AJO International最新文献_第5页

Epidemiology, risk factors, clinical outcomes, and prognostic factors of infectious keratitis: A tertiary center experience in Qatar 传染性角膜炎的流行病学、危险因素、临床结果和预后因素：卡塔尔三级中心的经验

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-10-24 DOI: 10.1016/j.ajoint.2025.100191

M. Basil Marchi , Adeya Al Harami , Ahmed Maher , Omar Al-Qahtani , Joenie Datingaling Anilao , Javed Iqbal , Hashem Abu Serhan

Purpose

To investigate the infectious keratitis profile, causative agents, underlying risk factors, and clinical outcomes reported over 5 years in Qatar.

Design

A retrospective cohort study.

Methods

A retrospective analysis of all patients who received treatment for infectious keratitis at Hamad Medical Corporation, Qatar, between January 2019 and December 2023 was performed. Data regarding culture results, risk factors for infectious keratitis, visual acuity at the time of presentation, and the clinical course were obtained from medical records and microbiological reports.

Results

A total of 143 patients with microbial keratitis were included. The median age was 38 years (30–47.5). 93 (65 %) of patients were male. The mean follow-up duration was 18 ± 3 months. 34 (21.1 %) were culture-positive, and 107 (79.9 %) were culture-negative. Pseudomonas aeruginosa and Staphylococci spp. were the most common pathogens in culture-positive patients (N = 18, 53 %). Most patients (N = 104, 72.7 %) had at least one risk factor. Of these, 25 (17.5 %) had two risk factors, and 14 (9.8 %) had three or more. Ocular trauma was the most common risk factor (N = 45, 31.5 %), followed by contact lens use (N = 34, 23.8 %) and ocular surface disease (N = 24, 16.8 %). 133 (93 %) of patients improved with medical treatment alone, while 10 (7 %) required surgical interventions. The mean CDVA (logMAR) improved from 0.78 at presentation to 0.48 at the final follow-up (p < 0.001). Multivariable regression analysis showed that culture positivity was significantly associated with poorer corneal healing (OR 1.91; 95 % CI 1.49–2.33). While this indicates a robust association, causal inference cannot be established due to the observational study design.

Conclusions

Ocular trauma is the major risk factor for infectious keratitis in Qatar. Pseudomonas aeruginosa and Staphylococci spp. were the most common organisms isolated. Awareness campaigns about occupational hazards and ocular safety equipment could help decrease the burden of trauma-related keratitis in the country.

目的调查卡塔尔5年来报道的感染性角膜炎的概况、病原体、潜在危险因素和临床结果。设计：回顾性队列研究。方法回顾性分析2019年1月至2023年12月在卡塔尔哈马德医疗公司接受感染性角膜炎治疗的所有患者。有关培养结果、感染性角膜炎危险因素、发病时的视力和临床病程的数据来自医疗记录和微生物学报告。结果共纳入143例细菌性角膜炎患者。中位年龄为38岁（30-47.5岁）。男性93例（65%）。平均随访时间18±3个月。培养阳性34例（21.1%），培养阴性107例（79.9%）。铜绿假单胞菌和葡萄球菌是培养阳性患者中最常见的致病菌（N = 18,53 %）。大多数患者（N = 104, 72.7%）至少存在一种危险因素。其中，25人（17.5%）有两个危险因素，14人（9.8%）有三个或更多危险因素。眼外伤是最常见的危险因素（N = 45, 31.5%），其次是使用隐形眼镜（N = 34, 23.8%）和眼表疾病（N = 24, 16.8%）。133例（93%）患者仅通过药物治疗得到改善，10例（7%）患者需要手术干预。平均CDVA （logMAR）从出现时的0.78改善到最终随访时的0.48 （p < 0.001）。多变量回归分析显示，培养阳性与较差的角膜愈合显著相关（OR 1.91; 95% CI 1.49-2.33）。虽然这表明存在强大的关联，但由于观察性研究设计，无法建立因果推理。结论眼外伤是卡塔尔地区感染性角膜炎的主要危险因素。铜绿假单胞菌和葡萄球菌是最常见的分离菌。开展关于职业危害和眼部安全设备的宣传活动，有助于减轻该国创伤性角膜炎的负担。

