Open Journal of Ophthalmology
Latest articles in this journal
Open Journal of Ophthalmology, Volume 11, pp 60-90; doi:10.4236/ojoph.2021.111006
Confocal microscopy is a method which has been increasingly used over the last decade in the study of the anterior ocular surface. The method allows testing and in vivo high resolution imaging of the structures of the anterior eye segment, at a cellular level, which is close to the histological examination of tissues. The data provided by this method allow for a better understanding of both the functional and pathological processes occurring in the anterior ocular surface not only for scientific purposes but also in clinical practice. The aim of the present work is to summarize the current knowledge and applications of confocal microscopy of the anterior ocular surface.
Open Journal of Ophthalmology, Volume 11, pp 1-17; doi:10.4236/ojoph.2020.111001
Introduction: Diabetic retinopathy (DR) is neglected in the planning of health services in Brazil. The purpose of this study was to investigate the frequency of Diabetic Retinopathy in patients with type 2 diabetes mellitus (DM2) registered in the Unified Health System (SUS) of the semi-arid of Paraíba (PB-Brazil), using a score developed by the researchers to track this condition. Methods: A cross-sectional study was carried out, in which DM2 patients registered at SUS in the city of S?o Mamede-PB was recruited. Ophthalmological and clinical data were collected, including: body mass index (BMI), waist circumference (WC), waist circumference/height ratio (WC/stature), smoking history, physical activity, time of diabetes and its control, blood pressure values and comorbidities. With these data, an original score for DR screening (DRSS) was performed. Qualitative variables were expressed by absolute and relative frequencies, and quantitative variables were expressed by means and standard deviations. p value ≤ 0.05 was used to reject the null hypothesis. Results: Ninety seven (64.7%) type 2 diabetic patients were recruited. Participants were predominantly women (64.9%), with a mean age of 65.8 years, of short stature (mean of 1.56 m), high BMI, with a predominance of the WC/stature ratio equal to or greater than 0.60, smokers and patients with systemic arterial hypertension (SAH). The main ophthalmological findings were: vascular changes compatible with Grade I/II Hypertensive Retinopathy (72.1%) and cataracts in about 50% of the eyes. The prevalence of DR was 12.4%. According to the DRSS results, it was found that most patients (85.6%) had a high risk score equal to or greater than 60 of developing DR. It was observed that the variables: WC, physical activity, time of diabetes and SAH showed a significant association with the risk of developing DR. In addition, BMI and WC/height ratio with higher values had a high risk of developing DR. Conclusion: There was association between medium and high DRSS risk diabetics with the probability of developing DR, recommending that all people with these characteristics should be referred to the specialist in order to screen for DR and other morbidities caused by diabetes.
Open Journal of Ophthalmology, Volume 11, pp 18-24; doi:10.4236/ojoph.2021.111002
Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transplantation developed acute severe pneumonia caused by Pneumocystis jiroveci (PJP) coinfection with Nocardia spp. and Cytomegalovirus (CMV). He was hospitalized due to acute respiratory failure. Chest radiographs and chest Computed Tomography (CT) revealed extensive ground-glass opacities. PJP was diagnosed from Bronchoalveolar Lavage Fluid (BALF). The pneumonia was persistent despite of receiving intravenous cotrimoxazole. Tracheal aspirate showed faint gram-positive filamentous beaded branching organisms. Consequently Nocardia spp. was proven. Intravenous cotrimoxazole was continued and intravenous imipenem was added. After a course of dual antibiotics, pneumonia was gradually improved. A week after, he developed the worsened acute respiratory failure. The bronchoscopy was performed. The new pathogens were not detected from BALF microbiology. The BALF cytology was unremarkable. PJP was detected by Polymerase Chain Reaction (PCR) from BALF. CMV antigenemia was detected from BALF and blood. Intravenous ganciclovir was given. This report describes PJP coinfected with Nocardia spp. and CMV in post corneal transplantation patient suffering from severe pneumonia. Multiple respiratory pathogens are common among transplantation patients representing host immunosuppression and inadequate antimicorbial prophylaxis.
