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Evaluating changes in pro- and anti-inflammatory mediators in keratoconus following corneal collagen cross-linking: A systematic review 评价角膜胶原交联后圆锥角膜中促炎介质和抗炎介质的变化:一项系统综述
Pub Date : 2025-10-13 DOI: 10.1016/j.ajoint.2025.100185
Ryan S. Huang , Andrew Mihalache , Marko M. Popovic , Clara C. Chan

Purpose

To investigate the changes in pro- and anti-inflammatory mediators following corneal collagen cross-linking (CXL) in patients with keratoconus (KC).

Design

Systematic review.

Methods

A comprehensive literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Library from inception to September 2024. Eligibility criteria included English studies reporting pre- and post-CXL changes in cytokine, chemokine, matrix metalloproteinase (MMP), and growth factor concentrations in adult patients with KC. The primary endpoint was the change in pro- and anti-inflammatory mediator concentrations following CXL. The secondary endpoint focused on correlations between post-CXL changes in inflammatory mediators and corneal tomography measurements. Descriptive statistics were used to report findings.

Results

Six prospective cohort studies were included, encompassing 173 eyes from 168 patients diagnosed with progressive KC. The mean age of participants was 25.3 years, and 69 % were male. Three studies reported on cytokine and chemokine levels, demonstrating a significant increase in interleukin-6 (IL-6) concentrations up to three months post-CXL, followed by a decline to levels below pre-CXL at 12 months. Additionally, MMP-9 levels and growth factors, such as nerve growth factor (NGF) and epidermal growth factor (EGF), significantly decreased 12 months post-CXL in two studies, respectively. Significant positive correlations were observed between changes in cytokine levels and tomographic parameters, including keratometry (Ks and Kf) and corneal thickness.

Conclusion

IL-6 levels may rise within the first three months post-CXL, followed by a decline to below baseline levels by 12 months. In contrast, MMP-13 concentrations may decrease within days of treatment, and MMP-9 levels may decline after one year. Similarly, both EGF and NGF may show post-CXL reductions, with NGF levels potentially reflecting underlying KC severity. Altogether, these patterns suggest an initial acute inflammatory response, followed by subsequent changes likely associated with the promotion of corneal healing. However, interpretation may be limited by the relatively small number of included studies and heterogeneity in patient severity, sample sizes, sampling methods, assays, and follow-up timepoints. Further research is required to elucidate their role in monitoring treatment response in patients with KC undergoing CXL.
目的探讨圆锥角膜(KC)患者角膜胶原交联(CXL)后促炎介质和抗炎介质的变化。DesignSystematic审查。方法采用Ovid MEDLINE、Embase、Cochrane Library等数据库进行自成立至2024年9月的综合文献检索。入选标准包括报告成年KC患者CXL前后细胞因子、趋化因子、基质金属蛋白酶(MMP)和生长因子浓度变化的英文研究,主要终点是CXL后促炎介质和抗炎介质浓度的变化。次要终点集中在cxl后炎症介质变化与角膜断层扫描测量之间的相关性。描述性统计用于报告研究结果。结果纳入6项前瞻性队列研究,包括168例进行性KC患者的173只眼睛,参与者平均年龄为25.3岁,69%为男性。三项关于细胞因子和趋化因子水平的研究表明,在cxl后3个月,白细胞介素-6 (IL-6)浓度显著增加,随后在12个月时下降到cxl前的水平以下。此外,在两项研究中,MMP-9水平和生长因子,如神经生长因子(NGF)和表皮生长因子(EGF),分别在cxl后12个月显著降低。细胞因子水平的变化与层析成像参数,包括角膜密度(Ks和Kf)和角膜厚度之间存在显著的正相关。结论il -6水平可能在cxl后的前三个月内上升,随后在12个月内下降到基线水平以下。相反,MMP-13浓度可能在治疗几天内下降,MMP-9水平可能在治疗一年后下降。同样,EGF和NGF也可能在cxl后出现减少,NGF水平可能反映潜在的KC严重程度。总之,这些模式表明最初的急性炎症反应,随后的变化可能与促进角膜愈合有关。然而,由于纳入的研究数量相对较少,以及患者严重程度、样本量、抽样方法、测定方法和随访时间点的异质性,解释可能受到限制。需要进一步的研究来阐明它们在监测接受CXL的KC患者的治疗反应中的作用。
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引用次数: 0
Retinal detachment risk in a cohort of von hippel-lindau patients at a Major U.S. tertiary care facility 美国一家主要三级医疗机构的von hippel-lindau患者队列视网膜脱离风险
Pub Date : 2025-10-12 DOI: 10.1016/j.ajoint.2025.100183
Konstantinos G. Baroutis, Gustavo Sakuno, Sandra Hoyek, Nimesh A. Patel, Joan W. Miller, Demetrios G. Vavvas

