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

Purpose: To investigate the risk factors for intraocular pressure (IOP) elevation in eyes with intraocular lens (IOL) subluxation or dislocation.

Methods: We retrospectively examined the eyes with IOL displacement (either IOL subluxation or IOL dislocation) who underwent IOL refixation combined with vitrectomy between September 1, 2012, and May 31, 2024, at Fukui University Hospital. Patients were divided into two groups: those with IOL subluxation and those with IOL dislocation. Additionally, subgroups were created for eyes without glaucoma and those without both glaucoma and exfoliation syndrome. IOL subluxation was defined as the movement of the IOL-capsular bag complex in the posterior chamber, while IOL dislocation was defined as a fall of the IOL-capsular bag complex into the vitreous space. Risk factors for preoperative IOP elevation in eyes with IOL displacement were identified using multivariate analysis with a multiple linear regression model.

Results: This study included 155 eyes with IOL displacement (IOL subluxation; 73 eyes and IOL dislocation; 82 eyes). Multivariate analyses revealed that IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). The preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (22.7 ± 9.0 vs. 15.5 ± 3.9 mmHg, P < 0.01, and 1.2 ± 1.7 vs. 0.2 ± 0.8, P < 0.01, respectively). The number of patients with exfoliation syndrome and glaucoma was significantly higher in the IOL subluxation group than in the IOL dislocation group (49% vs. 10%, P < 0.01, and 25% vs. 7%, P < 0.01, respectively). In the subgroup analysis in eyes without glaucoma (131 eyes), IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). In this subgroup, the preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (20.6 ± 8.5 vs. 15.5 ± 3.9 mmHg, P < 0.01, and 0.4 ± 1.0 vs. 0.04 ± 0.3, P < 0.01, respectively), and the incidence of exfoliation syndrome was significantly higher in the IOL subluxation group than in the IOL dislocation group (40% vs. 8%, P < 0.01). In another subgroup analysis in eyes without glaucoma and exfoliation syndrome (103 eyes), IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). In this subgroup, the preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (19.3 ± 7.3 vs. 15.7 ± 4.0 mmHg, P = 0.049, and 0.3 ± 0.9 vs. 0.0 ± 0.0, P < 0.01, respectively).

Conclusions: IOL subluxation, but not dislocation, is a risk factor for elevated IOP in eyes with IOL displa

Purpose: To compare iridian Swept-Source Anterior Segment OCT (SS-AS-OCT) and microbiological features in Aqueous Humor (AH) in patients with Fuchs Uveitis Syndrome (FUS) and Posner-Schlossman Syndrome (PSS).

Methods: Comparative, retrospective-prospective single center study examining 131 eyes from 66 patients, including 33 eyes with PSS, 37 eyes with FUS, and 61 healthy eyes. AH samples were collected from affected eyes in all patients. Cross-sectional 6 mm SS-AS-OCT B-scans were taken from iris quadrants and analyzed for Stromal Thickness (ST), Smooth Index (SI), and Optical Density (OD) with ImageJ®. Statistical analysis was performed using SPSS®.

Results: Among 32 PSS patients, Cytomegalovirus (CMV) was detected in 21 (65.5%). Of 34 FUS patients, 22 (64.7%) tested positive for Rubella Virus (RV) and one for CMV (2,9%). FUS eyes showed decreased ST compared to PSS ones in the superior (328.2 ± 49.4 vs 352.2 ± 47.4; p = 0.010) and temporal (322.6 ± 54.4 vs 294.3 ± 47.9; p = 0.024) quadrants. FUS eyes had a higher mean SI (p = 0.021), notably in the temporal quadrant (p = 0.002). Both FUS and PSS eyes showed significant differences in all parameters compared to healthy eyes, except for ST and OD in the temporal quadrant in PSS, and OD in the nasal quadrant in FUS. Quantitative analysis of iris OCT images showed that RV-related and non-RV-related FUS eyes were similar, as were CMV-associated and non-CMV-associated PSS eyes.

Conclusions: CMV and RV were found to be the main etiologies of PSS and FUS respectively. Quantitative analysis of iris OCT images has proved to be an objective method to differentiate between these two syndromes.

