Department Of Ophthalmology Research Articles

Association between hydroxychloroquine intake and damage to the outer nuclear layer in eyes without manifest retinal toxicity

BackgroundHydroxychloroquine (HCQ) is widely used to treat various autoimmune diseases but carries a risk of retinal toxicity, particularly with prolonged use. Despite advancements, uncertainty persists regarding optimal screening methods. Recent advances in OCT have enabled early detection of retinal damage, with studies suggesting that thinning of specific retinal layers may be an early indicator of toxicity. However, there is a gap in research on outer nuclear layer (ONL) thinning in HCQ users without apparent retinal toxicity. This information is crucial for improving screening and identifying the ONL as a reliable biomarker for screening. Therefore, this study aimed to investigate the association between HCQ intake and ONL damage in eyes without manifest retinal toxicity.MethodsA case‒control study was conducted at the ophthalmology department of Eye and Ear Hospital International from July 2022 to June 2023. The study included 20 individuals on HCQ and 20 age-matched controls. The data were obtained through chart reviews, and participants underwent comprehensive ophthalmic assessments.ResultsA total of 80 eyes were analyzed. Patients on HCQ exhibited significantly thinner perifoveal, parafoveal, and overall ONL compared to controls (P < .001, P < .012, and P < .004, respectively). Similarly, this association was found in the nasal, inferior, and temporal quadrants of both the inner (region 3: P < .01, region 4: P < .001, and region 5: P < .03) and outer zones (region 7: P < .04, region 8: P < .001, region 9: P < .02), most pronounced in the inferior regions. The cumulative dose was weakly associated with decreased ONL thickness only in the nasal quadrant of the inner zone (region 3: P < .047). Correlation analysis of the initial and most recent OCT scans in the same individuals revealed a weak association with ONL thinning in the central zone (region 1: P < .0048).ConclusionThe thickness of the ONL can significantly decrease in patients taking HCQ, even in the absence of of manifest retinal toxicity. This study is the first to evaluate this association in eyes with negative screening and diagnostic tests for HCQ retinopathy. The findings suggest that ONL thickness could serve as an early diagnostic indicator for HCQ retinal toxicity.

Dynamics of Treatment Response to Faricimab for Diabetic Macular Edema.

This study analyzes the dynamics of short-term treatment response to the first intravitreal faricimab injection in eyes with diabetic macular edema (DME). This retrospective, single-center, clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich. Patients with treatment-naïve and pretreated DME were included. Patient chart data and imaging were analyzed. Safety and efficacy (corrected visual acuity (CVA), central subfield thickness (CST), and signs of intraocular inflammation (IOI)) of the first faricimab intravitreal therapy (IVT) were evaluated weekly until 4 weeks after injection. Forty-three eyes (81% pretreated) of 31 patients were included. Four weeks after the first faricimab IVT, CVA remained stable and median CST (µm) decreased significantly (p < 0.001) from 325.0 (293.5-399.0) at baseline to 304.0 (286.5-358.0). CVA at week 4 was only associated with baseline CVA (p < 0.001). CST was the only predictive variable (p = 0.002) between baseline and week 4 CST. Weekly safety assessments did not show any sign of clinically significant IOI. This study suggests faricimab is an effective treatment for (pretreated) DME, showing structural benefit 1 month following the first injection without short-term safety signals.

Digital versus manual axis marking for toric phakic intraocular lens alignment: a prospective randomized intraindividual trial.

