Search

This document provides statistical data and analyses on the relationship between temporomandibular disorders (TMDs) and various symptoms. The data includes scores for TMDs, orofacial pain, and psychological distress, as well as correlations between these variables. The document also includes the results of multivariate logistic regression analyses, indicating the odds ratios for the presence of painful and "any" TMDs. The findings suggest that there is a significant association between TMDs and symptoms such as tinnitus, dizziness, ear pruritus, hearing loss, headache, eye pain, neck pain, and back pain. Further research is needed to better understand these relationships. [Extracted from the article]

Purpose: The aim of this study was to describe the clinical presentation, histopathologic characteristics, and management of phacolytic glaucoma. Patients and Methods: The database at the Florida Lions Ocular Pathology Laboratory was searched for surgical specimens at the Bascom Palmer Eye Institute. Patients with a diagnosis of "phacolytic glaucoma" on cytopathology between the years of 1997 and 2023 were included (n = 15). Patient demographics, anatomic site, laterality, clinical features, and ocular examination findings were obtained from available medical records. Results: The diagnosis of phacolytic glaucoma was established by light microscopic examination of cytology specimens in 15 eyes (Right = 8, Left = 6, not specified = 1). Between 1997 and 2023, there were 32 cytopathology cases with a preoperative diagnosis of phacolytic glaucoma. From this group of 15 cases, there were nine males and six females. Mean age was 64.2 years (Range: 39–87). Thirteen samples were from the anterior chamber and two were obtained from the vitreous. All 15 cases (100%) demonstrated histiocytes with engulfed foamy and/or granular presumed lenticular material. CD68 immunohistochemistry was positive within histiocytes in four cases that were stained (100%). Of the available medical records, clinical features, and ocular examination findings included: eye redness, decreased vision, eye pain, anterior chamber inflammation, dislocated or subluxed crystalline lens, cataract, and elevated intraocular pressure (average = 41.3 ± 8.67 mm Hg). Conclusions: Phacolytic glaucoma is a rare complication of mature/hypermature cataracts that presents with ocular pain, decreased vision, and anterior chamber inflammation. AC paracentesis with cytopathologic evaluation is a minimally invasive, rapid technique that can aid in the diagnosis and management of this disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the rare manifestation of retinal vasculitis in Familial Mediterranean fever (FMF) and its correlation with specific gene mutations, particularly the MEFV gene, with a focus on the severity of phenotypes and systemic vasculitis. Methods: A case report of a 45-year-old Armenian patient with FMF history and dual mutations (M680I and M694V) was analyzed. Clinical assessments, including ocular examinations, were conducted at various stages of the disease. Treatment modalities, including prednisone, Anakinra, and Canakinumab, were administered and their effectiveness was assessed. Results: The patient presented with bilateral ocular pain and decreased vision, exhibiting acute anterior uveitis, perivascular hemorrhages resembling Roth spots, and subsequent features of persistent vascular sheathing and cotton-wool spots. Dual mutations, especially M694V, were associated with a severe phenotype and systemic vasculitis. Treatment with prednisone induced remission, and IL-1 pathway inhibition with Anakinra and Canakinumab successfully managed relapses. Conclusion: This case underscores the rarity of retinal vasculitis in FMF, particularly involving arteries, and highlights the correlation between specific gene mutations (M680I, M694V) and disease severity. The successful management with IL-1 pathway inhibitors suggests a potential therapeutic approach. Increased clinical awareness, further research, and reporting are crucial for optimizing the understanding and treatment of FMF-related ocular manifestations. [ABSTRACT FROM AUTHOR]

Background: Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection. Case series: Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops. Case 2. A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated. Conclusion: When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection. [ABSTRACT FROM AUTHOR]

Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches. [ABSTRACT FROM AUTHOR]

Background: Ocular involvement is relatively common in granulomatosis with polyangiitis (GPA); however, choroidal involvement is rare. We present a case of serous retinal detachment resulting from choroidal involvement in GPA. Case presentation: A 55-year-old male presented to our clinic with bilateral eye redness and pain. Ocular examination revealed bilateral conjunctival injection, and dilation of the episcleral and scleral vessels. Slit-lamp examination revealed anterior chamber cells. Optical coherence tomography (OCT) confirmed serous retinal detachment (SRD) in the left eye. The patient had recently been diagnosed with GPA following a lung biopsy and had received immunosuppressive therapy, including systemic steroids, cyclosporine, mycophenolate mofetil, and rituximab. Five weeks after treatment, the clinical symptoms of the patient, including SRD, improved with alleviation of systemic symptoms. However, tapering systemic steroids and immunosuppressants and discontinuing rituximab led to disease reactivation. OCT demonstrated a recurrence of subretinal fluid, which had previously resolved, and slit-lamp examination showed mild bilateral engorged scleral vessels. Conclusions: Choroidal involvement can present as SRD and may indicate disease activity in patients with GPA. [ABSTRACT FROM AUTHOR]

