Ophthalmic Complaints Research Articles

The Use of CT Scan as a Diagnostic Tool in Pet Rabbits Presenting With Signs of Ophthalmic Disease.

To describe the findings of computed tomography (CT) used to investigate signs of ophthalmic disease in pet rabbits. Retrospective review of records of patients with signs of ophthalmic disease that underwent CT scans in three referral centers between 2001 and 2022. Signalment, presenting ophthalmic and nonophthalmic complaints, CT findings, and restrain modality were recorded. There were 85 rabbits representing 14 breeds including 28/85 (32.9%) crossbreed/unknown and 25/85 (29.4%) Dwarf rabbits. The top presenting ophthalmic complaints were ocular discharge (48/85, 56.5%), exophthalmos (34/85, 40%), and epiphora (14/85, 16.5%), while 38/85 (44.7%) rabbits also had nonophthalmic complaints. Anesthetic complications forced 1/85 (1.18%) CTs to be stopped. There were ophthalmic abnormalities in the remaining 81/84 (96.4%) CTs with exophthalmos and/or nasolacrimal duct disease affecting 76/81 (93.8%) rabbits and 68/81 (84%) also showing nonophthalmic abnormalities. Ophthalmic abnormalities were seen with nonophthalmic disease in 64/81 (79%) rabbits with dental disease being the most common (52/64, 81.3%) although only 20/52 (38.5%) had presented with dental complaints. No association was found between the presence of exophthalmos and/or NLD disease and dental disease. There were no obvious image artifacts in the 4/84 (4.8%) physically restrained patients. Examination with CT in the present study mainly supported the investigation of ocular discharge, exophthalmos, and epiphora, and of possible local and systemic involvement in one eye with intraocular neoplasia. Adnexal disease was often seen with previously unknown, nonophthalmic pathology, which warrants prospective, controlled studies. Image quality studies in a large number of physically restrained patients are also warranted.

Eye Emergencies in the Geriatric Population: Single Center Results from 2015-2023

Aim: To evaluate the clinical and demographic characteristics of geriatric patients who apply to the emergency department with ophthalmic complaints, to determine risk factors, design appropriate prevention strategies, and improve existing ones. Material and Methods: The records of patients aged ≥ 65 years who applied to the emergency department with ophthalmic complaints were evaluated retrospectively. The patients were divided into two groups traumatic and non-traumatic based on their presenting complaints. Results: The study included two hundred-five patients with a median age of 72 (65-100). Among the patients, 81 (39.51%) were women with a median age of 74 (65-100), and 124 (60.48%) were men with a median age of 71.5 (65-93). One hundred and twenty-four (60.48%) of the patients were admitted for traumatic reasons and 81 (39.51%) for non-traumatic reasons. Of the patients admitted for traumatic reasons, 25 (20.16%) were women and 99 (79.83%) were men; Of the patients admitted for non-traumatic reasons, 56 (69.13%) were women and 25 (30.86%) were men. Falls (24.19%) were the most common in those admitted for traumatic reasons. According to gender, eye traumas were statistically significantly more common in men than in women (p

Role of pattern and multifocal electroretinogram for macular evaluation in patients with multiple sclerosis treated with fingolimod

Objective To detect the role of pattern electroretinogram (PERG) and multifocal electroretinogram (MfERG) for macular function evaluation in patients with relapsing–remitting multiple sclerosis (RR-MS) treated by fingolimod. Patients and methods This prospective research was carried out on 25 patients with RR-MS (50 eyes), treated by fingolimod, with no ophthalmic disorders or complaints before the onset of the treatment, including no history of optic neuritis. PERG, MfERG, and spectral domain optical coherence tomography were performed before then 3 and 6 months after the treatment. Results Best-corrected visual acuity (BCVA) significantly decreased in third and sixth months compared to baseline (P<0.001). Central macular thickness showed nonsignificant change. PERG waveform abnormalities were detected in 2.5% of patients at third month (P=0.9) and 27.5% in sixth month (P<0.001). PERG P50 amplitude nonsignificantly decreased in third month (P=0.6), then significantly decreased at sixth month (P=0.021). PERG N95 amplitude showed no significant difference (P=0.345). MfERG revealed nonsignificant decrease of P1 amplitude of all five rings at third and sixth months. The duration of MS had significant negative correlations with BCVA, amplitude, and amplitude change of P1 of both ring 1 and ring 2. Conclusion Treatment with fingolimod for 6 months led to a significant reduction in BCVA and PERG responses and a slight decrease in P1 amplitude of MfERG before detection of any structural macular changes by optical coherence tomography. This indicates the role of PERG and MfERG as biomarkers for the early detection of macular function alteration in RR-MS fingolimod-treated cases.

