AJO International最新文献

Purpose

Seasonal Hyperacute Panuveitis (SHAPU) is an ocular emergency where the genesis between infective and immunological is under investigation. This is the first report in the literature that attempts to explore the unidentified cause using next-generation metagenomic sequencing and immunomarker analysis.

Design

Cross-sectional quantitative study.

Methods

In this study, vitreous samples were collected from the SHAPU cases during the outbreak of 2019/2020. The vitreous samples of 10 random cases got selected for metagenomic next-generation sequencing. And 5 vitreous samples ran for immune analysis of levels of interleukin (IL) 6 and 10 using the ELISA technique. The ocular samples were extracted and sequenced on Illumina iSeq100 and analyzed through CZ ID platform. The true hits, for the suspected causative organisms were confirmed using qPCR through designed primers specific for that particular organism.

Results

A total of 30 eyes of 30 patients were included. Upon sequencing the DNA libraries, hits were observed for Streptococcus pneumoniae in 2/10 cases, confirmed by qPCR. IL-6 level was increased in 5/5 cases with IL-6/IL-10 greater than 1.

Conclusion

We report the presence of S. pneumoniae for the first time using a metagenomics analysis and increased IL-6 to IL-10 ratio via immune-analysis, indicating that SHAPU could have both infective and immunological facets on its causation.

Purpose

While it has been well established that advanced glaucoma is associated with a large cup-to-disc ratio (CDR), it is not known if the shape of the cup, particularly excavated cups with expanded lower portions (bean-pot cups), play any additional role in glaucomatous damage. We investigated this among individuals of African ancestry, a population that is more vulnerable to glaucoma than any other ethnic group.

Design

Case-control study

Methods

Setting

Institutional (University of Pennsylvania)

Subjects

3,255 eyes from 1,734 glaucoma cases from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study.

Procedure

Two graders independently assessed quantitative and qualitative aspects of the optic cup, with any discrepancies adjudicated by an ophthalmologist. The predominant cup shape (>50 %) was chosen in cases in which features of two or more cup shapes were present in the same eye. Comparisons of demographic and ocular characteristics among three cup shape groups (conical, cylindrical, and bean-pot) performed using generalized linear models, and generalized estimated equations applied to account for inter-eye correlation.

Main Outcome Measures

Qualitative features of cup shape and phenotypic traits, in conjunction with demographic and genetic information.

Results

Of 3,255 eyes, a total of 1,339 (41.1 %) exhibit a conical cup shape, 1,470 (45.2 %) have a cylindrical cup shape, and 446 (13.7 %) display a bean-pot cup shape. Compared to other cup morphology, bean-pot cups are significantly associated with lower MD, larger CDR, higher IOP, thinner RNFL, and worse VA in logMAR (all p < 0.001). Genetic analysis does not show any association between various genetic variants and cup shape. Factors independently predictive of bean-pot cupping include younger age at diagnosis (aOR 0.96 per 1 year increase in age of enrollment, p < 0.0001), CDR (adjusted odds ratio (aOR) 1.87, p < 0.0001), and the presence of certain optic disc features, including visible pores in the LC (aOR 2.76, p < 0.0001), nasalization of vessels (aOR 2.64, p < 0.0001), and vessel bayonetting (aOR 2.94, p < 0.0001).

Conclusion

This study shows the clinical significance of different cup shapes in glaucoma in an African ancestry population and suggests that bean-pot cups are associated with the most severe glaucomatous damage, independent of cup-disc ratio. This association should be considered when determining prognosis following glaucoma interventions.

Purpose

To report three-year outcomes of a multicenter cohort undergoing Preserflo Microshunt surgery (PFMS).

Design

Retrospective cohort study

Methods

Retrospective review of 100 consecutive eyes (91 patients) undergoing PFMS from four tertiary-referral glaucoma centers. Primary outcome were success rates. Secondary outcomes included: intraocular pressure (IOP), best-corrected visual acuity, medication, complications and postoperative interventions.

