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

Background: Physical exercise has been proposed as a feasible strategy for preventing and managing glaucoma by modulating intraocular pressure (IOP) and ocular perfusion pressure (OPP). The primary objective of this cross-sectional study was to assess the IOP and OPP responses to dynamic resistance exercises (leg extension and biceps curl).

Methods: Twenty-six patients with primary open-angle glaucoma (POAG) (age = 68.9 ± 8.1 years) and 18 healthy age-matched controls (age = 69.6 ± 5.9 years) were recruited. Participants performed one set of 10 repetitions of both exercises at low- (light bar) and moderate-intensity (15RM). IOP and blood pressure were measured at baseline and after 1 and 5 min of passive recovery. Additionally, IOP was measured during training after each of the 10 repetitions.

Results: Our data showed a progressive IOP increase throughout the sets of leg extension and biceps curl exercises when performed at moderate intensity (p < 0.001). Remarkably, POAG patients showed a smaller IOP increase compared to controls (p = 0.048). The between-group differences for IOP changes were higher during the 10 exercise repetitions at moderate-intensity for both leg extension (average IOP rise: POAG = 0.3 ± 0.6 mmHg vs. control = 2.3 ± 0.7 mmHg) and biceps curl (average IOP rise: POAG = 1.4 ± 0.6 mmHg vs. control = 3.4 ± 0.8 mmHg) exercises. No changes in OPP were observed.

Conclusions: The findings of this study suggest that moderate-intensity dynamic resistance training is a safe intervention for potentially improving physical fitness in medically treated POAG patients.

Purpose: To examine the correlation of the spherical equivalent refraction (SER) and axial length with the visual field, and to determine cutoff values of SER and axial length for the risk of developing advanced primary open-angle glaucoma (POAG).

Methods: Patients with POAG or secondary glaucoma were retrospectively enrolled from a clinical database at Kyoto University Hospital between August 2011 and December 2018. Correlations between the mean deviation (MD) and axial length were evaluated in these patients using the Pearson's correlation coefficient. Advanced POAG was defined as having an MD of less than -12 dB as measured by the Humphrey visual field analyzer (HFA). The cutoff values of the axial length and SER for the risk of developing advanced POAG were determined using Fisher's exact test and Youden's J statistic for HFA 24-2 and 10-2, respectively.

Results: This study included 741 eyes of 438 patients. In POAG, axial length was negatively correlated with the MDs of the HFA 24-2 and 10-2. However, in secondary glaucoma, axial length did not significantly correlate with the MDs of the HFA. The cutoff axial length for the HFA 24-2 was 27.7 mm. For HFA 10-2, two peaks for the Youden's J statistic were observed, at 27.67 mm and 25.51 mm. No significant association was found between SER and severity of visual field changes.

Conclusions: Axial length measurement was clinically significant in assessing risk of severe or central visual field defects in young patients with POAG.

Purpose: Through this systematic review, we evaluated the therapeutic potential of topical eye insulin in different concentrations to treat several surface ocular pathologies, including: persistent epithelial defects, diabetic keratopathy after a vitrectomy, neutrophic keratopathy and dry eye syndrome. We have consolidated through the data, what are the doses used, the methods of preparation for insulin, whether there are adverse effects and what would be the effectiveness of the eye drops with insulin.

Methods: We carried out an extensive search including Pubmed, Cochrane Library, Scopus and Web Of Science. We found 43 relevant studies, after which we excluded duplicates, animal studies, case reports, we ended up with 13 studies to include in the article. Through the Newcastle-Ottawa scale for observational studies and the Jadad scale for randomized controlled trials, we investigated the methodological quality of these articles.

Results: Within the review we included a significant number of 268 patients who used eye drops with insulin in concentrations from 0.5 to 2 U/ml administered typically four times per day, having an ocular benefit in corneal healing rates without adverse effects. The quality analysis of the included studies showed a NOS score of moderate-high quality, whereas the Jadad scale showed a high quality.

Conclusions: Our systematic review demonstrates that topical insulin is a promising therapeutic option for persistent epithelial defects, diabetic keratopathy following vitrectomy, neurotrophic keratopathy, and dry eye syndrome, significantly enhancing corneal healing rates with a favorable safety profile. Given its accessibility, cost-effectiveness, and potential superiority over conventional treatments, topical insulin could serve as an alternative or adjunct to therapies such as autologous serum and amniotic membrane transplantation.

