AJO International最新文献

Purpose

To forecast the recovery time and likelihood of return to active play for National Hockey League (NHL) players who sustained retinal tears or detachments.

Methods

This retrospective study identified players who experienced a retinal injury while on an NHL roster between January 1, 2000 and January 1, 2022. The type of injury was identified from publicly available press releases and injury reports. Return to sport was defined as the number of days between injury and participation in a subsequent NHL game.

Results

Over the 22-year study period, 95 eye injuries were reported in the NHL. Of these injuries, 16 players experienced 17 retinal injuries (18 %). Fifteen of those players were able to return to sport (94 %). Experiencing a retinal detachment was associated with more days out of play (median 151 days [interquartile range [IQR], 85 to 231.5 days]) compared with a retinal tear or similar injury (median 28 days [IQR, 13 to 31 days]; P = 0.003). Finally, an examination of the impact of a retinal injury on player performance in the season after the injury found that the average time on ice (ATOI) per game decreased for players who suffered an injury compared with a matched cohort (P = 0.010).

Conclusions

Retinal injuries often occur in high-impact sports. Our study reveals that retinal detachments resulted in longer disability compared with retinal tears or lesser injuries and were more likely to prevent a return-to-sport. This information aids ophthalmologists in counseling patients on surgical recovery timelines and the likelihood of resuming athletic activities.

Purpose

To evaluate the efficacy of common methods used in the decontamination of non-critical and semi-critical ophthalmic equipment in Ghana.

Design

This study was conducted in two phases. First, a descriptive cross-sectional study was carried out, followed by a microbiological study

Methods

Questionnaires were distributed online to eye care practitioners. The common decontamination procedures identified from the online questionnaires were used in decontaminating the surfaces of the ophthalmic instruments. Swabs were taken from the instruments both before and immediately after decontamination (within the first 30s), as well as at 10-minute intervals up to 40 minutes after decontamination. The swabs were cultured on nutrient agar for 24 hours at 37 °C, and the contamination levels were estimated.

Results

The most commonly used disinfection technique in the selected eye clinics in Ghana was the use of Methylated spirit (34 %), and the least, Iso-alcohol swabs (1 %). All the decontamination methods were efficacious in the reduction of contamination levels on the surfaces of ophthalmic instruments. Hand sanitiser, Parazone (sodium hypochlorite), Autoclave, and UV showed highly effective decontamination activity compared to Methylated spirit, Hydrogen peroxide, and Isopropyl alcohol. There was a significant reduction in contamination for each of the time points (p < 0.001), except for 40 minutes after decontamination (p = 0.063ns), when compared to the contamination level before decontamination.

Conclusion

In Ghana, commonly used decontamination methods are effective in reducing levels of contamination of ophthalmic instruments, with their recontamination rates comparable to the use of autoclaves and UV germicidal irradiation.

Surgically induced necrotizing scleritis (SINS) is a rapidly progressive scleral inflammation that occurs after various ocular surgeries and can lead to blindness if not appropriately treated. However, there have been only 10 other case reports of necrotizing scleritis after strabismus surgery. Here we present a case of bilateral necrotizing scleritis post strabismus surgery that was successfully treated with scleral gluing and high dose steroid therapy and later transitioned to long-term immunosuppression.

Purpose

To document the anatomical changes occurring at the vitreoretinal interface during early posterior vitreous detachment (PVD).

Methods

Wide-angle and pseudo-motion optical coherence tomography (OCT) were obtained on 27 normal eyes during the early stages of age-related PVD. The wide-angle examination in a static phase consisted of montaged conventional OCT images. GIF-formatted pseudo-animation was generated with OCT images acquired initially in a static eye state, followed by scans immediately after ocular excursions.

Results

Initial stages of PVD included peripheral PVD with (stage 1a) or without (stage 1b) interposed material between the posterior vitreous cortex and the retina, and perifoveal PVD expanding to the periphery (stage 2). All stage 1 PVDs presented anterior to the papillomacular vitreous liquefaction. All eyes demonstrated mobility of the vitreous gel at the anterior face of the vitreous liquefaction; however, the adherent cortical vitreous layer comprising the posterior wall of the lacuna showed no mobility. Mobility of the posterior vitreous cortex was not present in eyes with stage 1a PVD and increased with the progression of the stage of PVD (p = 3.60×10⁻⁶).