Results

100 eyes of 91 patients were included. Qualified and complete success rates (95 % CI) were 80 % (72–87 %) and 56 % (47–65 %) for Criterion A (IOP≤21 mmHg), 75 % (67–83 %) and 55 % (46–65 %) for Criterion B (IOP≤18 mmHg), 44 % (31–50 %) and 39 % (30–49 %) for Criterion C (IOP≤15 mmHg) and 10 % (5–16 %) and 10 % (5–16 %) for Criterion D (IOP≤12 mmHg) respectively. Mean IOP decreased from 23.8 mmHg to 14.1 mmHg (reduction of 35.3 %) after 36 months with a reduction of IOP-lowering agents from 2.52 (0 – 4) to 0.69 (0 – 3). 7 eyes (7 %) needed additional glaucoma surgery. Of these, 3 eyes underwent a glaucoma drainage device and 4 eyes had a trabeculectomy.36 eyes received additional procedures after PFMS implantation. Of these, 14 eyes (14 %) underwent a surgical revision and 12 eyes (12 %) a bleb needling procedure.

The complication rate was low: 1 eye developed corneal decompensation and underwent a DMEK after 24 months. 1 eye had a conjunctival erosion requiring a revision surgery. 2 eyes developed a postoperative uveitis that was treated with topical steroids and resolved without further damage. There were no hypotony-related complications.

Conclusions

PFMS surgery is a safe and effective procedure for reducing IOP and pressure-lowering therapy.

Purpose

To compare the pre- and post-treatment differences in non-invasive tear breakup time (NITBUT) between a 1 % terpinen-4-ol (T4O) and a 1 % tea tree oil (TTO) eyelid cleanser

Design

A randomized controlled trial

Method

Thirty-three participants diagnosed with MGD were enrolled. All patients and the outcome evaluator were masked to the treatment allocation. One eye of each patient was randomly assigned to receive the T4O cleanser, while the fellow eye received the TTO cleanser. Baseline and eight week assessments included the collection of the ocular surface disease index (OSDI) questionnaire, NITBUT (in seconds), lipid layer thickness (in nanometers), ocular surface staining scores, and the presence of Demodex as cylindrical dandruff. The main outcome measurement was the pre- and post-treatment difference in NITBUT. Patient preference, safety, and tolerability were also assessed.

Results

There was a statistically significant increase in NITBUT in the T4O group (n = 30; 2.27 ± 1.09; 95 % confidence interval [CI]: 0.12–4.42; p = 0.038), but not in the TTO group (n = 30; 0.04 ± 1.10; 95 % CI: -2.19–2.11; p = 0.972). Both groups showed significant improvement in post-treatment ocular surface staining scores. Fifteen subjects (50 %) preferred TTO due to less cooling sensation experienced during application, nine (30 %) preferred T4O, and six (20 %) had no preference. No major adverse events were observed.

Conclusion

Eyelid cleaning with 1 % T4O in MGD for eight weeks was found to increase NITBUT with good tolerability, although it was less preferred compared to TTO.

Objective

Endophthalmitis is a sight threatening complication of intra-ocular procedures. It has been suggested that a predisposition to endophthalmitis is linked to a specific genotype in the human beta-defensin 1 (HBD-1) gene when previously analysed in a small UK cohort undergoing cataract surgery. We sought to test out this hypothesis in a larger international case: control study (centres in UK, Netherlands and Canada) following a variety of intraocular procedures.

Design

International case: control study

Participants & Methods

660 individuals undergoing an intraocular procedure were recruited (165 cases of endophthalmitis and 495 controls). DNA was extracted. Single nucleotide polymorphisms, SNPs, rs11362, rs1800972 and rs2702877 in the HBD-1 gene were analysed (both individual genotypes and haplotypes were obtained).

Results

No associations were found when individual SNPs were analysed across the combined international cohort. However, analysis of the Toronto sub-cohort, showed a statistically significant association between the endophthalmitis cohort and the rs1800972 C allele (OR: 3.18, CI: 1.32 - 7.68, p = 0.01) and rs2702877 G allele (OR: 3.06, CI: 1.35 - 6.95, p = 0.017). No haplotype association was identified with endophthalmitis compared to control in both institution sub-cohorts and combined cohort analysis. A strong trend associating the rs1800972, rs11362 GG mini-haplotype with culture positive endophthalmitis groups across all groups was noted, but this did not reach statistical significance.

Conclusions

This is the first study to demonstrate a genetic link between a certain genetic profile (HBD-1 gene SNP variation) and endophthalmitis. Future pre-operative genetic testing could help identify patients at risk of endophthalmitis to guide invasive treatment options.

