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Proportion of eyes with visual-acuity improvement after vitrectomy for post-traumatic endophthalmitis: A meta-analysis 创伤后眼内炎玻璃体切除术后视力改善的眼比例:一项荟萃分析
Pub Date : 2025-09-23 DOI: 10.1016/j.ajoint.2025.100174
Muhammad Alfatih , Ananda Kukuh Adishabri , Ni Luh Putu Yunia Dewi , Alfiani Zukhruful Fitri Rifa'i , Michaela Kemuning , Dillan Cunha Amaral , Bruno Fortaleza de Aquino Ferreira , Ricardo Noguera Louzada , Ari Djatikusumo , Hashem Abu Serhan

Purpose

Post-traumatic endophthalmitis (PTE) is a leading cause of irreversible vision loss after ocular trauma; despite widespread vitrectomy, outcomes vary and predictors remain unclear. This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.

Design

A systematic review and meta-analysis.

Methods

We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.

Results

Nine studies (n = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; p < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (p = 0.027; p = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (p = 0.45). Certainty was low to very low.

Conclusion

Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.
目的创伤后眼内炎(PTE)是眼外伤后不可逆性视力丧失的主要原因;尽管玻璃体切除术广泛应用,但结果各不相同,预测因素仍不清楚。本研究旨在系统评估PTE玻璃体切除术后最佳矫正视力(BCVA)改善和最终BCVA≥20/200的眼睛比例,并利用meta回归研究结果的潜在决定因素。设计系统回顾和荟萃分析。方法按照PRISMA指南进行meta分析,并在PROSPERO注册该方案(CRD42024606195)。符合条件的研究包括≥80%因PTE接受玻璃体切除术的参与者。预先指定的主要结局是BCVA改善的比例;最后随访时的最终BCVA≥20/200作为附加结果进行评估。进行随机效应荟萃分析,并使用亚组和荟萃回归分析来探索结果修饰因子。使用GRADE评估证据的确定性。结果纳入9项研究(n = 448只眼)。BCVA改善的眼睛总比例为0.80 (95% CI 0.63-0.90; I²= 90%),成人(≥18岁;0.91)显著高于儿童/青少年(18岁;0.65;p < 0.01)。meta回归显示,较高的硅油用量和IOFB比例与BCVA改善相关(p = 0.027; p = 0.017),而角膜进入和基线视网膜脱离无关。最终BCVA≥20/200的比例为0.33 (95% CI 0.23-0.45; I²= 67.9%),无年龄差异(p = 0.45)。确定性从低到非常低。结论玻璃体切除术治疗PTE通常能改善视力,尤其是成人,而移动视力(≥20/200)较少见。考虑到单臂荟萃分析、大量异质性和低确定性评级,这些估计应谨慎解释。需要多中心随机试验来验证这些发现,并评估硅油填塞的潜在作用。
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引用次数: 0
Tele-eye care: Perspective and acceptance among patients and eye care practitioners in Benin City 远程眼保健:贝宁市患者和眼保健从业人员的观点和接受程度
Pub Date : 2025-09-20 DOI: 10.1016/j.ajoint.2025.100172
God’sglory Isoken Braimoh, Faustina Idu, Clinton Ifeanyi Okechukwu

Purpose

To assess awareness, acceptance, and perceived barriers to tele-eye care among patients and eye care practitioners in Benin City, Nigeria.

Methods

A cross-sectional survey was conducted over three months among 332 patients attending clinics and 56 licensed eye care practitioners (optometrists and ophthalmologists). A structured questionnaire, adapted from prior studies, was administered via Google Forms. Practitioners received the survey through professional WhatsApp groups, while patients completed it during clinic visits. Data were analyzed using descriptive statistics and inferential tests (chi-square, t-tests, and logistic regression) to assess associations, with significance set at p < 0.05.

Results

Awareness of tele-eye care was modest among patients (47.6 %), and prior use was low (25.3 %), yet willingness to adopt mobile-based applications was high (88.6 %). Patients’ main concerns included reduced quality of care (81.3 %), limited personal interaction (53.0 %), and privacy risks (51.5 %). Most practitioners (93 %) were familiar with telemedicine, though only 32 % reported its use in their clinics. While 84 % believed it could expand access to care, concerns included diagnostic accuracy (67.9 %), restricted service applicability (73.2 %), and insufficient practitioner training (75 %).

