Department Of Ophthalmology Research Articles

Biomechanical Corneal Effects of LASIK-Xtra Compared to Conventional Femto-LASIK in High Myopic Eyes

Purpose: This study seeks to investigate the in vivo corneal biomechanical response to femtosecond laser-assisted in situ keratomileusis (FS-LASIK) combined with accelerated corneal crosslinking (LASIK-Xtra) compared to conventional FS-LASIK (convLASIK) in highly myopic eyes. Setting: Department of Ophthalmology, Goethe-University, Frankfurt, Germany Design: A prospective, randomized fellow eye-controlled clinical trial Methods: We enrolled patients who received treatment with LASIK-Xtra (30mW/cm2, 90 seconds with continuous UVA) in one eye and convLASIK in the fellow eye. Both eyes were subjected preoperatively and twelve months postoperatively to a Corvis ST examination. The stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), deformation amplitude 2 mm away from apex and the apical deformation (DARatio2mm) were evaluated. Results: The study included 38 high myopic eyes (-7.34±1.02 diopter) of 19 patients. The results of the corneal biomechanical measurement showed a significant reduction in overall corneal stiffness with a significant decrease in postoperative SP-A1 and increase in IIR, DA, and DARatio2mm (p<.001). In a direct comparison, there was no evidence of an increase in corneal stiffness in the LASIK-Xtra group compared to the convLASIK group twelve months postoperatively. No statistically significant difference was detected in any of the four biomechanical parameters (p>.05). Conclusion: The corneal biomechanical response to convLASIK and LASIK-Xtra did not vary significantly. With a similar corneal thickness-loss, there was no significant difference in the four biomechanical metrics between the convLASIK and LASIK-Xtra groups. Thus, LASIK-Xtra seems not to have a protective corneal stiffening effect compared to convLASIK twelve months postoperatively.

Dmitry S. Gorbachev – the path of a military doctor

The name of Dmitry S. Gorbachev has a worthy place in the list of teachers and ophthalmic surgeons of the Department of Ophthalmology of the Kirov Military Medical Academy and military ophthalmology in general.D.S. Gorbachev dedicated his life to military medicine, training and education of future military doctors. He is a student of Professor V.V. Volkov, and was deeply immersed in the complex problem of orbital surgery. At the Department, D.S. Gorbachev, due to his deep scientific immersion in the problem, brought the field of orbital surgery to a modern multidisciplinary level. He constantly passed on his knowledge and skills to his students, who are currently continuing his work.

The utilization of ophthalmological emergency departments is on the rise : 14-year results from aGerman tertiary university outpatient department

The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time. The aim of this study is to make awell-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived. Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1January 2010 to 31December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, aquestionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022. The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, ashift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without areferral from adoctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic. The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to adouble burden: providing treatment for emergency cases with specialist referrals and at the same time acting as acatchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.

Role of Suprachoroidal versus Intravitreal injection of triamcinolone: In diabetic macular edema.

Objective: To assess the efficacy of suprachoroidal versus intravitreal injection of triamcinolone in diabetic macular edema. Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, Ziauddin Hospital Kemari, Karachi. Period: 1st November 2022 and 30th October 2023. Methods: The study observed 71 eyes of 59 patients diagnosed with Diabetic macular edema. All patients that met the inclusion criteria were divided into two groups, Group A Suprachoroidal Triamcinolone and Group B Intravitreal Triamcinolone. Results: This research encompasses 71 eyes from 59 patients diagnosed with diabetic macular edema, divided into two groups based on their chosen treatment. Group A consisted of 34 patients, whereas Group B comprised 37 patients. The average age of patients in both groups was 43.6±6.2. Baseline visual acuity and macular thickness were recorded in both groups and compared after treatment. Significant improvement was observed in both groups, particularly notable in the 3rd month. The suprachoroidal triamcinolone injection exhibited a more stable response, accompanied by lower complication rate. Conclusion: In conclusion, the comparative analysis of Suprachoroidal Triamcinolone acetate and Intravitreal Triamcinolone Acetate showed a more significant improvement in IOP and CMT in the suprachoroidal group as compared to intravitreal. Hence Suprachoroidal injection was seen as the treatment of choice in treatment of Diabetic Macular Edema.

