Eye and Vision最新文献

Background: Anti-angiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) is currently the first-line treatment for macular edema (ME), but the specific metabolic changes in the aqueous humor (AH) after intravitreal anti-VEGF injections remain poorly understood.

Methods: A total of 120 AH samples from 60 ME patients before and after anti-VEGF treatment were collected from the ophthalmology clinic and ward of the Eye Hospital of Wenzhou Medical University. Non-targeted metabolomics analysis of the AH samples was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Orthogonal partial least squares discriminant analysis (OPLS-DA) was used to identify metabolite differences before and after anti-VEGF treatment in patients with different ME etiologies.

Results: Distinct metabolomic profiles were observed between pre- and post-treatment samples. A total of 145 significantly altered metabolites were identified after anti-VEGF treatment, with 84 upregulated metabolites related to carbohydrate and amino acid metabolism, and 61 downregulated metabolites involved in amino acid metabolism. Both common and etiology-specific metabolic alterations were observed. In age-related macular degeneration (AMD)-ME, treatment-induced metabolic changes mainly involved amino acid metabolism, whereas in branch retinal vein occlusion (BRVO)-ME, lipid metabolism was primarily affected. Diabetic macular edema (DME) patients showed more complex metabolic alterations, involving amino acid, lipid and carbohydrate metabolism.

Conclusions: Intravitreal anti-VEGF injections significantly alter AH metabolites in ME patients. These findings provide insight into underlying metabolic processes in ME pathogenesis and treatment efficacy.

Background: To analyze the fluid reservoir thickness over the whole cornea during scleral lens settling using wide-angle optical coherence tomography (OCT) images and customized computer software.

Methods: A total of 75 participants were recruited - 29 (myopes) with regular corneas and 46 with irregular corneas (35 with keratoconus, and 11 post-keratoplasty). All participants were fitted with customized scleral lenses and anterior segment OCT (Tomey Casia 2) images were taken 0, 30, 60, 120, and 240 min after lens application at the dispensing visit. Customized software was used to automatically segment the anterior cornea and the posterior surface of the scleral lens and determine the fluid reservoir thickness at 17 corneal regions across a 12 mm diameter.

Results: Fluid reservoir thickness decreased over time (P < 0.001) following an exponential decay, with no differences observed over time between the three groups (P = 0.97). The reduction in fluid reservoir thickness over four hours varied slightly between the central (149 ± 9 μm), mid-peripheral (139 ± 11 μm), and peripheral regions (131 ± 15 μm), P = 0.046. The fluid reservoir was thinnest in the superior mid-periphery for both the myopia and post-keratoplasty groups, and centrally for the keratoconus group. The fluid reservoir was thickest inferiorly for all groups, with the greatest level of asymmetry observed along the vertical meridian.

Conclusions: Fluid reservoir thickness decreased most rapidly during the first two hours of lens wear and followed an exponential decay for both regular and irregular corneas across all corneal locations. Fluid reservoir asymmetry was greatest along the vertical meridian with a thicker reservoir observed in the inferior corneal regions.

Background: Glaucoma causes permanent blindness. Current treatments have limited effectiveness, necessitating novel therapeutic strategies. We aimed to identify potential drug targets for glaucoma by integrating multi-trait and multi-omic analyses.

Methods: We sourced druggable gene expression and protein abundance summary-level data from quantitative trait loci studies, and genetic associations with glaucoma from a large-scale multi-trait analysis. We employed proteome and transcriptome Mendelian randomization (MR) and colocalisation to identify potential therapeutic targets, glaucoma endophenotype MR to explore the potential mechanisms of identified associations, and phenome-wide MR to investigate possible adverse effects of candidate targets.

Results: We identified CPXM1 and FLT4 as tier 1; INSR as tier 2; and CPZ and PXDN as tier 3 druggable genes. Genetically predicted higher levels of CPXM1 [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.81-0.91, P_FDR < 0.001], FLT4 (OR: 0.74, 95% CI: 0.64 - 0.87, P_FDR = 0.033), INSR (OR: 0.58, 95% CI: 0.43 - 0.78, P_FDR = 0.042), and CPZ (OR: 0.55, 95% CI: 0.40 - 0.74, P_FDR = 0.033) were associated with decreased glaucoma risk while those of PXDN (OR: 1.33, 95% CI: 1.15 - 1.54, P_FDR = 0.033) with increased risk. The associations for CPXM1 (OR: 0.53, 95% CI: 0.39 - 0.73, P < 0.001) and FLT4 (OR: 0.86, 95% CI: 0.78 - 0.95, P = 0.005) were confirmed transcriptome-wide and colocalisation was confirmed for CPXM1 [posterior probability H4 (PPH₄) = 0.940], FLT4 (PPH₄ = 0.701), and INSR (PPH₄ = 0.706). The protective effects of CPXM1 and CPZ may be attributed to intraocular pressure-lowering activities. The risk associated with PXDN is due to its involvement in glaucomatous neuropathy. No significant adverse effects were identified.

