Issues In Ophthalmology Research Articles

Surgical Management of Symptomatic Recurrent/Progressive Craniopharyngioma: Is There a Gold-Standard Approach?

The standard treatment for craniopharyngiomas (CPs) involves either initial gross total resection or subtotal resection with adjuvant radiotherapy. However, there is no consensus regarding the management of recurrent cases. We reviewed a series of patients with CP to evaluate the characteristics of patients with recurrent/progressing CP. We retrospectively reviewed 31 patients with biopsy-proven recurrent/progressed CP who were initially operated on at our clinic from 2015 to 2023. Demographic and clinical data, including age, sex, tumor localization, lesion size and features, radiological findings, and endocrine, neurologic, and ophthalmological issues, were compared between those with and without recurrence. Fifteen out of 31 patients (48.4%) underwent transnasal/transsphenoidal endoscopic surgery; the remaining 16 underwent microscopic transcranial or neuroendoscopic surgery. After treatment, recurrence and events (any medical condition related to the patient's current condition other than recurrence) were observed in 48.4% and 32.3% of the cases, respectively. There were no statistically significant disparities between patients with and without recurrence in terms of age, tumor dimensions, tumor localization, gender distribution, surgical modality, or the presence of calcifications or hydrocephalus (p > 0.05). The highest and lowest overall survival was 25 years and 6 months, respectively. The management of recurrent CP is too complicated to fit into a standard treatment algorithm. Therefore, surgical treatment for these patients should be individualized and planned according to patient symptoms and radiological findings, which is presumably a more versatile, efficient, and safe approach for recurrent CPs.

Maxillectomy and its ophthalmic implications: A comprehensive analysis over 20 years

PurposeMaxillectomy, a critical surgical intervention for head and neck malignancies, often leads to a comprehensive spectrum of ophthalmic complications due to its impact on orbital structures. This study, conducted over 20 years at a single university hospital, aims to evaluate the extent and severity of these complications, encompassing the entire range of ophthalmological issues encountered in the field. DesignA retrospective, observational cohort study. MethodsAmong the 163 patients who underwent maxillectomy at a single university hospital between January 2003 and December 2022, we analyzed the medical records of 101 patients with over one year of postoperative ophthalmological follow-up. Data on demographics, clinical parameters, surgical details, and ophthalmic complications were collected. Complications were categorized into six groups, with statistical analysis identifying factors influencing these outcomes. ResultsOur findings reveal a predominant occurrence of ophthalmic complications among maxillectomy patients. Only 4.4 % had no complications, while 95.6 % experienced at least one, especially with cornea/conjunctiva (56 %), eyelid (48.4 %), and lacrimal system issues (38.5 %) being the most frequent. Notably, 64.8 % had complications in two or more categories, and 33 % in three or more. Multivariate analysis identified that orbital floor resection was a significant risk factor for complications involving the eyelid and the cornea/conjunctiva (P = 0.008 and P = 0.021, respectively), while radiotherapy specifically emerged as a significant risk factor for cornea/conjunctiva complications (P = 0.009). Surgical management of complications following maxillectomy often involved major tissue transplantation in plastic surgery, particularly for cases of significant tissue contraction or severe orbital dystopia. Common secondary ophthalmic surgeries included dacryocystorhinostomy (DCR) in 14 eyes, tarsorrhaphy in 12 eyes, and lateral tarsal strip procedures in 5 eyes. The study found a high incidence of multiple complications, highlighting the complex nature of postoperative challenges. ConclusionMaxillectomy patients are highly susceptible to a range of ophthalmological complications, primarily influenced by surgical extent and adjuvant therapies. A multidisciplinary approach is essential for comprehensive management and improved quality of life in these patients. The study underscores the need for thorough ophthalmological evaluation and integrated care in treating maxillectomy-related complications.

Using Pupillometry to Evaluate Balance in Patients Implanted with a Cochleo-Vestibular Implant.