Assessment of visual function in patients with posterior fossa tumours

Introduction. Posterior fossa tumours (PFTs) frequently present with ophthalmic complaints. The literature is mainly focused on PFTs affecting the pediatric age group, and the post-treatment visual outcomes (VOs) are scarcely reported. Objective. To evaluate the VOs at 6 months following the index surgery in patients with PFTs. Materials and methods. This retrospective study involved 50 patients of all age groups who underwent surgical resection of PFTs in the Department of Neurosurgery. The patients with PFTs, except those with low-grade tumours, received concurrent chemo-radiotherapy. Pre- and postoperative (6 months after the index surgery) ophthalmic examinations were done and compared. VOs included colour vision, night vision, visual acuity (VA), pupillary function (size, reactivity), papilledema grade, splinter haemorrhage, retinal venous dilatation, strabismus (esotropia and hypertropia), and nystagmus. Results. The patients were mainly aged 1–10 years (22%) with slight female predominance (52%). The most common PFTs were brainstem glioma and pilocytic astrocytoma (each 18%). At 6 months, there was no significant change in colour and night vision, pupil size and reactivity, splinter haemorrhage, and hypertropia (all p-values>0.05). A significantly lesser proportion of patients had moderate VA (p-value=0.013), retinal venous dilatation (p-value=0.001), and grade 1 (p-value=0.005) as well as grade 4 papilledema (p-value=0.041). Moreover, a significantly greater proportion of patients had grade 0 papilledema (p-value<0.0001). While the incidence of nystagmus and esotropia increased significantly (both p-values<0.0001). Conclusion. At 6 months, the majority of the patients had good VOs, including significant improvement in moderate VA, papilledema, and retinal venous dilatation. While nystagmus and esotropia increased significantly.

Ocular and adnexal injuries after two major earthquakes in Turkey on February 6, 2023.

This study aimed to determine the forms of ocular and adnexal injuries and to examine the treatment modalities applied after two major earthquakes in Turkey on February 6, 2023. Following the earthquakes, the medical records of 34 patients admitted with emergency ophthalmic complaints to Hatay Training and Research Field Hospital and Etlik City Hospital were retrospectively reviewed. Of these patients, 35 eyes of 34 individuals diagnosed with earthquake-related ocular and adnexal injuries were included in the study. Demographic characteristics were recorded, including ocular and adnexal findings, treatment modalities, and postoperative complications. Of the patients, 16 (47.1%) were female, and 18 (52.9%) were male. The mean age was 37.38 ± 17.3 years. The mean time from the earthquake to the first admission to the hospital was 3.82 ± 1.78 days. Initial and final best-corrected visual acuities (BCVA) were 0.54 ± 0.66 logMAR and 0.22 ± 0.41 logMAR, respectively (p = 0.0003). The initial and final BCVA of 2 eyes was no light perception. The most common forms of ocular/periocular injury associated with earthquakes were eyelid laceration (n:25, 71.4%) and orbital fracture (n:17, 48.6%). The most common accompanied systemic trauma was extremity/rib fractures (38.2). The most frequently performed surgery was the primary repair of the eyelid/canalicular (n:17, 48.6%). While earthquake-related ocular and adnexal traumas are relatively uncommon, understanding the specific injury types, promptly identifying cases requiring urgent intervention, and mastering effective treatment modalities are essential for minimizing the risk of severe permanent visual impairment in these patients.

