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PURPOSE: Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia. METHODS: Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation. RESULTS: Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use. CONCLUSION: Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.
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Extracción de Catarata , Catarata , Hipertensión , Facoemulsificación , Humanos , Implantación de Lentes Intraoculares , Facoemulsificación/efectos adversos , Catarata/complicaciones , Estudios Retrospectivos , Presión IntraocularRESUMEN
PURPOSE: To compare long-term visual function after implantation of diffractive extended depth-of-focus (EDF) intraocular lenses (IOLs) using echelett optics and monofocal IOLs with the same platform. METHODS: In this prospective comparative case series, diffractive EDF or monofocal IOLs were implanted binocularly and followed up for 2 years. At the last visit, distance-corrected binocular visual acuities were measured at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m. Photopic and mesopic contrast sensitivity was also examined. Dynamic visual function was evaluated in terms of functional visual acuity (FVA), standard deviation of visual acuity (SDVA), visual maintenance ratio (VMR), mean response time, and number of blinks. The outcomes were compared between the two IOLs, and the influence of posterior capsule opacification (PCO) on contrast sensitivity and FVA was examined. RESULTS: Binocular visual acuity of eyes with EDF IOLs was better at distances of 0.5 and 0.7 m than that of eyes with monofocal IOL (P < 0.026). There were no differences in binocular visual acuity at other distances, contrast sensitivities, or dynamic visual functions. The influence of PCO on the visual functions was not found in eyes with EDF IOLs. CONCLUSION: Up to 2 years postoperatively, eyes with diffractive EDF IOLs sustained superior intermediate visual acuity together with visual function comparable to that of eyes with monofocal IOLs.
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Lentes Intraoculares , Facoemulsificación , Humanos , Implantación de Lentes Intraoculares , Estudios Prospectivos , Agudeza Visual , Sensibilidad de Contraste , Diseño de Prótesis , SeudofaquiaRESUMEN
PURPOSE: This study analyzed the relationship between patient age and the prevalence and fluoroquinolone susceptibility of gram-positive cocci from the ocular surface flora before ophthalmic surgery. METHODS: This surveillance study included scraped samples from the conjunctival sac of 8923 eyes of 5490 patients (70.0 ± 13.7 years) without ocular infection before ophthalmologic surgery between August 2018 and December 2020. A review of microbiological records regarding patient age was used to determine the number of isolates and gram-positive species obtained, as well as their fluoroquinolone susceptibility. Fluoroquinolone susceptibility was determined using the Clinical and Laboratory Standards Institute protocols of broth microdilution. Statistical analysis was performed using a generalized additive model and a log-linear model. RESULTS: In total, 9,894 bacterial isolates obtained from scraped samples from the patients were analyzed. The detected species were Staphylococcus epidermidis (31.0%), Staphylococcus aureus (6.1%), Staphylococcus lugdunensis (3.9%), Enterococcus faecalis (5.8%), Corynebacterium species (31.7%), and Cutibacterium acnes (7.5%) and others. The number of species isolated from the ocular surface was increased at the rate of 1.018 per 10 years of age (p < 0.0001). S. epidermidis, S. lugdunensis, E. faecalis, and Corynebacterium species were isolated more often with an increase in patient age. The levofloxacin resistance ratio of methicillin-sensitive S. epidermidis and Corynebacterium species increased at the rate of 1.204 and 1.087 respectively with a 10-year increase in age (both p < 0.0001). CONCLUSION: Gram-positive bacteria in the ocular surface flora (OSF) exhibited gradual changes in diversity and fluoroquinolone resistance with an increase in patient age. It is important to monitor the OSF of the patients before ophthalmologic surgery to prevent refractory ocular postoperative infection.