Open Journal of Ophthalmology, Volume 11, pp 25-35; doi:10.4236/ojoph.2021.111003
Introduction: Iris-claw Intraocular Lens (IOL) is one of the alternatives to correct aphakia without sufficient capsular support. This technique is preferred because it has a simple procedure. Iris-claw IOL was originally designed to be fixated on the anterior chamber. The use of retropupillary fixation is increasing because the location is more physiologic and it shows less risk to corneal endothelial damage. Purpose: To describe safety and efficacy of iris-claw Artisan IOL in correcting aphakia without sufficient capsular support. Methods: This is a descriptive retrospective study of patients with aphakic iris-claw Artisan IOL implantation in National Eye Center Cicendo Eye Hospital, Indonesia from July 2017-July 2019. Patients were divided into prepupillary and retropupillary group. The Uncorrected Visual Acuity (UCVA), Best-Corrected Visual Acuity (BCVA), Safety Index (SI), Efficacy Index (EI), and complications were recorded. The procedure is safe if SI value ≥ 1.0 and effective if EI value ≥ 1.0. Results: There were 54 eyes in the retropupilary group and 17 eyes in the prepupillary group. In the prepupillary group, there were 94.11% eyes with SI ≥ 1.0, the mean SI was 1.79 ± 1.02, 50% of eyes with EI ≥ 1.0, and the mean EI was 0.77 ± 0.20. In the retropupillary group, there were 96.29% eyes with SI ≥ 1.0, the mean SI was 2.49 ± 2.23, 74.07% of eyes with EI ≥ 1.0, and the mean EI was 1.75 ± 1.64. Postoperative UCVA and BCVA were improved significantly compared to preoperative visual acuity in both groups (p < 0.05) Conclusion: Prepupillary and retropupillary iris-claw IOL implantation are safe. Retropupillary fixation technique is more effective in improving visual acuity.
Open Journal of Ophthalmology, Volume 11, pp 36-48; doi:10.4236/ojoph.2021.111004
Background: Cell replacement therapies have been evaluated in recent years as an alternative for various retinal pathologies to evaluate the therapeutic efficacy of cell therapy, it is important to measure the severity of the disease. The aim of this study was to evaluate the effect of umbilical cord derived Mesenchymal Stem Cell (UC-MSC) implantation on severity of Retinitis Pigmentosa (RP). Methods: This single-center, clinical study included data of 138 eyes of 92 patients who had a confirmed diagnosis of RP and received stem cell implantation to the suprachoroidal area with a surgical procedure. Patients were evaluated before and 1 year after the surgery regarding to the outcome measures of Best Corrected Visual Acuity (BCVA), Optical Coherence Tomography (OCT) and Visual Field (VF) tests. BCVA, VF width and ellipsoid zone (EZ) width on OCT were recorded for each patient and a scoring criterion was established for each variable varying from 0 to 5 depending on its distribution. The cumulative score (from 0 to 15) was used to classify disease severity from grade 0 to 5. Results: All of the patients completed 12-month follow-up period. The median age of the patients was 40.8 years, 46% were female, 77% had been diagnosed within 10 years and 41% had a family history. 79% of the patients with family history had autosomal recessive inheritance pattern. There were statistically significant improvements in the mean BCVA and VF scores during the study (p < 0.05). The mean score and the mean grade of the disease also improved after the treatment (p < 0.05). There was a negative correlation between BCVA improvement and scoring and grading of the disease. Conclusions: This study demonstrated beneficial effect of suprachoroidally applied UC-MSCs on BCVA, VF and the severity score and grade of the disease during 12-month follow-up period. Cell mediated therapy based on the secretion of Growth Factors (GFs) seems to be an effective and safe option for the treatment of degenerative retinal diseases. This classification is simple, produces objective measure of disease severity and gives opportunity to compare the results of different treatment modalities.