The use of digital devices and changing habits among generation alpha in Hungary

AbstractPurposeThe aim of the study was to analyse the use of digital devices among children.Materials/MethodsA specially designed questionnaire was distributed to 249 schoolchildren to assess their use of digital devices both in school and outside school. The questionnaire was used before the start of the COVID-19 pandemic. The children were asked about the extent of their use of digital devices, as well as about ophthalmic and general health complaints. Their responses were assessed statistically.ResultsRegarding age distribution, 145 children were between seven and 10 years old when they started to use digital devices. Most of the children used a digital device for between one and two hours a day. The majority preferred using smartphones. The second most popular devices were laptops and tablets, and the third most popular was the desktop computer. Fifty-six children wore glasses, 14 to correct hyperopia and 42 to correct myopia. 97 children spent between one and two hours a day outdoors; 99 children spent more than two hours outdoors; and 51 spent less than one hour outdoors. 71 children reported eye problems; 48 reported other general health problems (back and neck pain); and 43 mentioned blurred vision while using a digital device.ConclusionsThe use of digital devices can be regarded as general among schoolchildren, and most children use a digital device for longer than the recommended time. Excessive use of digital devices may contribute to an increase in the prevalence of myopia and other general eye and back problems.

Exploring Diagnostic Precision and Triage Proficiency: A Comparative Study of GPT-4 and Bard in Addressing Common Ophthalmic Complaints.

In the modern era, patients often resort to the internet for answers to their health-related concerns, and clinics face challenges to providing timely response to patient concerns. This has led to a need to investigate the capabilities of AI chatbots for ophthalmic diagnosis and triage. In this in silico study, 80 simulated patient complaints in ophthalmology with varying urgency levels and clinical descriptors were entered into both ChatGPT and Bard in a systematic 3-step submission process asking chatbots to triage, diagnose, and evaluate urgency. Three ophthalmologists graded chatbot responses. Chatbots were significantly better at ophthalmic triage than diagnosis (90.0% appropriate triage vs. 48.8% correct leading diagnosis; p < 0.001), and GPT-4 performed better than Bard for appropriate triage recommendations (96.3% vs. 83.8%; p = 0.008), grader satisfaction for patient use (81.3% vs. 55.0%; p < 0.001), and lower potential harm rates (6.3% vs. 20.0%; p = 0.010). More descriptors improved the accuracy of diagnosis for both GPT-4 and Bard. These results indicate that chatbots may not need to recognize the correct diagnosis to provide appropriate ophthalmic triage, and there is a potential utility of these tools in aiding patients or triage staff; however, they are not a replacement for professional ophthalmic evaluation or advice.

Ophthalmic findings in Cohen syndrome patient without subjective ophthalmic complaints: A case report.

Cohen syndrome is a rare genetic disorder that can cause various symptoms, including ophthalmic manifestations that can significantly impact a patient's visual health and quality of life. We present the case of a 12-year-old boy diagnosed with Cohen syndrome who exhibited retinal degeneration and macular edema but could not express ophthalmic symptoms due to a developmental disability. The patient was diagnosed with Cohen syndrome by a heterozygous mutation in the VPS13B gene by whole exome sequencing and referred to ophthalmology for an ophthalmic examination. Ophthalmologic tests, including visual acuity, intraocular pressure, slit lamp examination, fundus photography, and optical coherence tomography, were performed. Visual acuity and intraocular pressure were not measured due to poor cooperation, and no abnormal findings were observed on the slit lamp examination. However, peripheral retinal degeneration was observed in the fundus examination, and cystoid macular edema was observed in both eyes on optical coherence tomography. Regular ophthalmologic examination is important for patients with Cohen syndrome, especially those with developmental disabilities who may not be able to express their symptoms. Clinicians should be aware of the potential ophthalmologic manifestations of Cohen syndrome and the importance of timely diagnosis and management.

