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Platelet-rich fibrin membrane versus conjunctival autograft in primary pterygium surgery: A comparative 12 months single center study 富血小板纤维蛋白膜与自体结膜移植在原发性翼状胬肉手术中的比较:一项为期12个月的单中心研究
Pub Date : 2025-12-31 DOI: 10.1016/j.ajoint.2025.100222
Hassan Moutei, Meriem bouzidi, Fouad Chraibi, Meriem Abdellaoui, Idriss Benatiya

Objective/Purpose

To compare the safety and preliminary efficacy of platelet-rich fibrin membrane (PRFm) versus conjunctival autograft (CA) for primary pterygium surgery.

Design

Prospective, comparative, non-randomized pilot study.

Subjects, Participants, and/or Controls

This pilot study enrolled 141 patients (76 Group A/CA; 65 Group B/PRFm) undergoing primary pterygium surgery between February 2024 and April 2025. Patients selected their preferred treatment approach.

Methods, Intervention, or Testing

Primary outcome was pterygium recurrence at 12 months (Solomon grading scale). Secondary outcomes included conjunctival inflammation (Efron scale), ocular surface symptoms (Visual Analog Scale and Ocular Surface Disease Index), corneal epithelialization time, visual acuity, surgical time, and graft integration (AS-OCT imaging).

Results

Recurrence occurred in 7 eyes (9.2%; 95% CI 3.8–17.8%) in Group A and 1 eye (1.5%; 95% CI 0.0–8.2%) in Group B. Mean surgical time was substantially shorter with PRFm (18.2 ± 5.2 min versus 38.5 ± 7.1 min; 53% reduction; p < 0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (p < 0.001 at 1 month), with resolution in both groups by 12 months. Within-group improvements in symptom scores were substantially greater with PRFm (VAS frequency 88.6% decrease versus 41.5%; OSDI 44.2% decrease versus 18.6%), with PRFm crossing from moderate to mild symptom category. However, between-group comparisons at individual postoperative timepoints demonstrated no statistically significant differences in symptom outcomes (all p > 0.05). AS-OCT measurements were comparable between groups at all timepoints, with no significant associations between graft morphology and clinical outcomes. Both procedures demonstrated excellent safety profiles with no serious adverse events.

Conclusions

This pilot study suggests PRFm may offer operational advantages and potentially favorable preliminary trends in recurrence and symptom improvement compared with CA for primary pterygium surgery. These exploratory findings warrant investigation in a larger randomized controlled trial with adequate power to determine whether observed trends represent clinically meaningful advantages.
目的比较富血小板纤维蛋白膜(PRFm)与自体结膜移植(CA)在原发性翼状胬肉手术中的安全性和初步疗效。前瞻性、比较性、非随机试验研究。受试者、参与者和/或对照本试点研究纳入了2024年2月至2025年4月期间接受原发性翼状胬肉手术的141例患者(76例A/CA组;65例B/PRFm组)。患者选择自己喜欢的治疗方法。方法、干预或检测主要结果为12个月翼状胬肉复发(所罗门分级量表)。次要结局包括结膜炎症(Efron评分)、眼表症状(视觉模拟评分和眼表疾病指数)、角膜上皮化时间、视力、手术时间和移植物整合(AS-OCT成像)。结果A组复发7只眼(9.2%;95% CI 3.8-17.8%), b组复发1只眼(1.5%;95% CI 0.0-8.2%), PRFm的平均手术时间明显缩短(18.2±5.2 min vs 38.5±7.1 min;减少53%;p < 0.001)。B组结膜炎症持续降低3个月(1个月时p <; 0.001),两组结膜炎症在12个月时消退。PRFm组内症状评分的改善明显更大(VAS频率下降88.6%对41.5%;OSDI下降44.2%对18.6%),PRFm从中度症状类别跨越到轻度症状类别。然而,术后各时间点组间比较显示症状结局无统计学差异(均p >; 0.05)。AS-OCT测量在所有时间点组间具有可比性,移植物形态和临床结果之间无显著关联。两种方法均表现出良好的安全性,无严重不良事件。结论与CA相比,PRFm在原发性翼状胬肉手术中可能具有手术优势,并且在复发和症状改善方面具有潜在的有利趋势。这些探索性发现值得在更大的随机对照试验中进行调查,以确定观察到的趋势是否代表临床有意义的优势。
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引用次数: 0
Impact of diabetic foot ulcers and nephropathy on risk of treatment-warranted diabetic eye disease: A retrospective cohort study 糖尿病足溃疡和肾病对治疗所需糖尿病眼病风险的影响:一项回顾性队列研究
Pub Date : 2025-12-24 DOI: 10.1016/j.ajoint.2025.100220
Alexander T. Hong , Ivan Y. Luu , Tze-Woei Tan , Brian C. Toy

Purpose

Microvascular complications of type 2 diabetes (T2DM), such as diabetic retinopathy, nephropathy (DN), and foot ulcers (DFU), are interrelated outcomes of hyperglycemia-induced vascular injury. Whether comorbid DFU or DN merely indicate diabetic microvascular disease burden or specifically contribute to progression to treatment-warranted diabetic eye disease (TW-DED) remains insufficiently explored. We hypothesized that DFU and DN are independently associated with increased risk of TW-DED.

Design

This retrospective cohort study used electronic health records from a nationwide federated database and followed patients for up to 10 years after index non-proliferative diabetic retinopathy (NPDR) diagnosis.

