Graefe's Archive for Clinical and Experimental Ophthalmology最新文献_第2页

Changing indications for keratoplasty: monocentric analysis of the past two decades 角膜移植适应症的变化：过去二十年的单中心分析

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-09-14 DOI: 10.1007/s00417-024-06639-y

Jan Vincent Hoffmann, Paola Kammrath Betancor, Philip Maier, Thabo Lapp, Sonja Heinzelmann, Daniel Böhringer, Stefan Lang, Thomas Reinhard

<h3 data-test="abstract-sub-heading">Purpose</h3><p>Over the past two decades, lamellar keratoplasty procedures, such as Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK) as well as Deep Anterior Lamellar Keratoplasty (DALK), have become an integral part of clinical practice. With advances in contact lens fitting for keratoconus management and the implementation of UVA-Riboflavin Crosslinking (CXL), the landscape of keratoplasty indications is undergoing changes. Procedures and indications in a single tertiary care center over the past two decades are reviewed in this retrospective analysis. Methods: Retrospective analysis utilized anonymized electronic data from the LIONS cornea bank Baden-Württemberg, Eye Center Freiburg, spanning from beginning of 2004 to end of 2023. The primary focus was on surgical procedures and indications for keratoplasty.</p><h3 data-test="abstract-sub-heading">Results</h3><p>The study encompassed a comprehensive analysis of 7130 corneal transplants. Penetrating keratoplasty (PK) exhibited a significant decline from 95% (<i>n</i> = 206, 2004) to 11% (<i>n</i> = 46, 2023), while DMEK increased from 48% (<i>n</i> = 157, 2012) to 82% (<i>n</i> = 347, 2023). Fuchs endothelial dystrophy (FED) emerged as the dominant indication, witnessing a significant increase from 24% (2004, <i>n</i> = 39) to 72% (2023, <i>n</i> = 288). Conversely, keratoconus (KC) showed a reciprocal change from 25% (2004, <i>n</i> = 40) to 4% (2023, <i>n</i> = 17). PK demonstrated a noteworthy indication shift in descending order from Bullous Keratopathy (BK), FED, and KC in 2004 to KC, graft failure, corneal scars, and ulcers in 2023. Repeat keratoplasty following DMEK remained rare, but a discernible upward trend was observed for PK.</p><h3 data-test="abstract-sub-heading">Conclusion</h3><p>This retrospective analysis highlights significant changes in both keratoplasty indications and techniques over the past two decades. DMEK has emerged as a successful intervention for treating endothelial diseases, while PK retains its qualitative indispensability for a wide range of indications. Modern corneal banks are urged to maintain a robust supply of grafts for all surgical techniques in anticipation of potential increased demand in the future, particularly for repeat keratoplasties.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><b><i>What is known</i></b></p><p>• Over the past two decades, lamellar keratoplasty procedures such as DSAEK and DMEK have increasingly replaced penetrating keratoplasty (PK) in clinical practice due to their improved outcomes and reduced complications for certain indications.</p><p><b><i>New Findings</i></b></p><p>• Our study reveals a significant shift in keratoplasty indications, with Fuchs endothelial dystrophy (FED) emerging as the predominant indication, increasing from 24% in 2004 to 72% in 2023, while keratoconus (KC) declined from 25 to 4% du

目的在过去的二十年里，板层角膜成形术，如戴斯麦剥离自动内皮角膜成形术（DSAEK）和戴斯麦膜内皮角膜成形术（DMEK）以及深前板层角膜成形术（DALK），已成为临床实践中不可或缺的一部分。随着用于角膜病治疗的隐形眼镜验配技术的进步以及 UVA-核黄素交联术（CXL）的实施，角膜成形术的适应症也在发生变化。本回顾性分析回顾了一家三级医疗中心过去二十年的手术和适应症。方法：回顾性分析采用了弗莱堡眼科中心巴登-符腾堡州 LIONS 角膜库的匿名电子数据，时间跨度为 2004 年初至 2023 年末。研究的主要重点是角膜移植手术的手术过程和适应症。结果该研究全面分析了 7130 例角膜移植手术。穿透性角膜移植术（PK）从 95% （n = 206，2004 年）显著下降到 11%（n = 46，2023 年），而 DMEK 从 48% （n = 157，2012 年）上升到 82%（n = 347，2023 年）。福氏内皮营养不良症（FED）成为主要适应症，从24%（2004年，样本数=39）大幅增至72%（2023年，样本数=288）。相反，角膜病（KC）则出现了相反的变化，从25%（2004年，样本数=40）下降到4%（2023年，样本数=17）。PK 显示了一个值得注意的适应症变化，即从 2004 年的大疱性角膜病 (BK)、FED 和 KC 到 2023 年的 KC、移植失败、角膜疤痕和溃疡。DMEK术后重复角膜移植术仍然很少见，但PK术后重复角膜移植术呈明显上升趋势。DMEK 已成为治疗角膜内皮疾病的成功方法，而 PK 则在广泛的适应症中保留了其不可或缺的特质。我们敦促现代角膜库为所有手术技术保持充足的移植物供应，以应对未来可能增加的需求，尤其是重复角膜成形术的需求。已知信息- 在过去的二十年里，由于 DSAEK 和 DMEK 等板层角膜成形术在某些适应症方面的疗效更好、并发症更少，它们在临床实践中越来越多地取代了穿透性角膜成形术（PK）。新发现--我们的研究显示，角膜成形术的适应症发生了重大变化，福氏内皮营养不良症（FED）成为最主要的适应症，从 2004 年的 24% 增加到 2023 年的 72%，而同期的角膜炎（KC）则从 25% 下降到 4%。- 穿透性角膜塑形术（PK）的使用率明显下降，从 2004 年占角膜塑形术的 95% 下降到 2023 年的 11%，而 DMEK 则增长到 2023 年占手术的 82%。

