Clinical ophthalmology最新文献

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The Impact of the COVID-19 Pandemic on Wait-Times for Ophthalmic Surgery in Ontario, Canada: A Population-Based Study. COVID-19 大流行对加拿大安大略省眼科手术等待时间的影响:基于人口的研究。
IF 1.8
Clinical ophthalmology Pub Date : 2023-06-26 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S409479
Michael Balas, Diana Vasiliu, Gener Austria, Tina Felfeli
{"title":"The Impact of the COVID-19 Pandemic on Wait-Times for Ophthalmic Surgery in Ontario, Canada: A Population-Based Study.","authors":"Michael Balas, Diana Vasiliu, Gener Austria, Tina Felfeli","doi":"10.2147/OPTH.S409479","DOIUrl":"10.2147/OPTH.S409479","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of the COVID-19 pandemic on case volumes and wait-times for ophthalmic surgery in Ontario, Canada.</p><p><strong>Design: </strong>Population-based retrospective cohort study.</p><p><strong>Participants: </strong>Patients undergoing ophthalmic surgery in Ontario, Canada, from 2010 to 2021, collected from the Ontario Health Wait Times Information System (WTIS) database.</p><p><strong>Methods: </strong>The WTIS contains non-emergent surgical case volume and wait-time data for six ophthalmic subspecialty surgery types, three priority levels (low, medium, high) and 14 different regions in Ontario. Case volume and wait-times were compared between the COVID-19 pandemic (2020-2021) and the preceding time period (2010-2019) across all stratifications.</p><p><strong>Results: </strong>There was a significant decrease in case volumes and significant increase in wait-times across geographic regions, priority levels, and subspecialty surgeries from the pre-pandemic to pandemic period. Moreover, COVID-19 exacerbated pre-existing wait-time disparities between sexes, with females waiting 4.1 days longer than males overall to receive surgery in 2010-2019 compared to waiting 8.8 days longer in 2020-2021 (117% increase).</p><p><strong>Conclusion: </strong>These findings highlight the impact of the COVID-19 pandemic on ophthalmic surgical wait times in Ontario. Cataract, strabismus and oculoplastic surgeries, the Waterloo Wellington, Central, and South East regions of Ontario, and those with female sex had the greatest relative increases in wait-times during the pandemic.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1823-1831"},"PeriodicalIF":1.8,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/ef/opth-17-1823.PMC10312341.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9737090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Posterior Pole Asymmetry Analysis as a Diagnostic Tool in Glaucoma Suspects: An Electrophysiological Approach. 作为青光眼疑似患者诊断工具的后极不对称分析:电生理学方法。
IF 1.8
Clinical ophthalmology Pub Date : 2023-06-21 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S411647
Andrew Tirsi, Paras P Shah, Vasiliki Gliagias, Daniel Barmas-Alamdari, Derek Orshan, Joby Tsai, Celso Tello
{"title":"Posterior Pole Asymmetry Analysis as a Diagnostic Tool in Glaucoma Suspects: An Electrophysiological Approach.","authors":"Andrew Tirsi, Paras P Shah, Vasiliki Gliagias, Daniel Barmas-Alamdari, Derek Orshan, Joby Tsai, Celso Tello","doi":"10.2147/OPTH.S411647","DOIUrl":"10.2147/OPTH.S411647","url":null,"abstract":"<p><strong>Purpose: </strong>Spectral domain optical coherence tomography (SD-OCT) with posterior pole asymmetry analysis (PPAA) provides a mapping of posterior pole retinal thickness with asymmetry analysis between hemispheres of each eye. We investigated whether these structural abnormalities were correlated with functional retinal ganglion cell (RGC) loss, quantified by steady state pattern electroretinogram (ssPERG), in glaucoma suspects (GS).</p><p><strong>Methods: </strong>Twenty GS (34 eyes) were enrolled in a prospective study at the Manhattan Eye, Ear, and Throat Hospital. All subjects underwent ophthalmological examination, including Humphrey visual field, Spectralis Glaucoma Module Premium Edition (GMPE) SD-OCT PPAA, and ssPERG testing. The ability of ssPERG parameters (Magnitude [Mag, µv], MagnitudeD [MagD, µv], and MagD/Mag ratio) to predict PPAA thickness (total, superior, and inferior thickness, [µm]) was tested via adjusted multivariate linear regression analysis.