Open Journal of Ophthalmology, Volume 11, pp 49-59; doi:10.4236/ojoph.2021.111005
Introduction: Keratoconus (KCN) is one of the degenerative corneal disorders, which causes impairment in normal visual acuity with a higher prevalence in Saudi Arabia. The study aimed to assess the awareness and knowledge regarding KCN, its risk factors, and management among the Saudi population. Materials and Methods: A survey was conducted using a pre-tested and validated questionnaire distributed through online platforms. A mixture of convenience and snowball sampling techniques was adopted for sample collection. Our analysis included a final sample size of 837 participant responses. The questionnaire had items related to sociodemographic characteristics (5 items), knowledge (10 items), and source of information (1 item). The mean knowledge scores were calculated and categorized (good, fair, and poor) to assess each participant’s knowledge. Pearson’s chi-square test was used to determine the statistical association between categorical variables. Results: The mean knowledge score was found to be 4.12 ± 2.6, and 67.5% of the participants showed “poor” scores. There was no statistically significant association of knowledge scores observed with any of the sociodemographic details. It was agreed by 76% and 42.5% that genetic predisposition and chronic eye inflammation could predispose to KCN. Only 38.1% (n = 157) agreed that KCN could be treated with optical glasses or contact lenses in the initial stages. Conclusion: The knowledge regarding KCN was not satisfactory among our study population. There is a need to create an increased level of awareness for KCN. Health awareness programs and community campaigns should be organized to raise awareness regarding KCN and better eye health care utilization.
Open Journal of Ophthalmology, Volume 11, pp 91-98; doi:10.4236/ojoph.2021.112007
Background: To determine the induced refractive error among the readymade garment workers. Those who are working in the knitting section and those who are working other than the knitting and computer section. Methods: It was a prospective cross-sectional analytic study among 600 workers in 2 factories at Joydevpur, Gazipur, Bangladesh on January 2020. Group: A comprises 300 workers who were working at knitting section for a minimum of six hours a day and 5 days a week. Group: B comprises another 300 workers who were appointed for loading-unloading, care-taker, driver and security guard also. Prevalence of refractive error in two groups was compared. Results: The mean age of participants in group: A was 26.61 ± 4.99 (CI 95%, 26.04 ± 27.18) and in group: B was 28.51 ± 5.69 (95% CI 27.86 ± 29.15). Prevalence of refractive error between two groups was 52 and 28.3 respectively. The chi-square statistic is 44.9775. The p-value is <0.00001. Significant at p < 0.05. Strong positive correlation shows in Pearson’s correlation between time duration of knitting and refractive error (R is: 0.7619). Visual acuity between two groups chi-square statistic is 33.1866. The p-value is <0.00001. Significant at p < 0.05. Conclusion: Knitting workers at readymade garment (RGM) are more prone to develop late onset myopia than other workers in the same premises.
Open Journal of Ophthalmology, Volume 10, pp 33-43; doi:10.4236/ojoph.2020.101005
Introduction: Myopia is the refractive anomaly of the eye in which the conjugate focus of the retina is at some finite point in front of the eye, when the eye is not accommodating. Myopia is else known as short-sightedness and is considered as one of the most frequent causes of reduced vision especially in adolescents. Adolescence is one of the life periods when most cases are diagnosed with myopia. Purpose: The aim of this study was to identify myopia in pre-school and school children (3 - 9 years old in Prishtina), to determine the prevalence of myopia among other refractive anomalies in cases included in the study; compare the prevalence of myopia in this population in Prishtina to other countries in the world; determine the effect of hereditary and socio-economic factors on the prevalence of myopia; and determine the degrees of myopia in our cases included in our study. Materials and Methods: This was a cross-sectional study involving 1027 pre-school children and pupils from 4 schools in Prishtina, aged 3 - 9 years old, who were screened for refractive anomalies, with a special focus on the incidence of myopia in this age group. The data were collected by screening children in the institutions of pre-school and primary school education, including 2 primary schools and two kindergarten during a two-year period 2010-2012 in Prishtina. Results: On the screening of pre-school and school children for refractive anomalies, were included 1027 subjects of ages 3 - 9 years old. Of the 1027 children screened 536 (52.2%) were male and 491 (47.8%) were female. Statistically, the prevalence of refractive anomalies in the total population studied is significant based on the resulting value (P < 0.0001). In general, the prevalence of refractive anomalies in this study results in 164/103 with an interval of 141/103 in 186/103 for 95% CI. Based on the age, out of 168 patients identified with refractive anomalies, the prevalence of refractive anomalies was 9.9% in the patients of age 3 and 21.4% on the patients of age 7. The prevalence of myopia as a specific refractive anomaly was present in 33 cases 3.4%. Other patients were diagnosed with hypermetropia 37 cases (3.8%) and with astigmatism 44 cases (4.5%). Out of 33 cases with myopia, 20 cases or 60% were diagnosed with a slight degree myopia (myopia of first degree or -1.0 to -3.0 DS). 13 cases were diagnosed with intermediate degree myopia (-3 to -6 DS). There were no cases with severe myopia identified in this study. Conclusions: The Prishtina study is a report of prevalence of myopia among pre-school and school-age children in the municipality. The study reveals that refractive error and myopia were significantly common finding among the study group, and the prevalence was found to be even higher in children within the school age-group. The number of newly diagnosed myopia was significant, suggesting the need for a robust school eye health programme, regular assessment of school children for refractive error and provision of timely refractive corrections.