Maintaining balance comes naturally to healthy people. In subjects with vestibulopathy, even when compensated, and especially if it is bilateral, maintaining balance requires cognitive effort. Pupillometry is an established method of quantifying cognitive effort. Background/Objectives: We hypothesized that pupillometry would be able to capture the increased effort required to maintain posture in subjects with bilateral vestibulopathy in increasingly difficult conditions. Additionally, we hypothesized that the cognitive workload during balance tasks, indexed by pupil size, would decrease with the activation of the BionicVEST cochleo-vestibular implants. Methods: Subjects with a cochleo-vestibular implant as of March 2023 were recruited, excluding those with ophthalmological issues that precluded pupillometry. Pupillometry was performed using a validated modified videonystagmography system. Computed dynamic posturography and a Modified Clinical Test of Sensory Integration on Balance were performed while the pupil was recorded. Tests were first performed after 24 h of deactivating the vestibular component of the implant. Thereafter, it was reactivated, and after 1 h of rest, the tests were repeated. The pupil recording was processed using custom software and the mean relative pupil diameter (MRPD) was calculated. Results: There was an average of 10.7% to 24.2% reduction in MRPD when the vestibular implant was active, with a greater effect seen in tasks of moderate difficulty, and lesser effect when the task was easy or of great difficulty. Conclusions: Despite technical challenges, pupillometry appears to be a promising method of quantifying the cognitive effort required for maintaining posture in subjects with bilateral vestibulopathy before and after vestibular implantation.

Origin and formation of early changes in the retina under the influence of atherosclerosis factors

Lesions of the microcirculatory bed of the retina are an urgent problem due to their prevalence, severity of irreversible changes and their association with an unfavorable cardiovascular prognosis. Their pathogenesis is associated with endothelial dysfunction. Determining the processes of the formation and progression of retinopathy (RP) will bring closer the solution of problematic issues in ophthalmology and cardiology, and reduce cardiovascular morbidity and mortality.Aim. To study the processes of formation and progression of retinopathy in the initial stages of mixed origin (hypertensive, diabetic, unspecified etiology).Material and methods. The origin and progression of I–II degree RP under the influence of predictors of this symptom has been revealed through statistical analysis using the data of the 2008–2013 prospective follow-up of 22 clinical indicators of a natural group of initially healthy 7.959 male workers of locomotive crews of the Trans-Baikal Railway aged 18–66 years. Multivariate stepwise analysis, a 2 × 2 confusion matrix, Cox and Kaplan-Meier proportional hazard models were used, and a relative risk was assessed.Results. Such predictors of grade I–II RP as arterial hypertension, I–III degree obesity, smoking, dyslipidemia, left ventricular hypertrophy, family history of early cardiovascular disease, hyperglycemia, aortic atherosclerosis, creatininemia, atherosclerotic plaque / intima-media complex thickening, microalbuminuria, type 2 diabetes mellitus and age showed statistical heterogeneity in mathematical models. The distinctive feature was the different mutually exclusive assessment of the predictors’ significance in the models used. Thus, the predictors of I–II degree RP showed their specific identification characteristics, defined in qualitative and quantitative dimensions, by which they could be found and studied in the cell as well as their damaging effect.Conclusions. The course of endothelial dysfunction varies significantly when influenced by RP predictors. Its manifestations are determined by the influence of a specific factor, a set of factors or by all predictors taken together and involved simultaneously. This shows the need to determine the qualitative and quantitative ultrastructural and biochemical specific markers of endothelial dysfunction of the microvasculature of the eye appearing under the influence of RP predictors during the formation and progression of this pathological symptom in order to restore the normal function of the endothelial cell and the affected organ as a whole, as long as there is still room for therapeutic efforts.

What We Learned About the Economic and Workforce Issues in Pediatric Ophthalmology: Access to Eye Care and Possible Solutions.

To provide a blueprint reviewing the major economic and workforce issues in pediatric ophthalmology and its effect on access to pediatric eye care, as well as potential solutions. This was a systematic review of the landmark studies examining the economic and workforce issues in pediatric ophthalmology was performed. The number of residents pursuing pediatric ophthalmology fellowship has steadily declined since the early 2000s. Increasing overhead costs, low Medicaid reimbursements, practice pattern changes, and workforce shortages have all contributed to a significant crisis in access to pediatric eye care. Solutions to improve access to pediatric eye care involve pursuing more economical strategies within the confines of the pediatric ophthalmology practice, early exposure to the field during medical education, and enhancing residents' interest through faculty mentorship. Low reimbursements are a major driver contributing to extended appointment wait times for pediatric ophthalmology visits at major academic eye centers. Legislative changes at both the federal and state levels are needed to make appropriate increases in reimbursements, starting with states in the lowest quartile of Medicaid reimbursements. [J Pediatr Ophthalmol Strabismus. 2023;60(5):323-329.].

