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

Background: To investigate whether patients with binocular reading inhibition due to central vision loss benefit from a new biofeedback (BF) rehabilitation method that aimed at improving fixation stability and at establishing a correspondence between the monocular preferred retinal loci (PRLs) on functioning retina in both eyes.

Methods: Thirty-three patients with bilateral macular disease and with binocular reading inhibition participated in 10 training sessions consisting of 10-min visual stimulation for each eye to stabilize fixation and relocate the PRL (if needed) using the BF module of the MP-1 microperimeter (Nidek Technologies Srl., Vigonza, PD, Italy). Binocular and monocular reading performance, contrast sensitivity, and visual acuity were evaluated pre and post training. Binocular summation/inhibition was evaluated with binocular ratio (BR).

Results: Fixation stability improved significantly post training in both eyes. Maximum reading speed during binocular viewing increased from 57 ± 24wpm pre training to 67 ± 24wpm post training. BR increased for all parameters of reading, visual acuity, and contrast sensitivity. Training resulted in a complete reversal of binocular reading inhibition in 30% of patients.

Conclusions: For patients with binocular inhibition due to central vision loss, BF training to stabilize fixation and to bring the monocular PRLs into correspondence on functioning retina in both eyes is an efficient rehabilitation method to improve binocular performance.

Purpose: To investigate the correlation between intracellular dark endothelial spots (IDESs) detected by specular microscopy and the incidence of graft failure after Descemet's membrane endothelial keratoplasty (DMEK).

Methods: We reviewed 100 consecutive DMEK patients performed by a single surgeon at two centres between January 2015 and July 2022. Central corneal thickness was evaluated using anterior segment optical coherence tomography (SS-1000; Tomey, Aichi, Japan), and endothelial cell density was measured using specular microscopy. Kaplan-Meier estimates and Cox regression models were used to evaluate graft failure and associated risk factors.

Results: Of the 97 eyes included, 9 experienced graft failure within the follow-up period (52.9 ± 23.9 months). IDES presence significantly correlated with decreased endothelial cell density and higher graft failure rates (hazard ratio = 4.68, 95% confidence interval = [0.96, 22.7], P = 0.034).

Conclusion: IDESs represent a significant risk factor for graft failure post-DMEK. Careful postoperative management is imperative to minimise this risk.

Purpose: To detect choroidal markers of disease activity in eyes with chronic active unilateral pachychoroid disease spectrum (PDS) compared to the non-active contralateral eyes, based on multimodal imaging and particularly indocyanine green angiography (ICGA).

Methods: An observational retrospective case-control study. The study evaluated individuals diagnosed with chronic active unilateral PDS (group 1) by comparing the eyes with the non-active fellow eyes (group 2). Imaging was performed using fundus photographs, ICGA, and spectral-domain optical coherence tomography (SD-OCT). Choroidal thickness, choroidal vascular density, choroidal vasodilation, choroidal vascular leakage, and choroidal meridian breakdown were evaluated.

Results: Of the 90 patients with chronic PDS with ICGA at our database, 27 Caucasians (mean age: 55.9 years) were identified with active unilateral PDS. Group 1 showed a higher prevalence of the following parameters compared to Group 2: choroidal meridian breakdown (81.5% vs. 25.9%; p < 0.001), choroidal vasodilation (88.9% vs. 48.1%; p < 0.001), greater subfoveal choroidal thickness (420 ± 79.8 μm vs. 346 ± 78.5 μm; p = 0.002), ICGA choroidal vascular leakage (96.3% vs. 29.6%; p < 0.001), and choroidal hyperpermeability (100% vs. 29.6%; p < 0.001), with a nonsignificant increase in choroidal vascular density (55.4%±13.4 vs. 49.3%±13.5 in the contralateral eye; p = 0.167).

Conclusion: Choroidal meridian breakdown, thicker choroid, choroidal vasodilation, and ICGA choroidal vascular leakage are potential posterior choroidal markers of disease activity in PDS.

Purpose: To investigate the risk of cataract in patients with Cushing's syndrome (CS) and evaluate whether disease onset occurs at an earlier age compared to general population.

Methods: A nationwide retrospective matched-cohort study including individuals diagnosed with endogenous CS from 2000 to 2023. Patients with CS were matched in a 1:5 ratio with a control group individually matched for age, sex, socioeconomic status, and body mass index. The primary outcome was the incidence of cataract and cataract surgery. The Cox proportional hazards model, accounting for death without cataract as a competing risk, was employed to estimate hazard ratio.

