Eye and Vision最新文献

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.

Background: Early detection of keratoconus is essential for maximizing the potential of cross-linking treatments designed to halt keratoconus progression, minimizing the risks of iatrogenic ectasia as well as reducing the need for corneal transplantation. This review focuses on the progress that has been made in the early detection of keratoconus using biomechanical and topographical properties derived from three different technologies, namely the ocular response analyser (ORA), corneal visualization Scheimpflug tonometer (Corvis ST) and optical coherence tomography (OCT).

Method: A PubMed search was performed using the keywords of 'early keratoconus', 'subclinical keratoconus', 'forme fruste keratoconus', 'very asymmetric ectasia with normal topography/tomography' and 'ocular response analyser' and/or 'Corvis ST'/'corneal visualized Scheimpflug tomographer/tomography' and/or 'optical coherence tomography/tomographer'.

Results: The integration of biomechanical parameters and corneal morphological data from the topography/tomography or OCT, or the assessment of bilateral asymmetry, has demonstrated improvement in the accuracy of diagnosing early-stage keratoconus.

Conclusions: As measurement principles differ depending on the technique used for keratoconus assessment, comprehensive metrics may be needed to reflect subtle anterior or posterior corneal changes and help identify eyes with very early ectasia. Although clinical experts have always, and will most likely, continue to play a pivotal role in decision-making for early keratoconus diagnosis, future developments in technology and AI may lead to enhanced early detection in the future.

Background: To investigate the relationship between obesity and corneal nerve metrics in patients with type 2 diabetes mellitus (DM).

Methods: This cross-sectional study included a total of 385 healthy controls and 663 patients with DM. Metrics for corneal nerve and epithelial cells were evaluated using in-vivo confocal microscopy (IVCM). Corneal nerve and epithelial cell parameters were quantified and compared between patients with and without obesity and across six different body mass index (BMI) categories. Multivariable regression analyses were conducted to determine the association between corneal nerve metrics and BMI in patients with DM.

Results: Of the DM participants, 162 (25.4%) had obesity. Compared to the non-obese group, patients with obesity had significantly lower corneal nerve fiber density (CNFD, P < 0.0001), corneal nerve fiber length (CNFL, P = 0.002), and corneal nerve branch density (CNBD, P = 0.005). Analyses across different BMI categories showed a progressive decline in corneal nerve parameters including CNFD (P < 0.0001), CNFL (P < 0.0001), CNBD (P < 0.0001), corneal nerve fiber total branch density (P = 0.003), corneal nerve fiber area (P = 0.04), and corneal nerve fiber fractal dimension (P = 0.02) with increasing obesity severity. Multivariable regression analyses demonstrated that lower CNFD (β: - 0.21, 95% CI: - 0.29 to - 0.13, P < 0.0001), shorter CNFL (β: - 0.12, 95% CI: - 0.17 to - 0.07, P < 0.0001), and lower CNBD (β: - 0.17, 95% CI: - 0.30 to - 0.04, P = 0.01) were significantly associated with BMI after adjusting for confounders. There were no significant differences in the corneal epithelial parameters between the obese and non-obese groups.

Conclusions: General obesity, specifically higher BMI, adversely affects corneal nerve health in individuals with DM. Evaluation of corneal nerves and resultant keratopathy should be considered in patients with DM and concomitant obesity.

Sturge-Weber syndrome (SWS) is a rare form of neurocutaneous disorder characterized by the involvement of neurologic, cutaneous and ocular problems. Among all SWS-related ocular abnormalities, glaucoma is the most common complication with a bimodal onset time. The occurrence of gene mutations in GNAQ has been identified as a cause of SWS. Recent studies have indicated that macrophages and mutations in GNA11 or GNB2 are also involved in the pathogenesis of SWS. Different mechanisms such as elevated episcleral venous pressure and focal venous hypertension can result in SWS secondary glaucoma (SG). In addition to glaucoma-related manifestations, SG may be associated with the typical site of facial port-wine birthmarks, choroidal vascular malformation and other ocular features. Medication and surgery are still the mainstay for SG. ROCK inhibitors have shown good performance in the control of intraocular pressure in SG but have not been verified in large sample populations. Due to the anatomical abnormalities, the incidence of surgical complications is higher. Non-penetrating surgical procedures, known for their safety and hypotensive characteristics, may be preferable instead. In general, the treatment of SG is a challenging undertaking. Early detection and treatment are crucial to preserve the visual function of patients with SWS. This review provides an overview of its pathogenesis, clinical manifestations, therapeutic agents, surgeries, and recent advances in the field of SG. The aim is to offer the latest perspectives and insights for the understanding and diagnosis of this disease.

