European Journal of Ophthalmology最新文献

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.

BackgroundEvidence for Descemet's membrane endothelial keratoplasty (DMEK) in patients under 30 years old remains limited, although understanding outcomes in this demographic is important given the requirement for decades of graft function and concerns about long-term DMEK survival.MethodsWe conducted a retrospective case series at Moorfields Eye Hospital of consecutive patients under 30 years undergoing DMEK between 2015 and 2022. Primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included change in central corneal thickness (CCT), graft failure rates, and post-operative complications.Results18 eyes of 17 patients underwent DMEK surgery (mean age 22.7 ± 5.1) over a mean follow-up of 1072.1 ± 869.8 days. Mean BCVA improvement was 0.36 logMAR from pre-operative to final follow-up (p > 0.05), though significant improvements occurred at 1-month and 12-month intervals (p < 0.001 and p < 0.01, respectively). CCT improved significantly from baseline by 111.3 μm (95% CI, 64.3-158.2 μm, p < 0.0001). At final follow-up, 22.2% of eyes achieved BCVA ≤ 0.3 logMAR (n = 4). No patient achieved BCVA ≤ 0.1 logMAR. Rebubbling was performed 9 times (50%) in 8 eyes and was similar between both SF6 and air (p > 0.05). Post-operative complications occurred in 11.1% (n = 2) with no rejection episodes, although secondary graft failure occurred in 22.2% (n = 4), all within 12 months.ConclusionsDMEK effectively improves visual and anatomical outcomes in patients under 30, though with higher complication rates than older populations. The complex pathology and longer follow-up requirements in this demographic necessitate careful patient selection and realistic expectations. Larger prospective studies are needed to establish definitive guidelines for this population.

BackgroundThis study aimed to evaluate dynamic thiol/disulfide homeostasis in the tear fluid of patients with type 2 diabetes and to investigate its relationship with the presence of diabetic retinopathy (DR), considering it as a potential biomarker of oxidative stress.MethodsA total of 96 individuals were included in the study. Participants were divided into three groups: 32 patients with diabetic retinopathy (Group 1, DR (+)), 31 patients with diabetes but without retinopathy (Group 2, DR (-)), and 33 healthy volunteers (Group 3). All participants underwent a comprehensive ophthalmological examination, including best-corrected visual acuity, slit-lamp biomicroscopy, and fundus evaluation. Tear samples were collected using Schirmer strips and stored in phosphate-buffered Eppendorf tubes at -80 °C until analysis. Total thiol, native thiol, and disulfide levels were analyzed using a spectrophotometric method. Patients with a history of intraocular surgery, trauma, glaucoma, or systemic diseases other than diabetes were excluded.ResultsThere were statistically significant differences between the groups in terms of total thiol, disulfide, disulfide/total thiol, and disulfide/native thiol ratios (p < 0.001). Total thiol levels were significantly lower, while disulfide levels and ratios were significantly higher in the DR (+) group. No significant difference was found in native thiol levels (p = 0.194). HbA1c and fasting blood glucose levels were significantly higher in the DR (+) group compared to the other groups (p < 0.001). Central macular thickness was also significantly greater in the DR (+) group (p < 0.001). Correlation analysis revealed a positive and significant relationship between HbA1c and fasting blood glucose (r = 0.551; p < 0.01), whereas no significant correlation was found between central macular thickness and glycemic parameters.ConclusionThe increased disulfide levels and disulfide ratios in the tear fluid of patients with diabetic retinopathy suggest a shift in thiol/disulfide homeostasis toward oxidative stress. These tear-based biomarkers may serve as valuable tools for the early diagnosis and monitoring of diabetic retinopathy.

IntroductionEven with recent improvements, the optimal timing of orbital implant placement after evisceration surgery - particularly in infected cases - remains unclear. This study aimed to compare the long-term outcomes of primary silicone orbital implants after evisceration for infectious and non-infectious causes, focusing mainly on implant-related complications such as exposure or extrusion.MethodsA total of 32 eyes that underwent evisceration were analyzed. Patients were divided into two groups: infectious causes (Group A, n = 10) and non-infectious causes (Group B, n = 22). Postoperative follow-up duration, implant size, histopathological results, and complications - including implant exposure or extrusion - were evaluated.ResultsDemographic characteristics were similar between the groups. The mean follow-up duration was 34.0 ± 17.7 months in group A and 28.18 ± 18.1 months in group B (p = 0.403). The mean implant size was 17.8 ± 2.6 mm in group A and 18.3 ± 1.8 mm in group B (p = 0.693). Mild symblepharon occurred in 2 patients (20%) in group A, while upper lid ptosis was noted in 2 patients (9%) in group B. No cases of implant exposure, extrusion, or sympathetic ophthalmia were observed in either group.ConclusionOrbital evisceration results in comparable long-term outcomes for both infectious and non-infectious indications, with no observed cases of implant exposure or extrusion. These findings support the safe use of primary silicone implants in both scenarios when appropriate surgical technique is applied and adequate postoperative follow-up is provided.

