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

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.

Purpose: To evaluate real world efficacy and safety of the Preserflo MicroShunt (PM) in a heterogenous patient cohort at a single tertiary eye care centre.

Patients and methods: A retrospective data analysis of PM implantations between 2019 and 2022 was performed. Primary outcome measures were complete-, qualified-, and overall- success as well as failure defined according to the WGA criteria. Secondary outcomes were intraocular pressure (IOP) and IOP lowering medications.

Result: 38 patients were included in the study. After 24 months, complete success was achieved in 31.58% and qualified success in 28.95% whereas 39.47% were classified as failure. IOP was reduced by 55.2% from mean 25.57 ± 10.03 mmHg at baseline to 11.45 ± 3.37 mmHg two years postoperative in eyes classified as success. The number of IOP lowering medications was reduced from 2.73 ± 1.33 before surgery to 1.14 ± 1.31 at the end of the follow-up period.

Conclusion: Two years postoperatively an overall success rate of 60.53% was achieved and a significant IOP reduction was preserved over the complete two years follow-up time.

Key messages: What is known Multiple studies have proven that the Preserflo MicroShunt is a safe and efficient surgical procedure to lower intraocular pressure. The success rates reported for primary open angle glaucoma are comparable to trabeculectomy. What is new Real world data including different glaucoma subtypes at one tertiary care centre are reported with a two-year follow up. An overall surgical success rate of 60.53% was achieved. An intraocular pressure reduction of 50.2% was sustained over the two years follow up period.

Purpose: To evaluate the efficacy and safety of TriMix, a new multiple-action tear substitute in patients with dry eye disease (DED).

Methods: This was a randomized, multicenter, single-masked, hyaluronic acid (HA)-controlled clinical trial conducted between July, 2023 and May, 2024. A total of 115 patients were randomly allocated to receive either TriMix tear substitute or 0.15% HA tear substitute 3 times daily. Clinical outcomes include ocular surface disease index (OSDI) questionnaire, non-invasive tear film break-up time (NIBUT) and Schirmer I test (ST) without anesthesia at 3 and 6 months of follow-up.

Results: Of the 115 patients randomized, 80 completed the study (TriMix, n = 56; HA, n = 24). At months 3 and 6, improvements from baseline were statistically greater with TriMix tear substitute compared to HA 0.15% tear substitute for OSDI: -3.7 points (95% CI, -6.9 to -0.6; p = 0.011) and - 7.5 points (95% CI, -10.3 to -4.6; p < 0.001), respectively. Similar results were reported for NIBUT: 0.9 s (95% CI, 0.3 to 1.6; P = 0.040) and 1.6 s (95% CI, 0.7 to 2.6; P < 0.001), respectively. Regarding safety, no serious ocular adverse events occurred. Three patients complained of burning after instillation of TriMix tear substitute.

Conclusion: This RCTs demonstrate that TriMix tear substitute provides statistically significant and clinically evidence of the reduction of DED symptoms with a satisfactory safety profile through 6 months of follow-up. Findings suggest the use of this tear substitute, but results should be confirmed independently over longer time periods.

Purpose: To assess the effects of oscillatory photodynamic therapy (OPDT) with verteporfin in patients with chronic central serous chorioretinopathy (cCSCR).

Methods: Retrospective study including eyes with cCSCR who underwent OPDT by a single retina specialist. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and subretinal fluid (SRF) height were assessed before and after OPDT. Full dose verteporfin was administered with half-fluence protocol. During the procedure, the laser beam was oscillated at 2-3 Hertz with the lens steady, treating areas with hyperpermeability on indocyanine green angiography (ICGA). Linear mixed models were used to compare BCVA, CMT, SRF height, and SFCT before and after treatment.

Results: A total of 28 eyes of 20 patients were included, mean age was 52.71 ± 13.22, and 4 were females (20%). OPDT involving the fovea was performed in 46.42% of the cases. After a mean of 12.57 ± 8.10 months, complete resolution of SRF was observed in 89.28% of eyes, with a full resolution after the first OPDT in 78.57%. Overall, BCVA improved from 0.21 ± 0.17 to 0.11 ± 0.11 logMar (p = 0.003), and CMT, SFCT, and SRF height showed a significant decrease at the last follow-up assessment (p = 0.007; p = 0.001; and p = 0.002 respectively). BCVA was similar in eyes treated with extra-foveal and foveal OPDT (p = 0.963). No major complications were observed at 12-month follow-up.

Conclusions: OPDT including foveal application is a safe and effective treatment in cCSCR, with complete resolution of SRF in almost 90% of cases with minimal changes or recurrence.

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: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.

Methods: 20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.

Results: CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.

Conclusion: The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.

Key messages: What is known Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD). For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels. What is new The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels. The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect. The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.

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: Risk stratification models can assist cataract surgeons in clinical decision-making by categorizing patients into distinct groups based on their likelihood of complications. In this systematic review, we assess the characteristics of cataract surgery risk stratification models.

Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched six databases (PubMed, OVID, Embase, CINAHL, Cochrane Trials, and Web of Science) in January 2024. We included peer-reviewed, full-text, English-language studies describing models used preoperatively to assess the likelihood of complications in cataract surgery. We excluded letters, editorials, and non-peer-reviewed publications, such as conference abstracts and studies describing predictive models that did not group the patients into distinct risk categories. We constructed a checklist from three frameworks to critically appraise the participants, predictors, and risk of bias in the models.

Results: Of 4192 articles, eight met the inclusion criteria. Most models were designed for attending surgeons only and for phacoemulsification to predict zonular complications and posterior capsule rupture. The most common risk factors identified in the models were poor patient positioning, advanced age, small pupils, and pseudoexfoliation syndrome. Methodological limitations included the lack of multivariable modeling, standardized outcome measures, and external validation.

Conclusion: Cataract surgeons should understand the limitations of cataract surgery risk stratification models. Existing models can be improved with more robust methods, the use of standardized metrics, and external validation.