Department Of Ophthalmology Research Articles

Shear-wave elastographic imaging in choroidal melanomas: clinical and hemodynamic correlations.

This study evaluated the role of shear wave elastography imaging (SWEΙ) in uveal melanomas and the associations between SWEI and clinical and hemodynamic findings. Prospective, clinical study METHODS: Twelve patients with uveal melanomas, scheduled to undergo Ru-106 brachytherapy, were prospectively recruited from the Department of Ophthalmology of the University Hospital of Heraklion (September-December 2022). B-mode, hemodynamic and SWEI ultrasonography examinations were performed with the HiScan (OPTIKON 2000) and the LOGIQ E9 (GE Healthcare) sonographic systems, respectively. Differences in SWEI scores (kPa) between tumor (TS) and adjacent non-affected choroid (CS), as well as between TS and orbital fat (FS) were examined. Correlations between SWEI and intra-tumoral hemodynamic parameters, including peak systolic and end diastolic velocities and resistivity index (RI) were also examined. TS was significantly correlated with intra-tumoral RI (Pearson's bivariate correlation coefficient 0.681, p=0.015) and with maximal tumor height (Pearson's bivariate correlation coefficient 0.620, p=0.031). TS was significantly higher than both FS and CS scores (paired-samples t-test, p=0.003 and p=0.006, respectively). SWEI score is applicable as a quantitative biomechanical marker in the assessment of choroidal melanoma. Choroidal melanomas are stiffer than both adjacent choroid and orbital fat. Moreover, choroidal melanomas with higher RI as well as those with higher apical elevations display higher SWEI scores.

Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic.

The aim of the research was to evaluate the use of teleophthalmology at a university practice during the COVID-19 pandemic, specifically examining precision, effectiveness, and patient satisfaction. Telemedicine visits were offered to new and established patients requesting appointments with the Stony Brook University Department of Ophthalmology between March 30 and June 2, 2020. Records from these visits were reviewed for chief complaint, past medical and ocular history, diagnoses, treatment/management, and providers' sub-specialty. Precision was determined by comparing agreement between diagnoses of the telemedicine visit with those of the subsequent in-person visit. The decision to follow up in person was made by the physician and patient. Diagnostic precision as well as progression, improvement, or stability of patients' symptoms were determined by the physician's assessment at follow-up visits. Post-telemedicine visit satisfaction surveys were sent to all patients. Telemedicine visits were offered to 783 patients, 520 (66.4%) of whom accepted. Of these 520 patients, 409 (78.7%) were established and 105 (20.2%) had in-person, follow-up visits. Overall, the diagnostic precision of the follow-up visits was 89.5%. Precision differed significantly across ophthalmologic subspecialties. Of the patients who had in-person follow-up visits, 56.8% remained stable, 32.4% improved, and 10.8% worsened. Established patients presented with more extensive ocular histories/procedures and experienced a higher percentage of worsening symptoms/disease stage compared to new patients. Oculoplastics/orbit was the most prevalent diagnostic subspecialty that worsened. Surveys were sent to all patients completing telemedicine visits, 15.0% of whom responded. Overall satisfaction was 91.9%, although only 23.0% of respondents preferred telemedicine to an in-office visit. Telehealth provides high levels of precision and patient satisfaction for a wide range of ophthalmologic visits, although most patients still prefer in-office examinations. Employing teleophthalmology for follow-up and emergency care may provide patients with an effective alternative during pandemic situations and beyond.

Comparison of Bimatoprost and Timolol for Treatment of Chronic Angle Closure Glaucoma

Angle-closure glaucoma occurs when the normal drainage of fluid within the eye, specifically the aqueous humor, is obstructed or restricted. Objective: To assess and compare bimatoprost 0.03% administered once daily versus timolol 0.5% administered twice daily in patients diagnosed with chronic angle closure glaucoma (CACG). Methods: This randomized controlled study was performed at the Department of Ophthalmology, Bahawalpur Victoria Hospital, Bahawalpur, Pakistan, from August 2023 to January 2024. Patients of either gender, aged 18 years or older, and diagnosed with unilateral or bilateral CACG were included. Patients were randomly allocated to either Bimatoprost 0.03% (once daily at night) or Timolol malete 0.5% (two times morning and night daily) adopting a lottery method. Patients were asked to visit after one and 3 months (final outcome) and intraocular pressure (IOP) measurements were taken between 8 to 10 am using an applanation tonometer. Results: A total of 110 patients of which 64 (58.2%) were female. The mean age was 58.9 ± 10.5 years. At baseline, the mean intraocular pressure was calculated to be 24.2 ± 5.7 mmHg. After 1-month (18.7 ± 4.2 mmHg vs. 20.5 ± 4.7 mmHg, p=0.0418) and 3-months of treatment (16.8±4.6 mmHg vs. 19.6 ± 4.3 mmHg, p=0.0030), the mean IOP were significantly less in Bimatoprost group when compared to Timolol group. The commonest adverse events were conjunctival hyperaemia, and pruritus reported by 19 (17.3%), and 9 (8.2%) patients respectively. Conclusions: Bimatoprost exhibited a significantly better reduction in IOP compared to timolol in chronic angle closure glaucoma. Both drugs showed relatively good safety and tolerability profiles.

