Journal of Clinical Medicine

2024

Jump to: 2023

12 pages, 1711 KiB

Open AccessArticle

Discriminating Diseases Mimicking Normal-Tension Glaucoma (NTG) from NTG

by Hee-Kyung Ryu, Seong-Ah Kim, Hee-Jong Shin, Chan-Kee Park and Hae-Young Lopilly Park

J. Clin. Med. 2024, 13(21), 6585; https://doi.org/10.3390/jcm13216585 - 1 Nov 2024

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Abstract

Background/Objectives: The aim of this study was to identify the most reliable ocular exam and establish a threshold for deciding whether to perform neuroimaging in order to screen for diverse diseases other than normal-tension glaucoma (NTG). A retrospective, observational, comparative study was used. [...] Read more.

Background/Objectives: The aim of this study was to identify the most reliable ocular exam and establish a threshold for deciding whether to perform neuroimaging in order to screen for diverse diseases other than normal-tension glaucoma (NTG). A retrospective, observational, comparative study was used. Methods: In total, 106 individuals with atypical features of NTG who underwent glaucoma assessments and contrast-enhanced MRI of the brain or orbit were included. The criteria for atypical NTG included the following: (1) unilateral normal-tension glaucoma, (2) visual field (VF) damage inconsistent with optic disc appearance, (3) fast VF progression, (4) worsening of visual acuity, (5) optic disc pallor, (6) scotoma restricted by a vertical line, and (7) central scotoma. Glaucoma evaluations included measurements of visual acuity, intraocular pressure, central corneal thickness, axial length, cup–disc ratio, retinal nerve fiber layer (RNFL) thickness, ganglion cell–inner plexiform layer (GCIPL) thickness, mean deviation (MD), and visual field index (VFI). Statistical analyses involved independent t-tests, receiver operating characteristic (ROC) curves, and area under the curve (AUC) in order to differentiate neuro-ophthalmological conditions from NTG, compare the diagnostic power of each factor, and determine the cut-off value. Results: Relatively fewer diagnoses of non-glaucomatous diseases were associated with unilateral NTG, the worsening of VA, and central scotoma. Factors such as rapid visual field progression, optic disc pallor, and scotoma restricted by a vertical line had a relatively higher diagnostic rate of non-glaucomatous diseases. There were significant differences in average RNFL and GCIPL thicknesses at the nasal quadrant between NTG and NTG-mimicking conditions. Only the GCIPL thickness at the nasal quadrant had reliable power for discriminating between neuro-ophthalmological disease and NTG. For the GCIPL thickness at the nasal quadrant, the AUC was 0.659, and the cut-off value was 65.75. Conclusions: When deciding whether to proceed with imaging, such as carrying out an MRI test, for NTG patients with atypical NTG characteristics, it would be advisable to consider the nasal sector cut-off value of GCIPL thickness. Full article

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18 pages, 814 KiB

Open AccessReview

From Gut to Eye: Exploring the Role of Microbiome Imbalance in Ocular Diseases

by Andreea-Talida Tîrziu, Monica Susan, Razvan Susan, Tanasescu Sonia, Octavia Oana Harich, Adelina Tudora, Norberth-Istvan Varga, Dragomir Tiberiu-Liviu, Cecilia Roberta Avram, Casiana Boru, Mihnea Munteanu and Florin George Horhat

J. Clin. Med. 2024, 13(18), 5611; https://doi.org/10.3390/jcm13185611 - 21 Sep 2024

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Abstract

Background: The gut microbiome plays a crucial role in human health, and recent research has highlighted its potential impact on ocular health through the gut–eye axis. Dysbiosis, or an imbalance in the gut microbiota, has been implicated in various ocular diseases. Methods: A [...] Read more.