THU668 Euthyroid Graves’ Ophthalmopathy: Case Series

Abstract Disclosure: S.S. Alfadl: None. A.A. Asiri: None. A.A. Jammah: None. O. Alsagheir: None. Introduction: Graves’ ophthalmopathy is an autoimmune disorder that affects the eyes, characterized by swelling, proptosis, lid lag, inflammation and eyelid retraction. A significant proportion of cases are associated with thyrotoxicosis and positive serum TSH receptor antibody tests. Case Description: We present a case series of euthyroid Graves’ ophthalmopathy in patients with a negative TSH receptor antibody. The first case is of a 37-year-old lady who was recently diagnosed with idiopathic intracranial hypertension due to history of recurrent headaches and was found on CT brain to have an incidental empty sella syndrome and findings highly suggestive of thyroid associated orbitopathy. A dedicated MRI orbit showed bilateral mild proptosis with bilateral medial and inferior recti thickening, sparing the tendinous insertion. The involved extraocular muscles show mild peripheral high T2 signals and minimal enhancement on post gadolinium images. The enlarged extraocular muscle demonstrates diffusion restriction with low Apparent Diffusion Coefficient (ADC) value. Clinically, the patient did not exhibit any symptoms of hyperthyroidism or hypothyroidism. She did not notice any changes in her eyes’ appearance, nor any changes in vision or double vision. On examination, she had mild proptosis, no restriction of extraocular movement or provoked double vision. Consequently, she was referred to Ophthalmology for further management. Investigations included a pituitary panel which did not reveal any abnormalities and a thyroid panel which revealed that she was biochemically euthyroid with a negative TSH receptor antibody test. The second case is of a 24-year-old male who is medically free and initially visited the ophthalmology clinic complaining of double vision, without any additional ophthalmic complaints. He was subsequently referred to our care to rule out thyroid eye disease. Clinically, the patient had no indications of thyroid dysfunction. Upon examination, he exhibited severe right eye proptosis with dystopia and early left eye proptosis. CT orbit showed swelling of the right-sided superior rectus, medial rectus, lateral rectus and left-sided superior rectus muscles. The left-sided superior rectus muscle was abutting the optic nerve. Nevertheless, all tendons were spared. Biochemically, he was euthyroid with unremarkable laboratory results. Conclusion: These findings provide insight into the clinical presentation of euthyroid Graves’ ophthalmopathy in patients without thyrotoxicosis or detectable circulating levels of TSH receptor antibodies. Thus, suggesting that thyroid ophthalmopathy might present earlier than Graves’ disease and even earlier than the presence of TSH receptor antibodies. We conclude that a high index of suspicion and proper follow up is recommended in similar patients for the development of Graves’s disease. Presentation: Thursday, June 15, 2023

Artificial intelligence chatbot performance in triage of ophthalmic conditions

ContexteIl n'est pas toujours possible d'avoir accès à un expert humain lorsque vient le temps de réaliser un triage à la fois abordable et efficace des affections ophtalmiques. Grâce aux progrès récents des robots conversationnels (chatbots) d'intelligence artificielle (IA) accessibles au public, tous peuvent maintenant utiliser ces outils pour réaliser un triage de leurs affections ophtalmiques. Il devient donc nécessaire de mener des études de validation pour évaluer l'efficacité des robots d'IA utilisés en tant qu'outil de triage et aviser le grand public de leur innocuité. ObjectifÉvaluer l'efficacité des robots d'IA pour réaliser un triage des affections ophtalmiques. NatureÉtude transversale. CadreÉtablissement unique. ParticipantsÉtudiants en ophtalmologie et 3 robots conversationnels : les interfaces OpenAI ChatGPT (GPT-4) et Bing Chat, et l'application WebMD Symptom Checker. MéthodesEn mars 2023, on a mis au point 44 vignettes cliniques portant sur des troubles ophtalmologiques fréquents de même que des messages-guides standardisés, que l'on a présentés à chaque robot conversationnel. Les paramètres principaux consistaient en la proportion de réponses qui faisaient ressortir le bon diagnostic inscrit parmi les 3 diagnostics les plus plausibles et la proportion de cas dont le degré d'urgence a été jugé de manière adéquate. Parmi les paramètres de mesure accessoires, citons la présence d’énoncés foncièrement inexacts, le niveau de lecture moyen, le nombre de mots moyens de chaque réponse, la proportion d'attribution et les sources le plus souvent citées. RésultatsLes étudiants en ophtalmologie et les 3 robots conversationnels (ChatGPT, Bing Chat et WebMD Symptom Checker) ont opté pour le diagnostic approprié parmi les 3 diagnostics les plus plausibles dans 42 (95 %), 41 (93 %), 34 (77 %) et 8 (33 %) des cas, respectivement. Le degré d'urgence en matière de triage était exact dans 38 (86 %), 43 (98 %) et 37 (84 %) des cas évalués par les étudiants en ophtalmologie, par ChatGPT et par Bing Chat, respectivement. ConclusionsL'exactitude du diagnostic et du triage obtenue avec ChatGPT, reposant sur le modèle GPT-4, était élevée et comparable à celle des étudiants en ophtalmologie, sans qu'il y ait d’énoncé manifestement inexact. L'interface Bing Chat était assorti d'un taux d'exactitude plus faible, et tendait à surestimer le caractère d'urgence lors du triage.

Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.

Self-Reported Perceptions of Preparedness among Incoming Ophthalmology Residents.

Purpose The purpose of this study was to assess the self-perceived preparedness of incoming postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) ophthalmology interns/residents to carry out core competencies in ophthalmology. Methods An online survey was created using the Survey Monkey survey platform and distributed to all ophthalmology resident applicants to the Bascom Palmer Eye Institute from the 2021 to 2022 and 2022 to 2023 application cycles. The survey contained questions pertaining to demographics, prior ophthalmic experience, online resources that were used to prepare for ophthalmology, and self-perceived preparedness to carry out key clinical skills in ophthalmology. Results A total of 170 responses were obtained (16.1% response rate). Of those, 119 (70%) were incoming PGY1 interns and 51 (30%) were incoming PGY2 residents for the 2022 to 2023 academic year. Most respondents (90.6%, n = 154) reported that their ophthalmology residency was affiliated with an integrated ophthalmology intern year. Incoming PGY2s moderately agreed with the statement that they felt as prepared to see patients in ophthalmology as they do in other surgical subspecialties, whereas incoming PGY1s only mildly agreed with that statement ( p = 0.003). Both incoming PGY1s and PGY2s felt most prepared to obtain histories relating to basic ophthalmic complaints and felt least prepared to read and interpret ophthalmic imaging studies. The most popular online resources used by respondents in order of popularity were EyeGuru (35.2%, n = 60), EyeWiki (32.9%, n = 56), Tim Root/OphthoBook (26.5%, n = 45), American Academy of Ophthalmology (13.5%, n = 23), and EyeRounds/University of Iowa (13.5%, n = 23). Conclusion A major challenge in integrating ophthalmic education into the medical school curricula is the gradual shift toward shorter preclinical curricula. However, having a core foundation of ophthalmic knowledge is critical for incoming ophthalmology residents to be able to maximize their specialty-specific training. Integrated ophthalmology intern years likely play a significant role in the increased self-efficacy of incoming PGY2s compared with incoming PGY1s. Adopting nontraditional teaching methods like flipped classroom learning, utilizing online medical education resources, and continuing to increase ophthalmology exposure during PGY1 year may better prepare incoming PGY2s to operate independently in ophthalmology settings.

Rochen-Duvigneaud syndrome with nasopharyngeal carcinoma

Nasopharyngeal carcinoma is an uncommon head and neck malignancy which can rarely present with cranial nerve palsies. Here we report a case of nasopharyngeal mass which presented initially with ophthalmic complaints due to compression of cranial nerves in superior orbital fissure resulting in Rochen-Duvigneaud syndrome. It was histologically proven as non keratinising differentiated type of Nasopharyngeal carcinoma

Prolonged Face Mask Use During COVID-19 Pandemic Contributes to Increased Symptoms and Signs of Dry Eye: A Systematic Literature Review

Introduction: Face mask has been a vital protective equipment against COVID-19 in this pandemic era. Several ophthalmic complaints have been associated with face mask use, leading to the term "mask-associated dry eye". There's still a question that arises whether the duration of use contributes to the condition. This review aimed to assess the correlation between prolonged face mask use on dry eyes.&#x0D; Methods: A thorough systematic search was performed through PubMed, Science Direct, and Google Scholar, following the PRISMA 2020 Guideline. Keywords were "mask associated dry eye," OR "dry eye AND face mask" OR "OSDI" OR "tear break up time" AND "COVID-19 pandemic".&#x0D; Results: A total of 1130 articles were identified, and only six cross-sectional studies met the eligibility criteria. Prolonged face mask use is correlated with decreased TBUT in four studies, decreased Schirmer score in two studies, and lower TM parameter in one study. Increased duration of wearing mask is correlated with more frequent symptoms and severity of dry eye according to either OSDI, SPEED Questionnaire or another unspecified questionnaire found in five studies.&#x0D; Conclusion: Prolonged face mask use during the COVID-19 pandemic contributes to increased symptoms and signs of dry eye.