Evaluation of Intraocular Pressure, Refraction, Anterior Chamber Depth, Macular Thickness, and Specular Microscopy Post-Neodymium-Doped Yttrium-Aluminum-Garnet Laser in Patients With Posterior Capsular Opacification.

Background Cataract is the leading cause of blindness globally, particularly in India. Despite advancements in surgical techniques, postoperative complications remain common, with posterior capsular opacification (PCO) being the most frequent issue. Although neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy is recommended for managing PCO, it is associated with various side effects. This study aimed to evaluate the effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP), visual acuity, anterior chamber depth (ACD), macular thickness, and corneal endothelium in Indian patients. Methodology This prospective, hospital-based study was conducted in the ophthalmology department at a tertiary care center in western Maharashtra from September 2022 to June 2024. Approval from the Institutional Scientific and Ethics Committee was obtained before commencing the research. In the study, 72 eyes from 72 patients with PCO following uncomplicated cataract surgery who were undergoing Nd:YAG laser capsulotomy were included, whereas patients with corneal pathology, retinal pathology, complicated cataract surgery, or trauma were excluded. Patients with active uveitis, non-compliant patients, and those unwilling to undergo the procedure were also excluded. Written informed consent was obtained from each patient. Data were managed in Microsoft Excel, and statistical analysis was conducted using the SPSS 26.0 software. As the continuous variables exhibited skewed distribution, the Wilcoxon test was employed to assess categorical variables such as the significance of IOP and endothelial cell differences over time. A significance level of 5% was assumed, with a p-value below 0.05 considered significant. Results The mean age of patients who underwent Nd:YAG capsulotomy was 64 years, with a female predominance of 37 (51.4%). In the study, 37 (51.4%) patients had their left eye treated, while 35 (48.6%) had their right eye treated. Overall, 45 (62.5%) patients had a baseline best-corrected visual acuity (BCVA) of 6/24-6/12. At one hour post-procedure, 46 (63.9%) patients in Group II had a BCVA of 6/24-6/12, and by one week after treatment, 53 (73.6%) patients had a BCVA of >6/12-6/6. ACD was normal in all patients before and after the procedure. Two patients developed macular edema at one hour and one week after the procedure. The mean IOP at baseline, one hour, and one week were 13.5, 13.86, and 13.69 mmHg, respectively. A significant increase in IOP was observed at one hour post-procedure, along with a significant decrease in endothelial cell count compared to baseline, which also persisted at one week. Conclusions Patients undergoing Nd:YAG capsulotomy experienced an initial rise in IOP, followed by a subsequent decline. Improved visual acuity was noted in most patients at one hour and by one week. A significant decline in endothelial cell count was observed following the procedure, and macular edema was noted in two patients. Anterior chamber reaction was observed in nearly all patients, which decreased by one week. With no change in ACD following the procedure up to one week, ocular refraction was not significantly impacted in the short term. Therefore, further large-scale intervention studies are needed to evaluate the effects of Nd:YAG laser capsulotomy size and the energy used on refractive error and post-procedure complications, as well as to explore the long-term effects on IOP.

Prevalence of Diabetic Macular Edema Using Optical Coherence Tomography in Type 2 Diabetics With Nephropathy in Comparison With Type 2 Diabetics Without Nephropathy.