Background: The gut microbiome plays a crucial role in human health, and recent research has highlighted its potential impact on ocular health through the gut–eye axis. Dysbiosis, or an imbalance in the gut microbiota, has been implicated in various ocular diseases. Methods: A comprehensive literature search was conducted using relevant keywords in major electronic databases, prioritizing recent peer-reviewed articles published in English. Results: The gut microbiota influences ocular health through immune modulation, maintenance of the blood–retinal barrier, and production of beneficial metabolites. Dysbiosis can disrupt these mechanisms, contributing to ocular inflammation, tissue damage, and disease progression in conditions such as uveitis, age-related macular degeneration, diabetic retinopathy, dry eye disease, and glaucoma. Therapeutic modulation of the gut microbiome through probiotics, prebiotics, synbiotics, and fecal microbiota transplantation shows promise in preclinical and preliminary human studies. Conclusions: The gut–eye axis represents a dynamic and complex interplay between the gut microbiome and ocular health. Targeting the gut microbiome through innovative therapeutic strategies holds potential for improving the prevention and management of various ocular diseases. Full article

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12 pages, 435 KiB

Open AccessReview

Visual Impairment in Women with Turner Syndrome—A 49-Year Literature Review

by Ewelina Soszka-Przepiera, Mariola Krzyścin and Monika Modrzejewska

J. Clin. Med. 2024, 13(18), 5451; https://doi.org/10.3390/jcm13185451 - 13 Sep 2024

Viewed by 936

Abstract

Aim: Among the severe organ complications occurring in patients with Turner syndrome (TS), ophthalmic dysmorphia and visual impairment are usually marginalized. There are only a few studies that take into account the prevalence of ophthalmic disorders in female patients with TS. Material and [...] Read more.

Aim: Among the severe organ complications occurring in patients with Turner syndrome (TS), ophthalmic dysmorphia and visual impairment are usually marginalized. There are only a few studies that take into account the prevalence of ophthalmic disorders in female patients with TS. Material and methods: Articles in PubMed, Scholar, and Website were reviewed, considering the prevalence of various ocular disorders in patients with X chromosome deficiency. Current standards for the management of patients with TS in the context of the prevalence of ophthalmic disorders were also analyzed. Results: Identification of visual impairment in people is important because it significantly impairs quality of life (QoL) along with other health problems. QoL affects cognitive and behavioral functioning and significantly increases self-esteem, acceptance of treatment, and, consequently, physical and mental health. Low self-esteem makes patients feel helpless and unable to plan their social development. Patients with TS are relatively more frequently diagnosed with various eye defects compared to the healthy population. Therefore, special attention should be paid to the early assessment of the visual system in people with TS to eliminate any factors that could potentially impair their QoL. Conclusions: Patients with TS should be referred to specialist ophthalmologists, pediatricians, or optometrists for preventive care or early treatment of visual impairment. The authors point out the need for comprehensive ophthalmological examinations as standard management in patients with TS. Full article

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7 pages, 201 KiB

Open AccessBrief Report

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

by Anat Horev, Gal Ben-Arie, Yair Zlotnik, Maor Koltochnik, Or Ben Chaim, Ron Biederko, Tamir Regev, Erez Tsumi, Ilan Shelef, Yana Mechnik Steen, Tal Eliav, Mark Katson, Erel Domany and Asaf Honig

J. Clin. Med. 2024, 13(6), 1547; https://doi.org/10.3390/jcm13061547 - 8 Mar 2024

Viewed by 1064

Abstract

While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent [...] Read more.

While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent underdiagnosis and improve our understanding of IIH’s underlying pathophysiology. We retrospectively reviewed electronic medical records and compared the clinical and radiological characteristics of non-obese (BMI < 30) and obese (BMI > 30) female patients with IIH. Two hundred and forty-six patients (age 32.3 ± 10) met our inclusion criteria. The non-obese patients (n = 59, 24%) were significantly younger than the obese patients (29.4 ± 9.9 vs. 33.2 ± 10.2, p = 0.004) and had higher rates of severe papilledema (Friesen 4–5; 25.4% vs. 11.8%, p = 0.019), scleral flattening (62.7% vs. 36.9%, p = 0.008), and optic nerve dural ectasia (78.0% vs. 55.6%, p = 0.044). Non-obese patients also had a tendency to have a higher lumbar puncture opening pressure (368 ± 92.7 vs. 344 ± 76.4, p = 0.062). Non-obese patients were three times more likely to present with a combination of scleral flattening and optic nerve dural ectasia (OR = 3.00, CI: 1.57–5.72, χ² = 11.63, α < 0.001). Overall, non-obese females with IIH were found to have a more fulminant presentation, typified by higher rates of severe papilledema and radiological findings typical for IIH. Full article

22 pages, 975 KiB

Open AccessReview

Unveiling Ocular Manifestations in Systemic Lupus Erythematosus

by Mutali Musa, Ekele Chukwuyem, Oluwasola Michael Ojo, Efioshiomoshi Kings Topah, Leopoldo Spadea, Carlo Salati, Caterina Gagliano and Marco Zeppieri

J. Clin. Med. 2024, 13(4), 1047; https://doi.org/10.3390/jcm13041047 - 12 Feb 2024

Cited by 2 | Viewed by 2710

Abstract

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of [...] Read more.