</p><p><strong>Results: </strong>Mag explained 8% of variance in total PPAA change (F(1,29)=6.33, B=6.86, 95% CI: 1.29-12.44, p=0.018), 8% in superior PPAA change (F(1,29)=5.57, B=6.92, 95% CI: 0.92-12.92, p=0.025), and 7.1% in inferior PPAA change (F(1,29)=5.83, B=6.80, 95% CI: 1.04-12.56, p=0.022). Similarly, MagD explained 9.7% of variance in total PPAA change (F(1,29)=8.09, B=6.47, 95% CI: 1.82-11.13, p=0.008), 10% in superior PPAA change (F(1,29)=7.33, B=6.63, 95% CI: 1.62-11.63, p=0.011), and 8.5% in inferior PPAA change (F(1,29)=7.25, B=6.36, 95% CI: 1.53-11.18, p=0.012). MagD/Mag ratio and PPAA were not significantly associated.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first study demonstrating a positive relationship between RGC dysfunction and retinal thickness changes between the superior and inferior hemispheres. The detection of asymmetrical structural loss, combined with functional RGC assessment using ssPERG, may be an informative tool for early glaucoma diagnosis.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1777-1787"},"PeriodicalIF":1.8,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/b4/opth-17-1777.PMC10290849.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10077029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Glycated Hemoglobin Improvement After Medical and Surgical Eye Care in American Veterans Involves Multidisciplinary Care. 美国退伍军人内科和外科眼科护理后糖化血红蛋白的改善涉及多学科护理。
IF 1.8
Clinical ophthalmology Pub Date : 2023-06-10 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S412187
Christopher M Santilli, Shaun Johnson, Coltt R Thunstrom, Karen R Armbrust
{"title":"Glycated Hemoglobin Improvement After Medical and Surgical Eye Care in American Veterans Involves Multidisciplinary Care.","authors":"Christopher M Santilli, Shaun Johnson, Coltt R Thunstrom, Karen R Armbrust","doi":"10.2147/OPTH.S412187","DOIUrl":"10.2147/OPTH.S412187","url":null,"abstract":"<p><strong>Purpose: </strong>The effects of diabetes mellitus (DM) on visual function have been extensively studied. Fewer studies evaluate the effect of visual function on DM, and previous small studies have shown mixed results concerning the relationship between glycated hemoglobin (HbA1c) and cataract surgery. We performed a retrospective, observational, single-site study at a Veterans hospital to evaluate this relationship and the relationship between HbA1c and non-surgical eye care.</p><p><strong>Patients and methods: </strong>We compared pre- and post-operative/examination HbA1c in 431 surgical and 431 matched, non-surgical subjects who underwent eye examination at the same institution. Subgroup analysis was performed by age, elevated (≥8) pre-operative/examination HbA1c, and change in diabetic management. We also assessed for a relationship between changes in best-corrected visual acuity (BCVA) and HbA1c. The Minneapolis Veterans Affairs Health Care System Research Administration determined this study to be Institutional Review Board exempt from the requirements of 38 CFR 16 under Category 4 (iii).</p><p><strong>Results: </strong>Pairwise comparison of pre- versus post-operative HbA1c trended towards reduction at 3-6 months in all surgical subjects, with a statistically significant reduction in older subjects, and those with higher pre-operative HbA1c. Eye examination subjects experienced a significant HbA1c reduction 3-6 months after eye examination. Reduction in post-operative/examination HbA1c was associated with concurrent change in diabetic management.</p><p><strong>Conclusion: </strong>We found an overall reduction in HbA1c in diabetic Veterans who interacted with an ophthalmologist, whether for cataract surgery or eye examination. HbA1c reduction was greatest when ophthalmic care was delivered as part of a multidisciplinary care team. Our findings add new evidence to further support the importance of ophthalmic care in patients with DM and suggest improved visual function may facilitate improved glycemic control.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1675-1682"},"PeriodicalIF":1.8,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/b7/opth-17-1675.PMC10266375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Response to Letter]. 颈动脉-海绵状瘘:眼超声在其鉴别中的应用[回复字母]。