This study compares visual and refractive outcomes and postoperative axis alignment for toric Implantable Collamer Lens (ICL) implantation in astigmatic myopia using manual versus digital marking techniques. Department of Ophthalmology, Medical University of Graz, Austria. Prospective randomized single-centered intraindividual comparison. Patients undergoing bilateral toric ICL implantation for myopia with astigmatism ≥ 0.5 diopters (D) were enrolled. Patients received both marking techniques and randomization was performed. Postoperative retroillumination photography assessed axis alignment, and visual and refractive parameters were evaluated. Duration of the surgeries was recorded. The study includes 20 patients and 40 eyes. Preoperative visual and refractive parameters showed no significant differences. Postoperatively, residual astigmatism (p=0.824) and spherical equivalent (p=0.309) were comparable. No notable differences between right and left eyes in terms of preoperative (p=0.371) and postoperative (p=0.824) astigmatism were observed. Although slight, corrected distance visual acuity (CDVA) increased in both groups postoperatively (p=0.381). Gain in CDVA was comparable between marking techniques (p=0.637). Safety and efficacy indices were comparable (p=0.991 and p=0.189, respectively). Postoperative axial misalignment was 2.8±3.1 degrees in the digital- and 4.4±5.1 degrees in the manual group (p=0.260). Vector analysis showed no significant differences between manual and digital marking. Duration remained uninfluenced by the marking technique (p=0.970) and side of surgery (p=0.682). In conclusion digital and manual marking techniques provided comparable results in axis alignment, surgical duration and visual and refractive outcomes. Both methods are viable for precise axis alignment, with digital marking offering a potential advantage in efficacy.

Associations between the Vessel Density in Deep Vascular Plexus and Macular Edema Recurrences in Patients with Retinal Vein Occlusion

Introduction: The aim of this study was to study the relationships between vessel density (VD) in different retinal vascular plexus and retinal vein occlusion-macular edema (RVO-ME) recurrence using wide-field swept source optical coherence tomography angiography (OCTA). Methods: Patients with a history of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) with macular edema in the Department of Ophthalmology, Shanghai General Hospital, from May 25, 2020, to January 12, 2023, were retrospectively reviewed and recruited. All patients were followed up for at least 6 months and divided in the release group and the recurrence group. The optical coherence tomography and OCTA examination were performed. Demographics, retinal structural, and angiographic data were collected and compared between two groups. The ordinal logistic regression was performed to assess the risk factors for RVO-ME. Results: A total of 85 patients were enrolled in this study. Among them, 30 patients had CRVO, while 55 had BRVO. The VD in the 6–9 mm ring in deep vascular plexus (DVP) was significantly higher in the recurrence group (25.414 ± 6.068% in the release group vs. 27.574 ± 7.767% in the recurrence group, p = 0.036). More patients with mean VD of the 6–9 mm ring in DVP no less than 30% were observed in the recurrence group (observed n = 20, expected n = 14.4, p = 0.043). The ordinal logistic regression reported that patients with mean VD of the 6–9 mm ring in DVP ≥30% had risk of RVO-ME increased to 11.508 (95% CI: 1.745–75.944, p = 0.011), when compared to the patients with mean VD of the 6–9 mm ring in DVP <20%, even with RVO type, baseline central macular thickness weighed. Conclusion: High vessel density of the 6–9 mm ring in DVP, especially those ≥30%, was associated with macular edema recurrences in patients with retinal vein occlusion.

Association of Various Optical Coherence Tomographic Patterns of Diabetic Macular Edema With Central Subfield Thickness and Visual Acuity: A Cross-Sectional Observational Study.