Introduction: To evaluate anatomical changes after implantation of a novel supraciliary minimally invasive glaucoma drainage device using swept-source anterior segment optical coherence tomography (AS-OCT).

Methods: Monocentric prospective interventional case series. Forty-eight eyes with open-angle glaucoma underwent standalone or combined MINIject (MJ) implantation and were imaged postoperatively using AS-OCT at 1 week, 1 month, 3 months, and 6 months. Implant depth (D), implant position (O), cleft width (CW) in Circumferential Lake (CL) or Cleft Angle (CA), the amount of suprachoroidal fluid (SCF), and number of quadrants with visible SCF were assessed.

Results: Following MJ implantation, intraocular pressure (IOP) significantly decreased from 22.5 ± 9.0 mmHg to 14.1 ± 6.4 mmHg (p < 0.001) at 6 months, with concurrent reduction in ocular hypotensive medications from 2.4 ± 1.2 to 0.4 ± 0.9 (p < 0.001). SCF grading decreased from 3.1 ± 1.0 on day 1 to 1.5 ± 1.1 at 6 months (p < 0.001). Cleft width grade measured in length (CL) remained stable from 3.3 ± 0.9 to 3.2 ± 0.6 (p = 0.8), and arc-angle(CA) decreased from 35.9 ± 8.8 to 30.2 ± 7.1 degrees at 6 months (p = 0.07). The number of quadrants with visible SCF decreased from 3.7 ± 0.8 to 2.2 ± 1.6 (p < 0.001). Implant depth and orientation remained stable, with 45.5% of implants anterior, 33.3% at Schwalbe's line, and 21.2% behind it. Implant orientation varied, with 13.0% touching the iris, 69.6% pointing toward the anterior chamber, and 17.4% directed at the cornea.

Conclusions: AS-OCT is a noninvasive tool for imaging the supraciliary and suprachoroidal space after MINIject implantation. Over 6 months, we found a gradual decrease in the amount of SCF drainage and the number of quadrants with visible SCF. Cleft width remained stable and was not statistically associated with IOP lowering.

Background: Descemet Stripping Only (DSO) is a minimally invasive procedure for Fuchs' Endothelial Corneal Dystrophy (FECD) that leverages peripheral endothelial regeneration without donor tissue. This study evaluates visual and anatomical outcomes of DSO and the role of guttae distribution in recovery.

Methods: A prospective study included 30 eyes of FECD patients undergoing DSO. Patients were classified by guttae distribution: type A (central) or type B (0º-180º meridian). Preoperative and postoperative outcomes, including corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD), were assessed over 12 months.

Results: Of 26 patients completing follow-up, 42.31% achieved a CDVA ≥ 0.22 logMAR by week 4, and 84.62% by month 12. Type B patients recovered faster, reaching CDVA ≥ 0.10 logMAR in 56 days versus 112 days for type A. Mean CCT improved from 606.96 ± 60.97 μm to 550.40 ± 29.67 μm (p = 0.0001). Postoperative ECD averaged 1402.7 ± 130.56 cells/mm². Corneal densitometry improved significantly but remained higher than controls.

Conclusions: DSO is an effective treatment for FECD with adequate peripheral endothelial reserve. Guttae distribution affects recovery speed, but final outcomes are similar. If no improvement occurs by the third month, a rescue DMEK is effective. Keratometry remains unchanged, epithelial thickness slightly increases, and corneal densitometry improves postoperatively.

Key messages: What is know: DSO is a donor-free surgical option for endothelial dystrophies like Fuchs' dystrophy, utilizing the eye's natural endothelial regenerative capacity in selected patients. Success relies on residual endothelial cell density and biomarkers like preoperative corneal thickness to predict regeneration outcomes.

What is new: Pattern of guttae distribution influences recovery timeline in DSO: Patients with type B guttae distribution (0º-180º meridian) achieve a CDVA of 0.1 logMAR faster than those with type A (central guttae), though finalvisual acuity, pachymetry, and endothelial cell density are similar at 12 months. DSO as an effective treatment for fuchs' endothelial corneal dystrophy: Descemet stripping only achieves corneal clearance in most cases within 3-4 months, with significant CDVA and quality of life improvements (NEI VFQ-25 scores), supporting its role as a minimally invasive alternative to donor graft surgeries.