IF 2.5
Clinical ophthalmology Pub Date : 2023-06-01 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S422888
Pawasoot Supasai, Kanwasee Kanjana, Yosanan Yospaiboon
{"title":"Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Response to Letter].","authors":"Pawasoot Supasai, Kanwasee Kanjana, Yosanan Yospaiboon","doi":"10.2147/OPTH.S422888","DOIUrl":"10.2147/OPTH.S422888","url":null,"abstract":"","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1555-1556"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/33/opth-17-1555.PMC10241348.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9591384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neuroprotection for Nonarteritic Central Retinal Artery Occlusion: Lessons from Acute Ischemic Stroke. 非动脉炎性视网膜中央动脉闭塞的神经保护:急性缺血性中风的教训。
IF 1.8
Clinical ophthalmology Pub Date : 2023-05-31 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S403433
Ogugua Ndubuisi Okonkwo, Chineze Thelma Agweye, Toyin Akanbi
{"title":"Neuroprotection for Nonarteritic Central Retinal Artery Occlusion: Lessons from Acute Ischemic Stroke.","authors":"Ogugua Ndubuisi Okonkwo, Chineze Thelma Agweye, Toyin Akanbi","doi":"10.2147/OPTH.S403433","DOIUrl":"10.2147/OPTH.S403433","url":null,"abstract":"<p><p>Nonarteritic central retinal artery occlusion (NA-CRAO) is a variant of acute ischemic stroke (AIS) and is a cause of sudden severe loss of vision. There are guidelines by the American Heart Association and the American Stroke Association for the care of CRAO patients. This review explores the basis of retinal neuroprotection for CRAO and its potential for improving the outcome of NA-CRAO. Recently, there have been significant advances in research into the use of neuroprotection to treat retinal diseases, including retinal detachment, age-related macular degeneration, and inherited retinal diseases. Also, neuroprotective research in AIS has been extensive, and newer drugs tested, including Uric acid, Nerinetide, and Otaplimastat, with promising results. Progress in cerebral neuroprotection after AIS offers hope for retinal neuroprotection after CRAO; and a possibility of extrapolating research findings from AIS into CRAO. Combining neuroprotection and thrombolysis can extend the therapeutic window for NA-CRAO treatment and potentially improve outcomes. Experimented neuroprotection for CRAO includes Angiopoietin (Comp Ang1), KUS 121, Gene therapy (XIAP), and hypothermia. Efforts in the field of neuroprotection for NA-CRAO should focus on better imaging to delineate the penumbra after an acute episode of NA-CRAO (using a combination of high-definition optical coherence angiography and electrophysiology). Also, research should explore details of pathophysiologic mechanisms involved in NA-CRAO, allowing for further neuroprotective intervention, and closing the gap between preclinical and clinical neuroprotection.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1531-1543"},"PeriodicalIF":1.8,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/be/opth-17-1531.PMC10239763.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9591381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Letter]. 颈动脉-海绵状瘘管:眼超声鉴别的应用[字母]。
IF 2.5
Clinical ophthalmology Pub Date : 2023-05-22 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S420582
Mario Graziano, Danilo Biondino, Isabella Fioretto
{"title":"Carotid-Cavernous Fistulas: The Utility of Ocular Echography in Their Differentiation [Letter].","authors":"Mario Graziano, Danilo Biondino, Isabella Fioretto","doi":"10.2147/OPTH.S420582","DOIUrl":"10.2147/OPTH.S420582","url":null,"abstract":"","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1421-1422"},"PeriodicalIF":2.5,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/86/opth-17-1421.PMC10216863.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9583850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does Surgical Resection of Horizontal Extraocular Muscles Disrupt Ocular Proprioceptors? 手术切除水平眼外肌是否会破坏眼球运动感受器?