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引用次数: 0

Compliance with rigid gas-permeable contact lens use in children younger than 6 years in China: a 6-year retrospective study 中国 6 岁以下儿童配戴硬性透气接触镜的依从性：一项为期 6 年的回顾性研究

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-09-11 DOI: 10.1007/s00417-024-06637-0

Xiao-Di Yang, Yong Lyu, Guang-Ming Wan

Purpose

To explore the abandonment rate and factors influencing the use of rigid gas-permeable contact lenses (RGPCL) among children aged < 6 years.

Methods

This retrospective case series study included 70 children aged < 6 years who were fitted with RGPCL for visual rehabilitation between January 2016 and December 2021. We collected data on indications, discontinuation rates, and reasons for discontinuation from medical records and via telephone calls and investigated the factors influencing contact lens abandonment.

Results

The median age of the 70 participants was 5.0 (interquartile range: 4.0–5.9) years. Further, 36 (51.4%) children stopped wearing contact lenses; among them, 17 (47.2%) stopped within 3 months, and the median duration of lens wearing was 4.0 (interquartile range: 1.0–11.5) months. Additionally, there was a correlation between the duration of lens wearing and lens abandonment (r = -0.698, P < 0.001). A high parental education level (hazard ratio [HR] = 0.425; 95% confidence interval [CI] 0.198, 0.913; P = 0.028) was a protective factor against lens abandonment, while parental assessment indicating harder than expected practicality (HR = 4.062; 95% CI 1.204, 13.707; P = 0.024) was a risk factor for abandonment.

Conclusion

Children aged < 6 years are susceptible to early discontinuation of RGPCL use. Since parents perform daily lens manipulation, they are crucial to the continuity of lens use in these children. To improve RGPCL use continuity, communication and supervision should be strengthened before and after RGPCL fittings.

目的探讨6岁儿童放弃使用硬性透气接触镜（RGPCL）的比率和影响因素。方法这项回顾性病例系列研究纳入了70名在2016年1月至2021年12月期间配戴RGPCL进行视力康复的6岁儿童。我们通过医疗记录和电话收集了有关适应症、停戴率和停戴原因的数据，并调查了影响隐形眼镜弃戴的因素。结果70名参与者的中位年龄为5.0（四分位距：4.0-5.9）岁。此外，36 名（51.4%）儿童停止佩戴隐形眼镜，其中 17 名（47.2%）在 3 个月内停止佩戴，佩戴时间的中位数为 4.0 个月（四分位间范围：1.0-11.5 个月）。此外，戴镜时间与弃镜率之间存在相关性（r = -0.698，P < 0.001）。父母受教育程度高（危险比 [HR] = 0.425; 95% 置信区间 [CI] 0.198, 0.913; P = 0.028）是防止弃镜的保护因素，而父母的评估表明实用性比预期的要难（HR = 4.062; 95% CI 1.204, 13.707; P = 0.024）则是弃镜的风险因素。由于父母每天都要操作镜片，因此他们对这些儿童持续使用镜片至关重要。为了提高 RGPCL 使用的连续性，应在 RGPCL 配戴前后加强沟通和监督。

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引用次数: 0

Polypseudophakia: from “Piggyback” to supplementary sulcus-fixated IOLs 多发性假性角膜病：从 "猪背式 "到辅助沟固定式人工晶体

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-09-11 DOI: 10.1007/s00417-024-06618-3

Ramin Khoramnia, Guenal Kahraman, Michael Amon, Grzegorz Łabuz, Isabella D. Baur, Gerd U. Auffarth