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition, and biotechnology for tailored and effective SLE ocular treatments. Full article

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12 pages, 1958 KiB

Open AccessArticle

How Age Affects Graves’ Orbitopathy—A Tertiary Center Study

by Michael Oeverhaus, Julius Sander, Nicolai Smetana, Nikolaos E. Bechrakis, Neumann Inga, Karim Al-Ghazzawi, Ying Chen and Anja Eckstein

J. Clin. Med. 2024, 13(1), 290; https://doi.org/10.3390/jcm13010290 - 4 Jan 2024

Cited by 2 | Viewed by 1668

Abstract

Purpose: Graves’ orbitopathy (GO) is an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis. The severity of GO can vary widely among individuals, making it challenging to predict the natural course of the disease accurately, which is important for tailoring the treatment approach [...] Read more.

Purpose: Graves’ orbitopathy (GO) is an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis. The severity of GO can vary widely among individuals, making it challenging to predict the natural course of the disease accurately, which is important for tailoring the treatment approach to the individual patient. The aim of this study was to compare the clinical characteristics, course, treatment, and prognosis of GO patients under 50 years with older patients. Methods: We reviewed the medical records of a random sample of 1000 patients in our GO database Essen (GODE) comprising 4260 patients at our tertiary referral center. Patients were divided into two groups: Group 1 (≤50 years) and Group 2 (>50 years). Only patients with a complete data set were included in the further statistical analysis. Results: The results showed that younger patients (n = 484) presented significantly more often with mild GO (53% vs. 33%, p < 0.0001), while older patients (n = 448) were more likely to experience moderate-to-severe disease (44% vs. 64%, p < 0.0001). Older patients showed more severe strabismus, motility, and clinical activity scores (5.9 vs. 2.3 PD/310° vs. 330° both p < 0.0001, CAS: 2.1 vs. 1.7, p = 0.001). Proptosis and occurrence of dysthyroid optic neuropathy (DON) showed no significant difference between groups (both 3%). Multiple logistic regression revealed that the need for a second step of eye muscle surgery was most strongly associated with prior decompression (OR = 0.12, 95% CI: 0.1–0.2, p < 0.0001) followed by orbital irradiation and age. The model showed good fitness regarding the area under the curve (AUC = 0.83). Discussion: In conclusion, younger GO patients present with milder clinical features such as a lower rate of restrictive motility disorders and less pronounced inflammatory signs. Therefore, older patients tend to need more steroids, irradiation, and lid and eye muscle surgery. Still, the risk of DON and the necessity of secondary eye muscle surgery are not or only slightly associated with age, respectively. Full article

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Graphical abstract

2023

Jump to: 2024

13 pages, 1971 KiB

Open AccessArticle

Longitudinal Changes of Ocular Surface Microbiome in Patients Undergoing Hemopoietic Stem Cell Transplant (HSCT)

by Suzanne Clougher, Marco Severgnini, Antonella Marangoni, Clarissa Consolandi, Tania Camboni, Sara Morselli, Mario Arpinati, Francesca Bonifazi, Michele Dicataldo, Tiziana Lazzarotto, Luigi Fontana and Piera Versura

J. Clin. Med. 2024, 13(1), 208; https://doi.org/10.3390/jcm13010208 - 29 Dec 2023

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Abstract

Purpose: To evaluate changes in the ocular surface microbiome (OSM) between pre- and post-haemopoietic stem cell transplant (HSCT) in the same patient, and to assess the potential impact of these changes in ocular graft-versus-host disease (o)GVHD development. Methods: Lower fornix conjunctival swabs of [...] Read more.