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PURPOSE: Ocular injuries due to Hymenoptera venom are uncommon and most injuries occur on the ocular surface. We reported two rare cases of corneal endothelial damage caused by hornet venom that was sprayed, not injected, through stinging in the eye. OBSERVATIONS: Case 1: A 57-year-old male patient was injured when a hornet sprayed venom into his left eye. He was referred to our hospital because the edoema and epithelial erosion of the cornea persisted. The patient presented with bullous keratopathy, asymmetrical iris atrophy, irreversible mydriasis, and glaucoma. His cataract progressed, and his best-corrected visual acuity was 0.03. Cataract surgery was performed after anti-inflammatory treatment with steroids, and Descemet-stripping automated endothelial keratoplasty was performed 6 months later. The patient recovered well postoperatively: his best-corrected visual acuity improved to 1.0 and he continued his glaucoma treatment. Case 2: A 75-year-old male patient had damage to his corneal epithelium, severe conjunctivitis, and conjunctival edoema when sprayed hornet venom entered his left eye. At initial presentation, the corneal endothelial cell density had decreased to 1042 cells/mm2. The conjunctival sac was washed, and steroid and topical antibacterial instillations were administered. His best-corrected visual acuity improved from 0.07 at the initial visit to 0.5. However, the corneal opacification and glaucoma persisted, and 3 months later the corneal endothelial cell density decreased to 846 cells/mm2. CONCLUSIONS AND IMPORTANCE: Corneal injuries caused by sprayed hornet venom are rare; however, they can cause intense anterior chamber inflammation and severe, irreversible corneal endothelial damage. In such cases, prompt initial treatment, the administration of adequate anti-inflammatory medication, and careful evaluation of the corneal endothelium are required.
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Catarata , Enfermedades de la Córnea , Glaucoma , Avispas , Anciano , Animales , Humanos , Masculino , Persona de Mediana Edad , Antiinflamatorios , Córnea , Enfermedades de la Córnea/etiología , Endotelio Corneal , PonzoñasRESUMEN
PURPOSE: To clarify the prognosis of corneal perforation, we compared the etiology and characteristics of patients with traumatic and non-traumatic corneal perforations. METHODS: This retrospective observational study included patients treated for traumatic or non-traumatic corneal perforations at a single tertiary hospital from 1989 to 2019. The variables collected included the primary cause of corneal perforation, final best-corrected visual acuity (BCVA), and treatment administered. The initial treatment administered and treatment success rates were compared between the traumatic and non-traumatic groups. Multivariate linear regression analysis was performed to determine the predictors of final visual acuity. RESULTS: Ninety eyes of 90 patients (mean age, 61.1 ± 19.7 years) were included. Traumatic and non-traumatic corneal perforations occurred in 40 (44.4%) and 50 eyes (55.6%), respectively. Among non-traumatic causes, infection and autoimmune disease were the causes for corneal perforation in 18 (20.0%) and 12 eyes (13.3%), respectively. The success rate for the closure of the perforated site with the initial procedure was significantly higher in traumatic corneal perforations than in non-traumatic corneal perforations (90.0% and 72.2%, respectively; p = 0.038). Patients with traumatic corneal perforation had significantly better final BCVA than those with non-traumatic corneal perforation (0.71 ± 1.18 and 1.52 ± 1.12, respectively; p = 0.0016). On multivariate analysis, older age and non-traumatic corneal perforation were significantly related to the final lower BCVA (p < 0.001 and p = 0.029, respectively). CONCLUSION: Traumatic corneal perforation demonstrated a significantly better prognosis than non-traumatic corneal perforation. It is critical to consider the primary cause of corneal perforation to anticipate prognosis.
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Perforación Corneal , Adulto , Anciano , Anciano de 80 o más Años , Córnea , Perforación Corneal/diagnóstico , Perforación Corneal/epidemiología , Perforación Corneal/etiología , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
BACKGROUND: Human herpesvirus 6B (HHV-6B) is known to cause exanthema subitem and has been detected in various ocular diseases, including keratitis, uveitis, optic neuritis, and endophthalmitis; however, the long-term outcome after the reactivation of HHV-6B has not been well-addressed. Sugita et al. previously reported the concomitant presence of HHV-6B with herpes simplex virus-1 (HSV-1) in the aqueous fluid at the onset of corneal endotheliitis. We focused on the same patient with corneal endotheliitis, in whom both HSV-1 and HHV-6B sequences were observed, and reported the clinical course and long-term outcomes. CASE PRESENTATION: A 64-year-old woman was referred to our center for visual disturbances in the left eye. Her best-corrected visual acuity in the left eye was 0.5 and the left intraocular pressure was elevated to 33 mmHg. Mid-sized keratic precipitates and 2+ cells were observed in the anterior chamber with corneal endothelial edema and reduction of the corneal endothelial cell density to 1828 cells/mm2. The patient was diagnosed with corneal endotheliitis with increased intraocular pressure. Polymerase chain reaction analysis revealed the concomitant presence of both HSV-1 and HHV-6B sequences in the left aqueous fluid. After treatment with oral valacyclovir and topical betamethasone, her intraocular inflammation gradually improved and has not recurred at 12 years after corneal endotheliitis onset although corneal opacity remained. CONCLUSIONS: Reactivation of HHV-6B infection might be associated with HSV-1 corneal endotheliitis; however, no serious late sequelae occurred after appropriate treatment for HSV-1 infection in this immunocompetent host.
