European Journal of Ophthalmology最新文献

PurposeTo compare the surgical outcomes of two different surgical techniques, resection and plication both in combination with recession, in basic intermittent exotropia.MethodsIn this prospective randomized trial, a total of 90 patients with basic intermittent exotropia were followed up pre- and post-operatively for at least 1 year in two treatment groups; 44 patients in the plication-recession (PR) group, 46 patients in the resection-recession (RR) group, and surgical outcomes were evaluated.ResultsThere were no significant differences in average deviation angles between the PR and RR groups during the first postoperative week and first month. Over time, the PR group showed a more pronounced exo-drift beginning within the first month and continuing until the sixth month before stabilizing, whereas the RR group maintained significantly lower deviation angles at the 3^rd month, 6^th month and the 1-year follow-up. Consequently, the PR group experienced lower success rates at the 1st month, 6th month, and 1-year follow-ups, with final 1-year success rates of 55% for the PR group compared to 80% for the RR group. All 1-year failures in both groups resulted from under-correction.ConclusionsAlthough the plication procedure has favorable outcomes in the short-term, significant exo-drift has caused suboptimal long-term outcomes.

Background/ObjectivesPatient information can influence decision-making and engagement with healthcare. This study compares the quality of cataract surgery patient information leaflets (PILs) generated by ChatGPT (an AI model) and two reputable hospitals, assessing AI's potential in producing high-quality patient information.Subjects/Methods15 ophthalmologists and 32 patients evaluated three anonymised cataract PILs: one generated by ChatGPT, one from Mount Sinai Hospital (USA) and Manchester Royal Eye Hospital (UK). Doctors used the DISCERN tool (16 questions) for quality assessment. Patients used a shortened version (5 questions). Additional preference and readability questions were added, alongside a readability assessment. PIL ratings and differences between doctor and patient scores were compared.ResultsThe ChatGPT PIL scored lowest amongst doctors (mean 42.75 (SD 9.06)/75), followed by Manchester (47.04 (8.56)/75), with Mount Sinai's PIL highest (54.65 (7.09)/75) (p=<0.01). Patients similarly rated ChatGPT lowest (mean total score 4.50 (0.21)/5), with Manchester highest (4.84 (0.06)/5) (p = 0.04). Despite this, doctors were evenly divided on their preferred PIL, while more patients preferred ChatGPT over Mount Sinai. Mount Sinai's PIL had the highest inter-rater reliability(k = 0.38, 95% CI 0.10-0.60), and ChatGPT the lowest (k = 0.13, 95% CI 0.10-0.15). ChatGPT had the lowest Flesch Reading Ease score but doctors rated it most readable.ConclusionsThis study is the first to assess AI-generated cataract PILs using doctor and patient feedback. While ChatGPT received the lowest ratings, some favoured it, particularly for its clarity and readability. Doctors' highest-rated PIL was the patients' least favoured. This study highlights AIs potential in PIL development and the importance of doctor and patient feedback in this process.

Intraocular lens (IOL) centration is pivotal in determining the visual quality and refractive success after cataract surgery, especially with premium IOLs such as multifocal, extended depth of focus (EDOF), and toric lenses. Despite the surgical and technological advancements, achieving perfect centration of the IOL remains a challenge, influenced by anatomical variations and intraoperative variables. Different preoperative variables, such as the patient's refractive status, the technique of axis marking, calculation of IOL power, IOL material and design, and measurement of visual angles, have a significant impact on the final visual outcome. Intraoperatively, following the correct surgical principles like creating a central capsulorhexis of adequate size, maintaining the zonular integrity, in-the-bag IOL placement on its planned axis, and various techniques to maintain this centration are important determinants of final optimal visual outcomes. This review intends to describe the current techniques employed for IOL centration, common challenges, and clinical outcomes. It also highlights the recent innovations that aim to improve the IOL centration accuracy and patient satisfaction.

