. METHODS: Fifty-five consecutive text-base...PURPOSE: To compare the diagnostic reasoning and case-based problem-solving abilities of ChatGPT o3-mini-high and DeepSeek-R1 in ophthalmological cases with text-based questions. METHODS: Fifty-five consecutive text-based case-solving questions from nine ophthalmology subspecialties were posed to two reasoning-capable LLMs, ChatGPT o3-mini-high and DeepSeek-R1. For each case, the multi-component diagnostic reasoning approach described by Elstein was applied. Overall diagnostic accuracy, diagnostic agreement between the models, reasoning competence, subspecialty-specific performance, and the tendency to request additional prompts were recorded. Two expert ophthalmologists then independently rated each model's diagnostic reasoning ability for all questions, using the Global Quality Score, a five-point scale (1=poor; 5=excellent). RESULTS: ChatGPT o3-mini-high correctly answered 80% of the questions, whereas DeepSeek-R1 achieved a correct response rate of 54.5% (P<0.001), and Cohen's kappa coefficient was 0.462. ChatGPT o3-mini-high tended to request additional prompts for responses to fewer questions (2 vs. 12; P: 0.013). For both LLMs, the highest accuracy was observed in the retina/vitreous-related cases, while the lowest accuracy was noted in glaucoma-related cases. When Elstein's medical reasoning components were evaluated with the GQS, ChatGPT o3-mini-high achieved a median score of 4.5 (IQR 2.5-5.0), whereas DeepSeek-R1 achieved 2.5 (IQR 1.0-4.5) (P<0.001). The weighted kappa was 0.407, indicating moderate agreement between the two models. CONCLUSION: This study provides evidence that ChatGPT o3-mini-high demonstrates superior diagnostic accuracy and reasoning capabilities in the analysis of ophthalmologic cases compared to DeepSeek-R1.