The primary vision-threatening complication in patients with diabetic retinopathy (DR) is diabetic macular edema (DME). Diabetic nephropathy (DN) often has DR that threatens their vision and has a risk of developing DME. Hence, the presence of DN could be the only risk factor for developing DME without the presence of other factors. Hence, this study proposes to predict the prevalence of DME using optical coherence tomography (OCT) in type 2 diabetics with nephropathy in comparison with diabetics without nephropathy. This is a cross-sectional study done on patients visiting the Ophthalmology Department at Saveetha Medical College and Hospital, Chennai, for one year. A total of 120 patients were included in the study, with 60 diabetic patients without nephropathy in Group 1 and 60 diabetic patients with nephropathy in Group 2. A detailed history was recorded. Their recent blood reports of fasting blood sugar, postprandial blood sugar, hemoglobin A1c (HbA1c), renal function test, and urine protein/creatinine ratio were all noted. Chronic kidney disease (CKD) staging in nephropathy patients as done by the nephrologist was also documented. The best corrected visual acuity (BCVA) was assessed for distant and near vision. A slit lamp examination and dilated fundus examination were done. Fundus findings were independently graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. OCT was done in all patients to confirm DME. In our study. males and females were 60 each in number. The majority of patients(32.5%) were >70 years old. A small percentage of patients (1.7%) in Group 1 had DM of >10 years, and 41.7% of the patients in Group 2 had DM of >10 years. Meanwhile, 73.3% of the patients in Group 1 had an HbA1c level between 6% and 7.5%, and 83.3% of the patients in Group 2 had an HbA1c level >7.5%. The percentage of patients with DME in Group 1 was 1.7%, and that in Group 2 was 21.7%. The majority of patients who had BCVA of 6/6 were in Group 1. The majority of patients with DME (46.4%) had stage V nephropathy. The coexistence of nephropathy in diabetic patients increases the incidence of DME. With long-standing diabetes and uncontrolled blood sugar levels being risk factors for developing DN and subsequently DME, such patients are to be screened regularly and advised on adequate glycemic control for achieving good visual prognosis and limit retinopathy progression. Moreover, the severity of DN should be kept in mind by nephrologists, and patients are to be promptly referred to the ophthalmology department for complete evaluation.

Climbing the Research Ladder: A 25-year Analysis of K-to-R Grant Conversion among Plastic Surgeons.

We evaluate the performance of plastic surgeons in converting National Institutes of Health K grants in early career to R grants intended for established investigators. We also investigate characteristics that may positively predict successful transition from K to R grants. K08, K23, and R01 (or equivalent) grants awarded to plastic surgeons and physicians within the departments of ophthalmology, dermatology, and neurosurgery were collected. Analyses of successful conversion rates from a K to an R grant between plastic surgeons and physicians within the selected departments were performed. Cross-sectional analysis of characteristics among identified plastic surgeons was completed via logistic regression to elucidate possible predictors of successful conversion. Comparison of pathway initiation rates demonstrate that plastic surgeons receive significantly fewer K grants relative to the size of their field when compared with other specialties (all P < 0.01). Of the analyzed plastic surgeons, 52.9% successfully converted to an R-series grant within 5.4 years of beginning their K-series grant. Conversion rates were not significantly different between plastic surgeons and physicians within the selected departments. Logistic regression analyses revealed that the time-adjusted mean relative citation ratio of K series-associated publications is a positive predictor of successful conversion (P = 0.047). With regard to increasing National Institutes of Health funding via the K-to-R pathway, we believe the field of plastic surgery could benefit from an increased effort to pursue a pathway of K-to-R conversion with a focus on quality over quantity when publishing articles associated with a K-series grant.

A retrospective observational study of orbital cellulitis in children - Recent trends

ABSTRACT Purpose: Orbital cellulitis is an acute post-septal orbital infection caused mostly by bacteria. This may result in serious complications including blindness, meningitis, cavernous sinus thrombosis, brain abscess, and even death. The delay in treatment increases morbidity and mortality. The purpose of present study was to review cases of orbital cellulitis in recent years regarding its clinical presentation, diagnostic evaluation, treatment policy, complications, and disabilities. The outcome of study will help in early diagnosis and better management of orbital cellulitis cases. Materials and Method: Total 20 cases of orbital cellulitis in children from March 2021 to February 2024 were evaluated and analyzed in department of ophthalmology, Patna Medical College and Hospital, Patna. Result: Total 20 children with ages &lt;18 years were evaluated. The average age of presentation was 7 years (range between 1 year and 17 years). 70% of cases were seen in male children. All patients presented with chemosis, congestion, eyelid swelling, proptosis, and restriction of eye movement. Orbital CT scan diagnosed 100% cases of orbital cellulitis (P &lt; 0.01). In 45% of children, sinusitis was initial site of infection (P &lt; 0.01). Swab culture was positive in 40% of the cases, organism being gram-positive cocci. Complete recovery was seen in 75% with 25% having some deficit in visual acuity or eye movement. Conclusion: Clinical symptoms and signs aided with orbital CT scan help in early diagnosis early detection and aggressive treatment with multidisciplinary approach may limit the complications of orbital cellulitis and also aid in complete recovery without any visual deficit.