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Edema Corneal , Herpesvirus Humano 1 , Herpesvirus Humano 6 , Queratitis , Endotelio Corneal , Femenino , Herpesvirus Humano 1/genética , Herpesvirus Humano 6/genética , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: To examine the severe ocular complications associated with contact lens wearing in Japan. METHOD: A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens-associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment. RESULTS: Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation. CONCLUSIONS: The major cause of serious contact lens-associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.
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Acanthamoeba , Lentes de Contacto Hidrofílicos , Queratitis , Ojo , Humanos , Japón/epidemiología , Queratitis/epidemiología , Queratitis/etiologíaRESUMEN
PURPOSE: To determine the relationship between fluoroquinolone susceptibility of gram-positive cocci (GPC) isolated from patients with bacterial keratitis and the age of the patients or the date of onset. METHODS: Bacterial isolates were obtained from corneal lesions of patients with infectious keratitis treated between January 2008 and December 2016. The fluoroquinolone susceptibility of GPC was assessed, and a retrospective review of microbiological records was performed. Fluoroquinolone susceptibility was measured through broth microdilution in accordance with protocols of the Clinical and Laboratory Standards Institute. Statistical analysis was performed using a generalized estimating equation and cubic spline to determine the association between fluoroquinolone susceptibility of GPC isolated from corneal lesions and patient age. RESULTS: Of the 1200 bacterial isolates, 471 GPC were identified. They included Staphylococcus epidermidis (45.6%), other coagulase-negative Staphylococcus sp. (17.8%), and Staphylococcus aureus (18.3%). Levofloxacin susceptibility of GPC exhibited a negative relationship with age and had an odds ratio of 0.893 (95% confidence interval, 0.825-0.967) for every 10 years of age. A non-adjusted cubic spline curve was well correlated with year-adjusted data in a generalized additive model, and the levofloxacin susceptibility of GPC was initially stable but gradually declined after 40 years of age, before re-stabilizing again after 70 years of age. CONCLUSION: The fluoroquinolone susceptibility of GPC isolated from corneal lesions of infectious keratitis is high in children under 15 years of age and declines with an increase in age of patients using a generalized estimating equation and cubic spline.
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Infecciones Bacterianas del Ojo , Cocos Grampositivos , Queratitis , Factores de Edad , Anciano , Antibacterianos/farmacología , Niño , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Fluoroquinolonas/farmacología , Humanos , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Queratitis/epidemiología , Pruebas de Sensibilidad Microbiana , Estudios RetrospectivosRESUMEN
PURPOSE: To investigate the effect of topical prostaglandin (PG) eyedrops on the biomechanics and shape of the cornea. METHODS: Consecutive patients with primary open-angle glaucoma who had been treated with the same anti-glaucoma PG (114 eyes, 57 patients) or ß-blocker (36 eyes, 18 patients) eyedrops in 1 eye alone for more than 3 months at Inouye Eye Hospital or Miyata Eye Hospital. The biomechanical properties of the cornea were measured using a Corvis ST device (Oculus, Wetzlar, Germany). Corneal tomography was measured with a Casia 1 or 2 (Tomey Corp., Nagoya, Japan). The biomechanical parameters and tomographic features of the cornea were compared between PG-treated eyes, ß-blocker-treated eyes, and contralateral eyes using a mixed-effect model adjusted for intraocular pressure and corneal thickness and a linear model adjusted for age, sex, intraocular pressure, and corneal thickness. RESULTS: The PG-treated eyes had a significantly smaller applanation 1 time, the highest concavity radius, and a larger deformation amplitude than the contralateral eyes. Also, the PG-treated eyes had a significantly smaller applanation 1 time and applanation 2 velocity but a larger peak distance than the ß-blocker-treated eyes. There were no significant differences in any of the Casia parameters between the PG-treated eyes and the contralateral eyes. CONCLUSION: The results of this study suggest that topical PG makes biochemical changes to the cornea but does not alter its shape.