Purpose

To report the retinal findings, cumulative incidence of retinal capillary hemangioblastoma (RCH), retinal detachment (RD) outcomes, and risk factors in a large cohort of von Hippel-Lindau (VHL) patients within a major U.S. Tertiary Care Facility.

Design

A retrospective cohort study was conducted between January 2005 and August 2024.

Methods

VHL patients were identified from Mass General Brigham’s Research Patient Data Repository. Manual chart review confirmed those with ophthalmologic examinations. A nested 1:2 matched case-control study compared RD cases with controls (VHL patients with RCH but without RD). Kaplan-Meier analysis estimated cumulative RCH incidence, and conditional logistic regression identified RD risk factors. Patients without RCH were censored at the last follow-up.

Results

Among 159 VHL patients, 104 had comprehensive eye examinations with a median follow-up of 7 years [IQR, 2–11]; 95% attended at least one follow-up appointment. The incidence rate of RCH was 2.3 per 100 person-years, calculated from person-time starting at birth and ending at age of first RCH diagnosis (for cases) or last follow-up visit (for non-cases). Eighteen eyes (14 patients, 13% of the cohort; 95% CI, 8%-22%) developed RD, predominantly combined rhegmatogenous/tractional (94%), with 29% bilateral involvement. Notably, no patient without an RCH developed an RD in our cohort. A case-control study found that each additional prior focal treatment significantly lowered the risk of RD (OR = 0.15, 95% CI 0.03–0.63; p = 0.01), while the presence of renal cell carcinoma and pancreatic cysts were associated with increased risk, possibly indicating more advanced systemic disease. All RD cases exhibited proliferative vitreoretinopathy (PVR; Grade C: 89%, Grade B: 11%) at the time of diagnosis. Overall, 12 of 16 eyes (75%) achieved reattachment, 11 of which (69%) required multiple surgeries (median, 2 [IQR, 1–3]), but visual outcomes remained poor (median final logMAR BCVA, 2.3 [IQR, 0.55–2.7], counting fingers).