Clinical and Etiology Presentations of Keratitis Caused by Mixed Infectious Agents (Bacteria and Fungi)

Introduction: Microbiological studies following the culture of corneal infiltrates are the gold standard for determining the etiology of infectious keratitis caused by bacteria or fungi; however, even if a culture of the corneal ulcer is obtained. Purpose: To investigate the predisposing factors and clinical and Etiology presentations of keratitis caused by mixed infectious agents (bacteria and fungi). Methods: This was a prospective study of cases with mixed bacterial and fungal keratitis, done between July to December 2022 in Department of Ophthalmology, Netraloy Eye Care Center, Thanthania, Bogura Sadar, Bogura, Bangladesh. Sixty (60) cases of mixed bacterial and fungal keratitis were identified. Samples (corneal swabs and scrapings) were collected aseptically from corneal ulcer patients. Isolation and identification of the microbial agents and antimicrobial susceptibility testing were done in the Microbiology and Pathology departments. Results: 38 cases (63.3%) were men, and the mean age was 54.2±9.3 years. The affected people were mostly (50; 83.3%) residing in the rural areas. 34 patients (56.7%) were involved in agricultural activities. The people of 41- 60 years of age were particularly prone to this disease (40; 66.7%). The most common predisposing factor for mixed keratitis was a history of ocular trauma (42; 70%) and 28 patients (46.7%) had a history of trauma with vegetative matter. The incidence of the disease was highest in the monsoon season, between June to September (32; 53.3%). The most common causative bacterial organisms was Staphylococcus aureus (26;43.3%) followed by Pseudomonas secies (10;16.7%) and among fungal organisms was Aspervgillus fumigates (22;36.7%) followed by Fusarium species (12;20%). Conclusion: The identification of the etiology and the predisposing factors of corneal ulcers in this region are important for the prevention and early treatment of the disease. Usually, patients with mixed bacterial and fungal keratitis have poor prognosis. Thus, when the infectious keratitis is running an atypical course or found unresponsive to the initial medical treatment, the possibility of a mixed infection by bacterial and fungal organisms should be considered.

IgG4-связанное заболевание с вовлечением тканей глазницы у пятилетнего ребенка

Case study IgG4-related disease involving the tissues of the orbit in a five-year-old child Yu.V. Kotova, E.E. Grishina, E.I. Kondratieva, G.I. Fokanova, I.M. Tarabanko Moscow Regional Research Institute of Childhood, Mytishchi, Moscow Region, Russian Federation M.F. Vladimirsky Moscow Regional Research Institute, Moscow, Russian Federation Purpose. To demonstrate a rare clinical case of IgG4-related disease in the practice of a rheumatologist, a pediatrician and an ophthalmologist. Material and methods. A 5-year-old child had a lesion in the left orbit, manifested by left-sided exophthalmos, medial displacement of the left eye, and limited outward eye mobility. He underwent an orbitotomy with histological and immunohistochemical examination of the biopsy specimen in the ophthalmology department of M.F. Vladimirsky Moscow Regional Research Institute. A diagnosis of IgG4-related disease involving the left orbital tissue was made. Results. In the rheumatology department of the Moscow Regional Research Clinical Institute of Childhood, the boy received pulse therapy with glucocorticoids. When trying to reduce the dose of glucocorticoids, exophthalmos and swelling of the eyelids on the left increased again. Cyclophosphamide therapy was ineffective. In addition to oral Prednisolone, Rituximab, a drug from the group of synthetic chimeric monoclonal antibodies, was prescribed. A stabilization of the process in the left orbit and an improvement in the general condition of the child ocurred. The duration of remission is 2 years. Discussion. IgG4-related disease is characterized by lymphoplasmacytic infiltration of tissues with a predominance of IgG4-positive cells and subsequent formation of fibrosis. Ophthalmological manifestations of IgG4-related disease are most often characterized by damage to the tissues of the orbit and lacrimal gland. Usually develops in middle-aged people; it is rare in pediatric practice. Conclusion. Patients with IgG4-related disease can be encountered in the practice of a rheumatologist, pediatrician and ophthalmologist. If diagnosis and treatment are not urgent, the disease is prone to progression, which leads to disability of the patient. The main treatment method is long-term use of glucocorticoids. In case of steroid resistance or steroid dependence, early use of immunosuppressive drugs or monoclonal antibodies could be considered. Key words: immunoglobulin G4-related disease, autoimmune orbital myositis, pediatric rheumatology, immunosuppressive therapy

Preoperative intravenous mannitol administration and its rationale before cataract surgery.