IF 1.8
Clinical ophthalmology Pub Date : 2023-05-15 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S381247
Ala Paduca, Per O Lundmark, J Richard Bruenech
{"title":"Does Surgical Resection of Horizontal Extraocular Muscles Disrupt Ocular Proprioceptors?","authors":"Ala Paduca, Per O Lundmark, J Richard Bruenech","doi":"10.2147/OPTH.S381247","DOIUrl":"10.2147/OPTH.S381247","url":null,"abstract":"<p><strong>Purpose: </strong>It has been promoted that disturbance of ocular proprioception may play a role in the pathogenesis of concomitant strabismus and other types of oculomotor anomalies. The aim of the study was to obtain knowledge about how surgical foreshortening of the myotendinous region potentially affects the proprioceptors that resides in this area of the muscles and to test the hypothesis that avoiding disruption of ocular proprioceptors result in a more favorable long term postoperative result.</p><p><strong>Patients and methods: </strong>The distal end of the lateral and medial rectus muscles from patients with manifest concomitant strabismus with a deviation of ≥15 prism diopters (PD) were collected during strabismus surgery and processed for light microscopy by standard histochemical techniques. Histological analysis served to differentiate between the tissue samples containing pure tendon, versus samples containing the myotendinous junction. Criteria for successful outcome was defined as a residual angle of deviation less than 10 PD. The binocular status of the patient was measured pre- and post-operatively at 6-months of follow-up.</p><p><strong>Results: </strong>Tissue samples from 43 patients (median age 19 years old, range 3-58 years) were collected during surgery. Twenty-six of the samples contained pure tendon, while 17 contained muscle fibres. The evolution of the post-operative result revealed a moderate reduction in the residual angle of deviation in patient-samples containing pure tendon. In contrast, the residual angle of deviation clearly increased in patient-samples containing muscle fibres. The difference between the two groups reached statistical significance after 6 months. Successful outcome was found to be more than three times more likely in cases where surgery was performed in pure tendon, compared to muscle fibres.</p><p><strong>Conclusion: </strong>The current study supports the hypothesis that avoiding disruption of ocular proprioceptors, located in the distal myotendinous region, results in a more favorable postoperative result.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1395-1405"},"PeriodicalIF":1.8,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/21/opth-17-1395.PMC10198280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9503744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of "Complex" Cataract Surgeries Performed by Long-Term Glaucoma Fellows in a Tertiary Eye Centre from Eastern India. 印度东部第三眼科中心长期青光眼研究员进行的“复杂”白内障手术的结果。
IF 2.2
Clinical ophthalmology Pub Date : 2023-05-05 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S405772
Avik Roy, Argentino Almeida, Aparna Rao
{"title":"Outcomes of \"Complex\" Cataract Surgeries Performed by Long-Term Glaucoma Fellows in a Tertiary Eye Centre from Eastern India.","authors":"Avik Roy,&nbsp;Argentino Almeida,&nbsp;Aparna Rao","doi":"10.2147/OPTH.S405772","DOIUrl":"10.2147/OPTH.S405772","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the outcomes of operating on \"complex cataracts\" by the glaucoma fellows.</p><p><strong>Patients and methods: </strong>This was a retrospective study done at a tertiary referral eye care centre in eastern India. After obtaining IRB approval, a retrospective chart review of all patients who underwent \"complex\" cataract surgery by one of four long-term (2 years) glaucoma fellows between January 2016 and November 2020 was conducted. 'Complex' was defined as cataracts complicated with pseudoexfoliation syndrome, phacodonesis with or without blunt ocular trauma, posterior polar cataract, small pupil, co-existent corneal opacity or uveal coloboma, post-glaucoma filtering surgery, post-vitreoretinal surgery, co-existent glaucoma or post-laser iridotomy and monocular patients.</p><p><strong>Results: </strong>Out of a total of 677 eyes done by the glaucoma fellows during the study period, 83 eyes had complex cataract surgery and completed the six-week post-operative follow-up. Intraoperative surgical complications like posterior capsular rent or vitreous loss were noted in 36 of the cases. Thirty of the eyes were left aphakic. Despite a high rate of complications, the LogMAR best-corrected visual acuity (mean ± standard deviation) improved from the preoperative level of 1.7 (±0.5) to 1.0 (± 0.8) at post-operative six weeks, significant at p < 0.001. As far as the surgeon's experience was concerned-less than or more than a year since joining the fellowship-there was statistically no difference in the final visual acuity. The group with greater experience had shorter surgical time and lesser complications though this difference was not statistically significant.</p><p><strong>Conclusion: </strong>This is the first study in the literature reporting the outcomes of \"complex\" cataract surgery performed by glaucoma fellows. Though high rates of postoperative complications were noted in this study, the mean best-corrected visual acuity improved significantly in all eyes after the surgery.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1315-1321"},"PeriodicalIF":2.2,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/dd/opth-17-1315.PMC10167976.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9473473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting Prognosis Based on Regional Prevalence, Ulcer Morphology and Treatment Strategy in Vision-Threatening Pythium insidiosum Keratitis. 基于区域患病率、溃疡形态和治疗策略预测视觉威胁型隐球菌性角膜炎的预后。