Introduction: This report describes a case of necrotizing scleritis caused by Pseudomonas aeruginosa infection soon after vitreous surgery, which caused severe scleral melting and rapidly progressive necrosis that led to scleral perforation and bacterial endophthalmitis. Case Presentation: The patient was an 86-year-old man with a history of type 2 diabetes mellitus who underwent pars plana vitrectomy (PPV) for vitreous hemorrhage in his right eye. On postoperative day 10, he complained of severe ocular pain and was found to have conjunctival edema and eyelid swelling, which was treated by topical and general systemic antibiotics. His ocular symptoms improved but subsequently worsened. On postoperative day 25, hypopyon and a fibrinous exudative membrane were observed in the anterior chamber, and the fundus could not be visualized. PPV was repeated with addition of silicone oil tamponade. During the surgery, the retina was found to be completely detached with severe anterior scleral melting, perforation, and necrosis, as well as abscess formation. Culture of an eye discharge specimen detected P. aeruginosa. After surgery, antibiotics were administered and the eye was washed with polyvinyl alcohol-iodine solution daily. Ten days later, the eye pain and eyelid swelling were significantly improved. The scleral inflammation gradually resolved without recurrence. Conclusion: In this case, rapidly progressive necrotizing scleritis caused by P. aeruginosa infection was controlled by a combination of antibiotics, removal of necrotic tissue, and daily eye washing with polyvinyl alcohol-iodine solution. [ABSTRACT FROM AUTHOR]

Introduction: Symblepharon is a challenging condition characterized by a painful blind eye. The main goal of treatment is to alleviate discomfort and improve the patient’s physical and mental well-being. Case Presentation: An Indonesian male, 38 years old, complained of vision loss and ocular pain in his right eye 1 month ago. The pain frequently manifests as a rapid, piercing, or scorching feeling that extends from the right eye to encompass the entire head. Both of his eyes exhibited symblepharon and xerophthalmia. At the age of 11, he experienced a previous occurrence of raised and blister-like skin lesions. Following his recovery, a gradual formation of membranes occurred, covering both of his eyes. His right eye had light perception for visual acuity, and the intraocular pressure was determined to be soft upon examination. The B-scan ultrasound revealed the presence of a long-term inflammatory or scarring process and a decrease in the length of the axis. The patient underwent surgery without experiencing any improvement. A psychological evaluation identified a headache caused by an eye condition, and we administered antipyretic, anticonvulsant, antidepressant, and multivitamin treatments. The patient saw a reduction in pain intensity from a level of 9 to 5 after undergoing treatment for a duration of 1 week. Patients who have previously undergone surgical treatment for symblepharon should have a comprehensive evaluation when they encounter symptoms of vision loss and ocular discomfort. Conclusion: The psychological factor is essential for the treatment’s success. Treatment of the underlying cause is essential, and the patient must understand the irreversible loss of visual function. A management plan primarily aims to mitigate the adverse impact on the overall well-being and standard of living. [ABSTRACT FROM AUTHOR]

Background: With the advent of targeted therapies, the survival prognosis for metastatic tumors has extended, and it has become necessary to diagnose and consider treatment that takes into account Quality of Life for metastatic tumors of the eye. The reports of checking tumor marker in the aqueous humor for diagnosis of metastatic intraocular tumors are few. Here, we report a case of masquerade syndrome with secondary glaucoma in which a high carcinoembryonic antigen (CEA) level in the aqueous humor could assist diagnosis, and continuing targeted therapy and trabeculectomy were effective. Case presentation: A 73-year-old man was referred to us for iritis and high intraocular pressure (IOP) with severe eye pain in the left eye. He had Stage IVB lung adenocarcinoma treated with a molecularly targeted drug, Osimertinib. His best corrected visual acuity was 0.15, and IOP was 52 mmHg in the left eye. Anterior chamber cells (+), numerous small nodules in the iris, and small masses in the inferior angle were observed. In the aqueous humor, the CEA level was higher than in the blood. Napsin A and Thyroid Transcription Factor-1 (TTF-1) positive cells showed in the resected tissue at iridectomy performed during trabeculectomy. The pathological diagnosis of metastatic iris tumor of the lung adenocarcinoma was made, and we injected bevacizumab intravitreally once and continued Osimertinib. His IOP lowered to 8–10 mmHg, and the iris masses disappeared. He lost vision by metastasis to the left optic nerve after termination of Osimertinib one and a half years later. The metastasis shrank after restarting the drug. He passed away from an exacerbation of his primary lung cancer two years and nine months after the first visit. Although he lost vision in his left eye, the metastatic tumor in his left eye and optic nerve had disappeared, and his quality of life was maintained without any pain in his eye. Conclusions: Checking tumor markers in the aqueous humor can aid in diagnosis, and aggressive treatment of metastatic iris tumors must help maintain patients' Quality of Life. [ABSTRACT FROM AUTHOR]