Loss-balanced parallel decoding network for retinal fluid segmentation in OCT

As a leading cause of blindness worldwide, macular edema (ME) is mainly determined by sub-retinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) accumulation, and therefore, the characterization of SRF, IRF, and PED, which is also known as ME segmentation, has become a crucial issue in ophthalmology. Due to the subjective and time-consuming nature of ME segmentation in retinal optical coherence tomography (OCT) images, automatic computer-aided systems are highly desired in clinical practice. This paper proposes a novel loss-balanced parallel decoding network, namely PadNet, for ME segmentation. Specifically, PadNet mainly consists of an encoder and three parallel decoder modules, which serve as segmentation, contour, and diffusion branches, and they are employed to extract the ME’s characteristics, the contour area features, and to expand the ME area from the center to edge, respectively. A new loss-balanced joint-loss function with three components corresponding to each of the three parallel decoding branches is also devised for training. Experiments are conducted with three public datasets to verify the effectiveness of PadNet, and the performances of PadNet are compared with those of five state-of-the-art methods. Results show that PadNet improves ME segmentation accuracy by 8.1%, 11.1%, 0.6%, 1.4% and 8.3%, as compared with UNet, sASPP, MsTGANet, YNet, RetiFluidNet, respectively, which convincingly demonstrates that the proposed PadNet is robust and effective in ME segmentation in different cases.

Assessing the Impact of Prolonged Screen Time on Ophthalmic Health among Students: A Post-COVID-19 Study in Pakistan

Human beings heavily rely on the sense of sight, as sight mainly controls approximately 80% of our perception. During the COVID-19 pandemic, students had to take their online classes by using different electronic devices. By not following the proper instructions to use these devices, primary students faced eyesight issues during the COVID-19 pandemic. Low Vision is a commonly diagnosed issue in ophthalmology in Pakistan. Therefore, the current study is a survey-based research. For this purpose, a population of 100 primary students was gathered who took online classes during the pandemic and developed eyesight issues after their online classes. Based on statistical analysis, the logistic regression model was used to analyze the eyesight issues among the primary students considering several variables including gender, age, distance with devices, duration of using the devices, and analyzing previous eyesight issues. The findings indicated that male students have a more chance of developing eyesight issues than female students. Hence, it was deduced that female students who used their devices from a distance of more than 16 inches for less than 3 hours had the least possibility of developing any eyesight issues.

MAC-Leonets-A novel optimized hybrid convolutional neural networks for the segmentation and diagnosis of Edema diseases using retinal OCT images

An intelligent segmentation and identification of edemas diseases constitutes a most important crucial ophthalmological issues since they provide important information for the diagnosis process in accordance to the disease severity. But diagnosing the different edema diseases using the OCT-images are considered to be daunting challenge among the researchers. The implementation of computational intelligence techniques such as machine learning, deep learning, bio inspired algorithms and image processing techniques may help the doctors for some extent in improving the automatic extraction and diagnosis process consequently improving patients’ life quality. But, these are liable to more errors and less performance, which requires further improvisation in designing the intelligent systems for an effective classification of edema diseases. In this context, this paper proposes the hybrid intelligent framework for the identification, segmentation and classification of three types of edemas such as using the retinal optical coherence tomography (OCT) Images. In this process, Single Feed Forward Training networks (SLFTN) are integrated with Convolutional Layers whose hyperparameters are tuned by using Lion Optimization algorithm. An intensive experimentation is carried out using the Kaggle Retinal OCT Image datasets-2020 with Tensor flow and the proposed framework is trained with the different set of 84,494 images in which performance metrics such as accuracy, sensitivity, specificity, recall and f1score are calculated. Results shows the proposed system has provided satisfactory performance, reaching the average highest accuracy of 99.9% in identifying and classifying the respectively.

Self-Assembling Nanoarchitectonics of Twisted Nanofibers of Fluorescent Amphiphiles as Chemo-Resistive Sensor for Methanol Detection.