Results: The study cohort included 609 patients with CS, 65% women and 35% men, and 3018 controls. The average age at CS diagnosis was 48.1 ± 17 years. Follow-up duration was 14.6 years (IQR 9.8-20.2). The source of hypercortisolism was Cushing's disease (CD) in 259 (42.6%) and adrenal CS (aCS) in 206 patients (33.8%). After CS diagnosis, cataract was observed in 171 patients (28.1%), and 771 controls (25.5%). Patients with CS had a 34% higher risk of developing cataract compared to their matched controls (HR = 1.34, 95% CI 1.03-1.75, p = 0.03). Cataract developed earlier in patients with CS compared to controls, with a mean age of onset at 64.7 ± 9.7 versus 67.6 ± 8.4 years, respectively (p = 0.01). A total of 49 (8.05%) patients had undergone cataract surgery after a diagnosis of CS compared to 177 (5.86%) in the control group (p = 0.07).

Conclusion: Patients with endogenous CS have an increased likelihood of developing cataracts and they experienced onset at a younger age. Guidelines should include annual cataract monitoring for CS patients, beginning 3-5 years earlier than the current general recommendations.

Purpose: Myopia (short-sightedness) is an emerging WHO priority eye disease. Rise in prevalence and severity are driven by changes in lifestyle and environment of children and young people (CYP), including less time spent in bright daylight and more time spent on near-vision activities. We aimed to systematically map the literature describing direct, objective measurements of the visual environment of CYP.

Methods: We conducted searches in Ovid Medline 1946, Ovid Embase and The Cochrane Central Register of Controlled Trials in November 2024. We included primary research written in English on environmental/behavioural factors and myopia onset/progression in CYP 3-18 years. Two reviewers independently screened titles/abstracts/full texts.

Results: We included 34 articles: 21 explored the association of indoor and/or outdoor light exposure and myopia and included light measurements, two near-vision activities, four both light and near-work, four time outdoors without illuminance measurements, and three light exposure based on meteorological data. Most measurements were carried out at the level of individual children, rather than the surrounding environment alone.

Conclusion: Despite limitations in measurement techniques, there is evidence that reduced illuminance, less time spent in bright light and increased daily duration/sustained episodes of near-vision activities and reduced working distance are associated with increased myopia prevalence/progression.

Purpose: To analyze the latest annual trends in immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) among patients with bilateral cataracts in Korea, and to identify the factors influencing the choice of surgery and the outcomes associated with ISBCS and DSBCS.

Methods: This retrospective, nationwide cohort study included all patients aged 65 and older who were covered by the Korean National Health Insurance and underwent ISBCS or DSBCS from 2016 to 2021. The study recorded yearly numbers of ISBCS and DSBCS procedures, the interval between surgeries in DSBCS cases, patient demographics, types of implanted intraocular lenses (IOLs), and the incidence of cystoid macular edema and endophthalmitis following ISBCS or DSBCS.

Results: A total of 50 878 (7.2%) patients underwent ISBCS, and 658 609 (92.8%) patients underwent DSBCS. ISBCS cases more than doubled in 2020 (7902) from 2019 (3703) before increasing even more significantly in number in 2021 (33 645). Age, hospital size, ocular and systemic comorbidities, type of IOL, and calendar year were associated with receiving ISBCS. In 2020 alone, the incidence of postoperative endophthalmitis among ISBCS patients was significantly higher (1.39 per 1000 procedures) than among DSBCS patients (0.40 per 1000 procedures; P = 0.001).

Conclusion: The number of patients undergoing ISBCS for bilateral cataracts increased annually, particularly after the onset of the COVID-19 pandemic in Korea in 2020. However, this significant rise in ISBCS also led to a surge in the incidence of postoperative endophthalmitis in 2020.

Purpose: To investigate whether sub-Tenon injection of triamcinolone acetonide (STTA) combined with anti-vascular endothelial growth factor (VEGF) prolongs the recurrence intervals of macular edema (ME) for chronic retinal vein occlusion (RVO) and to investigate the differences in intraocular inflammatory cytokines between good responders (GRs) and non-responders (NRs).

Methods: This retrospective, observational study involved 42 eyes of 42 patients with ME due to chronic RVO who had received only anti-VEGF for ≥ 1 year and were transitioned to combination therapy. GRs were defined as patients whose recurrence intervals were prolonged by ≥ 2 weeks compared with patients receiving anti-VEGF alone. Moreover, immediately before starting the combined therapy, aqueous humor was collected and the following inflammatory cytokines were compared between GRs and NRs: CCL11, MCP-3, IP-10, CCL13, G-CSF, GM-CSF, IL-1α, IL-15, IL-4, M-CSF, MMP-9, TNF-α, MCP-1, CXCL-1, CXCL12, IL-8, galectin-1, IFN-γ, IL-12, IL-2, IL-6, MMP-1, PDGF-AA, and VEGF-A. These results were analyzed by nominal logistic regression after stepwise variable selection.

Results: There were 26 eyes (62%) in the GR group. Nominal logistic analyses showed that a higher concentration of IL-1α (P = 0.016) and lower concentrations of IL-5 (P = 0.015), IL-6 (P = 0.022), and galectin-1 (P = 0.015) were significantly associated with the extension of the time from injection to recurrence of ME.