DP303c is a HER2-targeted ADC with a cleavable linker-MMAE payload. Previous in vitro studies demonstrated that DP303c showed similar or better antitumor activity than T-DM1 in xenograft models. This was a multicenter, dose escalation and dose expansion phase 1 study in China. Eligible patients were 18-75 years old with HER2-positive advanced solid tumors who were unable to benefit from standard therapy. DP303c was administered intravenously every 3 weeks, with accelerated titration at lower dose of 0.5 mg/kg and 3 + 3 design with dose levels of 1.0, 2.0, 3.0 or 4.0 mg/kg at dose escalation part, followed by the selected dose level at dose expansion part. The primary endpoints were safety and tolerability, as well as identification of recommended phase 2 dose. As of Feb 28, 2023, 94 patients were enrolled and received DP303c (dose escalation: n = 22; dose expansion: n = 72), of whom 68 patients had breast cancer. One dose limiting toxicity (Grade 3 eye pain) was observed at 4.0 mg/kg dose, and the maximum tolerated dose was not reached. The most common treatment-related adverse events at grade 3 or higher were blurred vison (16.0%), dry eye (6.4%), and peripheral neuropathy (5.3%). No treatment-related death occurred. Overall, among 91 efficacy evaluable patients, 39 patients (42.9%) achieved an objective response. Disease control was observed in 62 patients (68.1%). In 66 efficacy evaluable patients with breast cancer, 34 patients achieved an objective response (51.5%). Disease control was achieved in 51 patients (77.3%). Median PFS was 6.4 months. On a molar basis, DP303c Cmax at 3.0 mg/kg doses was 132-folder higher than that for free MMAE. DP303c demonstrated promising anti-tumor activity with acceptable safety in patients with pre-treated advanced HER2 positive solid tumors, especially in breast cancer. Based on safety and efficacy results, 3.0 mg/kg Q3W was determined as recommended phase 2 dose for DP303c. (Trial registration: ClinicalTrials.gov Identifier: NCT04146610). [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionBirdshot chorioretinitis (BSCR) is an ocular HLA-related disease with variable clinical progression. We examine the quality of life (QOL) of BSCR individuals aged ≥80 years, providing insights into the long-term disease impact.We utilized data from the CO-BIRD cohort (ClinicalTrials.gov Identifier: NCT05153057) conducted at Hôpital Cochin in Paris, France, focusing on BSCR patients aged ≥80. The main outcome was vision-related QOL using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). We used Spearman correlation to explore the impact of better BCVA and MD on the composite score, and the Wilcoxon test to evaluate specific visual symptoms’ effects.The study included 35 patients with a mean age of 83.9 ± 3.7 years, 74.3% of whom received systemic immunosuppression. The mean composite score was 58 ± 30, with a median of 75 (23–79). The lowest subscores were driving capacity (38 ± 38), mental health (49 ± 33), and role difficulties (50 ± 35), while the highest were for ocular pain (70 ± 25) and social function (70 ± 38). Decimal BCVA below 0.5 and MD below −6 dB were associated with lower subscores. BCVA and MD were strongly correlated with the composite score (R = 0.67). Symptoms of poor color and blurry vision were significantly associated with lower composite score (p < 0.005).Most BSCR patients over 80 in our cohort maintained sufficient vision for daily activities. The high standard deviation and wide range of VFQ-25 results reflect the heterogeneity of visual outcomes among elderly BSCR patients. [ABSTRACT FROM AUTHOR]

Invasive sinusitis is a rare complication of sinusitis. We present the case of a woman, age 72 years, who presented with acute encephalopathy in the setting of sepsis found to have extensive invasive sinusitis with intracranial extension secondary to Streptococcus intermedius, managed with intravenous antibiotics alone. S. intermedius is a rare cause of acute bacterial sinusitis, associated with infections of relatively greater severity and risk of intracranial spread, often requiring a combination of intravenous antibiotics and surgical debridement for source control. Successful treatment of invasive sinusitis with medical management alone may be achievable if surgical intervention is contraindicated. However, the probability of meaningful recovery without surgical source control is rare and is associated with greater morbidity and mortality. Therefore, factors contributing to the success of medical management alone should be investigated. [ABSTRACT FROM AUTHOR]

Purpose: To describe the epidemiological and clinical features and course of patients with posterior scleritis (PS). Methods: This retrospective, cross-sectional consecutive case series analyzed the medical records of 16 patients diagnosed with PS. Results: Female gender and unilateral involvement were dominant. Blurred vision (84.21%) and ocular pain (78.95%) were the most common presenting complaints. Serous retinal detachment was the most common ocular finding (84.21%), followed by optic disc swelling (42.11%). Increased scleral thickness was observed in all patients, although a T-sign was detected 8 of 19 eyes (42.1%). Recurrence occured in 5 of 19 eyes in mean 30.2 ± 34.7 months. Central macular thickness, choroidal thickness, and retinal nerve fiber layer thickness were reduced with treatment at final examination significantly (p =.005,.002, and.002, respectively). Conclusions: PS should be considered in patients presenting with unilateral ocular pain and decreased vision. Not only USG findings but also OCT findings are very useful in the follow-up of treatment response. [ABSTRACT FROM AUTHOR]

Purpose: We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis. Methods: In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments. Results: Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome. Conclusion: Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology. [ABSTRACT FROM AUTHOR]

Non-infectious uveitis (NIU) is an immune-mediated disorder manifesting as ocular pain, redness, floaters, and photophobia, and is a leading cause of preventable blindness. Managing NIU presents considerable challenges due to the condition's resistance to high-dose corticosteroids and various immunotherapies. This review assesses the efficacy and safety of rituximab (RTX) in the treatment of NIU, based on individual case reports and small-scale studies. A cohort of 78 patients (20 males, 58 females), with a mean onset age of 32.3 years (range 8– 72), was analyzed. Juvenile idiopathic arthritis (JIA) was the most frequently associated comorbidity, affecting 28 patients, while anterior uveitis was the predominant subtype, observed in 26 of 47 cases. Prior to RTX therapy, patients had been treated with an average of 1.7 conventional immunosuppressive agents (range 0– 5) and 1.1 biologics (range 0– 4). RTX was introduced following the failure of high-dose corticosteroids, immunosuppressive drugs, and biologics to control the uveitis. The median time from diagnosis to RTX initiation was 7.7 years (range 0.25– 21). Post-RTX, 44.2% of patients experienced improvement in visual acuity, 79.5% achieved resolution of ocular inflammation, and 8.9% showed partial improvement. Additionally, 81.1% were able to reduce their corticosteroid dosage. Overall, 88.6% (69 out of 78) demonstrated a positive response to RTX treatment. These findings indicate that RTX may serve as an effective therapeutic option for NIU unresponsive to steroids and multiple immunotherapies. It may also warrant consideration as a potential first-line treatment in certain cases. [ABSTRACT FROM AUTHOR]