Conclusion

Both patients and practitioners in Benin City expressed strong interest in tele-eye care, though actual use remains limited. Adoption is constrained by service limitations, privacy concerns, and inadequate training. Targeted practitioner education, improved digital infrastructure, and clear regulatory frameworks are needed to facilitate broader integration of tele-eye care into routine practice.
目的评估尼日利亚贝宁市患者和眼科医生对远程眼保健的认识、接受程度和感知障碍。方法对就诊的332例患者和56名眼科执业医师(验光师和眼科医生)进行为期3个月的横断面调查。通过谷歌表格进行结构化问卷调查,该问卷改编自先前的研究。从业人员通过专业的WhatsApp群接受调查,而患者在诊所就诊时完成调查。数据分析采用描述性统计和推理检验(卡方检验、t检验和逻辑回归)来评估相关性,显著性设置为p <; 0.05。结果患者对远程眼保健的认知度一般(47.6%),既往使用过的比例较低(25.3%),但采用移动端应用程序的意愿较高(88.6%)。患者的主要担忧包括护理质量下降(81.3%)、人际互动有限(53.0%)和隐私风险(51.5%)。大多数从业者(93%)熟悉远程医疗,尽管只有32%的人报告在他们的诊所使用了远程医疗。虽然84%的人认为它可以扩大获得医疗服务的机会,但他们担心的问题包括诊断准确性(67.9%)、服务适用性受限(73.2%)和从业人员培训不足(75%)。结论贝宁市的患者和医生都对远程眼保健表达了浓厚的兴趣,但实际应用仍然有限。采用受到服务限制、隐私问题和培训不足的限制。需要有针对性的从业者教育、改进的数字基础设施和明确的监管框架,以促进将远程眼科护理更广泛地纳入日常实践。
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引用次数: 0
Gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. public medical schools 美国公立医学院眼科专科医生级别和薪酬的性别差异
Pub Date : 2025-09-17 DOI: 10.1016/j.ajoint.2025.100173
Emily Sun , Chen Dun , Susan K. Burden , Ambar Faridi , Laura K. Green , Andrea L. Kossler , Christina R. Prescott , Jamie B. Rosenberg , Erin M. Shriver , Grace Sun , Christina Y. Weng , Kimberly M. Winges , Maria A. Woodward , Fasika A. Woreta

Purpose

To examine gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. medical schools.

Design

Retrospective cross-sectional

Methods

Gender and academic rank for faculty where state laws mandate public salary disclosure for university employees were collected from department websites. Annual salary was collected from GovSalaries.com. Differences in rank and salary, by gender, were analyzed using Student’s t-test.

Results

Salaries were available from 28/122 departments (23 %) from 17 states (538 ophthalmologists, 41.1 % women). A smaller proportion of women were full professors compared to men (25.8 % vs. 46.7 %). A larger proportion were assistant professors (47.1 % vs. 30.1 %) or associate professors (27.1 % vs. 22.7 %). Medical retina, neuro-ophthalmology, and comprehensive ophthalmology had the largest gender disparity among full professors between men and women (15.4 % vs. 61.5 %; 31.3 % vs. 69.0 %; 5.9 % vs. 42.1 % respectively).
Women had lower salaries compared to men across all subspecialties ($281,718 vs. $364,017, p < 0.0001), including assistant professors ($229,389 vs. $265,974, p = 0.03). There were no significant differences among associate ($280,704 vs. $324,434, p = 0.15) or full professors ($378,264 vs. $447,531, p = 0.08). Among assistant professors, women had lower salaries in comprehensive ophthalmology ($224,755 vs. $441,742 p < 0.0001), cornea ($181,284 vs. $276,121, p = 0.05), and medical retina ($204,057 vs. $393,616, p = 0.03). Overall, women earned significantly less after controlling for subspecialty, VA status, rank, and region ($278,751 vs. $308,629, p = 0.015), and earned significantly less in comprehensive ophthalmology ($230,837 vs. $355,782, p = 0.038) and cornea ($289,211 vs. $360,546, p = 0.018).

