Farabi Eye Hospital

Levodopa-induced dyskinesia (LID) is a disabling symptom of Parkinson's disease (PD). There have been prior attempts to find risk factors contributing to this symptom, but risk factors for the severity of LID have not been comprehensively studied. We aimed to evaluate factors that correlate with LID severity in patients with PD based on the Unified Dyskinesia Rating Scale (UDysRS). A cross-sectional study was designed on 52 idiopathic PD patients who were referred for LID between 2023 and 2024. Their demographic and clinical records were studied. Furthermore, cognitive decline (MoCA), PD severity (Hoehn and Yahr) and the severity of dyskinesia (UDysRS) were examined. The association between factors and LID severity was evaluated by carrying out univariate regression and multivariate regression backward elimination analysis. The mean age of patients with LID was 59.9 ± 11.4 years. Results of univariate regression analysis indicated that male sex (β = -0.24, P = 0.04), BMI (β = -0.3, P = 0.005), H&Y (β = 0.4, P = 0.002), diabetes mellitus (β = 0.3, P = 0.018) and levodopa dosage per kilogram (β = 0.37, P = 0.01) were significant factors involved in the severity of dyskinesia. The univariate regression model results showed that lack of constipation (P = 0.04), hyperlipidemia (P = 0.04) and total daily levodopa dosage per kilogram (P = 0.01) were associated with the severity of end-dose dystonia. This study revealed that female sex, more advanced PD, diabetes mellitus, daily levodopa dosage per kilogram body weight and BMI are associated with the severity of LID. Also, it suggests that hyperlipidemia and lack of constipation are associated with the severity of end-dose dystonia.

ABSTRACT Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis are rare but life-threatening mucocutaneous disorders, primarily triggered by adverse drug reactions. Although systemic manifestations have been extensively studied, ocular involvement remains a major cause of morbidity, often resulting in severe visual impairment or blindness. Methods This narrative review synthesizes current evidence regarding the clinical presentation, pathophysiology, and management strategies for ocular complications in SJS/TEN. A comprehensive literature search was conducted to highlight both acute and chronic ophthalmic manifestations and therapeutic interventions. Results Ocular involvement is reported in up to 75% of SJS/TEN patients during the acute phase, manifesting as conjunctivitis, pseudomembrane formation, corneal erosions, and eyelid abnormalities. Early interventions such as lubrication, topical corticosteroids, and amniotic membrane transplantation (AMT) have shown efficacy in mitigating long-term damage. Nonetheless, a substantial number of patients develop chronic complications including symblepharon, limbal stem cell deficiency, and severe dry eye syndrome. Long-term management involves scleral lenses and surgical procedures such as limbal stem cell transplantation, mucous membrane grafting (MMG), and keratoprosthesis. Innovations like ProKera® have improved epithelial healing, yet irreversible damage from the acute phase remains a persistent challenge. Conclusion Ocular complications of SJS/TEN are multifaceted and necessitate early and sustained multidisciplinary management. Timely ophthalmologic intervention is crucial in the acute phase, while chronic care aims to restore ocular surface stability and preserve vision. Further research is needed to develop standardized treatment protocols and explore emerging therapies that may enhance long-term outcomes and quality of life.

Abstract Retinopathy of Prematurity (ROP) represents a critical ophthalmological pathology affecting premature infants, with established associations to low birth weight (BW) and early gestational age (GA). Elevated risk of severe ROP, which can result in irreversible vision loss, is observed in infants exhibiting lower BW and GA. This research investigates the development of an automated diagnostic system designed to classify Plus disease, a marker of abnormal retinal vascularity, and ROP staging,a determinant of disease progression. Specifically, the model facilitates binary classification of Plus disease (Plus/Normal)and multi-class classification of ROP stage (Stage 0, 1, 2, 3) using a meticulously curated dataset of retinal fundus images. The proposed model demonstrates high diagnostic accuracy, achieving 0.996 for Plus disease detection and 0.98 for ROP stage classification. These results highlight the clinical utility of automated ROP screening methodologies in supporting timely diagnosis and intervention, thereby reducing the incidence of vision impairment in preterm populations.