The purpose of this study is to assess the variations in anterior chamber depth (ACD), axial length (AXL), and intraocular pressure (IOP) in both phakic and pseudophakic eyes undergoing preoperative intravenous mannitol infusion. The study was conducted at the Ophthalmology Department of IRCSS Humanitas in Milan, Italy. This is a prospective and non-randomized study. 40 patients with phakic eyes and 40 patients with pseudophakic eyes scheduled for cataract surgery in their fellow eye were included. Prior to the surgery, comprehensive ophthalmic examinations were conducted, including IOP measurement, and bilateral biometry performed with Anterion® (Heidelberg Engineering GmbH, 69,115, Heidelberg, Germany). All patients received intravenous infusion of mannitol before the surgery. One hour after cataract extraction, the patients underwent the same set of examinations. We analyzed the changes AXL, ACD and IOP in the eye opposite to the one that underwent surgery. The comparison between preoperative and postoperative parameters showed no differences in AXL (p = 0.34 and p = 0.53) and in ACD (p = 0.38 and p = 0.31) in the phakic and in the pseudophakic group, respectively. Instead, a statistically significant difference was found between the mean preoperative and postoperative IOP (p = 0.02) for the phakic group and (p = 0.03) for the pseudophakic group. The administration of mannitol does not lead to any changes in the ACD and AXL, regardless of whether the eyes are phakic or pseudophakic. However, there is a statistically significant reduction in IOP. Nonetheless, it is important to consider the various side effects associated with mannitol infusion.

The carbon footprint of French hospital ophthalmology consultations.

France carbon footprint, with 604 million tons of CO2 equivalent (CO2eq) annual emissions, far exceeds the worldwide scientific specifications to not exceed 2 °C of warming in 2100. The healthcare sector is one of the biggest contributors to greenhouse gas emissions. The aim of this study is to quantify and evaluate the carbon footprint of the consultation activity of an ophthalmology department at a single institution in France. The perimeter of the investigation included consultations and excluded the surgeries and the hospitalisation. We calculated the carbon footprint of a single day of practice in our scope of investigation. We included consumption of energy, patient travel, staff travel, pharmaceutics and medical devices purchases, computer hardware, biomedical equipment/exam materials, and waste. We used the official French public database of emission factors: Base Empreinte® of the Environmental and Energy Management Agency of France. The carbon footprint of a single day of our department was estimated at 1 688.65 kgCO2eq. It represents an average of 9.28 kgCO2eq per patient. Energy consumption contributed for 114.80 kgCO2eq (6.8%), travel for 1324.76 kgCO2eq (78.4%), pharmaceutics and medical devices for 208.33 kgCO2eq (12.3%), equipment for 14.38 kgCO2eq (0.9%) and waste for 26.38 kgCO2eq (1.6%). This study highlights the importance of patient travels, and possibly pharmaceutics, in the carbon footprint of hospital ophthalmology practice in France. More studies are needed to establish it at the national or international scale, as well as more carbon footprint analyses on products, especially those of high prices, to increase the accuracy of these studies.

Application of Convolutional Gated Recurrent Units U-Net for Distinguishing between Retinitis Pigmentosa and Cone–Rod Dystrophy

Abstract Artificial Intelligence (AI) has gained a prominent role in the medical industry. The rapid development of the computer science field has caused AI to become a meaningful part of modern healthcare. Image-based analysis involving neural networks is a very important part of eye diagnoses. In this study, a new approach using Convolutional Gated Recurrent Units (GRU) U-Net was proposed for the classifying healthy cases and cases with retinitis pigmentosa (RP) and cone–rod dystrophy (CORD). The basis for the classification was the location of pigmentary changes within the retina and fundus autofluorescence (FAF) pattern, as the posterior pole or the periphery of the retina may be affected. The dataset, gathered in the Chair and Department of General and Pediatric Ophthalmology of Medical University in Lublin, consisted of 230 ultra-widefield pseudocolour (UWFP) and ultra-widefield FAF images, obtained using the Optos 200TX device (Optos PLC). The data were divided into three categories: healthy subjects (50 images), patients with CORD (48 images) and patients with RP (132 images). For applying deep learning classification, which rely on a large amount of data, the dataset was artificially enlarged using augmentation involving image manipulations. The final dataset contained 744 images. The proposed Convolutional GRU U-Net network was evaluated taking account of the following measures: accuracy, precision, sensitivity, specificity and F1. The proposed tool achieved high accuracy in a range of 91.00%–97.90%. The developed solution has a great potential in RP diagnoses as a supporting tool.