Conclusions

Significant gender differences in rank and salary exist in several subspecialties. Further research is needed to identify effective strategies for these disparities.
目的探讨美国医学院眼科专科医生的级别和薪酬的性别差异。设计回顾性横断面方法从部门网站上收集州法律要求公开大学雇员工资的教员的性别和学术等级。年薪数据来自GovSalaries.com。按性别划分的级别和工资差异采用学生t检验进行分析。结果17个州122个科室中有28个科室(23%)(538名眼科医生,女性占41.1%)获得了薪酬。女教授的比例(25.8%比46.7%)比男教授少。助理教授(47.1%比30.1%)和副教授(27.1%比22.7%)的比例更大。医学视网膜、神经眼科学和综合眼科学的正教授性别差异最大(分别为15.4%对61.5%、31.3%对69.0%、5.9%对42.1%)。与男性相比,女性在所有亚专业的工资都较低(281,718美元对364,017美元,p < 0.0001),包括助理教授(229,389美元对265,974美元,p = 0.03)。副教授(280,704美元对324,434美元,p = 0.15)和正教授(378,264美元对447,531美元,p = 0.08)之间没有显著差异。在助理教授中,女性在综合眼科(224,755美元对441,742美元p <; 0.0001)、角膜(181,284美元对276,121美元,p = 0.05)和医学视网膜(204,057美元对393,616美元,p = 0.03)的薪水较低。总的来说,在控制了亚专科、退伍军人身份、级别和地区后,女性的收入明显减少(278,751美元对308,629美元,p = 0.015),在综合眼科(230,837美元对355,782美元,p = 0.038)和角膜(289,211美元对360,546美元,p = 0.018)的收入明显减少。结论多个专科在职级和薪酬方面存在显著的性别差异。需要进一步研究以确定应对这些差异的有效策略。
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引用次数: 0
Blindness and vision impairment in Querétaro, Mexico: A comparison of RAAB surveys conducted in 2015 and 2024 墨西哥querimazaro的失明和视力障碍:2015年和2024年RAAB调查的比较
Pub Date : 2025-09-10 DOI: 10.1016/j.ajoint.2025.100171
Bethania López , Ellery López-Star , Van C. Lansingh , João M Furtado

Purpose

: To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.

Design

: Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.

Methods

: A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.

Results

: Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the <20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.

Conclusions

: Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.
目的:估计墨西哥querimazaro≥50岁人群中视力障碍和失明的患病率及其原因,并评估自2015年进行的先前调查以来眼睛健康指标的进展。设计:基于人群的横断面研究,采用可避免盲症快速评估(RAAB)第7版方法。方法:采用整群抽样的方法,抽取6574人。训练有素的团队使用移动数据采集工具进行视力测试、晶状体检查和视力评估。计算有效白内障手术覆盖率(eCSC)和有效屈光不正覆盖率(eREC)。结果与2015年的RAAB研究进行了比较。结果:在符合条件的个体中,5111人(77.8% %)完成了检查。失明患病率为2.3 %(95 % CI: 1.7-3.0 %),中度至重度视力障碍患病率为11.4 %(95 % CI: 9.8-13.0 %)。白内障是致盲的主要原因(49.2% %),而屈光不正在轻度损伤中占主导地位。20/60阈值的eCSC为26.6 %(95 % CI: 20.4-32.8 %),远视力的eREC为37.6 %(95 % CI: 33.8-41.4 %)。与2015年相比,失明患病率和未满足的白内障手术需求均有所增加。障碍包括成本、恐惧和缺乏意识。结论:2015年以来,可避免盲症和视力障碍的负担有所增加。调查结果强调,需要将扩大、更高质量的白内障和屈光服务纳入公共卫生战略,以实现世卫组织2030年眼科健康目标。
{"title":"Blindness and vision impairment in Querétaro, Mexico: A comparison of RAAB surveys conducted in 2015 and 2024","authors":"Bethania López ,&nbsp;Ellery López-Star ,&nbsp;Van C. Lansingh ,&nbsp;João M Furtado","doi":"10.1016/j.ajoint.2025.100171","DOIUrl":"10.1016/j.ajoint.2025.100171","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>:</strong> To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.</div></div><div><h3>Design</h3><div><strong>:</strong> Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.</div></div><div><h3>Methods</h3><div><strong>:</strong> A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.</div></div><div><h3>Results</h3><div><strong>:</strong> Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the &lt;20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096496","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
Suprachoroidal triamcinolone in macular edema for patients with non-infectious uveitis resistant to subtenon triamcinolone 曲安奈德治疗对曲安奈德耐药的非感染性葡萄膜炎患者的黄斑水肿
Pub Date : 2025-09-10 DOI: 10.1016/j.ajoint.2025.100170
Mohammed Suhail Najm Al-Salam , Ahmed shakir Ali Al-Wassiti , Muthanna Basheer Yasir , Mohammed Tareq Mutar

Purpose

Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.

