Eye and Vision最新文献

Background: To investigate and compare the corneal denervation, tear neuromediators, and ocular surface changes following corneal lenticule extraction for advanced refractive correction (CLEAR) versus small incision lenticule extraction (SMILE).

Methods: In this randomized clinical trial, 19 patients were randomized to undergo CLEAR in one eye and SMILE in the other eye. Ocular surface assessments, in vivo confocal microscopy for seven corneal nerve parameters, four corneal dendritic cell parameters, three corneal epithelial parameters, and tear neuromediator analysis were performed preoperatively and 1, 3, 6 and 12 months postoperatively.

Results: There were no significant differences in all ocular surface assessments between CLEAR and SMILE throughout postoperative 1 year. CLEAR and SMILE led to significant and comparable reductions of corneal nerve fiber density (CNFD), nerve branch density, total branch density, nerve fiber length, area, and fiber fractal dimension, which did not restore even at 1 year. The reduction in CNFD was significantly correlated with the corrected spherical equivalent in both surgical types. Although post-SMILE eyes had significantly higher nerve growth factor concentrations at 1 month, there was no significant difference in substance P and calcitonin gene-related peptide (CGRP) concentrations between SMILE and CLEAR.

Conclusions: CLEAR and SMILE had comparable effects on ocular surface, corneal denervation and postoperative neuroinflammation. Corneal nerve metrics did not restore even at 1 year for both procedures.

Trial registration number: ClinicalTrials.gov NCT06774651, registration on 14 January 2025, https://clinicaltrials.gov/study/NCT06774651 .

Background: This study investigated how clinical and genetic factors impact the effectiveness of orthokeratology lenses in myopia.

Methods: A retrospective clinical study was conducted with a sample of 545 children aged 8-12 years who had myopia and have initially worn orthokeratology lenses for one year. Whole-genome sequencing (WGS) was also performed on 60 participants in two groups, one with rapid axial length (AL) progression of larger than 0.33 mm and the other with slow AL progression of less than 0.09 mm. The RetNet database was used to screen candidate genes that may contribute to the effectiveness of orthokeratology lenses in controlling myopia.

Results: Children with greater baseline AL, greater spherical equivalent (SE) and greater age had better myopia control with orthokeratology lenses. A significant excess of nonsynonymous variants was observed among those with slow myopia progression, and these were prominently enriched in retinal disease-related genes. Subsequently, RIMS2 [odds ratio (OR) = 0.01, P = 0.0097] and LCA5 (OR = 9.27, P = 0.0089) were found to harbor an excess number of nonsynonymous variants in patients with slow progression of high myopia. Two intronic common variants rs36006402 in SLC7A14 and rs2285814 in CLUAP1 were strongly associated with AL growth. The identification of these novel genes associated with the effectiveness of orthokeratology lens therapy in myopic children provides insight into the genetic mechanism of orthokeratology treatment.

Conclusion: The effectiveness of orthokeratology lens treatment relates to interindividual variability in the control of AL growth in myopic eyes. The efficacy increased when patients carried more nonsynonymous variants in retinal disease-related gene sets. These data serve as reference for genetic counselling and the management of patients who choose orthokeratology lenses to control myopia.

Background: To present the iridectomy combined with posterior approach anterior chamber gas injection technique for the treatment of extensive Descemet's membrane detachment (DMD), which is a novel surgical approach for the management of DMD after phacoemulsification.

Case presentation: The surgical technique was performed on a 68-year-old female with a history of cataract phacoemulsification surgery and two times of anterior chamber gas injection to treat DMD. After creating a scleral tunnel at 4 o'clock of the limbus, the iris root in that direction was cut off. This was confirmed via an iris root incision indicating that the syringe needle entered the posterior chamber through the scleral tunnel. The anterior chamber was filled about 3/4 with 16% C3F8. After surgery, patients were required to maintain a supine position without pillows. One month post-surgery, the cornea was transparent, DMD had fully recovered, and the best corrected visual acuity improved to 20/20.

Conclusions: The iridectomy combined with a posterior approach anterior chamber gas injection technique can be used as an alternative surgical option for the management of extensive DMD in patients who have undergone several ineffective anterior chamber gas injection surgeries.

Purpose: To evaluate myopia control efficacy in myopic children wearing spectacle lenses with highly aspherical lenslets (HAL) for 5 years.