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引用次数: 0

Inflammation and increased intraocular pressure associated with intravitreal aflibercept 8 mg: A systematic review and meta-analysis 炎症和眼压升高与玻璃体内注射阿布西普8mg相关：一项系统回顾和荟萃分析

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-10-03 DOI: 10.1016/j.ajoint.2025.100179

Nikoline Skindhøj Rebsdorf , Marie Martine Michaelsen , Natasja Kærmose Ølholm , Suffía Olsen , Celine Lee , Yousif Subhi , Marie Ørskov , Henrik Vorum , Lasse Jørgensen Cehofski

Topic

Aflibercept 8 mg was recently approved for the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). The increased intravitreal injection volume and higher drug concentration has raised concerns regarding the potential risks of adverse events. The purpose of this review was to evaluate the current evidence on intraocular inflammation (IOI) and intraocular pressure (IOP) associated with aflibercept 8 mg.

Methods

A systematic literature search was conducted in the PubMed and Embase databases on the 13th of July 2025. Four authors conducted the screening of the titles and abstracts followed by a full text review of the remaining studies for potential eligibility. For data extraction and risk of bias assessment, two independent evaluations of each study were performed.

Results

A total of 16 studies were identified, comprising 2019 eyes treated with 9481 injections of aflibercept 8 mg in total. Twenty-eight incidences of IOI were reported out of 8834 injections (0.32 %), in which the incidence rates differed between clinical trials (0.15 %) and real-world studies (0.93 %). IOP elevation was observed in 28 out of 8889 injections (0.31 %), including three events of IOP

\geq

35 mmHg pre- or post-injection. No real-world studies reported any IOP elevation. Six studies comprising of a total of 1897 injections, reported on long term pre-injection IOP and three studies with a total of 206 injections investigated short-term post-injection IOP.

Conclusion

A fairly low incidence of IOP-related adverse events was observed following administration of aflibercept 8 mg, despite the increased injection volume and higher concentration. The incidence of IOI was generally low, but a higher incidence of IOI was identified in real-world studies, highlighting the need for monitoring potential high-risk patients in daily clinical practice. Further insights related to the safety profile of aflibercept 8 mg may be gained through generation of real-world evidence and standardized reporting of adverse events.

topicafliberept 8mg最近被批准用于治疗新生血管性年龄相关性黄斑变性（nAMD）和糖尿病性黄斑水肿（DME）。玻璃体内注射量的增加和药物浓度的升高引起了人们对不良事件潜在风险的关注。本综述的目的是评估目前与阿伯西普8mg相关的眼内炎症（IOI）和眼压（IOP）的证据。方法于2025年7月13日在PubMed和Embase数据库进行系统的文献检索。四位作者对标题和摘要进行了筛选，然后对剩余研究的潜在合格性进行了全文审查。对于数据提取和偏倚风险评估，对每项研究进行两次独立评估。结果共纳入16项研究，包括2019只眼共9481次注射阿布西贝8mg。在8834次注射中报告了28例IOI发生率（0.32%），其中临床试验（0.15%）和现实研究（0.93%）的发生率不同。8889例注射中有28例（0.31%）的IOP升高，包括3例注射前或注射后IOP≥35 mmHg的事件。没有真实世界的研究报告任何IOP升高。6项研究（共1897次注射）报告了长期注射前IOP， 3项研究（共206次注射）调查了短期注射后IOP。结论阿非利西普8 mg后，尽管注射量和浓度增加，但与心肌梗死相关的不良事件发生率较低。IOI的发生率一般较低，但在现实世界的研究中发现IOI的发生率较高，这突出了在日常临床实践中监测潜在高危患者的必要性。通过生成真实世界的证据和标准化的不良事件报告，可以进一步了解afliberept 8mg的安全性。

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引用次数: 0

Comparison of ocular pathology among homeless and housed adults visiting a safety-net hospital 无家可归者和住在安全网医院的成年人眼部病理比较

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-10-11 DOI: 10.1016/j.ajoint.2025.100182

Hongan Chen , Jintong Liu , Jennifer L Patnaik , Cristos Ifantides

Purpose

People experiencing homelessness have a higher risk for chronic illness and mortality compared to the general population. Furthermore, visual impairment is an independent risk-factor for mortality. We sought to characterize the prevalence of ophthalmic conditions and visual impairment among homeless individuals.