Conclusions

VHL patients face a high lifetime risk of RCH and associated RD. PVR frequently complicates the surgical treatment of RD and yields limited visual recovery, underscoring the need for proactive surveillance and timely therapeutic intervention. The universal presence of PVR in these RD eyes is a novel finding that warrants investigation into a possible, though currently speculative, molecular link to pVHL dysregulation.
目的报告美国一家主要三级医疗机构的von Hippel-Lindau (VHL)患者的视网膜检查结果、视网膜毛细血管母细胞瘤(RCH)的累积发病率、视网膜脱离(RD)的结局和危险因素。DesignA回顾性队列研究于2005年1月至2024年8月进行。方法从麻省总医院布里格姆研究患者数据库中识别svhl患者。手工视力表复查证实了眼科检查。一项嵌套式1:2匹配病例-对照研究将RD病例与对照组(合并RCH但无RD的VHL患者)进行了比较。Kaplan-Meier分析估计了RCH的累积发病率,条件logistic回归确定了RD的危险因素。没有RCH的患者在最后一次随访时被删除。结果159例VHL患者中,104例进行了全面眼科检查,中位随访7年[IQR, 2-11];95%的患者至少参加了一次随访预约。RCH的发病率为每100人年2.3例,从出生时开始计算,到首次诊断为RCH的年龄(病例)或最后一次随访(无病例)时结束。18只眼(14例患者,占队列的13%;95% CI, 8%-22%)发生RD,主要是源性/牵引性合并RD(94%),其中29%累及双侧。值得注意的是,在我们的队列中,没有没有RCH的患者发展为RD。一项病例对照研究发现,每增加一次局灶性治疗可显著降低RD的风险(OR = 0.15, 95% CI 0.03-0.63; p = 0.01),而肾细胞癌和胰腺囊肿的存在与RD的风险增加相关,可能表明全身性疾病更晚期。所有RD病例在诊断时均表现为增殖性玻璃体视网膜病变(PVR; C级:89%,B级:11%)。总体而言,16只眼中有12只(75%)实现了复位,其中11只(69%)需要多次手术(中位数,2 [IQR, 1-3]),但视力结果仍然很差(最终logMAR BCVA中位数,2.3 [IQR, 0.55-2.7],计算手指)。结论svhl患者面临RCH和相关RD的高终生风险,PVR经常使RD的手术治疗复杂化,视力恢复有限,强调需要积极监测和及时的治疗干预。PVR在这些RD眼睛中的普遍存在是一项新发现,值得研究pVHL失调的可能分子联系,尽管目前尚在推测中。
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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
Pub 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
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
Pub 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。
{"title":"Posterior capsule rupture as a performance indicator in resident cataract surgery: An eight-year audit","authors":"Fatma F Shakarchi ,&nbsp;Sam Karimaghaei ,&nbsp;Jamal Azhari ,&nbsp;Alex Kilgore ,&nbsp;Ahmed F Shakarchi ,&nbsp;Andrew Melson ,&nbsp;Paul H. Phillips ,&nbsp;Ahmed B. Sallam","doi":"10.1016/j.ajoint.2025.100181","DOIUrl":"10.1016/j.ajoint.2025.100181","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze intraoperative rates of posterior capsule rupture (PCR) and postoperative visual and refractive outcomes in resident-performed cataract surgeries.</div></div><div><h3>Design</h3><div>Prospective continuous audit.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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 &lt; 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267173","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
The effects of a 13-year war on the reality of ophthalmology services and education in Syria 长达13年的战争对叙利亚眼科服务和教育现状的影响
Pub Date : 2025-10-06 DOI: 10.1016/j.ajoint.2025.100180
Oase Sbei , Waleed Kojan , Ibrahim Abboud , Lana Kuziez , Asad Loya , Ahmed Amer Zanabli , Fares Alahdab , Ahmad Al-Moujahed

Purpose

To evaluate the impact of the Syrian conflict on ophthalmology services, residency training, and clinical infrastructure, and to identify areas requiring urgent reform in the post-conflict healthcare reconstruction period.

Design

A mixed-methods study combining a comprehensive scoping review with two national cross-sectional surveys of ophthalmology residents and public ophthalmology hospitals across Syria.

Methods

A scoping review of English-language ophthalmology-related literature concerning Syria (1979–2025) was conducted using five major databases and grey literature. Two structured surveys were administered: one targeting ophthalmology residents to assess training quality and educational structure, and another targeting public hospitals to evaluate equipment, service delivery, and patient volume. Descriptive statistics and thematic analysis were used to analyze survey data.

Results

The scoping review included 49 studies categorized into five themes: war-related ocular trauma, disease prevalence, refugee eye health, ophthalmology education, and public awareness. The residency survey (n = 135) revealed that 63.5 % of respondents lacked structured curricula, 67.2 % reported no surgical case tracking, and 91.9 % reported absence of formal evaluation rubrics. The facility-based survey received responses from 4 of 13 hospitals, revealing critical equipment shortages, high patient loads, and unequal access to subspecialty and surgical services. The survey revealed significant shortages of functional ophthalmic equipment, including slit lamps, fundus cameras, perimeters, OCT machines, keratometers, tonometers, and YAG lasers. Many hospitals reported outdated or non-functional devices, with essential diagnostic and surgical tools either unavailable or in critical need of repair.