Setting

Data were aggregated from a multicenter network of 70 U.S.-based healthcare organizations, including both academic and non-academic institutions.

Participants

Patients aged ≥40 years with T2DM and NPDR were included, while those with prior TW-DED were excluded.

Exposures

Baseline DN and/or DFU, with propensity-matched clinical covariates, including demographics, comorbidities, medications, laboratory values, and healthcare utilization.

Main Outcomes

The primary outcome was progression to TW-DED, defined as proliferative DR, macular edema, vitreous hemorrhage, or need for DR-related treatments (intravitreal injection, panretinal photocoagulation, pars plana vitrectomy). Risk of blindness or low vision was also assessed. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

Among 135,172 patients with NPDR, 21.5% had DN only, 8.5% had DFU only, and 7.0% had both. Compared to those without DN or DFU, patients with DFU (HR 1.27, 95% CI 1.19–1.36), DN (HR 1.17, 95% CI 1.05–1.21), or both DFU and DN (HR 1.49, 95% CI 1.33–1.68) had an associated increased risk of TW-DED. DFU alone was associated with greater risk of TW-DED than DN alone (HR 1.15, 95% CI 1.05–1.28). Patients with DFU or DN had a 2-fold increased risk of PDR and VH, 50% increased risk of blindness/low vision, and 2-fold increased risk of undergoing vitrectomy.

Conclusions

Comorbid DFU and DN are associated with increased risk of diabetic eye disease progression, with DFU showing greater independent risk. Proactively identifying these complications may support risk stratification and guide more intensive ophthalmic monitoring for patients with NPDR.
2型糖尿病(T2DM)的微血管并发症,如糖尿病视网膜病变、肾病(DN)和足部溃疡(DFU),是高血糖诱导的血管损伤的相关结果。是否合并症的DFU或DN仅仅表明糖尿病微血管疾病负担或特别有助于进展到需要治疗的糖尿病眼病(TW-DED)仍未充分探讨。我们假设DFU和DN与TW-DED风险增加独立相关。设计:本回顾性队列研究使用来自全国联邦数据库的电子健康记录,并在诊断为非增殖性糖尿病视网膜病变(NPDR)后对患者进行长达10年的随访。SettingData来自70个美国医疗保健组织的多中心网络,包括学术和非学术机构。年龄≥40岁,伴有T2DM和NPDR的患者被纳入研究,而既往有TW-DED的患者被排除在外。基线DN和/或DFU,具有倾向匹配的临床协变量,包括人口统计学、合并症、药物、实验室值和医疗保健利用。主要结局:主要结局是进展为TW-DED,定义为增殖性DR、黄斑水肿、玻璃体出血,或需要进行DR相关治疗(玻璃体内注射、全视网膜光凝、玻璃体切除)。失明或低视力的风险也被评估。Cox比例风险模型估计了风险比(hr)和95%置信区间(ci)。结果在135172例NPDR患者中,21.5%的患者仅患有DN, 8.5%的患者仅患有DFU, 7.0%的患者两者兼有。与没有DN或DFU的患者相比,DFU(风险比1.27,95% CI 1.19-1.36)、DN(风险比1.17,95% CI 1.05-1.21)或DFU和DN同时存在(风险比1.49,95% CI 1.33-1.68)的患者发生TW-DED的风险增加。单独DFU比单独DN的TW-DED风险更高(HR 1.15, 95% CI 1.05-1.28)。DFU或DN患者PDR和VH的风险增加了2倍,失明/低视力的风险增加了50%,玻璃体切除术的风险增加了2倍。结论DFU和DN合并症与糖尿病眼病进展风险增加相关,其中DFU表现出更大的独立风险。主动识别这些并发症可以支持风险分层,并指导对NPDR患者进行更密切的眼科监测。
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引用次数: 0
Comment on “Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis” 点评“眼内抗生素降低白内障术后眼内炎风险的有效性:一项荟萃分析”
Pub Date : 2025-12-23 DOI: 10.1016/j.ajoint.2025.100219
Prashant Ramdas Kokiwar , Amit Singh Pawaiya , Ranjana Roy , Reenoo Jauhari
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引用次数: 0
The association of diabetic retinopathy and visual impairment with falls and falls reporting injuries: Findings from the behavioral risk factor surveillance system 糖尿病视网膜病变和视力损害与跌倒和跌倒报告损伤的关系:来自行为危险因素监测系统的发现
Pub Date : 2025-12-23 DOI: 10.1016/j.ajoint.2025.100221
Neel Edupuganti , Danny Alevy , Tommy Bui , George Liu , Kevin Dobbin , John E. Crews , Atalie C. Thompson

Purpose

To investigate the associations between visual impairment (VI) and diabetic retinopathy (DR) with the prevalence of falls, recurrent falls, and falls reporting injuries (FRIs).

Design

Cross-sectional analyses of associations between VI, DR, or both VI and DR with the prevalence of any fall, recurrent falls, and FRIs using data from 65,046 adults (45+ years) who completed the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Diabetes Module.

Subjects, participants, and/or controls

Participants were categorized into four groups: no VI or DR (reference), DR only, VI only, and both VI and DR.

Methods

Separate multivariable logistic regression models, adjusted for sociodemographics and comorbidities, were used to analyze the association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.

Main Outcome Measures

The association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.