Methods

A retrospective chart review between January 1, 2018, to February 9, 2022 conducted at Denver Health and Hospital Authority in Denver, CO, USA. Adults 18 years of age or older identified as homeless in the electronic medical record system and randomly selected controls among all eye clinic patients seen during the same period were included for analysis. Visual acuity was recorded as best-corrected or pinhole occluder visual acuity when available, or otherwise presenting visual acuity (with or without correction).

Results

A total of 718 homeless and 240 control patients were identified within the specified time frame. Compared to the housed controls, homeless patients had a higher prevalence of trauma-related injuries (25.2% versus 2.7%, p<0.001) and worse best-reported visual acuities. The most common ocular diagnoses among the homeless cohort were refractive error (43.5%), trauma-related injury (25.2%), and cataract (24.2%).

Conclusions

To our knowledge, this is the largest clinic-based retrospective cohort study of ocular pathology among individuals experiencing homelessness. Our study reinforces the importance of providing access to ophthalmic care to the homeless population while highlighting specific priorities distinct from the general patient population, namely management of higher rates of ocular trauma.

目的与一般人群相比，无家可归者患慢性病和死亡的风险更高。此外，视力障碍是死亡的独立危险因素。我们试图描述无家可归者中眼科疾病和视力损害的患病率。方法回顾性回顾2018年1月1日至2022年2月9日在美国科罗拉多州丹佛市丹佛市卫生和医院管理局进行的病历。在电子医疗记录系统中被确定为无家可归的18岁或以上的成年人，以及在同一时期看到的所有眼科诊所患者中随机选择的对照组，被纳入分析。视力记录为最佳矫正视力或针孔闭塞视力（如果有），或以其他方式呈现视力（有或没有矫正）。结果在规定时间内共发现无家可归者718人，对照组240人。与被收容的对照组相比，无家可归的患者有更高的创伤相关损伤患病率（25.2%对2.7%,p<0.001）和更差的最佳报告视力。在无家可归的人群中，最常见的眼部诊断是屈光不正（43.5%）、外伤（25.2%）和白内障（24.2%）。据我们所知，这是在无家可归者中进行的最大的以临床为基础的眼部病理回顾性队列研究。我们的研究强调了为无家可归者提供眼科护理的重要性，同时强调了与普通患者群体不同的特定优先事项，即对高眼外伤率的管理。

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引用次数: 0

Special issue on evidence-based global health in ophthalmology – AJO international 国际眼科循证全球健康特刊

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-09-04 DOI: 10.1016/j.ajoint.2025.100169

Mapa Prabhath Piyasena

引用次数: 0

Posterior capsule rupture as a performance indicator in resident cataract surgery: An eight-year audit 后囊膜破裂作为住院白内障手术的表现指标：一项8年的审计

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-10-06 DOI: 10.1016/j.ajoint.2025.100181

Fatma F Shakarchi , Sam Karimaghaei , Jamal Azhari , Alex Kilgore , Ahmed F Shakarchi , Andrew Melson , Paul H. Phillips , Ahmed B. Sallam

Purpose

To analyze intraoperative rates of posterior capsule rupture (PCR) and postoperative visual and refractive outcomes in resident-performed cataract surgeries.

Design

Prospective continuous audit.