Evaluation of foveal avascular zone changes in patients with type 1 diabetes using optical coherence topography angiography

Aim To evaluate vascular changes in the foveal avascular zone in pediatric patients with type 1 diabetes by using optical coherence tomography angiography (OCTA). Patients and methods This cross-sectional study was performed in Benha University Hospital at Department of Ophthalmology. The patients were obtained from the Pediatric Endocrinology Clinic in Benha University Hospital. The study was conducted on 48 patients (96 eyes) divided into two groups: group A, 24 diabetic children with type 1 diabetes, group B, 24 healthy children of the same age and sex who met the inclusion criteria. The patients were collected from April 2022 to April 2023. The patients were photographed using the Optovue AngioVue OCTA System. Results Our results show that according to the foveal avascular zone it was slightly wider in type 1 diabetic cases with no clinically evident diabetes retinopathy (DR) than control. There were insignificant differences between the two groups as regards foveal density, but as regards foveal thickness, it was significantly lower in diabetic cases than in the control group. Conclusion We discovered that OCTA could consistently identify microvascular changes in the Deep and Superficial Capillary Plexus prior to the clinical indications’ onset of DR. In order to assess the OCTA potential for the screening of DR in children with T1DM, it is necessary to conduct numerous prospective studies.

Assessing Prevalence and Severity of Dry Eye Disease Across Various Types of Allergic Conjunctivitis

Background: Allergic conjunctivitis (AC) is a prevalent ocular condition triggered by environmental allergens, causing significant discomfort and reduced quality of life. Dry Eye Disease (DED), marked by ocular discomfort and visual disturbances, frequently overlaps with AC symptoms. This study examines the prevalence of DED in AC patients and explores the relationship between different AC types and DED severity. Method: A cross-sectional, observational study was conducted from June to September 2023 in the Department of Ophthalmology at a tertiary center in North India. A total of 264 AC patients aged 18 years and older with itchy eyes were included. Patients with contact lens use, recent ocular surgery, trauma, corneal pathology, or certain systemic diseases were excluded. DED was assessed using the Ocular Surface Disease Index (OSDI), Schirmer’s test, and Tear Film Break-Up Time (TFBUT). Results: DED was found in 70% of AC patients, with 20% mild, 19% moderate, and 32% severe cases. Females were more affected (64%). VKC patients showed higher tear production and better TFBUT scores. PAC patients had the most severe DED. Conclusion: DED is common in AC patients, with PAC associated with more severe DED, while VKC shows milder symptoms. Tailored treatment approaches are needed for managing AC and DED.

Comparative Analysis of AI Chatbots ChatGPT, Gemini, and Copilot’s Answers to Common Cataract Questions