Introduction: We describe a unique case of sclerouveitis that progressed to endogenous Fusarium endophthalmitis in a 69‐year‐old male with chronic lymphocytic leukemia (CLL). We highlight the risk of treating sclerouveitis with oral corticosteroids, which can exacerbate an infection and contribute to disease progression. Case Presentation: A 69‐year‐old male with CLL on zanubrutinib, a second‐generation Bruton's tyrosine kinase inhibitor, was admitted to the hospital for osteomyelitis of the left foot. At presentation, the patient also reported right eye pain for 1 week and vision loss over the course of 1 month. Vision in the right eye was hand motion. Slit lamp examination revealed scleral inflammation in the right eye with violaceous injection, chemosis, inflammation in the anterior chamber, and diffuse subconjunctival hemorrhage. There was significant corneal edema preventing fundus examination. B‐scan ultrasonography demonstrated a flat retina with no vitritis or scleral thickening. Forty‐eight hours after treatment with oral and topical corticosteroids, the patient's eye pain improved but his vision worsened. Repeat B‐scan showed new‐onset vitritis. Fungal culture obtained by diagnostic pars plana vitrectomy (PPV) revealed growth of Fusarium. The patient was treated with oral and intravitreal voriconazole in addition to intravenous voriconazole and amphotericin B for systemic therapy. Corticosteroids were discontinued. Despite aggressive therapy, the patient's disposition declined to the point of transitioning to comfort‐focused care, and he passed away. Conclusion: Endogenous fungal endophthalmitis is most commonly seen in immunocompromised patients, and oral corticosteroid therapy for such patients should be used with caution as it can worsen an infection. In cases of fusarial endophthalmitis, visual prognosis is poor. [ABSTRACT FROM AUTHOR]

Purpose: Congenital aniridia is a serious eye disease characterized by absence of iris to various degrees. The aims of this study were to investigate health‐related quality of life (HRQoL) in adults with aniridia and assess the relationships between HRQoL, psychological status, ocular health and obesity. Methods: Twenty‐nine adults with congenital aniridia (48% male, aged 18–79 years) participated. HRQoL was measured with SF‐36 and the EQ visual analogue scale (VAS). The physical (PCS) and mental (MCS) component summaries of the SF‐36 were calculated with higher scores indicating better HRQoL. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Obesity was assessed with the Patient‐Reported Outcomes in Obesity (PROS). Sociodemographic characteristics, genetic variants and ocular and medical health variables were also analysed. Results: The participants scored significantly lower in the general health domain of the SF‐36 than the general population (65.2 vs. 75.3, p = 0.017). The EQ VAS score was also lower in the aniridia group (64.9 vs. 77.9, p = 0.021). Low PCS score was correlated with presence of ocular pain (p = 0.019), high HADS score (p = 0.017) and high PROS score (p = 0.009). Low MCS score was related to higher educational level (p = 0.038) and high HADS score (p < 0.001). High HADS and PROS scores were both related to low EQ VAS scores. Conclusion: Adults with congenital aniridia scored worse on certain measures of HRQoL than the general population. Poorer HRQoL was associated with increased symptoms of anxiety, depression and obesity and with presence of ocular pain. [ABSTRACT FROM AUTHOR]

Background: 22q11.2 deletion syndrome (22q11.2DS) is a genetic disorder caused by the deletion of the q11.2 band of chromosome 22. It may affect various systems, including the cardiovascular, immunological, gastrointestinal, endocrine, and neurocognitive systems. Additionally, several ocular manifestations have been described. Results: We report a case of a 34-year-old female diagnosed with 22q11.2DS who presented with visual discomfort and foreign body sensation in both eyes. She had no history of recurrent ocular pain. A comprehensive ophthalmological examination was performed, including anterior segment optical coherence tomography and in vivo confocal microscopy. Overall, the exams revealed bilateral corneal map-like lines, dots, and fingerprint patterns, consistent with a diagnosis of epithelial basement membrane dystrophy (EBMD). In addition to presenting with this novel corneal manifestation for 22q11.2 DS, we review the ocular clinical features of 22q11.2DS in the context of our case. Conclusions: The EBMD may represent a new corneal manifestation associated with 22q11.2 syndrome, although the link between these conditions is unknown. Further research is warranted to investigate potentially shared genetic or molecular pathways to the understanding of the phenotypic variety observed among this rare syndrome. [ABSTRACT FROM AUTHOR]

