Eye最新文献

Chimeric Antigen Receptor (CAR-T) cell therapy represents a groundbreaking advancement in the field of cancer immunotherapy, where it offers a highly targeted and personalized approach to cancer treatment [1]. Since its birth in 1993, this innovative therapy has been built upon the genetic engineering of a patient’s own T cells to express a chimeric antigen receptor (CAR), which is designed to recognize and bind to specific antigens present on cancer cells [1]. By reprogramming the immune system to better recognize and destroy malignant cells, CAR-T therapy improves the body's natural ability to fight cancer cells with unprecedented precision and effectiveness [1].

The therapeutic potential of CAR-T cells has been particularly promising in the treatment of hematological malignancies, such as lymphoma and multiple myeloma (MM) [2]. The ability to specifically target antigens, such as CD19 in B cell malignancies, CD20 in lymphomas, and CD138 in MM, allows for a more directed and efficient immune response and significantly reduces the off-target effects that often accompany traditional cancer treatments like chemotherapy or radiation [2, 3].

Kyrieleis plaques are focal segmental intra-arterial plaques that simulate arterial emboli and are seen in infectious uveitis conditions such as tuberculosis, toxoplasmosis, cytomegalovirus (CMV) retinitis, syphilis, and viral acute retinal necrosis [1, 2].

Objectives

To compare the 2-year efficacy and safety of various anti-vascular endothelial growth factor (VEGF) regimens for neovascular age-related macular degeneration (nAMD).

Methods

A comprehensive search was performed on multiple electronic databases up to April 2023 and updated in June 2024, to identify relevant randomized controlled trials (RCTs). Key outcomes included the proportion of patients achieving a vision gain of ≥15 letters and maintaining stable vision (loss of <15 letters) in best-corrected visual acuity (BCVA), changes in mean BCVA from baseline, serious ocular adverse events (SAEs), adverse events leading to treatment discontinuation and any cause of death at 2 years.

Results

Nineteen trials with 12,654 patients and 25 treatment regimens were analyzed in the study. All anti-VEGF regimens showed superior efficacy compared to sham therapy. Specifically, faricimab 6 mg (4+up to Q16W) and ranibizumab 0.5 mg (2-week T&E) displayed top-level effect in vision gain. Bevacizumab 1.25 mg (2-week T&E) and aflibercept 2 mg (2-week T&E) demonstrated the most stable vision outcomes. Bevacizumab 1.25 mg (2-week T&E) and ranibizumab 0.5 mg (2-week T&E) exhibited the most pronounced mean BCVA improvement. Compared to sham therapy, the risk of SAEs was significantly higher for brolucizumab 6 mg (3 + Q12W/ Q8W) (RR = 6.04, 95% CI: 1.30–28.02) and PDS 100 mg/ml (Q24W) (RR = 10.95, 95% CI: 2.14–56.02), but not for other anti-VEGF regimens.

Conclusions

Ranibizumab 0.5 mg (2-week T&E) emerges as a potentially optimal regimen for nAMD over a 2-year period. Future studies need to consider the impact of baseline characteristics on treatment outcomes.

Objectives

To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically.

Methods

The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed.

Results

Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients’ wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245–351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297–51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493–56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004).

Conclusions

High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.

We read with interest the article by Nanji et al., which details that meta-analyses in ophthalmology are frequently fragile, and their statistical significance hinges on the event status of very few patients [1]. We would like to add to this finding with information regarding the relevance of meta-analyses within ophthalmology and how we could improve their overall reliability (Table 1).

Meta-analyses were originally written to compile data across publications with similar research aims, to increase robustness and reliability of scientific research as a whole. However, with the current ease of reviewing literature, abundance of analytical software to simplify this process, new statistical techniques to generate different types of meta-analyses, and the relative accessibility given that meta-analyses do not require a lab setting, the number of meta-analyses published across all fields have starkly increased especially during the COVID-19 pandemic [2].

Purpose

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm.

Design

Retrospective, monocentric, consecutive case series.

Participants

Patients with primary MH operated at Lariboisière Hospital, Paris, France.

Methods

Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed.

Main outcome measures

Postoperative MH closure rate and visual acuity.

Results

74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameter was 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR.

Conclusion

MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

Background/objectives: The predictive factors of surgical results in uveitic retinal detachment (RD) are lacking. The objective was to study the surgical outcomes and determine the risk factors for surgical failure in rhegmatogenous RD associated with intraocular inflammation (RRDIOI).

Methods: Retrospective series of consecutive eyes with RRDIOI undergoing vitreoretinal surgery between 2012 and 2019 in two French referral centres. Patients underwent 23- or 25 G pars plana vitrectomy (PPV), scleral buckling (SB), or a combination of both. The main objective was to describe the predictive factors of visual recovery and anatomical success after surgery.

Results: Seventy-one eyes were included. Posterior and panuveitis accounted for 91.5% of eyes. Seventy-five percent of eyes had an infectious cause for their uveitis. The first surgery consisted in PPV alone, SB alone, or both in 87.3%, 4.2% and 8.5% of cases respectively. The reattachment rate was 74.6% after one surgery (100% in case of SB, either alone or in association with PPV). On multivariate analysis, the only predictive factor of visual improvement was a baseline BCVA ≥ 20/400, while the only predictive factor for surgical success at 12 months was the absence of RD recurrence within the first 6 weeks of surgery.

Conclusions: RRDIOI has a relatively favourable anatomical prognosis. The addition of scleral buckling may be beneficial in selected cases.

Background/objectives: The Government of Kerala initiated a pilot screening programme for diabetic retinopathy in 16 Family Health Centres in Thiruvananthapuram district in 2019 in collaboration with the ORNATE India project. The evaluation of this pilot included a study of its costs and cost-effectiveness to inform decisions about extending the programme throughout Kerala.

Subjects/methods: The participants comprise all 5307 people who were screened for diabetic retinopathy under the pilot programme for whom data could be collected.

Results: The costs of the pilot programme are estimated at INR 11.3 million (including INR 1.9 million costs to individuals) and the benefits at 514 QALYs, slightly over one QALY per person treated. The cost per QALY was INR 22,000, which is well below India's Gross National Income per person.

Conclusions: Kerala's 2019 pilot screening programme for diabetic retinopathy was highly cost-effective.