Graefe’s Archive for Clinical and Experimental Ophthalmology最新文献

Purpose: To compare the clinical outcomes after manual continuous curvilinear capsulorhexis (CCC) on one eye and precision pulse capsulotomy (PPC) on the other eye in cataract surgery.

Methods: 60 eyes from 30 patients who underwent manual capsulorhexis on one eye (CCC group, N = 30) and precision pulse capsulotomy on the other eye (PPC group, N = 30) were retrospectively enrolled. Uncorrected and corrected visual acuity, manifest refraction, and corneal endothelial cell density were evaluated.

Results: There were also no significant differences between the two groups according to the change in the corneal endothelial cell density at 3 months after cataract surgery (p > 0.05). The horizontal diameter (mm) and area (mm2) of the capsulotomy of the PPC group were significantly smaller than those of the CCC at postoperative 1 day and 3 months (P < 0.05). The circularity of PPC group was significantly better than that of the CCC at postoperative 1 day and 3 months (P < 0.05) (Table 4). Postoperative reduction of the capsulotomy area of the PPC group (6.64 ± 1.47) was higher than that of the CCC group (3.48 ± 1.21) from 1 day to 3 months after cataract surgery (P < 0.05).

Conclusions: PPC was as safe as CCC and more efficient than CCC for making perfectly round capsulotomy. The initial capsulotomy size of PPC was smaller than that of CCC. PPC size decreased more than CCC after several months because it might damage the anterior capsule with thermal energy.

Purpose: No effective treatment for leber hereditary optic neuropathy (LHON) caused by ND1 mutation is available.This study evaluated the safety and efficacy of a single unilateral intravitreal injection rAAV2-ND1 in various doses for the treatment of LHON.

Methods: Twelve patients with LHON (ND1 mutation) in two groups with six participants each.The low-dose group received injection of rAAV2-ND1 in a dose of 1.5 × 10⁸ vg/eye while the high-dose group received 1.5 × 10⁹ vg/eye.The safety endpoint was the incidence of adverse events (AEs).The primary efficacy endpoint was changes of best corrected visual acuity (BCVA).The secondary efficacy endpoints were improvement in visual field (VF), visual field index (VFI), and mean deviation (MD) and change in retinal nerve fiber layer (RNFL) thickness.

Results: In total,11 mild eye-related AEs occurred in the participants in both groups, and short-term drug treatment returned to normal.The difference was statistically significant in BCVA of the injected eyes in the low-dose group between 12 months after treatment and at baseline.The differences in BCVA of the uninjected eyes in the high-dose group between baseline and 3 months or 6 months after treatment were statistically significant.At 12 months after treatment, the rate of improvement in BCVA for the injected eyes in the low-dose groups was 66.7% (4/6),while BCVA for the uninjected eyes in the high-dose groups was 50.0% (3/6),and patients in both groups had binocular VF (VFI, MD) and RNFL thicknesses that did not significantly differ from baseline.

Conclusion: Preliminary clinical evidence shows that rAAV2-ND1 ophthalmic injection is a safe and effective treatment for LHON due to ND1 mutation.

Trial registration: Trial registration number: ChiCTR2000041574, Date:12/29/2020.

Purpose: To investigate the clinical characteristics of early-onset optic neuritis (ON) following the corona virus disease 2019 (COVID-19) Omicron variant and explore the possible pathophysiological mechanisms.

Methods: This was a retrospective, observational study. All enrolled patients with ON following the COVID-19 Omicron variant were followed for at least 6 weeks to observe their clinical characteristics and prognostic factors and to analyze the factors influencing earlier or later occurrence of ON following the COVID-19 Omicron variant.

Results: A total of 47 eyes from 47 patients (22 males [46.8%] and 25 females [53.2%]) were enrolled in this study and divided into late- and early-onset groups. Compared to the late-onset group, the early-onset group had a higher dual-seronegative antibody status (21.43% vs. 63.16%, P = 0.004) and a higher CD8 + /lymphocyte percentage (23.3% [20.1%, 28.3%] vs. 31.0% [29.8%, 34.2%], P = 0.008). Furthermore, Pearson's partial correlation analysis showed that dual-seronegative antibody status (adjusted r = 0.800, adjusted P = 0.001) and CD8 + /lymphocyte percentage (adjusted r = 0.747, adjusted P = 0.002) were independently associated with early-onset ON following the COVID-19 Omicron variant. Further partial correlation analysis also showed that a swollen optic disc (r = -0.347, P = 0.035) was the only factor independently associated with final best-corrected visual acuity (BCVA).