Key messages: What is known The etiopathogenesis of Fuchs Uveitis Syndrome (FUS) and Posner-Schlossman Syndrome (PSS) remains under discussion. Viral etiology is the most widely accepted theory: Rubella virus (RV) has been associated mostly with FUS and cytomegalovirus (CMV) with PSS. Although FUS and PSS are distinct conditions, their differential diagnosis can be challenging at times due to clinical similarities, particularly iris damage. What is new The quantitative analysis of iris images from Swept Source Anterior Segment OCT is an objective, reliable, and non-invasive method that allows differentiation between FUS and PSS. In this study, RV in FUS and CMV in PSS have been detected in almost 2/3 of patients. This is the first study to perform a comparative analysis of aqueous humor results between PSS and FUS along with the examination of iris images using SS-AS-OCT.

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.

Aims: To investigate the potential effect of anti-VEGF treatment on choroidal thickness (CT) in unilateral neovascular age-related macular degeneration (AMD) patients.

Method: This is a cross-sectional study where patients were included as part of an ongoing prospective study which included patients with unilateral neovascular (n) AMD. The fellow-eye served as control. All patients had spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) done at every visit. CT was measured independently by two graders at five locations: subfoveal, 1500 micron temporal and nasal, 3000 micron temporal and nasal. The average of the measurements was used after statistical verification of their accuracy. CT differences were initially analysed via a paired T-test and later via multiple linear regression. Variables such as number of injections were studied and presence of geographic atrophy (GA) in fellow-eyes was evaluated via SD-OCT.

Results: A total of 112 patients met the inclusion criteria (Female 67%). The median (IQR) years of treatment was 2.6 (4.1). The subfoveal choroidal thickness (SFCT) in the neovascular (NV) eye appeared thinner in the NNV eye initially (-11.0 μm difference between NV and NNV SFCT (CI -23.4 to 1.3). However, after age-adjustment this trend disappeared (CI -29.8 to 4.6). In fact, apart from age (CI -6.2 to -0.1)), no other variable including number of anti-VEGF injections (CI -1.5 to 1.4) predicted SFCT. Presence of GA in fellow eyes did not influence the SFCT compared to non-GA fellow eyes, difference (CI -59.7 to 46.6).

Conclusions: This study shows no statistically significant CT difference in NV versus NNV eyes. There was no relationship between number of injections and CT.

Key messages: What is known Intravitreal injection with anti-vascular endothelial growth factors (anti-VEGF) is the mainstay treatment for exudation secondary to neovascular AMD. One quarter of anti-VEGF treated neovascular AMD patients will develop signs of macular atrophy within 2 years, possibly related to anti-VEGF treatment. What this study adds A hypothesized mechanism for atrophy induction is the effect of anti-VEGF on choroidal thickness. In this cross-sectional study, we found a non-significant 11 micron difference between anti-VEGF treated eyes and non-treated eyes in long-term follow-up neovascular AMD patients. A relationship between choroidal thinning and the number of anti-VEGF injections was furthermore not shown. How this study might affect research, practice or policy There is no significant choroidal thickness difference between anti-VEGF treated and non-treated long-term follow-up neovascular AMD. We therefore suggest that atrophy induction through choroidal thinning secondary to anti-VEGF injections is of limited concern.

Purpose: To evaluate the refractive tolerance in eyes with enhanced monocular intraocular lens (IOL) with a new aspheric design.

Methods: This study included two assessments. Clinical records of consecutive eyes with conventional monofocal IOL (SY60WF, Alcon) were retrospectively reviewed, and changes in uncorrected distance visual acuity (UDVA) with myopic and hyperopic refractive errors were evaluated using segmented regression analysis. Next, in 39 eyes of 39 cataract patients who received an enhanced monofocal IOL (NSP-3, Nidek), UDVA, refractive error, and photopic and mesopic contrast sensitivities were examined at one-three months postoperatively. Changes in the UDVA with refractive error were evaluated in the same manner. With resultant segmented regression lines, ranges of UDVA of 0.20 logMAR or better were obtained as refractive tolerances.

Results: The clinical records of 717 eyes of 551 patients with SY60WF were analyzed. Segmented regression analysis revealed a breakpoint in emmetropia and UDVA degradation myopically and hyperopically. The refractive tolerance was 2.03 D, while it was 0.73 D on the myopic side. In the prospective study, there was a breakpoint at -1.088 D, where there was a relatively flat slope between the breakpoint and emmetropia, then UDVA steeply degraded. Refractive tolerance on the myopic side was 1.12 D. There was no significant degradation in the photopic/mesopic contrast sensitivity.