<h3 data-test="abstract-sub-heading">Abstract</h3><p>Polypseudophakia, the concept of using a second intraocular lens (IOL) to supplement an IOL that has already been placed in the capsular bag, was first used as a corrective measure where the power requirement was higher than that of available single IOLs. Subsequently, the technique was modified to compensate for post-operative residual refractive errors. In these early cases, an IOL designed for the capsular bag would be implanted in the sulcus. Although these approaches were less than ideal, alternative means of correcting residual refractive errors were not without their limitations: IOL exchange can be traumatic to the eye and is not easily carried out once fibrosis has occurred, while corneal refractive surgical techniques are not suitable for all patients. Piggyback implantation was the term first coined to describe the use of two IOLs, placed together in the capsular bag. The term was later extended to include the procedure where an IOL designed for the capsular bag was placed in the sulcus. Unfortunately, the term piggyback has persisted even though these two approaches have been largely discredited. Intraocular lenses are now available which have been specifically designed for placement in the ciliary sulcus. As these newer IOLs avoid the many unacceptable complications brought about by both types of earlier piggyback implantation, it is time to employ a new terminology, such as supplementary IOL or secondary enhancement to distinguish between the placement of an unsuitable capsular bag IOL in the sulcus and the implantation of an IOL specifically designed for ciliary sulcus implantation. In addition to minimising possible complications, supplementary IOLs designed for the sulcus have expanded the options available to the ophthalmic surgeon. With these new IOLs it is possible to correct presbyopia and residual astigmatism, and to provide temporary correction of refractive errors in growing, or unstable, eyes. This article aims to review the literature available on supplementary IOL implantation in the ciliary sulcus and to summarise the evidence for the efficacy and safety of this intervention.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><b><i>What is known</i></b></p><ul><li><p>Polypseudophakia has been used for over 30 years to correct hyperopia or residual refractive error, but early techniques were associated with significant complications.</p></li></ul><p><b><i>What is new</i></b></p><ul><li><p>The development of specially designed sulcus-fixated supplementary IOLs significantly reduces the risks associated with these procedures, and has also opened up new opportunities in patient care.</p></li><li><p>The reversibility of the procedure allows patients to experience multifocality, and to provide temporary and adjustable correction in unstable or growing eyes.</p></li><li><p>The terms “secondary enhancement” or “DUET” to describe supplementary IOL implant

摘要假性角膜屈光不正（polypseudophakia）的概念是使用第二个眼内人工晶体（IOL）来补充已放入囊袋的人工晶体，它最初是作为一种矫正措施，用于矫正功率要求高于现有单个人工晶体的情况。随后，该技术进行了改进，以补偿术后残余屈光不正。在这些早期病例中，专为囊袋设计的人工晶体被植入沟内。虽然这些方法并不理想，但其他矫正残余屈光不正的方法也并非没有局限性：人工晶体置换可能会对眼睛造成创伤，而且一旦发生纤维化就不容易进行，而角膜屈光手术技术也并非适合所有患者。背负式人工晶体植入术（Piggyback implantation）这一术语最早是用来描述将两个人工晶体一起植入囊袋的情况。后来，该术语被扩展到包括将设计用于囊袋的人工晶体植入沟内的手术。遗憾的是，尽管这两种方法在很大程度上已被否定，但 "背负式 "一词却一直存在。现在已经有了专门设计用于在睫状沟内放置的人工晶体。由于这些较新的人工晶体避免了早期两种背负式植入术带来的许多不可接受的并发症，因此现在应该使用新的术语，如补充人工晶体或二次增强，以区分在沟内植入不合适的囊袋人工晶体和植入专门为睫状沟植入设计的人工晶体。除了最大限度地减少可能出现的并发症外，专为睫状沟设计的辅助人工晶体还扩大了眼科医生的选择范围。使用这些新型人工晶体可以矫正老花眼和残余散光，还可以暂时矫正发育期或不稳定眼球的屈光不正。本文旨在回顾有关在睫状沟植入辅助性人工晶体的现有文献，并总结这种干预措施的有效性和安全性的证据。已知信息聚假性角膜用于矫正远视或残余屈光不正已有 30 多年的历史，但早期的技术与严重的并发症有关。这种手术的可逆性让患者体验到多焦点性，并为不稳定或成长中的眼睛提供临时和可调整的矫正。"二次增强 "或 "DUET "是描述辅助人工晶体植入术的术语，优于 "搭载"。

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引用次数: 0

Risk factors for early and late retinal detachment after boston type I keratoprosthesis surgery 波士顿 I 型角膜移植手术后视网膜早期和晚期脱离的风险因素

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-09-11 DOI: 10.1007/s00417-024-06613-8

Eva Calpe, Jorge Fernández-Engroba, Gemma Julio, Josip Pavan, Clara Bonel, Rafael I. Barraquer