Introduction Diabetic macular edema (DME) is the most common and vision-threatening complication in diabetic patients with diabetic retinopathy (DR), especially in those with Type 2 diabetes mellitus. Optical coherence tomography (OCT) is a reliable tool most commonly used for assessing macular morphology and provides quantitative information on the macula. OCT also examines the outer retinal layers, which can predict visual outcomes. Thus, our study aims to identify the association of various OCT-detected DME morphological patterns with central subfield thickness (CST) and visual acuity. Materials and methods This is a cross-sectional observational study of 50 patients with DME detected on OCT who visited the Ophthalmology Department of Saveetha Medical College and Hospitals for a period of six months, from November 2023 to April 2024. A complete ocular examination, including best corrected visual acuity, scored with the logMAR scale, anterior segment examination, and fundus biomicroscopy using 90D and 78D lenses, was performed. Early Treatment of Diabetic Retinopathy Study (ETDRS) grading of DR into mild to very severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) was noted. Spectral-domain OCT was used to diagnose DME. The CST was measured, and DME was classified into four patterns: sponge-like retinal swelling (SLRS), cystoid macular edema (CME), subretinal fluid (SRF), and posterior hyaloid traction (PHT). Results In the present study, males represented 60%, and females represented 40%. The mean age of the patients was 58.07 ± 6.80 years, with a mean duration of diabetes of 11.91 ± 5.14 years. Of the 50 patients with 100 eyes, only 60 eyes showed DME on OCT. CME was the most common morphological pattern (37%), while the least common pattern was PHT (10%). No significant association was found between a specific morphological pattern and control of diabetes. The most common pattern observed was SLRS in moderate NPDR, CME in severe NPDR, SRF in very severe NPDR, and PHT in PDR. Very severe NPDR patients showed all patterns of DME, and the PHT pattern was observed only in very severe NPDR and PDR. The highest mean CST was observed in the very severe NPDR stage, and the least was in the moderate NPDR stage. The mean CST was highest in SRF patterns and lowest in SLRS patterns. The best mean visual acuity was observed in the SLRS pattern, while the worst mean visual acuity was observed in the SRF pattern, followed by the PHT pattern. Conclusion Our study highlights the importance of OCT in patients with diabetes, as OCT patterns of DME are critical for predicting visual outcomes in DR. Severe grades of DR are usually associated with SRF and PHT patterns. Since patients with SRF and PHT patterns have the worst visual outcomes, these patients, upon identification, need to be counseled about their poor visual prognosis. Those with less severe DR should be closely monitored and advised on effective diabetes control to prevent progression and protect their vision.

Ocular Sarcoidosis as Initial Presentation of the Disease: Clinical Characteristics and Risk Factors Associated with Disease Recurrence

ABSTRACT Purpose To review the clinical presentation and diagnostic workup of patients presenting with ocular sarcoidosis as initial manifestation of the disease and identify risk factors for disease recurrence. Methods All cases of sarcoidosis followed in our departments of Ophthalmology and Internal Medicine were retrospectively reviewed. Among 177 patients, 50 had ocular sarcoidosis as initial presentation of the disease. Clinical, biological, radiological, and treatment data were collected. Logistic regression analysis was conducted to identify risk factors for recurrence. Results Mean age of patients was 51 years, with an equal M/F ratio. Bilateral ocular involvement was present in 86% of cases, with granulomatous panuveitis being the most common manifestation (48%). Two-thirds of patients had extraocular symptoms related to the disease, mostly fatigue. The most frequently involved extraocular site was the supradiaphragmatic lymph nodes, identified in 84% of cases. CRP was normal in 68% of patients, while ACE and lysozyme were elevated in 19% and 64% of cases, respectively. Histopathological confirmation was obtained in 68% of patients. Female sex (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.50–40.40, p = 0.021) and granulomatous panuveitis (OR 7.23, 95% CI 1.70–40.99, p = 0.013) were identified as significant risk factors for disease recurrence. Conclusion Ocular sarcoidosis is a common initial presentation of systemic sarcoidosis. Diagnosis should be suspected in the presence of bilateral granulomatous panuveitis. Chest CT scan or 18F-FDG PET/CT is mandatory for systemic workup and biopsy is necessary for definite diagnosis. Female sex and a panuveitis presentation are significantly associated with disease recurrence.

Effect of virtual reality-based visual training for myopia control in children: a randomized controlled trial