Conclusions: This study provides novel insights into glaucoma pathophysiology and promotes pharmaceutical target innovation.

Background: Despite extensive research on keratoconus (KC) detection with traditional machine learning models, stacking ensemble learning approaches remain underexplored. This paper presents a stacking ensemble learning method to enhance automated KC screening.

Methods: This study utilizes a clinical dataset containing detailed corneal data from 2491 cases classified as non-KC (NKC), subclinical KC (SCKC) and clinical KC (CKC). Each cornea is represented by 79 features extracted from Pentacam imaging. Following extensive pre-processing, key corneal features that are strongly correlated with the target diagnosis are identified. These features are the keratometry of the steepest anterior point, surface variance index, vertical asymmetry index, height decentration index, and height asymmetry index. A novel stacking ensemble model is developed using the selected features to improve corneal classification into NKC, SCKC, and CKC by integrating top tree-based classifiers (random forest, gradient boosting, decision trees) with a support vector machine meta-classifier.

Results: The pre-processing and feature selection techniques reduced the model's parameters to just 6.33% of the original dataset, improving classification performance, and cutting over 85% of the training time. The performance of the developed model was validated and tested on unseen data. Experimental results showed that the model outperforms existing studies, achieving 99.72% accuracy, precision, sensitivity, F1, and F2 scores, with a Matthews correlation coefficient of 0.995. It accurately classified all NKC and CKC cases, with just one misclassification involving an SCKC case. The model also demonstrated consistent performance on 100 additional unseen test cases, underscoring its generalizability and robustness in KC screening.

Conclusions: By combining the strengths of diverse base models and key Pentacam indices, the stacking ensemble approach ensures reliable, accurate KC screening, providing clinicians with an automated tool for early detection and better patient management.

Background: A post hoc analysis of the STAR study, which was a 48-week, phase IV, multicenter randomized controlled multicenter clinical trial was performed. This study aims to identify the baseline factors associated with visual and anatomic changes over 48 weeks in the treatment of active polypoidal choroidal vasculopathy (PCV) with conbercept.

Methods: In the STAR study, 249 participants were randomized to either the 3 + Q12W (3 monthly injections followed by injections every 12 weeks) or 3 + TAE (3 monthly injections followed by treat and extend regimen) group. The association of 27 baseline factors with three outcomes-changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and maximum retinal thickness (MRT) from baseline to 48 weeks-was investigated using univariate regression analysis followed by multivariate linear regression analysis.

Results: The final multivariate model indicated that worse baseline BCVA (P < 0.01), CRT ≤ 400 μm (P < 0.01), fewer polypoidal lesions (P < 0.01), and younger age at baseline (P = 0.04) were associated with greater BCVA gain at week 48. Higher CRT and MRT at baseline were associated with a greater reduction in CRT and MRT at week 48, separately (P < 0.01 and P < 0.01, respectively). Smaller pigment epithelial detachment (PED) volume at baseline was associated with greater reductions in CRT and MRT at week 48 (both P < 0.01). Eyes with relatively good BCVA (> 73 letters) at baseline exhibited lower reductions in CRT and MRT at week 48 (P < 0.01 and P = 0.02, respectively). At week 48, eyes with hemorrhagic PEDs showed greater reductions in CRT and MRT than those with fibrovascular PEDs (P = 0.02 and P = 0.03, respectively). Furthermore, eyes with shallow irregular or sharp-peaked PEDs exhibited greater reductions in CRT (both P < 0.01) and MRT (P = 0.01 and P < 0.01, respectively) than those with multilobular PEDs from baseline to week 48.

Conclusions: In Chinese patients with PCV receiving intravitreal injections of conbercept, baseline characteristics, including age, BCVA, CRT, MRT, number of polypoidal lesions, PED volume, and PED types and morphology, served as predictors of visual and anatomical changes over 48 weeks.

Background: Patient expectations for post-cataract surgery outcomes have risen. This study aims to evaluate patient satisfaction after bilateral implantation of enhanced monofocal IOL (RayOne EMV RAO200E) designed with positive spherical aberration, used for monovision with a 1.00 D offset.