<h3 data-test="abstract-sub-heading">Purpose</h3><p>To determine the differential risk factors for retinal detachment (RD) after Boston Type 1 Keratoprosthesis (B1KPro) during the first year after surgery (early RD; ERD) and afterwards (late RD; LRD).</p><h3 data-test="abstract-sub-heading">Methods</h3><p>Retrospective cohort study of 94 eyes (90 patients) undergoing B1KPro implantation at Centro de Oftalmología Barraquer from June 2006 to July 2022 with a minimum follow-up of one year.</p><h3 data-test="abstract-sub-heading">Results</h3><p>The incidence of RD in the whole sample after B1KPro implantation was 29% (27/94), occurring in 21% of eyes (ERD; 20/94) the first year, and in 7% afterwards (LRD; 7/94). Hypotony was revealed as a significant risk factor for ERD (16/19 = 84%; OR = 14.5, <i>P</i> < 0.0001), together with aphakia (16/20 = 80%; OR = 5.9, <i>P</i> = 0.004), intraocular lens (IOL) removal (4/8 = 50%; OR = 6.2, <i>P</i> = 0.03), previous choroidal detachment (CD; 7/20 = 35%; OR = 35.5, <i>P</i> = 0.001) and previous pars plana vitrectomy (PPV; 15/20 = 75%; OR = 6.6, <i>P</i> = 0.006). Multivariate analysis included hypotony and PPV <i>at any time</i> as variables significantly associated with ERD occurrence. The occurrence of LRD was significantly related to peripheral retinal changes, detected few days before (4/6 = 66%; OR = 65, <i>P</i> < 0.0001).</p><h3 data-test="abstract-sub-heading">Conclusion</h3><p>Hypotony emerged as one of the main factors influencing ERD occurrence after B1KPro implantation. Additionally, previous CD, PPV, aphakia, and IOL removal should be considered to estimate the risk of postoperative retinal detachment. In contrast, peripheral retinal changes after B1KPro seem to be significantly related to LRD occurrence. This study reinforces the need for frequent intraocular pressure evaluation, and comprehensive periodic retinal assessment over time.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><b><i>What is known</i></b></p><ul><li><p>Retinal detachment (RD) is a severe complication after Boston Type 1 Keratoprosthesis (B1KPro) implantation, resulting in a permanent reduction of visual acuity in a clinically relevant percentage of eyes.</p></li><li><p>The time of RD occurrence after B1KPro implantation differs in the literature but is reported to be more common within the first year. Previous aphakia, choroidal detachment, or RD repair, intraocular lens removal, vitritis, or history of Nd-YAG laser have been described as risk factors for RD after B1KPro surgery in samples with varying follow-ups.</p></li></ul><p><b><i>What is new:</i></b></p><ul><li><p>Multivariate analysis in the first year after B1KPro surgery showed hypotony and pars plana vitrectomy <i>at any time</i> as significant risk factors for early RD.</p></li><li><p>Late RD cases, occurring after one year following the B1KPro surgery, seem to be significantly related to peripheral retinal changes suffered a few da

目的确定波士顿1型角膜前列腺移植术（B1KPro）术后第一年（早期视网膜脱离；ERD）和术后第二年（晚期视网膜脱离；LRD）视网膜脱离（RD）的不同风险因素。方法对2006年6月至2022年7月期间在Centro de Oftalmología Barraquer接受B1KPro植入术的94只眼睛（90名患者）进行回顾性队列研究，随访至少一年。结果B1KPro植入术后RD的发生率为29%（27/94），第一年发生率为21%（ERD；20/94），术后发生率为7%（LRD；7/94）。低眼压是 ERD 的重要风险因素（16/19 = 84%；OR = 14.5，P < 0.0001），此外还有无晶体眼（16/20 = 80%；OR = 5.9，P = 0.004）、眼内人工晶体（IOL）摘除（4/8 = 50%；OR = 6.2，P = 0.03）、既往脉络膜脱离（CD；7/20 = 35%；OR = 35.5，P = 0.001）和既往玻璃体旁切除术（PPV；15/20 = 75%；OR = 6.6，P = 0.006）。多变量分析将低眼压和任何时间的 PPV 作为与 ERD 发生显著相关的变量。LRD的发生与几天前发现的周边视网膜变化有明显关系（4/6 = 66%; OR = 65, P < 0.0001）。此外，在估算术后视网膜脱离的风险时，还应该考虑先前的 CD、PPV、无晶体眼和人工晶体摘除。相比之下，B1KPro术后视网膜周边的变化似乎与LRD的发生有很大关系。关键信息已知信息视网膜脱离（RD）是波士顿 1 型角膜前膜（B1KPro）植入术后的一种严重并发症，会导致临床上相关比例的眼睛视力永久性下降。B1KPro 植入术后视网膜脱离发生的时间在文献中不尽相同，但据报道在第一年内更为常见。在随访时间不同的样本中，以前的无晶体眼、脉络膜脱离或RD修复、眼内晶状体摘除、玻璃体炎或Nd-YAG激光史都被描述为B1KPro手术后RD的风险因素。新发现：B1KPro手术后第一年的多变量分析显示，低眼压和任何时候的玻璃体旁切除术都是早期RD的重要风险因素。晚期RD病例发生在B1KPro手术后一年之后，似乎与视力丧失和RD诊断前几天发生的周边视网膜变化有很大关系。

