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

Purpose: To investigate changes in macular hole-related oedema depending on positioning.

Methods: Prospective interventional study of 40 patients with primary macular hole (MH). Optical coherence tomography scanning was done at 9 a.m., 1 p.m., and 3 p.m. Between the first and second scanning, the patients were instructed to stay upright, whereas they were positioned recumbent thereafter. Automated mean retinal thickness measurements were derived from the ETDRS grid for the central, parafoveal, and perifoveal subfields. Mean ocular perfusion pressure (MOPP) was calculated for all time points. Primary endpoints were changes in MH-related oedema from 9 a.m.-1 p.m., and from 1 p.m.-3 p.m.

Results: In upright position from 9 a.m.-1 p.m., the mean parafoveal retinal thickness decreased from 362 μm (SD = 56) to 350 μm (SD = 51) (P < 0.001). The reduction of MH-related oedema when upright was positively correlated with a reduction in MOPP. Eyes with vitreomacular traction (VMT) exhibited significantly less reduction in MH-related oedema compared to eyes without VMT. In recumbent position from 1 p.m.-3 p.m., the mean parafoveal retinal thickness increased to 356 μm (SD = 52) (P = 0.002).

Conclusion: MH-related oedema belongs to the non-vasogenic cystoid maculopathies. The decrease in MH-related oedema when upright and its positive correlation to a reduction in MOPP is therefore unexpected. In recumbent position, the situation is reversed, and the oedema increases. This may be related to subtle leakage from the retinal capillaries. The presence of VMT seems to counteract the resolution of the oedema. In a clinical setting, upright positioning after MH surgery facilitates absorption of the oedema which is beneficial for MH closure.

Key messages: What is known: Macular hole formation is associated with cystoid macular oedema, possibly due to hydration of the outer retinal layers exposed to the hypotonic vitreous fluid. This oedema promotes the elevation of the hole edges from the retinal pigment epithelium.

What is new: Macular hole-related oedema decreases when the patients are upright and increases, in parallel with an increase in mean minimum macular hole diameter, when they are recumbent. The reduction of macular oedema is correlated with a reduction in mean ocular perfusion pressure, indicating that the oedema is influenced by subtle leakage from retinal capillaries. The results suggest that upright positioning might be beneficial in the early postoperative period of macular hole surgery.

Background: In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. We aim to compare cataract surgery complication rates and clinical outcomes using different pupil expansion methods.

Methods: This retrospective cohort study grouped patients according to four techniques of mechanical pupil expansion techniques: sphincterotomy (N = 339), iris stretching (N = 242), iris hooks (N = 391) and expansion rings (N = 294). Incidences and odds ratios for major complications and outcomes were compared between the groups.

Results: This single-center study included 1266 adult patients who underwent routine cataract surgery with mechanical pupil dilatation. The mean (± SD) age was 75.5 (± 13.0) years and 727 (57%) patients were male. The risk of pseudophakic cystoid macular edema (PCME) did not differ between the groups. Iris hooks were associated with the highest incidence of posterior capsular rupture (PCR) (3.3%) as compared to sphincterotomy, stretching and expansion rings (0.9%, 0.4% and 1.4%, respectively, P = 0.016). However, this effect was not supported by multivariable analysis. Zonular dialysis tended to be higher among eyes operated with iris hooks and pupil expansion rings, compared with iris stretching and sphincterotomy (2.0% and 1.7%, respectively, P = 0.058) and was found to be independently associated with a specific mechanical pupil expansion method on multivariable analysis (P = 0.050). No differences were observed for other complications, intraocular pressure or best-corrected visual acuity (VA) gain. Surgeon seniority was a significant protective factor from postoperative uveitis on multivariable analysis (P = 0.032).

Conclusions: Our large cohort study found no difference between the groups regarding major complications or clinical outcomes, suggesting that all four methods may be equally safe.

Key messages: WHAT IS KNOWN : • In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. • Different pupil dilation methods have been used, ranged from topical and intracameral mydriatics and visco-mydriasis to mechanical dilation maneuvers. • Four principal techniques of mechanical pupil expansion, including sphincterotomies, manual iris stretching, iris retracting hooks and pupil expansion rings, are available.