The inhalation, ingestion, and body absorption of noxious gases lead to severe tissue damage, ophthalmological issues, and neurodegenerative disorders; death may even occur when recognized too late. In particular, methanol gas present in traces can cause blindness, non-reversible organ failure, and even death. Even though ample materials are available for the detection of methanol in other alcoholic analogs at ppm level, their scope is very limited because of the use of either toxic or expensive raw materials or tedious fabrication procedures. In this paper, we report on a simple synthesis of fluorescent amphiphiles achieved using a starting material derived from renewable resources, this material being methyl ricinoleate in good yields. The newly synthesized bio-based amphiphiles were prone to form a gel in a broad range of solvents. The morphology of the gel and the molecular-level interaction involved in the self-assembly process were thoroughly investigated. Rheological studies were carried out to probe the stability, thermal processability, and thixotropic behavior. In order to evaluate the potential application of the self-assembled gel in the field of sensors, we performed sensor measurements. Interestingly, the twisted fibers derived from the molecular assembly could be able to display a stable and selective response towards methanol. We believe that the bottom-up assembled system holds great promise in the environmental, healthcare, medicine, and biological fields.

Unanswered Questions Pertaining to the Economic and Workforce Issues in Pediatric Ophthalmology

To create a survey that examines remaining unanswered questions related to the economic and workforce issues in pediatric ophthalmology. A 12-question survey was distributed to U.S.-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) discussion board and various other social media forums. Statistical analysis was performed on the basis of practice setting groups. Two hundred eighty-seven pediatric ophthalmologists completed the survey. Of all respondents, 150 (52.3%) believed pediatric ophthalmology is a prestigious subspecialty, 137 (47.7%) thought that a hybrid fellowship combining pediatric ophthalmology and adult cataract surgery would increase the number of practicing pediatric ophthalmologists, 189 (65.9%) felt that early exposure during medical school would increase the number of residents who ultimately apply to pediatric ophthalmology fellowship, and 81 (28.2%) believed that the lobbyists hired by the AAPOS will be successful in preventing further Centers for Medicare and Medicaid Services reimbursement cuts. Medicaid patients comprised more than 25% of the total practice for 156 (54.4%) respondents. New patient, follow-up, and surgery wait times were greater than 2 months in 50.9%, 46.7%, and 38.7% of respondents, respectively. As the economic crisis in pediatric ophthalmology continues to worsen, questions related to increasing interest in the field through early exposure, hybrid fellowship, prestige, appointment wait times, and belief in the success of AAPOS lobbyists remain. Exceptional measures are required to revitalize the field and improve access to care. [J Pediatr Ophthalmol Strabismus. 2023;60(3):163-169.].

The Medicaid Dilemma and Its Profound Effect on the Economic and Workforce Issues in Pediatric Ophthalmology and Ultimately on Access to Pediatric Eye Care.

To identify new patient, follow-up, and surgery appointment wait times for children seeking care at academic eye centers/children's hospitals (AEC/CHs) in the setting of very low Medicaid reimbursements and workforce issues in pediatric ophthalmology. Each state in the United States with AEC/CHs was contacted by phone or email. Using a standardized script, the authors inquired about approximate wait times for non-emergency new patient, follow-up, and surgery appointment times, as well as percentage of patients insured by Medicaid seen at the AEC/CH. Medicaid reimbursements for new patient visits, follow-up visits, sensorimotor examinations, and one-muscle strabismus surgery were examined for each state. The mean percentage of children enrolled in Medicaid across the United States was 38.0%. Appointment and Medicaid inquiry calls were conducted across 41 states. Mean wait times across the United States for new patient, follow-up, and surgery appointments were 3.9, 3.4, and 2.7 months, respectively. Mean percentage of patients insured by Medicaid at AEC/CHs was 57.1%. High Medicaid-insured states offered longer wait times for new patient appointments than low Medicaid-insured states (4.4 versus 3.5 months; P = .20). The lowest Medicaid reimbursements for new patient visit, follow-up visit, sensorimotor examination, and one-muscle strabismus surgery occurred in Illinois, California, Ohio, and Michigan, respectively. Across the United States, states with higher percentages of patients insured by Medicaid exhibited longer new patient appointment wait times, suggesting that challenges related to Medicaid reimbursements directly contribute to disparities in access to pediatric eye care. [J Pediatr Ophthalmol Strabismus. 2023;60(3):170-177.].

