Eye and Vision最新文献

Background: To investigate the functional results of the AcrySof IQ Vivity (Alcon, Fort Worth, TX) extended depth-of-focus intraocular lens (EDoF-IOL) and explore correlations between the preoperative biometric parameters and the postoperative functional outcomes.

Methods: In a prospective, single-center, non-randomized study, axial length, keratometry, anterior chamber depth, scotopic and photopic pupil diameters, pupil decentration, corneal asphericity, corneal higher-order aberrations (HOAs), coma and spherical aberration were measured preoperatively. The EDoF-IOL was implanted bilaterally. Three months postoperatively, manifest refraction, monocular and binocular uncorrected and corrected visual acuity at 4 m, 66 cm and 40 cm, binocular defocus curve, binocular contrast sensitivity, halometry and Strehl ratio were measured. Visual disturbances and spectacle independence were assessed with McAlinden and IOLSAT questionnaires, respectively. Assuming a minimum Pearson r correlation coefficient between variables of 0.5 with a power of 80% and a P value less than 0.05, a minimum sample size of 29 (58 eyes) cases was required.

Results: Forty-three patients were enrolled. Binocular distance corrected visual acuity was lower than 0.1 logMAR for a defocus between + 1.0 and - 1.5 D. The mean values at 66 cm and 40 cm were - 0.07 ± 0.06 and 0.19 ± 0.13 logMAR, respectively. McAlinden's questionnaire revealed mean scores close to zero for all questions. The IOLSAT questionnaire showed that spectacles were never used for distance and intermediate vision. Regression analysis did not disclose any significant correlation between the preoperatively measured variables and the postoperative outcomes, with a few exceptions: preoperative higher order corneal aberrations were correlated to halometry area (r² = 0.2592, P = 0.0006) and the Q value to contrast sensitivity (r² = 0.1717, P = 0.00574) under photopic conditions with glare at a spatial frequency of 18 cpd and without glare for all spatial frequencies (P < 0.01); it was also correlated to contrast sensitivity under mesopic conditions without glare at a spatial frequency of 12 cpd (r² = 0.2311, P = 0.0011).

Conclusions: In healthy unoperated eyes, the visual outcomes for this EDoF-IOL are independent of most of the patients' preoperative parameters. Attention should be paid to preoperative corneal aberrations and asphericity, which did not lead to visual disturbances, but may be potential sources of halo and reduced contrast sensitivity.

Background: To assess the safety and efficacy of phakic refractive lens (PRL) implantation for correcting high myopia, as well as an ophthalmic viscosurgical device-free (OVD-free) method for PRL implantation.

Methods: In this real-world prospective study, consecutive patients implanted with PRL in one or both eyes were enrolled. Based on the surgical techniques used, the eyes were divided into the OVD-free method group and the conventional method group. The patients were examined 2 h after surgery and were scheduled for follow-up at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months. The corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), the manifest refraction spherical equivalent (MRSE), intraocular pressure (IOP) and lens vault were assessed postoperatively. Corneal endothelial cell density (ECD) was measured at the 3- and 12-month postoperative visits.

Results: Fifty-seven consecutive patients (108 eyes) were enrolled. At the 3-month postoperative visit, both mean UDVA and CDVA were significantly improved after PRL implantation (0.19 ± 0.21 and 0.01 ± 0.14 logMAR) with efficacy index and safety index of 0.92 and 1.30, respectively. None of the eyes had any loss of CDVA. The percentage of eyes within ± 0.50 D and ± 1.00 D of target refraction was 58% and 83%, respectively. Mean MRSE changed from - 14.49 ± 4.22 D, preoperatively, to - 1.22 ± 1.26 D at 1 day (P < 0.001) and remained stable thereafter. Mean endothelial cell loss was 11.3%, 9.6%, respectively, at 3 and 12 months, with no significant difference between the two follow-ups (P = 0.395). Fifty-nine eyes received the OVD-free method, and 49 eyes received the conventional method. The OVD-free method demonstrated a significant reduction in the incidence of early acute IOP elevations (28.8% vs. 53.1%, P = 0.022) compared to the conventional method. The difference of initial endothelial cell loss (9.4 ± 14.2% vs. 13.6 ± 14.6%) between the two groups trended toward significance (P = 0.056). In both groups, no other major complications were observed up to 12-month follow-up.