Conclusion

Ophthalmology services and education in Syria have been severely affected by conflict-related damage, infrastructure collapse, and displacement. This study underscores the urgent need for national reconstruction efforts focused on standardizing residency curricula, upgrading hospital infrastructure, and ensuring equitable access to advanced ophthalmic care. International partnerships, targeted investments, and sustainable reform strategies will be critical in rebuilding Syria’s ophthalmic healthcare and education system.
目的评估叙利亚冲突对眼科服务、住院医师培训和临床基础设施的影响,并确定冲突后医疗重建时期急需改革的领域。设计一项混合方法研究,结合对叙利亚眼科住院医师和公立眼科医院的两项全国性横断面调查进行全面的范围审查。方法采用5个主要数据库和灰色文献对叙利亚1979-2025年眼科相关英文文献进行回顾性分析。进行了两项结构化调查:一项针对眼科住院医师评估培训质量和教育结构,另一项针对公立医院评估设备、服务提供和患者数量。采用描述性统计和专题分析对调查数据进行分析。结果纳入49项研究,分为5个主题:与战争有关的眼外伤、疾病流行、难民眼健康、眼科教育和公众意识。住院医师调查(n = 135)显示63.5%的受访者缺乏结构化的课程,67.2%的受访者没有手术病例跟踪,91.9%的受访者缺乏正式的评估标准。这项以设施为基础的调查收到了13家医院中4家的答复,揭示了关键设备短缺、病人负荷高、获得亚专科和外科服务的机会不平等。调查显示,功能性眼科设备严重短缺,包括裂隙灯、眼底相机、周长、OCT机器、角膜屈光度计、眼压计和YAG激光器。许多医院报告设备过时或失效,基本的诊断和手术工具要么无法获得,要么急需修复。结论叙利亚的眼科服务和教育受到冲突相关破坏、基础设施崩溃和流离失所的严重影响。这项研究强调了国家重建工作的迫切需要,重点是标准化住院医师课程,升级医院基础设施,并确保公平获得先进的眼科护理。国际伙伴关系、有针对性的投资和可持续的改革战略对于重建叙利亚的眼科医疗和教育体系至关重要。
{"title":"The effects of a 13-year war on the reality of ophthalmology services and education in Syria","authors":"Oase Sbei ,&nbsp;Waleed Kojan ,&nbsp;Ibrahim Abboud ,&nbsp;Lana Kuziez ,&nbsp;Asad Loya ,&nbsp;Ahmed Amer Zanabli ,&nbsp;Fares Alahdab ,&nbsp;Ahmad Al-Moujahed","doi":"10.1016/j.ajoint.2025.100180","DOIUrl":"10.1016/j.ajoint.2025.100180","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of the Syrian conflict on ophthalmology services, residency training, and clinical infrastructure, and to identify areas requiring urgent reform in the post-conflict healthcare reconstruction period.</div></div><div><h3>Design</h3><div>A mixed-methods study combining a comprehensive scoping review with two national cross-sectional surveys of ophthalmology residents and public ophthalmology hospitals across Syria.</div></div><div><h3>Methods</h3><div>A scoping review of English-language ophthalmology-related literature concerning Syria (1979–2025) was conducted using five major databases and grey literature. Two structured surveys were administered: one targeting ophthalmology residents to assess training quality and educational structure, and another targeting public hospitals to evaluate equipment, service delivery, and patient volume. Descriptive statistics and thematic analysis were used to analyze survey data.</div></div><div><h3>Results</h3><div>The scoping review included 49 studies categorized into five themes: war-related ocular trauma, disease prevalence, refugee eye health, ophthalmology education, and public awareness. The residency survey (<em>n</em> = 135) revealed that 63.5 % of respondents lacked structured curricula, 67.2 % reported no surgical case tracking, and 91.9 % reported absence of formal evaluation rubrics. The facility-based survey received responses from 4 of 13 hospitals, revealing critical equipment shortages, high patient loads, and unequal access to subspecialty and surgical services. The survey revealed significant shortages of functional ophthalmic equipment, including slit lamps, fundus cameras, perimeters, OCT machines, keratometers, tonometers, and YAG lasers. Many hospitals reported outdated or non-functional devices, with essential diagnostic and surgical tools either unavailable or in critical need of repair.</div></div><div><h3>Conclusion</h3><div>Ophthalmology services and education in Syria have been severely affected by conflict-related damage, infrastructure collapse, and displacement. This study underscores the urgent need for national reconstruction efforts focused on standardizing residency curricula, upgrading hospital infrastructure, and ensuring equitable access to advanced ophthalmic care. International partnerships, targeted investments, and sustainable reform strategies will be critical in rebuilding Syria’s ophthalmic healthcare and education system.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320530","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
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
Pub 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 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
Propensity score analysis of treat-and-extend therapy with aflibercept versus faricimab in age-related macular degeneration 阿非利西普与法利西单抗治疗与延长治疗在老年性黄斑变性中的倾向性评分分析
Pub Date : 2025-09-29 DOI: 10.1016/j.ajoint.2025.100178
Akira Obana, Ryo Asaoka, Kaori Ishii, Risa Nakazawa, Kei Asaoka, Norikazu Matsumura, Yuko Gohto