Purpose: To compare the readability and quality of the answers given by artificial intelligence (AI) chatbots to the twenty-five most frequent searches about cataracts on Google. Study Design: Cross sectional comparative study. Place and Duration of study: Serdivan State Hospital's Ophthalmology Department from March 2024 to April 2024. Methods: The word 'Cataract' was entered into Google Trends, and 25 trending searches made worldwide since 2004 were identified. These 25 trending searches were entered separately into AI programs. The answers were examined for quality using the Ensuring Quality Information for Patients (EQIP) test, while the readability was evaluated using the Flesch-Kincaid Reading Ease (FKRE) and Flesch-Kincaid Grade Level (FKGL). Results: The keywords searched most frequently were ‘Cataract surgery,’‘Eye cataract and 'After Cataract’. The EQIP category of all three AI chatbots was found to be 'serious quality issues.' When EQIP scores were compared, ChatGPT had a lower median value than Gemini and Copilot (p:0.001, p:0.007, respectively), while there was no significant difference between Gemini and Copilot (p:0.098). When FKRE values were compared, ChatGPT had a lower median value than Gemini and Copilot (p:0.001, p:0.001, respectively), with no significant difference between Gemini and Copilot (p:0.557). When FKGL values were compared, ChatGPT had a higher median value than Gemini and Copilot (p:0.003, p:0.001, respectively), with no significant difference between Gemini and Copilot(p:0.245). Conclusion: All three AI chatbots had an EQIP category of 'serious issues with quality .'The readability of all three was not at the recommended level.

PREVALENCE OF DIDANOSINE-RELATED RETINAL TOXICITY AT AN URBAN ACADEMIC CENTER AS DIAGNOSED WITH ULTRA-WIDEFIELD IMAGING.

Antiretroviral therapy has revolutionized HIV treatment with didanosine (DDI) as a pioneering drug. However, DDI has been associated with retinal toxicity, characterized by peripheral chorioretinal degeneration with macular sparing. Despite its clinical recognition, the prevalence and risk factors for didanosine-induced retinopathy are not well described. This retrospective case series analyzed 127 DDI-treated patients at Weill Cornell Medicine Department of Ophthalmology. Inclusion criteria included at least 6 months of DDI use and available ultra-widefield imaging. Patients were categorized as affected or unaffected based on retinal imaging assessed by two reviewers. The affected group was further divided into "probable" or "possible" retinopathy. Patient demographics, DDI usage characteristics, and imaging findings were analyzed with statistical comparisons drawn between affected and unaffected cohorts. Of the 127 patients, 9 (7%) showed signs of didanosine-induced retinal toxicity. On average, the affected group was older compared with the unaffected group (65.1 vs. 56.5 years, P = 0.025), with lower BMI (23.2 vs. 27.4, P = 0.04), and older at the start of the treatment (51.6 vs. 40.8 years, P = 0.026). Mild phenotypes with peripheral pigmentary changes were also identified using ultra-widefield imaging. This pioneering academic study highlighted a notable prevalence of DDI-induced retinal toxicity. Statistical analysis demonstrated age, BMI, and age at treatment initiation as potential risk factors. Ultra-widefield autofluorescence emerged as a valuable tool in detecting and delineating findings. Follow-up studies are needed to determine the necessity of regular screening for individuals on or with a history of didanosine use.

Global, psychological, and visual quality of life after evisceration/enucleation surgery (QOLAE study): A descriptive case series.

To describe the early health-related quality of life (HRQoL) of patients who have undergone an eye removal surgery. A descriptive monocentric study was conducted. Patients with a surgical indication of eye amputation were enrolled. Three standardized surveys were given to each patient 1-3 months after the surgery. The following standardized questionnaires were used: National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) (range: 0-100), Short Form-36 (SF-36) (range: 0-100), and Perceived Stress Scale (PSS-10) (range: 0-40). Between January 2021 and January 2022, in the Ophthalmology Department of the University Hospital of Besançon (France), 20 patients who were going to undergo an eye removal surgery were included. The population comprised a majority of men (12 men vs. 8 women) with a mean age of 70 (±16.2) years. The underlying conditions leading to the eye amputation were varied: three infections (15%), three retinal detachments (15%), three chronic uveitis (15%), 11 traumas (55%), three tumors (15%), and five chronic high intraocular pressures (25%). The surgical procedure consisted of an evisceration in 15 cases (75%) or an enucleation in five cases (25%). On average, the composite NEI VFQ-25 scored 68.7 (±22.4). Regarding the SF-36 score, the physical composite score was 63.1 (±15.4), and the mental composite score was 64.7 (±14.4). The overall PSS-10 score was 12.3 (±8.7). The patients who had undergone an eye amputation had an early reduction in their HRQoL in all its domains, especially in the vision, mental, and physical specific quality of life. These patients need personalized preparation before the surgery. These findings need to be assessed in the long term.