BackgroundTo assess the efficacy and safety of virtual reality-based visual training (VRVT) in myopia control among children.MethodsThe randomized, parallel-group, single-blind clinical trial conducted at the Department of Ophthalmology of Shanghai Tenth People’s Hospital enrolled 65 low-myopic children (aged 8 to 13 years) with cycloplegic spherical equivalent (SE) between − 0.50 and − 3.00 diopters (D), astigmatism less than − 1.00 D, anisometropia less than 1.50D, and best corrected visual acuity (BCVA) more than 0.0 logarithm (LogMAR) of the minimum angle of resolution. The participants were enrolled in December 2020, and the follow-up of this study concluded on August 2021. Children were assigned randomly to the intervention group (VRVT plus single-vision spectacle [SVS]) and the control group (only SVS without receiving VRVT). The intervention group was administered for 20 min per day with VRVT under parental supervision at home. The primary outcome was changes in axial length (AL) at 3 months. Macular choroidal thickness (mCT) was regarded as a key secondary outcome.ResultsAmong 65 participants (mean age: 10.8 years, 52.3% male), 60 children (92.3%) who completed the 3-month intervention and 6-month follow-up were included in the analysis (30 in the intervention group and 30 in the control group). The changes of AL were 0.063 ± 0.060 mm (95% confidence interval [CI], 0.074 to 0.119 mm) in the intervention group and 0.129 ± 0.060 mm (95% CI, 0.107 to 0.152 mm) and in the control group at 3 months (t = − 2.135, P = 0.037), and the mean difference between the two groups was 0.066 mm. The change of mCT were 22.633 ± 36.171 μm (95% CI, 9.127 to 36.140 μm) in the intervention group and − 3.000 ± 31.056 μm (95% CI, − 14.597 to 8.597 μm) in the control group at 3 months (t = 2.945, P = 0.005). VR vertigo was the most common adverse event which was occurred in two children (2/30, 6.67%) in the intervention group.ConclusionsVRVT is a promising method for myopia control in children with good user acceptability. Among children aged 8 to 13 years with low-myopia, nightly use of VRVT resulted in slowing myopia progression.Trial registrationThis protocol was registered with ClinicalTrials.gov (NCT06250920), retrospectively registered on 01 February 2024.

Study on association of dry eye disease (DED) with visual display terminal (VDT) use among medical college students

To study the prevalence of Dry Eye Disease (DED) among undergraduate medical students using Visual Display Terminal (VDT). : Cross-sectional study was conducted on 444 students at Medical college Hospital in the department of Ophthalmology. All the consented study participants, after ruling out the exclusion criterion, underwent dry eye workup which included routine slit lamp examination and Tear film break up time (TBUT). In this study, TBUT ≤ 10 seconds was considered abnormal. They were asked to fill out an OSDI (Ocular Surface Disease Index) questionnaire (Allergen Inc, Irvine, Calif, USA). The participants were asked to answer questions related to VDT use. Statistical analysis was done using the SPSS software (IBM). Based on the OSDI questionnaire, clinically significant DED was found in 28.8%. DED was classified as mild DED in 17.1%, moderate DED in 6.3% and severe DED in 5.4% of the participants. Among those with DED, VDT use was 2 to 4 hours in 29% of the participants, VDT &amp;#62; 4 hours was seen in 32.7% of participants. Thereby, indicating that increase in VDT use had an association with increase in prevalence of DED. DED based on signs (TBUT&amp;#60; or = 5 sec) was observed in 86.3% of participants.: There is a statistically significant association between VDT use and DED among young students.

Choroidal thickness in type 2 diabetes mellitus patients using spectral domain optical coherence tomography

To measure the choroidal thickness in patients with type 2 diabetes mellitus and its comparison to healthy age-matched individuals.This prospective comparative study conducted at departments of Ophthalmology, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura. Study included 192 patients, 96 with diabetes and 96 age-matched controls. Data acquired comprised demographics, a thorough eye examination, fundus photography and spectral domain optical coherence tomography measurements of choroidal thickness using enhanced depth imaging.Mean age was 60.17±7.727 years with male predominance in both cases and controls. The mean duration of diabetes was 5.67±3.39 years. Positive correlation was noted between duration of diabetes and severity of retinopathy (p = 0.001). 21 patients did not have any evidence of diabetic retinopathy, while 75 patents had features of non-proliferative diabetic retinopathy, of which (31) had mild, (21) moderate, (12) severe and (11) with proliferative diabetic retinopathy. Mean choroidal thickness of controls was 327.308±18.945 microns, as compared to thinner choroids 295±15.082 microns in cases without retinopathy and 271 ± 36.122, 242 ±30.048, 193±15.748 microns in mild, moderate, severe non-proliferative diabetic retinopathy respectively and 191.492± 23.834 microns in proliferative diabetic retinopathy. Statistically significant differences were noted on comparing choroidal thickness between controls and cases (p = 0.001).Choroidal thickness was maximum in control group with a p value of &amp;#60;0.001, while cases showed overall thinner choroids with increasing severity of retinopathy. Thinnest choroids were observed in patient with proliferative diabetic retinopathy. Choroidal thickness can be used as a non-invasive prognostic bio marker for diabetic retinopathy.

