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

Purpose: This study aimed to investigate the peripheral retinal and choroidal thicknesses in eyes with reticular pseudodrusen (RPD).

Methods: Imaging data of ultrawide-field swept-source optical coherence tomography taken from 40 patients with age-related macular degeneration (AMD) were analyzed. Thirty-nine eyes of 20 patients had RPD (RPD group) and 39 eyes of 20 patients had no RPD (control group). Eyes with RPD were divided into localized/intermediate and diffuse types according to the fundus distribution. The retinal and choroidal thicknesses were measured at the fovea and six peripheral points in each eye, and the results were statistically analyzed.

Results: The mean ages were 78.0 ± 6.1 years in the RPD group and 74.4 ± 7.2 years in the control group. The RPD group showed a thinner retina only at the nasal point (p = 0.002) than the control group. The choroid was significantly thinner in the RPD group than in the control group at most peripheral points, except for the far temporal and far inferior points. Diffuse and localized/intermediate types of RPD eyes showed no significant difference in choroidal thickness, except at the nasal point, which was thinner in the diffuse type (p = 0.049).

Conclusion: In eyes with RPD, most peripheral retinal thicknesses were not different from those of eyes with AMD without RPD; however, most peripheral choroidal thicknesses were thinner regardless of the fundus distribution status of the RPD. Nasal choroidal thickness may be associated with RPD severity.

Purpose: Generative adversarial networks (GANs) are key components of many artificial intelligence (AI) systems that are applied to image-informed bioengineering and medicine. GANs combat key limitations facing deep learning models: small, unbalanced datasets containing few images of severe disease. The predictive capacity of conditional GANs may also be extremely useful in managing disease on an individual basis. This narrative review focusses on the application of GANs in ophthalmology, in order to provide a critical account of the current state and ongoing challenges for healthcare professionals and allied scientists who are interested in this rapidly evolving field.

Methods: We performed a search of studies that apply generative adversarial networks (GANs) in diagnosis, therapy and prognosis of eight eye diseases. These disparate tasks were selected to highlight developments in GAN techniques, differences and common features to aid practitioners and future adopters in the field of ophthalmology.

Results: The studies we identified show that GANs have demonstrated capacity to: generate realistic and useful synthetic images, convert image modality, improve image quality, enhance extraction of relevant features, and provide prognostic predictions based on input images and other relevant data.

Conclusion: The broad range of architectures considered describe how GAN technology is evolving to meet different challenges (including segmentation and multi-modal imaging) that are of particular relevance to ophthalmology. The wide availability of datasets now facilitates the entry of new researchers to the field. However mainstream adoption of GAN technology for clinical use remains contingent on larger public datasets for widespread validation and necessary regulatory oversight.

Purpose: This study aims to evaluate the effect of Müller's muscle-conjunctival resection (MMCR) with tarsectomy on lower eyelid position in patients with unilateral aponeurotic ptosis in the East Asian population.

Methods: A retrospective review was conducted on patients undergoing unilateral MMCR surgery. Margin reflex distance (MRD) 1 and 2 were measured preoperatively and three months postoperatively. The primary outcome was the change in MRD2 following surgery. Additionally, we investigated the relationship between the relative change of MRD1 and that of MRD2. The secondary outcome was the influence of factors including age, sex, and preoperative MRD on the change in MRD2.

Results: Sixty-one patients were included. In the ptotic eye, postoperative MRD1 increased from 1.47 ± 0.88 mm to 3.57 ± 1.00 mm (p < 0.001), while MRD2 decreased from 5.53 ± 0.97 mm to 5.31 ± 0.96 mm (p = 0.007). A negative correlation was observed between the relative change of MRD1 and MRD2 in the ptotic eye (r = -0.335, unstandardized coefficient [B] = -0.016, 95% confidence interval [CI] -0.028 to -0.004, p = 0.009). Additionally, a positive correlation was found between the relative change in MRD2 in the ptotic and normal eyes (r = 0.818, B = 0.760, 95% CI 0.621 to 0.899, p < 0.001). Preoperative MRD2 in the ptotic eye was a predictor of postoperative MRD2 reduction (B = -0.189, 95% CI -0.327 to -0.051, p = 0.008).

Conclusion: This study demonstrates that MMCR alters lower eyelid position, with reductions in MRD2 correlating with the degree of upper eyelid correction. It is important to inform patients of this potential alteration preoperatively.