Accuracy of Diagnosing Optic Neuritis Using DANTE T1-SPACE Imaging.

To evaluate the use of delay alternating with nutation for tailored excitation-prepared T1-weighted turbo spin echo (DANTE T1-SPACE) imaging for diagnosing optic neuritis and to analyze its correlation with clinical findings before and after treatment. Patients diagnosed with optic neuritis or non-arteritic anterior ischemic optic neuropathy (NA-AION) were evaluated at the Ophthalmology Department of Kyoto University Hospital. All patients underwent magnetic resonance (MR) studies before treatment initiation and ophthalmic examinations before and after treatment. Three ophthalmologists independently reviewed the MR scans for abnormalities. The magnetic resonance imaging (MRI) assessments included post-contrast DANTE T1-SPACE, post-contrast volumetric interpolated breath-hold examination (VIBE), and short T1 inversion recovery (STIR) scans. The presence of abnormalities in each sequence was determined. Of 36 eyes from 30 patients, 21 eyes from 17 patients were diagnosed with optic neuritis, and 15 eyes from 13 patients were diagnosed with NA-AION. DANTE T1-SPACE sequences showed better sensitivity for detecting optic neuritis than STIR sequences (100% vs 67%, p = 0.009). VIBE images did not confirm enhancement of lesions in some cases with optic neuritis. No differences were observed among the sequences for NA-AION. Lesion length evaluated by DANTE T1-SPACE sequences was associated with circumpapillary retinal nerve fiber layer thickness at the initial visit, eye pain, and the time interval from symptom onset to MRI scan. Contrast-enhanced DANTE T1-SPACE was better than other sequences of MRI for diagnosing optic neuritis.

Gender and personalized profile information influence online ratings of Canadian academic ophthalmologists

ObjectiveTo determine the characteristics associated with higher online ratings of academic ophthalmologists in Canada. DesignRetrospective cross-sectional study. MethodsAll ophthalmologists affiliated with Canadian ophthalmology departments were queried in March 2023 using WebMDs. Online ratings and physician profile details were extracted and descriptively analyzed using nonparametric tests with significance at p < 0.05. Subgroup analysis was conducted using ≥ 4-star rated profiles. ResultsEight hundred and ninety-nine department faculty from 15 institutions were considered, and 660 ophthalmologists with active, rated profiles were included. A total of 27,823 online ratings with a median of 4.14 stars (out of 5) were observed. Most profiles were of men (74.1%). Women received lower overall ratings compared to men (median = 4.08 vs. 4.20; p = 0.021), and lower number of reviews (median = 23 vs. 34; p < 0.001). Most profiles included office addresses (87.9%), private practice affiliation (79.8%), and contact information (51.1%). There was a positive correlations between higher ratings and profiles that included biographies (rho = 0.13; p = 0.001), languages spoken (rho = 0.15; p < 0.001), educational background (rho = 0.13; p < 0.001), areas of expertise (rho = 0.10; p = 0.010), awards (rho = 0.12; p = 0.002), and among physicians indicating they accept new patients (rho = 0.15; p < 0.001) and accommodate virtual visits (rho = 0.09; p = 0.020). ConclusionsCanadian ophthalmologists having certain personal information on their online profiles tended to have higher ratings, despite weak associations, possibly due to wider public outreach. Women had fewer and lower overall ratings compared to men. Further research about online ratings’ influence on physician selection and physician career satisfaction is needed.