What is new: • This single-center study included 1266 adult patients found no difference between the groups regarding major complications or clinical outcomes such as pseudophakic cystoid macular edema (PCME), posterior capsular rupture, zonular dialysis, intraocular pressure, uveitis or best-corrected visual acuity gain. • Surgeon seniority was a significant protective factor from postoperative uveitis.

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.

Purpose: To investigate the presence of tubulation in the outer nuclear layer of patients with Bietti crystalline dystrophy (BCD) using optical coherence tomography (OCT) and evaluate its relationship with visual field, visual field progression, and retinal volume.

Methods: This retrospective cross-sectional study included 37 patients diagnosed with BCD who underwent spectral-domain OCT examination. OCT examinations and Humphrey visual field tests (10-2 program) were conducted. We performed correlation analyses to assess the correlation of the number of tubulations with the visual field parameters and retinal volume. We also compared the number and prevalence of tubulations in groups based on median values of the parameters. The primary outcome measure was the number and prevalence of tubulations.

Results: The average age of the participants was 58.7 ± 9.6 years. The mean deviation (MD) value was -25.0 ± 9.0 decibels (dB). The MD slope value during an average follow-up period of 5.9 ± 3.8 years was -0.91 ± 1.02 dB/year. The number of tubulations tended to increase as the MD values worsened (P = 0.055, r = -0.33). Moreover, the number (P = 0.48) and prevalence (P = 0.42) of tubulations tended to be higher in the group with lower MD values. The number of tubulations decreased with worsening logarithmic minimum angle of resolution (logMAR) (P = 0.68, r = -0.07). The prevalence of tubulations was higher in the group with poorer logMAR (P = 0.068). We observed no significant correlations between the number of tubulations and the retinal outer, inner, or center volume (P = 0.46, r = -0.13; P = 0.76, r = 0.05; P = 0.47, r = 0.12, respectively). However, the prevalence of tubulations in the group with smaller retinal center volume was lower (P = 0.054).

Conclusion: The number of tubulations correlated with the severity of visual field loss in patients with BCD; however, it did not correlate with visual field progression or retinal volume measurements. Further studies are needed to understand the development of tubulations and their implications for retinal atrophy in BCD.

Purpose: To investigate the role of corneal epithelium- and Bowman's layer-thickness (ET and BLT) changes as possible early biomarkers of keratoconus (KC) development.

Methods: In this cross-sectional study patients with unilateral KC (UKC) and a group of healthy controls underwent polarization sensitive optical coherence tomography (PS-OCT) for the evaluation of corneal ET and BLT. These values were compared among three subgroups of eyes, i.e., eyes with KC, topographically and tomographically normal fellow eyes (FE) of patients with UKC, and healthy eyes (HE).

Results: Twelve patients with UKC (12 eyes with KC and 12 FE) and 21 healthy age-matched controls (HE) were included. While KC eyes showed the typical epithelial "doughnut pattern" on epithelial maps, there were no differences in ET between FE and HE. BLT was significantly higher in FE compared to HE (average BLT p = 0.049, minimum BLT p = 0.02, nasal-inferior quadrant p = 0.04) as weIl as KC eyes (average BLT p = 0.048, minBLT p = 0.04, nasal-inferior quadrant p = 0.03).

Conclusions: Increase in BLT seems to occur before epithelial thinning in FE of patients with UKC. Since many of KC patients develop the disease bilaterally, Bowman's layer thickening might represent an early biomarker of KC-development.

Purpose: To investigate whether in diabetic cataract (DC), FoxO1 regulates high glucose (HG)-induced activation of NLRC4/IL-6 inflammatory mediators in human lens epithelial cells (SRA01/04) via the JAK1/STAT1 pathway, leading to cataract formation.

