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

Purpose: To evaluate the posterior scleral stiffness of different regions in high myopic eyes and to explore its associations with macular choroidal and peripapillary retinal nerve fiber layer (pRNFL) thickness and vasculature.

Methods: Thirty subjects with high myopic eyes and 30 subjects with low myopic eyes were included in this study. The elastic modulus of the macular and peripapillary sclera at the temporal, nasal, superior and inferior regions were determined via shear wave elastography (SWE). Optical coherence tomography and angiography (OCT/OCTA) centered on the fovea and optic disc was obtained by using a commercially available swept-source OCT/OCTA device. Built-in automated software was used to quantify macular subfovea choroidal vessel volume (SFCVV), macular subfovea choroidal thickness (SFCT) and pRNFL thickness.

Results: The SWE results demonstrated that high myopic eyes had significantly lower macular and peripapillary scleral elastic modulus than low myopic eyes (P < 0.001). The reduction in the elastic modulus was slightly greater in the temporal peripapillary region, followed by the superior peripapillary, inferior and nasal peripapillary regions (P > 0.05). The linear regression analysis demonstrated a significant association between the posterior scleral elastic modulus and SFCT and inferior pRNFL thickness (P < 0.001).

Conclusion: High myopic eyes had weakened posterior scleral stiffness. The regional change in the elastic modulus was associated with the SFCT and inferior quadrant pRNFL thickness. This novel in vivo quantitative assessment of scleral stiffness via SWE may help to characterize the underlying pathologic mechanism of scleral biomechanics on choroid and pRNFL changes in high myopia.

Key messages: WHAT IS KNOWN : Previous studies reported significant choroid thickness and peripapillary nerve fiber layer thickness decrease in high myopia The scleral stiffness is weakened in myopic eyes WHAT IS NEW : Shear wave elastography (SWE) is a novel tool to detect posterior scleral biomechanics in myopic eyes in vivo Stiffness of the posterior sclera at macular and peripapillary regions is lower in high myopic than in low myopic eyes The posterior scleral stiffness is correlated with subfovea choroidal thickness and inferior quadrant peripapillary nerve fiber layer thickness.

Purpose: Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.

Methods: A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.

Results: Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2-10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.

Conclusions: Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.

Purpose: To define the anatomical variance between orbital floor and medial orbital wall blowout fractures, and its change with age.

Methods: This was a retrospective, observational study analyzing data from 557 patients with isolated blowout fractures of the orbital floor or medial orbital wall. Axial and quasi-sagittal CT images were analyzed to compare radiologic data on orbital wall morphology between fracture site groups and among age groups. Patient ages were classified as: 0-9 (childhood), 10-18 (adolescence), 19-44 (early adulthood), 45-64 (middle adulthood), and ≥ 65 years (late adulthood).

Results: The orbital floor fracture group demonstrated significantly steeper orbital floors (p < 0.001), while the medial wall fracture group exhibited a tendency for more convex medial orbital walls (p = 0.066). Among age groups, medial wall fracture was predominant in the late adulthood group only (p < 0.001). Patients in the childhood and late adulthood groups had significantly flatter orbital floors (p < 0.001). Patients in the childhood group presented with a concave medial orbital wall (p < 0.001). The anteroposterior length of the medial orbital wall and the number of ethmoid air cells were not different between fracture groups (p = 0.603 and 0.753, respectively) and among age groups (p = 0.306 and 0.456, respectively).

Conclusion: Patients with orbital floor and medial orbital wall fractures had anatomically steeper orbital floors and convex medial orbital walls, respectively. Age-related differences in the shape of the orbital walls may influence variation in orbital blowout fracture sites by age.

Key messages: WHAT IS KNOWN : Fracture sites of the orbital walls differ according to age groups. The floor is more commonly fractured in children, with a shift to the medial wall in the elderly.