Purpose: To evaluate changes in the ocular surface microbiome (OSM) between pre- and post-haemopoietic stem cell transplant (HSCT) in the same patient, and to assess the potential impact of these changes in ocular graft-versus-host disease (o)GVHD development. Methods: Lower fornix conjunctival swabs of 24 patients were obtained before and after HSCT and subjected to DNA extraction for amplification and sequencing of the V3-V4 regions of the bacterial 16S rRNA gene. The obtained reads were reconstructed, filtered, and clustered into zero-radius operational taxonomic units (zOTUs) at 97% identity level before taxonomic assignment, and biodiversity indexes were calculated. Transplant characteristics were recorded, and dry eye was diagnosed and staged 1–4 according to the Dry Eye WorkShop (DEWS) score. Results: No significant difference in OSM alpha diversity between pre- and post-transplant was found. A significant difference in beta diversity was observed between patients with a DEWS score of 1 versus 3 (p = 0.035). Increased corneal damage between pre- and post-HSCT was significantly associated with a decrease in alpha diversity. The changes in OSM were not associated with oGVHD, nor with any transplant parameter. Conclusions: This preliminary study is the first study to analyse changes in the OSM before and after HSCT longitudinally. No trend in OSM biodiversity, microbial profile, or overall composition changes before and after HSCT was significant or associated with oGVHD onset. The great variability in the observed OSM profiles seems to suggest the absence of a patient-specific OSM “signature”. Full article

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29 pages, 408 KiB

Open AccessReview

The Haemodialysis Session Effect on the Choroidal Thickness and Retinal and Choroidal Microcirculation—A Literature Review

by Joanna Roskal-Wałek, Joanna Gołębiewska, Jerzy Mackiewicz, Paweł Wałek, Agnieszka Bociek, Michał Biskup, Dominik Odrobina and Andrzej Jaroszyński

J. Clin. Med. 2023, 12(24), 7729; https://doi.org/10.3390/jcm12247729 - 16 Dec 2023

Cited by 2 | Viewed by 1415

Abstract

Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular [...] Read more.

Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation. Full article

11 pages, 3264 KiB

Open AccessArticle

Optic Disc Swelling in Cancer Patients: Etiology and Implications

by Yacoub A. Yousef, Isra M. Sid Ahmed, Danah Kanj Ahmad, Mona Mohammad, Hala Makahleh, Reem AlJabari, Fawzieh Alkhatib, Mario Damiano Toro, Robert Rejdak, Mustafa Mehyar and Ibrahim Alnawaiseh

J. Clin. Med. 2023, 12(22), 7140; https://doi.org/10.3390/jcm12227140 - 17 Nov 2023

Cited by 1 | Viewed by 1800

Abstract

Purpose: To analyze the etiology and implications of optic disc swelling in cancer patients treated at a specialized tertiary cancer center in Jordan. Methods: This was a retrospective study of all cancer patients who had optic disc swelling between January 2019 and December [...] Read more.

Purpose: To analyze the etiology and implications of optic disc swelling in cancer patients treated at a specialized tertiary cancer center in Jordan. Methods: This was a retrospective study of all cancer patients who had optic disc swelling between January 2019 and December 2020 at King Hussein Cancer Center (KHCC). Patients’ data included age, sex, laterality, visual acuity, and the underlying cause and management for the optic disc swelling. Results: Optic disc swelling was present in 58 cancer patients (96 eyes), with 38 (65%) having bilateral involvement. Among these, 33 (57%) were female, and 43 (74%) were ≤40 years old. At diagnosis, 58 (63%) eyes had a best-corrected visual acuity (BCVA) better than 0.5, improving to 73 (76%) eyes at the last follow-up. High intracranial pressure (ICP) was the most common primary cause (30 patients/52%), followed by tumor infiltration of the optic nerve (10 patients/17%), optic nerve compression (7 patients/12%), and optic nerve inflammation (5 patients/9%). Four patients had pseudopapilledema. Among the 30 patients with high ICP, CNS tumors were predominant (21 patients/70%), with only 3 having idiopathic intracranial hypertension. Medications, including ATRA (All-Trans Retinoic Acid) and systemic steroids, contributed to increased ICP in six patients (20%). BCVA was less than 0.5 in all eyes (100%) affected by tumor infiltration, optic nerve inflammation, and ischemic optic neuropathy, while only eight eyes (14%) with optic disc swelling due to elevated ICP had a BCVA less than 0.5 (p < 0.0001). Management included steroids (53 patients/91%), acetazolamide (30 patients/52%), chemotherapy (20 patients/34%), radiation therapy (13 patients/22%), frequent lumbar punctures (12 patients/21%), and surgery (28 patients/48%). Visual acuity improved in 40 eyes (42%), with only 4 eyes (4%) experiencing deterioration. At a 12-month median follow-up period, 11 (19%) patients were dead, 10 (10%) eyes had poor vision (BCVA less than 0.1), and 21 (22%) eyes had BCVA 0.5 or better. Conclusions: Various underlying pathologies can induce optic disc swelling in cancer patients, a grave condition capable of causing vision loss. Notably, tumor infiltration of the optic nerve tends to result in more profound visual impairment compared to papilledema due to elevated ICP. Timely detection is crucial, and immediate symptomatic treatment followed by addressing the underlying cause is essential to prevent irreversible optic nerve damage and vision loss in cancer patients. Full article