Results

Compared to adults with no VI or DR, those with VI reported 1.72 greater odds of experiencing any fall (adjusted odds ratio (aOR)=1.716, p < 0.001), 1.82 greater odds of an increasing number of falls (aOR=1.824, p < 0.001), and 2.08 greater odds of FRIs (aOR=2.076, p < 0.001). Similarly, those with DR only also had substantially greater odds of experiencing any fall (aOR=1.741, p < 0.001), an increasing number of falls (aOR = 1.735, p < 0.001), and FRIs (aOR=1.658, p = 0.004). The interaction effect between VI and DR was not significant. Subjects with both VI and DR experienced 3.80 greater odds of any fall, 2.73 greater odds of increasing falls, and 2.79 greater odds of FRIs, which was greater than those with VI or DR alone or neither condition. Further, subjects aged 45–64 years had significantly higher odds of FRIs than those aged 65+.

Conclusions

Using data from 17 states and territories implementing the 2018 BRFSS Diabetes Module, we found that adults with both VI and DR experienced a greater likelihood of falls, recurrent falls, and FRIs than those with neither or either condition. However, the inability to infer temporal or causal relationships from this cross-sectional, self-reported analysis should be considered. These findings underscore the importance for practitioners to communicate fall risks among people with DR and VI and support policies promoting tailored interventions for people experiencing these specific conditions.
目的探讨视力损害(VI)和糖尿病视网膜病变(DR)与跌倒、复发性跌倒和跌倒报告损伤(FRIs)发生率之间的关系。横断面分析VI、DR或VI和DR与任何跌倒、复发性跌倒和fri患病率之间的关系,使用来自65,046名完成2018年行为风险因素监测系统(BRFSS)糖尿病模块的45岁以上成年人的数据。受试者、参与者和/或对照组将参与者分为四组:无VI或DR(参考)、仅DR、仅VI和同时有VI和DR。方法采用独立的多变量logistic回归模型,根据社会人口统计学和合并症进行调整,分析VI、DR或VI和DR与经历任何跌倒、复发性跌倒或fri的几率之间的关系。主要结局指标:VI、DR或VI和DR与发生任何跌倒、复发性跌倒或fri的几率之间的关系。结果与没有VI或DR的成年人相比,VI患者发生跌倒的几率高出1.72(调整优势比(aOR)=1.716, p < 0.001),跌倒次数增加的几率高出1.82 (aOR=1.824, p < 0.001), fri的几率高出2.08 (aOR=2.076, p < 0.001)。同样,那些仅患有DR的人也有更大的几率经历跌倒(aOR=1.741, p < 0.001),跌倒次数增加(aOR= 1.735, p < 0.001), fri (aOR=1.658, p = 0.004)。VI与DR的交互作用不显著。同时患有VI和DR的受试者跌倒的几率比单独患有VI或DR的受试者高3.80,跌倒次数增加的几率比单独患有VI或DR的受试者高2.73,fri的几率比单独患有VI或DR的受试者高2.79。此外,45-64岁的受试者患fri的几率明显高于65岁以上的受试者。使用实施2018年BRFSS糖尿病模块的17个州和地区的数据,我们发现患有VI和DR的成年人比没有或两种情况的成年人更容易跌倒、复发性跌倒和fri。然而,不能从这种横断面的、自我报告的分析中推断出时间或因果关系,应该加以考虑。这些发现强调了从业人员向DR和VI患者宣传跌倒风险的重要性,并支持促进针对这些特定疾病患者的量身定制干预措施的政策。
{"title":"The association of diabetic retinopathy and visual impairment with falls and falls reporting injuries: Findings from the behavioral risk factor surveillance system","authors":"Neel Edupuganti ,&nbsp;Danny Alevy ,&nbsp;Tommy Bui ,&nbsp;George Liu ,&nbsp;Kevin Dobbin ,&nbsp;John E. Crews ,&nbsp;Atalie C. Thompson","doi":"10.1016/j.ajoint.2025.100221","DOIUrl":"10.1016/j.ajoint.2025.100221","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the associations between visual impairment (VI) and diabetic retinopathy (DR) with the prevalence of falls, recurrent falls, and falls reporting injuries (FRIs).</div></div><div><h3>Design</h3><div>Cross-sectional analyses of associations between VI, DR, or both VI and DR with the prevalence of any fall, recurrent falls, and FRIs using data from 65,046 adults (45+ years) who completed the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Diabetes Module.</div></div><div><h3>Subjects, participants, and/or controls</h3><div>Participants were categorized into four groups: no VI or DR (reference), DR only, VI only, and both VI and DR.</div></div><div><h3>Methods</h3><div>Separate multivariable logistic regression models, adjusted for sociodemographics and comorbidities, were used to analyze the association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.</div></div><div><h3>Main Outcome Measures</h3><div>The association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.</div></div><div><h3>Results</h3><div>Compared to adults with no VI or DR, those with VI reported 1.72 greater odds of experiencing any fall (adjusted odds ratio (aOR)=1.716, <em>p</em> &lt; 0.001), 1.82 greater odds of an increasing number of falls (aOR=1.824, <em>p</em> &lt; 0.001), and 2.08 greater odds of FRIs (aOR=2.076, <em>p</em> &lt; 0.001). Similarly, those with DR only also had substantially greater odds of experiencing any fall (aOR=1.741, <em>p</em> &lt; 0.001), an increasing number of falls (aOR = 1.735, <em>p</em> &lt; 0.001), and FRIs (aOR=1.658, <em>p</em> = 0.004). The interaction effect between VI and DR was not significant. Subjects with both VI and DR experienced 3.80 greater odds of any fall, 2.73 greater odds of increasing falls, and 2.79 greater odds of FRIs, which was greater than those with VI or DR alone or neither condition. Further, subjects aged 45–64 years had significantly higher odds of FRIs than those aged 65+.</div></div><div><h3>Conclusions</h3><div>Using data from 17 states and territories implementing the 2018 BRFSS Diabetes Module, we found that adults with both VI and DR experienced a greater likelihood of falls, recurrent falls, and FRIs than those with neither or either condition. However, the inability to infer temporal or causal relationships from this cross-sectional, self-reported analysis should be considered. These findings underscore the importance for practitioners to communicate fall risks among people with DR and VI and support policies promoting tailored interventions for people experiencing these specific conditions.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating patient-facing eye disease information: ChatGPT-5 vs. Pfizer health answers 评估患者眼病信息:ChatGPT-5与辉瑞健康答案
Pub Date : 2025-12-22 DOI: 10.1016/j.ajoint.2025.100215
Adriana Kaganovski , Anisha Kasi , Aliya Grinberg , Michael Kozlov , Riya Patel , Minwoo Kwon , Carolyn Lai , Inci Dersu