Retinal Microstructural Changes Reflecting Treatment-Associated Cognitive Dysfunction in Patients with Lower-Grade Gliomas

PurposeTo determine whether microstructural retinal changes, tumor features, and Apolipoprotein E (APOE) ε4 polymorphism are correlated with clinically detectable treatment-associated cognitive dysfunction (TACD) in patients with lower-grade gliomas. DesignCohort study. Participants and ControlsSixteen lower-grade glioma patients at a U.S. academic Ophthalmology department between January 2021 and November 2023. Normal controls were recruited from convenient sampling. MethodsMontreal Cognitive Assessment (MoCA) scores and retinal changes were assessed in 6-months intervals. APOE genotyping was performed, and tumor details were recorded. Partial least-squares discriminant (PLSD) model was established to evaluate the association between TACD with APOE genotype, ophthalmic, and tumor features. Main Outcome MeasuresThe main outcome measure was cognitive status as measured by the MoCA score and analyzed in relation to ophthalmic measurements, tumor features, and APOE genotype. ResultsMedian time to first eye exam was 34 months (2–266) from tumor diagnosis and 23 months (0–246) from radiation. Nine patients (56%) had abnormal cognition (MoCA <26/30). MoCA scores were significantly worse in patients with temporal (22±7.2) than frontal lobe tumors (26±3.1, p=0.02) and those with oligodendrogliomas (22±4.1) than astrocytomas (26±3.6, =0.02). Patients with TACD had significant radial peripapillary capillary density loss (45%±4.6) compared to those with normal cognition (49%±2.6, p=0.02). A PLSD model correlated MoCA scores with retinal nerve fiber thickness, intraocular pressure, foveal avascular zone, best-corrected visual acuity, months since first diagnosis, and tumor pathology (oligodendroglioma or not). Using these features, the model identified patients with TACD with 77% accuracy. APOE genotyping showed: two ε2/ε3 (13%), ten ε3/ε3 (63%), and one ε3/ε4 (6%). ConclusionRetinal microstructural changes may serve as biomarkers for TACD in patients with lower-grade gliomas. Temporal lobe tumors and oligodendrogliomas may increase susceptibility to TACD. Utilization of retinal markers may enhance TACD diagnosis, progression monitoring, and inform management of lower-grade glioma patients. A larger study with serial eye exams is warranted to evaluate the role of APOE ε4 and develop a predictive model.

Etiological analysis of ocular herpes virus infection.

To do the etiological analysis of ocular herps virus infection, revealing the pathogen species and the distribution of different virus types within the eye. Samples were collected from 2017 to 2021 at the Department of Ophthalmology, Peking University Third Hospital and tested using real-time PCR for common ocular viruses: herpes simplex virus 1 (HSV-1), cytomegalovirus (CMV), varicella-zoster virus (VZV) and Epstein-Barr virus (EBV). The pathogenesis of the different viruses was classified and analyzed according to the site of infection. Viral PCR detections were performed on 3627 samples collected over the 5-years and 649 (17.89%) samples contained one or more of the viruses tested. The overall detection rate of CMV was highest at 9.93%. Of all sample types, aqueous humor was the most common (1752 cases), of which 340 were positive (19.41% positive rate). Corneal samples were the next most common, with 1481 cases and 250 positive results (16.88% positive rate). CMV positivity was higher in aqueous humor and corneal samples than other viruses; vitreous body had the highest positive rate at 36.36% (20/55), among which 18 cases were VZV positive. Distribution of virus types differed among infection sites, with CMV the most common virus type detected in the cornea and aqueous humor, while VZV was the most common virus detected in the vitreous body.

Structural, blood flow and functional changes in the macular area and the expression of aqueous humor factors in myopia.

To compare the macular area parameters and aqueous humor factors between myopia and emmetropia. Convenience sampling was used to select patients who visited the Changzhi Aier Eye Hospital's department of ophthalmology from December 2018 to December 2022 as the study participants. They were divided into three groups according to whether they were diagnosed as mild myopia myopic, highly myopic or not as follows: the mild myopia group (60 cases, 108 eyes), the high myopia group (46 cases, 78 eyes) and the healthy emmetropia group (40 cases, 65 eyes). The differences in the macular integrity (MI) assessment, optical coherence tomography and optical coherence tomography angiography parameters and aqueous humor factors were compared between the three groups. AL in high myopia group was the highest, and that in emmetropia group was the lowest. The BCVA of mild myopia group was the highest. The RS in the high myopia group were significantly lowest in the three groups (26.42 ± 1.04 vs. 28.34 ± 0.76 vs. 31.92 ± 0.77) (F = 5.374, p = 0.013). The 63% BCEA, 95% BCEA and MI in the high myopia group were significantly highest (p < 0.05). The mean RPE thickness, mean CT and mean RT in the high myopia group were lowest (p < 0.05). The blood flow density were lowest in the superficial fovea, paracentral fovea and different subdivisions of the paracentral fovea in the high myopia group (p < 0.05). The VEGF concentration in the aqueous humor of the high myopia group was lowest (25.62 ± 17.43 vs. 32.45 ± 24.67 vs. 64.37 ± 21.14) (F = 9.237, p < 0.001). The MMP-2 concentration was highest (483 ± 201.48 vs. 410 ± 142.37 vs. 386 ± 154.34) (F = 5.542, p = 0.018). The VEGF concentration in the aqueous humor factor was negatively correlated with the AL in the myopia group (r = -0.438, p = 0.002), the MMP-2 concentration was positively correlated with the AL (r = 0.484, p = 0.010). Patients with high myopia showed decreased retinal light sensitivity, fixation stability, superficial blood flow density and retinal thickness compared with people with emmetropia. A decreased VEGF concentration and increased MMP-2 concentration in the aqueous humor factor have potential associations with the development of high myopia.

