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Objectives: To characterise the natural course of epiretinal membrane-foveoschisis (ERM-F) using optical coherence tomography (OCT) and analyse morphological and visual changes.

Methods: Retrospective single-centre study of treatment-naïve idiopathic ERM-F eyes. Functional and morphological changes from baseline to the final visit were assessed. The primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included subtype transitions, progression to lamellar macular hole (LMH) or mixed ERM-F/LMH.

Results: A total of 124 eyes from 113 patients (mean age 67.9 ± 8.0 years) were followed for 58.8 ± 47.4 months. Mean BCVA remained stable (baseline: 0.16 ± 0.15 logMAR; final: 0.18 ± 0.15 logMAR; p = 0.29). Baseline ERM-F subtypes were open-flat (61.3%), open-elevated (24.2%), and closed (14.5%), shifting to 46.8%, 28.2%, and 9.7%, respectively, at the final visit. Conversion to mixed ERM-F/LMH and LMH occurred in 11.3% and 2.4% of eyes, respectively; two eyes (1.6%) developed a normal foveal contour, while two eyes progressed from open-flat ERM-F via mixed ERM-F/LMH phenotype to full-thickness macular hole. Central foveal thickness (CFT) did not change significantly (p = 0.457). Structural changes included increased foveal wall verticalisation and emergence of subfoveal EZ disruption, undermined edges, retinal tissue loss, and foveal bump in a subset of patients. Subfoveal EZ disruption was associated with worse final BCVA on univariable analysis, but not after multivariable adjustment for baseline BCVA and cataract surgery.

Conclusion: ERM-F shows morphological plasticity with generally stable visual outcomes. A minority of eyes progress to mixed ERM-F/LMH or LMH.

Background: Retinopathy of prematurity (ROP) is an avoidable cause of childhood blindness. Effective ROP screening enables the detection of cases requiring treatment, but the frequency of ROP varies in units across South Africa (SA). Recent evidence suggests that a high proportion of infants in SA do not complete screening. A comparison of ROP prevalence and completeness of screening in units within the same region has yet to be described.

Methods: A prospective study of infants screened for ROP at five units was conducted between 1 February 2023 and 30 April 2024 in Cape Town, SA. Data were extracted for infants with birth weight <1250 grams or gestational age <32 weeks from the Retinopathy of Prematurity South African (ROPSA) register.

Results: Screening was initiated in 933 infants and completed in 468 (50.2%). Completeness of screening varied in the units from 36.8% to 74.6%. The prevalence of ROP among infants who started screening (16.1%-71.2%), completed screening (13.1%-64.3%), and those incompletely screened (25.0%-79.2%) also varied in the units. Among those diagnosed with ROP (n = 315), 179 (56.8%) had incomplete screening, including 30 (n = 51, 58.8%) infants with stage 3 ROP.

Conclusion: Completeness of screening and ROP prevalence varied widely in the units. Of concern is the high proportion of infants with ROP, including stage 3 ROP, who do not complete screening. Measures to increase completeness of screening are needed to improve the detection of cases requiring treatment. The ROPSA register will allow these improvements to be monitored over time.

Purpose: To identify clinical phenotypes in pachychoroid disease (PD), characterise long-term progression patterns, and evaluate the effect of photodynamic therapy (PDT) using machine learning and longitudinal probabilistic modelling.

Methods: This retrospective cohort study included 973 eyes from 663 patients (mean age 54.4 ± 12.8 years; 80% male) diagnosed with PD. Eyes were classified based on macular fluid status into no history, primary, recurrent, or resolved fluid categories. Multimodal imaging data were analysed at baseline and at the final follow-up visit ( > 5 years). Phenotypic clusters were identified using cross-validated K-means clustering on imaging and clinical features. Longitudinal changes in phenotype were evaluated with Markov modelling, including the effect of photodynamic therapy (PDT) on cluster transitions. Visual acuity (VA) changes were estimated with linear mixed models.

