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Needle goniotomy decreases early intraocular pressure spike compared with phacoemulsification alone 与单纯超声乳化术相比，针式开孔术可降低早期眼压骤升：经济有效的方法

AJO International

Pub Date : 2024-03-23 DOI: 10.1016/j.ajoint.2024.100004

Eva X DeVience , Stephen J DeVience , Guadalupe Villarreal , Tracy Wright , Christopher Shen , Kenneth Olumba , Benjamin Rubin

Purpose

To evaluate the effect of needle goniotomy during phacoemulsification cataract surgery on early IOP spikes in patients with glaucoma compared with phacoemulsification alone.

Design

Retrospective case control series

Methods

Cataract surgeries with concurrent goniotomy for glaucoma (n = 46) were compared with controls (n = 115) with and without glaucoma. IOP was measured prior to surgery and monitored through six months postoperatively. Between-group differences in IOP and postoperative IOP reduction were tested with ANOVA and Welch's 2-sided t-tests. Demographic, clinical, and intraoperative variables were also analyzed for significant association with postoperative IOP using univariate analysis. The incidence of IOP spike was evaluated according to two criteria: IOP > 30 mmHg or IOP > 10 mmHg above baseline.

Results

Phaco-goniotomy significantly lowered IOP at postoperative day one and month six. Following goniotomy, IOP was reduced on average 28 % (95 % CI [21, 36]) at month six compared with baseline, a mean reduction of -6.3 mmHg (95 % CI [-8.6, -4.0]), and a significantly greater reduction than in glaucoma controls (1 %, 95 % CI [-9, 7] and -0.3 mmHg, 95 % CI [-1.7, 1.1], p < 0.05). The average month six IOP following phaco-goniotomy was 12.9 mmHg (95 % CI [11.6, 14.1]), significantly lower than for glaucoma controls (15.6 mmHg, 95 % CI [14.0, 17.3], p < 0.05). The incidence of early IOP spike was significantly higher in glaucoma controls (23.1 %) than in the phaco-goniotomy cohort (6.0 %) (OR = 4.5, p < 0.05). There were no associations between CDE, ultrasound and aspiration time, or irrigation volumes on postoperative IOP. We showed that preoperative IOP was the only significant contributor to postoperative IOP reduction after phaco-goniotomy.

Conclusion

Incidence of early postoperative IOP elevation after phacoemulsification alone was 4.5 times higher than after phaco-goniotomy. Needle goniotomy may be a consideration for IOP lowering in glaucomatous eyes having cataract surgery.

目的评估在白内障超声乳化手术中进行针眼切开术与单纯超声乳化手术相比，对青光眼患者早期眼压峰值的影响。方法将同时进行青光眼针眼切开术的白内障手术（n = 46）与患有和未患有青光眼的对照组（n = 115）进行比较。手术前测量眼压，术后监测六个月。用方差分析和韦尔奇双侧 t 检验法检验了组间眼压和术后眼压降低的差异。此外，还采用单变量分析法对人口统计学、临床和术中变量与术后眼压的显著相关性进行了分析。眼压飙升的发生率根据两个标准进行评估：结果咽喉部开孔术显著降低了术后第 1 天和第 6 个月的眼压。眼球切开术后，与基线相比，第六个月的眼压平均降低了 28% (95 % CI [21, 36])，平均降低了 -6.3 mmHg (95 % CI [-8.6, -4.0])，与青光眼对照组相比，降低幅度明显更大（1%, 95 % CI [-9, 7] 和 -0.3 mmHg, 95 % CI [-1.7, 1.1], p <0.05）。咽喉部开孔术后第六个月的平均眼压为 12.9 mmHg (95 % CI [11.6, 14.1])，明显低于青光眼对照组（15.6 mmHg, 95 % CI [14.0, 17.3], p <0.05）。青光眼对照组早期眼压飙升的发生率（23.1%）明显高于咽喉部开颅手术组（6.0%）（OR = 4.5，p < 0.05）。CDE、超声波和抽吸时间或冲洗量与术后眼压之间没有关联。结论单纯超声乳化术后术后早期眼压升高的发生率是超声乳化开孔术的 4.5 倍。接受白内障手术的青光眼患者在降低眼压时，可考虑采用针眼切开术。

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引用次数: 0

Assessment of intraocular pressure changes following intravitreal injections of three anti-VEGF agents 评估玻璃体内注射三种抗血管内皮生长因子药物后的眼压变化

AJO International

Pub Date : 2024-03-16 DOI: 10.1016/j.ajoint.2024.100001

Amit Hibsh , Adiel Barak , Efrat Fleissig, Michael Regenbogen, Ainat Klein

Purpose

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents has emerged as the primary treatment for prevalent retinal diseases. Despite its efficacy, IVI may induce intraocular pressure elevation due to vitreous fluid shifts. This study aims to compare the effects of three distinct anti-VEGF agents on intraocular pressure (IOP) elevation within a single clinic setting.

Design

A prospective study, conducted at a single retinal clinic in a tertiary medical center (Tel Aviv Sourasky Medical Centre, Tel-Aviv, Israel).

Methods

Patients receiving 3 different anti VEGF medications; bevacizumab, aflibercept, and ranibizumab, were examined. IOP was measured pre- and post-injection using an iCare Pro-tonometer. Demographic parameters and ocular characteristics were collected.

Results

The study included 195 patients (average age 76.13 years; 100 males, 95 females). The medications administered were aflibercept (N = 70, 35 %), bevacizumab (N = 73, 37.4 %), and ranibizumab (N = 52, 26.7 %). In patients with a normal baseline intraocular pressure, no significant variance was observed in the post-injection versus pre-injection pressure change (delta) across medications. Conversely, in patients with higher pressure (>20 mmHg), aflibercept incited a more substantial increase than bevacizumab or ranibizumab. No correlation emerged between the pressure rise and age or lens status.