Purpose: This retrospective cohort study aims to investigate chromosomal aberrations in Southeast Asian (SEA) uveal melanoma (UM) patients, evaluate their impact on clinical outcomes, and compare findings with the TCGA-Uveal Melanoma (TCGA-UM) dataset to explore potential genetic differences.

Methods: Formalin-fixed paraffin-embedded (FFPE) tumour samples from 20 UM patients diagnosed between 2004 and 2018 were initially analysed using the OncoScan™ CNV Array to detect chromosomal aberrations, with 14 samples yielding valid results for cytogenetic analysis. BAP1 immunohistochemistry was performed on all 20 samples to assess BAP1 protein expression using automated immunostaining techniques validated in the Clinical Pathology Laboratory of the Singapore General Hospital. Clinical data were retrospectively reviewed, and chromosomal aberration frequencies were compared with the TCGA-UM dataset.

Results: A total of 78 chromosomal gains, 48 losses, and two cases of copy-neutral loss of heterozygosity (CN-LOH) were identified. Compared to the TCGA-UM cohort, SEA patients exhibited a lower frequency of monosomy 3 (14% vs. 53%) and a higher incidence of chromosome 1q gains (20% vs. 6%). Gains in chromosome 1q were significantly associated (P = 0.0289) with shorter progression-free survival (PFS). In comparison, gains in chromosome 9q were correlated with longer PFS in SEA patients, a trend not observed in the TCGA-UM cohort. BAP1 loss was detected in 20% of cases and was associated with reduced survival rates, consistent with TCGA data.

Conclusions: This study highlights significant genetic differences between SEA and Western UM patients, particularly the lower incidence of monosomy 3 in SEA patients. This preliminary observation raises concerns about the reliability of using BAP1 loss alone, assessed through gene expression or immunostaining, as a sole marker for metastasis surveillance and risk stratification in Asian UM patients. These findings underscore the need for further research to determine whether additional genetic markers are required to improve prognostic accuracy in this population. Expanding molecular profiling in SEA would improve risk stratification and inform treatment strategies, while collaborative research with larger cohorts is essential to validate these findings and refine prognostic models globally.

Background: Acute acquired comitant esotropia (AACE) can significantly impair binocular vision, and its prevalence is increasing. This study aims to compare the effectiveness of botulinum toxin (BTX) injections with strabismus surgery in patients diagnosed with AACE and to investigate the factors predicting success.

Methods: Sixty AACE patients were included in this prospective comparative clinical study. Twenty-seven patients underwent incisional strabismus surgery (surgery group) and 33 patients received BTX injection (chemodenervation group). Patients were followed up visit at 1, 3, and 6 months post-treatment. The primary outcome was the success rate at 6 months post-treatment, defined as a horizontal deviation of 10 prism diopters (PD) or less with confirmed binocular single vision. Secondary outcomes included risk factors for the recurrence of AACE.

Results: The present study included 27 patients in the surgery group and 33 in the chemodenervation group. No significant differences were observed in the motor success rate at 1 and 3 months post-treatment between the two groups. However, the surgery group had a significantly higher motor success rate compared to the chemodenervation group at 6 months post-treatment (100% vs. 69.7%, P < 0.001). The success rate of achieving stereopsis at near ≤ 100 arcsec in the chemodenervation group was significantly higher than in the surgery group at 1 month post-treatment (51.5% vs. 14.8%, P < 0.001). By the 6 months post-treatment, no significant differences were observed in sensory outcomes between the chemodenervation and surgery groups (P > 0.05 for all). In the chemodenervation group, patients with an anisometropia less than 1 dioptor (D)demonstrate significantly higher motor success rate, and better sensory outcomes, including stereopsis at near (84%, 21/25) and stereopsis at near ≤ 100 arcsec (56%, 14/25), compared to those with anisometropia of 1 D or more (P = 0.044).

Conclusion: The success rate after BTX injection was similar to that of surgery for 3 months but lower at 6 months post-treatment. Patients who received BTX showed restoration of stereopsis within the initial first postoperative month, with sustained preservation of this function across 6 months post-treatment. Anisometropia of 1 D may indicate suitability for BTX injection as a preferred treatment option for AACE. Trial registration This study was registered on the Chinese Clinical Trial Registry (ChiCTR2100053717. Registered 28 November 2021. https://www.chictr.org.cn/showprojEN.html?proj=140975 ).