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引用次数: 0

Correction: 170 years of data-mining: history and future. 更正：数据挖掘 170 年：历史与未来。

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-09-10 DOI: 10.1007/s00417-024-06640-5

Bernd Kirchhof

引用次数: 0

Comparison between indocyanine green angiography and optical coherence tomography angiography for the detection of nonexudative macular neovascularization 吲哚青绿血管造影术与光学相干断层血管造影术在检测非渗出性黄斑新生血管方面的比较

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-07-27 DOI: 10.1007/s00417-024-06597-5

Stefan Kickinger, Martin Stattin, Anna-Maria Haas, Daniel Ahmed-Balestra, Michael Jacob, Claus Zehetner, Katharina Krepler, Siamak Ansari-Shahrezaei

What is known

•The prevalence of nonexudative MNV (neMNV) in the opposite eyes of patients with unilateral exudative neovascular AMD (nAMD) ranges from 6 to 27%. The importance of screening and in consequence close monitoring of a detected neMNV is underlined by the 14 to 23-fold risk of conversion to exudative disease, which they carry within the first two years of follow up.

•In the only study designed to compare the sensitivity of OCTA vs. ICGA, 3/41 eyes exhibited neMNV in both modalities and were therefore equally effective.

What is new

•This study showed that in a larger study population of 241 patients the sensitivity of ICGA and OCTA were equal with 80% (32/40) and 83% (33/40), although some neMNV would be missed by solely employing one imaging method.

•Accurate detection of neMNV using multimodal imaging should result in better monitoring of patients who are at high risk of conversion to exudative nAMD.

已知情况 -单侧渗出性新生血管性黄斑病变（nAMD）患者对侧眼非渗出性新生血管性视网膜病变（neMNV）的发病率为 6% 至 27%。在最初两年的随访中，非渗出性新生血管性视网膜病变患者转为渗出性疾病的风险高达 14 至 23 倍，这突出表明了筛查和密切监测已发现的新生血管性视网膜病变的重要性。-这项研究表明，在一个由 241 名患者组成的更大的研究群体中，ICGA 和 OCTA 的灵敏度相当，分别为 80%（32/40）和 83%（33/40），尽管仅使用一种成像方法会漏掉一些新生血管。-使用多模态成像技术准确检测新MNV，应能更好地监测有高风险转为渗出性nAMD的患者。

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引用次数: 0

Invivo generated autologous plasmin enzyme assisted vitrectomy, partial circumferential-oral retinotomy, silicone oil injection in patients with chronic retinal detachment without posterior vitreous detachment 对无玻璃体后脱离的慢性视网膜脱离患者进行体内生成的自体血浆蛋白酶辅助玻璃体切除术、部分周口视网膜切开术和硅油注射术

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-04-17 DOI: 10.1007/s00417-024-06466-1

Cengiz Aras, Fevzi Senturk, Sevil Karaman Erdur, Mahmut Dogramaci, Mehmet Selim Kocabora, Ali Demircan, Yunus Emre Budak

Purpose

To report the results of invivo generated autologous plasmin enzyme(IVAP) assisted vitrectomy, partial circumferential-oral retinotomy and silicone oil injection for surgical treatment of patients with chronic retinal detachment without posterior vitreous detachment(PVD).

Methods

Study was performed in retrospective, comparative manner. A total of 16 consecutive eyes with chronic retinal detachment who had intravitreal injection of 50 µgr of t-PA and 0.1 ml of autologous whole blood, 3 days before surgery, underwent lens extraction with phacoemulsification, IVAP assisted vitrectomy, partial circumferential-oral retinotomy, and silicone oil injection(Study Group) were compared to a similar group of 15 eyes who had undergone vitrectomy, with or without lens extraction and silicone oil injection(Control Group) for the treatment of chronic retinal detachment. Primary outcome measures were initial retinal reattachment and number of operations at postoperative 6 months.

Results

Mean age of 16 patients of whom 7 were female, was 39.31 ± 17.76 years in study group and 15 patients of whom 4 were female, was 35.40 ± 11.92 years (p = 0.607). Mean follow-up time was 10.68 ± 7.15 months in study group and 29.13 ± 18.83 months in control group (p = 0.001). Initial retinal reattachment was achieved in 87.50% (14 out of 16 patients) in the study group, whereas it was 46.66% (7 out of 15 patients) in the control group (p = 0.017). The mean number of operations for reattachment in the study group was 1.12 ± 0.34, whereas it was 1.46 ± 0.51 in the control group (p = 0.039) at postoperative 6 months While the preoperative LogMAR visual acuity was 1.25 ± 0.64, it was 0.53 ± 0.37 at postoperative 6 months in study group (p = 0.001). Conversely, in the control group, the preoperative LogMAR visual acuity was 1.22 ± 0.33, it was 1.20 ± 0.89 at postoperative 6 months (p = 0.780). At postoperative 6 months,, epiretinal membrane developed in 2 eyes of the study group, 1 eye in the control group, and phthisis bulbi occurred in 1 eye of control group.