Conclusion: Enhanced monofocal IOLs provided wider myopic refractive tolerance, in which UDVA of 0.2 logMAR or better would be anticipated between emmetropia and myopic error of -1.12 D.

Purpose: To train generative adversarial network (GAN) models to generate predictive optical coherence tomography (OCT) images of central serous chorioretinopathy (CSC) at 3 months after observation using multi-modal OCT images.

Methods: Four hundred forty CSC eyes of 440 patients who underwent Cirrus OCT imaging were included. Baseline OCT B-scan images through the foveal center, en face choroid, and en face ellipsoid zone were collected from each patient. The datasets were divided into training and validation (n = 390) and test (n = 50) sets. The input images for each model comprised either baseline B-scan alone or a combination of en face choroid and ellipsoid zones. Predictive post-treatment OCT B-scan images were generated using GAN models and compared with real 3-month images.

Results: Of 50 generated OCT images, there were 48, 47, and 48 acceptable images for UNIT, CycleGAN, and RegGAN, respectively. In comparison with real 3-month images, the generated images showed sensitivity, specificity, and positive predictive values (PPV) for residual fluid in the ranges of 0.762-1.000, 0.483-0.724, and 0.583-0.704; for pigment epithelial detachment (PED) of 0.917-1.000, 0.974-1.000, and 0.917-1.000; and for subretinal hyperreflective material (SHRM) of 0.667-0.778, 0.925-0.950 and 0.700-0.750, respectively. RegGAN exhibited the highest values except for sensitivity.

Conclusions: GAN models could generate prognostic OCT images with good performance for prediction of residual fluid, PED, and SHRM presence in CSC. Implementation of the models may help predict disease activity in CSC, facilitating the establishment of a proper treatment plan.

Purpose: Diagnosing pseudo-papilloedema (PPO) in children presents challenges and may lead to invasive investigations, with optic disc drusen (ODD) being the most common etiology. Other specific causes include tilted disc, optic neuritis, tumoral infiltration, vitreo-papillary traction, and Leber hereditary optic neuropathy. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are frequently observed in these cases, yet their pathophysiology remains unexplained, particularly their relation to ODD, which is still debated. Here, we explored whether patients with PPO associated with ODD, or seemingly isolated cases, could exhibit PHOMS without ODD or ODD without PHOMS, and how this might affect retinal nerve fiber layer (RNFL) thickness.

Methods: In this two-centre retrospective observational study, we included patients under 20 years old presenting with PPO without specific causes, with a subgroup followed for at least one year. Enhanced depth imaging optical coherence tomography was used to assess the presence and evolution of PHOMS and ODD, as well as RNFL thickness.

Results: We included twenty-seven patients, with thirteen followed for at least one year. In all eyes, we observed concomitant PHOMS and either deep or superficial ODD. RNFL thickness was increased in patients with deep ODD and decreased in those with superficial ODD, which was observed during follow-up.

Conclusions: ODD and PHOMS are concomitant features present in patients with PPO. PHOMS sometimes serve as indicators, as buried ODD are challenging to identify in young children. However, ODD tend to become more superficial over time, while RNFL thickness decreases.

Key messages: WHAT IS KNOWN : Diagnosing the cause of pseudo-papilledema (PPO) in children is challenging and often requires invasive investigations. The relationship between optic disc drusen (ODD) and peripapillary hyperreflective ovoid mass-like structures (PHOMS) in the context of PPO remains poorly understood.

What is new: PHOMS and ODD seem to consistently co-occur in pediatric PPO cases where no other specific causes are identified. Retinal nerve fiber layer (RNFL) thickness increases in the presence of deep ODD and decreases as ODD become more superficial with age. RNFL thinning progresses in correlation with the patient's age.

Purpose: Mucous membrane pemphigoid (MMP) is a systemic autoimmune condition characterized by blistering and cicatrization, predominantly affecting mucous membranes, including those lining the esophagus, oropharynx, nasal cavity, trachea, conjunctiva, and genitalia. Ocular mucous membrane pemphigoid (OMMP) is observed in approximately 70% of MMP cases. This study aims to review the pathophysiology, clinical manifestations, diagnosis, treatment, and complications of OMMP.

Methods: A literature search was conducted using MEDLINE and EMBASE databases.