Purpose: Behçet's disease (BD) is a multisystem inflammatory disorder with diverse clinical manifestations. Identifying biomarkers predictive of clinical outcomes, such as tumor necrosis factor (TNF) inhibitor initiation and ocular inflammatory attack frequency, is critical for improving management. This study aimed to identify biomarkers predicting the clinical course of BD using peripheral blood test data and unbiased clustering combined with machine learning.

Methods: A retrospective cohort study of 238 BD patients diagnosed at Tokyo Medical University Hospital (2004-2020) was conducted. Unsupervised hierarchical clustering was applied to peripheral blood data, dividing patients into distinct groups. Machine learning techniques were used to explore biomarkers predicting the clinical course.

Results: Cluster analysis identified four groups: Group A (low C-reactive protein), Group B (high angiotensin-converting enzyme), Group C (high anti-streptolysin O), and Group D (low neutrophil count). Group C had a higher rate of TNF inhibitor initiation (47%, p = 0.04), while Group D had fewer ocular inflammation attacks per year (1.4, p = 0.04). Logistic regression analysis identified red blood cell count (p < 0.01) and monocyte percentage (p = 0.02) as predictive biomarkers for TNF inhibitor initiation. Machine learning further confirmed mean corpuscular hemoglobin concentration (MCHC) as a significant predictor of TNF inhibitor initiation. Additionally, multiple regression analysis identified the neutrophil/lymphocyte ratio as a predictor of the number of inflammatory attacks per year (p = 0.02).

Conclusions: Unsupervised clustering of blood test data identified distinct BD clinical phenotypes. Monocyte percentage may predict TNF inhibitor initiation, while neutrophil/lymphocyte ratio may predict ocular inflammation frequency, highlighting pathophysiologic heterogeneity in BD.

Purpose: To investigate the clinical characteristics and associated risk factors of peripapillary intrachoroidal cavitation (PICC) in myopic eyes with open-angle glaucoma (OAG).

Methods: In this study, eyes of consecutive participants were categorized into the myopia only group and the myopia with OAG group. PICC was identified by radial scans centered on the optic disc using optical coherence tomography. The myopic maculopathy, optic disc morphology, and visual field defect were also assessed. The prevalence of PICC was compared between the two groups, and risk factors of PICC in the myopia with OAG group were investigated by multivariate logistic regression analysis.

Results: Of 775 enrolled myopic eyes with or without OAG, 58 eyes were found to have PICC. Compared with the myopia only group, the myopia with OAG group had a significantly higher prevalence of PICC (10.4% [44/422] vs 4.0% [14/353]) (P = 0.001). In the myopia with OAG group, participants with PICC were older and showed longer axial length, worse BCVA, more severe myopic fundus changes than those without PICC (all P < 0.01). Multivariate regression analysis showed that older age, optic disc tilt, inferior rotation of the optic disc, larger peripapillary atrophy, and posterior staphyloma were risk factors for PICC in the myopia with OAG group.

Conclusion: PICC was more prevalent in eyes with myopia and coexisting OAG than in eyes with myopia alone. And risk factors for the presence of PICC in eyes with myopia and coexisting OAG were older age and more severe myopic fundus changes.

Despite current screening models, enhanced imaging modalities, and treatment regimens, diabetic retinopathy (DR) remains one of the leading causes of vision loss in working age adults. DR can result in irreversible structural and functional retinal damage, leading to visual impairment and reduced quality of life. Given potentially irreversible photoreceptor damage, diagnosis and treatment at the earliest stages will provide the best opportunity to avoid visual disturbances or retinopathy progression. We will review herein the current structural imaging methods used for DR assessment and their capability of detecting DR in the first stages of disease. Imaging tools, such as fundus photography, optical coherence tomography, fundus fluorescein angiography, optical coherence tomography angiography and adaptive optics-assisted imaging will be reviewed. Finally, we describe the future of DR screening programmes and the introduction of artificial intelligence as an innovative approach to detecting subtle changes in the diabetic retina. CLINICAL TRIAL REGISTRATION NUMBER: N/A.