Applanation Ultrasound versus Optical Biometry in the measurement of Axial Length in a Normal Eye

Objectives Accurate measurement of the axial length (AL) of the eye is important to make sure that the patient is emmetropic postoperatively. Multiple studies conducted around the globe compare AL using optical and ultrasound biometry. However, results are still inconclusive, as some studies stated that there is no difference in both modalities, whereas other studies considered optical biometry to be more superior. We aim to compare AL measurements using applanation ultrasound and optical biometry AL Scan, in Islamabad, in order to find out which modality is more superior. Methods This was a prospective cross-sectional study that was conducted at the department of Ophthalmology, PAF Hospital, E9 Islamabad. The study was conducted over a period of eight months, from April to November 2023. Participants were enrolled using non-probability, consecutive sampling. The axial length of each eye was measured by both optical and ultrasound biometer. Results There were 80 eyes of 40 participants including both males (77.5%) and females (22.5%) aged between 16-58 years. The axial length using the optical biometer showed a greater value ranging from 22.01 to 30.18mm with a mean value of 23.89 ± 1.31mm whereas the axial length measured using applanation ultrasound was 21.62 to 30.00mm with a mean of 23.53 ± 1.29mm. The mean difference between both was 0.36 ± 0.21mm which was statistically significant (P &lt;0.005). Conclusion There is a statistically significant difference between the mean readings of the AL measured by the IOL master and ultrasound biometer, so both the devices cannot be used interchangeably.

Demographic and Clinical Characteristics of Retinoblastoma Cases at a Tertiary Care Center in Eastern India.

This study aims to evaluate the burden, demographic profile, clinical characteristics, and management of retinoblastoma (RB) cases at a tertiary care center. This was a hospital-based study conducted in a tertiary care center in the Department of Ophthalmology from January 2018 to December 2022. All referred and newly diagnosed cases of RB coming to the outpatient department were included in the study after obtaining written informed consent from parents or guardians. Data collected were analyzed in terms of demographic profile, socioeconomic status, and clinical characteristics of the disease at the time of presentationand its treatment. Out of 155,671 new patients seen in the outpatient eye department during the study period, 118 eyes of 94 patients were diagnosed with RB. The burden of disease was found to be 60.4 cases per 100,000 patients. Malignancy was unilateral in 74.47% and bilateral in 25.53% of cases. The male-to-female ratio was 1.7:1. The mean age at presentation was 30.86±19.5 months. A family history of RB was seen in 4.26% of cases. Of the patients,80.85% belonged to upper-lower socioeconomic status. Most of the cases presented to us at an advanced stage of the disease (i.e., groups E and D). Most of our cases present at an advanced stage of RB, resulting in poor outcomes and survival rates. It is necessary to organize awareness campaigns about the fatal nature of the disease so it can be diagnosed early, leading to better visual and survival outcomes.

A STUDY TO EVALUATE THE TYPE AND CAUSE OF BLINDNESS/LOW VISION IN APPLICATIONS FOR BLINDNESS CERTIFICATE PRESENTING IN CHAMBA DISTRICT OF HIMACHAL PRADESH

Objective: This study aims to assess the prevalence, causes, and socio-economic impacts of visual impairment in the Chamba District of Himachal Pradesh, India. It seeks to identify the major factors contributing to visual disability and the role of literacy and employment status in influencing the lives of the visually impaired. Methods: A cross-sectional, hospital-based study was conducted over a period of one year, enrolling patients from the outpatient department of ophthalmology who were applying for visual disability certification. The study utilized a randomized sampling method and a semi-structured interview along with an examination form for data collection. Ethical approval was obtained, and the study adhered to ICMR and Helsinki Declaration guidelines. Participants underwent comprehensive ophthalmic evaluations, and data were analyzed using SPSS version 17.0. Results: Among the 270 participants evaluated, a higher prevalence of visual impairment was observed in males (n=149) compared to females (n=121), particularly within the age group of 21-40 y. The leading causes of visual disability included Corneal Opacity (16.25%), Retinitis Pigmentosa (15.83%), and Congenital Malformation (14.17%). Furthermore, literacy played a crucial role in employment opportunities, with 75.83% of the literate participants being employed, indicating a significant impact on the socio-economic status. Conclusion: The study highlights the multifaceted nature of visual impairment in the Chamba District, emphasizing the need for integrated public health strategies to address the identified challenges. Enhancing preventive measures, improving access to healthcare, and supporting rehabilitation services are essential steps towards mitigating the burden of visual impairment.

Real world treatment outcomes in polypoidal choroidal vasculopathy in a Caucasian population of British ethnicity.