Results: OMMP is characterized by the deposition of autoantibodies along the basement membrane zone of mucous membranes, particularly affecting the conjunctival epithelium. OMMP manifests as chronic ocular discomfort, inflammation, conjunctival scarring, eyelid abnormalities, and visual impairment. Given the extensive range of similar conditions, including drug-induced pseudo-pemphigoid and paraneoplastic conjunctival cicatrization, challenges in differential diagnosis may arise. The clinical diagnosis of OMMP is supported by confirmatory biopsy with histopathology and immunofluorescence studies. The mainstay of management includes systemic immunomodulatory medications and anti-inflammatory agents, tailored to disease severity. Surgical interventions may be necessary, although caution is warranted due to the risk of exacerbating OMMP. Prompt diagnosis and treatment are essential to halt disease progression and prevent vision loss. Complications of OMMP include corneal disorders, lid disorders, and vision disturbances. A comprehensive understanding of OMMP aids in timely intervention and improved patient outcomes.

Conclusion: OMMP is a bilateral, chronic, progressive, relapsing-remitting condition. Early diagnosis and treatment of OMMP are necessary to prevent disease progression. The management of OMMP varies according to the severity of the disease, but often involves both medical control of the underlying inflammatory process and subsequent surgical correction of residual anatomical changes.

Purpose: Safety glasses are an important measure to prevent blindness, especially in one- eyed patients. However, patient compliance with eye protection is often limited. Unlike previous studies that described protective eyewear wearing in anophthalmic patients, this study analyzed their usage in functionally one-eyed children, having a significantly reduced visual acuity in one eye, determining common obstacles to their use.

Methods: A survey-based study analyzing protective eyewear usage in children with one eye vision loss (mean logarithm of the Minimum Angle of Resolution (logMAR) visual acuity ≤ 0.7).

Results: This study included 83 functionally one-eyed children (44 males), who received a recommendation to wear safety glasses. Ninety-nine percent of their caregivers were aware of this recommendation; however, 31% of them did not know the glasses' true purpose. Regarding actual usage, only 29 (35%) children wore safety glasses at least 90% of the day, 26 (31%) children wore them part-time (10-90% of the day) and 28 (34%) wore them rarely or never at all (< 10% of the day). Compliance was higher when glasses provided optical correction. Reasons provided for non-compliance included: discomfort, appearance, cost and vision reduction. Many respondents recollected incidents in which the glasses prevented an eye injury, and less commonly an eye injury occurring while the child was not wearing eye protection.

Conclusions: Compliance with safety glasses in functionally one-eyed children is limited. Emphasizing that numerous gaps and barriers need to be bridged to improve eyewear protection in these children to prevent trauma in the better-seeing eye with its devastating lifestyle effect.

Key messages: WHAT IS KNOWN : Anophthalmic patients often do not wear protective glasses, which are needed to prevent trauma to their only remaining eye.

What is new: Non-anophthalmic children with reduced visual acuity in one eye use protective glasses even less often, even when doing sports. Common reasons for not wearing safety glasses include: discomfort, dislike of self-appearance with glasses, and lens-induced vision reduction.

Purpose: Juvenile Idiopathic Arthritis (JIA) can affect ocular structures, but choroidal involvement is not well understood. This study investigates the Choroidal Vascularity Index (CVI) in JIA patients compared to healthy controls and explores its relationship with disease activity.

Methods: In this cross-sectional study, 35 JIA patients and 40 healthy controls underwent comprehensive ophthalmic examination and swept-source optical coherence tomography (SS-OCT). CVI, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were measured. The Juvenile Arthritis Disease Activity Score (JADAS) was calculated for JIA patients. Statistical analysis included comparison between groups and correlation analysis.

Results: JIA patients showed significantly lower CVI compared to controls (68.3 ± 2.5% vs. 72 ± 4.6%, p < 0.001). No significant difference was found in SFCT. CVI demonstrated a moderate negative correlation with JADAS (r = -0.368, p < 0.05). However, receiver operating characteristic (ROC) analysis revealed poor diagnostic performance of CVI for detecting JIA (AUC = 0.25).

Conclusion: The study reveals reduced choroidal vascularity in JIA patients and a correlation between CVI and disease activity. While CVI shows limited diagnostic utility, it may serve as a potential marker for monitoring inflammatory burden and treatment response in JIA. Further research is needed to establish its clinical utility fully.