Conclusion: Combined anti-VEGF and STTA therapy for chronic RVO was effective in 62% of patients, suggesting the effectiveness of STTA. Higher IL-1α and lower IL-5, IL-6, and galectin-1 were the factors associated with combined treatment effectiveness.

High altitude (HA) exposure induces impairments in visual function. This study was designed to dynamically observe visual function after returning to lowland and elucidate the underlying mechanism by examining the structure and function of retina and visual pathway. Twenty-three subjects were recruited before (Test 1), and one week (Test 2) and three months (Test 3) after their return from HA (4300 m) where they resided for 30 days. The clock task was used to assess visual cognition; and pattern-reversal visual evoked potential (p-VEP) and full-field electroretinogram (ff-ERG) were employed to record electrophysiological responses of retinal cells; optical coherence tomography (OCT), color doppler imaging (CDI) and magnetic resonance imaging(MRI) were used to measure structures of retina and visual pathway. In Test 2 vs. Test 1, there was increased reaction time during angle task; the amplitudes of scotopic 3.0 cd·s/m² and scotopic 10.0 cd·s/m² ERG a-wave and scotopic 3.0 cd·s/m² oscillatory potential in the right eye were significantly decreased, all of which were negatively correlated with the increased reaction time during the angle task. In Test 3 vs. Test 1, there were decreased amplitude of scotopic 10.0 cd·s/m² a-wave in the right eye and increased velocity of ophthalmic artery and ocular perfusion pressure in bilateral eyes. The VEP and visual pathway structures remained normal throughout the entire test. HA exposure caused damage to rod and cone responses in both outer and inner retina. After returning to sea level, the damaged visual cell functions gradually recovered over time, coinciding with an increase in the ocular perfusion.

Purpose: To examine the nine-item National Eye Institute Vision Function Questionnaire (NEI-VFQ-9) scores at baseline and 12 months in participants enrolled in the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT) and determine factors associated with improvements in vision-related quality-of-life (VRQOL).

Methods: Retrospective review of NEI-VFQ-9 scores at baseline and 12-month follow-up in a community-based eye health screening study conducted in Upper Manhattan, New York. Participants were age ≥ 40 years and older, living independently in public/affordable housing developments and able to provide informed consent. Paired t-tests compared baseline and 12-month NEI-VFQ-9 composite and sub-scores and a multivariable linear regression model identified significant predictors of improvement in quality-of-life at the 95% confidence interval (CI).

Results: A total of 515 participants completed both the NEI-VFQ-9 at baseline and 12-months. Significant increases in the composite NEI-VFQ-9 score were seen with general vision, near vision tasks, and role limitation (P < 0.001). Multivariable linear regression showed that being unemployed was associated with a statistically significant increase in NEI-VFQ-9 composite score (β = 5.6, 95% CI: 0.5,10.7, P = 0.033), and the absence of ocular conditions was negatively associated with improvement in the composite score over 12 months (β = -5.4, 95% CI: -10.3, -0.5, P = 0.031).

Conclusions: These results can help researchers, clinicians, and eye health professionals better understand the factors associated with VRQOL outcomes in underserved populations utilizing the NEI-VFQ-9. Community-based vision research clinical trials can easily incorporate the NEI-VFQ-9 into baseline and follow-up instruments to assess VRQOL for future comparisons.

Purpose: The retinal pigment epithelium (RPE) plays an important role in the pathogenesis of age-related macular degeneration (AMD) and other retinal degenerative diseases. The introduction of healthy RPE cell cultures into the subretinal space offers a potential treatment strategy. The aim of this study was the long-term culture and characterisation of RPE cells on nanofiber scaffolds.

Methods: Nanofiber scaffolds consisting of polycaprolactone (PCL) and collagen were prepared by electrospinning. Porcine RPE cell cultures were maintained on PCL scaffolds, PCL-collagen scaffolds, and controls at the bottom of 24-well plates. Cell culture analysis was performed by immunohistochemistry, while the release of inflammatory cytokines IL-6, IL-8, TNF-α, and PDGF-β was measured by ELISA and multiplex assays. Ultrastructural features were examined by transmission electron microscopy.

Results: The observation period averaged 42.7 weeks for controls, 38.7 weeks for PCL scaffold cultures, and 36.1 weeks for PCL-collagen scaffold cultures, with cell number and morphology remaining stable. TNF-α levels in the supernatants were minimal, IL-6 levels were consistently low, and IL-8 levels decreased from initially high to lower levels over time.

Conclusion: RPE cells were stably cultured on nanofiber scaffolds for extended periods of time. The long-term physiological properties of RPE cells, including phagocytic ability and visual cycle enzyme activity, need to be further investigated before clinical application. In addition, controlling the expression of inflammatory mediators is a major challenge. Despite these hurdles, overcoming them is critical given the increasing prevalence of retinal degenerative diseases.