To assess treatment response of Polypoidal choroidal vasculopathy (PCV) in a Caucasian population of British ethnicity with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections alone and with a combination of anti-VEGF injections and photodynamic therapy (PDT). Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, United Kingdom. Retrospective review of 95 Caucasian patients in a single centre with diagnosis of PCV between 2013 and 2018 were included. Best corrected visual acuity (BCVA), central retinal thickness (CRT), indocyanine green angiography (ICGA) characteristics, numbers and type of treatment were analysed at baseline and at 1 year. One hundred and one eyes included from 95 patients received either anti-VEGF injections (n = 79, 78.2%) alone or combination therapy with anti-VEGF and PDT (n = 6, 6%). A third untreated group was also observed (n = 16, 15.8%). Five eyes were excluded from the study due to structural retinal damage. Mean number of injections was 7.3 in the monotherapy group and 6.5 in the combination group. Both treatment groups showed improvement in BCVA at 1 year and this was statistically significant in the monotherapy group with a mean gain of 8.3 letters (p < 0.001). Mean CRT decreased in all treatment groups at twelve months and this change was significant (p < 0.01). In the observation group, vision and CRT remained stable. This study demonstrates significant improvements in BCVA at one year in our Caucasian cohort of British ethnicity with PCV in the treatment group.

A clinical study of the neodymium-doped yttrium–aluminium–garnet laser posterior capsulotomy: Visual outcome and early complications

Objectives: The objectives of this study were as follows: To study the efficacy of neodymium-doped yttrium–aluminium–garnet (Nd:YAG) laser capsulotomy in posterior capsular opacification (PCO) by analysing the visual outcome. To study any other early complications seen following Nd:YAG laser capsulotomy. Materials and Methods: A prospective interventional study was done in the Department of Ophthalmology of a tertiary care hospital in the Marathwada region of Maharashtra. A total of 55 eyes developing PCO after cataract surgery were included in the study from November 2022 to October 2023. Routine pre-laser evaluation using slit-lamp biomicroscopy, intraocular pressure (IOP) measurements and dilated fundus examination was done. Thirty-eight patients had undergone manual small incision cataract surgery with polymethyl methacrylate intraocular lens (IOL) implantation and 17 patients had undergone phacoemulsification surgery with acrylic foldable IOL implantation. The patient was then followed up on Days 2, 7, 30, and 3 months to look for any early post-laser complications. Results: A total of 55 eyes were included in the study. The age group of patients included in the study is from 50 to 75 years. Most of the patients 21 were in the age group of 56–60 years. Twenty (36%) were male and 35(63%) females; thus, female preponderance is seen. On retro-illumination of the slit lamp, 9 (16.3%) patients had severe PCO having vision ≤3/60, 24 (43.6%) patients had moderate PCO with vision 3/60–6/60 and 22 (40%) patients had mild PCO with vision 6/60–6/18. Forty-seven patients (85%) had visual acuity of more than 6/12 at the end of 3 months. In most patients, an appropriate central capsulotomy was achieved within the total energy of 60 mJ but in three cases more than 100 mJ energy was used due to the thick posterior capsule. About 6% of subjects showed increased IOP of more than 21 mm Hg but returned to normal level within 1 week. Mild uveal reaction in the form of anterior chamber flare and cells was seen in 2% of cases. IOL pitting was seen in 5 (8%) cases. One (2%) patient had a vision of 3/60 and a significant increase in macular thickness at day 7 post-laser which decreased at 1 month follow-up by appropriate treatment. No evidence of any retinal tears or retinal detachment seen. Conclusion: PCO is a common delayed complication seen after cataract surgery. This opacification decreases the vision of the patient to affect day-to-day activities. It can be easily managed on an outdoor basis by a non-invasive and effective Nd:YAG laser posterior capsulotomy procedure. This procedure has been shown to increase the visual outcome and has fewer complications which can be managed easily.

Gender, Race, and Ethnicity of US Academic Ophthalmology Faculty and Department Chairs From 1966 to 2021