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Córnea/fisiopatología , Topografía de la Córnea/métodos , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Presión Intraocular/fisiología , Prostaglandinas/administración & dosificación , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Córnea/efectos de los fármacos , Córnea/patología , Paquimetría Corneal , Elasticidad , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Endogenous bacterial endophthalmitis, also called metastatic endophthalmitis, is a rare bacterial endophthalmitis derived from distant infectious foci via the bloodstream. This infection can potentially cause not only severe visual disturbance, but also loss of the eyeball or death, as most patients are immunocompromised. This retrospective Japanese multicenter study analyzed 32 eyes in 25 definitive cases. Twelve patients (48.0%) had diabetes mellitus. Typical ocular findings were vitreous haze (87.5%), cells in the anterior chambers (62.5%) and retinal infiltrates (50.0%). Elevated body temperature (64.0%), high serum C-reactive protein (96.0%) and leukocytosis (52.0%) were also frequently observed. Culture positivity rates for intraocular fluid were higher in the vitreous (62.5%) versus aqueous humor (28.6%). High positivity rates were also observed for blood (57.1%) and central venous catheters (100%). The most common pathogen was Staphylococcus aureus (10 cases), including methicillin-resistant S. aureus (4 cases). The next most common pathogen was Klebsiella pneumoniae (7 cases), which was highly associated with liver abscess. Compared to a previous 1991 national multicenter study, there has been a fourfold increase in the ratio of S. aureus. Antibiotic susceptibility tests revealed that all Gram-positives were susceptible to vancomycin and all Gram-negatives were susceptible to third-generation cephalosporins, imipenem/cilastatin, gentamycin and levofloxacin. Prognostic factors influencing poor visual outcome included poor initial visual acuity (p < 0.01), K. pneumoniae (p = 0.027) and gram-negative bacteria (p = 0.014) as the causative bacteria. Intravitreal antibiotic injection in combination with vancomycin and ceftazidime may be applicable for use as part of the standard treatment regimen for EBE.
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Antibacterianos/farmacología , Endoftalmitis/tratamiento farmacológico , Klebsiella pneumoniae/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Humor Acuoso/microbiología , Quimioterapia Combinada , Endoftalmitis/sangre , Endoftalmitis/microbiología , Femenino , Humanos , Japón , Klebsiella pneumoniae/aislamiento & purificación , Absceso Hepático/sangre , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/microbiología , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Estudios Retrospectivos , Staphylococcus aureus/aislamiento & purificación , Cuerpo Vítreo/microbiologíaRESUMEN
PURPOSE: To conduct a long-term follow-up study evaluating the efficacy and safety of transplantation of preserved limbal allograft and amniotic membrane for recurrent pterygium. METHODS: This was a retrospective, non-comparative, interventional case series conducted at a private eye hospital. Eighty-four eyes of 80 patients with recurrent pterygium were included in the study. The mean number of previous surgeries for pterygium was 1.36 ± 0.98 (range, 1-8). All subjects received transplantation of preserved limbal allograft and amniotic membrane. RESULTS: The mean follow-up period was 73.0 ± 38.1 months (range, 12-154 months). Pterygium recurred in 10 eyes (11.9 %). The mean period to recurrence was 16.3 ± 11.3 months (range, 5-33 months). Symblepharon was cured in 21 eyes, persisted in 2 eyes, and newly occurred in 3 eyes. Diplopia was cured in eight eyes, persisted in five eyes, and newly occurred in one eye. As for complications, intraocular pressure elevations over 21 mmHg were recognized in ten eyes of nine cases, in which the intraocular pressure was controlled by reduction of topical steroid in four eyes and by addition of topical prostaglandin derivatives in six eyes. Twenty-four eyes (28.6 %) gained two lines or more of Landolt best spectacle-corrected visual acuity (BSCVA), 56 eyes (66.7 %) stayed within one line from preoperation, and four eyes (4.8 %) lost two lines or more. There were no major complications and no graft rejection. CONCLUSIONS: Transplantation of preserved limbal allograft and amniotic membrane is a safe and effective procedure for recurrent pterygium.