This report describes a case of idiopathic hypertrophic cranial pachymeningitis (IHCP) with scleritis and optic disc involvement. The patient was a 56-year-old woman with chief complaints of fever, headache, binocular pain, and redness. Biochemical and immunological indicators, cranial magnetic resonance imaging, and relevant ophthalmological examinations were employed for evaluation. Infectious and neoplastic causes were excluded. Typical meningeal thickening and enhancement on magnetic resonance imaging revealed IHCP. Diffuse hyperaemia and oedema of the conjunctiva and the T-shape sign on the B-scan suggested anterior and posterior scleritis, respectively. Abnormalities in fundus photography, optical coherence tomography, and visual field examination suggested optic disc involvement. After anti-infection and steroid therapy, the patient's temperature returned to normal and the symptoms of headache, binocular pain, and redness improved. Neurologists and ophthalmologists should consider the combination of IHCP with scleritis in their differential diagnosis when patients complain of headache accompanied by ocular pain and redness. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionPrecisThe aim of our study is to assess subjective disease burden parameters (SVR and OP) as well as objective ones (BCVA and ODI) as predictors of HRQoL in Egyptian patients with BD uveitis.Ninety-six patients with BD uveitis were recruited in this cross-sectional study from the Rheumatology Department, Cairo University Hospital. HRQoL was assessed using RAND-36 item health survey 1.0, subjective visual rating (SVR) was measured on a 6-point Likert scale. Ocular pain (OP) was rated on a numeric rating scale. The Ocular Damage Index (ODI) was calculated using the ocular domain of the BD damage index. Linear regression was performed to determine predictors of HRQoL metrics.SVR predicted Vitality (β = 0.15, p = 0.004), Emotional Well-being (EW) (β = 0.13, p = 0.005), General Health (β = 0.18, p = 0.012) and Mental Component Summary (β = 0.22, p = 0.002). OP predicted Social Function (β = -3.18 p < 0.001), General Health (β = −1.55, p = 0.004), Physical Component Summary (β = -2.00, p = 0.007) and Mental Component Summary (β = -1.53, p = 0.005). BCVA predicted Physical Function (β = 31.1, p = 0.02) and Emotional Well-being (β = 7.94, p = 0.01). ODI failed to predict any HRQoL metrics. ODI was independent predictor of legal blindness adjusted for uveitis duration and severity. Legally blind patients had worse HRQoL metrics than patients with better vision.In BD uveitis patients, subjective disease burden parameters were more informative about HRQoL metrics than objective ones. Longitudinal studies are needed to elucidate the utility of ODI as an outcome measure in BD uveitis.In Behcet’s uveitis patients, health-related quality of life was related to visual outcome, ocular pain, and subjective visual rating. Ocular damage was an independent predictor of legal blindness, adjusted for uveitis duration and severity. [ABSTRACT FROM AUTHOR]

Background: Dry eye disease (DED) includes neurosensory abnormalities as part of its multifactorial etiology. Nerve growth factor is important for maintaining corneal nerve integrity and wound healing. Cenegermin (recombinant human nerve growth factor) is a topical biologic that promotes corneal healing in patients with neurotrophic keratitis. The purpose of this study was to evaluate efficacy and safety of cenegermin in moderate-to-severe DED and identify an optimal dosing strategy. Methods: This was a phase II, multicenter, randomized, double-masked, vehicle-controlled, dose-ranging clinical trial in patients with moderate-to-severe DED, including Sjögren's DED (NCT03982368). Patients received 1 drop of cenegermin 3 times daily (t.i.d.; 20 mcg/mL), cenegermin 2 times daily (b.i.d.; 20 mcg/mL) and vehicle once daily, or vehicle t.i.d. for 4 weeks. Follow-up continued for 12 additional weeks. The primary endpoint was change in Schirmer I score from baseline to week 4. Other key endpoints included rate of responders (Schirmer I test > 10 mm/5 min) after treatment and change in Symptoms Assessment iN Dry Eye (SANDE) scores from baseline to end of follow-up. A 1-sided test (α = 0.025) was used to evaluate statistical significance. Results: At week 4, mean changes in Schirmer I scores were not statistically significantly different in either cenegermin group versus vehicle (cenegermin vs vehicle [treatment difference; 95% CI]: t.i.d., 2.60 mm and b.i.d., 3.99 mm vs 1.68 mm [t.i.d.: 0.93; −1.47 to 3.32, P = 0.078; b.i.d.: 2.31; −0.08 to 4.70, P = 0.066]). More patients responded to treatment with cenegermin t.i.d. and b.i.d. versus vehicle (t.i.d.: 25.9% [21/81, P = 0.028]; b.i.d.: 29.3% [24/82, P = 0.007] vs 11.9% [10/84]), with statistical significance (set at P < 0.025) observed in the b.i.d. group. Only cenegermin t.i.d. yielded statistically significant (P < 0.025) reductions in SANDE scores versus vehicle, which were sustained up to the end of follow-up (P value range, 0.002–0.008). Eye pain, primarily mild and transient, was the most frequently observed treatment-emergent adverse event with cenegermin. Similar results were observed in patients with Sjögren's DED. Conclusions: Cenegermin was well tolerated and although this study did not meet its primary endpoint, significant improvement in patient-reported symptoms of dry eye was observed through follow-up. Larger studies evaluating cenegermin in patients with DED are warranted. Trial registration: NCT03982368; registered May 23, 2019. [ABSTRACT FROM AUTHOR]

In this era of industrialization and high-speed traffic, the incidence of trauma is increasing in general. According to research, ocular trauma is also one of the causes of quite high rates of blindness. A male patient, 35 years old, came to the Bhayangkara Denpasar Eye Clinic initially on October 3 2023 with a complaint. The patient complained of pain in the right eye after being hit by a shuttlecock approximately 1 hour before the patient came to the hospital. Complaints are accompanied by red eyes, blurred vision, pain and watering. The patient said he had not received therapy for his complaint. Denied history of complaints of fever, cough, runny nose, shortness of breath. blunt ocular trauma which causes complications of hyphema and secondary glaucoma. [ABSTRACT FROM AUTHOR]