Background: A Phase I/II trial to evaluate the initial safety and performance of a novel corneal crosslinking device, the Corneal Crosslinking Pen in keratoconus patients. This was a prospective exploratory study with 12 months of follow up.

Methods: Twenty-one eyes of 21 patients aged 14-27 years and diagnosed with progressive keratoconus were enrolled and treated unilaterally. Corneal crosslinking (CXL) following an accelerated epi-off protocol with riboflavin was done using the Corneal Crosslinking Pen. Effectiveness endpoints included changes in astigmatism, maximum keratometry (KMax), and best corrected visual acuity (BCVA) compared to baseline. Safety included adverse events and changes in pachymetry, intraocular pressure (IOP), and endothelial cell count (ECC).

Results: Astigmatism was significantly reduced at 12 months by a mean (95% CI) of 0.56 (0.10, 1.03) D. KMax was also reduced by a mean of 0.63 D, but this was not significant. BCVA improved significantly by nearly four lines of vision (- 0.38; logMAR). No corneal thinning was observed; pachymetry, IOP and ECC all remained stable across 12 months. Adverse events were infrequent and mild.

Conclusion: These early results suggest that the Corneal Crosslinking Pen was safe and effective for CXL. Future studies will seek to confirm the large improvement seen for BCVA and elucidate a potential mechanism.

Background/aims: Glaucoma drainage devices (GDDs) are essential in managing complex glaucoma cases. This review focuses on the Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI), the most commonly used GDDs. We aim to evaluate complications associated with AGV and BGI, particularly post-operative hypotony.

Methods: We systematically reviewed randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing AGV and BGI. The primary outcome was persistent hypotony (IOP < 5 mmHg). Secondary outcomes included hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, vision loss, cystoid macular edema, diplopia, corneal decompensation, endophthalmitis, hyphema, further surgery for IOP control, tube interventions, exposure, and occlusion.

Results: Thirteen studies (4 RCTs, 9 NRSs) with 2,513 eyes were analyzed. AGV was associated with a lower incidence of persistent hypotony in RCTs (0.6% vs. 4.4%, p = 0.006), choroidal effusion (4.95% vs. 15.8%, p < 0.0001), vision loss (9% vs. 18.9%, p = 0.01), and cystoid macular edema (2.5% vs. 9.6%, p = 0.009). BGI showed a lower need for further surgery to control IOP in RCTs (14.5% vs. 7.5%, p = 0.01). No significant differences were found for other outcomes, including suprachoroidal hemorrhage, corneal decompensation, and tube-related complications.

Conclusion: AGV seems to offers a safer profile with fewer hypotony-related complications compared to BGI. Personalized device selection is crucial for optimizing glaucoma surgery outcomes. Further high-quality, well-designed studies are needed to validate those results.

Purpose: To investigate the conjunctival and eyelid margin bacterial microbiota in children with blepharoconjunctivitis by using 16S rDNA amplicon sequencing.

Methods: In this prospective cross-sectional study, 20 children aged between 3-15 years with blepharoconjunctivitis or blepharokeratokonjunctivitis formed Blepharitis Group and 21 children aged between 3-15 years without any ocular and sysemic diseases except mild refractive errors formed Control Group. Swap samples from all children were taken. The alpha diversity of the ocular surface microbiota within each group were evaluated by using Shannon's, Simpson, and Chao index. Beta diversity was evaluated by Bray Curtis index.

Results: Microbiological diversity was higher in the patient group than in the control group. According to Shannon's, Simpson, and Chao index, there were statistically difference between groups (p: 0.000013, p:000003 p: 0.00235, respectively). According to the Bray Curtis index, the healthy eye microbiome in the control group is observed to be highly similar, consistent with other analyses, and the overlapping cluster with the blepharitis eye microbiome is quite low (pco1: 40.93%). Sphingoblump, Micrococus, Lacnospiracebacterium, Stenothermophilus, Aurelmonass, Micrococus, Blatiabeum, Delfiacdiovorans and Vellonella densities were found to be higher in the patient group.

Conclusion: Both alpha and beta diversity analyses were significantly higher in pediatric age group patients with blepharitis. In addition, Lacnospiracebacterium, Stenothermophilus, Aurelmonass, Micrococus, Blatiabeum, Delfiacdiovorans and Vellonella densities were found to be higher, which may lead to future studies focused on diagnosis and treatment.

Purpose: To evaluate the effect of 4 commonly used eyelid speculums on intraocular pressure (IOP) among children undergoing examination under anesthesia.