Conclusion

During nonpathological PVD, macula is protected from tractional insults conveyed by mobile vitreous due to overlying vitreous liquefaction. However, the vitreoretinal interface anterior to the lacunae experiences tractional forces until vitreoretinal separation occurs. These observations reinforce the hypothesis that vitreous liquefaction, vitreous mobility, and vitreoschisis formation contribute to PVD initiation and support that premacular lacunae protect the macula during PVD initiation and early progression.

Purpose

To report displacement of thick submacular hemorrhage with pars plana vitrectomy (PPV) and subretinal tissue plasminogen activator (tPA) in a patient with Acute Myeloblastic Leukemia (AML).

Design and Methods

Case report.

Results

A 65-year-old man with a new diagnosis of AML developed significant intraretinal hemorrhages in both eyes; subretinal and sub-inner limiting membrane (ILM) hemorrhage in the left eye. He underwent 23-gauge PPV, subretinal tPA injection, and air-fluid exchange for subretinal hemorrhage. Foveal subretinal hemorrhage and visual acuity improved after surgery, but he had late post-operative vitreous hemorrhage.

Observations

A 65-year-old man with a new diagnosis of AML developed significant intraretinal hemorrhages in both eyes; subretinal and sub-inner limiting membrane (ILM) hemorrhage in the left eye. He underwent 23-gauge PPV, subretinal tPA injection, and air-fluid exchange for subretinal hemorrhage. Foveal subretinal hemorrhage and visual acuity improved after surgery, but he had late post-operative vitreous hemorrhage.

Conclusions and Importance

This novel case report documents successful displacing subretinal hemorrhage associated with AML with PPV and subretinal tPA.

Purpose

Significant advances in artificial intelligence (AI) have led to promising applications in ophthalmology. This study highlights the involvement of clinicians in the most cited ophthalmology publications on AI in ophthalmology journals indexed by Web of Science.

Methods

Articles examining AI in ophthalmology journals were processed from Web of Science. After selecting relevant articles, we performed bibliometric analyses at the article and author levels as of March 2024. The primary outcome measure was the number of citations per article. Secondary outcomes included article measures (publication year, subspecialties, article type, databases, imaging) and author attributes (gender, academic metrics, location).

Results

The top 100 publications were cited between 58 and 734 times, with a median of 91 citations. Publication reprint addresses were mainly based in America (44) and in Europe (22). Common subspecialties were retina (60), glaucoma (44) and cornea (18). Most imaging modalities were fundus photography (47), optical coherence tomography (47) and visual fields (19). 76 studies were aimed at the development and evaluation of a diagnostic technology. Some private databases (44 %) and public databases (40 %) were specified. Among the 399 men and 163 women authors, 297 were physicians (52.9 %). Women and men had significantly different h-indexes (women: 23 [interquartile range (IQR): 13–46] vs. men: 38.5 [17–65]; P = 0.02) and number of published documents (women: 104 [32–277] vs. men: 188.5 [63.5–394]; P = 0.03).

Conclusion

The most influential articles in AI and ophthalmology by number of citations predominantly used AI for image recognition and improving diagnostic technology in retina followed by glaucoma. Physicians had a predominant role in these, highlighting the continued importance of clinician involvement in this research.

Purpose

Patient information videos are excellent for conveying information on eye health. Language barriers lead to inaccessibility for ethnic minorities. So far, overcoming language barriers have been very expensive, but in this short communications paper, we share our experiences with an inexpensive generative artificial intelligence-based translation system for videos.

Design

Explorative study.

Methods

We developed a patient information video on a very common and broadly relevant issue: how to use eye drops. The original video was made in Danish. We used HeyGen (HeyGen, Los Angeles, California, USA) to translate the video into three categories according to distance from Danish according to comparative linguistics: highly related (English and German), remotely related (French and Polish), and no recognizable relationship (Arabic and Turkish). Ophthalmologists with high proficiency in Danish and each of these languages evaluated and commented on the accuracy of the translations.