To present a novel association of multiple autoimmune syndrome (MAS) in a patient with sclerouveitis and alkaptonuria. A 68-year-old female with alkaptonuria, Hashimoto's thyroiditis, and familial autoimmunity presented with decreased VA, red eye, foreign body sensation, and ocular pain. Ophthalmological examination: OD conjunctival hyperemia, ochronosis, a reddish-violet scleral nodule, keratic precipitates, 2+ cells in the anterior chamber, 0.5+ vitreous cells, and mild vitreous haze. The patient was diagnosed with anterior uveitis and anterior nodular scleritis. Due to the associated sicca symptoms, a salivary gland biopsy was ordered, confirming Sjögren's syndrome. Then, MAS was diagnosed, and immunomodulatory medications were started; however, as she was refractory to more than two of them, it was suggested to start biological treatment. We present a novel MAS-type 2 pattern consisting of Hashimoto's thyroiditis, sclerouveitis, and Sjögren's syndrome. Its diagnosis and management represent a challenge, so a multidisciplinary approach should be provided. [ABSTRACT FROM AUTHOR]

Bacillus cereus endophthalmitis is a severe vision-threatening disease. This study aimed to analyze the clinical characteristics, antibiotic susceptibility, and risk factors for poor final visual acuity (VA) and enucleation or evisceration (ENEV) outcomes of B. cereus endophthalmitis patients. We retrospectively reviewed 52 cases (52 eyes) of culture-proven B. cereus endophthalmitis at Zhongshan Ophthalmic Center from January 2013 to December 2023. The mean age of the patients was 38.1 ± 20.1 years, and males composed the majority (90.4%) of the sample size; laborers (32.7%) and farmers (19.2%) were the primary occupations of the patients. All cases were caused by ocular trauma. Forty-one of 51 eyes (80.4%) had a final VA worse than the ability to count fingers (CFs), and 15 of the 52 total eyes (28.8%) underwent ENEV. Binary logistic forward (LR) regression analysis demonstrated that red eye (odds ratio [OR], 13.13; 95% confidence interval [CI], 1.58–108.80; p = 0.017), eye pain (OR, 22.87; 95% CI, 1.00–522.72; p = 0.050), and corneal edema/ulcer (OR, 13.13; 95% CI, 1.58–108.80; p = 0.017) were significant risk factors for poor VA outcomes. Conjunctival sac purulent discharge (OR, 10.08; 95% CI, 2.11–48.12, p = 0.004) and white blood cell (WBC) count (OR, 1.35; 95% CI, 1.06–1.72, p = 0.016) were significant risk factors for ENEV outcomes. B. cereus showed susceptibility rates of 100.0% to vancomycin and ofloxacin; 98.0% to levofloxacin; 93.3% to ciprofloxacin; 87.5% to imipenem; and 78.9% to tobramycin. The susceptibility to azithromycin and clindamycin was 66.7% and 50.0%, respectively. In contrast, B. cereus was resistant to penicillin (susceptibility at 3.8%), cefuroxime (5.6%), and cefoxitin (37.1%). [ABSTRACT FROM AUTHOR]

Purpose: To assess ocular pain in patients undergoing multiple intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) who have previous factors that may influence pain sensitivity. Methodology: This is a prospective, observational, case series study involving patients who underwent multiple (≥ 3) pro re nata intravitreal injections of ranibizumab or aflibercept to treat any cause of chorioretinal vascular disease. Ocular pain was assessed by the numerical analog scale during intravitreal injection. For this study, the main variable was ocular pain and the secondary variables included age, sex, previous history of glaucoma, primary retinal vascular disease, severe dry eye history, trigeminal pain, scleral buckle surgery, collagen diseases, fibromyalgia, severe migraine history, pars plana vitrectomy, scleral thickness measurements, and type of anti-VEGF. Results: In a total of 894 patients, 948 eyes (4822 intravitreal injections), 793 patients (88.6%) had ocular pain sensitivity between no pain to mild pain, 80 patients (8.9%) had moderate ocular pain, 15 patients (1.6%) had severe ocular pain, and 6 patients (0.7%) had extremely severe ocular pain. Patients with severe dry eye (p = 0.01) and previous history of scleral buckle surgery (p = 0.01) showed a significant correlation with ocular pain during intravitreal injection. Pars plana scleral thickness (> 550 um) and diabetic neuropathy were associated with ocular pain but did not meet the criteria for statistical significance (p = 0.09 and p = 0.06, respectively). Conclusion: Dry eye and prior scleral buckle surgery may contribute to pain associated with intravitreal injection. These issues should be taken into consideration in patients undergoing multiple intravitreal injections. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the effectiveness of preoperative bupivacaine inferotemporal retrobulbar blocks to postoperative liposome- encapsulated bupivacaine (Nocita) line blocks for analgesia following enucleation. ANIMALS 39 client-owned dogs (40 eyes) presenting to the Ophthalmology Service for enucleation. METHODS Dogs were randomly assigned to receive either a preoperative inferotemporal retrobulbar block with 0.5% bupivacaine ora peri-incisionalline block with liposome-encapsulated bupivacaine (Nocita) at closure. Patients underwent unilateral enucleation and were hospitalized for 24 hours after surgery. Pain scores were performed by a masked observer with the Glasgow Composite Measure Pain Scale and the University of Wisconsin Ocular Pain Scale at 0.25, 0.5,1,2,4,6,8, and 24 hours following surgery. Intraoperative use of blood pressure and anesthetic support mediations as well as need for rescue pain control were recorded and compared between groups. RESULTS There was no significant difference in rescue rates between treatment groups. When comparing the use of medical intraoperative heart rate, blood pressure, or anesthetic plane support, there were no significant differences in use between groups. CLINICAL RELEVANCE Use of preoperative bupivacaine retrobulbar blocks and postoperative Nocita line blocks were equally effective at postoperative pain control with similarly low complication rates. [ABSTRACT FROM AUTHOR]