Methods

We performed a continuous prospective audit for all residents’ cataract surgeries from July 2017 to January 2025. We grouped residents into senior trainees, in their final postgraduate year (PGY-4) of ophthalmology residency, and junior trainees, in PGY-2 and PGY-3. We used a funnel plot to visualize the variations in PCR rates across and within grades. The primary outcome measure was PCR rate, and the other outcomes were best corrected visual acuity (BCVA) and deviation from refractive target (±1.0 diopter).

Results

Our study included 3985 cataract surgeries performed by 23 residents. Senior residents (PGY-4) performed 3186 (80%) of these surgeries. Resident-performed cataract surgeries had an overall PCR rate of 3.5%, with significantly higher rates among junior compared to senior trainees (6.5% vs 2.7%; RR=0.42, P < 0.001) and greater inter-surgeon variability early in training and below the 100 surgeries mark. In multivariable analysis, senior residents remained significantly less likely to have PCR (adjusted RR = 0.38, 95% CI: 0.27–0.53), while complex cases were independently associated with a four-fold higher risk (adjusted RR = 4.15, 95% CI: 2.98–5.73). Most patients (91.7%) achieved a BCVA of 20/40 or better, and 91.4% achieved a refraction within ±1D of the refractive target.

Conclusion

Cataract surgeries performed by residents have an acceptable PCR rate and excellent BCVA and refractive outcomes. Appropriate outcome tracking is essential for resident surgical development, and a continuous audit of surgical logbooks can help bridge the gap created by unstructured reporting of surgical complications.

目的分析住院医师白内障手术中后囊膜破裂的发生率及术后视力和屈光结果。前瞻性持续审核。方法对2017年7月至2025年1月住院医师白内障手术患者进行连续前瞻性审计。我们将住院医师分为高级见习生和初级见习生，前者在他们的最后一年（PGY-4），后者在PGY-2和PGY-3。我们使用漏斗图来可视化不同年级和不同年级间PCR率的变化。主要指标为PCR率，其他指标为最佳矫正视力（BCVA）和屈光目标偏差（±1.0屈光度）。结果本研究纳入23名住院医师的3985例白内障手术。其中老年住院医师（PGY-4）完成3186例（80%）。住院医师进行的白内障手术的总体PCR率为3.5%，初级实习生的PCR率明显高于高级实习生（6.5% vs 2.7%； RR=0.42, P < 0.001），并且在培训早期和100例手术以下，外科医生之间的差异更大。在多变量分析中，老年居民仍然明显不太可能有PCR（校正RR = 0.38, 95% CI: 0.27-0.53），而复杂病例与4倍高的风险独立相关（校正RR = 4.15, 95% CI: 2.98-5.73）。大多数患者（91.7%）BCVA达到20/40或更好，91.4%患者屈光达到屈光目标±1D以内。结论住院医师白内障手术的PCR率可接受，BCVA和屈光效果良好。适当的结果跟踪对于住院医师手术的发展至关重要，对手术日志的持续审计可以帮助弥合因手术并发症的非结构化报告而产生的差距。

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引用次数: 0

Bridging the diagnostic and therapeutic gaps in retinoblastoma: A referral center’s perspective from Southeast Asia 弥合视网膜母细胞瘤的诊断和治疗差距：东南亚转诊中心的观点

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-11-04 DOI: 10.1016/j.ajoint.2025.100199

Thanaporn Kritfuangfoo , Duangnate Rojanaporn

Purpose

To highlight diagnostic and therapeutic disparities in retinoblastoma care and share our institutional approach to bridging these gaps in a resource-limited setting in Southeast Asia.

Design

Perspective and selected literature review.

Methods

A narrative overview of our referral center’s experience was combined with key findings from the literature. We describe evolving diagnostic resources, as well as treatment advancements such as intra-arterial chemotherapy (IAC) and high-dose intravitreal topotecan.