Purpose

To evaluate and compare the quality, accuracy, understandability, and actionability of responses generated by a health-specific AI chatbot (Health Answers by Pfizer) and a general-purpose AI chatbot (ChatGPT/GPT-5) to ophthalmology-related patient queries.

Methods

We input the top five Google Trends search queries on three leading causes of blindness worldwide — glaucoma, cataract, and age-related macular degeneration — into both chatbots. We evaluated each chatbot response with the Flesch Reading Ease test, Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool, and DISCERN tool to assess the quality, accuracy, understandability, and actionability of each response.

Results

ChatGPT-5 produced responses that were easier to read (Flesch Reading Ease of 48.1 vs 39.0, p = 0.02) and written at a lower grade level (Flesch-Kincaid Grade Level of 8.9 vs 12.2, p = 0.003). ChatGPT-5 also scored higher for understandability (PEMAT-P understandability scores of 83.8% vs 80.5%, p = 0.024) and information quality (DISCERN scores of 41.3 vs 36.4, p = 0.047). In contrast, Health Answers by Pfizer produced content that was significantly more actionable (PEMAT-P actionability scores of 41.3% vs 23.3%, p = 0.004).

Conclusions

This study highlights the utility of Health Answers by Pfizer in producing content of higher actionability, compared to ChatGPT-5, which produced content of greater understandability, quality, and readability. It is paramount for effective patient education in ophthalmology to improve AI chatbots to balance clarity with actionability, especially given the critical nature of silently progressing diseases like glaucoma.
目的评估和比较健康专用AI聊天机器人(辉瑞公司的Health Answers)和通用AI聊天机器人(ChatGPT/GPT-5)对眼科相关患者查询产生的回答的质量、准确性、可理解性和可操作性。方法:我们在两个聊天机器人中输入关于全球三种主要致盲原因(青光眼、白内障和年龄相关性黄斑变性)的谷歌趋势搜索查询前五名。我们使用Flesch Reading Ease test、Flesch- kincaid Grade Level、Patient Education Materials Assessment Tool和DISCERN工具来评估每个聊天机器人的反应,以评估每个反应的质量、准确性、可理解性和可操作性。结果schatgpt -5产生的回答更容易阅读(Flesch Reading Ease为48.1 vs 39.0, p = 0.02),书写水平较低(Flesch- kincaid grade level为8.9 vs 12.2, p = 0.003)。ChatGPT-5在可理解性(PEMAT-P可理解性得分为83.8%比80.5%,p = 0.024)和信息质量(DISCERN得分为41.3比36.4,p = 0.047)方面得分也更高。相比之下,辉瑞公司的健康答案产生的内容更具可操作性(PEMAT-P可操作性得分为41.3%对23.3%,p = 0.004)。与ChatGPT-5相比,本研究突出了辉瑞公司的Health Answers在产生更高可操作性内容方面的效用,后者产生的内容更具可理解性、质量和可读性。对于有效的眼科患者教育来说,改进人工智能聊天机器人以平衡清晰度和可操作性是至关重要的,特别是考虑到青光眼等悄无声息发展的疾病的关键性质。
{"title":"Evaluating patient-facing eye disease information: ChatGPT-5 vs. Pfizer health answers","authors":"Adriana Kaganovski ,&nbsp;Anisha Kasi ,&nbsp;Aliya Grinberg ,&nbsp;Michael Kozlov ,&nbsp;Riya Patel ,&nbsp;Minwoo Kwon ,&nbsp;Carolyn Lai ,&nbsp;Inci Dersu","doi":"10.1016/j.ajoint.2025.100215","DOIUrl":"10.1016/j.ajoint.2025.100215","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate and compare the quality, accuracy, understandability, and actionability of responses generated by a health-specific AI chatbot (Health Answers by Pfizer) and a general-purpose AI chatbot (ChatGPT/GPT-5) to ophthalmology-related patient queries.</div></div><div><h3>Methods</h3><div>We input the top five Google Trends search queries on three leading causes of blindness worldwide — glaucoma, cataract, and age-related macular degeneration — into both chatbots. We evaluated each chatbot response with the Flesch Reading Ease test, Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool, and DISCERN tool to assess the quality, accuracy, understandability, and actionability of each response.</div></div><div><h3>Results</h3><div>ChatGPT-5 produced responses that were easier to read (Flesch Reading Ease of 48.1 vs 39.0, <em>p</em> = 0.02) and written at a lower grade level (Flesch-Kincaid Grade Level of 8.9 vs 12.2, <em>p</em> = 0.003). ChatGPT-5 also scored higher for understandability (PEMAT-P understandability scores of 83.8% vs 80.5%, <em>p</em> = 0.024) and information quality (DISCERN scores of 41.3 vs 36.4, <em>p</em> = 0.047). In contrast, Health Answers by Pfizer produced content that was significantly more actionable (PEMAT-P actionability scores of 41.3% vs 23.3%, <em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>This study highlights the utility of Health Answers by Pfizer in producing content of higher actionability, compared to ChatGPT-5, which produced content of greater understandability, quality, and readability. It is paramount for effective patient education in ophthalmology to improve AI chatbots to balance clarity with actionability, especially given the critical nature of silently progressing diseases like glaucoma.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anatomical and visual outcomes of pneumatic retinopexy in primary rhegmatogenous retinal detachment 气动视网膜固定术治疗原发性孔源性视网膜脱离的解剖学和视觉效果
Pub Date : 2025-12-22 DOI: 10.1016/j.ajoint.2025.100218
Hassan Moutei, Meriem Abdellaoui, Fouad Chraibi, Idriss Benatiya