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12 pages, 860 KiB

Open AccessSystematic Review

Relationship between Dry Eye Disease and Dyslipidemia: A Systematic Review

by Tzu-Hao Wang, Yuan-Jen Tsai, Yuan-Hung Wang, Chien-Liang Wu and I-Chan Lin

J. Clin. Med. 2023, 12(20), 6631; https://doi.org/10.3390/jcm12206631 - 20 Oct 2023

Cited by 2 | Viewed by 2116

Abstract

Background: Dyslipidemia has been suggested to be associated with the occurrence of dry eye disease (DED). However, whether dyslipidemia is responsible for the development of DED remains unclear. In this systematic review, we explored the relationship between DED and dyslipidemia by using quantitative [...] Read more.

Background: Dyslipidemia has been suggested to be associated with the occurrence of dry eye disease (DED). However, whether dyslipidemia is responsible for the development of DED remains unclear. In this systematic review, we explored the relationship between DED and dyslipidemia by using quantitative data. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar, and obtained six relevant studies. Results: Our findings indicated that the majority of the selected studies reported a statistically significant association between dyslipidemia and DED, particularly in women. However, our quantitative analysis revealed that only two studies reported statistically significant differences in total cholesterol and high-density lipoprotein cholesterol values. Conclusion: No statistically significant differences exist in the majority of lipid profile parameters between individuals with and without DED, but there is a statistically significant association between dyslipidemia and DED. Full article

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11 pages, 264 KiB

Open AccessArticle

Individuals with Diabetes Mellitus Have a Dry Eye Phenotype Driven by Low Symptom Burden and Anatomic Abnormalities

by Elyana V. T. Locatelli, Jaxon J. Huang, Simran Mangwani-Mordani, Arianna A. Tovar Vetencourt and Anat Galor

J. Clin. Med. 2023, 12(20), 6535; https://doi.org/10.3390/jcm12206535 - 15 Oct 2023

Viewed by 1418

Abstract

Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to [...] Read more.

Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to the dry eye disease phenotype. A prospective, cross-sectional study was conducted at the Miami Veteran Affairs Medical Center ophthalmology clinic between October 2013 and September 2019. Participants included a volunteer sample of 366 South Florida veterans with one or more symptoms or signs of dry eye disease [Dry Eye Questionnaire-5 ≥ 6 OR tear break-up time ≤ 5 OR Schirmer’s test score ≤ 5 OR corneal fluorescein staining ≥ 2]. Participants were divided into three groups: (1) individuals without diabetes mellitus (controls); (2) individuals with diabetes mellitus but without end-organ complications; and (3) individuals with diabetes mellitus and end-organ complications. Dry eye metrics were compared across groups. The main outcome measures included ocular symptom questionnaires [e.g., 5-item Dry Eye Questionnaire, Ocular Surface Disease Index, and ocular pain assessment] and clinical parameters obtained from an ocular surface evaluation. A total of 366 individuals were included (mean age 59 ± 6 years; 89% males; 39% White; 11% diabetes mellitus and end-organ complications; 15% diabetes mellitus but without end-organ complications). Individuals with diabetes mellitus and end-organ complications had lower symptom scores on the dry eye disease and pain-specific questionnaires compared to individuals with diabetes mellitus but without end-organ complications and controls (Ocular Surface Disease Index: 42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2; p < 0.001; numerical rating scale of ocular pain intensity: 4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7; p = 0.02). Eyelid laxity was also more severe in the group with diabetes mellitus and end-organ complications (0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77; p = 0.004) compared to the two other groups. The diabetic dry eye disease phenotype is driven by signs more so than by symptoms, with anatomic eyelid abnormalities being more frequent in individuals with diabetes mellitus and end-organ complications. Given this, ocular surface abnormalities in individuals with DM may be missed if screened by symptoms alone. As such, individuals with DM should undergo a slit lamp examination for signs of ocular surface disease, including anatomic abnormalities. Full article