Open Journal of Ophthalmology, Volume 10, pp 69-76; doi:10.4236/ojoph.2020.101009
Introduction: Nystagmus is a static ocular disorder characterized by an oscillatory, involuntary and rhythmic movement of eyes. In Libreville, no data on the subject is available. The purpose of this study is to describe clinical characteristics of nystagmus in albinos living in Libreville. Methods: This is a descriptive, cross-sectional study including 43 albinos with oculocutaneous albinism and nystagmus during the period from February 01, 2017 to February 01, 2018. Variables studied were age, sex, visual acuity, objective refraction, characteristics of the nystagmus including morphology, direction, intensity and associated signs such as stiff neck and squint. Results: The mean age was 21.2 ± 17 years with a female-dominated ratio of 0.53. The visual acuity from afar without correction (AVLSC) was less than 3/10 in 88.4% of the cases. The most common ametropia was astigmatism in 51.2% of cases. Nystagmus was present in all albinos. The spring type was found in 69.7% of cases. The direction was horizontal in 67.4% of the cases and rotary in 32.6% of the cases. The intensity was moderate in 55.8% of cases. The blocking position was the primary near vision position in 69.7% of the cases. Nystagmus was associated with a stiff neck in 28% of the cases and strabismus in 48.8% of the cases. Conclusion: The albinos nystagmus living in Libreville is of the spring type, horizontal direction, of moderate intensity and calmed in the primary position in near vision.
Open Journal of Ophthalmology, Volume 10, pp 1-9; doi:10.4236/ojoph.2020.101001
Lipodermoids are abnormal epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid (dermolipoma) is usually located near the temporal fornix and is composed of adipose tissue and dense connective tissue. The overlying conjunctival epithelium is normal, and hair follicles are absent. Lipodermoids may be extensive, sometimes involving orbital tissue, lacrimal gland, and extraocular muscle. Surgical treatment is only indicated when the existing lipodermoid disturbs the patient either functionally or aesthetically. Purpose The main purpose of this study is to present our experience on the surgical treatment of lipodermoids in those cases when lipodermoids cause functional and aesthetic problem to the patient. Materials and Methods In our study we have included two cases of male gender, one with bilateral lipodermoid (in both eyes) while the other with a mono lateral lipodermoid (only in one eye). The treatment was surgical, where we carefully removed the lipodermoid lesion inside palpebral fissures, to fully preserve the bulbar conjunctiva and Tenon’s membrane during the removal of the conjunctival lipodermoid.Surgery was performed under local anesthesia (lidocaine 2% and adrenaline). The surgical area was set ready by using betadine 5%. Results In both cases there were neither intra-operative nor extra-operative complications and the results were positive.Also the functional and aesthetic problems were corrected. There was no recurrence encountered.Conclusions In conclusion, based on the results of this study, in the rare cases of lipodermoids where surgical treatment is necessary, it is very important to perform a careful surgical intervention, in order to prevent any intra-operative injuries of the lacrimal gland and the lateral and superior rectus muscles. In general the surgical treatment is a successful method on treating lipodermoids, in cases when they concern the patient both functionally and aesthetically.