Results

Significant disparities persist between high- and low-resource settings in both diagnosis and treatment of retinoblastoma. While high-income countries have access to advanced tools such as aqueous humor analysis, molecular diagnostics, and globe-salvaging therapies, many lower-resource centers must rely primarily on clinical examination and imaging, as aqueous humor testing remains unavailable in most regions. In these settings, close clinical monitoring is essential, particularly in diagnostically uncertain cases. Treatment options are also limited, with restricted access to IAC and other advanced modalities. At our center, protocol refinements, multidisciplinary coordination, and adaptation of emerging therapies have contributed to improved outcomes. In institutions without IAC capability, high-dose intravitreal topotecan may offer a feasible alternative when used in combination with other available treatments.

Conclusion

Retinoblastoma management in resource-limited settings requires tailored approaches. Institutional adaptation of IAC protocols and incorporation of emerging therapies such as high-dose intravitreal topotecan can improve outcomes, even in advanced disease. Broader access to diagnostic tools, regional training, and inter-institutional collaboration are essential to bridge global gaps in retinoblastoma care.

目的强调在资源有限的东南亚地区，视网膜母细胞瘤护理的诊断和治疗差异，并分享我们的制度方法来弥合这些差距。设计视角和选定的文献综述。方法对我们转诊中心的经验进行叙述性概述，并结合文献中的主要发现。我们描述了不断发展的诊断资源，以及治疗进展，如动脉内化疗（IAC）和高剂量玻璃体内拓扑替康。结果高资源地区和低资源地区在视网膜母细胞瘤的诊断和治疗方面存在显著差异。虽然高收入国家可以获得房水分析、分子诊断和全球挽救疗法等先进工具，但由于房水检测在大多数地区仍然无法获得，许多资源较低的中心必须主要依靠临床检查和成像。在这些情况下，密切的临床监测至关重要，特别是在诊断不确定的病例中。治疗选择也很有限，IAC和其他先进方式的使用受到限制。在我们的中心，方案的完善，多学科的协调和适应新兴疗法有助于改善结果。在没有IAC能力的机构中，当与其他可用的治疗方法联合使用时，高剂量玻璃体内拓扑替康可能是一种可行的选择。结论在资源有限的情况下，视网膜母细胞瘤的治疗需要有针对性的方法。机构调整IAC方案和结合新疗法，如高剂量玻璃体内拓扑替康，可以改善预后，即使是晚期疾病。更广泛地获得诊断工具、区域培训和机构间合作对于弥合视网膜母细胞瘤治疗方面的全球差距至关重要。

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引用次数: 0

Retinoblastoma: Bridging the gap in diagnosis and treatment in Nigeria 视网膜母细胞瘤：弥合尼日利亚诊断和治疗方面的差距

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-11-05 DOI: 10.1016/j.ajoint.2025.100198

Dupe S. Ademola-Popoola , Ibrahim A. Yusuf

Purpose

Retinoblastoma is generally curable and the most common intraocular childhood cancer, with a 3-year survival of 95 %-99.5 % in high-income countries compared to 80 % in MICs and 57 % in LMICs. This article highlights the gap in retinoblastoma management as well as the efforts made to improve its diagnosis and treatment in Nigeria, a case study for a LMIC.

Design

Perspective article

Methods

This perspective is based on the authors clinical and programmatic experience in developing national and regional retinoblastoma services, combined with synthesis of published evidence and collaborative inputs from African and international partners involved in retinoblastoma care.

Results

Multi-level scalable strategies, including task shifting, affordable treatment innovations, legislation, telemedicine, regional and international collaborative efforts have been implemented successfully. These efforts transformed a new service into a referral center and established a network of retinoblastoma services. Human capacity was developed to enhance early detection, improve access and delivery of essential treatments, and attract resources, thereby enabling cure within a resource-limited setting.