Purpose

To evaluate pneumatic retinopexy (PnR) outcomes for primary rhegmatogenous retinal detachment (RRD) in a real-world North African cohort and identify factors associated with surgical failure.

Design

Retrospective observational case series.

Methods

A total of 112 eyes from 112 patients treated for primary RRD with PnR (January 2023–March 2025) were reviewed. Patient selection followed PIVOT trial criteria, including single retinal break or clustered breaks ≤1 clock hour, located within superior 8 clock hours (between 8 and 4 o'clock), with documented postoperative compliance. Preoperative demographics, ocular characteristics, and postoperative complications were systematically recorded. The primary anatomical outcome was defined as complete retinal reattachment without additional surgery at 6 months. Anatomical failure was defined as subretinal fluid persistence exceeding 4 weeks requiring secondary intervention. The primary visual outcome was best-corrected visual acuity (BCVA) at 6 months and its change over time. Logistic regression was used to identify factors associated with anatomical and visual failure.

Results

Single-operation anatomical success was 67 % (75/112 eyes); secondary procedures achieved 98 % final reattachment (110/112). Mean final BCVA was 0.12 logMAR, with 80 % of visual improvement occurring within the first postoperative month (0.62 logMAR gain; p < 0.001). Pseudophakia (OR=3.49, p < 0.001), high myopia (OR=1.82, p = 0.02), and prolonged symptom duration (OR=1.12 per day, p = 0.002) were independent factors associated with anatomical failure. New or missed retinal breaks (OR=2.16, p = 0.03) and proliferative vitreoretinopathy (PVR) (OR=1.96, p = 0.02) were independent postoperative factors of failure. For visual outcomes, pseudophakia (OR=3.2, p = 0.001), high myopia (OR=2.49, p = 0.004), worse preoperative BCVA (OR = 2.23, p = 0.002), and prolonged symptom duration (OR=1.35 per day, p = 0.002) were independent factors associated with poor outcomes. Postoperative complications (missed breaks OR=2.8; PVR OR=1.8) also independently contributed to poor visual recovery.

Conclusions

PnR achieves competitive anatomical and visual outcomes in real-world practice when rigorous patient selection and meticulous surgical technique are applied. Success depends equally on preoperative patient selection and surgical execution. Optimization through timely intervention, comprehensive preoperative examination, enhanced visualization, and rigorous surveillance may increase real-world success rates toward trial-level performance while maintaining procedural simplicity and cost-effectiveness in resource-limited settings.
目的评估北非现实世界人群中原发性孔源性视网膜脱离(RRD)的气压视网膜固定术(PnR)结果,并确定与手术失败相关的因素。设计回顾性观察病例系列。方法回顾性分析2023年1月~ 2025年3月收治的112例原发性RRD合并PnR患者的112只眼。患者选择遵循PIVOT试验标准,包括单个视网膜断裂或聚集性断裂≤1时钟小时,位于优越的8时钟小时内(8点至4点之间),并记录术后依从性。系统记录术前人口统计学、眼部特征和术后并发症。主要解剖结果被定义为6个月时视网膜完全复位,无需额外手术。解剖失败定义为视网膜下积液超过4周,需要二次干预。主要视力指标为6个月时的最佳矫正视力(BCVA)及其随时间的变化。使用逻辑回归来确定与解剖和视觉功能障碍相关的因素。结果单次手术解剖成功率为67%(75/112眼);二次手术最终复位率为98%(110/112)。平均最终BCVA为0.12 logMAR, 80%的视力改善发生在术后第一个月内(0.62 logMAR增益;p < 0.001)。假性近视(OR=3.49, p < 0.001)、高度近视(OR=1.82, p = 0.02)和症状持续时间延长(OR=1.12 /天,p = 0.002)是解剖衰竭的独立相关因素。新发或漏发视网膜断裂(or =2.16, p = 0.03)和增殖性玻璃体视网膜病变(or =1.96, p = 0.02)是术后失败的独立因素。对于视力结果,假性晶光(OR=3.2, p = 0.001)、高度近视(OR=2.49, p = 0.004)、术前BCVA恶化(OR= 2.23, p = 0.002)和症状持续时间延长(OR=1.35 /天,p = 0.002)是与预后不良相关的独立因素。术后并发症(漏断OR=2.8; PVR OR=1.8)也是导致视力恢复差的独立原因。结论通过严格的患者选择和细致的手术技术,spnr在实际应用中获得了良好的解剖和视觉效果。成功与否同样取决于术前病人的选择和手术的执行。通过及时的干预、全面的术前检查、增强的可视化和严格的监测进行优化,可以提高实际成功率,达到试验水平,同时在资源有限的情况下保持程序的简单性和成本效益。
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引用次数: 0
In memoriam, Nobuhiko Matsuo, 1931-2025 为了纪念,松尾信彦1931-2025
Pub Date : 2025-12-20 DOI: 10.1016/j.ajoint.2025.100217
Toshihiko Matsuo
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引用次数: 0
Assessing demographic variation in large language model outputs for patient education materials in cataract surgery 评估白内障手术患者教育材料的大语言模型输出的人口统计学差异
Pub Date : 2025-12-19 DOI: 10.1016/j.ajoint.2025.100216
Angel Gao , Abu Bakar Butt , Fred Min , Amin Hatamnejad , Keean Nanji , Husayn Gulamhusein