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17 pages, 2359 KiB

Open AccessArticle

Advanced Anterior Eye Segment Imaging for Ichthyosis

by Anna Micińska, Anna Nowińska, Sławomir Teper, Joanna Kokot-Lesik and Edward Wylęgała

J. Clin. Med. 2023, 12(18), 6006; https://doi.org/10.3390/jcm12186006 - 16 Sep 2023

Viewed by 1380

Abstract

The purpose of this study was to describe ocular surface and anterior eye segment findings in various types of ichthyoses. Methods: This was a single-center prospective observational study. The study group consisted of five patients (P1–P5) aged 13–66 years. Multimodal imaging was performed, [...] Read more.

The purpose of this study was to describe ocular surface and anterior eye segment findings in various types of ichthyoses. Methods: This was a single-center prospective observational study. The study group consisted of five patients (P1–P5) aged 13–66 years. Multimodal imaging was performed, including slit-lamp examinations, swept-source optical coherence tomography (SS-OCT), and in vivo confocal microscopy (IVCM). Results: All patients were diagnosed with moderate-to-severe dry eye disease (DED). The corneas showed a significant pattern of irregularity, with a significant difference between the corneal thickness at the apex (CAT) and the corneal thinnest thickness (CTT), exceeding 375 µm. Three patients were diagnosed with ectasia patterns based on SS-OCT. All patients showed abnormalities in at least one Fourier index parameter for at least one eye at 3 or 6 mm in the keratometric, anterior, or posterior analyses. IVCM examinations revealed changes in all corneal layers. Conclusions: By combining the results of multimodal imaging, we were able to detect preclinical abnormalities, distinguish characteristic changes common to ichthyosis, and reveal the depth and characteristics of corneal abnormalities. Therefore, patients with ichthyosis should be examined for DED and ectatic disorders early in clinical practice. Full article

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8 pages, 813 KiB

Open AccessCase Report

Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis

by Christine M. Bourke, Brendan K. Cummings, Daire J. Hurley, Conor C. Murphy and Sarah Chamney

J. Clin. Med. 2023, 12(16), 5259; https://doi.org/10.3390/jcm12165259 - 12 Aug 2023

Cited by 2 | Viewed by 1771

Abstract

Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an [...] Read more.

Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an unusual presentation of isolated ocular Stevens–Johnson syndrome in a patient with recently diagnosed ulcerative colitis being treated with Infliximab. The case had an insidious and atypical onset and represented a diagnostic dilemma. The diagnosis was more difficult, due to the fact that the inciting agent had long been stopped. Severe bacterial conjunctivitis such as that caused by Chlamydia Trachomatis, Corynebacterium diphtheria, and Neisseria Gonorrhea can cause forniceal shortening and symblepharon; this diagnosis was ruled out with microbiological swabs. A conjunctival biopsy was the key to diagnosis. Treatment involved high-dose IV steroids and dual immunosuppression with Infliximab and mycophenolate mofetil. We sought to employ interventions with the greatest impacts on our patient’s condition. Our experience contributes to the growing evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss. Full article

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14 pages, 706 KiB

Open AccessSystematic Review

Ocular Manifestations of Takayasu’s Arteritis—A Case-Based Systematic Review and Meta-Analysis

by Urszula Szydełko-Paśko, Joanna Przeździecka-Dołyk, Łukasz Nowak, Artur Małyszczak and Marta Misiuk-Hojło

J. Clin. Med. 2023, 12(11), 3745; https://doi.org/10.3390/jcm12113745 - 29 May 2023

Cited by 6 | Viewed by 4231

Abstract

Takayasu’s arteritis (TA) is a type of vasculitis in which inflammation develops in large vessels, especially in the aorta and its branches. Our study aims to determine the prevalence and type of ocular manifestations in TA. A systematic literature search was conducted in [...] Read more.