Clinician Confidence in Managing Ophthalmological Presentations: A Model for Collaborative Post-Graduate Training in Ophthalmology

Clinicians working in emergency medicine (EM), general practice (GP) and general medicine are frequently expected to review, assess and manage those presenting with ophthalmic complaints. They are in many instances the gatekeepers to accessing secondary ophthalmological care services. Often these clinicians have received only undergraduate teaching on ophthalmology and infrequently utilise their skills with ophthalmological equipment such as fundoscopes and rarely a slit lamp. Due to this, clinician confidence in managing ophthalmological issues is often poor.

An investigation into the development of qualitative tear film disorders in dogs following cryoepilation for distichiasis.

The aim of this prospective study was to compare tear film quality between dogs who have previously undergone cryoepilation for distichiasis to a reference population. Nine dogs (17 eyes) were recruited after surgery and were compared to a reference population of 21 dogs (42 eyes). Canine patients who had previously undergone cryoepilation for distichiasis for a minimum of 1month prior to examination were recruited. A complete ophthalmic examination was performed by an ABVO resident (BDR), with additional tear tests, including tear film interferometry, infra-red meibography, and a tear film break-up time (TFBUT) performed. The tear test results were compared to a reference population obtained from client-owned dogs with no history of ophthalmic complaints, a normal ophthalmic examination performed by an ABVO resident (BDR) and a Schirmer Tear Test-1 > 15 mm/min. Statistical analysis was performed of the results obtained. The treated group was significantly more affected with meibomian gland dropout (MG-dropout) in 11/17 (64.7%) cases, compared to the reference population of 2/21 (9.5%) (p < .01). The treated group had an odds ratio of 23.8 to develop MG-dropout compared to the reference population (p < .01). Tear film breakup time (TFBUT) was significantly shorter in the treatment group (5.8 ± 2.6s) compared to the reference population (10.1 ± 1.1s) (p < .001). In the treatment group, 12/17 (70.5%) of treated eyes had a TFBUT < 5s compared to 2/21 (9.5%) of the reference population. Cryoepilation for distichaiasis appears to be a risk factor for developing MG-dropout and qualitative tear film disorders post-operatively in canines.

Screening of oral tamoxifen ocular toxicity in patients with breast cancer

Background Carcinoma of the breast is considered as one of the main cancer types among women. Its prevalence is reported to be the second most common type. Several treatment lines have been used in breast cancer besides surgical and radiological interventions. Tamoxifen is one of the medical treatments used in postsurgical prophylaxis of breast cancer. Various visual problems were reported with tamoxifen therapy. These include posterior subcapsular cataracts, color vision affection, intraretinal crystals, and optic neuritis. Aim The aim of this work was to screen for ocular toxicity of tamoxifen used for breast cancer treatment in patients having no ophthalmic complaints and treated with tamoxifen for at least 2 years with a dose of 20 mg per day. Patients and methods We included 50 women with breast carcinoma on tamoxifen therapy for at least 2 years, and then we divided them into two groups regarding duration of tamoxifen intake from 2 to 4 years (group 1) and from 5 to 8 years (group 2). All participants underwent complete careful history taking and full ophthalmological examination. Best-corrected visual acuity was measured using Snellen chart with conversion to logMAR notation for statistical analysis. We assessed the retinal structural changes by optical coherence tomography (OCT) and correlated these changes with the function affection (color vision testing and electrophysiological studies). Results There was a statistically significant correlation between duration of tamoxifen intake and Retinal Pigment Epithelium (RPE) mottling. No other significant correlations were detected. There was no significant difference between the two groups in mean best-corrected visual acuity; intraocular pressure; cup values; disc parameters; ganglion cell complex thickness; retinal nerve fiber layer zones, except for in the inferior quadrant; and macular thickness, except for in the superior quadrant. OCT layer thinning shows retinal nerve fiber layer affection in 34% of cases, ganglion cell complex affection in 48% of cases, and macula affection in 64% of cases. Color vision defects were found in 12%, and electrophysiological test changes were found in a few cases. Conclusion Tamoxifen therapy causes minimal affection on the ocular structure and function. OCT layer thinning (34–64% of cases) precedes the clinical changes. This highlights the importance of OCT examination in those patients to evaluate tamoxifen toxicity, and further studies will be needed to evaluate the reversibility of these changes after stoppage of therapy. The main ocular complications associated with tamoxifen therapy were correlated with duration of treatment.