Design

Prospective Single Arm Clinical Study

Methods

The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.

Results

The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).
The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with >60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.

Conclusion

Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.
目的葡萄膜性黄斑水肿是葡萄膜炎的严重并发症,如处理不当可引起视力损害。本研究旨在评估亚tenon曲安奈德耐药患者对曲安奈德脉络膜上注射曲安奈德对葡萄膜黄斑水肿的反应。通过治疗前、治疗后1个月和3个月黄斑中心厚度(CMT)和视力(VA)的变化来测量疗效。设计前瞻性单组临床研究方法本研究纳入9例接受全身类固醇和免疫抑制治疗的非感染性葡萄膜炎患者。这些患者有葡萄膜性黄斑水肿,尽管眼内炎症得到了充分的控制,但仍持续存在,并且对后腱亚类固醇注射没有反应。这些患者可考虑使用曲安奈德脉络膜上注射;在脉络膜上腔注射4 mg。结果男性占44.4%;平均年龄为35岁。潜在病因包括Vogt-Koyanagi-Harada (VKH)综合征3例(33.3%),足底部炎4例(44.5%),Behcet病2例(22.2%)。三个月内,平均黄斑中心厚度CMT从556µm下降到270µm, LogMAR视力从0.876提高到0.470。3个月后,8例患者CMT下降40%,3例患者CMT下降60%。VA方面,6例患者获得2行,2例患者获得4行。结论脉络膜上曲安奈德能显著改善非感染性葡萄膜炎患者1个月和3个月时的视力和降低CMT。
{"title":"Suprachoroidal triamcinolone in macular edema for patients with non-infectious uveitis resistant to subtenon triamcinolone","authors":"Mohammed Suhail Najm Al-Salam ,&nbsp;Ahmed shakir Ali Al-Wassiti ,&nbsp;Muthanna Basheer Yasir ,&nbsp;Mohammed Tareq Mutar","doi":"10.1016/j.ajoint.2025.100170","DOIUrl":"10.1016/j.ajoint.2025.100170","url":null,"abstract":"<div><h3>Purpose</h3><div>Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.</div></div><div><h3>Design</h3><div>Prospective Single Arm Clinical Study</div></div><div><h3>Methods</h3><div>The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.</div></div><div><h3>Results</h3><div>The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).</div><div>The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with &gt;60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.</div></div><div><h3>Conclusion</h3><div>Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096495","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
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 : 2025-09-01 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
Development of a deep learning model to classify choroidal melanoma risk factors based on color fundus photographs 基于眼底彩色照片的脉络膜黑色素瘤危险因素分类深度学习模型的开发
Pub Date : 2025-08-31 DOI: 10.1016/j.ajoint.2025.100167
Huzaifa Suri , P. Connor Lentz , David A. Leske , Mostafa Mousavi , Haley S. D’Souza , Muhammad B. Qureshi , Raymond Iezzi , Yogatheesan Varatharajah , Lauren A. Dalvin
Choroidal melanoma is the most common malignant primary intraocular tumor and can develop either de novo or from a preexisting choroidal nevus, a benign pigmented lesion. Key risk factors for the transformation of choroidal nevus into melanoma include tumor diameter > 5 mm, tumor thickness > 2 mm, orange pigment, subretinal fluid, and low internal reflectivity on ultrasound. However, the assessment of many of these risk factors requires multimodal imaging equipment and skilled subspecialists, only available at tertiary referral centers. In this study, we developed and validated a deep learning approach to identifying these risk factors based solely on fundus images of choroidal nevi. Results indicate acceptable to excellent predictive performance for detection of all five risk factors. These findings suggest that deep learning models may be valuable tools for identifying high-risk choroidal nevi, particularly in resource-limited settings.
脉络膜黑色素瘤是最常见的恶性原发性眼内肿瘤,既可以是新生的,也可以是由原有的脉络膜痣(一种良性色素病变)发展而来。脉膜痣向黑色素瘤转变的关键危险因素包括肿瘤直径5mm、肿瘤厚度2mm、橙色色素、视网膜下积液、超声内反射率低。然而,对许多这些危险因素的评估需要多模式成像设备和熟练的专科医生,只有在三级转诊中心才有。在本研究中,我们开发并验证了一种深度学习方法,仅基于眼底脉络膜痣图像来识别这些风险因素。结果表明,对所有五种危险因素的检测可接受到优异的预测性能。这些发现表明,深度学习模型可能是识别高风险脉络膜痣的有价值的工具,特别是在资源有限的情况下。
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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
Pub 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
The value of plasma calprotectin as an inflammatory marker in giant cell arteritis 血浆钙保护蛋白作为巨细胞动脉炎炎症标志物的价值
Pub Date : 2025-08-20 DOI: 10.1016/j.ajoint.2025.100165
Michael Stormly Hansen , Lene Terslev , Uffe Møller Døhn , Viktoria Fana , Mads Radmer Jensen , Anne Katrine Wiencke , Steffen Heegaard , Oliver Niels Klefter , Yousif Subhi , Jane Maestri Brittain , Niklas Rye Jørgensen , Steffen Hamann