Background/AimsThe goal of glaucoma care is to preserve vision and quality of life This study aimed to develop, and rank patient-centered priorities for glaucoma care in Croatia and compare them with the perspectives of ophthalmologists.MethodsA five-phase, Delphi-based national study was conducted involving patients of the Croatian National Glaucoma Referral Center and Croatian ophthalmologists. An initial 20-item questionnaire was completed by 75 patients to identify patient priorities in glaucoma care. The most frequent responses were synthesized into a final 12 patient-centered priority statements, which patients and clinicians ranked independently. Rankings were compared overall and across prespecified patient and clinician subgroups.ResultsThe 20-item questionnaire informed a final 12-item survey completed by 130 patients and 97 ophthalmologists. Highest-ranking items across stakeholders were impaired quality of life and fear of losing sight or independence; patient associations ranked lowest. Clinicians emphasized reducing topical therapy burden and side-effects, whereas patients prioritized innovative and curative treatments (including vision restoration), faster, simpler diagnostics, and better communication with clinicians. Subgroup analyses showed stable patterns across clinician groups; among patients, later disease stage shifted focus toward disease control, longer treatment duration increased preference for innovation, and urban-rural differences were minimal.ConclusionThis study provides a ranked, stakeholder-informed set of glaucoma-care priorities for Croatia. Patient perspectives centered on preventing sight loss, preserving independence, and reducing treatment burden, while highlighting unmet needs in innovation, diagnostics, and communication. These findings complement ongoing European Glaucoma Society initiatives and may inform future Europe-wide strategies in patient-centered glaucoma care.

A 7-year-old boy, diagnosed with bilateral congenital glaucoma presented with elevated intraocular pressure (IOP). Anterior segment optical coherence tomography (AS-OCT) of the right eye revealed an artificial plane within the Haab's striae (HS), corresponding to separation of the Descemet membrane-pre-Descemet layer (DM-PDL) complex. Following medical reduction of IOP, slit-lamp examination demonstrated linear reddish discoloration within the HS, which was confirmed on AS-OCT as a hyperreflective intra-lamellar collection of blood between the posterior stroma and endothelium. The eye had not undergone any previous intraocular surgery or trauma. This observation represents a unique instance of de novo intra-lamellar hemorrhage within Haab's striae in an unoperated eye. The presumed mechanism involves reflux of blood into Schlemm's canal, with secondary ingress into the artificial plane created by partial DM-PDL separation, possibly triggered by a Valsalva maneuvre combined with low IOP. This finding underscores the potential anatomical continuity between the PDL and the trabecular meshwork, as previously demonstrated histologically. Recognition of this phenomenon is important to distinguish it from postoperative endothelial hemorrhage or corneal blood staining and to expand our understanding of corneal structural responses in congenital glaucoma. To our knowledge, this is the first reported case demonstrating intra-lamellar bleeding within a pre-existing Haab's striae, documented non-invasively using high-resolution AS-OCT.

PurposeThis study compares the anatomical and functional outcomes of two treatments for acute submacular haemorrhage (SMH): pars plana vitrectomy with subretinal recombinant tissue plasminogen activator (tPA) and gas tamponade versus intravitreal tPA and gas injection.MethodsA retrospective single-centre study was conducted of patients treated for acute SMH at Buckinghamshire Healthcare NHS Trust between January 2016 and December 2022. Patients received either intravitreal tPA and gas ± anti-VEGF (Group A) or pars plana vitrectomy with subretinal tPA and gas tamponade ± anti-VEGF (Group B). The primary outcome was anatomical success, defined as displacement of haemorrhage from the fovea. Secondary outcomes were visual acuity (VA) improvement, central foveal thickness (CFT) reduction, and complication rates.ResultsEighty eyes from 73 patients (mean age: 79.8 ± 11.5 years; 57.5% female) were analysed, with 53 eyes in Group A and 27 in Group B. Anatomical success was achieved in 71.6% of Group A and 77.8% of Group B. VA improved in 66% of Group A and 63% of Group B. CFT decreased by over 50% in both groups. No statistically significant differences were found between the two treatment groups and in anatomical or functional improvement.ConclusionIn this real-world study, both approaches effectively displaced SMH and improved vision with comparable outcomes, suggesting that treatment selection may be best determined by patient-specific and logistical factors.