PurposeThis systematic review evaluates the efficacy and safety of different nasal adrenaline concentrations for bleeding control in endoscopic dacryocystorhinostomy (eDCR).MethodsFollowing PRISMA guidelines, we searched PubMed for studies reporting bleeding and cardiovascular events in adult eDCR. Outcomes were analysed using random-effects models. Statistical analyses employed random-effects models and I² statistic. The protocol was registered with the Open Science Framework (OSF) (DOI: https://doi.org/10.17605/OSF.IO/EZDWG).ResultsAmong 103 screened articles, seven studies (comprising 856 patients) were included for meta-analysis. The 1:200,000 infiltrative adrenaline had significantly higher bleeding risk (15.3%, 95% CI: 11.1-20.5%) than 1:100,000 (3.8%, 95% CI: 2.0-6.5%) and 1:80,000 (2.0%, 95% CI: 0.7-4.3%), with an absolute risk difference of +13.3% (95% CI: + 9.8-16.8%, p < 0.0001) between 1:200,000 and 1:80,000. No significant difference existed between 1:100,000 and 1:80,000 (RD=+1.8%, 95% CI: -1.2-4.7%, p = 0.23). Each 100,000-fold dilution increased absolute bleeding risk by 12.1% (p < 0.001), with a number needed to treat (NNT) of 8 favouring 1:80,000 or 1:100,000 over 1:200,000.The most common infiltrative concentrations (n = 8,648) were 1:100,000 (57%), 1:200,000 (23%), and 1:80,000 (18%). For topical applications (n = 6,343), 1:1,000 (48%) and 1:100,000 (22%) predominated. While no particular topical concentration showed superior haemostasis (p > 0.05), 30-min 1:1,000 adrenaline application reduced bleeding vs. 5-min use (p < 0.05). Rare complications included ocular and cardiovascular events.Conclusions1:100,000 or 1:80,000 infiltrative adrenaline is preferred over 1:200,000 for lower bleeding risks, while topical adrenaline benefits from prolonged 30-min application. Surgeons should remain vigilant for rare systemic complications.

PurposeTo evaluate the predictability and uniformity of femtosecond laser-assisted in situ keratomileusis flap created by 3 femtosecond lasers.Methods：In this prospective study, 196 corneal flaps were performed by LDV Z8 (66 eyes), LDV Z2 (70 eyes), VisuMax (60 eyes) laser. The expected flap thickness was 100 μm. Flap thickness was measured one week postoperatively at 28 points using RTVue Fourier-domain optical coherence tomography (OCT).The side-cut angle was measured at three peripheral positions.ResultsThe LDV Z8 had a significantly thicker mean central flap thickness (107.0 ± 5.0 μm) and mean flap thickness (110.5 ± 4.0 μm) compared to both the LDV Z2 (mean central 103.1 ± 4.2 μm (P ＜ 0.001), mean 107.5 ± 4.0 μm (P ＜ 0.001)) and the VisuMax (mean central 105.1 ± 5.4 μm (P ＜ 0.027), mean 108.3 ± 3.9 μm(P ＜ 0.002)). The mean overshoot of flap thickness between the actual and planned values was statistically significant (all groups, P < 0.001). The corneal flap thicknesses of the 0-, 45-, 90- and 135-degree meridians showed great uniformity in all groups. The center-peripheral corneal thickness difference in the LDV Z2 (6.1 ± 3.3 μm) was larger compared to the differences in the LDV Z8 (4.0 ± 3.9 μm) (P = 0.003) and the VisuMax (3.4 ± 5.1 μm) (P = 0.002). The mean side-cut angles for the VisuMax, LDV Z8, and LDV Z2 were 62.4 ± 4.5 degrees, 92.3 ± 14.4 degrees, and 147.6 ± 6.7 degrees, respectively.ConclusionThe corneal flaps generated by three femtosecond lasers exhibit good morphology. The thickness of the flaps in all groups was close to but slightly thicker than the target thickness.

IntroductionThe coexistence of heterogeneous tumors, spindle cell hemangioma (SCH) and cavernous hemangioma, is a rare clinical presentation. SCH is an uncommon vascular disease that most often presents as cutaneous or subcutaneous nodules in the distal extremities and only rarely in deep soft tissues.Case presentationA 57-year-old woman developed secondary orbital involvement with two tumors 40 years after removal of a cavernous hemangioma in the same orbit. CT and MRI images showed two tumors in the left orbit. Both were removed entirely via a transconjunctival anterior orbital approach combined with a nasal endoscopic transethmoidal approach. Pathology showed SCH and cavernous hemangioma.ConclusionCoexistence of SCH and cavernous hemangioma in the same area suggests a continuum and a shared origin. Although SCH is rare and its preoperative diagnosis is challenging, it should be included in the differential diagnosis of cavernous hemangioma.

PurposeTo explore the relationship between systemic comorbidities and presenting tumor T category in patients with uveal melanoma.MethodsSingle-center, retrospective cohort study of patients with posterior uveal melanoma initially diagnosed between January 2000 and December 2016. Univariate and multivariate ordinal logistic regression analyses were performed to identify comorbidities associated with presenting tumor T category, as classified by AJCC criteria.ResultsInitial presenting AJCC T category was T1 in 190 (43%), T2 in 130 (29%), T3 in 89 (20%), and T4 in 38 (9%). The most common comorbidities present were hypertension (250 patients, 56%), hyperlipidemia (211, 47%), obesity (137, 31%), and diabetes mellitus (87, 19%). Of these, obesity (p = 0.034), hypertension (p = 0.017), and diabetes mellitus (p < 0.001) were associated with earlier presenting T category on univariate ordinal logistic regression. After multivariate regression, only diabetes mellitus (p = 0.01) and obesity (p = 0.04) remained significantly associated with earlier T category on initial presentation.ConclusionAmong patients presenting with uveal melanoma, diabetes mellitus and obesity were associated with earlier presenting T category, which could reflect earlier detection of uveal melanoma in patients undergoing annual diabetic retinopathy screening examinations or having more frequent contact with the healthcare system. Larger studies should further explore this association and examine the utility of increased ocular screening in early detection of uveal melanoma.