Purpose

To evaluate whether large language model (LLM)-generated patient education materials for cataract surgery vary in readability, length, and accuracy based on demographic modifiers including race, gender, geography, and insurance status.

Design

Cross-sectional study

Methods

This study analyzed 7,000 responses from five LLMs (ChatGPT, Claude, Copilot, DeepSeek, and Gemini) between March-May 2025 using 280 standardized prompts that varied by race, gender, province/territory, and insurance coverage. Each prompt was submitted five times. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), and SMOG index. Accuracy was assessed by dual blinded reviewers against AAO clinical guidelines. ANOVA was performed (α = 0.05).

Results

LLM outputs differed significantly across all metrics (p < 0.001). Gemini generated the longest (876 ± 143 words) and among the most complex text (FKGL 11.9 ± 1.2). Race, insurance status, and geography significantly impacted readability. Prompts referencing Indigenous patients were the most complex (FKGL 11.1 ± 1.8, FRE 36.5 ± 7.9). Insured prompts were longer and more complex (11.0 ± 1.7 vs. 10.8 ± 1.7; 429 vs. 399 words; p < 0.001). Prompts from Nunavut and Manitoba were the least readable (FKGL ≥ 11.1), while Quebec and PEI were most readable. Gender had minimal impact. No outputs contained clinically unsafe information, but most lacked sufficient depth. None of the responses met the AMA’s sixth-grade readability recommendation.

Conclusion

LLM-generated patient education for cataract surgery varies by patient demographics. These disparities may hinder equitable access to health information and highlight the need for bias-aware development of AI tools in healthcare.
目的评估大语言模型(LLM)生成的白内障手术患者教育材料在可读性、长度和准确性方面是否存在差异,这取决于人口统计学修饰因素,包括种族、性别、地理位置和保险状况。设计横断面研究方法本研究分析了2025年3月至5月期间来自5位法学硕士(ChatGPT、Claude、Copilot、DeepSeek和Gemini)的7000份回复,使用280个标准化提示,这些提示因种族、性别、省份/地区和保险范围而异。每个提示被提交了5次。采用Flesch- kincaid Grade Level (FKGL)、Flesch Reading Ease (FRE)和SMOG指数评估可读性。根据AAO临床指南进行双盲评估。方差分析(α = 0.05)。结果sllm的输出在所有指标上都有显著差异(p < 0.001)。双子座生成了最长的(876±143个单词)和最复杂的文本(FKGL 11.9±1.2)。种族、保险状况和地理显著影响可读性。本土患者提示最复杂(FKGL 11.1±1.8,FRE 36.5±7.9)。投保提示更长、更复杂(11.0±1.7 vs 10.8±1.7;429 vs 399; p < 0.001)。来自努纳武特和马尼托巴的提示可读性最低(FKGL≥11.1),而魁北克省和PEI的提示可读性最高。性别影响最小。没有输出包含临床不安全信息,但大多数缺乏足够的深度。没有一个回答符合美国医学协会的六级可读性建议。结论法学硕士对白内障手术患者的教育因患者的不同而不同。这些差异可能妨碍公平获取卫生信息,并突出表明需要在卫生保健领域开发具有偏见意识的人工智能工具。
{"title":"Assessing demographic variation in large language model outputs for patient education materials in cataract surgery","authors":"Angel Gao ,&nbsp;Abu Bakar Butt ,&nbsp;Fred Min ,&nbsp;Amin Hatamnejad ,&nbsp;Keean Nanji ,&nbsp;Husayn Gulamhusein","doi":"10.1016/j.ajoint.2025.100216","DOIUrl":"10.1016/j.ajoint.2025.100216","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether large language model (LLM)-generated patient education materials for cataract surgery vary in readability, length, and accuracy based on demographic modifiers including race, gender, geography, and insurance status.</div></div><div><h3>Design</h3><div>Cross-sectional study</div></div><div><h3>Methods</h3><div>This study analyzed 7,000 responses from five LLMs (ChatGPT, Claude, Copilot, DeepSeek, and Gemini) between March-May 2025 using 280 standardized prompts that varied by race, gender, province/territory, and insurance coverage. Each prompt was submitted five times. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), and SMOG index. Accuracy was assessed by dual blinded reviewers against AAO clinical guidelines. ANOVA was performed (α = 0.05).</div></div><div><h3>Results</h3><div>LLM outputs differed significantly across all metrics (<em>p</em> &lt; 0.001). Gemini generated the longest (876 ± 143 words) and among the most complex text (FKGL 11.9 ± 1.2). Race, insurance status, and geography significantly impacted readability. Prompts referencing Indigenous patients were the most complex (FKGL 11.1 ± 1.8, FRE 36.5 ± 7.9). Insured prompts were longer and more complex (11.0 ± 1.7 vs. 10.8 ± 1.7; 429 vs. 399 words; <em>p</em> &lt; 0.001). Prompts from Nunavut and Manitoba were the least readable (FKGL ≥ 11.1), while Quebec and PEI were most readable. Gender had minimal impact. No outputs contained clinically unsafe information, but most lacked sufficient depth. None of the responses met the AMA’s sixth-grade readability recommendation.</div></div><div><h3>Conclusion</h3><div>LLM-generated patient education for cataract surgery varies by patient demographics. These disparities may hinder equitable access to health information and highlight the need for bias-aware development of AI tools in healthcare.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intravitreal injection history and cataract surgery complications: A multicenter retrospective cohort 玻璃体内注射史与白内障手术并发症:一项多中心回顾性队列研究
Pub Date : 2025-12-18 DOI: 10.1016/j.ajoint.2025.100214
Justus Zemberi , Julian Peregoff , Matthew Santos