Risk factors and prognostic factors associated with retinal detachment and visual outcomes in acute retinal necrosis

ObjectiveTo investigate the risk factors and prognostic factors that affect the long-term clinical outcomes of acute retinal necrosis (ARN).MethodsA retrospective study of patients with ARN who underwent treatment and completed follow-up in our ophthalmology department from 2011 to 2021 was conducted. The incidence and risk factors of retinal detachment (RD) and prognostic factors affecting long-term clinical outcomes, such as late-onset RD and final vision loss (< 20/200), were analyzed.ResultsTotally 59 ARN patients (65 eyes) with an average follow-up of 48.9 months were enrolled. During the follow-up period, RD occurred in 34 eyes (52.3%). The risk factors for RD included quadrants of involved retinal necrosis (odds ratio [OR], 4.181; 95% confidence interval [CI], 1.950–10.834) and initial intraocular viral load (OR, 1.721; 95% CI, 1.071–3.083). Early intravitreal antiviral treatment (OR, 1.204; 95% CI, 1.040–1.480) was independently associated with a decreased risk of late-onset RD. The factors independently associated with an increased risk of final vision loss were worse initial visual acuity (OR, 3.895; 95% CI, 1.551–13.662) and late-onset RD (OR, 8.043; 95% CI, 1.380–67.216). In addition, we utilized the fluctuating magnitude of viral load to quantify the extent of its reduction in comparison to its original value following the initial intravitreal antiviral injection (IAI). This ratio was strongly related to initial intraocular IL-8 concentration (Spearman correlation coefficient=-0.741, P = 0.000) and moderately related to the initial degree of aqueous flare (Spearman correlation coefficient=-0.508, P = 0.010).ConclusionRD is a common and severe complication of ARN with multiple risk factors, such as initial retinitis involvement area and initial intraocular viral load. Active local antiviral therapy may reduce the risk of late-onset RD. The antiviral medication should be adjusted according to the inflammatory state. Therefore, timely detection of causative viruses and intensive systemic and local antiviral therapy is crucial for preserving visual function in ARN patients.

To study efficacy of tacrolimus (0.03%) Eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis

VKC (Vernal keratoconjunctivitis) is a chronic, bilateral ocular inflammatory disorder that primarily impacts young patients. Management of VKC is challenging due to its complex immunological etiology and chronic inflammatory components. This prospective, single-center, randomized study was executed at the Outpatient Department of Ophthalmology, SGT Medical College, Hospital and Research Institute (FMHS), Budhera, Gurugram, for a duration of 18 months. A total of 102 clinically diagnosed VKC patients, aged above 5 years, have been then randomly divided into 3 groups (34 each). Group A received fluorometholone (0.1%) eye drops, Group B received cyclosporine (0.1%) eye drops, and Group C received tacrolimus (0.03%) eye ointment. Patients were evaluated at days 0, 7, 14, 28, 35, and two weeks post-medication using the Clinical Scoring System by Bleik and Tabbara to assess TSSS (Total Subjective Symptom Score) and TOSS (Total Objective Ocular Sign Score). Most patients were between 6-10 years old, with over 78% being males. Group A showed significant symptom reduction from the first week (mean TSSS reduction from 2.29±0.46 to 0.21±0.41, p&amp;#60;0.0001), while Groups B and C showed significant improvements from the second week (Group B: mean TSSS reduction from 2.5±0.51 to 0.12±0.33, p&amp;#60;0.0001; Group C: mean TSSS reduction from 2.29±0.46 to 1.00±0.00, p&amp;#60;0.0001). Conjunctival hyperemia and tarsal papillae improvements were more pronounced in Group B as compared to Groups A &amp; C. No ocular complications were found, except for dose-dependent irritation in Group C. While fluorometholone (0.1percent) eye drops provided early symptom relief, its effects were not sustained. Cyclosporine (0.1percent) eye drops and tacrolimus (0.03percent) eye ointment showed delayed but sustained efficacy, making them suitable for long-term treatment of moderate to severe VKC. Fluorometholone may be used initially alongside immunomodulators for rapid symptom relief, followed by tapering as immunomodulators take effect.