Macular hemorrhage – therapy

Submacular hemorrhage treatment is still an important issue in ophthalmology. At present we lack algorithms of treatment that could be used in clinical practice. Efficacy of every treatment method seems to differ by individual factors simultaneously existing in each patient. Therefore, anti-VEGF agents remain crucial in treating patients with coexisting vasculopathy, while in posttraumatic hemorrhage we should lean towards other approaches, like pneumatic displacement. Operative methods, despite being more invasive and burdened with higher potential risk, are indispensable in large hemorrhages, significantly speeding up clot removal. The primary aim of this work is to collect recent data regarding this issue and to determine usefulness of treatment methods in specific cases, regarding factors such as hemorrhage pathophysiology. The following article pertains to currently used treatment methods, such as: pneumatic displacement, anti-VEGF therapy, rtPA and operative methods.

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.

Optical and reconstructive surgery of a patient with a contusion damage of the eyeball and iridodialysis of 180 degrees: a clinical case

Traumatic eyeball damages is a topical issue in present-day ophthalmology as they constitute one of the main causes of vision loss in people of working age. Purpose: to assess the feasibilty, effectiveness and safety of one-time early-stage microinvasive optical reconstructive surgery of a patient with traumatic eyeball damage consequences: a swelling cataract, lens ligamentous apparatus defect, iridodialysis, and traumatic mydriasis. Material and methods. Patient V., 27, was under observation with the following diagnosis: “OS — condition after a contusion damage to the eyeball: traumatic swelling cataract; stage II subluxation of the lens; traumatic mydriasis, iridodialysis of 180 degrees”. OS visual acuity — correct light projection. The patient underwent an ORO of the left eye: phacoaspiration of a swelling cataract with implantation of an intracapsular ring and an intraocular lens in combination with closed iridoplasty. Results. No intraoperative complications took place. In the postoperative period, the best corrected visual acuity was 0.6, IOP remained stable, the lens was centered in the capsular bag, the iris sutures were consistent, the pupil rounded, centered, 4 mm in diameter. The patient felt satisfied with the cosmetic and functional result of surgery. Conclusion. One-time iridoplasty in combination with cataract surgery is an effective and safe method of surgical treatment of traumatically damaged iris and lens.

Pathogenic variants in CASK: Expanding the genotype-phenotype correlations.

Pathogenic variants in CASK, an X-linked gene that plays a role in brain development and synaptic function, are the cause of both microcephaly with pontine and cerebellar hypoplasia (MICPCH), and X-linked intellectual disability (XLID) with or without nystagmus. MICPCH is caused by loss of function variants in CASK, typically affects females, and is associated with moderate-to-severe intellectual disability (ID). Additional findings, present in about one-third of individuals, include feeding difficulties, ophthalmologic issues, hypertonicity, epilepsy, and sensorineural hearing loss. Only a few affected males with MICPCH phenotype have been reported and most have had profound developmental disability and intractable epilepsy. The XLID phenotype is typically caused by missense variants and most often manifests in males; carrier females are mildly affected or unaffected. Nystagmus is often present. In total, over 175 patients have been reported in the literature. We now report an additional 11 patients with pathogenic variants in CASK that expand these phenotypes and reported genotype-phenotype correlations.

Special Issue on Ophthalmic Optics and Visual Function

Exploring quality of vision is one of the most important issues in modern ophthalmology, and research into ophthalmic optics and visual function is essential for making progress in this field [...].

Polyaphron Formulations Stabilised with Different Water-Soluble Polymers for Ocular Drug Delivery.

As drug delivery to the eye has evolved over the last decades, researchers have explored more effective treatments for ocular diseases. Despite this, delivering drugs to the cornea remains one of the most problematic issues in ophthalmology due to the poor permeability of the cornea and tear clearance mechanisms. In this study, four different types of polyaphron formulations are prepared with 10% poloxamer 188 (P188), 10% poly(2-ethyl-2-oxazoline), 1% polyquaternium 10, and 3% sodium carboxymethylcellulose solutions mixed with 1% Brij® L4 in a caprylic/capric triglycerides solution. Their physicochemical characteristics, rheological properties, and stability are assessed. Additionally, a polyaphron with 3% polyquaternium 10 was prepared for the assessment of ex vivo corneal retention along with four other polyaphrons. The best retention on the ex vivo cornea was displayed by the 3% polyquaternium 10-based formulation. The 10% poloxamer 188 along with 1% polyquaternium 10-based polyaphrons appeared to be the most stable among the four prepared formulations. A toxicological evaluation of these formulations was performed using a slug mucosal irritation test and bovine corneal opacity and permeability assay, with all four polyaphrons proving good biocompatibility with ocular tissues. The developed drug delivery systems demonstrated an excellent potential for ocular drug delivery.

