Medical Hypothesis, Discovery, and Innovation in Ophthalmology最新文献

{"title":"Aflibercept or ranibizumab for diabetic macular edema.","authors":"Mahmoud Abdelhalim Ali Ali, Hanan Saied Hegazy, Mohammed Othman Abdelkhalek Elsayed, Ehab Tharwat, Mona Nabeh Mansour, Mohamed Hassanein, Ezzeldin Ramadan Ezzeldin, Ashraf Mohammed GadElkareem, Essam Mahmoud Abd Ellateef, Ahmed A Elsayed, Ibrahim Hassan Elabd, Mahmoud H Abd Rbu, Ramy Saleh Amer, Abdel Ghany Ali El Gabbar, Hatem Mahmoud, Hazem Mohamed Abdelhameed, Amr Mohammed Elsayed Abdelkader","doi":"10.51329/mehdiophthal1490","DOIUrl":"10.51329/mehdiophthal1490","url":null,"abstract":"<p><strong>Background: </strong>Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME.</p><p><strong>Methods: </strong>This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography.</p><p><strong>Results: </strong>Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all <i>P</i> >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both <i>P</i> >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both <i>P</i> = 0.001), with no statistically significant difference between groups at all follow-up visits (all <i>P</i> >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both <i>P</i> = 0.001), with no statistically significant differences between groups at all follow-up visits (all <i>P</i> >0.05). No serious adverse effects were documented in either group.</p><p><strong>Conclusions: </strong>Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 1","pages":"16-26"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559913","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}

{"title":"Surgical management of chronic sixth cranial nerve palsy: case report and literature review.","authors":"Christine Hakimeh, Kourosh Shahraki, Luc Courtois, Donny W Suh","doi":"10.51329/mehdiophthal1494","DOIUrl":"10.51329/mehdiophthal1494","url":null,"abstract":"<p><strong>Background: </strong>Esotropia resulting from sixth cranial nerve palsy can substantially impact an individual's visual acuity and overall quality of life. If the condition does not resolve in 6-10 months, surgical intervention may be necessary. Various muscle surgeries may be considered, with vertical rectus muscle transposition emerging as the primary option for treatment of complete palsy. However, this technique carries the risk of anterior segment ischemia and post-surgery deviations. Herein, we present a successful treatment of chronic complete sixth nerve palsy using a modified Nishida procedure, without splitting or tenotomy, and an adjunct botulinum toxin A (BTA) injection in the ipsilateral medial rectus muscle.</p><p><strong>Case presentation: </strong>A 59-year-old woman with a history of traumatic sixth nerve palsy had previously undergone horizontal muscle strabismus surgeries. Following multiple left medial rectus recessions, lateral rectus resection, and BTA injections, esotropia persisted. The worsening of her condition led to emotional distress and impaired social interaction. Initial examination revealed marked esotropia and limited left eye abduction. Magnetic resonance imaging (SIGNA MR750w, GE Healthcare, Waukesha, WI, USA) of the left eye revealed a contracted medial rectus muscle and substantial atrophy of the left lateral rectus muscle. A modified Nishida procedure was performed with an injection of 3 units of BTA into the ipsilateral medial rectus muscle, resulting in improved ocular alignment and stable findings after nine postoperative months. Furthermore, we supported our successful outcome with a summary of similar reported cases of sixth nerve palsy managed using the modified Nishida procedure with or without adjunctive procedures.</p><p><strong>Conclusions: </strong>Following the modified Nishida procedure, the patient experienced a reduction in diplopia, improved ocular alignment and stability, and an increased binocular diplopia-free field. This case underscores the importance of an individualized approach to complex strabismus cases and highlights the modified Nishida procedure as a valuable tool in such circumstances. In the future, strabismus management will focus on refining personalized treatment and exploring innovative techniques for complex cases. Our success in using a combination of Nishida procedure and BTA injection should be further investigated in large-scale studies.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 1","pages":"55-62"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559885","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}