Association of Refractive Errors with Axial Length and Anterior Chamber Depth in Different Age Groups

Purpose: To determine association of refractive errors with axial length and anterior chamber depth in different age groups. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department of Dow University Hospital (Ojha campus),Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan from October 2020 to December 2020. Methods: Eighty-three individuals of different age groups ranging from 11-80 years were included in the study.Ocular measurements including refractive error, axial length, and anterior chamber depth were determined in all participants. The association of refractive error with anterior chamber depth and axial length was tested by using two independent sample t test, Mann-Whitney U test and ANOVA. Results: Among 83 individuals, males were 42.2% (n=35) and females were 57.8% (n=48). Most common type of refractive error was astigmatism which was found in 48.2% (n=40) participants. The overall average depth of anterior chamber (mm) and average axial length (mm) were 3.11±0.39 and 23.27±0.87 respectively. Mean differences in anterior chamber depth were statistically significant among different age groups . Statistically significant differences in mean axial length were found among different refractive errors . Conclusion: These results show a significant relation of different refractive errors with axial length and anterior chamber depth and it can be helpfulin explaining the risk factors of different ocular diseases as well asit can also be helpful in clinical and diagnostic purposes in ophthalmology.

A COMPARATIVE STUDY OF PRE-CORNEAL TEAR FILM BETWEEN DIABETICS AND NON-DIABETICSUSING OCULAR SURFACE DISEASE INDEX

Purpose: To determine distinctive characteristics of pre-corneal tear film in eyes of diabetics and compare them with non-diabetics. Design: Hospitalbasedobservationalcross-sectional study. Methods: The study was done in thedepartmentofophthalmology from July2022-December2023. Patients presenting to outpatient department of ophthalmology who were of age&gt;45 years, have a history of diabetes for more than three years and those without diabetes as control groups were chosen.300patients weretaken forthestudyand dividedinto two groups(150 diabetics and 150 non-diabetics). Sample size was decided based on a convenient sampling method.Ocular surface disease index(OSDI) questionnaire was used to assess symptoms and signs.Corneal sensitivity test, Tear film breakup time(TBUT) and Schirmer tests were done. The corneal and conjunctival stains were used. Chi-square test was used to examine outcomes. Other tests were applied accordingly. Results: Diabetic patients had poorer OSDI scores compared to Non-diabetic patients(p 0.001*). Patients with diabetes had reduced corneal sensitivity(p&lt;0.05*). Schirmer II and TBUT values were significantly prolonged in Diabetics compared to Non-diabetcs(p&lt;0.05*). Duration of diabetes significantly increased the severity of dry eye. Dry eye was more prevalent in diabetic retinopathy patients(p=0.02*). Strong association was found between HbA1C and severity of diabetic retinopathy with P&lt;0.05*. Conclusion:The duration of diabetes and stage of retinopathy are closely linked to the occurrence and severity of tear film dysfunction. Early detection and treatment are vital for preventing dry eye syndrome and its potential progression to vision-threatening complications, through simple non-invasive methods.

Clinical characteristics and visual outcomes of animal-induced ocular injuries: a prospective multicenter study in Iran.

Animal-induced ocular injuries represent an under-documented health problem that may pose significant visual complications. This study aimed to investigate the clinical characteristics and outcomes of ocular injuries caused by animals. This multicenter prospective study enrolled patients with a history of animal-induced ocular injuries presenting to the ophthalmology departments of two tertiary hospitals over a one-year period. All participants underwent comprehensive assessments by ophthalmologists, and the following data were collected: demographic information, animal species involved, injury details, pre- and post-treatment visual data, management strategies, and follow-up outcomes. Seventy-two patients (62.5% male) were included in the study. Insects were the most common species, causing 37.5% of ocular injuries. The type of animal involved was significantly associated with injury patterns (p < 0.0001), visual impairments at presentation (p < 0.05), and need for surgery (p < 0.001). Insects predominantly caused periorbital soft tissue injuries; birds primarily affected the anterior segment; dogs and cats mainly led to adnexal injuries; and equines often involved both anterior and posterior segments. Equine-related injuries resulted in the most severe visual impairments, requiring surgical interventions in all cases. At the same time, the majority of cases involved with other animal species experienced no visual impairment. The number of patients without visual impairment increased from 46 cases (63.9%) at the time of presentation to 58 (80.6%) at discharge after treatment. At follow-up, eight patients (11.1%) experienced complications, including traumatic cataract (n = 6, 8.3%), endophthalmitis (n = 3, 4.2%), corneal scarring (n = 1, 1.4%), and retinal detachment (n = 1, 1.4%). Rooster pecking was the leading cause of complications, including endophthalmitis and traumatic cataract. This study revealed that depending on the type of animal causing the injury, animal-induced ocular injuries present with diverse characteristics, requiring appropriate treatment approaches and potentially resulting in different outcomes. These findings may promote public awareness and improve preventive strategies and clinical guidelines development.

