Ocular Complaints Research Articles

Central serous chorioretinopathy secondary to intramuscular testosterone therapy.

A patient treated with intramuscular testosterone replacement therapy for primary hypogonadism developed blurred vision shortly after receiving his testosterone injection. The symptom resolved over subsequent weeks and recurred after his next injection. A diagnosis of central serous chorioretinopathy (CSR) was confirmed following ophthalmology review. A decision was made to change the patient's testosterone regime from this 12-weekly intramuscular injection to a daily topical testosterone gel, given the possibility that peak blood levels of testosterone following intramuscular injection were causing his ocular complaint. His CSR did not recur after this change in treatment. CSR secondary to testosterone therapy is a rare finding but has been reported previously in the literature. Blurred vision in patients treated with testosterone replacement therapy (TRT) should prompt an ophthalmology review. The potential for reduced risk of central serous chorioretinopathy (CSR) with daily transdermal testosterone remains a matter of conjecture. CSR is a rare potential side effect of TRT.

Detecting color vision deficiency in patients presenting with ocular complaints.

Objective: To detect color vision deficiency in patients presenting with ocular complaints. Study Design: Descriptive Cross Sectional study (Case Series). Setting: Department of Outpatient, THQ hospital, Daska, Sialkot. Period: 01 January 22 to 30 June 22. Material & Methods: Patients of all ages and both genders presenting to the outpatient department with ocular complaints. Patients who were uncooperative / non responsive, aware of their CVD, visually/ mentally handicapped or deaf, had a medical history of systemic disease, on CNS medications, had ocular pathology (corneal, retinal disease, cataract). Color vision defects were detected using Ishihara pseudo isochromatic colored plates (38). All the data was entered and analyzed using Microsoft excel spreadsheet software. Descriptive data was represented as range and mean ± SD whereas the qualitative variables were represented as frequencies and percentages. Results: Out of 687, 65.79 % (452) were males with a mean age of 36±12.62 years and 34.2% (235) were females with a mean age of 37±9.2 years. We found color vision deficiency in 4.22% of males and in 0.58% of females. Conclusion: We found CVD was present in a significant number of patients and none were aware of their Color vision deficiency and handicap.

Relationship of Corneal Endothelial Morphology and Central Corneal Thickness to Age and Sex in Normal Healthy individuals in our Community

Background: Central corneal thickness and corneal endothelial morphology was studied along it's relationship with age and sex. Objective: To determine the normative data of central corneal thickness and endothelial morphology in our population. Methodology: This is a Cross-sectional study. The study was done at Ophthalmology Department, FRPMC in accordance with the declaration of Helsinki from March 2021 to August 2021 with approval from the Institutional review board. All healthy individuals aged 20 to 70 years presenting with any ocular complaints but no corneal pathology were included. Individuals with any systemic and ocular co-morbidity were excluded. After a complete ocular examination, corneal specular microscopy was done using REXAM SPM-700 corneal specular microscopes. In our study, we analyzed CCT, ECD, MCA, CV and hexagonality. The data was collected and recorded on an Excel spreadsheet and then transformed to SPSS version 22 for statistical analysis. Results: 724 eyes from 362 individuals were studied for CCT and endothelial morphology using Rexam SPM-700 microscopes. There were 241(66.6%) males and 121(33.4%) females with mean age 38.33±10.17 years. Among 724 eyes we found CCT (508.43±33.4um), ECD (2565.12±254.15cell/mm2), AVG (393.81±40.72um2), CV (39.54±6.43%), and Hexa (46.18±6.64%). Statistically, there was no significant difference between the right and left eyes of the study population as well as gender-wise. There is a statistically significant inverse correlation of ECD with age (p<0.00, r:-0.19). However, a statistically insignificant inverse correlation is found for CV and Hexa with age (p<0.17, r:-0.05) (p<0.70, r:-0.014) respectively. Conclusion: Our study reports the normative corneal endothelial morphology and thickness in the Pakistani population attending FRPMC Ophthalmology Department. We also found that Central corneal thickness and Endothelial cell density decrease with aging and no statistical difference gender-wise.

Access to Pediatric Eye Care During a Pandemic: Systematic Review and Meta-Analysis.