Methods: Prospective, non-comparative, interventional case series. Patients underwent bilateral cataract surgery and implantation of an enhanced monofocal IOL (RayOne EMV IOL RAO200E, Rayner, Worthing, UK) with target refraction of -1.00 D in the non-dominant eye and emmetropia in the dominant eye. Patient-reported outcome measures (PROMs) were assessed 3 months postoperatively using the Spanish version of the Catquest-9SF and a self-administered questionnaire. Other outcome measures included subjective refraction, visual acuity at various distances, and contrast sensitivity.

Results: Both eyes of 51 patients were included (102 eyes). Three months postoperatively, all patients reported being satisfied or very satisfied with the overall surgical outcomes. The majority of patients reported that their vision during night driving was as good or better than before the surgery (95%); further, there was no difficulty in recognizing faces (93%), navigating uneven terrain (95%), and viewing prices while shopping (81%). The mean subjective spherical equivalent for dominant and non-dominant eyes were -0.24 ± 0.34 D and -0.86 ± 0.33 D, respectively. Binocular UDVA (4 m), UIVA (66 cm), and UNVA (40 cm) were 0.06 ± 0.09, 0.25 ± 0.12, and 0.30 ± 0.11 logMAR, respectively. Contrast sensitivity was within the population norms (CSV-1000).

Conclusion: Monovision with the RayOne EMV IOL provided high patient satisfaction, with preserved contrast sensitivity, good distance vision, and functional intermediate and near vision.

Trial registration: Clinicaltrials.gov, NCT06528678. Registered 22 July 2024-Retrospectively registered, https://clinicaltrials.gov/study/NCT06528678 .

Background: Interleukin detection is helpful in screening vitreoretinal lymphoma (VRL). However, the levels of interleukin in aqueous humor (AqH) can be abnormally low in some cases, leading to underdiagnosis of VRL merely dependent on AqH. The purpose of this study was to investigate the correlation of interleukins between paired AqH and vitreous humor (VH) samples in VRL cases, and to explore potential factors affecting interleukin levels and diagnostic parameters.

Methods: This was a case series study. Reviewed were consecutive biopsy-proven B-cell VRL cases of which adequate paired AqH and VH samples were obtained for the measurement of interleukin 10 (IL-10) and interleukin 6 (IL-6). The correlations of IL-10 and IL-6 between AqH and VH were analyzed. Influences of clinical manifestations on IL levels and positive rates of IL-related parameters in AqH and VH were evaluated, which included AqH IL-10 > 30 pg/mL, VH IL-10 > 65 pg/mL, IL-10/IL-6 ratio > 1, and Interleukin Score for Intraocular Lymphoma Diagnosis (ISOLD) > 0 in both the AqH and VH.

Results: Seventy-four eyes of 64 patients with VRL were included. IL-10 in VH was significantly higher than in AqH (median: 1159.77 vs. 225.74 pg/mL, P < 0.001). For both IL-10 and IL-6, the AqH concentrations were positively correlated with VH concentrations in the form of power functions (P < 0.001 and P < 0.001, respectively). The positive rate of AqH IL-10/IL-6 > 1 (77%) was lower than that of VH IL-10 > 65 pg/mL (91%), VH IL-10/IL-6 > 1 (89%) and VH ISOLD > 0 (91%). Eyes without intraretinal infiltration tended to have lower IL-10 levels in the AqH and VH (median: 141.08 pg/mL vs. 449.10 pg/mL, 825.48 pg/mL vs. 2285.77 pg/mL; P = 0.001 and P < 0.001, respectively), and lower positive rates of AqH IL-10 > 30 pg/mL (78% vs. 97%, P = 0.018) and AqH ISOLD > 0 (76% vs. 97%, P = 0.033).

Conclusions: IL-10/IL-6 in AqH may not be as sensitive as the parameters (including IL-10, IL-10/IL-6 and ISOLD) in VH for VRL screening. Cases without intraretinal involvement were less likely to be positive for IL-10 > 30 pg/mL and ISOLD > 0 in AqH; the possibility of VRL should be ruled out more cautiously in these cases.

Background: Transepithelial photorefractive keratectomy (transPRK) can be safely and predictably performed to correct low-to-high astigmatism. This study explored the effects of fixation stability, corneal density (CD), ocular residual astigmatism (ORA), and the surgically-induced change in the epithelial thickness (ΔET) on the efficacy of astigmatism correction by transPRK.

Methods: Eighty-three consecutive patients who underwent transPRK to correct myopia and myopic astigmatism were divided into two groups according to refractive astigmatism [high refractive astigmatism (RA) group: ≥ 2.0 D, n = 31; low RA group: < 2.0 D, n = 52]. Fixation stability was evaluated by measuring the lateral movement of the pupil center on the eye tracker images. The CD was measured using a Pentacam Scheimpflug imaging system, epithelial thickness mapping was performed using optical coherence tomography, and the ORA was determined using vector analysis. Multiple linear regression analyses were performed to identify factors associated with the correction index (CI) and angle of error (AOE).