{"title":"Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus.","authors":"Amr Mounir, Engy Mohamed Mostafa, Ibrahim Amer, Ahmed Abdelaleem Abdelgbar, Hamdy Osman Osman, Mostafa Abdelrahman Ahmed, Hossam Ziada, Abdel Ghany Ali El Gabbar, Mohamed Alsadawy Hassan, Alaa Mahmoud","doi":"10.51329/mehdiophthal1491","DOIUrl":"10.51329/mehdiophthal1491","url":null,"abstract":"<p><strong>Background: </strong>Intrastromal corneal ring segments are commonly implanted in the corneas of eyes with mild-to-moderate keratoconus; however, changes in corneal densitometry (CD) after implantation are a matter of debate in the current literature. We evaluated the changes in CD 1 and 3 months after femtosecond laser-assisted Keraring implantation.</p><p><strong>Methods: </strong>This retrospective, non-comparative, multicenter, case series study included patients with keratoconus who underwent femtosecond laser-assisted implantation of double segments with 90° and 160° arc lengths or two 160° arc length Keraring segments. Demographic and baseline clinical ophthalmic data were recorded. Corneal topography and tomography data acquired using a Pentacam HR Scheimpflug tomography system (Pentacam High Resolution; Oculus, Wetzlar, Germany) with a best-fit sphere were used as a reference surface. Using the Pentacam HR, CD measurements were acquired over a corneal area of 12 mm in total and at four concentric zones (0-2, 2-6, 6-10, and 10-12 mm) of three corneal stromal depths: 120 μm of the anterior corneal stromal layer, 60 μm of the posterior corneal stromal layer, and the central layer of stroma lying between these two layers.</p><p><strong>Results: </strong>We included 40 eyes of 40 patients, including 8 (20%) male and 32 (80%) female individuals, with a mean (standard deviation) age of 21.0 (6.4) years. We observed a significant improvement in the topographic values of steep keratometry (K), flat K, maximum K, and corneal astigmatism (all P < 0.05), but not in the mean K, thinnest corneal pachymetry, corneal thickness at the apex, back elevation, or front elevation (all P > 0.05). The mean total anterior, central, and posterior CD differed significantly among the time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05) and no difference between those of the 1-month and 3-month postoperative visits (all P > 0.05). The mean CD for the anterior layer in the central, paracentral, and mid-peripheral zones, and the central layer in all four zones, differed significantly among time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05), which remained unchanged from the 1-month to the 3-month postoperative visit (all P < 0.05), except for the central 2-6-mm zone, which decreased significantly from the 1-month to the 3-month postoperative visit (P < 0.001). The CD of the central 10-12-mm zone did not differ significantly in each pairwise comparison (all P > 0.05). In contrast, CD for the posterior layer in the paracentral zone decreased significantly from the preoperative to the 1-month and 3-month postoperative visits but increased, to a lesser extent, from the 1-month to the 3-month postoperative visit (all P < 0.05).</p><p><strong>Conclusions: </strong>Femtosecond laser-assisted Keraring implantation signi","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 1","pages":"27-34"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559914","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}

{"title":"Fenofibrate and diabetic retinopathy.","authors":"Omer Karti, Ali Osman Saatci","doi":"10.51329/mehdiophthal1492","DOIUrl":"10.51329/mehdiophthal1492","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR), a sight-threatening ocular complication of diabetes mellitus, is one of the main causes of blindness in the working-age population. Dyslipidemia is a potential risk factor for the development or worsening of DR, with conflicting evidence in epidemiological studies. Fenofibrate, an antihyperlipidemic agent, has lipid-modifying and pleiotropic (non-lipid) effects that may lessen the incidence of microvascular events.</p><p><strong>Methods: </strong>Relevant studies were identified through a PubMed/MEDLINE search spanning the last 20 years, using the broad term \"diabetic retinopathy\" and specific terms \"fenofibrate\" and \"dyslipidemia\". References cited in these studies were further examined to compile this mini-review. These pivotal investigations underwent meticulous scrutiny and synthesis, focusing on methodological approaches and clinical outcomes. Furthermore, we provided the main findings of the seminal studies in a table to enhance comprehension and comparison.