Schimmelpenning-Feurstein-Mims Syndrome (SFMS) is a rare neurocutaneous disorder. Herein, we describe a novel case and review the phenotypic spectrum and molecular findings of SFMS from an ophthalmology perspective. Clinical case including presentation, management, pathology, and genetic analysis is described. A literature search on Schimmelpenning-Feuerstein-Mims and its synonyms, Linear nevus sebaceous syndrome, Organoid nevus syndrome, Jadassohn nevus phacomatosis, and Solomon syndrome, was conducted. An updated review and description of published cases with identified genetic mutations are described. A 13-year-old boy with SFMS presented with acute right eye pain and an enlarging orbital mass. Excisional biopsy of the mass revealed an orbital choristoma. Genetic analysis of the orbital tumor confirmed a KRAS c.35 G>A, p.G12D mutation. A literature search revealed 19 cases of SFMS with mutations in the RAS-pathway. KRAS, HRAS, and NRAS mutations were identified in 74%, 21%, and 5% of patients, respectively. Ophthalmic pathology was seen in 83% of patients. Systemic findings varied and involved the skin, central nervous system, and eyes most commonly. SFMS, a rare neurocutaneous disorder, results from postzygotic mosaic mutations in the RAS/MAPK pathway. Patients present with various systemic findings and ophthalmic manifestations occur in most cases. This is the first case description of a KRAS mutation identified in an orbital choristoma in SFMS. The disease is described under various names in the literature, and we propose that all syndromic cases with mosaic RAS mutations be reported under the eponym, SFMS. [ABSTRACT FROM AUTHOR]

Background Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented malignancy of the ocular surface and is represents with a wide morphological types and clinical symptoms. Along with that it has wide range of histologic diagnoses, ranging from mild epithelial dysplasia to invasive squamous carcinoma. The diagnosis rely on histopathological examination of the excised mass and imaging to rule out infiltration. Aim The aim to study the demographics, presenting features, different morphological types, histopathological types and associated risk factors of ocular surface squamous neoplasia (OSSN). Methods This was a prospective case study of 27 cases with conjunctival masses suspicious of OSSN presenting to our centre between November 2022 and October 2023. Results Among 27 cases 17 (62.96%) males and 10 (37.03%) females, with a mean age of 54.3 years (range 22-68 years). The main presenting symptoms were a mass or growth on the eye, followed by eye irritation or pain, pigmentation and visual impairment. The associated risk factors included chronic sun exposure, smoking and tobacco usage, HIV serology positive, and Ocular trauma. The lesions were most common near the limbus, most commonly seen in the interpalpebral area, nasal quadrant. Among the lesions 59.25% had less than 3 clock hours of limbal involvement. The most common presenting clinical morphological feature of the tumor was a leukoplakic lesion, followed by papilliform, nodular, gelatinous, pigmented and mixed morphology accordingly. Vascularization, hyperpigmentation and pterygium was the most common association. Conjunctival or corneal intraepithelial neoplasm (17) was most common in comparison with squamous cell carcinoma (10) Conclusion OSSN in our study mainly presented with leukoplakic variant, most commonly involving limbus with a feeder vessel. Most common in males. HIV serology was positive in younger patients. Larger lesion, papilliform variant most commonly showed squamous cell neoplasia in histology. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of non-granulomatous anterior uveitis (clinical, IVCM in vivo confocal microscopy, and anterior optical coherence tomography (OCT) findings) in a non-immunosuppressed patient with mpox infection. Methods: A 24-year-old male was consulted for bilateral ocular pain, red eye, itchiness, and mucoid discharge. In his left eye, multiple vesicles and papules, some with central ulceration, were found in the superior and inferior eyelids. Mucoid discharge, chemosis, limbitis, and an anterior chamber reaction were also found. A conjunctival PCR swab for mpox was positive. The patient was treated with topical steroids with a good response. Results: OCT and IVCM showed sub-endothelial deposits, stromal edema, hyperreflective multinucleated images in the epithelial layer, activated stromal images, and stromal edema characterized by fusiform hyperreflectivity that was resolved with the proposed treatment. Conclusions: This is the first report of OCT and IVCM in a non-immunosuppressed patient with mpox infection with a good response to topical steroids. [ABSTRACT FROM AUTHOR]

Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (β = −0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function. [ABSTRACT FROM AUTHOR]