Conclusion

IVAP assisted vitrectomy, partial circumferential-oral retinotomy and silicone oil injection is effective and safe for the surgical treatment of chronic retinal detachment without PVD.

目的报告体内生成的自体血浆蛋白酶（IVAP）辅助玻璃体切除术、口周视网膜部分切除术和硅油注射术治疗无玻璃体后脱离（PVD）的慢性视网膜脱离患者的结果。连续16例慢性视网膜脱离患者在术前3天进行了50微克t-PA和0.1毫升自体全血的玻璃体内注射，并接受了超声乳化晶状体摘除术、IVAP辅助玻璃体切除术、部分环口视网膜切开术和硅油注射（研究组），与同类的15例接受玻璃体切除术、晶状体摘除术或未接受玻璃体切除术和硅油注射治疗的患者（对照组）进行了比较。结果研究组 16 名患者（其中 7 名女性）的平均年龄为（39.31 ± 17.76）岁，对照组 15 名患者（其中 4 名女性）的平均年龄为（35.40 ± 11.92）岁（P = 0.607）。研究组的平均随访时间为（10.68 ± 7.15）个月，对照组为（29.13 ± 18.83）个月（P = 0.001）。研究组有 87.50%（16 例患者中有 14 例）的患者实现了初次视网膜重接，而对照组只有 46.66%（15 例患者中有 7 例）（P = 0.017）。研究组术后 6 个月的平均再粘连手术次数为 1.12 ± 0.34，而对照组为 1.46 ± 0.51（p = 0.039）。研究组术前的 LogMAR 视力为 1.25 ± 0.64，而对照组术后 6 个月的 LogMAR 视力为 0.53 ± 0.37（p = 0.001）。相反，对照组的术前 LogMAR 视力为 1.22 ± 0.33，术后 6 个月时为 1.20 ± 0.89（p = 0.780）。术后 6 个月时，研究组有 2 只眼睛出现了视网膜外膜，对照组有 1 只眼睛出现了视网膜外膜，对照组有 1 只眼睛出现了鼓室炎。

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引用次数: 0

Histopathological findings of failed blebs after microinvasive bleb surgery with the XEN Gel Stent and Preserflo MicroShunt 使用 XEN 凝胶支架和 Preserflo MicroShunt 进行微创眼泡手术后失败眼泡的组织病理学检查结果

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-04-16 DOI: 10.1007/s00417-024-06479-w

Jonas Neubauer, Daniela Suesskind, Caroline J. Gassel, Emil Nasyrov, Bogomil Voykov

Purpose

The success of XEN Gel Stent (XEN) and Preserflo MicroShunt (Preserflo) implantation depends mainly on the development of bleb fibrosis. This study aimed to describe the histological findings of bleb fibrosis after XEN and Preserflo surgery.

Methods

This retrospective study included patients with different types of glaucoma who underwent revision surgery after XEN or Preserflo implantation. The available clinical information and histological samples of removed fibrotic tissue were analyzed.

Results

Thirty-six patients were included. Revision surgery was performed at a median of 195 (range = 31–1264) days after primary surgery. The mean intraocular pressure changed from 29.1 (± 10.3) mmHg at baseline to 18.3 (± 8.7) mmHg (− 37%; p < 0.0001) and 16.2 (± 4.2) mmHg (− 45%; p < 0.0001) after 6 and 12 months, respectively. Histological analysis revealed an increase in activated fibroblasts and macrophages in all specimens and a parallel orientation of fibroblasts in a minor part of the probe in 60% of the specimens. No pronounced inflammatory reaction in the form of lymphocytic or granulocytic infiltration was observed. The comparison of specimens from uveitic glaucoma and primary open-angle glaucoma patients revealed no significant differences.

Conclusions

The histological analysis of fibrotic blebs from the XEN and Preserflo implants did not show any pronounced immune or foreign-body reaction and revealed a similar histological pattern of failed blebs after trabeculectomy.

目的 XEN凝胶支架（XEN）和Preserflo微分流术（Preserflo）植入手术的成功与否主要取决于眼泡纤维化的发展。本研究旨在描述 XEN 和 Preserflo 手术后眼泡纤维化的组织学结果。方法这项回顾性研究纳入了在 XEN 或 Preserflo 植入术后接受翻修手术的不同类型青光眼患者。研究分析了现有的临床信息和切除纤维组织的组织学样本。翻修手术在初次手术后中位 195 天（31-1264 天）进行。6个月和12个月后，平均眼压分别从基线时的29.1 (± 10.3) mmHg降至18.3 (± 8.7) mmHg (- 37%; p < 0.0001)和16.2 (± 4.2) mmHg (- 45%; p < 0.0001)。组织学分析表明，所有标本中的活化成纤维细胞和巨噬细胞都有所增加，60%的标本中探针的小部分成纤维细胞呈平行排列。没有观察到淋巴细胞或粒细胞浸润形式的明显炎症反应。对葡萄膜炎性青光眼和原发性开角型青光眼患者的标本进行比较后发现，两者并无明显差异。结论对 XEN 和 Preserflo 植入物纤维化出血点的组织学分析未显示任何明显的免疫或异物反应，并显示小梁切除术后失败出血点的组织学模式相似。