</p><p><strong>Results: </strong>Growing evidence indicates that fenofibrate treatment slows DR advancement owing to its possible protective effects on the blood-retinal barrier. The protective attributes of fenofibrate against DR progression and development can be broadly classified into two categories: lipid-modifying effects and non-lipid-related (pleiotropic) effects. The lipid-modifying effect is mediated through peroxisome proliferator-activated receptor-α activation, while the pleiotropic effects involve the reduction in serum levels of C-reactive protein, fibrinogen, and pro-inflammatory markers, and improvement in flow-mediated dilatation. In patients with DR, the lipid-modifying effects of fenofibrate primarily involve a reduction in lipoprotein-associated phospholipase A2 levels and the upregulation of apolipoprotein A1 levels. These changes contribute to the anti-inflammatory and anti-angiogenic effects of fenofibrate. Fenofibrate elicits a diverse array of pleiotropic effects, including anti-apoptotic, antioxidant, anti-inflammatory, and anti-angiogenic properties, along with the indirect consequences of these effects. Two randomized controlled trials-the Fenofibrate Intervention and Event Lowering in Diabetes and Action to Control Cardiovascular Risk in Diabetes studies-noted that fenofibrate treatment protected against DR progression, independent of serum lipid levels.</p><p><strong>Conclusions: </strong>Fenofibrate, an oral antihyperlipidemic agent that is effective in decreasing DR progression, may reduce the number of patients who develop vision-threatening complications and require invasive treatment. Despite its proven protection against DR progression, fenofibrate treatment has not yet gained wide clinical acceptance in DR management. Ongoing and future clinical trials may clarify the role of fenofibrate treatment in DR management.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 1","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559915","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}

{"title":"Keratoconus: imaging modalities and management.","authors":"Noor Alqudah","doi":"10.51329/mehdiophthal1493","DOIUrl":"10.51329/mehdiophthal1493","url":null,"abstract":"<p><strong>Background: </strong>Keratoconus (KCN) is characterized by gradual thinning and steepening of the cornea, which can lead to significant vision problems owing to high astigmatism, corneal scarring, or even corneal perforation. The detection of KCN in its early stages is crucial for effective treatment. In this review, we describe current advances in the diagnosis and treatment of KCN.</p><p><strong>Methods: </strong>This narrative review focuses on recent advancements in the diagnosis and treatment of KCN, especially evolving approaches and strategies. To ensure the inclusion of the most recent literature, relevant publications discussing advanced imaging techniques and treatment options for KCN were extensively gathered from the PubMed/MEDLINE and Google Scholar databases. The following index terms and keywords were used for the online search: keratoconus, diagnosis of keratoconus, advances in the diagnosis of keratoconus, topography or tomography, anterior segment optical coherence tomography, treatment of keratoconus, advances in the treatment of keratoconus, collagen crosslinking, intrastromal ring, keratoplasty, and new techniques in keratoconus.</p><p><strong>Results: </strong>Various screening methods such as corneal topography, tomography, anterior segment optical coherence tomography, and assessment of corneal biomechanics have been developed to identify KCN in its early stages. After diagnosis, KCN management focuses on preventing disease progression. Corneal collagen crosslinking is a minimally invasive treatment that can slow or stop the progression of the condition. Recent research has also explored the use of copper sulfate eye drops (IVMED-80) as a noninvasive treatment to prevent the progression of KCN. Current treatment options for visual improvement include scleral lenses, intracorneal ring segments, corneal allogeneic intrastromal ring segments, and deep anterior lamellar keratoplasty. Recently, novel alternative procedures, such as isolated Bowman layer transplantation, either as a corneal stromal inlay or onlay, have demonstrated encouraging outcomes. Artificial intelligence has gained acceptance for providing best practices for the diagnosis and management of KCN, and the science of its application is contentiously debated; however, it may not have been sufficiently developed.