Eye最新文献

Objectives: We aimed to investigate the distribution of small optic discs and large cup-to-disc ratio in children and to examine associations with maternal and environmental factors.

Methods: Retinal photographs were graded from over 3000 12-year-olds in the Avon Longitudinal Study of Parents and Children. Regression models examined associations between disc parameters and maternal and early-life exposures.

Results: Mean cup-to-disc area ratio (CDAR) for 3288 children was 0.21 (95%CI 0.20,0.21). Discs with CDAR > 0.3 were present in 11%. The odds of CDAR > 0.3 were increased nearly three-fold in underweight children (adjusted odds ratio (aOR) 2.9 (1.1, 7.3) p = 0.03) and 28-fold in severely premature ( < 28 weeks) children (paOR 28 95%CI 4.6,172, p < 0.001) with nearly one in four children affected. Mean cup-to-fovea/disc diameter (CF/DD) for 3327 children was 2.48 (95%CI 2.47,2.50). Small discs (CF/DD > 3) were present in 6% of which a third were bilateral. The odds of a small disc were increased in the offspring of mothers who smoked in pregnancy (aOR 1.7 (1.0,2.8) p = 0.04) and more than doubled in children born with a small head circumference (aOR 2.5 (1.4,4.5) p < 0.001).

Conclusions: Small optic discs and high cup-to-disc ratio are more frequent than usually supposed at age 12. The odds of CDAR > 0.3 are increased by severe prematurity and pathologically low child BMI. The odds of a small disc are increased by maternal smoking and small head circumference. Optimisation of risk factors in pregnancy and delivery and early childhood nutrition may play an important role in ophthalmic neurodevelopment and thus have a lifelong impact on ocular health.

Objectives: To determine the correlation of inner retinal hyper-reflective foci (HRFs) number with Flood-illumination Adaptive Optics Ophthalmoscopy (FIAOO) grading and systemic organ involvement in a cohort of patients with Fabry disease (FD).

Methods: Observational and cross-sectional study. Thirty-two eyes of 16 genetically proven FD patients (11 females) were included in the analysis. Data regarding therapeutic regimen and organ involvement (heart, kidney, and brain) of each patient were reviewed. Patients underwent full ophthalmological examination including best-corrected visual acuity, retinography, spectral domain optical coherence tomography and FIAOO imaging grading of retinal vessels. The number of inner-retinal HRFs was determined within the central 2500 μm at the foveal level in each patient and correlation with ocular imaging findings and systemic involvement parameters was assessed through Spearman correlation analysis and Generalized Linear Models (GLM) with a robust Huber White standard error estimation.

Results: Inner retinal HRFs number showed a significant association with male gender, use of enzyme replacement therapy and presence of retinal vessel tortuosity (all p < 0.001). Severity of NHYA class and presence of cornea verticillata reached a quasi-significant association (p = 0.089 and p = 0.07, respectively). Increase of FIAOO grading was associated to increased HRFs number (p < 0.001) and increase in estimated glomerular filtration rate was inversely associated with HRFs number (p = 0.04).

Conclusions: Inner retinal HRF number correlated with organ involvement and ocular imaging findings in FD patients. They may represent a biomarker of disease severity in diagnosed patients and their presence should enhance the suspect of FD in the appropriate clinical setting.

Background: To present the morphological and functional characteristics of individuals with benign yellow dot maculopathy (BYDM).

Methods: Assessments included ocular examinations, best-corrected visual acuity (BCVA) testing, optical coherence tomography (OCT), blue-light fundus autofluorescence (BAF), and near-infrared autofluorescence (NIR-AF). First degree family members were also examined whenever available.

Results: 25 individuals with BYDM (15 females, 10 males) from 19 unrelated families with a median age at first presentation of 37 years (range, 4-54 years) were included in the study. The 19 index patients were referred for assessment of early-onset drusen (n = 10), macular dystrophy (n = 6), or an unrelated ocular condition (n = 3). Clinical examination of 15 first-degree family members of 8 probands revealed vertical transmission in 6 relatives. After excluding 6 patients with other ocular pathologies, BCVA was 20/25 or better in all patients. Fundoscopically, all patients had yellow dots in the macular area, extending to the vascular arcades in 19 and beyond in 11 individuals. Hyper-autofluorescent dots on BAF topographical matched the dots seen on fundoscopy, while hypo-autofluorescent dots were noted on NIR-AF. OCT revealed no abnormalities in 14 cases, but mild ellipsoid zone irregularities were observed in 11. No morphological or functional progression was noted in 15 individuals over an average follow-up period of 3.6 years.

Conclusion: BYDM may present with a mild phenotype with yellow dots extending to the vascular arcades and beyond, suggesting it could be more common than previously reported. Recognizing this phenotype may reduce unnecessary investigations and follow-ups. Yellow dots show hypo-autofluorescence on NIR-AF and there is no morphological or functional progression.

Purpose: This study evaluated the short-term efficacy and safety of the A-stream Glaucoma Shunt (A-stream; MICROT Inc., Republic of Korea) in patients who completed 6 months of follow-up after implantation.

Methods: Medical records of 49 patients (49 eyes) who underwent A-stream implantation between October 2023 and February 2024 were retrospectively reviewed. Primary outcomes included surgical success and intraocular pressure (IOP) reduction at 6 months postoperatively. Success was defined as achieving an IOP ≤ 18 mmHg, with at least a 20% reduction from preoperative IOP, and without clinically significant hypotony (IOP < 6 mmHg persisting >1 month or with hypotony maculopathy), classified as qualified (with or without medications) or complete (without medications). Ripcord removal timing and its effect on IOP, postoperative interventions, and complications were analysed.

