Eye最新文献

Purpose: To evaluate the safety and efficacy of a novel cataract surgery pathway that combines a See-and-Treat (S&T) model with Immediate Sequential Bilateral Cataract Surgery (ISBCS) at the Nightingale Hospital, Exeter, UK.

Methods: A retrospective observational study was conducted on 102 consecutive patients (204 eyes) who underwent S&T ISBCS between July 2023 and July 2024. Patients were triaged based on referral information and underwent preoperative telephone consultations. On the day of surgery, clinical assessment and bilateral cataract surgery were completed in a single visit. Data collected included patient demographics, intraoperative and postoperative outcomes, and complications.

Results: Of the 127 patients listed, 102 (84.3%) completed S&T ISBCS. No intraoperative complications were recorded. Fourteen patients (13.7%) required unplanned postoperative consultations, with most cases being non-sight-threatening and self-resolving. Cystoid macular oedema (CMO) was reported in 2.9% of eyes, with no cases of visual loss or endophthalmitis.

Conclusion: The S&T ISBCS model demonstrated safety and efficiency in delivering cataract care, with a high one-visit completion rate and low complication rates. This model offers significant time and resource savings whilst maintaining patient safety. It holds potential for broader implementation in healthcare settings facing increased demand for cataract services. Further studies are recommended to assess long-term outcomes and optimise this approach.

Background/objectives: Cataract surgery, one of the most frequent conducted surgeries around the world, is associated with cardiovascular diseases. We aim to determine the association of cataract surgery and the risk of stroke.

Methods: Adults aged over 65 years old in the National Health and Aging Trends Study were followed 7 years annually. There were 6700 stroke-free participants included at baseline survey. These participants were divided into two groups based on past history of cataract surgery. Demographics and multiple comorbidities were compared between the two groups. We identified newly developed cases of stroke over a 7-year period and performed survival analysis. Cox regression was further performed to yield adjusted hazard ratios.

Results: Among 6700 elderly participants, 2803 of them had a history of cataract surgery while 3897 of them had not. Over the 7-year follow-up period, the cumulative stroke-free survival rate among the cataract surgery group and the control group were 84.4% versus 88.6% (p < 0.0001, log-rank test). Compared with the control group, elderly with a history of cataract surgery had a higher risk of developing stroke (adjusted HR 1.36, 95% CI 1.03 to 1.79, p = 0.026) after adjusting for multiple covariates. Other significant predictors included age ≥80 years old, having comorbidities with heart disease, lung disease, and dementia. Contrarily, protective factors for further stroke development included higher education and more frequent outdoor activities.

Conclusions: Our findings suggest that patients with a history of cataract surgery had a 1.36-fold increased risk of future stroke development.

Background/objectives: Trabeculectomy is the gold standard surgery in treatment of glaucoma but there is little reported on its early impact in health-related quality of life (HRQoL). Here we characterise HRQoL in the early post-operative period with two generic patient-reported outcome measures tools (PROMs), the EQ-5D and SF-6D, and compare them to visual-related and glaucoma-specific PROMs, the VF-25 and GUI.

Subjects/methods: We prospectively enrolled 168 patients with failed medical treatment undergoing trabeculectomy and assessed HRQoL at baseline and in the post-operative period using the PROMs above. Paired t-tests, ANOVA and linear regression tests were used to analyse outcomes.

Results: A significant drop in HRQoL was identified in the first month post-operatively with the SF-6D, the VF-25 and the GUI but not with the EQ-5D. This drop was reversed to pre-operative levels by month 3. Four dimensions of HRQoL, including physical functioning, social functioning and adaptation to physical and to emotional roles had the most impact on the generic HRQoL. Visual acuity dropped one line in the operated eye at month 1 and was the only measurable clinical factor contributing to HRQoL.

Conclusions: The early post-operative period in trabeculectomy surgery is associated with a reversible loss of HRQoL, which is the result of transient worsening of vision but also physical, emotional and social restrictions caused by the busy medication regimen and drastic lifestyle changes. The SF-6D was better than the EQ-5D at picking up changes in HRQoL.

Background: There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH).

Methods: A systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into "small" (1-disc diameter [DD] in radius or less) and "large" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence.

Results: Five RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)).

Conclusions: Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. ILM peel size probably has no significant effect on postoperative VA.

Objective: To identify subgroups of angle closure disease by considering age-independent anterior segment parameters.

Methods: Anterior-segment optical coherence tomography (ASOCT) was performed in primary angle closure suspect (PACS) and primary angle closure glaucoma (PACG) patients. Clustering analysis using age-independent parameters, anterior chamber width (ACW), anterior vault (AV), posterior corneal arc length (PCAL), and iris area was performed. The optimum number of subgroups was determined using Bayesian Information Criterion and subjects were classified into subgroups by Gaussian Mixture Model methods.

Results: A total of 650 PACS and 411 PACG were analysed. The optimal number of subgroups of the combined PACS and PACG dataset was 3. Subgroup 1 (n = 186, 29.3%) has the largest anterior chamber dimension with large AV and total anterior chamber area, subgroup 2 (n = 16, 2.5%) has the widest ACW and shallowest anterior chamber depth (ACD), and subgroup 3 (n = 432; 68.1%) has large iris area with the smallest anterior chamber dimensions, characterised by a small ACW, AV, and PCAL. Subgroup 3 comprised a significantly greater proportion of PACG compared to PACS (74.2% vs 64.6%, p = 0.04) while subgroup 1 had the greatest proportion of PACS ≥ 70 years old, yet to have progressed to PACG.

Conclusion: We identified 3 subgroups of angle closure eyes, each characterised by distinct structural components based on ASOCT. A greater proportion of older PACS yet to have progressed to PACG belonging to the subgroup with the largest anterior chamber dimensions suggests that a more spacious anterior chamber may be associated with PACS that remains stable.

Objectives: To present a series of normative measurements for the width of the frontal and infraorbital nerve branches of V1 and V2, respectively.

Methods: Cadaveric dissection study of 15 embalmed cadaver heads (30 orbits). The frontal nerve was excised en bloc from the superior orbital rim to the superior orbital fissure. Similarly, the infraorbital nerve was excised en bloc from the inferior orbital rim to the orbital apex. Measurements were recorded of the maximal width of the frontal nerve, infraorbital nerve within the orbital floor, and pterygopalatine segment of the maxillary nerve. Any value greater than 2 standard deviations (SD) above the mean value, was defined as nerve enlargement.

Results: The mean transverse diameter of the frontal nerve was 2.27 ± 0.66 mm (1 SD). The mean transverse diameter of the infraorbital nerve branch, and the maxillary nerve within the pterygopalatine fossa, was 3.31 ± 0.68 mm (1 SD) and 3.59 ± 0.76 mm (1 SD), respectively. The upper limit of normal, defined as 2 SD above the mean value, for the widths of the frontal nerve, infraorbital nerve, and pterygopalatine segment of V2 widths were 3.59 mm, 4.67 mm, and 5.10 mm, respectively.

Conclusions: The frontal and infraorbital nerves are implicated in various inflammatory and neoplastic orbital pathologies. Defining the normative data for width is important to compare with pathological states.