Workforce diversity is integral to optimal function within health care teams. To analyze gender, race, and ethnicity trends in rank and leadership among US full-time academic ophthalmology faculty and department chairs between 1966 and 2021. This cohort study included full-time US academic ophthalmology faculty and department chairs registered in the Association of American Medical Colleges. Study data were analyzed in September 2023. Identifying with an underrepresented in medicine (URiM) group. The main outcome measures were demographic (ie, gender, race, and ethnicity) changes among academic faculty and department chairs, assessed in 5-year intervals. The term minoritized race refers to any racial group other than White race. There were 221 academic physicians in 1966 (27 women [12.2%]; 38 minoritized race [17.2%]; 8 Hispanic, Latino, or Spanish [3.6%]) and 3158 academic faculty by 2021 (1320 women [41.8%]; 1298 minoritized race [41.1%]; 147 Hispanic, Latino, or Spanish ethnicity [4.7%]). The annual proportional change for women, minoritized race, and Hispanic, Latino, or Spanish ethnicity was +0.63% per year (95% CI, 0.53%-0.72%), +0.54% per year (95% CI, 0.72%-0.36%), and -0.01% (95% CI, -0.03% to 0%), respectively. Women were underrepresented across academic ranks and increasingly so at higher echelons, ranging from nonprofessor/instructor roles (period-averaged mean difference [PA-MD], 19.88%; 95% CI, 16.82%-22.94%) to professor (PA-MD, 81.33%; 95% CI, 78.80%-83.86%). The corpus of department chairs grew from 77 in 1977 (0 women; 7 minoritized race [9.09%]; 2 Hispanic, Latino, or Spanish ethnicity [2.60%]) to 104 by 2021 (17 women [16.35%]; 22 minoritized race [21.15%]; 4 Hispanic, Latino, or Spanish ethnicity [3.85%]). For department chairs, the annual rate of change in the proportion of women, minoritized race, and Hispanic, Latino, or Spanish ethnicity was +0.32% per year (95% CI, 0.20%-0.44%), +0.34% per year (95% CI, 0.19%-0.49%), and +0.05% per year (95% CI, 0.02%-0.08%), respectively. In both faculty and department chairs, the proportion of URiM groups (American Indian or Alaska Native, Black or African American, Hispanic, and Native Hawaiian or Other Pacific Islander) grew the least. Intersectionality analysis suggested that men and non-URiM status were associated with greater representation across ophthalmology faculty and department chairs. However, among ophthalmology faculty, URiM women and men did not significantly differ across strata of academic ranks, whereas for department chairs, no difference was observed in representation between URiM men and non-URiM women. Results of this cohort study revealed that since 1966, workforce diversity progressed slowly and was limited to lower academic ranks and leadership positions. Intersectionality of URiM status and gender persisted in representation trends. These findings suggest further advocacy and intervention are needed to increase workforce diversity.

Clinical characteristics of acute macular neuroretinopathy in China associated with COVID-19 infection

Objective: To investigate the clinical features of acute macular neuroretinopathy (AMN) following coronavirus disease 2019 (COVID-19). Methods: This retrospective case series study included 15 patients (28 eyes) diagnosed with AMN at the Department of Ophthalmology, Peking University Third Hospital, from November 2022 to January 2023. The AMN group comprised 4 males and 11 females, with a mean age of (31.36±8.08) years. A control group of 15 individuals [5 males, 10 females; mean age (33.20±5.10) years] who had COVID-19 but did not develop AMN was also included. Data collected for all patients included best-corrected visual acuity (BCVA), slit-lamp examination, dilated fundus examination, color fundus photography, fluorescein fundus angiography (FFA), and optical coherence tomography (OCT) results. Serum cytokine levels, including interleukins (ILs), interferons (IFNs), and tumor necrosis factor-alpha (TNF-α), were measured for both groups. Results: Among the 28 eyes, severe vision loss (BCVA≤0.3) was observed in 3 eyes (10.7%), moderate vision loss (BCVA>0.3 and≤0.5) in 2 eyes (13.3%), and mild vision loss (BCVA>0.5 and≤1.0) in 23 eyes (82.1%). OCT findings in all 28 eyes revealed hyperreflectivity of the outer nuclear layer and disruption of outer retinal structure. Additionally, 3 eyes (10.7%) exhibited cotton wool spots in the posterior pole, 2 eyes (7.1%) showed mild cystoid macular edema with intraretinal hyperreflective dots, and 1 eye (3.6%) presented with paracentral acute middle maculopathy. FFA indicated retinal vasculitis in 2 cases (4 eyes, 14.3%). Serum levels of IL-4, IL-5, IFN-α, and IFN-γ were significantly higher in the AMN group compared to the control group: IL-4 [4.49 (3.66, 6.08) vs. 1.40 (0.62, 1.68) pg/ml], IL-5 [7.34 (5.04, 14.06) vs. 0.17 (0.11, 1.86) pg/ml], IFN-α [8.42 (6.31, 14.89) vs. 0.50 (0.30, 0.83) pg/ml], and IFN-γ [17.93 (12.75, 32.44) vs. 7.43 (0.00, 14.74) pg/ml], with all differences being statistically significant (all P<0.05). Conclusion: AMN following COVID-19 can present with wedge-shaped dark red lesions in the macular area, often accompanied by cotton wool spots and retinal vasculitis. Additionally, there is a significant elevation in various inflammatory cytokines in the serum.

Correlation of posterior segment lesions with anterior segment biometric parameters and FBN1 genotype in patients with Marfan syndrome