Methods: This is a randomized, double-masked extended trial. Myopic children aged 8 to 13 years who were originally allocated to the HAL group in the 2-year clinical trial. The HAL group underwent a 5-year assessment for myopia progression using cycloplegic spherical equivalent refraction (SER) and axial length (AL). An extrapolated single-vision spectacle lenses (ESVL) group was used as a control group. The 5-year myopia progression and axial elongation of the ESVL group was calculated based on the 2-year data from the single-vision spectacle lenses group in the same clinical trial, and the data for the following 3 years was estimated by assuming an annual reduction in SER by 9.7% and in AL by 15%. A generalized linear model approach was used to evaluate the treatment efficacy. The validity of the ESVL group was evaluated by comparing myopia progression in the first year of the 3-year estimates with a single-vision spectacle lenses (SVL2) group from a 1-year extended study of the same clinical trial.

Results: Forty-three participants from the original HAL group completed the 5-year visit (74%). Five-year myopia progression [mean ± standard error (SE)] in the HAL group was - 1.27 ± 0.14 D. Compared with the ESVL (- 3.03 ± 0.18 D), myopia progression was - 1.75 ± 0.24 D less for the HAL group (P < 0.001). The mean AL elongation over 5 years was 0.67 ± 0.06 mm for the HAL group compared with 1.40 mm in the ESVL group (P < 0.001), AL elongation was slower by 0.72 ± 0.10 mm for the HAL group (P < 0.001). No significant differences were found for myopia (- 0.58 ± 0.04 D vs. - 0.56 ± 0.05 D) or AL elongation (0.28 ± 0.02 mm vs. 0.28 ± 0.02 mm) between the ESVL group and SVL2 group (P_SER = 0.83; P_AL = 0.93) in year 3.

Conclusions: In this 5-year study, HAL spectacles reduced the rate of myopia progression and axial elongation, preventing the equivalent of 3 years of myopia progression and axial elongation. Long-term use of HAL spectacles also decreased the incidence of high myopia. Extrapolated control groups are valid for evaluating myopia progression in long-term studies. Trial registration The study was registered at the Chinese Clinical Trial Registry (ChiCTR2100047262), https://www.chictr.org.cn/showproj.html?proj=127182 .

Background: In patients with Fuchs endothelial corneal dystrophy (FECD), the most beneficial stage to perform Descemet membrane endothelial keratoplasty (DMEK) remains uncertain. The goal of this study was to compare the surgical outcomes after DMEK in FECD patients with subclinical corneal edema and clinical corneal edema to test the hypothesis of whether performing surgery in subclinical corneal edema stages achieves better surgical outcomes.

Methods: In this prospective, observational, single-institution cohort study, 106 pseudophakic eyes of 85 patients with FECD were divided into two groups depending on the presence of preoperative subclinical and clinical corneal edema. Subclinical corneal edema was diagnosed if more than one of the following criteria was present in Scheimpflug tomography: loss of regular isopachs, displacement of the thinnest point of the cornea, and focal posterior corneal surface depression. Clinical corneal edema was diagnosed with slit-lamp biomicroscopy. The primary outcome was the corrected distance visual acuity (CDVA) 4 months after DMEK. Secondary outcomes were central corneal thickness (CCT), thinnest corneal thickness (TCT), and total corneal density (TCD) in Scheimpflug tomography, as well as endothelial cell loss (ECL) and the re-bubbling rate. The differences between both groups were analyzed using clustered Wilcoxon rank-sum tests or a Chi-squared test.

Results: Postoperative CDVA was significantly better in the group with subclinical edema (0.18 ± 0.12 logMAR) compared to the group with clinical edema (0.24 ± 0.19 logMAR; P = 0.026). Four months after DMEK, TCD was higher in the group with preoperative clinical edema [31.7 ± 8.3 gray scale units (GSU)] compared to the group with subclinical edema (27.8 ± 6.1 GSU; P = 0.005). The postoperative CCT, TCT, ECL, and re-bubbling rates did not differ significantly between both groups (all P > 0.05).

Conclusions: DMEK for FECD yielded better visual acuity after 4 months when performed in the early stage of FECD compared to a later stage with clinical edema. This may be attributable to persistent corneal fibrosis after DMEK in eyes with preoperative clinically evident corneal edema, as suggested by higher postoperative corneal density in eyes with clinical edema. Consequently, the findings advocate for the consideration of earlier DMEK in FECD patients to achieve better surgical recovery.

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.