Methods: Expression levels of FoxO1, inflammatory factor IL-6 and inflammatory vesicle NLRC4 were examined in SRA01/04 under high glucose (HG) stress at 25-150 mM. Rat lenses were also cultured using HG medium with or without the addition of the FoxO1 inhibitor AS1842856 and the JAK1 agonist RO8191. 5.5 mM glucose concentration group (NG) was used as a control. Real-time PCR, Western blots, and immunofluorescent staining evaluated the mRNA and protein levels of FoxO1, NLRC4, and IL-6. Apoptosis, cell viability, and EDU Staining were also assessed.

Results: HG stimulation induced elevated FoxO1 expression and caused NLRC4/IL-6 activation in a concentration-dependent manner. Whereas knockdown of FoxO1 inhibited the high expression of NLRC4/IL-6 inflammatory mediators in response to HG stimulation. The growth of SRA01/04 was inhibited under HG condition, and the cell proliferation ability was restored and even promoted by knocking out FoxO1. HG incubation of rat lens resulted in lens clouding and cataract formation, which was prevented by AS1842856 treatment and reversed by RO8191.

Conclusion: FoxO1 positively regulates HG-induced SRA01/04 inflammatory activation through the JAK1/STAT1 pathway and promotes DC. This provides a feasible strategy for the treatment of diabetic cataract.

Purpose: To calculate the crystalline lens power and astigmatism, as well as their changes following cycloplegia, in individuals with myopia using swept-source optical coherence tomography (SS-OCT).

Methods: Participants were divided into two groups according to axial length (AL). Crystalline lens parameters, including power, lens thickness (LT), anterior chamber depth (ACD), and astigmatism, were measured with SS-OCT and analysed before and after cycloplegia. The lensmaker's equation was used to calculate lens power, and differences between three consecutive measurements < 22.5 degrees was set as the screening criterion for meridian direction measurement repeatability.

Results: Sixty-three eyes met the screening criterion on the anterior surface both before and after cycloplegia was included. The majority of eyes exhibited lens astigmatism ranging from + 0.76 D to + 1.50 D on both anterior and posterior surfaces. Before cycloplegia, 61 eyes (96.8%) had with-the-rule (WTR) astigmatism on the anterior surface. Meanwhile, 25 eyes met the criterion on posterior surface, of which 21 eyes (84.0%) had against-the-rule (ATR) astigmatism. After cycloplegia, 60 eyes (95.2%) had WTR astigmatism on the anterior surface. Meanwhile, 23 eyes met the criterion on posterior surface, of which 19 eyes (82.6%) had ATR astigmatism. After cycloplegia, there were significant changes in the lens power, astigmatism, thickness, and ACD.

Conclusions: Astigmatism of crystalline lens on the anterior and posterior surfaces was mainly WTR and ATR, respectively, with similar refractive power. After cycloplegia, changes in parameters and refractive power of the lens mainly occur on the anterior surface.

Background: To establish an objective method for assessing plus disease severity in retinopathy of prematurity.

Methods: Six images of plus diseases that were color-coded according to severity and published in the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3) were analyzed. These images were individually processed, and the best-fit curve and vessel course in zone I were obtained using ImageJ software. Tortuosity indices (TIs) of the major vessels in the temporal quadrants were calculated. Data from real-world patients with no plus, pre-plus, and plus diseases were analyzed and compared with those of the ICROP.

Results: The TIs of the arteries and veins, the sum of these TIs, and the artery/vein (A/V) TI ratios increased incrementally from grades 1 to 6. The trend revealed that the arterial tortuosity increased more than the venous tortuosity. The degree of venous tortuosity was similar from grades 3-5 but higher in grade 6. The A/V TI ratio increased in grades 1-3, stabilized in grades 3-5, and peaked in grade 6. Analysis of data from real-world patients showed increased TI of both arteries and veins, similar to the ICROP3. However, the A/V TI ratio did not show an increasing trend.

Conclusion: Objective methods for assessing disease severity can provide insights into the potential pathophysiological mechanisms of plus disease progression. Arterial tortuosity is more prominent than venous tortuosity. Venous features become more prominent as plus disease progresses, which may obscure the progression of arterial tortuosity.