Visual impairment affects many children and can lead to blindness if untreated. The coronavirus disease 2019 (COVID-19) pandemic has led to various restrictions and other challenges accessing in-person medical care, including essential pediatric eye care. The aim of this article was to determine and quantify the effect that pandemics have on access to pediatric eye care. A systematic literature search was conducted using various databases, which yielded 257 articles; nine were included in the final review. All included studies reported a decrease in the number of children accessing eye care during COVID-19. Most studies described virtual triage systems, which restricted in-person care to emergent cases. The average decrease in daily pediatric visits was 67.32% and reached statistical significance in the meta-analysis (P < .01). However, out of all patients with ocular complaints, the proportion of pediatric visits was unchanged, suggesting that the decrease in access to eye care was not specific to pediatric patients. [Pediatr Ann. 2023;52(2):e68-e75.].

OCULAR COMPLAINTS DURING COVID-19 LOCKDOWN AMONGST PRIVATE UNIVERSITY STUDENTS IN SELANGOR, MALAYSIA

Aim:COVID-19 lockdown has led to the emerging concept of studying from home. Research has shown that increased near visual work causes dry eye complaints. This study aims to determine the association between electronic device usage during the COVID-19 lockdown and ocular complaints among university students. Methods:Through convenience sampling, the 544 responses to an online survey were distributed to private university students in Selangor, Malaysia. Results: Analysis of the responses demonstrated a dramatic increase in the percentage of students who spent 5 hours and more on an electronic device from 44.8% before the lockdown to 94.1% during the lockdown. 83.3% of the participating students had symptoms of dry eye disease, and 54.1% were graded as severe. There was a statistically signicant association between age groups, race, and taking breaks between electronic device usage, room illumination, and OSDI severity. Conclusion: The results indicate that lockdown does have an impact on dry eye symptoms. On this basis, frequent breaks in between continuous usage of electronic devices should be cultivated. Further research with a larger sample size is needed to identify the association between the sociodemographic factors, electronic device usage-related factors, and the severity of dry eye symptoms

“Rede hit sofft”: John Audelay's Practice of Care

“Rede hit sofft”: John Audelay's Practice of Care

Spectacle compliance postcataract surgery significantly improved vision function-related quality of life of adult patients in India: Evidence from a multicenter longitudinal cohort study.

Cataract is the leading cause of avoidable blindness globally. This study aims to measure the changes in Vision function-related quality of life (VFQoL) before and after cataract surgery and identify the predictors of an improvement in these outcomes. A multicenter, longitudinal cohort study was conducted. Patients with first eye cataracts were interviewed before and 6 months after cataract surgery. Multiple classification analysis (MCA) was performed to assess variation in the intensities of mean change scores for general function, psychosocial impact, and visual function with select factors. A total of 747 participated in the baseline assessment. The 6-month follow-up rate was 86.5%. The mean general function, psychosocial impact, and visual function scores were 35.3 (±8.6), 12.5 (±3.4), and 8.3 (±3) in the baseline and 17 (±5.3), 6 (±2.2) and 3.8 (±1.3) in the follow-up assessments, respectively. In MCA, patients using spectacles postsurgery (β 0.111) and those having a very good postoperative visual acuity (β 0.098) had the most impact on general function. Patients reporting no ocular complaints postsurgery had a relatively higher effect on the psychosocial impact, (β 0.168) and similarly, patients using spectacles postsurgery and those aged 70 and older had the most impact on the visual function scores (β 0.146 and 0.126), respectively. Cataract surgery is associated with meaningful improvements in vision and VFQoL in general. The determinants of better VFQoL include the usage of spectacles postsurgery. Strategies to further improve patient participation in postoperative review visits are needed for spectacle provision and patient education regarding spectacle use and compliance is imparted during such visits.

A modified surgical technique of fibrin glue-assisted double bipedicle conjunctival flaps for patients with ocular surface diseases.

This study aimed to describe and investigate the surgical outcome and complications of fibrin glue-assisted double bipedicle conjunctival flaps (CFs) (FADCOF), an alternative surgical technique that restores a stable ocular surface in patients with painful blinding ocular surface disease combined with a shortage of bulbar conjunctiva. Six eyes of six patients with painful blinding ocular surface disease were enrolled in this study. All patients had inadequate superior or inferior conjunctiva tissue to cover the whole corneal surface owing to previous surgeries or ocular surface diseases. These patients received FADCOF between 2009 and 2019. The main outcome included surgical success rate, visual analog scale (VAS) pain score, ocular inflammation score, and postoperative complications. Surgical success was defined as resolution of initial ocular complaints and restoration of a stable ocular surface with no flap melting, retraction, or dehiscence resulting in re-exposure of the corneal surface. All of the six eyes (100%) achieved surgical success. All patients reported significant improvement in subjective symptoms and complete resolution of ocular pain after the surgery (VAS pain score: 6.5 ± 0.5 preoperatively to 0.0 ± 0.0 at 1 month). Ocular inflammation score decreased significantly from a presurgical value of 1.83 ± 0.69 to 0.33 ± 0.47 1 month after the surgery. No postoperative complication was found during the long-term follow-up (range: 12-82 months). FADCOF is a reliable alternative for patients with painful blinding ocular surface diseases unsuitable for single total CF surgery. This surgical technique yields fast ocular surface stabilization, satisfactory recovery, and low complication rates.