Results: At 6 months, the mean IOP significantly decreased from 26.9 ± 8.3 mmHg to 11.9 ± 3.5 mmHg (P < 0.01). Complete success was achieved in 77.6% and qualified success in 93.9% of the eyes. The ripcord was removed in 73.5% of eyes at an average of 1.8 ± 1.3 months postoperatively, which led to further IOP reduction of 6.8 ± 5.0 mmHg 1 month after removal. No cases of clinically significant hypotony or vision-threatening complications were observed.

Conclusions: The A-stream demonstrated excellent short-term efficacy and safety in lowering IOP with high success rates. The ripcord enabled controlled IOP adjustments postoperatively. Further studies are warranted to evaluate long-term outcomes and compare them with conventional surgeries.

Optic neuropathies are a group of disorders characterized by damage or dysfunction of the optic nerve, which transmits visual information from the retina to the brain. Common causes include glaucoma, ischemic optic neuropathy, optic neuritis, hereditary optic neuropathies and traumatic or compressive optic neuropathies. These conditions can result in vision loss, decreased visual acuity, color vision defects, and visual field abnormalities. The effective treatment strategies have been urgently addressed for long. Consequently, development of both spontaneous and experimental disease models is crucial to thoroughly illustrate disease property and biological mechanisms. As the largest ocular study conducted in non-human primates (NHPs), NHP eye study (NHPES) provided a comprehensive insight into optic nerve survey by launching normal range of relevant parameters and some spontaneous optic nerve disorders, laying the foundation for translation from monkey models to human clinical applications. NHPs are the most ideal animal models because of the marked species proximity through evolution between them and human, so substantial efforts have been attempted toward establishing NHP models for optic nerve research. These animals are of great importance for accelerating the exploitation of novel treatment targets, promoting advantageous drug delivery methods and enhancing patients' outcomes. Furthermore, the sophisticated structure and physiological function of monkeys faithfully replicate the typical pathology and progression of specific diseases. In the current narrative review, we provide an overview of why NHPs could be used to study the optic nerve and the significance of NHPES compared with other eye studies of monkeys.

Purpose: To identify demographic and baseline OCT characteristics that are predictive of VA outcomes after the first and post-loading injections in patients treated with 2 mg aflibercept.

Methods: This study evaluated VA outcomes in 1999 eyes of 1862 patients with nAMD initiated on aflibercept therapy. Demographic and OCT (Spectralis, Heidelberg Engineering) features associated with good VA outcome defined as VA ≥ 68 ETDRS letters (Snellen ≥  6/12) and poor VA outcome of <54 ETDRS letters (Snellen < 6/18) or a loss of ≥5 ETDRS letters after first and post-loading injections were analysed using logistic regression via generalised estimating equations.

Results: The mean age was 79.3 (SD 7.8) years, 1126 (60.5%) were females, and predominantly white ethnic background (1772 [95.2%]). The mean presenting VA was 58.0 (SD 14.5) ETDRS letters. After the loading phase, 930/1994 (46.6%) eyes achieved VA ≥ 68 ETDRS letters, and 457 (22.9%) attained VA < 54 ETDRS letters. Increasing age, non-white ethnicity, and baseline VA < 54 letter score is associated with VA < 54 letters. The OCT parameters associated with reduced odds of VA ≥ 68 ETDRS letters and increased odds of VA < 54 ETDRS letters after first and post-loading phase included fovea-involving intraretinal fluid, all types of macular neovascularisation (MNV) versus type 1 MNV, fovea-involving MNV (vs. non-foveal MNV), subfoveal MNV complex, increased central subfield thickness, foveal presence of subretinal hyper-reflective material, atrophy, fibrosis, ungradable or ellipsoid zone and/or external limiting membrane loss.

Conclusion: This study could provide individual-level visual prognosis about their post-loading VA based on demography, VA and OCT characteristics at presentation.

Purpose: To report the visual and surgical outcomes of mitomycin-C (MMC) augmented non-penetrating deep sclerectomy (NPDS) and phacoemulsification in patients with severe and end-stage glaucoma.

Materials and methods: A retrospective analysis of 349 eyes of 320 patients who underwent combined NPDS with phacoemulsification surgery between January 2018 to December 2020 were included.

Main outcome measures: Best corrected visual acuity (BCVA), status of central visual fields, intra ocular pressure (IOP), number of antiglaucoma medications (AGM) were compared from baseline to post-operative visits, surgical complications and interventions were noted.

Results: Mean logMAR BCVA improved significantly from baseline of 0.54 ± 0.42 to 0.30 ± 0.37 & 0.29 ± 0.40 at 6(p < 0.001) & 12 months (p < 0.001) postoperatively. HFA 10-2 analysis revealed no significant post operative change in mean deviation from baseline at 6 & 12 months (p = 0.072, p = 0.143) respectively. Significant post-operative reduction in mean (SD) IOP was noted from baseline of 17.54(5.43) mmHg to 15.10(5.34) & 16.23(6.87) mmHg at 6 months(p < 0.001) and one year(p < 0.001) respectively. Similarly, the need for AGM also reduced significantly from 2.95(1.01) to 1.93(0.98) & 2.01 (0.99) at 6 (p < 0.001)& 12 months(p < 0.001) postoperatively. Cumulative surgical success was 95% and 93% at 6 months and 1 year respectively. Complications were seen in 17.8% patients and most were related to poor IOP control (8.3%). Two (0.6%) patients underwent tube surgery and 3 (0.9%) had undergone diode laser cyclophotocoagulation for refractory high IOP.

Conclusion: MMC augmented NPDS combined with phacoemulsification surgery is a safe and a viable option in eyes with advanced glaucoma maintaining stable visual acuity and visual fields postoperatively.