Purpose

This study compared the 15-month outcomes of treat-and-extend (TAE) therapy with aflibercept (Af) and faricimab (Fa) in comparable cases selected by propensity score matching (PSM).

Design

Retrospective observational study.

Methods

Forty-seven eyes in the Af and Fa groups were matched for age, sex, baseline best-corrected visual acuity (BCVA), central macular thickness (CMT), age-related macular degeneration subtype, intraretinal fluid, and subretinal hyperreflective material. The TAE regimen consisted of three monthly injections, followed by monthly interval adjustments up to a maximum of four months. Changes in BCVA and CMT were assessed after 15 months.

Results

At 15 months, dry macula was achieved in 35 eyes (74.5 %) in the AF group and 37 eyes (78.7 %) in the Fa group. Both groups revealed significant improvements in the BCVA and CMT with no intergroup differences. The mean number of injections was identical (6.4 ± 0.7). No serious systemic adverse events occurred after 303 injections in either group. One Fa-treated eye developed a large subretinal hemorrhage that required displacement surgery, and no other serious ocular complications were noted.

Conclusions

PSM analysis demonstrated that Fa-based TAE was as effective as Af-based TAE in real-world practice, providing a foundation for evaluating long-term outcomes.
目的:本研究比较了通过倾向评分匹配(PSM)选择的比较病例中,阿非利西ept (Af)和faricimab (Fa)的治疗延长(TAE)治疗15个月的结果。设计回顾性观察性研究。方法对Af组和Fa组的47只眼进行年龄、性别、基线最佳矫正视力(BCVA)、黄斑中央厚度(CMT)、年龄相关性黄斑变性亚型、视网膜内液和视网膜下高反射物质的匹配。TAE方案包括每月注射3次,随后每月间隔调整,最长可达4个月。15个月后评估BCVA和CMT的变化。结果15个月时AF组35眼(74.5%)、Fa组37眼(78.7%)出现干性黄斑。两组BCVA和CMT均有显著改善,组间无差异。平均注射次数相同(6.4±0.7)次。两组注射303次后均未发生严重的全身不良事件。一只接受fa治疗的眼睛出现了大量的视网膜下出血,需要进行置换手术,没有发现其他严重的眼部并发症。结论spsm分析表明,fa - TAE与af - TAE在实际应用中同样有效,为评估长期疗效提供了基础。
{"title":"Propensity score analysis of treat-and-extend therapy with aflibercept versus faricimab in age-related macular degeneration","authors":"Akira Obana,&nbsp;Ryo Asaoka,&nbsp;Kaori Ishii,&nbsp;Risa Nakazawa,&nbsp;Kei Asaoka,&nbsp;Norikazu Matsumura,&nbsp;Yuko Gohto","doi":"10.1016/j.ajoint.2025.100178","DOIUrl":"10.1016/j.ajoint.2025.100178","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared the 15-month outcomes of treat-and-extend (TAE) therapy with aflibercept (Af) and faricimab (Fa) in comparable cases selected by propensity score matching (PSM).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Methods</h3><div>Forty-seven eyes in the Af and Fa groups were matched for age, sex, baseline best-corrected visual acuity (BCVA), central macular thickness (CMT), age-related macular degeneration subtype, intraretinal fluid, and subretinal hyperreflective material. The TAE regimen consisted of three monthly injections, followed by monthly interval adjustments up to a maximum of four months. Changes in BCVA and CMT were assessed after 15 months.</div></div><div><h3>Results</h3><div>At 15 months, dry macula was achieved in 35 eyes (74.5 %) in the AF group and 37 eyes (78.7 %) in the Fa group. Both groups revealed significant improvements in the BCVA and CMT with no intergroup differences. The mean number of injections was identical (6.4 ± 0.7). No serious systemic adverse events occurred after 303 injections in either group. One Fa-treated eye developed a large subretinal hemorrhage that required displacement surgery, and no other serious ocular complications were noted.</div></div><div><h3>Conclusions</h3><div>PSM analysis demonstrated that Fa-based TAE was as effective as Af-based TAE in real-world practice, providing a foundation for evaluating long-term outcomes.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267172","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
Association between screen time and guardian-reported vision difficulty in children and adolescents: A population-based analysis 儿童和青少年的屏幕时间与监护人报告的视力困难之间的关系:一项基于人群的分析
Pub Date : 2025-09-27 DOI: 10.1016/j.ajoint.2025.100177
Andrew Mihalache , Panthea Rahmdel , Ryan S. Huang , Marko M. Popovic , Behnam Rahmdel , Stacey Chong , Crystal S.Y. Cheung , Rajeev H. Muni