Prospective Study of Clinical Characteristics and Visual Outcome in Vogt–Koyanagi–Harada Syndrome in a Tertiary Eye Hospital in South India

Purpose: To describe the demographic pattern, clinical characteristics, treatment modalities, and visual outcome in Vogt–Koyanagi–Harada (VKH) disease patients observed at a tertiary eye care centre in South India. Methods: A prospective chart analysis of 38 patients with VKH disease. Results: Of the 38 VKH patients, 31 (81.6%) were female, the mean age was 39.8 years, and the median duration of symptoms was 10 days (range: 2 to 180 days). The most common ocular complaint was a defective vision (70 eyes or 92.1%). Extraocular manifestations were headache (13 patients or 34.2%) and tinnitus (4 patients or 10.5%). Twenty-four patients (63.2%) presented with bilateral panuveitis, and 12 patients (31.6%) had posterior uveitis. The most common posterior segment presentation included bilateral serous retinal detachment (100%), disc oedema (37 eyes or 48.7%), and vitritis (31 eyes or 40.8%). All patients (100%) were treated with oral and topical prednisolone, based on the ocular inflammation status, 9 patients (23.7%) required dexamethasone (intramuscular), 39 eyes (51.3%) required posterior subtenon triamcinolone, 16 patients (28.9%) required methotrexate, 1 (2.6%) required cyclophosphamide, 1 (2.6%) required azathioprine. At the final visit, the majority of the patients had statistically significant good visual outcomes. Conclusion: Prompt diagnosis and early initiation of treatment with systemic, local steroid and immunosuppressive therapy showed faster recovery with good visual outcome.

Evaluation of incidence of the adult-onset vitelliform macular dystrophy among patients in Far Eastern Federal District of Russia

BACKGROUND: Adult-onset vitelliform macular dystrophy is one of the pathologic conditions , which successfully masks as age-related macular degeneration.&#x0D; AIM: To assess the incidence of the adult-onset vitelliform macular dystrophy among patients of a major ophthalmological clinic in the Far Eastern Federal District of Russia.&#x0D; MATERIALS AND METHODS: We revealed the cases of adult-onset vitelliform macular dystrophy among 1000 patients aged 40 years and older who addressed for various ocular complaints.&#x0D; RESULTS: Adult-onset vitelliform macular dystrophy was found in 2 male patients aged 43 and 66 years. In the macular area of both eyes of the 1st patient, round yellow lesions in the foveola, local detachment of neuroepithelium, optically dense material deposits on the outer photoreceptor segments were detected (vitelliruptive stage of adult-onset vitelliform macular dystrophy). In the left eye of the 2nd patient, in the foveola, a single round yellow focus of 200 m was found, optically dense vitelliform material was detected between the pigment epithelium and neuroepithelium layers without any signs of choroidal neovascularization (vitelliform stage of adult-onset vitelliform macular dystrophy).&#x0D; CONCLUSIONS: The incidence of adult-onset vitelliform macular dystrophy among patients with various ocular conditions was 0.2%. Morphological changes in the macula consist in presence of deposits of vitelliform material, localized between the neuroepithelium and retinal pigment epithelium layers.

Microsporidial Keratitis - First Case Series of a Rare Pathogen in the Wake of Flood Disasters of 2022 in Pakistan.

The recent monsoon rains in Pakistan were unprecedented and caused flooding all over Pakistan, especially in Sindh and Balochistan. Following this national disaster, various water-borne and contagious diseases started erupting all over the country. In such a calamity-struck city of Jacobabad, we started receiving cases with a peculiar set of ocular complaints mimicking viral keratoconjunctivitis. Failure to respond to traditional treatment and the unique appearance of these corneal opacities led to a rare diagnosis of Microsporidial Keratoconjunctivitis, which was later confirmed by microscopy and staining of corneal scrapings of the most affected case. In line with published literature, all cases were treated with topical fluoroquinolone and topical anti-fungal therapy, following which the disease was cleared within a week. The disease has seen an upward trend the world over, especially among Asia. To the best of our knowledge, no such cases have been reported in Pakistan as yet. In this case series, we highlightthe strong correlation of emergence of microsporidial keratitis in patients following exposure to pooled water bodies after the monsoon rainy season and floods. Moreover, this report will help create awareness in eye professionals regarding the prevention, timely diagnosis and treatment of these rare and emerging cases. Key Words: Keratitis, Spores, Water-borne diseases, Microsporidia.