Conclusions: Earlier onset of ON following COVID-19 Omicron variant indicated a higher CD8 + /lymphocyte percentage in the serum and a greater possibility of dual-seronegative antibody status. Whether ON following the COVID-19 Omicron variant occurred earlier or later did not independently affect final BCVA, and the only independent factor predicting better final BCVA was a swollen optic disc.

Purpose: Incisional glaucoma surgery is indicated in advanced glaucoma or glaucoma refractory to less invasive therapies, and can be performed with implants to lower IOP including glaucoma drainage or filtration devices. The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) represents the largest U.S. publicly-available repository of device-related incisional glaucoma surgery complications, enabling insight into complications experienced with incisional glaucoma surgery in real-world practice to develop a risk profile for the use of each device.

Methods: MAUDE database was searched between January-2012 and December-2021 for Brand Name: Ahmed ClearPath, Ahmed Glaucoma Valve, Baerveldt, Ex-PRESS, and Molteno. Reports were categorized by complication;when multiple were present, multiple categories were attributed. Reports with identical text and dates were counted as duplicate and excluded. Literature reports comparing multiple devices without clear device specification per complication were excluded.

Results: The search yielded 1538 reports, of which 1379 reports describing 2429 adverse events met inclusion criteria. The most common events for were hypotony/hypotony maculopathy (284), device-iris touch (282), device occlusion (213), elevated IOP (210), and device explanted due to possible exclusion (176). Delivery system failures occurred (166). Patients also experienced flat/shallow anterior chambers (147) and corneal edema/bullous keratopathy/endothelial cell count reduction/corneal decompensation/Descemet's membrane tears (128).

Conclusion: By drawing on the real-world complications collected in the MAUDE database, this study identifies adverse events of greatest clinical pertinence for device-related incisional glaucoma surgery overall and by brand. Understanding the most common adverse events may support surgeons in counseling patients and preparing for device implantation.

Purpose: To evaluate the efficacy and safety of phacoemulsification combined with glaucoma surgeries based on new criteria of axial length (AL) in nanophthalmos patients with secondary angle closure glaucoma (NSACG).

Methods: This retrospective study analyzed medical records of NSACG patients, categorized into two groups based on AL. Group 1 (AL: 17-20 mm) underwent phacoemulsification with intraocular lens implantation, viscogonioplasty, and anterior pars plana vitrectomy (PVP), combined with trabeculectomy (Trab) or endoscopic photocoagulation (ECP). Group 2 (AL < 17 mm) underwent PVP combined with trabeculectomy and sclerectomy (PVPTS).

Results: A total of 22 patients (31 eyes) with NSACG were enrolled with a mean follow-up of 50.2 ± 26.2 months. Patients with axial length < 17 mm (Group 2) exhibited significantly worse visual acuity (P < 0.05) and required more IOP-lowering medications (P = 0.007) than those with axial length ≥ 17 mm (Group 1). Postoperatively, both groups demonstrated statistically significant reductions in IOP and the number of IOP-lowering medications (All P < 0.05). IOP reduction ≥ 20% was achieved in 92.3% (Group 1) and 94.4% (Group 2), with IOP < 21 mmHg in 69.2% and 77.8%, respectively. No postoperative malignant glaucoma occurred in either group.

Conclusions: PVP combined with Trab or ECP and PVPTS are effective and safe surgical interventions for patients with NSACG. Surgeries applied using the new criteria of AL have the potential to achieve better IOP control outcomes with lower complication rates.

Key messages: What was known before Nanophthalmos with secondary angle closure glaucoma (NSACG) is challenging to manage surgically due to unique anatomical features and high risk of complications. Short axial length (AL) is a risk factor for postoperative complications in nanophthalmos. What that study adds Phacoemulsification with viscogonioplasty and anterior pars plana vitrectomy (PVP) combined with trabeculectomy or endoscopic cyclophotocoagulation is effective and safe for NSACG patients with AL ≥ 17 mm and < 20 mm. PVP combined with trabeculectomy and sclerectomy (PVPTS) is effective and safe for NSACG patients with AL < 17 mm. The new AL criteria can be considered an effective surgical intervention strategy in treating patients with NSACG.