Improving Compliance to Follow-Up Care After Primary Emergency Department Ophthalmic Consultation

To identify factors that affect the likelihood of follow-up after emergency department (ED) visit for ophthalmic complaints and to evaluate a protocol to improve compliance. Prospective interventional study with historical controls. This study was conducted at Jamaica Hospital Medical Center in Jamaica, New York. The study population included 962 patients who presented to the ED and who required ophthalmology consultation. Participants in the control group were given only verbal follow-up instructions. Participants in the intervention group were given verbal instructions, written instructions, telephone calls, and, if not responding to calls, a mailed letter. The primary outcome was the overall follow-up rate. Secondary outcomes were follow-up rate by demographic subgroup. Patients in the intervention group were significantly more likely to follow up (68.8% vs 42.9%, P < .001). Nearly all subgroups exhibited significantly improved follow-up with the intervention, with the exception of patients 18 to 29 years of age, patients with diagnosis severity class III, patients with no insurance, patients with hospital financial aid, patients paying with workers' compensation, and patients with an unknown employment status. Before the intervention, most patients receiving ophthalmology consultation in the ED did not return for follow-up care. These patients tended to be young, unemployed, uninsured or use hospital financial aid, were in the control group, had good visual acuity, reported no change in vision, and had a condition that was not vision-threatening. Follow-up rates were improved in nearly all subgroups by providing written instructions, telephone calls, and mailed letters. Such instructions should be considered in similar populations.

Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review.

Purpose:Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM).Methods:The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants.Results:A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases.Conclusions:Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.

A clinical case of the development of a rare manifestation of cat scratch disease

Introduction. Cat scratch disease is a common infectious disease caused by intracellular microorganisms Bartonella henselae, which are widespread among wild and domestic animals. The aim of study was to demonstrate a rare clinical case of chorioretinitis against the background of a 10-year-old child’s bartonellosis. Materials and methods. A 10-year-old child received with complaints about a significant decrease of vision and lowering of the upper eyelid of the left eye. The disease began with increase in temperature to 37.5 °C, abdominal pain. Three days later, these ophthalmic complaints appeared. After examining a paediatric ophthalmologist, neurologist and conducting an additional instrumental survey, the patient was hospitalised in an ophthalmological hospital. When acuity of vision of the left eye was 0.02 n/a, the upper eyelid was lowered. On the fundus there was a pronounced extensive edema of the optic nerve disc (OND) with prominance, from OND to the macular zone there was an extensive high retinal swelling. The department conducted a standard clinical examination, blood test for chronic infections, examination of visual evoked potentials and other instrumental examinations. From the first day, local and general antibacterial and anti-inflammatory treatment was carried out. Results and Discussion. Positive dynamics has been observed since the fourth day of treatment, but the visual acuity of the left eye has not improved. On the eighth day, the patient was discharged for subsequent hospitalisation at the Federal State Budgetary Institution NMRC of Eye Diseases named after Helmholtz, in which he was examined for bartonellosis and identified IgG to Bartonella henselae 1:160. Final clinical diagnosed: Left eye neuroretinitis associated with bartonellosis. On the fourteenth day after treatment, the patient was discharged - the left eye was almost calm, visual acuity was 0.06. In this clinical case, a rare manifestation of cat scratches disease is described. Due to the late visit to an ophthalmologist and the late start of medical treatment, it was not possible to fully restore the vision of the left eye. Conclusion. In most cases, it takes a lot of time to make a diagnosis, and specific treatment begins late, in connection with which it is necessary to draw attention to this problem of doctors of different directions. It should also be remembered that any atypical manifestation of the disease serves as a reason to exclude rickettsiosis, including bartonellosis.