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Amnios/trasplante , Apósitos Biológicos , Trasplante de Córnea/métodos , Limbo de la Córnea/cirugía , Pterigion/cirugía , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Aloinjertos , Betametasona/administración & dosificación , Femenino , Fluorometolona/administración & dosificación , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Pterigion/diagnóstico , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To investigate the causative fungi of fungal keratitis in Japan and their drug susceptibility. METHODS: Identification and antifungal susceptibility test for 8 drugs (micafungin, amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, miconazole and pimaricin) were performed using isolated fungi from patients with fungal keratitis treated at 27 facilities in Japan between November 1, 2011 and October 31, 2013. RESULTS: Fungal strains were detected in 72 (50.7%) out of 142 samples. The major isolates were Fusarium spp. (18), Candida parapsilosis (12), C. albicans (11) and Alternaria spp. (6), in all, fungi of 31 species were identified by gene analysis. In the yeast-like fungi, susceptibility rates were evident for more than 80% in voriconazole, pimaricin, flucytosine, micafungin, amphotericin B and fluconazole. In filamentous fungi, the susceptibility rate was less than 50% except for PMR (90%). Fusarium spp., which were susceptible to amphotericin B and pimaricin, showed lower susceptibility rates compared with other genera. CONCLUSIONS: Although various genera and species of fungi cause fungal keratitis, the obtained drug susceptibility data in this study demonstrates the different susceptibility patterns among the major isolates (Fusarium spp., C. parapsilosis, C. albicans and other groups). This is important evidence useful for fungal keratitis treatment.
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Úlcera de la Córnea/microbiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Queratitis/diagnóstico , Micosis/diagnóstico , Úlcera de la Córnea/diagnóstico , Pruebas Genéticas , Humanos , Japón , Queratitis/microbiología , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To investigate the current status of fungal keratitis in Japan. METHODS: The patients with fungal keratitis were examined at 27 facilities in Japan from November 1st 2011 to October 31st 2013, concerning isolates, patient background, clinical findings, treatment and prognosis. RESULTS: Out of 139 cases, 133 were diagnosed as fungal keratitis, of which fungi were isolated from 72 samples of 71 cases (yeast-like fungi 32 strains and filamentous fungi 40 strains). The corrected visual acuity at the first visit of 88 cases (66.2%) was less than 20/200 and 42 cases (31.6%) were involved with deep stromal lesions, indicating high proportion of severe cases in this study. Three months later, 56 cases (42.1%) were still under treatment, and corrected visual acuity of 57 cases (42.9%) was less than 20/200. In cases with yeast-like fungi, there were significantly more cases with past history of corneal diseases, ocular surgery including keratoplasty, and eye drops' use such as steroids than those with filamentous fungi. On the other hand, there were significantly more cases of filamentous fungi, with trauma on the onset and with intervention of previously attending doctors than those with yeast-like fungi. Logistic regression analyses revealed that contact lens wearing was a significant factor of good prognosis, and yeast-like fungi as one of poor outcome compared with no fungal isolation. CONCLUSION: Although the choice of antifungal drugs has been increasing, fungal keratitis is still severe, refractory and vision-threatening disease.
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Enfermedades de la Córnea/tratamiento farmacológico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Queratitis/diagnóstico , Queratitis/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Córnea/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Femenino , Humanos , Japón , Queratitis/microbiología , Masculino , Persona de Mediana Edad , Oftalmología/métodos , Pronóstico , Estudios Prospectivos , Agudeza Visual/efectos de los fármacos , Agudeza Visual/inmunología , Adulto JovenRESUMEN
OBJECTIVE: To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. METHODS: Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. RESULTS: Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. CONCLUSIONS: Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.