The management of persistent subretinal fluid (SRF) in neovascular age-related macular degeneration (nAMD) varies, with no comprehensive review of outcomes from different treatment approaches. This systematic review evaluates the efficacy of interventions for managing persistent SRF in nAMD patients. Using a structured search strategy, a systematic review examined anti-vascular endothelial growth factor (VEGF) treatments for nAMD with persistent SRF. After removing duplicates, 861 articles were screened, 255 underwent full-text review, and 19 met the eligibility criteria. The included studies demonstrated variable outcomes regarding the management of persistent SRF in nAMD. Several studies supported tolerating SRF, showing no significant difference in visual acuity between patients with and without persistent SRF. Conversely, some studies advocated for more aggressive treatment, demonstrating a significant reduction in SRF and potential visual benefits. Patients with SRF generally have better visual outcomes compared to those with intraretinal fluid or cysts. High-frequency anti-VEGF regimens, especially with aflibercept, reduce SRF and maintain visual acuity. However, less aggressive protocols achieve stable outcomes with fewer injections. Persistent SRF in nAMD does not necessarily lead to worse visual outcomes. Standardized protocols and further research are needed to improve management strategies.

PurposeTo report a rare case of orbital hydatid cyst involving the medial rectus muscle, which presented as progressive proptosis, with subsequent detection of liver involvement after further investigations.Case presentationWe present the case of a 12-year-old boy from a rural area with exposure to wildlife dogs. The patient had a two-month history of gradually progressive proptosis in the right eye, accompanied by periorbital swelling and limited medial ocular motility. Orbital magnetic resonance imaging (MRI) revealed a large mass within the medial rectus muscle, which showed peripheral enhancement with no central enhancement, consistent with a cystic lesion based on its imaging characteristics. The patient underwent orbitotomy, during which the lesion was aspirated, and its walls were resected. Pathological examination confirmed a structure of a hydatid cyst. Given the suggestive signs of a hydatid cyst as part of a systemic echinococcal infection, further investigations, including liver sonography, revealed a similar cystic lesion in the hepatic lobe. With the diagnosis of an orbital hydatid cyst and suspected echinococcal infection, the patient was treated with oral Albendazole for one month. His symptoms, including periorbital swelling, improved, and no recurrence was observed at a six-month follow-up.ConclusionsOrbital hydatid cysts may present as inflammatory proptosis and should be considered in populations from endemic areas of human echinococcosis. Early diagnosis using orbital MRI, systemic investigations such as liver sonography, timely surgery for definitive diagnosis and treatment, and appropriate adjuvant antiparasitic medication are crucial for effective management.

Corneal ulcer is one of the most important ophthalmic emergencies. A portable, recordable, and smartphone-attachable slit-lamp device called the “Smart Eye Camera” (SEC) is introduced to compare evaluating corneal ulcers between the SEC and the conventional slit-lamp. A total of 110 participants were included in the study, consisting of 55 patients with corneal ulcers and 55 age- and gender-matched healthy volunteers as controls. The participants were first subjected to examination by a conventional slit lamp. The video recording with SEC and imaging with a slit lamp were done by a non-medical person. Both SEC videos and slit-lamp photos were reported by two independent ophthalmologists and compared with a slit-lamp examination as a gold standard. The average age of the study participants was 48.85 ± 20.45 years and 68 participants (61.8%) were male. All corneal ulcers were detected by two ophthalmologists using SEC. Ulcer size evaluated in slit lamp and SEC horizontally (Intraclass Correlation Coefficient (ICC); 0.90, 95% CI; 0.84–0.94) and vertically (ICC; 0.90, 95% CI; 0.84–0.94) is correlated about 90%. Hypopyon size (ICC; 0.95, 95% CI; 0.92–0.97), and corneal epithelial defect (CED) size horizontally (ICC; 0.94, 95% CI; 0.91–0.96) and vertically (ICC; 0.94, 95% CI; 0.91–0.96) also correlated about 94%. The infiltration pattern evaluated by SEC was consistent with the pattern evaluated in slit lamps in more than 80% of patients. The SEC is so accurate in diagnosing corneal ulcers and its reliability makes it a valuable telemedicine device.