Spectrum of retinal microvascular ischemia in patients with COVID-19 based on multimodal imaging

PurposeTo describe and evaluate the multimodal imaging findings in retinal microvascular ischemia associated with COVID-19 infection. MethodsPatients with COVID-19 associated retinal microvascular ischemia and visiting the outpatient Department of Ophthalmology, Shanghai General Hospital from December 2022, to February 2023, were documented and their multimodal images were retrospectively reviewed. Retinal microvascular ischemia was defined as the presence of isolated or multiple focal retinal whitening(s) on color fundus images. Patients with retinal vessel occlusion or retinopathies secondary to systematic disorders diagnosed before infection were excluded. ResultsA total of 32 eyes from 21 patients were included, 24 (75.00 %) eyes with multiple retinal whitenings, while 8 (25.00 %) eyes with isolated lesions. When divided by the types of ischemia, 9 (28.13 %) eyes had only inner retinal involvement (known as cotton wool spot, CWS), 4 (12.50 %) eyes had only middle retinal involvement (known as paracentral acute middle maculopathy, PAMM), and 19 (59.38 %) eyes had both. In addition, 4 (12.50 %) eyes had coincident angular sign of Henle fiber layer hyperreflectivity (ASHH). Patients with hypertension tended to have multiple lesions rather than isolated lesion of retinal microvascular ischemia (P = 0.008). Transient uncontrolled high blood pressure or acute kidney injury was simultaneously detected in some cases. ConclusionsOcular manifestation of COVID-19 associated microvascular ischemia can be variable, including CWS, PAMM and ASHH. Multimodal fundus imaging technologies are useful tools to reveal involved retinal layers, extent, and severity. Moreover, ocular manifestations may serve as a window of COVID-19 related microcirculation in other systems throughout the body.

Selective Laser Trabeculoplasty after a Previous Glaucoma Treatment.

Recent prospective studies have shown that selective laser tra-beculoplasty (SLT) is a safe and cost-effective alternative to pressure-reducing eye drop therapy as a first-line treatment for ocular hypertension or open-angle glaucoma. In addition to its comparable efficacy to eye drop therapy, SLT has been particularly effective in delaying the time until a surgical intervention is needed. The aim of our evaluation is to analyze patients who have received SLT following a pressure-reducing procedure. The primary endpoint is the duration until a subsequent interventional or surgical procedure is required. A retrospective analysis of 98 patients who underwent selective laser trabeculoplasty following a previous pressure-reducing procedure between 2017 and 2023. The statistical analyses included Cox regression and Kaplan-Meier survival estimations. In total, 122 eyes of 98 patients received selective laser trabeculoplasty following a previous pressure-reducing procedure at the Department of Ophthalmology in Freiburg. The median follow-up period was 381.5 days (range 43.25-862.75 days). Approximately 68% of the eyes did not require another pressure-reducing procedure 365 days after the intervention, while about 58% of the eyes remained without another procedure after 730 days, according to Kaplan-Meier analysis. No significant difference was found between the different types of glaucoma regarding the duration until a subsequent pressure-reducing procedure was needed. The study indicated a tendency for patients with pseudoexfoliation glaucoma to undergo a secondary intervention earlier compared to those with primary open-angle glaucoma (p = 0.16). The intraocular pressure before SLT had a significant impact on the duration until the subsequent operation (p = 0.005). SLT is an effective method even after a previous pressure-reducing procedure for patients in whom further pressure-reducing interventions need to be delayed.