Results

All translations resulted in a recognizable clone of the original individual with synchronized lip movements and understandable language. We observed certain inaccuracies in the translation, however, these differed across languages without a specific pattern. Inconsistencies in formal/informal pronouns were observed across languages. But overall, the general information was conveyed across all languages.

Conclusion

Modern generative artificial intelligence-based translation tools can help tearing down language barriers and improve accessibility of patient information videos in ophthalmology.

Purpose

To review the existing literature regarding on the topic of sex differences in the glaucoma.

Design

Systematic review of the available data on sex and gender differences in the glaucoma population.

Methods

A PubMed search was conducted using the words “glaucoma”, “gender”, “sex”, “female”, “women”, “hormone”, “estrogen”, “menopause”, “dry eye”, “socio-economic”, and “vascular”. Inclusion criteria were papers studying female risk factors for glaucoma. A total of 42 studies met the study criteria and were included in this study. 15 studies refer to female sex, and 14 studies refer to woman gender. 13 studies do not clearly differentiate between gender and sex and include information on both female sex and woman gender. We discuss 6 main topics: the effect of female reproductive factors from reproductive age until menopause on glaucoma, the effect of pregnancy on glaucoma, the particularities of acute angle closure glaucoma in women, dry eye disease in women and its impact on glaucoma, the vascular theory behind susceptibility to glaucoma, and finally socio-economic status and gender disparity in glaucoma. When the type of glaucoma is not specified, the section included data on all the types of glaucoma.

Results

Glaucoma is more prevalent in post-menopausal women compared to pre-menopausal women, which suggests the protective effect of estrogen in women before menopause. Pregnancy can induce changes in intraocular pressure and glaucoma should be well monitored before during and after pregnancy. Special consideration should be given during pregnancy and lactation phase as many eyedrops used in glaucoma can reach the fetal circulation. Acute angle closure glaucoma is more prevalent in women due to proven differences in anterior chamber measurements in the female population. Dry eye disease is more prevalent in women and increases the sensitivity of the ocular surface to anti-glaucoma eye drops. Primary vascular dysregulation is more common in women than in men and leads to changes in vascular autoregulation that may decrease blood flow to the optic nerve, leading to glaucomatous optic neuropathy. Finally, the socioeconomic status of a country and the sex disparities within this country correlates with the burden of glaucoma.

Conclusions

Glaucoma in women has unique particularities encompassing various aspects. By deepening our understanding of these associations and the pathogenesis of glaucoma, we may potentially uncover novel preventative measures and therapeutic interventions.

Purpose

We estimated the association between corneal ulcer and two outcomes: visual impairment and vision-related quality of life. We investigated for differential effects by rural/urban location.

Design

Population-based matched prospective cohort study.

Methods

We followed 540 incident corneal ulcer cases identified in a cluster randomized trial in Nepal. Cases were pair-matched to individuals without incident corneal ulcers by age, sex and location using incidence density sampling. Clinical examinations were performed to assess outcomes in both groups after 12 months, which included visual acuity and a modified version of the Hong Kong vision-related quality of life questionnaire.

Results

392 matched pairs had complete outcome data and were included in the analyses. Median age was 42 years (interquartile range [IQR]: 28, 53) and 63.8 % were female. After controlling for education and occupation, corneal ulcer was associated with an approximately 1-line reduction in visual acuity (0.11 logMAR units, 95 % CI 0.06 to 0.15, P < 0.001), and with an increased risk of low vision/blindness (adjusted risk ratio 1.89, 95 % CI 1.44 to 2.48, P < 0.001). Corneal ulcer was associated with lower vision-related quality of life on the 20-question questionnaire (adjusted mean difference in score -1.69, 95 % CI -2.78 to -0.61, P = 0.002). We were unable to demonstrate effect modification for any outcome by rural/urban status.

Conclusions

We observed worse visual acuity and lower vision-related quality of life among those with incident corneal ulcers compared to those without. The population-based design, which captured the full spectrum of disease, confirms that corneal ulcers are an important cause of vision loss in the general population of Nepal and highlights the need for effective community-based corneal ulcer prevention interventions.