Shhedding New Light on the Role of Hedgehog Signaling in Corneal Wound Healing.

The cornea, an anterior ocular tissue that notably serves to protect the eye from external insults and refract light, requires constant epithelium renewal and efficient healing following injury to maintain ocular homeostasis. Although several key cell populations and molecular pathways implicated in corneal wound healing have already been thoroughly investigated, insufficient/impaired or excessive corneal wound healing remains a major clinical issue in ophthalmology, and new avenues of research are still needed to further improve corneal wound healing. Because of its implication in numerous cellular/tissular homeostatic processes and oxidative stress, there is growing evidence of the role of Hedgehog signaling pathway in physiological and pathological corneal wound healing. Reviewing current scientific evidence, Hedgehog signaling and its effectors participate in corneal wound healing mainly at the level of the corneal and limbal epithelium, where Sonic Hedgehog-mediated signaling promotes limbal stem cell proliferation and corneal epithelial cell proliferation and migration following corneal injury. Hedgehog signaling could also participate in corneal epithelial barrier homeostasis and in pathological corneal healing such as corneal injury-related neovascularization. By gaining a better understanding of the role of this double-edged sword in physiological and pathological corneal wound healing, fascinating new research avenues and therapeutic strategies will undoubtedly emerge.

Treatment of macular diseases: an overview of key randomized clinical trials

Macular diseases are traditionally a serious issue in ophthalmology, which has great social impact due to widespread occurrence and significant vision loss, often irreversible. Over the past few decades, the possibilities for the diagnosis and treatment of pathologies of the retina and choroid have been significantly expanded. Randomized clinical trials provided ophthalmologists with valuable information on the natural course and treatment strategies of common retinal diseases from the viewpoint of evidence-based medicine. However, due to the large number of trials conducted, it is often difficult to make an adequate choice of data to be used in daily practice. In this review, we systematize the most valuable randomized clinical trials. To this end, we selected 42 randomized clinical studies conducted between 1979 and 2019 and focused on the treatment of age-related macular degeneration (AREDS 1, AREDS 2, ANCHOR, MARINA, PrONTO, CATT, IVAN, VIEW 1, VIEW 2, EVEREST II, PLANET, SEVEN-UP, ALTAIR, HAWK, HARRIER), choroidal neovascularization of multiple etiology (myopic, post-inflammatory, angioid-streak-related, etc. — RADIANCE, REPAIR, MYRROR, MINERVA), diabetic eye lesions (diabetic retinopathy and diabetic macular edema — ETDRS, DRCR.net Protocols B, I, S and T, RISE, RIDE, VIVID-DME, VISTA-DME, MEAD, FAME), retinal vein occlusions (BVOS, CVOS, SCORE-CRVO, SCORE-BRVO, BRAVO, CRUISE, GALILEO, COPERNICUS, VIBRANT), as well as retinopathy of prematurity (CRYO-ROP, ETROP, RAINBOW). The review summarizes the main results of these studies, which confirm the effectiveness and safety of such treatment methods as antiVEGF and photodynamic therapy, retinal laser photocoagulation, cryotherapy, corticosteroids and nutraceuticals from the viewpoint of evidence-based medicine. For greater clarity, we provide a table summarizing information on each of the randomized clinical trials considered.

Smoking and Alcoholism: Risk Factors for Papillitis?

Introduction. The inflammation of the optic nerve at the level of the optic papilla or optic disc is known as papillitis. We couldn’t find enough published studies to back up smoking and alcoholism as absolute risk factors for papillitis, but the possibility has been raised, so we decided to conduct this study to see if we could find a statistically significant causal association between these factors and papillitis in our hospital. Methodology. In patients with papillitis treated at the Ophthalmology Center of Santiago de Cuba, an analytical investigation of cases and controls was conducted (2017–2019). 42 patients in Group 1 (Cases). Group 2 (Controls): 84 patients’ partners who visited at the same time as the patients but did not have any ophthalmological issues. Results. We found an OR = 1.60, with a CI of [0.74; 3.48], in the smoking-papillitis connection, but p > 0.05. Alcoholism was linked to papillitis with an OR of 1.19, a CI of [0.53; 2.68], and a p value of 0.05. Conclusions. Smoking and drunkenness had no statistically significant causal relationship with papillitis in our investigation.