Purpose

To evaluate whether a recent history of intravitreal injection is associated with postoperative complications after cataract surgery in a large, real-world cohort.

Design

Retrospective, propensity score–matched cohort study.

Methods

Adults undergoing cataract surgery with or without at least one intravitreal injection within 90 days before surgery were identified from the U.S. TriNetX research network. Cohorts were matched for demographic characteristics and ocular and systemic comorbidities. Postoperative complications at 14, 30, and 90 days were compared using risk ratios with 95% confidence intervals.

Results

After matching, 10,107 patients with recent intravitreal injection and 10,107 controls were included. A recent intravitreal injection history was associated with higher rates of postoperative macular edema at 14, 30, and 90 days (RR range 2.07–2.69) and vitreous hemorrhage at 90 days (RR 1.74). Absolute risk differences were modest. No significant associations were observed for infection, retinal detachment, anterior vitrectomy, lens dislocation, anterior uveitis, or secondary lens procedures.

Conclusion

In this large retrospective analysis, patients undergoing cataract surgery with a recent history of intravitreal injection had higher observed rates of postoperative macular edema and vitreous hemorrhage, while other major complications were not increased. These associations likely reflect the presence of underlying retinal disease rather than a direct effect of the injection procedure itself and should be interpreted as non-causal.
目的在一项大型真实队列研究中,评估近期玻璃体内注射史是否与白内障术后并发症有关。设计回顾性、倾向评分匹配的队列研究。方法从美国TriNetX研究网络中确定接受白内障手术的成年人,术前90天内至少有或没有一次玻璃体内注射。根据人口统计学特征和眼部及全身合并症对队列进行匹配。术后14、30和90天的并发症发生率比较采用95%可信区间的风险比。结果匹配后纳入10107例近期玻璃体内注射患者和10107例对照组。近期玻璃体内注射史与术后14、30和90天黄斑水肿(RR范围2.07-2.69)和90天玻璃体出血(RR 1.74)的发生率较高相关。绝对风险差异不大。未观察到感染、视网膜脱离、前玻璃体切除术、晶状体脱位、前葡萄膜炎或继发性晶状体手术的显著相关性。结论在这项大型回顾性分析中,近期有玻璃体内注射史的白内障手术患者术后黄斑水肿和玻璃体出血的发生率较高,而其他主要并发症未增加。这些关联可能反映了潜在视网膜疾病的存在,而不是注射过程本身的直接影响,应该被解释为非因果关系。
{"title":"Intravitreal injection history and cataract surgery complications: A multicenter retrospective cohort","authors":"Justus Zemberi ,&nbsp;Julian Peregoff ,&nbsp;Matthew Santos","doi":"10.1016/j.ajoint.2025.100214","DOIUrl":"10.1016/j.ajoint.2025.100214","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether a recent history of intravitreal injection is associated with postoperative complications after cataract surgery in a large, real-world cohort.</div></div><div><h3>Design</h3><div>Retrospective, propensity score–matched cohort study.</div></div><div><h3>Methods</h3><div>Adults undergoing cataract surgery with or without at least one intravitreal injection within 90 days before surgery were identified from the U.S. TriNetX research network. Cohorts were matched for demographic characteristics and ocular and systemic comorbidities. Postoperative complications at 14, 30, and 90 days were compared using risk ratios with 95% confidence intervals.</div></div><div><h3>Results</h3><div>After matching, 10,107 patients with recent intravitreal injection and 10,107 controls were included. A recent intravitreal injection history was associated with higher rates of postoperative macular edema at 14, 30, and 90 days (RR range 2.07–2.69) and vitreous hemorrhage at 90 days (RR 1.74). Absolute risk differences were modest. No significant associations were observed for infection, retinal detachment, anterior vitrectomy, lens dislocation, anterior uveitis, or secondary lens procedures.</div></div><div><h3>Conclusion</h3><div>In this large retrospective analysis, patients undergoing cataract surgery with a recent history of intravitreal injection had higher observed rates of postoperative macular edema and vitreous hemorrhage, while other major complications were not increased. These associations likely reflect the presence of underlying retinal disease rather than a direct effect of the injection procedure itself and should be interpreted as non-causal.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100214"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“Indocyanine green enhanced TTT Vs TTT for treatment of thicker tumors in Retinoblastoma- a randomised control trial” 吲哚菁绿增强TTT Vs TTT治疗视网膜母细胞瘤中较厚肿瘤的随机对照试验
Pub Date : 2025-12-16 DOI: 10.1016/j.ajoint.2025.100213
Ipsita Barman , Rachna Meel , Neelam Pushker , Vinod Kumar , Neiwete Lomi , Anjolie Chhabra , Mandeep S. Bajaj