Purpose

Blood tests used in workup for giant cell arteritis (GCA) have shortcomings such as lack of disease specificity. We evaluated if plasma calprotectin at first clinical presentation could predict the final clinical diagnosis of GCA as evaluated at follow-up after six months.

Design

Prospective cohort study.

Methods

Blood was drawn at presentation in consecutive patients suspected of GCA. Plasma calprotectin was measured using the Gentian GCAL® Calprotectin Reagent Kit. The final diagnosis of GCA was given at six-month follow-up.

Results

Of 110 patients reviewed, 103 were eligible for data analysis, and 76 had plasma calprotectin analysis available. Of these 76, 44 (58 %) had a final diagnosis of GCA, 31 (41 %) had no GCA, and one case (1 %) was inconclusive. Plasma median calprotectin concentration was significantly higher in those with GCA than in those without (p < 0.001). Comparing the upper reference limit of the Gentian GCAL® (≥0.970 mg/L) with the final clinical diagnosis, plasma calprotectin performed with sensitivity 67 % (95 %CI: 50–81 %) and specificity 75 % (95 %CI: 55–89 %). The area under the receiver operating characteristics curve (AUC) was 0.71 (95 %CI: 0.58–0.84). Accuracy was 70 % (95 %CI 58–81 %). Using an optimal ROC cut-off limit of 0.635 mg/L, test statistics reached sensitivity 87 % (95 %CI: 73–96 %), specificity 61 % (95 %CI: 41–79 %), AUC 0.74 (95 %CI: 0.61–0.87), and accuracy 76 % (95 %CI: 64–86 %).

Conclusions

Plasma calprotectin was elevated in cases where GCA was subsequently confirmed. The value of plasma calprotectin as an inflammatory marker in cases with suspected GCA warrants further studies.
目的用于巨细胞动脉炎(GCA)检查的血液检查存在缺乏疾病特异性等缺点。我们评估了首次临床表现时的血浆钙保护蛋白是否可以预测6个月后随访评估的GCA的最终临床诊断。前瞻性队列研究。方法连续对疑似GCA患者就诊时抽血。血浆钙保护蛋白检测采用龙胆草GCAL®钙保护蛋白试剂盒。GCA的最终诊断在6个月的随访中给出。结果在110例患者中,103例符合数据分析,76例可进行血浆钙保护蛋白分析。在这76例中,44例(58%)最终诊断为GCA, 31例(41%)没有GCA, 1例(1%)不确定。GCA患者血浆钙保护蛋白中位数浓度显著高于无GCA患者(p < 0.001)。将龙胆草GCAL®的参考值上限(≥0.970 mg/L)与临床最终诊断结果进行比较,血浆钙保护蛋白的敏感性为67% (95% CI: 50 ~ 81%),特异性为75% (95% CI: 55 ~ 89%)。受试者工作特征曲线下面积(AUC)为0.71 (95% CI: 0.58 ~ 0.84)。准确率为70% (95% CI 58 - 81%)。采用最佳ROC截止限为0.635 mg/L,试验统计量达到敏感性87% (95% CI: 73 - 96%),特异性61% (95% CI: 41 - 79%), AUC 0.74 (95% CI: 0.61-0.87),准确性76% (95% CI: 64 - 86%)。结论GCA患者血浆钙保护蛋白升高。血浆钙保护蛋白在疑似GCA病例中作为炎症标志物的价值值得进一步研究。
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引用次数: 0
Three-year outcomes of a multidisciplinary ocular genetics clinic: Diagnostic yield and workflow insights from an Australian tertiary center 多学科眼遗传学诊所的三年结果:来自澳大利亚三级中心的诊断产量和工作流程见解
Pub Date : 2025-08-12 DOI: 10.1016/j.ajoint.2025.100163
Sujan A. Surendran , Sena A. Gocuk , Aamira J. Huq , Alex W. Hewitt , Thomas G. Campbell , Doron G. Hickey , Lisa Kearns , Joshua Schulz , Thomas L. Edwards , Jonathan B. Ruddle , Lauren N. Ayton