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Astigmatismo/cirugía , Topografía de la Córnea , Pterigion/patología , Pterigion/cirugía , Anciano , Análisis de Varianza , Astigmatismo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pterigion/fisiopatología , Refracción Ocular/fisiología , Errores de Refracción/fisiopatología , Estudios Retrospectivos , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To compare the post cataract surgery anti-inflammatory effect of bromfenac monotherapy and of bromfenac and betamethasone combination therapy in diabetes mellitus patients. METHODS: A prospective study approved by the Institutional Review Board. Fifty-one eyes of 51 patients were randomly allocated to either bromfenac 0.1% monotherapy (n = 23) or combined therapy with bromfenac 0.1% and betamethasone 0.1% (n = 28). After surgery, monotherapy group was administered bromfenac alone for 8 weeks, while the combined therapy group was administered both bromfenac and betamethasone for 2 weeks, bromfenac alone for the next 6 weeks. The amount of change from preoperative values in anterior chamber flare and foveal thickness were compared between the 2 groups. RESULTS: There was no significant difference in change in anterior chamber flare between the 2 groups. The increase in foveal thickness 4 weeks postoperatively was significantly larger in the bromfenac group (p = 0.0356). Four patients of the bromfenac group, all with a history of diabetic macular edema, developed macular edema after surgery. CONCLUSION: Bromfenac and betamethasone combination exhibited a stronger anti-inflammatory effect after cataract surgery patients with diabetes mellitus. In particular, patients with a history of diabetic macular edema were susceptible to foveal thickening and macular edema, and a combined treatment is desirable.
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Antiinflamatorios/uso terapéutico , Benzofenonas/uso terapéutico , Betametasona/uso terapéutico , Bromobencenos/uso terapéutico , Catarata , Complicaciones de la Diabetes , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Extracción de Catarata/métodos , Quimioterapia Combinada/métodos , Femenino , Humanos , Edema Macular/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
We describe a case of globe rupture due to a forklift accident. A 64-year-old man presented to the ophthalmology hospital shortly after the jaws of a forklift struck his left eye. The left eye was shrunken with a full-thickness scleral laceration. B-scan ultrasonography revealed a hypotonic eyeball with antero-posterior shrinkage. We promptly performed scleral suturing to maintain the ocular shape. The patient's intraocular pressure improved to 7.1 mmHg, and visual acuity was limited to light perception. Despite this, intraocular hemorrhage in the anterior chamber persisted, and an electroretinogram demonstrated poor response to light. Subsequently, the patient underwent a vitrectomy with silicone oil tamponade to address the vitreous hemorrhage, proliferative membranes, and retinal detachment. However, proliferative vitreoretinopathy with tractional retinal detachment progressed postoperatively, resulting in the loss of light perception. Ocular trauma caused by forklifts accident is rare; however, the strong external forces they exert can cause severe and irreversible visual impairment. Therefore, it is necessary for forklift operators and other concerned individuals to exercise caution to prevent forklift-related ocular trauma. Moreover, ophthalmologists should be aware of the dangers of forklift-related ocular trauma and treatment and management of the same.
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Cataract surgery outcomes in centenarian patients have not previously been explored. This study aimed to examine characteristics and report clinical results of people aged ≥100 years undergoing cataract surgery. This was a retrospective observational study, including patients aged ≥100 years who underwent cataract surgery between 2003 and 2021 at Miyata Eye Hospital in Japan. Medical charts were reviewed for information on cataract severity, surgery type, anesthesia, as well as ocular and medical comorbidities. Using Mann-Whitney test, visual acuity, intraocular pressure, and corneal endothelial cell density were compared before and after surgery. Eight eyes of 5 patients were included in the study (mean age, 101.5â ±â 1.2 years). Seven of these eyes (87.5%) belonged to women. All surgeries were performed under topical anesthesia using phacoemulsification and insertion of the intraocular lens fixed in the bag. All patients had multiple preoperative medical comorbidities; however, there were no intraoperative, postoperative ocular, or general complications. The postoperative best-corrected visual acuity was significantly improved compared to that before surgery (1.18â ±â 0.74 and 0.29â ±â 0.52, respectively, Pâ =â .004). Neither intraocular pressure nor corneal endothelial cell density demonstrated a significant difference postoperatively. Cataract surgery can be safely performed under topical anesthesia in centenarians without complications using proper perioperative medical control and preparation.