Purpose

To investigate associations between screen time and guardian-reported vision difficulties among paediatric populations in the United States.

Design

Retrospective, population-based, cross-sectional study.

Methods

Using data from the 2020 and 2022 National Health Interview Survey, this study included participants aged 2-17 years with complete guardian-reported data pertaining to vision status and screen time usage. We performed logistic regressions to explore associations between screen time and vision difficulties, reporting odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 5,112 participants (mean age: 10.1 ± 4.7 years) were included in 2020, and 6,473 participants (mean age: 9.9 ± 4.7 years) were included in 2022. In our univariable analysis, children who had a screen time of >2 hours/day had a higher odds of guardian-reported vision difficulty in 2020 (OR=1.53, 95%CI=[1.08, 2.16], p=0.017) and in 2022 (OR=1.38, 95%CI=[1.02, 1.86], p=0.038). These findings were consistent in a subgroup of female children (p=0.002 in 2020 and p=0.014 in 2022). Our multivariable analysis of 2020 data found that the odds of guardian-reported vision difficulty among children with a screen time of >2 hours/day was significantly higher in females (OR=1.73, 95%CI=[1.02, 2.93], p=0.040) and children residing in the Midwest (OR=2.41, 95%CI=[1.11, 5.20], p=0.026). No findings were significant in our adjusted analysis of 2022 data.

Conclusion

Screen time was associated with guardian-reported vision difficulties in paediatric populations in the United States in our univariable analysis. However, this association was not consistently observed in adjusted models of 2020 data, and no associations remained significant in the multivariable analysis of 2022 data. Public health initiatives aimed at promoting healthy screen time habits and regular eye care among vulnerable groups of children and adolescents are encouraged.
目的调查美国儿童人群中屏幕时间与监护人报告的视力困难之间的关系。设计:回顾性、基于人群的横断面研究。方法使用2020年和2022年全国健康访谈调查的数据,本研究纳入了2-17岁的参与者,他们的视力状况和屏幕使用时间的完整数据由监护人报告。我们进行了逻辑回归来探索屏幕时间和视力困难之间的关系,报告了优势比(ORs)和95%置信区间(ci)。结果2020年共纳入受试者5112人,平均年龄10.1±4.7岁;2022年共纳入受试者6473人,平均年龄9.9±4.7岁。在我们的单变量分析中,每天屏幕时间为2小时的儿童在2020年(OR=1.53, 95%CI=[1.08, 2.16], p=0.017)和2022年(OR=1.38, 95%CI=[1.02, 1.86], p=0.038)的监护人报告视力困难的几率更高。这些发现在女性儿童亚组中是一致的(2020年p=0.002, 2022年p=0.014)。我们对2020年数据的多变量分析发现,每天屏幕时间为2小时的儿童中,女性儿童(OR=1.73, 95%CI=[1.02, 2.93], p=0.040)和中西部儿童(OR=2.41, 95%CI=[1.11, 5.20], p=0.026)的监护人报告视力困难的几率明显更高。在我们对2022年数据的调整分析中,没有发现有意义的结果。结论:在我们的单变量分析中,屏幕时间与美国儿童人群中监护人报告的视力困难有关。然而,在2020年数据的调整模型中并没有一致地观察到这种关联,在2022年数据的多变量分析中也没有显著的关联。鼓励在弱势儿童和青少年群体中提倡健康的屏幕使用习惯和定期眼部护理的公共卫生倡议。
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引用次数: 0
Non-linear association between serum lipid levels and diabetic retinopathy in a nationally representative Korean population 在具有全国代表性的韩国人群中,血脂水平与糖尿病视网膜病变之间的非线性关联
Pub Date : 2025-09-26 DOI: 10.1016/j.ajoint.2025.100176
Seowoong Jun , Joon Yul Choi , Tae Keun Yoo

