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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.