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Facoemulsificación , Agudeza Visual , Humanos , Femenino , Estudios Retrospectivos , Anciano de 80 o más Años , Masculino , Facoemulsificación/métodos , Presión Intraocular/fisiología , Catarata , Resultado del Tratamiento , Implantación de Lentes Intraoculares/métodos , Implantación de Lentes Intraoculares/estadística & datos numéricos , Extracción de Catarata/métodos , Extracción de Catarata/estadística & datos numéricos , Japón/epidemiologíaRESUMEN
INTRODUCTION: Traffic trauma can lead to ocular damage. Open globe injuries usually have a poor prognosis, which can be ameliorated by prompt diagnosis and appropriate treatment. Nonetheless, few studies have focused on the visual outcomes of patients following traffic accidents. In this study, we aimed to examine the characteristics and prognosis of ocular complications in patients following traffic accidents at a specialized tertiary eye hospital. METHODS: We classified 44 patients from traffic accidents (88 eyes) into groups with equal or better (better group) and worse (worse group) corrected-distance visual acuity than a logarithm of the minimum angle of resolution 0 at the initial presentation. Final corrected-distance visual acuity, intraocular pressure, corneal injury, presence of traumatic cataracts, and treatment were compared between the groups. In addition, a multivariate linear regression analysis was performed to identify factors associated with the final visual acuity. RESULTS: Globe contusion, orbital blowout fracture, traumatic iritis, and trochlear nerve palsy were observed in 14.8%, 3.4%, 2.3%, and 2.3% of the patients, respectively. Topical instillation and ophthalmological treatment/surgery were performed in 17.0% and 9.1% of the patients, respectively. The better group (68 eyes) had significantly better final visual acuity than the worse group (20 eyes) (P < 0.001). However, there was no between-group difference in demographic characteristics. Multivariate analysis demonstrated that there was a significant correlation between the initial and final visual acuities (P < 0.001). CONCLUSIONS: Assessing visual acuity at the initial presentation is crucial for predicting the final visual acuity. Our findings will help to inform ophthalmologists aiming to improve the prognosis and treatment of ocular trauma in patients following traffic accidents.
RESUMEN
AIM: To develop an artificial intelligence (AI) algorithm that diagnoses cataracts/corneal diseases from multiple conditions using smartphone images. METHODS: This study included 6442 images that were captured using a slit-lamp microscope (6106 images) and smartphone (336 images). An AI algorithm was developed based on slit-lamp images to differentiate 36 major diseases (cataracts and corneal diseases) into 9 categories. To validate the AI model, smartphone images were used for the testing dataset. We evaluated AI performance that included sensitivity, specificity and receiver operating characteristic (ROC) curve for the diagnosis and triage of the diseases. RESULTS: The AI algorithm achieved an area under the ROC curve of 0.998 (95% CI, 0.992 to 0.999) for normal eyes, 0.986 (95% CI, 0.978 to 0.997) for infectious keratitis, 0.960 (95% CI, 0.925 to 0.994) for immunological keratitis, 0.987 (95% CI, 0.978 to 0.996) for cornea scars, 0.997 (95% CI, 0.992 to 1.000) for ocular surface tumours, 0.993 (95% CI, 0.984 to 1.000) for corneal deposits, 1.000 (95% CI, 1.000 to 1.000) for acute angle-closure glaucoma, 0.992 (95% CI, 0.985 to 0.999) for cataracts and 0.993 (95% CI, 0.985 to 1.000) for bullous keratopathy. The triage of referral suggestion using the smartphone images exhibited high performance, in which the sensitivity and specificity were 1.00 (95% CI, 0.478 to 1.00) and 1.00 (95% CI, 0.976 to 1.000) for 'urgent', 0.867 (95% CI, 0.683 to 0.962) and 1.00 (95% CI, 0.971 to 1.000) for 'semi-urgent', 0.853 (95% CI, 0.689 to 0.950) and 0.983 (95% CI, 0.942 to 0.998) for 'routine' and 1.00 (95% CI, 0.958 to 1.00) and 0.896 (95% CI, 0.797 to 0.957) for 'observation', respectively. CONCLUSIONS: The AI system achieved promising performance in the diagnosis of cataracts and corneal diseases.