Background

Transpupillary thermotherapy (TTT) is used as a focal treatment modality for smaller retinoblastoma tumors, however its efficacy in thicker tumors is limited. This study evaluated whether indocyanine green (ICG) augmentation of TTT (ICGeTTT) improves tumor regression compared to TTT alone for residual chemoreduced retinoblastomas >2 mm in height.

Methods

In this randomized controlled trial, simple randomisation table was used to allocate 28 chemoreduced tumors to treatment with either TTT (group 1) or ICGeTTT (group 2). Treatment was administered every 3–4 weeks until tumor height was <2 mm or a maximum of four sessions were completed.

Results

The baseline tumor height was higher for the ICGeTTT group. Adjusted analysis for this baseline difference showed a statistically significant greater reduction in tumor height for group 2 (44 %) as compared to group 1 (21 %) (p = 0.018). The percentage of tumors achieving complete regression was higher in group 2 but this difference did not reach statistical significance. The cumulative energy used and side effects from treatment were similar between the groups.

Conclusion

Despite the limitations of the study including the small sample size and the baseline difference, the study still demonstrated a greater tumor height reduction with the use of ICGeTTT as compared to TTT in chemoreduced thick residual tumors and hence ICGeTTT may be preferred in such cases.
背景:上突热疗法(TTT)被用作小视网膜母细胞瘤的局部治疗方式,但其对较厚肿瘤的疗效有限。本研究评估了与单纯TTT相比,吲哚菁绿(ICG)增强TTT是否能改善高度为2mm的残留化疗减少视网膜母细胞瘤的肿瘤消退。方法在本随机对照试验中,采用简单随机化表将28例化疗减少肿瘤分配到TTT(1组)或ICGeTTT(2组)治疗。治疗每3-4周进行一次,直到肿瘤高度达到2mm或最多完成4次治疗。结果ICGeTTT组基线肿瘤高度较高。对基线差异的校正分析显示,与1组(21%)相比,2组(44%)的肿瘤高度降低具有统计学意义(p = 0.018)。2组肿瘤完全消退的百分比较高,但差异无统计学意义。两组之间的累积能量消耗和治疗副作用相似。结论尽管本研究存在样本量小、基线差异等局限性,但与TTT相比,在化疗减少的厚壁残余肿瘤中,ICGeTTT的肿瘤高度降低更大,因此ICGeTTT可能是这类病例的首选。
{"title":"“Indocyanine green enhanced TTT Vs TTT for treatment of thicker tumors in Retinoblastoma- a randomised control trial”","authors":"Ipsita Barman ,&nbsp;Rachna Meel ,&nbsp;Neelam Pushker ,&nbsp;Vinod Kumar ,&nbsp;Neiwete Lomi ,&nbsp;Anjolie Chhabra ,&nbsp;Mandeep S. Bajaj","doi":"10.1016/j.ajoint.2025.100213","DOIUrl":"10.1016/j.ajoint.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>Transpupillary thermotherapy (TTT) is used as a focal treatment modality for smaller retinoblastoma tumors, however its efficacy in thicker tumors is limited. This study evaluated whether indocyanine green (ICG) augmentation of TTT (ICGeTTT) improves tumor regression compared to TTT alone for residual chemoreduced retinoblastomas &gt;2 mm in height.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, simple randomisation table was used to allocate 28 chemoreduced tumors to treatment with either TTT (group 1) or ICGeTTT (group 2). Treatment was administered every 3–4 weeks until tumor height was &lt;2 mm or a maximum of four sessions were completed.</div></div><div><h3>Results</h3><div>The baseline tumor height was higher for the ICGeTTT group. Adjusted analysis for this baseline difference showed a statistically significant greater reduction in tumor height for group 2 (44 %) as compared to group 1 (21 %) (<em>p</em> = 0.018). The percentage of tumors achieving complete regression was higher in group 2 but this difference did not reach statistical significance. The cumulative energy used and side effects from treatment were similar between the groups.</div></div><div><h3>Conclusion</h3><div>Despite the limitations of the study including the small sample size and the baseline difference, the study still demonstrated a greater tumor height reduction with the use of ICGeTTT as compared to TTT in chemoreduced thick residual tumors and hence ICGeTTT may be preferred in such cases.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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AJO International
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