{"title":"Histopathological findings of failed blebs after microinvasive bleb surgery with the XEN Gel Stent and Preserflo MicroShunt","authors":"Jonas Neubauer, Daniela Suesskind, Caroline J. Gassel, Emil Nasyrov, Bogomil Voykov","doi":"10.1007/s00417-024-06479-w","DOIUrl":"https://doi.org/10.1007/s00417-024-06479-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The success of XEN Gel Stent (XEN) and Preserflo MicroShunt (Preserflo) implantation depends mainly on the development of bleb fibrosis. This study aimed to describe the histological findings of bleb fibrosis after XEN and Preserflo surgery.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study included patients with different types of glaucoma who underwent revision surgery after XEN or Preserflo implantation. The available clinical information and histological samples of removed fibrotic tissue were analyzed.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Thirty-six patients were included. Revision surgery was performed at a median of 195 (range = 31–1264) days after primary surgery. The mean intraocular pressure changed from 29.1 (± 10.3) mmHg at baseline to 18.3 (± 8.7) mmHg (− 37%; <i>p</i> < 0.0001) and 16.2 (± 4.2) mmHg (− 45%; <i>p</i> < 0.0001) after 6 and 12 months, respectively. Histological analysis revealed an increase in activated fibroblasts and macrophages in all specimens and a parallel orientation of fibroblasts in a minor part of the probe in 60% of the specimens. No pronounced inflammatory reaction in the form of lymphocytic or granulocytic infiltration was observed. The comparison of specimens from uveitic glaucoma and primary open-angle glaucoma patients revealed no significant differences.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The histological analysis of fibrotic blebs from the XEN and Preserflo implants did not show any pronounced immune or foreign-body reaction and revealed a similar histological pattern of failed blebs after trabeculectomy.</p>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140588538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of cycloplegia on crystalline lens morphology and location in acute acquired concomitant esotropia 环视麻痹对急性获得性并发内斜视患者晶状体形态和位置的影响

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-04-16 DOI: 10.1007/s00417-024-06484-z

Weibin Chen, Jiawen Liu, Wei Dai, Jie Hao, Jiayu Chen, Jing Fu

Purpose

The study aims to compare morphology and location of crystalline lens between acute acquired concomitant esotropia (AACE) patients and control subjects, both before and after cycloplegia.

Methods

This is a prospective and observational clinical study. Morphological and locational parameters of the crystalline lens in 53 AACE patients and 32 control subjects were assessed before and after cycloplegia using CASIA2 system, which represents the latest swept-source anterior segment optical coherence tomography. Cycloplegic refraction was recorded by administering 1% atropine in patients younger than 12 years and 1% cyclopentolate in those > 12 years old. Morphological parameters included anterior radius of curvature (ARC), posterior radius of curvature (PRC), lens thickness (LTH), and equivalent diameter of lens (LED). Locational parameters comprised lens decentration (LD) and lens tilt (LT). Comparison of these parameters before and after cycloplegia were conducted between AACE and controls. Additionally, the study analyzed and compared the changes in these parameter post-cycloplegia.

Results

Our findings suggest no significant difference in morphological parameters including ARC, PRC, LTH and LED between AACE patients and controls before or after cycloplegia. However, 2D-modeling data in the 0° meridian revealed that variation post-cycloplegia of LD (lens shift) in right eyes was different in AACE patients, measuring − 0.03(0.08) [median(interquartile range)] which was significantly distinct from the control group, exhibiting a measurement of 0.01(0.06) (z = − 2.373, p = 0.018). In left eyes, a similar trend was observed with lens shift in the 0° meridian being 0.02(0.06) in AACE, significantly differing from control group's measurement of − 0.02(0.08) (z = − 2.809, p = 0.005). Further, correlation analysis revealed that larger temporal shift of lens was associated with greater changes in ARC (r = 0.294, p = 0.006) and LTH (r = − 0.230, p = 0.031).

Conclusions

The morphological features of the crystalline lens were similar in AACE patients and controls; however, the change of lens location by cycloplegia was observed only in AACE patients, suggesting an association with excessive accommodation.