Conclusions

Increasing national, regional and global initiatives remain crucial not only to scale up successful programs but also to urgently address the lack universal access to care, genetic testing across many African countries, and survivorship support, providing long-term care of complications, including other non-ocular cancers, which are becoming evident, thereby closing the survival gaps and offering a model for retinoblastoma care progress

视网膜母细胞瘤通常是可治愈的，也是最常见的儿童眼内癌，高收入国家的3年生存率为95% - 99.5%，而中等收入国家为80%，中低收入国家为57%。这篇文章强调了视网膜母细胞瘤管理方面的差距，以及尼日利亚为改善其诊断和治疗所做的努力，这是一个低收入和中等收入国家的案例研究。该观点基于作者在发展国家和地区视网膜母细胞瘤服务方面的临床和规划经验，并结合已发表的证据和参与视网膜母细胞瘤护理的非洲和国际合作伙伴的合作投入。结果成功实施了任务转移、平价治疗创新、立法、远程医疗、区域和国际合作等多层次可扩展策略。这些努力将一个新的服务转变为一个转诊中心，并建立了一个视网膜母细胞瘤服务网络。发展了人的能力，以加强早期发现，改善基本治疗的获取和提供，并吸引资源，从而在资源有限的情况下实现治愈。增加国家、区域和全球倡议至关重要，不仅可以扩大成功项目的规模，还可以紧急解决许多非洲国家缺乏普遍获得护理、基因检测和幸存者支持的问题，提供包括其他非眼部癌症在内的并发症的长期护理，这些问题越来越明显，从而缩小生存差距，并为视网膜母细胞瘤治疗进展提供一个模式

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引用次数: 0

Bridging gaps in ophthalmology education through large language models 通过大型语言模型弥合眼科教育的差距

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-08-23 DOI: 10.1016/j.ajoint.2025.100166

Shahrzad Gholami , Beth Wilson , Sarah Page , Daniel B. Mummert , Joseph Carr , Robert R. McNabb , Rahul Dodhia , Juan M. Lavista Ferres , William B. Weeks , Dale E. Fajardo , Karine D. Bojikian

Purpose

To assess the performance of general-domain large language models (LLMs), particularly OpenAI’s Generative Pre-trained Transformer (GPT) models, within the American Academy of Ophthalmology (AAO) Self-Assessment Program, which is based on AAO’s Basic and Clinical Science Course.

Methods

We input 3357 questions into GPT-4o, GPT-4-Turbo, o1 and o3-mini via Microsoft’s Azure OpenAI Service using zero-shot and chain-of-thought (CoT) prompting. Questions with images were analyzed using the multimodal version of GPT-4o and GPT-4.1. The performance of the LLMs was compared to 1371 unique residents who had previously participated in the program. Additionally, we compared the performance on 1399 questions, including information on 3 question types: recall, interpretation, and decision-making or clinical management. Average accuracy rates were used to evaluate performance and compare statistical significance across categories.

Results

o1 (CoT) was the most accurate model (95% confidence interval [CI]: 90.3%–92.1%) with performance ranging from 95.17% (general medicine) to 86.9% (cornea) and 91.1% accuracy on a synthesized sample test. It also outperformed residents in recall-type, interpretation-type, and decision-making or clinical management questions (95.7%, 85.3%, and 90.8%, respectively, P < 0.001). Third-year residents were more accurate than first-year or second-year residents (78.2%, 68.3%, 74.9%, respectively). On multimodal inputs, adding images improved the model’s accuracy but all models still underperformed compared to residents.

Conclusions

The accuracy of the LLMs models continues to improve, with o1 (CoT) showing the highest overall performance. Multimodal inputs can enhance model accuracy, but current models still need improvement. LLMs shows great potential in democratizing access to high-quality medical knowledge.