IF 2.2
Clinical ophthalmology Pub Date : 2023-05-05 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S412274
Bharat Gurnani, Kirandeep Kaur
{"title":"Predicting Prognosis Based on Regional Prevalence, Ulcer Morphology and Treatment Strategy in Vision-Threatening <i>Pythium insidiosum</i> Keratitis.","authors":"Bharat Gurnani,&nbsp;Kirandeep Kaur","doi":"10.2147/OPTH.S412274","DOIUrl":"10.2147/OPTH.S412274","url":null,"abstract":"<p><p><i>Pythium insidiosum</i> is an oomycete belonging to the phylum Straminipila and family Pythiaceae. It causes rapidly progressive vision-threatening keratitis. Clinically, microbiologically and morphologically, it closely resembles fungal keratitis; hence it is also labelled as a \"parafungus\". The clinical features mimicking fungus are subepithelial and stromal infiltrate, endo-exudates, corneal melt and hypopyon. The hallmark features of <i>Pythium</i> are tentacular projections, reticular dot-like infiltrate, peripheral furrowing and thinning, and rapid limbal spread. Microbiological corneal smearing on KOH and Gram stain reveal septate or aseptate, obtuse to perpendicular hyphae which mimic fungal hyphae. Culture on any nutritional agar reveals cream, cottonwool-like, fluffy colonies, and diagnosis is confirmed by zoospore formation by the leaf incarnation method. Medical management with antifungals and antibacterials still presents a dilemma. Early therapeutic keratoplasty has been the proposed treatment in most cases. We hypothesize that the prognosis of <i>Pythium</i> keratitis is governed by regional geographical variations, ulcer size and density on presentation, and initial treatment strategy. The available literature supporting the proposed hypothesis is also discussed, along with the hallmark features of <i>Pythium</i> and how it masquerades as other microorganisms causing keratitis. We also aim to propose a novel diagnostic and treatment algorithm for managing this vision-threatening keratitis.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1307-1314"},"PeriodicalIF":2.2,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/a6/opth-17-1307.PMC10167989.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Initial Real-World Experience with Faricimab in Treatment-Resistant Neovascular Age-Related Macular Degeneration. Faricimab治疗难治性新血管年龄相关性黄斑变性的初步现实经验。
IF 2.2
Clinical ophthalmology Pub Date : 2023-05-05 eCollection Date: 2023-01-01 DOI: 10.2147/OPTH.S409822
Ella H Leung, Daniel J Oh, Shannon E Alderson, Joshlynn Bracy, Mia McLeod, Litzi I Perez, Alexander Bottini, David Chin Yee, Krishna Mukkamala
{"title":"Initial Real-World Experience with Faricimab in Treatment-Resistant Neovascular Age-Related Macular Degeneration.","authors":"Ella H Leung,&nbsp;Daniel J Oh,&nbsp;Shannon E Alderson,&nbsp;Joshlynn Bracy,&nbsp;Mia McLeod,&nbsp;Litzi I Perez,&nbsp;Alexander Bottini,&nbsp;David Chin Yee,&nbsp;Krishna Mukkamala","doi":"10.2147/OPTH.S409822","DOIUrl":"10.2147/OPTH.S409822","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the initial efficacy and safety of intravitreal faricimab in eyes previously treated for neovascular age-related macular degeneration (nARMD).</p><p><strong>Patients and methods: </strong>A retrospective review of all patients with nARMD previously treated with anti-vascular endothelial growth factor (anti-VEGF) injections who received at least 3 intravitreal faricimab injections with at least 3 months of follow-up.</p><p><strong>Results: </strong>A total of 190 eyes were included. Patients received a mean of 34.2±23 anti-VEGF injections over 182.41±128 weeks prior to switching to faricimab. Patients then received a mean of 6.99±2.3 faricimab injections with an average 34.88±8.2 weeks of follow-up. The mean best corrected visual acuities improved from 0.33±0.32 logMAR ≈20/43 to 0.27±0.32 logMAR ≈20/37 (<i>P</i>=0.0022). The central subfield thickness (CST) improved from 312±87μm to 287±71μm (<i>P</i><0.0001). At the last clinical visit, 24% had no subretinal fluid or intraretinal fluid on optical coherence tomography. The mean dosing interval between the last two consecutive faricimab injections (7.64±6.2 weeks) was significantly longer than that for ranibizumab (5.16±2.0 weeks, <i>P</i><0.001) or aflibercept (5.57±3.6 weeks, <i>P</i><0.001). No patients developed idiopathic intraocular inflammation.</p><p><strong>Conclusion: </strong>Intravitreal faricimab was associated with improved vision and CSTs, even in treatment-resistant nARMD eyes. The mean last dosing interval for faricimab was longer than for ranibizumab or aflibercept. No significant adverse events were directly attributed to faricimab during the study.</p>","PeriodicalId":10442,"journal":{"name":"Clinical ophthalmology","volume":"17 ","pages":"1287-1293"},"PeriodicalIF":2.2,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/8c/opth-17-1287.PMC10167970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9470355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
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