Commentary: What the eye sees, Let's make the world see - Smart evolution of teleophthalmology.

Commentary: What the eye sees, Let's make the world see - Smart evolution of teleophthalmology.

Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India.

To report the demographic profile of patients registered through e-Sanjeevani OPD seeking teleophthalmology services. This was a cross-sectional data analysis of patients with ocular complaints registered through the e-Sanjeevani platform at a tertiary care center. It was a doctor-to-doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient's age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. e-Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment.

A Novel Ocular Tonometry Task Trainer.

The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry. We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice. The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}). We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.

Risk Factors Affecting Dry Eye Symptoms among Visual Display Terminal Users

Introduction: Dry eye symptoms are the common ocular complaints that are found at the ophthalmologic outpatient services. This research’s main purposes were to study the risk factors associated with dry eye symptoms and to evaluate the severity of dry eye among Visual Display Terminal (VDT) users. Methods: This study was a descriptive observational study involving 104 VDT users in 3 branches of the Social Security Offices and the Bureau of Labor Protection and Welfare in Samutprakarn province, Thailand. The study instruments used were: (1) questionnaires associated with VDT use and dry eye symptoms that were evaluated by using the Ocular Surface Disease Index (OSDI) and (2) Lux meter for desk-brightness and the angle of gaze measurement during VDT use. Data were analyzed using a Chi-square test and multiple logistic regression. Results: The results found that VDT users had severe dry eye symptoms, accounting for 51.9%, and experienced moderate and mild dry eye symptoms in the same number, which was 24.0%. In addition, dry eye symptoms were related to VDT use for 5-7 hours/day with statistically significant value. Other VDT use factors, including the desk-brightness or the angle of gaze during VDT use, were related to severe dry eye symptoms with no statistically significant difference. Conclusion: Based on the findings, VDT users should use VDT no more than 5 hours/day in order to reduce VDT-related dry eye symptoms. these factors were not statistically significant for the occurrence of severe dry eye symptoms.

Ocular Injuries Related to Grooming Visits in Dogs: 161 Cases (2004-2020).

Owners of dogs with ocular issues often suspect their pet's eye problems are linked to recent grooming visits. A medical records search was performed to identify dogs presenting with ocular complaints initially noted within 24 hr of a commercial grooming appointment. Data collected included signalment, type of injury, treatment, and notations regarding behavioral issues potentially contributing to injury. One hundred sixty-one episodes involving 159 dogs were identified. Male dogs accounted for 57% of episodes. Median age at presentation was 59 mo. Shih tzu were involved in 34% of incidents, and 71% involved small-breed dogs. Aggressive or reactive behaviors were reported in 33% of dogs. Corneal ulceration was the most common injury (71% of incidents), followed by conjunctivitis (11%), eyelid lacerations (7%), and subconjunctival hemorrhage (6%). Surgical management was required in 14% of cases, including four dogs that underwent enucleation. Ocular injury during grooming appointments can occur via several mechanisms including trauma, exposure to grooming products, or inadvertent strangulation. Small-breed dogs, particularly shih tzu, appear to be at increased risk. Reactive or aggressive behavior likely increases risk of ocular injury. Veterinarians can help limit grooming-associated ocular injuries by recommending behavioral or pharmacological interventions before grooming visits.

The Impact of the COVID-19 Pandemic on Emergency Department Visits Resulting in Ophthalmology Consultations.

