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Indian Journal of Ophthalmology Dec 2023Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes.... (Review)
Review
Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
Topics: Humans; Prognosis; Retrospective Studies; Eye Injuries; Retinal Detachment; Visual Acuity; Eye Injuries, Penetrating; Trauma Severity Indices
PubMed: 37991288
DOI: 10.4103/IJO.IJO_1496_23 -
Ophthalmology and Therapy Oct 2023It remains unclear whether systemic factors are associated with an increased risk of vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV), and...
INTRODUCTION
It remains unclear whether systemic factors are associated with an increased risk of vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV), and there is no method to predict the possibility of VH occurrence in patients with PCV. This study aimed to investigate and visualize systemic risk factors for VH in patients with PCV.
METHODS
Data on the sex, age, history of systematic diseases, best-corrected visual acuity, intraocular pressure, and laboratory data of patients with PCV were collected from the medical record system. Univariate and multivariate binary logistic regression analyses were applied to investigate independent risk factors for VH in patients with PCV. Receiver operating characteristic analysis and nomograms were used to visualize the independent risk factors.
RESULTS
The patient population comprised 115 patients with VH secondary to PCV and 181 patients with PCV without VH. Binary logistic regression analyses showed that higher white blood cell count [WBC; odds ratios (OR) 1.247], higher aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT; OR 2.339), and longer activated partial thromboplastin time (APTT; OR 1.196) were independent risk factors of VH in patients with PCV. Integrated application of APTT, AST/ALT, and WBC as markers showed the best performance for distinguishing patients with VH, with an area under the curve of 0.723. The nomogram was created for doctors to calculate the possibility of VH in a patient with PCV.
CONCLUSIONS
Higher WBC, higher AST/ALT, and longer APTT are independent serum risk factors of VH secondary to PCV, which may shed light on VH prevention in patients with PCV.
PubMed: 37556039
DOI: 10.1007/s40123-023-00783-0 -
Pharmaceutics Jul 2023Retinal diseases are one of the leading causes of blindness globally. The mainstay treatments for these blinding diseases are laser photocoagulation, vitrectomy, and... (Review)
Review
Retinal diseases are one of the leading causes of blindness globally. The mainstay treatments for these blinding diseases are laser photocoagulation, vitrectomy, and repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF) or steroids. Unfortunately, these therapies are associated with ocular complications like inflammation, elevated intraocular pressure, retinal detachment, endophthalmitis, and vitreous hemorrhage. Recent advances in nanomedicine seek to curtail these limitations, overcoming ocular barriers by developing non-invasive or minimally invasive delivery modalities. These modalities include delivering therapeutics to specific cellular targets in the retina, providing sustained delivery of drugs to avoid repeated intravitreal injections, and acting as a scaffold for neural tissue regeneration. These next-generation nanomedicine approaches could potentially revolutionize the treatment landscape of retinal diseases. This review describes the availability and limitations of current treatment strategies and highlights insights into the advancement of future approaches using next-generation nanomedicines to manage retinal diseases.
PubMed: 37514191
DOI: 10.3390/pharmaceutics15072005 -
Indian Journal of Ophthalmology Aug 2023Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are...
BACKGROUND
Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral.
PURPOSE
To discuss the new proposed classification of prepapillary capillary loops.
SYNOPSIS
: Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction.
HIGHLIGHTS
The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic.
VIDEO LINK
: https://youtu.be/gbq_oP7Y2q4.
Topics: Humans; Vitreous Hemorrhage; Retinal Vessels; Retinal Artery; Eye Abnormalities
PubMed: 37530298
DOI: 10.4103/IJO.IJO_639_23 -
Journal of Clinical Medicine Oct 2023: Vitreous hemorrhage (VH) is a common vitreoretinal condition causing impairment of vision due to various etiologies. No consensus exists on the best timing for... (Review)
Review
: Vitreous hemorrhage (VH) is a common vitreoretinal condition causing impairment of vision due to various etiologies. No consensus exists on the best timing for performing pars plana vitrectomy (PPV) in fundus-obscuring VH. : Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, we conducted a systematic review of the timing of PPV in VH. We assessed the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for all the included publications, in accordance with the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. : A total of 1731 articles were identified. Following the removal of duplicates and screening of abstracts, 1203 articles remained. Subsequently, a comprehensive full-text review of 30 articles was conducted. Ultimately, 18 articles met the predefined inclusion criteria. : Despite the small number of studies on the timing of treatment for VH, the advantage of early over late PPV seems to be a reasonable approach in selected cases, and it might be considered modern standard care.
PubMed: 37892789
DOI: 10.3390/jcm12206652 -
Korean Journal of Ophthalmology : KJO Jun 2024Dense vitreous hemorrhage is a vision-threatening disease with varied clinical manifestations. Herein, we aimed to evaluate its causes and outcomes in patients without...
PURPOSE
Dense vitreous hemorrhage is a vision-threatening disease with varied clinical manifestations. Herein, we aimed to evaluate its causes and outcomes in patients without diabetes.