</p><p><strong>Conclusions: </strong>Early detection and advancements in screening methods using current imaging modalities have improved diagnosis of KCN. Improvement in the accuracy of current screening or diagnostic tests and comparison of their validities are achievable by well-designed, large-scale, prospective studies. The safety and effectiveness of emerging treatments for KCN are currently being investigated. There is an ongoing need for studies to track progress and evaluate clinicians' knowledge and practices in treating patients with KCN. Artificial intelligence capabilities in management approach considering the currently available","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 1","pages":"44-54"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559916","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}

{"title":"Ocular injuries sustained at home in five metropolitan cities: a review of 5008 cases.","authors":"Meisam Sharifi, Mohammad Sedaghat, Mohammad Vaseie","doi":"10.51329/mehdiophthal1486","DOIUrl":"https://doi.org/10.51329/mehdiophthal1486","url":null,"abstract":"<p><strong>Background: </strong>In Iran, ocular injuries sustained at home are a growing public health issue, and few studies have explored their prevalence and the frequencies of different causes of these injuries. We investigated the features of ocular injuries at home among children and adolescents (aged < 18 years), adults (18 - 64 years), and the elderly ( ≥ 65 years) in five metropolitan cities.</p><p><strong>Methods: </strong>In this cross-sectional study, we recruited individuals with ocular injuries sustained at home who presented to 12 public/teaching hospitals in five metropolitan cities during a 5-month period. Using clinical records within the emergency department archives, we collected the following data: age, sex, frequency of injuries requiring hospital admission or surgical intervention, and causes of eye injuries, documented as 1) cleaning products, 2) chemical products, 3) kitchen items, 4) cooking activities, 5) toys, 6) falls from height, 7) sports equipment, 8) penetrating or cutting, 9) abrasions, 10) foreign bodies, and 11) direct blows by other individuals.</p><p><strong>Results: </strong>Of 5008 participants from the five cities, 74% (n = 3711) were male and 26% (n = 1297) were female. The most frequent causes of injury among children and adolescents, adults, and the elderly were toys, kitchen items, and cooking activities, respectively. In children and adolescents, injuries were caused by kitchen items, toys, foreign bodies, and direct blows by other individuals more frequently than in adults or the elderly, and by cleaning products and abrasions more frequently than in the elderly (all <i>P</i> < 0.05). In adults, injuries were caused by cleaning products, cooking activities, falls from height, sports equipment, penetrating or cutting, and abrasions more frequently than in children and adolescents or the elderly (all <i>P</i> < 0.05), and by kitchen items, toys, and blows by other individuals more frequently than in the elderly (all <i>P</i> < 0.05). In the elderly, injuries were caused by chemical products more frequently than in children and adolescents or adults, and by cooking activities, falls from height, and sports equipment more frequently than in children and adolescents (all <i>P</i> < 0.05). In adults, the frequency of ocular injuries was significantly higher in Tehran and lower in Mashhad when comparing each with that of the other four cities (all <i>P</i> < 0.05). We found a significantly higher frequency of ocular injuries by cleaning and chemical products in Tehran, by toys in Shiraz, by falls from height in Isfahan, and by direct blows by other individuals in Ahvaz when comparing each to that of the other four cities (all <i>P</i> < 0.05). Regarding the prevalence of severe ocular injuries among the children/adolescent and adult age groups, conditions were relatively better in Shiraz and relatively unfavorable in Mashhad.</p><p><strong>Conclusions: </strong>Ocular trauma was more common in male individu","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"12 4","pages":"194-202"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861206","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}