Results: At 6 months postoperatively, the RA was higher in the high RA group (- 0.66 ± 0.44 D) than in the low RA group (- 0.29 ± 0.29 D, P < 0.001), whereas no significant differences were found in CI or AOE between two groups. Multiple linear regression analyses showed that for the low RA group, preoperative anterior CD of the central 2 mm (CD_0-2A, β =  - 0.482, P = 0.011) and ΔET (β = 0.295, P = 0.041), were associated with CI, whereas the vector length of the pupil center shift (PCVL, β =  - 0.404, P = 0.005) and ΔET (β =  - 0.293, P = 0.036) were associated with AOE. For the high RA group, ΔET (β = 0.519, P = 0.038) was associated with CI, whereas static cyclotorsion (β =  - 0.493, P = 0.040) was associated with AOE. No significant associations were found between ORA and CI or AOE.

Conclusions: Postoperative changes in epithelial thickness were associated with the efficacy of transPRK in both the low and high RA groups, whereas the pupil center shift and anterior CD were associated with the efficacy of transPRK in the low RA group.

Vitreoretinal lymphoma (VRL) is often a diffuse large B-cell lymphoma in nature, and patients may have or eventually develop central nervous system lymphoma, which frequently leads to a poor prognosis. Currently, there are no international or domestic clinical guidelines specifically for the diagnosis and treatment of VRL, and no standardized diagnostic procedures or treatment evaluation systems for this disease. VRL is clinically characterized by prominent vitreous opacities, multiple lesions beneath the retinal pigment epithelium or subretinal, and intraretinal infiltration, making it one of the most common masquerade syndromes in ophthalmology. To promote early diagnosis and standardized treatment of VRL, the Ocular Immunology Group of the Chinese Medical Association Ophthalmology Branch has developed "Clinical Guidelines for the Diagnosis and Treatment of Vitreoretinal Lymphoma in Chinese Patients (2024)", based on extensive references to diagnosis, treatment experiences and relevant clinical recommendations. The working group systematically reviewed and comprehensively summarized the latest research evidence from both domestic and international sources. Using the Oxford Evidence Level System, we assessed the quality of evidence and the strength of recommendations. This guideline provides crucial academic references and clinical practice guidance for the diagnosis and treatment of VRL patients. This guideline, including VRL diagnostic methods, processes, and treatment recommendations is suitable for clinical practice in China and is intended to assist ophthalmologists in clinical diagnosis and treatment of VRL.

Background: This study aimed to investigate the combined effects of obstructive sleep apnea (OSA) risk and short sleep duration on glaucoma prevalence and intraocular pressure (IOP) using data from the 2019 to 2021 Korea National Health and Nutrition Examination Survey (KNHANES).

Methods: This cross-sectional study analyzed data from 7,732 KNHANES participants aged ≥ 40 years. OSA risk was assessed using the STOP-BANG questionnaire, with a high risk defined as a score ≥ 3. The diagnosis of glaucoma was based on the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Multivariate logistic regression models were used to evaluate the associations among glaucoma prevalence, OSA risk, and sleep duration, adjusting for demographic and health-related variables. The interaction effects of OSA risk and sleep duration on glaucoma and IOP were also assessed.

Results: Among the 7,732 participants, 5.28% (n = 408) were diagnosed with glaucoma. Individuals with a high risk of OSA had significantly higher odds of glaucoma compared to those with a low risk (odds ratio: 1.34, 95% confidence interval: 1.02-1.77; P < 0.05), with the STOP-BANG components "snoring", "pressure", and "age" being most associated with increased glaucoma risk. No significant association was observed between abnormal sleep duration (< 7 h or ≥ 9 h) alone and glaucoma prevalence (P > 0.05). Individuals with a high risk of OSA with a sleep duration < 9 h showed a significantly higher glaucoma prevalence than those with ≥ 9 h of sleep (P < 0.05), suggesting that sleep duration modifies the association between OSA risk and glaucoma. Similar trends were observed for IOP, with significant interaction effects between OSA risk and sleep duration.

Conclusions: Our findings suggest that sleep duration modulates the association between OSA risk and both glaucoma prevalence and higher IOP, highlighting the importance of including sleep duration in glaucoma risk assessments for patients with OSA. Further research is required to clarify the mechanisms underlying the association between OSA, sleep duration, and glaucoma.