Results: Four distinct clusters were defined: Cluster 1 (233 eyes) consisted of younger patients exhibiting active fluid and mild structural alterations (LogMAR 0.16); Cluster 2 (317 eyes) represented mild or resolving PD with optimal VA (LogMAR 0.05); Cluster 3 (336 eyes) featured chronic fluid accumulation, significant structural damage, and moderate visual impairment (LogMAR 0.35); Cluster 4 (87 eyes) corresponded to severe bilateral disease and worst VA (LogMAR 0.66). At baseline, Clusters 1 to 4 were distributed as follows: 22.7%, 25.5%, 39.8%, and 12.0%. Over follow-up (mean 90.2 ± 24 months), the distribution shifted to 3.7%, 32.4%, 36.6%, and 27.3%, indicating progression toward more advanced phenotypes. Cluster 1 had frequent transitions, with 53% eyes progressing to Cluster 2 and 37% to Cluster 3. Cluster 4 showed minimal transition (96% stable). Interaction indicated greater visual deterioration in more severe baseline phenotypes (p = 0.01). PDT administration did not significantly alter disease progression (p > 0.5).

Conclusion: PD exhibits distinct, dynamically evolving phenotypes with measurable probabilistic progression over time. As this represents an exploratory, data-driven analysis, the identified clusters should be interpreted as hypothesis-generating. Significant structural changes occurred despite PDT, underscoring the need for therapies capable of modifying the underlying disease course rather than its local manifestations.

Objectives: To evaluate the efficacy and safety of full corneal epithelial debridement (FCED) combined with local corticosteroids for recurrent corneal erosion (RCE), and to monitor corneal healing using in vivo confocal microscopy (IVCM).

Methods: This prospective study included 65 eyes from 65 patients with RCE who failed conventional treatments between May 2022 and July 2024. Data were collected via chart review and telephone surveys. Outcome measures included demographics, aetiology, symptom duration/recurrence, additional treatments, and complications. IVCM was performed pre-FCED and at 2 weeks, and 1, 3, and 6 months post-FCED.

Results: The study involved 28 males and 37 females with a mean age of 37.7 years. The primary cause was trauma (90.8%). Mean follow-up was 19.8 months. Mean best-corrected visual acuity (BCVA) improved from 0.29 pre-operatively to 0.11 post-operatively (p < 0.05). After 7 months, 71% of eyes showed complete resolution; after 1 year, the effective rate was 70%. Pain relief was reported in 97% of eyes after 3 days. Complications included elevated intraocular pressure in 2 patients and grade 2 haze in 1. Recurrence occurred in 29% of eyes, mostly within 3 months. IVCM revealed complete corneal epithelial repair by 2 weeks, but inflammatory cells persisted for up to 12 months, and sub-basal nerve regeneration was a lengthy process.

Conclusions: FCED with corticosteroids effectively alleviates symptoms and prevents recurrence in RCE. IVCM provides valuable insights into the healing process, confirming treatment efficacy. Adequate corticosteroid treatment is crucial to manage inflammatory responses and prevent recurrence.

HLA-B27 positivity is strongly associated with acute anterior uveitis (AAU). This study investigated HLA-B27-dependent metabolic alterations in AAU and identified potential biomarkers of disease activity using plasma metabolomics. Untargeted and targeted metabolomics were employed to compare plasma metabolic profiles of HLA-B27-positive and negative patients. Distinct metabolic signatures, characterised by significant alterations in pyruvic acid and L-kynurenine, were identified in HLA-B27-positive individuals compared to HLA-B27-negative individuals. Furthermore, citric acid levels in these HLA-B27-positive patients correlated significantly with disease activity, particularly in those not receiving systemic medication. Pathway analysis revealed significant differences between HLA-B27-positive and negative patients in several key metabolic pathways, including the citrate cycle, tryptophan metabolism, pyruvate metabolism, and glycolysis/gluconeogenesis. A diagnostic model with citric acid alongside C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) demonstrated improved performance in predicting disease activity compared to a model utilising CRP and ESR alone (AUC: 0.727 vs. 0.713 and 0.674 vs. 0.670 in the untargeted and targeted cohorts, respectively). These findings offer insights into the metabolic dysregulation associated with HLA-B27-positive AAU and suggest that citric acid may be a potential biomarker for assessing disease activity, warranting further validation.