Purpose

Some patients with neovascular age-related macular degeneration (nAMD) do not respond to anti-VEGF treatment or develop tolerance or tachyphylaxis. If optimal treatment response is lacking with a given drug, switching to another is a common practice. The aim of this study was to report short-term outcomes of treatment switch to faricimab in real-world patients with nAMD resistant to both aflibercept and ranibizumab.

Design

Single-center, retrospective real-world cohort study.

Methods

Chart-review of 13 eyes of 13 multi-switch patients using electronic injection database, electronic medical records, and optical coherence tomography (OCT) data from May–September 2023.

Results

Faricimab treatment led to absence of fluid (subretinal, or both subretinal and intraretinal fluid) in 31% of the eyes and a reduction of fluid in 77% of the eyes at 4 weeks following the switch. The best-corrected visual acuity did not change significantly. No ocular or systemic safety events were observed.

Conclusions

Switching to faricimab seems a reasonable option in patients with nAMD who were previously resistant to both aflibercept and ranibizumab treatment. We noted a high rate of morphological response and improvement in anatomical parameters, with nearly one-third of the patients achieving dry macula after just one injection. No change in BCVA was seen. No safety issues were noted. The durability of these results warrants additional investigations.

Trial registration

ClinicalTrials.gov, registration number: NCT06231121, date of registration: 21/01/2024, retrospectively registered.

Purpose

This study assessed the changes in the prevalence of visual impairment (VI)/blindness, cataract surgical coverage (CSC), visual outcome after cataract surgery, and main barriers to cataract surgery among the population aged 50 years and older in Gegharkunik province of Armenia from 2003 - 4 to 2019.

Design

A cross-sectional study.

Methods

A multi-stage cluster sampling technique was used to conduct Rapid Assessment of Cataract Surgical Services (RACSS) and Rapid Assessment of Avoidable Blindness (RAAB) surveys in 2003–4 and 2019, respectively. Overall, 56 clusters (40 people in each cluster) were selected for RACSS, and 24 clusters (50 people in each cluster) for RAAB. Both surveys collected data on participants’ demographics, presenting/pinhole visual acuity (PVA/PinVA), the principal cause of VI, CSC, and barriers to cataract surgery.

Results

Overall, 1,787 people participated in RACSS and 1,099 people in RAAB. Between 2003–4 and 2019, age- and sex-adjusted prevalence of bilateral blindness decreased from 2.0 % to 1.4 % while severe VI decreased from 5.2 % to 2.2 % and moderate VI from 16.0 % to 7.3 %. Untreated cataract contributed to 71.9 % and 40.9 % of all blindness cases in 2003–4 and 2019, respectively. The CSC at the threshold <6/18 improved from 23.7 % in 2003–4 to 64.8 % in 2019. Both surveys mentioned the cost as the most common barrier to cataract surgery.

Conclusion

Despite substantial improvements, cataract remained the main cause of blindness in the province. Increasing financial coverage of cataract surgeries and improving the quality of surgeries could increase their utilization of services and help improve visual outcomes in the population.

Purpose

As an inhibitor of the insulin-like growth factor-1 (IGF-1) receptor, teprotumumab is utilized in the treatment of thyroid eye disease (TED) in which there is overexpression of IGF-1 receptors by orbital fibroblasts. Clinical trials and additional studies have brought the otologic side effects of the drug to attention. Discontinuing the drug leads to resolution in some patients, whereas others report chronic symptoms, including hearing loss. Gustatory side effects have not been elucidated to the same degree, and there are no specific recommendations on how to screen for or address otologic or gustatory complications of teprotumumab. This case report details the course of a patient with prolonged aural fullness and ageusia following teprotumumab treatment.

Design and Methods

Case report.

Results

A 71-year-old woman presenting with thyroid eye disease underwent seven cycles of teprotumumab infusion therapy. Her symptom profile, including aural fullness and ageusia, led to treatment cessation prior to completion of her final infusion. Following this treatment course, her thyroid eye disease clinical activity score improved and almost all her medication-associated adverse effects resolved.

Conclusion

This report highlights the first documented case of ageusia, and an unusually protracted course of aural fullness, with teprotumumab use. The case affirms the value of otologic and gustatory screening and continued evaluations before, during, and after receiving teprotumumab, and further characterizes aural fullness and ageusia as potential lasting consequences of therapy.