Introduction The aim of this study is to determine the characteristics of eye-related emergency department (ED) visits resulting in ophthalmology consultation during the COVID-19 pandemic and compare them against an equivalent period from the previous year. Methods In this study, we reviewed the charts of patients who were admitted to ED with ocular complaints between March 11th, 2020 (the date of the first COVID-positive case in our country) and March 11th, 2021 (Study period 1; SP1) and those who were admitted to ED within the equivalent period of the previous year (Study period 2; SP2). The frequency of eye-related cases, the urgency status of complaints, diagnosis, treatment applied, and hospitalization status of the patients were compared. Results The proportion of ophthalmology consultations among all medical departments decreased from 4.52% to 4.04% (p<0.001). There was a 40.5% reduction in eye-related ED admissions during the pandemic, and the top three ocular diagnoses were foreign bodies of the ocular surface (24.3%), corneal abrasion (18.7%), and blow-out fractures (6.2%) during SP1. The proportion of urgent eye-related emergency visits increased during the pandemic year (80.7% of total cases) compared to the year prior to the pandemic (66.0% of total cases) (p<0.001). Although the number of ophthalmology consultations per day decreased during lockdown periods, this decrease was not statistically significant. Conclusion During the first year of the COVID-19 pandemic, the number of eye-related ED visits decreased in comparison to the year which preceded the pandemic. However, the proportion of urgent visits increased during the pandemic. Understanding the circumstances under which patients seek eye care in EDs is critical to rendering the optimal level of service of available resources.

This Month in Anesthesiology

This Month in Anesthesiology

Ocular findings in asymptomatic patients with primary antiphospholipid syndrome.

Primary antiphospholipid syndrome (PAPS) is characterized by the presence of antiphospholipid antibodies (aPL), repetitive fetal loss, and arterial/venous thrombosis and no association with other autoimmune rheumatic disease. Ocular involvement can also occur including retinal vascular thrombosis and neuro-ophthalmological manifestations, such as optic neuropathy and amaurosis fugax. Early detection of ocular changes is crucial to minimize functional loss. To perform a multimodal evaluation, including the use of Optical Coherence Angiotomography (OCTA), in patients with PAPS without ocular complaints and compare with healthy individuals. We performed a complete structural and functional ophthalmological evaluation using OCTA and microperimetry exam in patients with PAPS, followed at a tertiary Rheumatology outpatient clinic. We included 104 eyes of 52 subjects [PAPS without ocular complaints (N = 26) and healthy individuals (N = 26)]. Among PAPS patients, 21 were female (80.8%) and 21 (80.8%) were Caucasians. PAPS manifestations were venous (65.4%), arterial thrombosis (34.6%), and obstetrical (34.6%) and all of them had lupus anticoagulant. Ophthalmologic findings were more frequent in PAPS compared to healthy individuals (19.2% vs. 0%, p = 0.05). The most common retinal change was paracentral acute middle maculopathy (PAMM) (3 patients, 5 eyes), followed by drusen (1 patient, 2 eyes) and pachychoroid pigment epitheliopathy (PPE) (1 patient, 1 eye). Hypertension and hyperlipidemia were present in 100% of the PAPS patients with PAMM, while only six patients (26.1%) with PAPS without PAMM presented these two risk factors together (p = 0.03). We provide novel evidence that approximately 20% of our asymptomatic PAPS patients without ocular symptoms have ophthalmologic findings that require early identification and careful surveillance focusing on minimizing systemic and vascular risk factors.

How Are Sicca Signs and Symptoms Associated With Depression Among Men Classified With and Without Sjögren Disease?

Sjögren disease (SjD) cohorts represent rich resources to study associations between dry eye/mouth (sicca) signs/symptoms and depression. Because SjD affects mainly women, little is known about men with sicca signs/symptoms and associations with depression. The Sjögren's International Collaborative Clinical Alliance contained many men allowing for studying associations between sicca signs/symptoms and depression. We hypothesized that sicca symptoms would be positively associated with depression in males. Cross-sectional study. At baseline, participants completed questionnaires and underwent ocular and oral examinations. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression models were used to identify associations between depression and SjD diagnostic criteria and sicca symptoms. Of 309 males, 98 were classified as SjD, whereas 198 were classified as non-SjD. We found that having a labial salivary gland biopsy with focus score ≥1 foci/mm2 was associated with a lower odds of being classified as depressed (odds ratio [OR]: 0.36, 95% CI: 0.18-0.73, P=.01). Having positive anti-Sjögren syndrome antigen A antibody was associated with lower odds of being classified as depressed (OR: 0.44, 95% CI: 0.23-0.88, P=.02). Higher odds of depression were found with ocular burning (OR: 3.16, 95% CI: 1.74-5.73, P < .001), light sensitivity (OR: 2.59, 95% CI: 1.48-4.55, P=.001), and complaints of dry mouth (OR: 4.58, 95% CI: 1.54-13.63, P=.006). Ophthalmologists should be specific when inquiring about ocular discomfort (focusing on burning and light sensitivity) and consider querying about depression and/or providing mental health resources to those who endorse such qualities.