PurposeTo report a case of subconjunctival dirofilariasis presenting as an inflammatory mass-like lesion in a healthy individual.Case presentationA 20-year-old male with a recent history of wildlife exposure in a rural village presented with an inflammatory subconjunctival mass in his left eye. The lesion was surgically excised, and histopathological examination confirmed the presence of an immature nematode of Dirofilaria immitis. The patient was treated with oral ivermectin for two weeks postoperatively. After two months, the lesion had almost completely resolved, and no recurrence was observed during the 6-month follow-up.ConclusionsGiven the rarity of ocular dirofilariasis and its diverse presentations in different ocular and adnexal structures, prompt and complete excision followed by meticulous histopathological evaluation is crucial to guide appropriate management and achieve favorable outcomes.

BackgroundPilomatrixoma is an uncommon benign skin neoplasm originating from the hair follicle. Here, we report a rare case of giant and atypical proliferating pilomatrixoma affecting the eyelid.Case presentationA 47-year-old male presented with a solitary, giant mass on his left upper eyelid, which had recently shown progressive enlargement. The lesion appeared well-circumscribed with a firm consistency, and measuring 7 × 10 cm. Orbital computed tomography scan revealed no intraorbital extension. The lesion was surgically excised. Histopathological examination identified the mass as an atypical proliferating pilomatrixoma, characterized by a minimal infiltrating margin of the deep plane and focal cytological atypia of the basaloid cells. No recurrence was observed up to one year postoperatively.ConclusionsPilomatrixoma is a rare periocular tumor with potential for malignant transformation, often mimicking other lesions in this region. Therefore, any enlarging masses in this area should be excised for histopathological evaluation to rule out malignancy.

To analyze the correlation between orbital computed tomography (CT) scan measurements including the fracture area (FA), the fracture location, the soft-tissue herniation volume (HV), the fractured orbital volume ratio (OVR) to the normal orbit, and the clinical enophthalmos in acute isolated orbital floor fractures. We enrolled 100 patients with acute isolated unilateral orbital floor fractures from May 2017 to January 2021. Based on the CT scan findings, we measured the FA, HV, OVR, and fracture site. We assessed enophthalmos using both clinical (CE) and radiographic (RE) measurements. Additionally, we investigated the correlation between CE and the measured parameters, along with the relationship between the pattern of diplopia and the fracture site. We identified enophthalmos in 81% and diplopia in 78% of the patients with an acute blowout orbital floor fracture. CE was moderately correlated with the FA (R 2 = 0.4341, P < 0.001). CE was weakly correlated with the HV (R 2 = 0.2861, P = 0.04). Anterior fractures caused diplopia in both vertical gazes, but posterior fractures were mostly associated with diplopia in the up gaze. OVR was strongly associated with RE (R 2 = 0.663, P < 0.0001) and moderately associated with CE (R 2 = 0.4378, P < 0.0001). The univariate regression analysis also showed that OVR could significantly predict CE and RE. OVR surpasses other CT scan measurements such as FA and HV in the prediction of clinical enophthalmos. Thus, OVR could be utilized to estimate clinical enophthalmos at the time of presentation, especially when the acute clinical setting prohibits the proper clinical evaluation.

An 8-year-old male patient was presented with a chief complaint of visual perception of a spherical object located in the visual field of his right eye. According to the patient's prior medical records, they exhibited a sole incident of minor visual impairment in the right eye, characterized by blurred vision (best-corrected visual acuity: 8/10), which first manifested during preschool assessments at the age of 5 years. During the fundoscopic examination of the patient, a pigmented, lobulated, and mobile vitreous cyst was observed in the right eye, whereas the examination of the patient's left eye revealed no abnormalities. A video of a smartphone slit-lamp imaging was also captured to facilitate subsequent examinations and patient follow-up.