{"title":"Ocular surface lesions in clinical grades of Bell's phenomenon.","authors":"Omer Faruk Yilmaz, Halit Oguz","doi":"10.51329/mehdiophthal1484","DOIUrl":"https://doi.org/10.51329/mehdiophthal1484","url":null,"abstract":"<p><strong>Background: </strong>Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell's phenomenon that includes the inverse Bell's phenomenon. Using this scale, we investigated the characteristics of Bell's phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades.</p><p><strong>Methods: </strong>In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 - 20 years, 21 - 40 years, 41 - 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade + 2 Bell's phenomenon were included in the symptomatic group. Bell's phenomenon was classified into five grades: grade + 2 (strong positive), grade + 1 (weak positive), grade 0 (no Bell's phenomenon, no eye movement), grade -1 (weak inverse), and grade -2 (strong inverse).</p><p><strong>Results: </strong>We detected higher frequencies of grade + 2, + 1, and 0 in individuals aged 4 - 40, 41 - 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (<i>P</i> < 0.001). Pairwise analysis revealed a significantly lower frequency of grade + 2 in the age group > 60 years compared with the 4 - 20 and 21 - 40 year groups (both <i>P</i> < 0.05). Grade + 2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (<i>P</i> > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (<i>P</i> < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all <i>P</i> < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (<i>P</i> > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, + 1, -1, and -2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade + 1, -1, and -2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade + 1, -1, and -2: 7 lesions).</p><p><strong>Conclusions: </strong>Using a simple, practical grading scale for Bell's phenomenon that includes inverse Bell's phenomenon, we observed that inverse Bell's phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degr","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"12 4","pages":"177-186"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852078","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}

{"title":"COVID-19 and children's eyes.","authors":"Nima Rastegar Rad","doi":"10.51329/mehdiophthal1488","DOIUrl":"https://doi.org/10.51329/mehdiophthal1488","url":null,"abstract":"","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"12 4","pages":"213-216"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868149","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}

{"title":"Safety and efficacy of implantable phakic contact lens versus implantable collamer lens in myopia correction.","authors":"Ibrahim Amer, Hossameldin A Ziada, Akram Fekry Elgazzar, Walid Shaban Abdella, Ahmed Abdelaleem Abdelgbar, Islam Goda, Ramy Saleh Amer, Hamdy Osman Abdel-Rahman Osman, Sanaa Ahmed Mohamed, Mona N Mansour, Mohamed Alsadawy Hassan, Abdel Ghany Ali El Gabbar, Mohamed Atito Hamed","doi":"10.51329/mehdiophthal1482","DOIUrl":"https://doi.org/10.51329/mehdiophthal1482","url":null,"abstract":"<p><strong>Background: </strong>Phakic intraocular lenses (pIOLs) have proven to be excellent substitutes for excimer laser keratorefractive surgery in certain situations. We aimed to assess the efficacy and safety of two pIOLs, the implantable collamer lens (ICL V4c) versus the implantable phakic contact lens (IPCL V2), for myopic correction.</p><p><strong>Methods: </strong>In this prospective randomized clinical trial, we allocated eligible eyes with myopia > - 6 diopters into IPCL or ICL implantation groups, each including 100 eyes of 100 individuals. Preoperative and postoperative assessments at 3, 6, and 12 months included measurements of the spherical equivalent (SE), uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), maximum keratometry (K1), minimum keratometry (K2), mean keratometry (Kmean), anterior chamber depth (ACD), anterior chamber angle (ACA), and endothelial cell density (ECD).