Glaucoma is a leading cause of irreversible blindness worldwide. There is no current cure for glaucoma, and it is managed by lowering intraocular pressure, a major modifiable risk factor. Nutraceuticals have long been studied to protect retinal ganglion cells and the optic nerve from degeneration by targeting the metabolic and neurodegenerative aspects of glaucoma, and even contributing to pressure lowering. A range of vitamins, minerals and nutraceuticals have been and are undergoing investigation for glaucoma. Compounds such as NAD-boosting supplements, antioxidants, and combination therapies can potentially support retinal ganglion cell metabolism and reduce oxidative stress, leading to healthier neurons to preserve vision for longer. However, varying levels of evidence exist to support the use of nutraceuticals in glaucoma. Herein lies a comprehensive review on the latest research evidence for 35 different vitamins, minerals, and nutraceuticals, their proposed mechanism of action, and reported effects on retinal ganglion cell health and in people with glaucoma.

PurposeTo compare macular microvascular changes after horizontal rectus and inferior oblique (IO) muscle surgeries using swept-source optical coherence tomography angiography (OCTA) and to assess the distinct vascular effects of each surgical approach.MethodsEighty-two pediatric and adolescent patients with concomitant strabismus underwent unilateral extraocular muscle surgery. Group 1 (n = 43) received horizontal rectus muscle surgery; Group 2 (n = 39) underwent IO weakening surgery. The fellow unoperated eye served as a control. Macular microvasculature was evaluated before surgery, at 1 week, and 1 month postoperatively using a swept-source OCTA system. Vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC), as well as the foveal avascular zone area (FAZ), was quantitatively analyzed.ResultsIn the horizontal rectus group, SCP VD significantly increased in the 1st week compared to baseline (49.97% ± 2.41% vs. 51.16% ± 3.23%, p = 0.037) and returned to baseline values in the 1st month. A transient increase in CC VD was also observed at the 1st week (p = 0.006). No significant changes occurred in the DCP and FAZ. In the IO group, no significant changes were found in the SCP, DCP, or FAZ. However, a mild, transient increase in CC VD was observed at the 1st week (p = 0.001), which returned to baseline by the 1st month.ConclusionHorizontal rectus muscle surgery induces significant but transient changes in macular retinal and choroidal perfusion. In contrast, IO muscle surgery induces only localized and temporary choroidal alterations. OCTA may therefore serve as a valuable noninvasive tool for postoperative monitoring of vascular alterations in strabismus surgery.

PurposeTo compare the clinical and refractive outcomes of anterior vitrectomy (AnV) and pars plana vitrectomy (PPV) in patients undergoing modified Yamane intrascleral fixation for secondary intraocular lens (IOL) implantation.MethodsIn this retrospective, comparative study, 74 eyes of 74 patients who underwent modified Yamane intrascleral fixation between January 2021 and August 2024 were included. Patients were categorized into two groups: AnV (n = 45) for subluxated IOLs and PPV (n = 29) for nucleus drop or IOL luxation. Postoperative visual acuity (uncorrected [UDVA] and corrected distance [CDVA]), refractive stability, IOL tilt, endothelial cell count (ECC), lenticular astigmatism, and complications were assessed. IOL tilt was measured by using swept-source optical coherence tomography.ResultsPostoperative UDVA and CDVA were significantly higher in the AnV group (p < 0.001). IOL tilt was similar between groups (p = 0.591). Corneal astigmatism was lower in the AnV group (-1.00 D vs. -1.75 D, p < 0.001), while ECC was significantly better preserved compared to the PPV group (1784 ± 520 vs. 1234 ± 652 cells/mm², p < 0.001). The median tilt angle was 1.87° (range: 0.15°-10°) in the AnV group and 1.85° (range: 0.47°-8.50°) in the PPV group (p = 0.591). Postoperative lenticular astigmatism values were similar between the groups (p = 0.124). Lenticular astigmatism correlated with IOL tilt (r = 0.794, p < 0.001). Complication rates, including cystoid macular edema and epiretinal membrane formation, were similar between groups (p = 0.383, p = 0.780).ConclusionsBoth AnV and PPV yielded comparable refractive and IOL positioning outcomes in modified Yamane intrascleral fixation. However, AnV demonstrated superior endothelial preservation, lower corneal astigmatism, and better visual acuity, suggesting an advantage.