Aims: To investigate the changes in quality-of-life (QoL) metrics at a 24-month interval in non-acute VKHD patients and their association with inflammation, treatment, and visual function. Methods: SF-36 and VFQ-25 questionnaires were administered at two 24-month-apart moments to 22 non-acute VKHD patients followed for ≥12 months since acute disease onset. "Improvement," "unchanged," or "worsening" in questionnaires scores (difference >5-point) between M1 and M2 and their associations were sought. Results: Absence of systemic treatment or optic disc hyperfluorescence was associated with improved general health (SF-36). Improvement in binocular contrast sensitivity resulted in better ocular pain score; absence of anterior uveitis relapse, stable fundus findings, no use of cyclosporine or no intravitreal injections resulted in unchanged/better dependency score; no intravitreal injections resulted in unchanged/better mental health score (VFQ-25). Conclusion: Stability/improvement in QoL scores was associated with controlled inflammation, better visual function, and no need for treatment. Subclinical inflammatory signs did not impact QoL scores. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. Methods: A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning.This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. Results: The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). Conclusion: Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Sociedad Colombiana de Oftalmología is the property of Sociedad Colombiana de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Many patients suffered from rhino-orbital-cerebral mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic in India. Diabetes is a known risk factor of COVID-19 infection and mucormycosis. Objective The present study was done to describe the clinical spectrum and histopathological findings of mucormycosis in COVID-19 patients and their outcomes. Methods A cross-sectional study was done over a period of two and half months. The biopsy samples or scrapings from sinonasal or periorbital tissue of 38 patients were analyzed. Hematoxylin & Eosin (H&E stain) slides were evaluated along with Grocott-Gomori methenamine–silver and Periodic acid–Schiff stains to highlight the fungal elements. Results The male to female ratio was 2.5:1, and the mean age of the subjects was 53 years old. A total of 68.4% (n = 26/38) of the patients had diabetes as a comorbidity, 84.2% (n = 32/38) had a history of steroid intake, and 55.3% (n = 21/38) were given supplemental oxygen during their treatment. The common presentations were nasal blockage, discharge, eye pain, headache, and altered mentation. The sites of biopsy were: nasal cavity 76.3% (n = 29/38), periorbital fat/orbit 21.1% (n = 8/38), maxillary sinus 15.8% (n = 6/38) and ethmoid sinus 13.2% (n = 5/38). In 76.3% (n = 29/38) cases, broad, irregular, nonseptate, and right-angle branching hyphae were seen on H&E-stained tissue sections. Conclusion COVID-19 led to various complications in individuals affected by it. Mucormycosis was one such lethal complication. An early diagnosis and prompt treatment is crucial to control the progression of the disease and improve outcomes. [ABSTRACT FROM AUTHOR]

A 67-year-old female presented with 2 weeks of right eye pain, redness, and diplopia. An orbital mass was found on magnetic resonance imaging (MRI), and biopsy revealed Merkel cell carcinoma (MCC). She had no primary head or neck lesion and no previous history of MCC. Positron emission tomography (PET) scan showed hypermetabolic subcutaneous lesions of the lower extremity andmultiple osseous lesions of the axial and appendicular skeleton. She received palliative external radiation of 20 Gy in 5 fractions to the orbit. After discussing immunotherapy, she opted for comfort care and expired 1 month later. To the best of our knowledge, this is only the third case of MCC with distant metastasis to the orbit and the first case in which the patient had no previous diagnosis of MCC and no known primary tumor. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Argentine Society of Rheumatology/Revista de la Sociedad Argentina de Reumatología is the property of Editorial Biotecnologica S.R.L and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and aim. Thyroid-associated ophthalmopathy (TAO), often referred to as thyroid eye disease or Graves' ophthalmopathy, is a syndrome characterized by autoimmune inflammation affecting the eye muscles, connective tissue, and orbital fat. The aim of this literature review is to present TAO and integrate the available data in the literature regarding the pathogenesis and treatment methods. Based on these, the authors aim to examine whether, despite the extensive knowledge already available on TAO, there are still issues to be investigated. Material and methods. In this literature review, books and scientific publications in both Polish and English languages have been assessed. The search criteria included keywords such as TAO, Graves' disease, thyroid-associated ophthalmopathy. The evaluation covered the following databases: PubMed, Scopus, Google Scholar. Analysis of the literature. Typically, the eyeball is not involved, but in exceptional cases, corneal ulceration may occur, or inflammation of the optic nerve may ensue. TAO most commonly occurs in the course of hyperthyroidism in Graves' disease, involving up to 25-50% of cases. The coexistence of autoantigens shared between the thyroid and orbital tissues is considered the primary cause of TAO when it occurs concurrently with hyperthyroidism, later in its course, or even preceding the manifestation of hyperthyroidism, with or without concurrent thyroid dysfunction. TAO is generally bilateral, although dominance on one side is often observed. Common symptoms include eye pain, photophobia, diplopia, varying degrees of proptosis, and impaired vision. The cornerstone of treatment lies in managing hyperthyroidism, as TAO cannot be cured without it. Conclusion. First-line treatment involves glucocorticoids, with radiation therapy as a supplementary option, and in cases unresponsive to pharmacological treatment, surgical intervention may be necessary [ABSTRACT FROM AUTHOR]

Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0–8), 3.29 ± 3.24 (range, 0–8) on the day of surgery, 4.67 ± 1.90 (range, 2–10) on day 1, 3.25 ± 1.39 (range, 1–6) on day 2, and 2.71 ± 1.30 (range, 1–6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0–10) preoperatively, 4.04 ± 3.78 (range, 0–10) on the day of surgery, 5.75 ± 2.01 (range, 2–10) on day 1, 4.25 ± 1.89 (range, 2–10) on day 2, and 3.88 ± 1.54 (range, 2–8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information. [ABSTRACT FROM AUTHOR]

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed. [ABSTRACT FROM AUTHOR]