</p><p><strong>Results: </strong>The groups had comparable demographic characteristics and baseline visual and anatomical values (all <i>P</i> > 0.05). The UCDVA, BCDVA, and SE of the two groups were comparable at baseline and at all postoperative follow-up examinations (all <i>P</i> > 0.05). Both groups experienced significant improvements in UCDVA, BCDVA, and SE at three months postoperatively (all <i>P</i> = 0.001), and measurements remained stable for up to 12 months. Keratometry readings were comparable between the groups over the follow-up period and remained unchanged at all visits (all <i>P</i> > 0.05). The ACA in the ICL group was significantly decreased at three months postoperatively (<i>P</i> = 0.001) and then widened significantly at 6 and 12 months (both <i>P</i> = 0.001). In the IPCL group, the postoperative ACA was significantly decreased at three months (<i>P</i> = 0.001) and was comparable to that in the ICL group (<i>P</i> > 0.01). However, at the 6- and 12-month postoperative visits, the ACA was significantly narrower in the IPCL group than in the ICL group (both <i>P</i> = 0.001). The ACD in both groups was decreased at three months postoperatively (both <i>P</i> = 0.001) and remained stable until the end of the study. The ECD remained comparable between the groups at all postoperative visits (all <i>P</i> > 0.05). We did not observe a significant ECD reduction in either group at any postoperative follow-up visit (all <i>P</i> > 0.05). We encountered no serious complications in either group.</p><p><strong>Conclusions: </strong>ICL and IPCL had comparable safety and efficacy outcomes in terms of anterior chamber morphometrics, visual and refractive results, and corneal parameters. Further multicenter randomized clinical trials with longer follow-up periods, larger sample sizes, and measurement of additional anterior chamber and corneal morphometrics, vault, and other vision parameters are needed to verify these findings.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"12 4","pages":"160-167"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866720","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}

{"title":"Pseudovitelliform maculopathy associated with hereditary hemochromatosis.","authors":"Ante Vukojevic, Marija Vukojevic, Tomislav Jukic, Igor Petricek, Kresimir Mandic, Nenad Vukojevic","doi":"10.51329/mehdiophthal1487","DOIUrl":"https://doi.org/10.51329/mehdiophthal1487","url":null,"abstract":"<p><strong>Background: </strong>Hereditary hemochromatosis (HH) is an inherited autosomal recessive iron metabolism disorder resulting from a C282Y mutation in the <i>HFE</i> gene. Mutations in the <i>HFE</i> gene may result in iron accumulation and oxidative stress in the retina, resulting in macular degeneration. This article describes two patients with HH who were treated with erythrocytapheresis or phlebotomy, with no exposure to deferoxamine or any other chelation therapy, and who developed visual symptoms.</p><p><strong>Case presentation: </strong>Both patients had known diagnoses of HH. Because of visual symptoms, they were referred to the ophthalmology clinic and underwent a retinal exam, multimodal imaging, and electrodiagnostic studies, which revealed structural and functional degeneration of the central macula. Fundus photography, fluorescein angiography, and fundus autofluorescence revealed changes at the level of the retinal pigment epithelium (RPE) in the central macula. In addition, optical coherence tomography revealed subfoveal accumulation of hyperreflective material at and below the RPE. Multifocal electroretinography confirmed a decreased cone response, whereas the full-field electroretinogram was unremarkable. Genetic testing ruled out Best's vitelliform macular dystrophy and the other known hereditary macular dystrophies. The patients had known diagnoses of HH, homozygous C282Y mutations in the <i>HFE</i> gene, and no comorbidities; thus, we presumed that HH led to the observed morphological and functional disorders of the RPE, which in turn caused structural macular changes in both patients.</p><p><strong>Conclusions: </strong>Considering the macular findings and the nature of the patients' primary illness, we believe that the accumulation of iron and photoreceptor metabolic products caused dysfunction in the RPE, which led to morphological and functional changes in the macula. Because the patients were not treated using chelating agents, we attribute the macular changes solely to iron accumulation and oxidative stress caused by the pathophysiological processes of HH. Further studies are needed to identify the plausible molecular or cellular insults underlying pseudovitelliform macular degeneration in patients with HH.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"12 4","pages":"203-212"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866087","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}