Takayasu’s arteritis (TA) is a type of vasculitis in which inflammation develops in large vessels, especially in the aorta and its branches. Our study aims to determine the prevalence and type of ocular manifestations in TA. A systematic literature search was conducted in December 2022 using three electronic databases (PubMed, Scopus, and Web of Science). The following data were extracted from each article: the name of the first author; the patient’s age, sex, and origin (continent); circumstances connected with the diagnosis of TA; symptoms given by the patients; reported ocular manifestations; and administered treatment. The final analysis was based on data collected from 122 cases. Retinal ischemia, followed by optic neuropathy, cataract, and retinal artery occlusion, were the most prevalent eye conditions associated with the disease. Systemic steroid therapy, vascular procedures, and methotrexate were mainly used to treat pulseless disease. Patients mostly complained of gradual vision acuity loss, sudden vision acuity loss, ocular pain, and amaurosis fugax. The diagnosis of Takayasu’s arteritis should be considered in patients presenting symptoms of visual decline/loss, ocular pain, or signs of retinal ischemia, optic neuropathy, or early cataract formation. A proper diagnosis is crucial to ensure the patient receives treatment without significant delay. Full article

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12 pages, 622 KiB

Open AccessArticle

Pyridostigmine Bromide Pills and Pesticides Exposure as Risk Factors for Eye Disease in Gulf War Veterans

by Lauren E. Truax, Jaxon J. Huang, Katherine Jensen, Elyana V. T. Locatelli, Kimberly Cabrera, Haley O. Peterson, Noah K. Cohen, Simran Mangwani-Mordani, Andrew Jensen, Raquel Goldhardt and Anat Galor

J. Clin. Med. 2023, 12(6), 2407; https://doi.org/10.3390/jcm12062407 - 21 Mar 2023

Viewed by 3435

Abstract

To examine associations between the pyridostigmine bromide (PB) pill and/or pesticide exposure during the 1990–1991 Gulf War (GW) and eye findings years after deployment. A cross-sectional study of South Florida veterans who were deployed on active duty during the GW Era (GWE). Information [...] Read more.

To examine associations between the pyridostigmine bromide (PB) pill and/or pesticide exposure during the 1990–1991 Gulf War (GW) and eye findings years after deployment. A cross-sectional study of South Florida veterans who were deployed on active duty during the GW Era (GWE). Information on GW exposures and ocular surface symptoms were collected via standardized questionnaires and an ocular surface examination was performed. Participants underwent spectral domain–ocular coherence tomography (SD-OCT) imaging that included retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and macular maps. We examined for differences in eye findings between individuals exposed versus not exposed to PB pills or pesticides during service. A total of 40.7% (n = 44) of individuals reported exposure to PB pills and 41.7% (n = 45) to pesticides; additionally, 24 reported exposure to both in the GW arena. Demographics were comparable across groups. Individuals exposed to PB pills reported higher dry eye (DE) symptoms scores (the 5-Item Dry Eye Questionnaire, DEQ-5: 9.3 ± 5.3 vs. 7.3 ± 4.7, p = 0.04) and more intense ocular pain (average over the last week: 2.4 ± 2.6 vs. 1.5 ± 1.8, p = 0.03; Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E): 18.2 ± 20.0 vs. 10.8 ± 13.8, p = 0.03) compared to their non-exposed counterparts. DE signs were comparable between the groups. Individuals exposed to PB pills also had thicker OCT measurements, with the largest difference in the outer temporal segment of the macula (268.5 ± 22.2 μm vs. 260.6 ± 14.5 μm, p = 0.03) compared to non-exposed individuals. These differences remained significant when examined in multivariable models that included demographics and deployment history. Individuals exposed to pesticides had higher neuropathic ocular pain scores (NPSI-E: 17.1 ± 21.1 vs. 11.6 ± 12.9, p = 0.049), but this difference did not remain significant in a multivariable model. Individuals exposed to PB pills during the GWE reported more severe ocular surface symptoms and had thicker OCT measures years after deployment compared to their non-exposed counterparts. Full article

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Ocular Manifestations of Systemic Diseases

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2024

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