Objective: To investigate the characteristics of posterior segment lesions in Marfan syndrome (MFS) patients and their relationship with anterior segment biometric parameters and FBN1 genotype. Methods: A cross-sectional study was conducted. A total of 121 MFS patients, 76 males and 45 females, with an average age of (11.72±11.66) years, who visited the Department of Ophthalmology, Eye & ENT Hospital of Fudan University from January 2013 to March 2023 were included. The presence of posterior scleral staphyloma was observed using B-mode ultrasound, and macular lesions were identified and classified using the atrophy-traction-neovascularization system based on ultra-widefield fundus images, color fundus images, and optical coherence tomography scans. Anterior segment biometric parameters, including axial length of the eye, average corneal curvature, corneal astigmatism, horizontal corneal diameter, anterior chamber depth, and lens thickness, were collected, and the direction and extent of lens dislocation were observed. Molecular genetic analysis of FBN1 gene mutations in patients was performed using next-generation sequencing based on a panel of ocular genetic diseases, and the impact of the genotype and anterior segment biometric parameters on the posterior segment manifestations was analyzed. Results: Sixty patients exhibited posterior segment lesions, including retinal detachment (4 cases, 3.31%), macular lesions (47 cases, 38.84%), and posterior scleral staphyloma (54 cases, 44.63%). There was statistically significant difference in axial length of the eye between patients with and without posterior scleral staphyloma [23.09 (22.24, 24.43) and 27.04 (25.44, 28.88) mm], between patients with and without macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.78) mm], and between patients with and without atrophic macular lesions [23.16 (22.24, 24.61) and 27.04 (25.74, 28.79) mm] (all P<0.001). There was statistically significant difference in anterior chamber depth between patients with and without macular lesions [3.11 (2.75, 3.30) and 3.34 (3.09, 3.60) mm] (P<0.05). There was also statistically significant difference in corneal astigmatism between patients with and without posterior scleral staphyloma [2.15 (1.20, 2.93) and 1.40 (1.00, 2.20) diopters] (P<0.05). The location and region of the FBN1 gene mutation not only showed statistically significant difference from the positive rates of posterior scleral staphyloma and macular lesions (all P<0.05), but also influenced the occurrence of atrophic macular lesions (both P<0.05). Patients with FBN1 mutations located in the transforming growth factor β regulatory sequence had the highest proportion of posterior scleral staphyloma and macular lesions (both 10/11). Conclusions: Posterior scleral staphyloma and macular lesions have a relatively high incidence in MFS patients and tend to progress to more severe grades. The age, axial length of the eye, anterior chamber depth, corneal astigmatism, and location and region of the FBN1 gene mutation are factors affecting the posterior segment lesions in MFS patients.

Clinical observation of the subthreshold micropulse laser combined with ranibizumab for treatment of diabetic macular edema

Objective: To evaluate the efficacy and safety of the subthreshold micropulse laser (SMPL) combined with ranibizumab in treating diabetic macular edema (DME). Methods: This was a prospective randomized controlled study. Patients diagnosed with DME in the Ophthalmology Department of Beijing Hospital were enrolled from January 2020 to December 2022. Patients were randomized in a ratio of 1∶1 using a table of random numbers into the ranibizumab monotherapy group and the SMPL combined with ranibizumab therapy group. We compared the changes of best-corrected visual acuity, central macular thickness measured by optical coherence tomography and optical coherence tomography angiography parameters, including the vessel density of the superficial and deep capillary plexus (DCP), foveal avascular zone size and peripapillary vessel density, at baseline, 6 and 12 months after the treatment. After 12 months of follow-up, fundus fluorescein angiography results, adverse events, and the number of injections or laser therapies were recorded. The Fisher's exact test and group t-test were used for statistical analysis. Results: Seventy-two patients (72 eyes) were enrolled, with a mean age of (61.1±8.2) years. Patients in the combination therapy group included 19 males and 17 females, while patients in the ranibizumab monotherapy group were 17 males and 19 females. There was no statistically significant difference in baseline characteristics between the two groups (P>0.05). A significant improvement in best-corrected visual acuity was shown in both groups at 6 and 12 months [(58.5±12.9) and (58.2±12.2) ETDRS letters in the combination therapy group, and (63.3±13.1) and (63.8±12.5) ETDRS letters in the ranibizumab monotherapy group]. A significant reduction in central macular thickness was shown in both groups at 6 and 12 months [(451.0±185.5) and (380.4±159.3)μm in the combination therapy group, and (387.5±135.5) and (372.8±146.1)μm in the ranibizumab monotherapy group]. However, there was no significant difference between groups at each timepoint (all P>0.05). At 12 months, the vessel density of the superficial capillary plexus showed no statistical difference compared to the baseline value in each group or between groups (42.6%±5.9% in the ranibizumab monotherapy group and 42.2%±5.5% in the combination therapy group, P>0.05). The vessel density of the DCP in the combination therapy group significantly increased to 47.5%±5.6% at 12 months, significantly different from that in the ranibizumab group (43.4%±5.1%; P<0.05). The foveal avascular zone size in the ranibizumab monotherapy group reduced to (0.32±0.13) mm2, significantly different from that in the combination therapy group [(0.34±0.16) mm2] at 12 months (P<0.05). Patients in the ranibizumab monotherapy group received (7.3±2.5) intravitreal injections, while patients in the combination therapy group received 3 injections. No unfavorable outcomes on fundus fluorescein angiography or systemic or topical severe adverse events were observed during the follow-up. Conclusions: The SMPL combined with intravitreal ranibizumab injections was effective and safe in treating DME patients. The combination treatment significantly reduced the number of injections and improved the vessel density of the DCP and macular ischemia, compared to the ranibizumab monotherapy.