目的在美国眼科学会（AAO）自我评估计划中评估通用领域大型语言模型（llm）的性能，特别是OpenAI的生成预训练转换器（GPT）模型，该计划基于AAO的基础和临床科学课程。方法通过微软Azure OpenAI服务，采用零射击和思维链（CoT）提示方式，在gpt - 40、GPT-4-Turbo、o1和o3-mini中输入3357个问题。使用gpt - 40和GPT-4.1的多模态版本分析带有图像的问题。法学硕士的表现与之前参加该计划的1371名独特的居民进行了比较。此外，我们比较了1399个问题的表现，包括3个问题类型的信息：回忆、解释和决策或临床管理。平均准确率用于评估性能并比较不同类别的统计显著性。结果tso1 （CoT）是最准确的模型（95%置信区间[CI]: 90.3% ~ 92.1%），在综合样本检验中准确率为95.17%（普通医学）~ 86.9%（角膜），准确率为91.1%。它在回忆型、解释型、决策或临床管理问题上也优于住院医生（分别为95.7%、85.3%和90.8%,P < 0.001）。第三年住院医师比第一年或第二年住院医师更准确（分别为78.2%、68.3%和74.9%）。在多模式输入中，添加图像提高了模型的准确性，但与居民相比，所有模型的表现仍然较差。结论LLMs模型的准确性不断提高，其中0.1 （CoT）的综合性能最高。多模态输入可以提高模型的精度，但目前的模型仍有待改进。法学硕士在实现高质量医学知识的民主化方面显示出巨大潜力。

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引用次数: 0

Is renal function associated with glaucoma or suspected glaucomatous optic neuropathy -Findings from health screening data in Japan 肾功能是否与青光眼或疑似青光眼视神经病变有关——来自日本健康筛查数据的发现

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-10-28 DOI: 10.1016/j.ajoint.2025.100195

Risa Nakazawa , Ryo Asaoka , Shigeki Muto , Hiroshi Murata , Kazunobu Sugihara , Kaori Ishii , Akira Obana , Masaki Tanito

Purpose

This study aimed to examine the association between chronic kidney disease (CKD) and glaucoma in large-scale health checkup data in Japan.

Design

Retrospective cross-sectional study.

Methods

The dataset consisted of 23,761 eyes of 12,020 subjects in two regions in Japan (Hamamatsu City and Shimane Prefecture). Subsequently, the associations between glaucoma and CKD, CKD stage, and estimated glomerular filtration rate (eGFR) were investigated using the linear mixed model, with adjustment for age, sex, hypertension, diabetes, lipidemia, body mass index, smoking status, and intraocular pressure (IOP), using each data set. Similarly, the association between IOP and CKD, CKD stage, and eGFR was also investigated.

Results

The prevalence of glaucoma was 4.5%. The mean age of those with glaucoma or suspected glaucomatous optic neuropathy was older (58.6 years old) than those without (53.6 years old) in the datasets. In this dataset showed no significant association was found between glaucoma or suspected glaucomatous optic neuropathy and CKD, stage of kidney function, and eGFR (P > 0.05). However, a significant association was found between IOP and CKD (β = − 0.71 [95% CI: −1.30 to −0.13] mmHg, p = 0.016), and eGFR (per 10 mL/min/1.73 m²: β = 0.064 [95% CI: +0.012 to +0.12] mmHg, p = 0.016).

Conclusions

The current study with a large-scale health screening program in Japan suggested no association between CKD/renal function and glaucoma or suspected glaucomatous optic neuropathy.

目的研究日本大规模健康体检数据中慢性肾脏疾病（CKD）与青光眼的关系。设计：回顾性横断面研究。方法数据集包括日本滨松市和岛根县两个地区的12,020名受试者的23,761只眼睛。随后，使用线性混合模型研究青光眼与CKD、CKD分期和肾小球滤过率（eGFR）之间的关系，并对每个数据集进行年龄、性别、高血压、糖尿病、血脂、体重指数、吸烟状况和眼内压（IOP）进行调整。同样，IOP与CKD、CKD分期和eGFR之间的关系也被研究。结果青光眼患病率为4.5%。在数据集中，青光眼或疑似青光眼视神经病变患者的平均年龄（58.6岁）大于无青光眼患者（53.6岁）。该数据集显示，青光眼或疑似青光眼视神经病变与CKD、肾功能分期和eGFR之间无显著相关性（P > 0.05）。然而，IOP和CKD （β = - 0.71 [95% CI: - 1.30至- 0.13]mmHg, p = 0.016）和eGFR（每10 mL/min/1.73 m²：β = 0.064 [95% CI: +0.012至+0.12]mmHg, p = 0.016）之间存在显著关联。结论：目前在日本进行的一项大规模健康筛查项目的研究表明，CKD/肾功能与青光眼或疑似青光眼视神经病变之间没有关联。