Epidemiology of Common Eye Diseases in North Kordofan, Sudan

Introduction: Eye illness epidemiology is critical because it identifies the most dangerous diseases in the community and helps decision-makers make better management decisions. This study aims to explore the epidemiology of prevalent eye diseases in north Kordofan State. Methodology: This retrospective descriptive study was conducted at El-Obeid Teaching Hospital's Ophthalmology Department, North Kordofan State, Sudan, and Dr. Khalil's Ophthalmology Center. Out of almost 50000 patient files, we selected 1000 files for this study using a random systemic selection of 1 in 50. The data collection sheet was created, and all data were collected. Results: The corneal diseases made up 19.6% of the 1000 cases in this study, followed by conjunctival 17.7%, lens 15.3%, eye surface 9.8%, uveal tract 9.1%, refractive errors 6.4%, eye lids 5.4%, orbital 5.4%, glaucoma 4.3%, retinopathy 4.6%, anterior chamber diseases 2.1%, lacrimal drainage system disorders 1.8%, and nerve palsies 0.5%. Conclusion: The western Sudan is heavily affected by eye diseases, with corneal diseases being the most common, closely followed by conjunctival diseases. This report delves into the eye disease situation in western Sudan. With absence of such literature from Sudan, the findings of this study presenting baseline of future research in this context.

Bilateral Granular Macular Dystrophy Associated with Bilateral Cataracts: About a Case

Macular granular dystrophy is an autosomal recessive genetic disease characterized by corneal opacities responsible for a decrease in visual acuity. We report a case of bilateral granular dystrophy associated with cataract in a young adult seen at Zinder National Hospital. This is a 51-year-old patient with no significant personal or family ophthalmological history who consulted the ophthalmology department of the National Hospital of Zinder for progressive and bilateral visual acuity decline that has been evolving for several years. The ophthalmological examination of the day noted a decrease in visual acuity at a distance in bilateral., corneal deposits in stain and a grade II cortico-nuclear cataract was noted. Immediate bisequential cataract surgery was performed using the phacoAlternative technique with simple postoperative follow-up and good visual recovery. Keywords: Groenouw II, cataract, Zinder

POST-STROKE VISUAL FIELD DEFECTS AND OTHER OPHTHALMOLOGICAL ABNORMALITIES: A RETROSPECTIVE STUDY

Objective: The study aimed to estimate prevalence of visual field defects (VFDs) and other ophthalmological abnormalities in post-stroke patients. Methods: This retrospective study, conducted in department of ophthalmology in collaboration of department of neurology of a tertiary care medical institute, analyzed data from 80 adult patients undergoing ophthalmological examination including perimetry for presence of VFDs. Demographic data, including age and gender were extracted. Medical records were reviewed to assess visual disturbances, systemic illnesses, and medications. Gender distribution and presence of risk factors such as diabetes and hypertension were analyzed. Ophthalmological findings and the type and severity of VFDs were noted from perimetry reports. Magnetic resonance imaging and computed tomography scans were analyzed to identify brain lesions causing VFDs. Results: In a study of 80 stroke patients, males were more prevalent (58.8%) than females (41.2%), with the most affected age group being 31– 40 years (33.8%). Hypertension was the most common risk factor (35.0%), and ischemic stroke was the most frequent type (66.3%). The anterior circulation was the predominant site of lesions (85.0%). The most frequent VFDs was complete homonymous hemianopia, observed in 20 patients (25.0%), followed by partial homonymous hemianopia in 6 patients (7.5%). Constriction and inferior quadrantanopia were each noted in 3 patients (3.75%), while superior quadrantanopia was seen in 2 patients (2.5%). Hemianopia combined with quadrantanopia and scotoma were the least common (1.25% each). The other common ophthalmological finding was gaze palsy which was seen in 13 (16.25%) patients. Conclusion: Visual filed defects and other ophthalmological manifestations such as gaze palsies are common in post-stroke patients. Early detection and targeted rehabilitation of these abnormalities enhance recovery, reduce disability and optimize outcomes for stroke survivors.