METHODS
A retrospective cohort including 60 eyes from 60 patients with an initial diagnosis of nontraumatic fundus-obscuring dense vitreous hemorrhages and without diabetes was recruited. The relevant medical records from January 2013 to December 2019 were reviewed and analyzed. We classified patients into the following four groups, depending on the underlying cause of dense vitreous hemorrhage: eight cases in the age-related macular degeneration group, four cases in the posterior vitreous detachment group, 20 cases in the tear group, and 28 cases in the vascular group.
RESULTS
The most common cause of dense vitreous hemorrhage was retinal vascular obstructive disease (46.7%); the age-related macular degeneration group showed the worst prognosis. The extent of best-corrected visual acuity change was significantly better in patients who underwent vitrectomy compared to those receiving conservative treatment; best-corrected visual acuity change (logarithm of the minimum angle of resolution) was 1.62 ± 0.57 in the surgical group and 1.06 ± 0.88 in the nonsurgical group (Student t-test, p = 0.007).
CONCLUSIONS
Retinal vascular disease is the most common cause of vitreous hemorrhages, and surgical treatments have a better visual outcome than nonsurgical treatments.
Topics: Humans; Vitreous Hemorrhage; Retrospective Studies; Male; Visual Acuity; Female; Middle Aged; Aged; Vitrectomy; Adult; Follow-Up Studies; Tomography, Optical Coherence; Aged, 80 and over; Fluorescein Angiography
PubMed: 38584442
DOI: 10.3341/kjo.2023.0116 -
European Journal of Ophthalmology Sep 2023
Topics: Humans; Male; COVID-19; COVID-19 Vaccines; Priapism; Vaccination; Vitreous Hemorrhage
PubMed: 37291877
DOI: 10.1177/11206721231172290 -
Clinical Ophthalmology (Auckland, N.Z.) 2023The aim of this study was to evaluate the efficiency and safety of a 27-gauge (G) 20,000 cuts per minute (cpm) vitreous cutter in clinical settings.
PURPOSE
The aim of this study was to evaluate the efficiency and safety of a 27-gauge (G) 20,000 cuts per minute (cpm) vitreous cutter in clinical settings.
PATIENTS AND METHODS
This was a retrospective and observational study of 40 eyes of 40 patients with idiopathic epiretinal membrane (ERM). Twenty patients (20 eyes) were treated using a 27G 10,000-cpm vitreous cutter (Advanced ULTRAVIT Probe, Alcon), whereas the remaining 20 patients (20 eyes) were treated using a 27G 20,000-cpm cutter (Hypervit dual-blade probe, Alcon). All the surgeries were performed by the same surgeon (YM). The time from the start of vitrectomy to the start of ERM peeling was independently measured by two separate examiners using digital videos of each surgery. The average duration of vitrectomy was calculated for each patient. Additionally, the data of the patients in the two groups were extracted from their medical and surgical records and compared.
RESULTS
The time from the initiation of vitrectomy until the start of ERM peeling was 184 ± 56.9 and 152 ± 39.5 s for the 10,000-cpm and 20,000-cpm groups, respectively. The duration of vitrectomy was significantly shorter in the 20,000-cpm group than in the 10,000-cpm group (p = 0.041). Postoperative vitreous hemorrhage was observed in one patient in the 10,000-cpm group, whereas no complications were observed in the 20,000-cpm group.
CONCLUSION
In a clinical setting, the 27G 20,000-cpm vitreous cutter may have a higher safety profile and higher efficacy for vitreous removal than that of the 27G 10,000-cpm vitreous cutter.
PubMed: 37483843
DOI: 10.2147/OPTH.S418371 -
American Journal of Ophthalmology Case... Mar 2024To describe a case of retinal vaso-occlusive vasculitis with associated lid edema and conjunctivitis following intravitreal pegcetacoplan administration in a patient...
PURPOSE
To describe a case of retinal vaso-occlusive vasculitis with associated lid edema and conjunctivitis following intravitreal pegcetacoplan administration in a patient with geographic atrophy (GA).
OBSERVATION
A 78 year old Caucasian woman presented with complaints of lid edema, conjunctival injection, loss of vision, and mild ocular discomfort eleven days after receiving an intravitreal pegcetacoplan injection in the left eye for geographic atrophy. Visual acuity on presentation was decreased to 20/400 from 20/200 previously in that eye. Eyelid edema and conjunctival injection were present with minimal anterior chamber reaction. Dilated fundus examination revealed hemorrhages throughout the retina and signs of retinal vasculitis. The patient subsequently developed hyphema and vitreous hemorrhage. Laboratory evaluations for common infectious and inflammatory causes including aqueous and vitreous cultures for bacteria and Herpes simplex PCR were normal or negative. A delayed hypersensitivity to pegcetacoplan was suspected and was treated with topical, oral subconjunctival and intravitreal steroids.
CONCLUSION
This index report illustrates a case of retinal vaso-occlusive vasculitis associated with intravitreal pegcetacoplan associated with lid edema and conjunctival injection and subsequent hyphema and vitreous hemorrhage. Therapy with steroids topically, systemically, periocularly and intravitreally were used to treat the inflammatory process and prevent further visual loss.
PubMed: 38298266
DOI: 10.1016/j.ajoc.2024.101999