Purpose: Coronary artery disease (CAD) is the leading cause of death in the United States and its assessment still relies on invasive diagnostic procedures requiring contrast, such as coronary angiography (CAG) or computed tomography angiography (CCTA). The retinal vasculature is the only microvascular site in the human body that can be assessed non-invasively, and it has been described as a promising method for predicting cardiovascular risk since the classification of hypertensive retinopathy in the 19th century. Unfortunately, most classifications still rely on qualitative findings, which exhibit high rates of interobserver and intraobserver variability. With advances in ophthalmology exams, particularly the advent of optical coherence tomography angiography (OCTA), the capability of quantitatively assessing retinal vasculature can enable a more reliable non-invasive exam that could aid in estimating cardiovascular risk and assessing coronary lesions. This review aims to provide an extensive overview of the available evidence establishing the correlation of retinal and choroidal microvascular damage observed in OCTA and parameters such as coronary stenosis grade, number of affected vessels and scores like Gensini and SYNTAX evaluated via CAG or CCTA.

Methods: Review of the literature published until December 2024 on PubMed/MEDLINE, SCOPUS and EMBASE by searching "optical coherence tomography angiography" or "OCTA" AND "Coronary artery disease" or "Coronary heart disease".

Results: Findings from sixteen studies suggest a potential correlation between vascular parameters in OCTA and results from coronary exams. Reductions in vessel density analysis of the retinal plexus, especially the superficial capillary plexus (SCP), could improve patient selection and diagnostic yield for more invasive diagnostic procedures, such as CAG and CCTA.

Conclusion: OCTA is a non-invasive technology that can provide visualization and quantification of retinal microvascular disfunction that may correlate with macrovascular disease, particularly in the coronary circulation. Longitudinal assessment of quantitative OCTA parameters may provide biomarkers for monitoring CAD patients over time.

Purpose: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.

Methods: This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.

Results: The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).

Conclusion: The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.

Background: To perform a three-dimensional assessment of the choroid, including choroidal volume and choroidal vascularity index (CVI), during the transition from intermediate to neovascular age-related macular degeneration (AMD), and following anti-VEGF therapy.

Methods: A total of 42 participants (42 eyes) with intermediate AMD at baseline who developed neovascular AMD within 3 months were included in the analysis. Optical coherence tomography (OCT) scans at follow-up visits (after transition to neovascular AMD and 12 months after the initiation of anti-VEGF therapy) were compared with values at the latest visit with evidence of intermediate AMD to quantify longitudinal choroidal changes. Enhanced depth imaging (EDI) OCT scans were analyzed to obtain the following metrics: (i) choroidal volume, (ii) choroidal stromal volume, (iii) choroidal vascular volume, and (iv) CVI.

Results: At baseline, the mean (median; IQR) choroidal volume (i.e., including both the stromal and vascular components) was 0.156 mm³ (0.149; 0.065), increasing to 0.163 mm³ (0.148; 0.068) at the follow-up when treatment-naïve exudative MNV was first detected (p = 0.013). After 12 months of anti-VEGF therapy, it returned to near-baseline levels at 0.156 mm³ (0.146; 0.065; p = 0.457). Similarly, the choroidal stromal and choroidal volumes increased at MNV detection but returned to baseline after treatment. Conversely, no alterations in CVI were observed between the baseline and follow-up visits.

Conclusion: The transition from intermediate to exudative neovascular AMD is associated with a significant increase in choroidal volume, affecting both stromal and luminal components. After anti-VEGF treatment, these changes regress, returning to baseline levels.

Purpose: To describe early cone changes detected by adaptive optics (AO) in patients on chronic hydroxychloroquine (HC) treatment with no abnormalities on standard functional or structural retinal tests.

Methods: Case-control study including 36 eyes of 36 female patients. Cases included 18 women on HC for autoimmune disease whose cumulative dose exceeded 1600 g and who demonstrated no evidence of retinal toxicity on visual field (VF), spectral domain optical coherence tomography (SD-OCT), or multifocal electroretinography (mfERG). Controls included 18 women with no known systemic or ocular disease and no history of HC use. For each eye of every study participant, an image was captured using a commercially available flood-illuminated AO retinal camera (rtx1^TM,Imagine Eyes, France), at 2 degrees nasal and 2 degrees temporal to the fovea. The cone density and spacing measurements were automatically detected by the software provided by the RTX1 in a region of interest (ROI).

Results: The control group exhibited mean nasal and temporal cone densities of 28,967 ± 1759 and 29,446 ± 1934 cells/mm², respectively, along with mean nasal and temporal spacing of 6.47 ± 0.19 and 6.43 ± 0.21 μm, respectively. The case group showed mean nasal and temporal cone densities of 26,967 ± 1667 and 26,099 ± 2052 cells/mm², respectively, and mean nasal and temporal spacing of 6.72 ± 0.20 and 6.84 ± 0.28 μm, respectively. A significantly (p < 0.01) lower density and larger spacing of cones were observed in the case group compared to the control group.

Conclusions: AO may detect retinal changes from HC toxicity before they become apparent on VF, SD-OCT, or mfERG.