Background

Genetic diagnosis of inherited retinal diseases (IRDs) is challenging due to significant disease heterogeneity and the many potential gene loci. The Royal Victorian Eye and Ear Hospital Ocular Genetics Clinic (OGC) was established in 2018 to streamline IRD diagnosis in Victoria, Australia. This study audited the activities of the OGC during its first three years of operation, focusing on clinical and genetic diagnoses, and identifying areas for improvement in clinic workflow. The aim was to highlight how an integrated multidisciplinary care model – combining ophthalmology, clinical genetics, and genetic counselling – can address gaps in diagnostic access, care coordination and variant interpretation.

Methods

Retrospective chart review of suspected or confirmed IRD patients assessed in the OGC between December 2018 to December 2021. Genetic testing approach was determined by the OGC and tailored to each patient’s clinical presentation, in conjunction with sequencing and panel options available through funded laboratories. Demographic data, clinical information and timing between key steps within the clinical workflow were systematically recorded.

Results

Five hundred and thirty-nine patients were seen in the first three years of operation. Of the total, 249 patients (46.2 %) underwent diagnostic genetic testing, the mean age of the IRD group being 36.2 years and 51.8 % male, 219 patients (40.6 %) had an IRD phenotype. Panretinal pigmentary retinopathies were the most common phenotype (63.9 %), followed by macular retinopathies (26.9 %), stationary retinopathies (5.5 %), and hereditary vitreoretinopathies (5.5 %). Diagnostic yield of the tested cohort was 71.2 %. Comparison between 2019 and 2020-2021 revealed an overall improvement in mean time from referral to disclosure of results of 647 to 467 days (p=0.001).

Conclusion

The OGC provides patients with an accessible, holistic care model for diagnosing inherited retinal diseases. The distribution of phenotypes and diagnostic yield of genetic tests were consistent with published literature. It provides a good framework for global healthcare systems implementing an ocular genomic service, especially where subspeciality ophthalmologists and genetics services are a limited resource. Although in its early stages, there are opportunities to improve clinic workflow, and a compelling case for increased resources to support timely diagnosis, especially as emerging therapies for IRDs become available.
遗传性视网膜疾病(IRDs)的遗传诊断具有挑战性,因为疾病具有显著的异质性和许多潜在的基因位点。皇家维多利亚眼耳医院眼遗传学诊所(OGC)成立于2018年,旨在简化澳大利亚维多利亚州的IRD诊断。这项研究审查了OGC在其运作的头三年的活动,重点是临床和遗传诊断,并确定了临床工作流程中需要改进的领域。其目的是强调综合多学科护理模式——结合眼科、临床遗传学和遗传咨询——如何能够解决诊断获取、护理协调和变异解释方面的差距。方法回顾性分析2018年12月至2021年12月期间在OGC评估的疑似或确诊的IRD患者。基因检测方法由OGC确定,并根据每位患者的临床表现量身定制,同时通过资助实验室提供测序和小组选择。系统地记录了人口统计数据、临床信息和临床工作流程中关键步骤之间的时间。结果手术前3年共539例。其中,249例患者(46.2%)接受了诊断性基因检测,IRD组平均年龄为36.2岁,51.8%为男性,219例患者(40.6%)具有IRD表型。全视网膜色素性视网膜病变是最常见的表型(63.9%),其次是黄斑视网膜病变(26.9%),固定性视网膜病变(5.5%)和遗传性玻璃体视网膜病变(5.5%)。被检测队列的诊断率为71.2%。2019年与2020-2021年的比较显示,从转诊到披露结果的平均时间从647天缩短至467天(p=0.001)。结论OGC为遗传性视网膜疾病的诊断提供了一种方便、全面的护理模式。基因检测的表型分布和诊断率与已发表的文献一致。它为全球医疗保健系统实施眼科基因组服务提供了一个良好的框架,特别是在亚专科眼科医生和遗传学服务资源有限的情况下。尽管尚处于早期阶段,但仍有机会改善临床工作流程,并且有必要增加资源以支持及时诊断,特别是随着针对ird的新兴疗法的出现。
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引用次数: 0
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AJO International
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