Purpose

To investigate the associations between serum lipid levels and diabetic retinopathy (DR) in Korean adults with diabetes.

Design

Cross-sectional analysis of a nationally representative survey.

Methods

We analyzed 1,378 adults with diabetes from the Korea National Health and Nutrition Examination Survey (2008–2011). DR was ascertained from fundus photographs and medical history. Lipids (total cholesterol, HDL, LDL, triglycerides, non-HDL) were modeled by quintiles and with restricted cubic splines. Multivariable logistic regression adjusted for age, sex, systolic blood pressure, hemoglobin A1c, and statin use. Sensitivity analyses used multiple imputation.

Results

DR was present in 301/1,378 participants (21.8%). Adjusted models showed no linear trends for cholesterol measures. In quintile analyses, total cholesterol exhibited higher odds of DR at both extremes versus the middle quintile (Q3): Q1 OR 1.63 (95% CI, 1.04–2.57); Q4 OR 1.64 (1.06–2.57); Q5 OR 1.59 (1.03–2.49); P for U-shape = 0.008 (Q2 OR 1.42 [0.90–2.23]). LDL and non-HDL also demonstrated U-shaped patterns (P for U-shape = 0.029 and 0.038). Spline models supported U-shaped association for total cholesterol (P = 0.031), LDL (P = 0.039), and non-HDL (P = 0.014). No consistent nonlinear associations were observed for HDL or triglycerides. Multiple-imputation results were concordant, reinforcing the U-shape for total cholesterol.

Conclusions

Total cholesterol, LDL, and non-HDL showed U-shaped nonlinear associations with DR, indicating elevated risk at both low and high concentrations. Maintaining lipids within an intermediate range may support retinal vascular health and refine metabolic risk stratification in diabetes.
目的探讨韩国成人糖尿病患者血脂水平与糖尿病视网膜病变(DR)的关系。设计一项全国代表性调查的横断面分析。方法对韩国国家健康与营养调查(2008-2011)中1378名成人糖尿病患者进行分析。DR是根据眼底照片和病史确定的。脂质(总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯、非高密度脂蛋白)用五分位数和受限三次样条建模。多变量logistic回归校正了年龄、性别、收缩压、糖化血红蛋白和他汀类药物的使用。敏感性分析采用多重输入。结果1378例患者中有301例出现dr(21.8%)。调整后的模型显示胆固醇测量没有线性趋势。在五分位数分析中,与中间五分位数(Q3)相比,总胆固醇在两个极端表现出更高的DR几率:Q1 OR 1.63 (95% CI, 1.04-2.57);Q4或1.64 (1.06-2.57);Q5或1.59 (1.03-2.49);u型P = 0.008 (Q2 OR 1.42[0.90-2.23])。低密度脂蛋白和非高密度脂蛋白也呈u形分布(u形P = 0.029和0.038)。样条模型支持总胆固醇(P = 0.031)、低密度脂蛋白(P = 0.039)和非高密度脂蛋白(P = 0.014)的u形关联。HDL和甘油三酯之间没有一致的非线性关联。多次代入结果一致,强化了总胆固醇的u形。结论总胆固醇、低密度脂蛋白和非高密度脂蛋白与DR呈u型非线性相关,表明低浓度和高浓度均会增加DR的风险。将血脂维持在中间范围内可能有助于视网膜血管健康并改善糖尿病代谢风险分层。
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引用次数: 0
Comments on “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”
Pub Date : 2025-09-25 DOI: 10.1016/j.ajoint.2025.100175
Vikrant Abbot , Arvind Kumar , Pradnya Phalak , Hariharan Srinivasan
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引用次数: 0
期刊
AJO International
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