Conclusions: PRL implantation was a safe, efficient, predictable and stable method for correcting high myopia. The potential of lower incidence of early acute IOP elevations makes the OVD-free method a promising alternative to the conventional method.

Trail registration: Chinese Clinical Trial Registry, ChiCTR2100043600. Registered on 23 February 2021, https://www.chictr.org.cn/showproj.html?proj=122229.

Background: To assess the repeatability and reproducibility of the Colombo IOL biometer (Moptim, China), which utilizes spectral-domain optical coherence tomography (SD-OCT), in measuring ocular parameters of normal subjects and to compare its agreement with the swept-source optical coherence tomography (SS-OCT)-based IOLMaster 700 biometer (Carl Zeiss Meditec AG, Germany).

Methods: This prospective study included 91 eyes from 91 normal subjects. The evaluated parameters were axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), anterior chamber depth (ACD), lens thickness (LT), flattest and steepest meridian keratometry (Kf and Ks), mean keratometry (Km), astigmatism (AST) magnitude, white-to-white (WTW) distance, and pupil diameter (PD). The within-subject standard deviation (S_w), test-retest repeatability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) were calculated to determine the repeatability and reproducibility. Paired t-tests and Bland-Altman plots with 95% limits of agreement (LoA) were employed to assess the agreement.

Results: With respect to intraobserver repeatability, the S_w and TRT values of all evaluated parameters were low. Except J₄₅ and PD, the ICCs were all higher than 0.928. The reproducibility S_w and TRT values of Colombo IOL were also low, and ICCs were not lower than 0.900. Comparing Colombo IOL and IOLMaster 700, the 95% LoA of AL, CCT, AQD, ACD, LT, Kf, Ks, Km, AST, J₀, J₄₅, WTW and PD ranged from - 0.08 to 0.03 mm, - 21.58 to 5.09 μm, 0.01 to 0.15 mm, - 0.01 to 0.14 mm, - 0.05 to 0.10 mm, - 0.14 to 0.59 D, - 0.31 to 0.40 D, - 0.13 to 0.40 D, - 0.68 to 0.32 D, - 0.09 to 0.34 D, - 0.07 to 0.25 D, 0.11 to 1.47 mm, and - 0.97 to 2.31 mm, respectively.

Conclusion: The new SD-OCT-based Colombo IOL biometer demonstrates excellent repeatability and reproducibility. Moreover, it generally agrees well with the SS-OCT-based IOLMaster 700, except for the WTW and PD measurements.

Purpose: To identify foveal structure-function topographic association and relationship in patients with idiopathic epiretinal membrane (ERM) related to ectopic inner foveal layer (EIFL).

Methods: This was a cross-sectional, observational study that involved 40 individuals with idiopathic ERM: 22 without EIFL (Group 1) and 18 with EIFL (Group 2). Quantitative foveal light sensitivity was measured using microperimetry, and foveal microstructure was assessed using spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). Multiple indices of microvascular parameters of OCTA images were further processed using the AngioTool software. LASSO regression and quantile regression analyses were performed to identify the spatial distribution correlation between foveal light sensitivity and foveal microstructure parameters.

Results: Group 2 exhibited reduced light sensitivity across all parameters of microperimetry compared to Group 1 (P < 0.001). Additionally, the central foveal thickness, the percentage of ellipsoid zone disruption, and the foveal avascular zone area were significantly lower in Group 1 than in Group 2 (all P < 0.005). Compared to Group 1, the vessel density (VD) and perfusion density of the foveal region was significantly increased in Group 2 (P < 0.001). In contrast, Group 2 showed significantly decreased VD in the parafoveal region compared with Group 1 (P < 0.05). Significant differences in OCTA parameters including 'total number of junctions', 'junction density', 'total vessel length', 'average vessel length', 'total number of end points' were observed between Group 1 and Group 2 (all P < 0.01). The foveal light sensitivity was significantly positively correlated with VD in the parafoveal region and negatively correlated with EIFL alteration, best-corrected visual acuity and ellipsoid zone disruption [Log(λ) = - 0.18303, λ = 0.6561].