Microcystic Macular Edema Caused by Non-Glaucomatous Optic Atrophy: A Single-Center, Retrospective, Cohort Study in France.

Optic Atrophy (OA) can be associated with the development of microcystic macular edema (MME) in the perifoveal retinal inner nuclear layer (INL). We aimed here to retrospectively determine the prevalence of MME in patients with non-glaucomatous OA in our tertiary ophthalmology department between 2015 and 2020. We then examined how MME affected the thicknesses of the different retinal layers and the differences in demographic and clinical characteristics between those patients who developed MME and those who did not. A total of 643 eyes (429 patients) were included (mean age 45.9 ± 17.8 years, 52% female). MME developed in 95 (15%) eyes and across all etiologies of OA except for toxic/nutritional causes, but the prevalence of MME varied between the different etiologies. The development of MME was associated with thinning of the ganglion cell layer (11.0 vs. 9.6 μm; p = 0.001) and the retinal nerve fiber layer (10.1 vs. 9.15 μm; p = 0.024), with INL thickening in the 3- and 6-mm diameter areas of the central fovea. Patients developing MME had significantly worse distance best-corrected visual acuity than those not developing MME (0.62 vs. 0.38 logMAR; p = 0.002). Overall, the presence of MME in OA cannot be used to guide the diagnostic work-up of OA.

Etiologies of Infectious Keratitis in Malawi.

Infectious keratitis is a leading cause of corneal blindness worldwide with little information known about causative etiologies in Malawi, Africa. This area is resource-limited with ophthalmologist and microbiology services. The Department of Ophthalmology at the Kamuzu College of Health Sciences in Blantyre, Malawi, is a participating site of an international corneal ulcer consortium, capriCORN (Comprehensive Analysis of Pathogens, Resistomes, and Inflammatory-markers in the CORNea). In this study, 50 patients with corneal ulcers were swabbed for pathogen identification using RNA-sequencing. Corneal trauma was reported in 41% and 19% of the patients worked in agriculture. A pathogen was identified in 58% of the cases. Fungal pathogens predominated, followed by viruses and bacteria. Aspergillus, Fusarium, HSV-1, and Gardnerella were the most common pathogens detected. 50% of patients reported treatment with an antibiotic before presentation. Pathogens unusual for infectious keratitis, such as Subramaniula asteroids, Aureobasidium pullulans, and Gardnerella vaginalis, were also detected.

Etiologies and Outcomes of Granulomatosis With Polyangiitis-Associated Optic Neuropathy: A Case Series and Review of the Literature.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is a rare autoimmune disease characterized by inflammation of small- to medium-sized blood vessels (vasculitis). We described the 3 causes of GPA-associated optic neuropathy (compressive, inflammatory, or ischemic) and analyzed initial and final visual acuities (VAs) in each group, which could potentially help prognosticate visual outcomes depending on the etiology of optic neuropathy. This was a retrospective chart review of patients who were diagnosed with GPA-associated optic neuropathy and were seen in the Department of Ophthalmology at Mayo Clinic in Rochester, Minnesota. Only patients who met the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology GPA classification criteria were included. A total of 12 patients with GPA-associated optic neuropathy were identified. The etiology of the optic neuropathy was compressive in 6 patients, inflammatory in 4 patients, and ischemic in 3 patients. One patient had compressive optic neuropathy initially, then presented with GPA-related optic neuritis years later. Four patients in the compressive optic neuropathy group had orbital masses requiring orbitotomy for debulking, and the remaining 2 patients had compression from pachymeningitis. Average logarithm of the minimum angle of resolution (logMAR) VA at optic neuropathy onset was 1.50, 1.50, and 0.67 (Snellen equivalent 20/600, 20/600, and 20/100, respectively). At the last follow-up, average logMAR VA was 0.91, 1.73, and 1.10 (Snellen equivalent 20/160, 20/1,000, and 20/250, respectively) for each group. Visual outcomes were variable, with compressive and inflammatory optic neuropathies showing improvement in 4 eyes and worsening in 3 eyes in total. Patients with ischemic optic neuropathy from GPA were either stable or worsened over the course of the disease.