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引用次数: 0

Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis 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

AJO International

Pub Date : 2025-12-11 Epub Date: 2025-09-01 DOI: 10.1016/j.ajoint.2025.100168

Hashem Abu Serhan , Hamad A. Alkorbi , Elhassan Mahmoud , Muhammad Zain Kaleem , Omar Abousaad , Mohamed Nasser Elshabrawi , Ibrahim M. Alrawi , Abdulrahman Nasir Al Khatib , Ahmed E. Habib , Ayman G. Elnahry

Purpose

Postoperative endophthalmitis is a rare but serious complication following cataract surgery, often leading to severe vision loss and increased healthcare burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of intracameral antibiotic prophylaxis in reducing the risk of postoperative endophthalmitis.

Design

A systematic review and meta-analysis.

Methods

A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EMBASE up to September 18, 2024. Studies were included if they compared intracameral antibiotic prophylaxis with no prophylaxis in patients undergoing cataract surgery. The primary outcome was the odds of developing postoperative endophthalmitis. Random-effects and quality-effects models were used for meta-analysis, with heterogeneity assessed via the I² statistic. Subgroup analyses were conducted based on antibiotic type, study design, and geographic region.

Results

A total of 25 studies involving 5665,621 participants were included. The pooled odds ratio (OR) for the risk of endophthalmitis with intracameral antibiotics was 0.31 (95 % CI: 0.15–0.61), indicating a 69 % reduction in risk compared to no prophylaxis. Subgroup analysis revealed significant differences in efficacy based on antibiotic type, with moxifloxacin (OR: 0.24, 95 % CI: 0.20–0.29) and vancomycin (OR: 0.11, 95 % CI: 0.04–0.30) showing the greatest protective effects. Sensitivity analyses confirmed the robustness of results, though publication bias was suggested by funnel and Doi plots asymmetry.

Conclusions

Intracameral antibiotic prophylaxis significantly reduces the risk of postoperative endophthalmitis following cataract surgery, with moxifloxacin and vancomycin showing the strongest protective effects. Given the variability in efficacy across antibiotic types, further randomized controlled trials are needed to optimize prophylactic strategies. These findings support broader adoption of intracameral antibiotics to enhance patient safety and reduce the global burden of post-cataract endophthalmitis.

目的术后眼内炎是白内障手术后罕见但严重的并发症，常导致严重的视力下降和增加医疗负担。本系统综述和荟萃分析旨在评估眼内抗生素预防在降低术后眼内炎风险方面的有效性。设计系统回顾和荟萃分析。方法对截至2024年9月18日的PubMed、Cochrane Library、Scopus和EMBASE进行综合文献检索。如果比较白内障手术患者的内窥镜抗生素预防和无预防，则纳入研究。主要观察指标是术后眼内炎发生的几率。meta分析采用随机效应和质量效应模型，通过I²统计量评估异质性。根据抗生素类型、研究设计和地理区域进行亚组分析。结果共纳入25项研究，涉及5665621名受试者。眼内炎的合并优势比（OR）为0.31 (95% CI: 0.15-0.61)，表明与不进行预防相比，风险降低了69%。亚组分析显示，不同抗生素类型的疗效差异显著，莫西沙星（OR: 0.24, 95% CI: 0.20-0.29）和万古霉素（OR: 0.11, 95% CI: 0.04-0.30）的保护作用最大。敏感性分析证实了结果的稳健性，尽管漏斗图和Doi图不对称表明存在发表偏倚。结论单院系抗生素预防可显著降低白内障术后眼内炎的发生风险，其中莫西沙星和万古霉素的保护作用最强。鉴于不同抗生素类型的疗效差异，需要进一步的随机对照试验来优化预防策略。这些发现支持更广泛地采用眼内抗生素，以提高患者安全并减少白内障后眼内炎的全球负担。

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引用次数: 0