Conclusions: The presence of EIFL and decreased VD in the parafoveal region, factors that collectively elevate the risk of disease progression, are significantly and independently correlated with reduced microperimetric retinal sensitivity in patients with idiopathic ERM.

Background: Keratoconus (KC) is a prevalent corneal condition with a modest genetic basis. Recent studies have reported significant genetic associations in multi-ethnic cohorts. However, the situation in the Chinese population remains unknown. This study was conducted to identify novel genetic variants linked to KC and to evaluate the potential applicability of a polygenic risk model in the Han Chinese population.

Methods: A total of 830 individuals diagnosed with KC and 779 controls from a Chinese cohort were enrolled and genotyped by whole-genome sequencing (WGS). Common and rare variants were respectively subjected to single variant association analysis and gene-based burden analysis. Polygenic risk score (PRS) models were developed using top single-nucleotide polymorphisms (SNPs) identified from a multi-ethnic meta-analysis and then evaluated in the Chinese cohort.

Results: The characterization of germline variants entailed correction for population stratification and validation of the East Asian ancestry of the included samples via principal component analysis. For rare protein-truncating variants (PTVs) with minor allele frequency (MAF) < 5%, ZC3H11B emerged as the top prioritized gene, albeit failing to reach the significance threshold. We detected three common variants reaching genome-wide significance (P ≤ 5 × 10^-8), all of which are novel to KC. Our study validated three well known predisposition loci, COL5A1, EIF3A and FNDC3B. Additionally, a significant correlation of allelic effects was observed for suggestive SNPs between the largest multi-ethnic meta-genome-wide association study (GWAS) and our study. The PRS model, generated using top SNPs from the meta-GWAS, stratified individuals in the upper quartile, revealing up to a 2.16-fold increased risk for KC.

Conclusions: Our comprehensive WGS-based GWAS in a large Chinese cohort enhances the efficiency of array-based genetic studies, revealing novel genetic associations for KC and highlighting the potential for refining clinical decision-making and early prevention strategies.

Background: Acanthamoeba keratitis (AK) is the most challenging corneal infection to treat, with conventional therapies often proving ineffective. While photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) with riboflavin/UV-A has shown success in treating bacterial and fungal keratitis, and PACK-CXL with rose bengal/green light has demonstrated promise in fungal keratitis, neither approach has been shown to effectively eradicate AK. This case study explores a novel combined same-session treatment approach using both riboflavin/UV-A and rose bengal/green light in a single procedure.

Case presentation: A 44-year-old patient with active AK in the left cornea, unresponsive to 10 months of conventional treatment according to American Academy of Ophthalmology (AAO) guidelines, was treated using same-session sequential PACK-CXL with riboflavin/UV-A (365 nm) irradiation (10 J/cm²) and rose bengal/green light (522 nm) irradiation (5.4 J/cm²) in a single setting. The procedure was repeated twice due to persistent signs of inflammation and infection. After three combined same-session PACK-CXL treatments, the patient's cornea converted to a quiescent scar, and symptoms of ocular pain, photophobia, epiphora, and blepharospasm resolved. Confocal microscopy revealed no detectable Acanthamoeba cysts. The patient currently awaits penetrating keratoplasty.

Conclusions: The same-session combination of riboflavin/UV-A and rose bengal/green light PACK-CXL effectively treated a patient with confirmed AK that was resistant to conventional medical therapy, suggesting that using two chromophores in a single procedure may represent a future treatment alternative for AK.

Purpose: To explore the associations between myopia defocus dosage (MDD), aberration coefficients (primary spherical aberration and coma), and axial elongation in children undergoing orthokeratology (ortho-k) with back optic zone diameters (BOZD) of 5 mm and 6 mm over 2 years.

Methods: Data from 80 participants from two ortho-k studies were analyzed: 22 and 58 children wore lenses with 5-mm and 6-mm BOZD, respectively. Four MDD metrics were calculated from corneal topography data over a 5-mm pupil for the 1-month and 24-month visits: the circumferential, flat, steep, and volumetric MDD. Corneal primary spherical aberration and comatic aberrations were also extracted from topography data over a 5-mm pupil. Linear mixed modelling was performed to explore the associations between the MDD, corneal aberrations, and axial elongation over 2 years, while controlling for confounding factors (e.g., baseline age and sex).