Methods: In this comparative cross-sectional study, IOP of children undergoing EUA at Soroka Medical Center was measured by manually opening the eyelids and the result was compared to measurements taken with 4 commonly-used speculums. Barraquer and Alfonso speculums were used in patients of all ages, whereas V- and U-shaped speculums were used in patients older than 6 months of age only. All measurements were taken using a Tono-Pen tonometer.

Results: Data were collected from 41 eyes of 21 patients (8 eyes ≤ 6 months of age). Mean age was 3.6 years (range 10 days-14 years), and 52% were male. Mean IOP without an eyelid speculum was 14.3 ± 4.7 mmHg. In comparison to manual eyelid opening, the mean IOP measurement with the Barraquer speculum did not differ significantly (14.7 vs. 14.3 mmHg, respectively, p = 0.139). However, all other types of speculums significantly increased IOP measurements (14.3 vs. 18.9 mmHg, p < 0.001) for Alfonso speculum, (15.0 vs. 19.0 mmHg, p < 0.001) for V-shape speculum, and (15.0 vs. 18.8 mmHg, p < 0.001) for the U-shape speculum. The results were the same when the data from each eye were analyzed separately.

Conclusions: The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to age 14 years. IOP measurements obtained with other types of speculums are expected to be overestimated.

Key messages: What is known: • Obtaining accurate IOP measurements in children with glaucoma is important to assess disease progression and guide treatment decisions.

What is new: • The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to 14 years. • IOP measurements obtained with other types of speculums are usually overestimated.

Purpose: To investigate the association between systemic blood pressure-related hemodynamic indices and central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma (NTG).

Methods: This cross-sectional study examined 36 eyes of 36 early and moderate NTG patients with CMVFD from 295 consecutive NTG patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Hemodynamic variables and ocular examination results were compared between two groups. CMVFD was defined as a glaucomatous defect with at least one abnormal point at P < 1% within the central 5 degrees on two consecutive 24-2 or 30-2 visual field tests.

Results: There were no significant differences in baseline demographics except for body weight (P = .009). The cup-to-disc ratio, pattern standard deviation in visual field test, and inferotemporal segmental thickness of retinal nerve fiber layer in OCT showed significant differences in the ophthalmic examinations. Univariate logistic regression analysis revealed significant association between CMVFD and 24-h average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure, and body weight. In multivariate logistic regression analysis, only the nighttime average diastolic blood pressure (odds ratio [OR] 0.877; P = .037) was independently associated with CMVFD in early and moderate NTG.

Conclusion: Central-most visual field defects were identified in some patients with early and moderate NTG. Particularly, low nocturnal diastolic blood pressure (nocturnal diastolic hypotension) was independently related to CMVFD, and should be considered when managing systemic care for NTG patients.

Key messages: What is known: • The visual field defects are at greater risk in glaucoma patients with nocturnal hypotension.

What is new: • The nocturnal diastolic hypotension is independently related to the presence of central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma. • If average nocturnal diastolic blood pressure is found to be low, it should be considered a modifiable risk factor for CMVFD.

Purpose: To review the phenomenon of spontaneous epiretinal membrane (ERM) resolution focusing on the clinical settings, mechanisms of resolution, and implications for management.

Methods: A comprehensive review of case reports and studies describing spontaneous ERM resolution was conducted. Data were extracted regarding ERM type, patient demographics, visual outcomes, and suspected mechanisms. Findings were analyzed to identify trends and to compare cases of spontaneous resolution across different ERM types.

Results: Spontaneous ERM resolution was more frequently observed in younger patients or cases associated with posterior vitreous detachment (PVD). In idiopathic ERMs, spontaneous separation often involved PVD and extracellular matrix remodeling. Inflammatory ERMs demonstrated resolution due to reduced inflammation and traction, while secondary ERMs linked to vascular or traumatic events benefited from mechanisms such as photocoagulation-induced PVD or gliotic contraction. Visual outcomes varied, with improvements in best-corrected visual acuity (BCVA) and metamorphopsia in most cases, though persistent structural changes occasionally limited functional recovery.

Conclusion: Spontaneous ERM resolution is a rare but clinically significant event influenced by vitreoretinal interface dynamics and patient-specific factors. Younger age, the presence of PVD, and underlying inflammatory or vascular conditions may contribute to natural resolution. Recognizing these cases allows for tailored management strategies supporting observation in selected patients while minimizing unnecessary surgical interventions. These insights may guide future research into therapeutic approaches that mimic natural resolution mechanisms.