Conclusions

No significant difference was found in the increase of intraocular pressure following injection among different medications in patients with low-normal intraocular pressure. However, for patients prone to higher baseline pressure, caution is recommended with aflibercept due to a more pronounced increase. Further research is essential to comprehend the factors influencing pressure increase and their associated clinical implications.

目的抗血管内皮生长因子（anti-VEGF）药物的玻璃体内注射（IVI）已成为治疗流行性视网膜疾病的主要方法。尽管疗效显著，但静脉注射可能会因玻璃体液转移而导致眼压升高。本研究旨在比较三种不同的抗血管内皮生长因子药物在单一诊所环境下对眼压（IOP）升高的影响。方法对接受贝伐单抗、阿弗利百普和雷尼单抗三种不同抗血管内皮生长因子药物治疗的患者进行检查。使用iCare Pro眼压计测量注射前后的眼压。研究包括 195 名患者（平均年龄 76.13 岁；男性 100 人，女性 95 人）。所用药物为阿弗利百普（70例，35%）、贝伐单抗（73例，37.4%）和雷尼单抗（52例，26.7%）。在基线眼压正常的患者中，不同药物注射后与注射前的眼压变化（delta）无明显差异。相反，在眼压较高（20 mmHg）的患者中，阿夫利拜因引起的眼压升高比贝伐珠单抗或雷尼珠单抗更明显。结论在低正常眼压患者中，不同药物注射后眼压的升高没有明显差异。然而，对于基线眼压较高的患者，由于阿夫利拜因的升高更为明显，建议谨慎使用。要了解影响眼压升高的因素及其相关的临床意义，必须开展进一步的研究。

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引用次数: 0

A global survey of visual symptoms in female carriers of choroideremia and X-linked retinitis pigmentosa 对脉络膜血症和 X 连锁视网膜色素变性女性携带者视觉症状的全球调查

AJO International

Pub Date : 2024-03-16 DOI: 10.1016/j.ajoint.2024.100002

Sena A Gocuk , Thomas L Edwards , Jasleen K Jolly , Lauren N Ayton

Purpose

To investigate self-reported visual impairment in a large cohort of female carriers of X-linked retinal diseases around the world, using the validated Michigan Retinal Degeneration Questionnaire (MRDQ).

Design

Cross-sectional global survey study

Methods

An online survey collecting demographic and MRDQ data was distributed to self-reported female carriers of X-linked retinal diseases, and healthy controls (females with no eye disease). Respondents indicated their visual symptoms relating to everyday activities in seven visual domains: central vision, colour vision, contrast sensitivity, scotopic function, photopic peripheral vision, mesopic peripheral vision, and photosensitivity. Mann-Whitney test was used to compared visual disability scores between female carriers and healthy controls.

Results

Two-hundred and thirty-seven female carriers of X-linked retinal diseases (74.3% choroideremia and 25.7% X-linked retinitis pigmentosa) and 100 age-matched healthy controls completed the questionnaire (median age: 51 vs. 47.5 years of age, respectively). Most female carriers resided in the USA (53.6%) and Australia (17.3%), whilst healthy controls were mostly from Australia (93%). Female carriers had significantly worse visual disability, compared to controls. Female carriers who were older than 50 years had significantly worse visual function impairment for all domains, except photosensitivity, when compared to carriers less than 50 years of age.

Conclusions

This study has shown that female carriers of choroideremia and X-linked RP report significantly worse visual symptoms, compared to healthy controls. Future studies are required to correlate MRDQ responses with clinical findings, to determine the degree of retinal changes required to impact female carriers’ quality of life.

目的通过使用经过验证的密歇根视网膜变性问卷（MRDQ），调查全球大量 X 连锁视网膜疾病女性携带者自我报告的视力损伤情况。设计横断面全球调查研究方法向自我报告的 X 连锁视网膜疾病女性携带者和健康对照组（无眼疾的女性）发放一份在线调查问卷，收集人口统计学和 MRDQ 数据。受访者从中心视力、色觉、对比敏感度、散光功能、光周边视力、中焦周边视力和光敏感度这七个视觉领域来描述与日常活动相关的视觉症状。结果237名X连锁视网膜疾病（74.3%为脉络膜血症，25.7%为X连锁色素性视网膜炎）女性携带者和100名年龄匹配的健康对照者完成了问卷调查（中位年龄分别为51岁和47.5岁）。大多数女性携带者居住在美国（53.6%）和澳大利亚（17.3%），而健康对照者大多来自澳大利亚（93%）。与对照组相比，女性携带者的视力残疾程度明显更严重。与年龄小于 50 岁的携带者相比，年龄大于 50 岁的女性携带者在除光敏感性以外的所有方面的视觉功能障碍都明显更严重。结论这项研究表明，与健康对照组相比，脉络膜血症和 X 连锁 RP 的女性携带者的视觉症状明显更严重。未来的研究需要将 MRDQ 反应与临床发现联系起来，以确定影响女性携带者生活质量所需的视网膜变化程度。

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引用次数: 0

Insights on Mesenchymal to Epithelial Transition (MET) for fibrosis reversal in ocular tissue 关于间充质向上皮细胞转化（MET）以逆转眼组织纤维化的见解

AJO International

Pub Date : 2024-03-15 DOI: 10.1016/j.ajoint.2024.100003

Sarbani Hazra

引用次数: 0

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