目的本研究旨在比较急性获得性并发内斜视（AACE）患者和对照组受试者在环切术前后晶状体的形态和位置。使用 CASIA2 系统评估了 53 名 AACE 患者和 32 名对照组患者在屈光环切前后的晶状体形态和位置参数，该系统代表了最新的扫源前节光学相干断层扫描技术。对 12 岁以下的患者使用 1%阿托品，对 12 岁以上的患者使用 1%环戊托品，记录环戊托品屈光度。形态参数包括前曲率半径（ARC）、后曲率半径（PRC）、晶状体厚度（LTH）和晶状体等效直径（LED）。定位参数包括晶状体分散（LD）和晶状体倾斜（LT）。在 AACE 和对照组之间进行了这些参数在环形麻痹前后的比较。结果我们的研究结果表明，AACE 患者和对照组在接受环形角膜屈光手术前后，在 ARC、PRC、LTH 和 LED 等形态参数上没有明显差异。然而，0°子午线上的二维建模数据显示，AACE 患者右眼在环状角膜缩小术后的 LD（晶状体偏移）变化不同，测量值为 - 0.03(0.08) [中位数（四分位间距）]，与对照组的测量值 0.01(0.06) 有明显差异（z = - 2.373，p = 0.018）。左眼观察到类似的趋势，AACE 的 0°子午线晶状体偏移为 0.02(0.06)，与对照组的测量值 - 0.02(0.08)明显不同（z = - 2.809，p = 0.005）。结论 AACE患者和对照组的晶状体形态特征相似；但是，只有AACE患者通过回旋瞳孔术观察到晶状体位置的变化，这表明与过度调节有关。

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引用次数: 0

Influence of submacular hemorrhage at baseline on the long-term outcomes of aflibercept treatment for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy 基线时黄斑下出血对阿弗利百普治疗典型新生血管性老年性黄斑变性和多形性脉络膜血管病长期疗效的影响

Graefe's Archive for Clinical and Experimental Ophthalmology

Pub Date : 2024-04-16 DOI: 10.1007/s00417-024-06453-6

Mio Morizane Hosokawa, Chihiro Ouchi, Yusuke Shiode, Shuhei Kimura, Ryo Matoba, Tetsuro Morita, Yuki Morizane

Purpose

To investigate the influence of submacular hemorrhage (SMH) at baseline on long-term visual outcomes of patients with typical age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) treated with intravitreal aflibercept (IVA).

Methods

In this retrospective study, eyes of treatment-naïve patients with tAMD and PCV who initiated IVA under a treat-and-extend regimen and were followed up for ≥ 5 years were classified into the tAMD-SMH ( +), tAMD-SMH (-), PCV-SMH ( +), and PCV-SMH (-) groups based on the presence of SMH at baseline. Best-corrected visual acuity (BCVA) changes and macular fibrosis and atrophy incidences were assessed.

Results

This study included 127 eyes (127 patients), including 51 with tAMD and 76 with PCV; 18 eyes had SMH at baseline. In the tAMD-SMH ( +) group (n = 6), the mean logMAR BCVA significantly deteriorated from 0.59 ± 0.45 at baseline to 0.88 ± 0.47 at the final visit (P = 0.024). No significant BCVA changes were observed in the tAMD-SMH (-) (n = 45), PCV-SMH ( +) (n = 12), or PCV-SMH (-) (n = 64) groups (all P > 0.05). The tAMD-SMH ( +) group showed a significantly higher incidence of macular fibrosis at the final visit than did the tAMD-SMH (-) group (P = 0.042). There was no influence of baseline SMH on the macular fibrosis incidence in eyes with PCV and the macular atrophy incidence in eyes with tAMD and PCV.

Conclusion

The presence of SMH at baseline resulted in poorer long-term visual acuity in eyes with tAMD, even with aflibercept treatment. However, no such influence was observed in eyes with PCV.

目的研究基线时黄斑下出血（SMH）对接受玻璃体内阿弗利百普（IVA）治疗的典型年龄相关性黄斑变性（tAMD）和多形性脉络膜血管病（PCV）患者的长期视觉疗效的影响。方法在这项回顾性研究中，根据基线时是否存在SMH，将开始接受IVA治疗并随访≥5年的tAMD和PCV患者分为tAMD-SMH（+）组、tAMD-SMH（-）组、PCV-SMH（+）组和PCV-SMH（-）组。结果这项研究纳入了127只眼睛（127名患者），包括51名tAMD患者和76名PCV患者；18只眼睛基线时有SMH。在 tAMD-SMH ( +) 组（n = 6）中，平均 logMAR BCVA 从基线时的 0.59 ± 0.45 显著恶化到最终检查时的 0.88 ± 0.47（P = 0.024）。在 tAMD-SMH (-) 组（n = 45）、PCV-SMH ( +) 组（n = 12）或 PCV-SMH (-) 组（n = 64）中均未观察到明显的 BCVA 变化（所有 P 均为 0.05）。tAMD-SMH ( +) 组在最终检查时黄斑纤维化的发生率明显高于 tAMD-SMH (-) 组（P = 0.042）。基线 SMH 对 PCV 眼的黄斑纤维化发生率以及 tAMD 和 PCV 眼的黄斑萎缩发生率没有影响。但是，在 PCV 患者中没有观察到这种影响。

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引用次数: 0