Eye最新文献

Objectives: Understanding the developmental anatomy of the lacrimal sac fossa (LF) and nasolacrimal canal (NLC) is critical for paediatric lacrimal diseases.

Methods: This observational study analysed cranial CT images of 144 paediatric patients undergoing imaging for non-ocular conditions and 80 adults with phthisis bulbi as a matched comparison. Measurements included LF vertical dimension (height) and anteroposterior dimension (width), NLC diameter and vertical dimension, and frontal process of the maxilla (FPM) structures. Developmental changes were assessed using the generalised additive model (GAM), with structural comparisons between children and adults.

Results: Children enrolled had an even distribution in age and gender (77 males and 67 females, average ages of 9.83 and 9.44 years, respectively). Except for the proportion of FPM contributing to the LF and inferior LF height (part below the operculum of middle turbinate), which showed minimal age-related change, the GAM model revealed that most structures grew rapidly before age 10, then slowed. The NLC vertical dimension exhibited the fastest growth, increasing approximately threefold from birth to adulthood, while other structures generally increased by 1.5 to 2 times. Males consistently had larger dimensions than females in most measurements. Differences compared to adults were more significant in children under 10.

Conclusions: The various segments of the lacrimal drainage system exhibit different developmental patterns in children. While most LF and NLC structures grow rapidly before age 10, a few remains minimal age-related change. This study provides predictive values by age, which may serve as useful references for surgical planning in CNLDO.

Objective: To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido-zonulo-iridectomy.

Materials and methods: In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido-zonulo-iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error.

Results: Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed.

Conclusions: Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido-zonulo-iridectomy is a significantly effective and safe treatment for AM.

Background: Early diagnosis and treatment of neovascular age-related macular degeneration (NvAMD) improve vision outcomes. This analysis investigates associations of English indices of multiple deprivation 2019 (IMD2019) with baseline characteristics, key care processes and visual acuity (VA) outcomes for NvAMD in the National Ophthalmology Database (NOD).

Methods: Eligible eyes started treatment for NvAMD in England between 01/04/2020 and 31/03/2023. Participating centres with ≥25 eyes with baseline VA and IMD2019 data were included.

Results: Eligible for analysis were 48,583 eyes from 60 English centres. Between decile 1 (most deprived) and decile 10 (least deprived), median age at start of treatment ranged from 79 to 82 years and median baseline VA ranged from 56 to 60 ETDRS letters. After one year of treatment (-28 to +84 days), the median number of injections administered ranged from 7 to 8 across deciles. Loss to follow-up was observed in 13.7% eyes in decile 1, and 11.8% in decile 10. Median VA at 12 months ranged from 61 to 65 ETDRS letters across deciles. A "good" VA outcome (≥70 ETDRS letters) was achieved by 45.5% in decile 10, compared with 35.9% observed in decile 1 (p < 0.001). A "poor" VA outcome (≥10 ETDRS letter loss from baseline) occurred in 18.4% of eyes in decile 1 versus 14.5% in decile 10 (p < 0.001).

Conclusions: Patients starting NHS-funded treatment in England for NvAMD and living in areas of higher socioeconomic deprivation were typically younger, had lower baseline acuity and achieved worse VA outcomes than those from lower deprivation areas, with little variation in treatment between the deciles.

Background and objectives: Ocular trauma is a major cause of blindness. The objectives of this study were to report epidemiology, aetiology, visual outcomes, and interactions with ophthalmology services of paediatric ocular trauma patients.

Methods: A retrospective review of consecutive paediatric ocular trauma presentations between 01 January 2017 and 31 December 2019, within the Belfast Trust. Patients were younger than 16 years old at presentation.

Results: In total, 535 paediatric ocular trauma patients are reported. Epidemiology-Median age was 8.18 years old, with 63.8% of patients being male. Incidence was 0.45 cases per 1000 children aged 0-15, per year. Areas were ranked according to deprivation measures, incidence ranged from 0.43 in the 2nd quintile to 0.64 in the quintile with lowest deprivation measures. Aetiology-Blunt (n = 277, 52%), chemical (n = 96, 18%), sharp (n = 87, 16%), and laser injuries (n = 27, 5%) were the most common mechanisms. There were 2 open globe injuries reported (1.7 per 1,000,000 children aged 0-15, per year). Visual outcomes-Visual acuity at presentation was available for 408 eyes (72%), with 174 (43%) achieving 6/6 or better and 338 (83%) 6/12 or better. 6 eyes (3%) presented with vision worse than 6/60; three improved to better than 6/12 at follow-up, and two remained worse than 6/60. Ophthalmology services-16 patients (3.0%) were admitted.

Conclusions: Paediatric ocular trauma occurs most commonly in males, in the home setting, with a blunt injury mechanism. Chemical and laser eye mechanisms contribute a significant proportion of presentations.

Background: This study aimed to investigate the relationship of high-altitude environmental features and ethnic Tibetan background with myopia.

Methods: This cross-sectional study was conducted at highland and lowland sites. The highland sites were located on the Chinese Tibetan Plateau, approximately 4000 m above sea level. A total of 3634 Tibetans and 377 Hans were included in the highland group. The lowland group was from the Yaoxi community, in Wenzhou City, located 10-20 m above sea level, where 176 Han individuals were included. Non-cycloplegic spherical equivalent refraction (SER) and biochemical function tests were measured.

Results: Age-specific myopia prevalence was highest in highland Hans, followed by lowland Hans and highland Tibetans. Among participants in the highland group, including Tibetans and Hans, increased risk of moderate and high myopia was associated with gender [OR (95% CI): 0.47 (0.23, 0.97) for females], education level [OR (95% CI): 3.62 (1.76, 7.45) for middle school education and above], and elevated mean haemoglobin per red blood cell (MCH) [OR (95% CI): 8.04 (1.04, 62.34)]. Among Han participants in both groups, only elevated mean corpuscular volume (MCV) [OR (95% CI): 5.91 (1.00, 34.92)] was associated with increased risk of moderate and high myopia.

Conclusions: The higher prevalence of myopia in Hans compared to Tibetans, and in highland Hans compared to lowland Hans, suggests that both ethnicity and high-altitude environment influence myopia development, potentially through gene-environment interactions. Elevated MCV and MCH levels, particularly in highland Hans, may serve as biomarkers for risk, warranting further investigation.