Results: Participants in the 5-mm BOZD group displayed less axial elongation than the 6-mm BOZD group over 2 years (0.15 ± 0.21 mm vs. 0.35 ± 0.21 mm, P < 0.001). A greater volumetric MDD was observed in the 5-mm BOZD group compared with the 6-mm BOZD group at the 1- and 24-month visits (both P < 0.001). No significant differences were observed between the two groups for the other MDD metrics or corneal aberration coefficients (all P > 0.05). Less axial elongation was associated with a greater volumetric MDD at the 1- and 24-month visits (both β = -0.01, P < 0.001 and P = 0.001), but not with any other MDD metrics or corneal aberrations (all P > 0.05).

Conclusions: The volumetric MDD over a 5-mm pupil after 1 month of ortho-k lens wear was associated with axial elongation after 24 months, and may be a useful predictor of future axial elongation in children undergoing ortho-k.

Background: To investigate the anatomical and functional outcomes of macular hole-associated retinal detachment (MHRD) after vitrectomy using the inverted internal limiting membrane (ILM) flap technique with autologous blood clot (ABC).

Methods: This retrospective observational study included 80 eyes with MHRD that underwent vitrectomy with ILM flap without (46 eyes) or with ABC (34 eyes). Fundus photography and optical coherence tomography were evaluated. The pre- and postoperative best-corrected visual acuities (BCVAs) and BCVA improvement were compared between the two groups.

Results: The MH closure rates after initial surgery were similar in the ILM flap group and ILM flap with ABC group [40 (87%) vs. 29 (85%) eyes, respectively]. The proportion of eyes with hyperreflective bridging tissue (HBT) was lower in the ILM flap group than ILM flap with ABC group [13 (32%) vs. 16 (55%) eyes, P = 0.060]. The postoperative improvement in BCVA was significantly better in the ILM flap group (P = 0.027). Multiple linear regression analysis revealed that preoperative BCVA was positively associated with postoperative improvement in BCVA (β = 0.638, P = 0.000), while the ILM flap with ABC technique was negatively associated with postoperative improvement in BCVA (β =  - 0.299, P = 0.039, adjusted r² = 0.415).

Conclusions: The inverted ILM flap technique alone resulted in better foveal configurations and visual outcomes than the ILM flap technique combined with ABC in patients with MHRD.

Over the past two decades, both suture and sutureless techniques for scleral fixation of intraocular lenses have seen significant advancement, driven by improvements in methodologies and instrumentation. Despite numerous reports demonstrating the effectiveness, safety, and superiority of these techniques, each approach carries with it its own drawbacks, including an elevated risk of certain postoperative complications. This article delves into various surgical techniques for scleral fixation of posterior chamber intraocular lenses, discussing their procedural nuances, benefits, drawbacks, postoperative complications, and outcomes. Furthermore, a comparative analysis between suture and sutureless fixation methods is presented, elucidating their respective limitations and associated factors. It is hoped that this comprehensive review will offer clinicians guidance on how to individualize procedural selection and mitigate surgical risks, and thus achieve optimal visual outcomes. This review will also endeavor to provide guidance for future advancements in intraocular lens fixation techniques.

Background: This article describes a rare occurrence of bilateral retinal occlusive vasculitis secondary to intravitreal faricimab injection.

Case presentation: A 72-year-old female with age-related macular degeneration presented with bilateral retinal occlusive vasculitis following intravitreal faricimab injections. The patient was treated with 3 days of intravenous methylprednisolone followed by oral prednisolone taper and topical steroid therapy. Resolution of retinal occlusive vasculitis was observed 2 months post treatment.

Conclusions: Retinal occlusive vasculitis is a rare complication of intravitreal anti-vascular endothelial growth factor (anti-VEGF), particularly with faricimab injections. We also present a review of literature regarding retinal occlusive vasculitis following intravitreal anti-VEGF injections and propose further information regarding its pathophysiology.