Clinicoepidemiological Profile of Retinopathy of Prematurity.

Purpose In previously performed studies, retinopathy of prematurity (ROP) has been shown to occur postpartum. As a result, mechanical ventilation and oxygen dependence were eventually connected to the development of ROP in these preterm children, and ROP prevalence is on the rise globally. Despite various improvements in childcare, ROP still tends to arise due to various risk factors associated with the disease. So, clinically the research was performed to determine the clinical and epidemiological profile of ROP. Materials and methods A total of 268 participants were to be enrolled in the study. It was an observational, cross-sectional study carried out at Department of Ophthalmology and Neonatal Intensive Care Unit in Veer Surendra Sai Institute of Medical Sciences and Research Centre, Burla, Sambalpur, Odisha, India. Ethical approval was provided on 30 November 2019. Results Overall 123 (46%) infants out of 268 infants developed retinopathy of prematurity. Majorly, the infants had stage 1 and stage 2 ROP. Most of the infants were male. Birth weight in ROP patients was 1000 g or less in 54% of infants, 1000-1500 g in 46% of infants and >1500 g in 33% of infants. Gestational age was found to be a predictor of retinopathy of prematurity. The adverse events that were found to be associated with retinopathy of prematurity were sepsis (53%), respiratory distress syndrome (RDS) (54.6%), intraventricular haemorrhage (IVH) (60%), anaemia (61.5%). Conclusion It has been observed that babies with higher birth weights and older gestations are also susceptible to developing ROP. Therefore, the greater birth weight newborns up to 1750 g and older gestational age babies >34 weeks should also be included in the screening criteria, especially if they have risk factors such as oxygen supplementation, sepsis, RDS, and anaemia.

To evaluate the effects of the application of 0.03% tacrolimus ointment in patients of vernal keratoconjunctivitis at a tertiary care hospital

Context: The aim of this study was to evaluate the effect of the application of 0.03% tacrolimus eye ointment in treating patients diagnosed with vernal keratoconjunctivitis (VKC) specifically within a tertiary care hospital setting. Materials and Methods: From October 2019 to October 2021, a prospective observational study took place at the department of ophthalmology in a tertiary care center. The study involved 42 consecutive VKC cases that had not seen relief with antihistaminics, mast cell stabilizers, or topical steroids. When steroid is applied in VKC patient it leads to various complications. So, in steroid refractory VKC tacrolimus application is used. Treatment involved applying topical 0.03% tacrolimus ointment was an effective and safe treatment. The study assessed changes in symptoms and signs posttreatment and monitored potential complications at 1, 4, 7, 10, and 14 weeks into the treatment during follow-up sessions. Results: The mean age of the patients was 10.7 ± 3.3 years. Following the administration of 0.03% tacrolimus, all signs and symptoms such as itching, foreign body sensation, tearing, photophobia, papillae, conjunctival hyperemia, limbal edema, Horner-Trantas dots, as well as keratitis (superficial punctate keratitis) showed significant improvement (P &lt; 0.001). Conclusion: The application of 0.03% tacrolimus has been found effective in reducing the symptoms and signs of VKC, particularly in cases refractory to steroids, with very few cases reporting minimal side effects. This study emphasizes the crucial role of tacrolimus in preventing the severe visual complications often linked to this disease.

A cross-sectional survey of ocular problems after COVID-19 infection among healthcare workers at a teaching hospital.

The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection. This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms. A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common. A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.