What is new: Orbital floor and medial orbital wall fractures present with anatomically higher floor and medial walls, respectively, compared to each other.  This indicates steeper convexities of the walls which predispose them to fracturing. Children's medial orbital walls are initially concave, then shift to convex structures with facial bone and sinus maturation. This explains why there is a change in blowout fracture site between age groups, as it has been documented that concave structures are more resistant to deformation.

Purpose: Assessing the quality of the visual field is important for the diagnosis of ophthalmic and neurological diseases and, consequently, for rehabilitation. Visual field defects (VFDs) are typically assessed using standard automated perimetry (SAP). However, SAP requires participants to understand instructions, maintain fixation and sustained attention, and provide overt responses. These aspects make SAP less suitable for very young or cognitively impaired populations. Here we investigate the feasibility of a new and less demanding form of perimetry. This method assesses visual sensitivity based on pupil responses while performing the perhaps simplest task imaginable: watching movies.

Method: We analyzed an existing dataset, with healthy participants (n = 70) freely watching movies with or without gaze-contingent simulated VFDs, either hemianopia (left- or right-sided) or glaucoma (large nasal arc, small nasal arc, and tunnel vision). Meanwhile, their gaze and pupil size were recorded. Using a recently published toolbox (Open-DPSM), we modeled the relative contribution of visual events to the pupil responses to indicate relative visual sensitivity across the visual field and to dissociate between conditions with and without simulated VFDs.

Result: Conditions with and without simulated VFDs could be dissociated, with an AUC ranging from 0.85 to 0.97, depending on the specific simulated VFD condition. In addition, the dissociation was better when including more movies in the modeling but the model with as few movies as 10 movies was sufficient for a good classification (AUC ranging from 0.84 to 0.96).

Conclusion: Movie-viewing pupil perimetry is promising in providing complementary information for the diagnosis of VFDs, especially for those who are unable to perform conventional perimetry.

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: Age-related cataract (ARC) remains one of the leading causes of blindness globally. Despite the satisfactory outcomes of surgical interventions, significant disparities in access to medical care prevent many patients from receiving effective treatment. Thus, identifying reliable biomarkers and therapeutic targets to expand treatment options for ARC is essential. Recent evidence indicates that microRNAs (miRNAs) play a role in the development of cataracts and may serve as promising biomarkers. Consequently, this study aims to investigate miRNAs' levels and potential functions in ARC.

Methods: We conducted a meta-analysis following the PRISMA guidelines by searching three databases from inception to March 31, 2023. The quality of the articles was assessed using the NOS. Subsequently, the targets of the miRNAs identified in the meta-analysis were predicted using six databases, and their GO functions and KEGG pathway enrichment information were analyzed via DAVID.

Results: An initial search yielded 225 publications, from which 22 miRNAs across 37 studies were selected for our meta-analysis. We identified eight differentially expressed miRNAs (DEmiRNAs) in ARC, comprising two up-regulated miRNAs (miR-124 and miR-125a) and six down-regulated miRNAs (miR-15a, miR-23b, miR-34a, miR-221, miR-222, and miR-378a). A total of 972 targets for these miRNAs have been confirmed, and subsequent bioinformatics analysis has revealed their potential functions and pathways in various ARC-related processes.

Conclusions: This study indicates that eight differentially expressed miRNAs (miRNA-15a, miRNA-23b, miRNA-34a, miRNA-124, miRNA-125a, miRNA-221, miRNA-222, and miRNA-378a) may serve as biomarkers for ARC. Bioinformatics analyses suggest varied potential roles for each miRNA, providing a framework for future research in ARC. This systematic evaluation represents the initial depiction of the miRNA-biomarker landscape in ARC.

Key messages: What is known MicroRNAs(miRNAs) could serve as biomarkers for age-related cataract(ARC) since their abundances are associated with ARC and can play a role in cataractogenesis. However, existing studies have reported inconsistent results regarding the miRNA level in ARC. Therefore, achieving a consensus on the role of miRNAs in ARC is essential to clarify their involvement. What is new This study suggested that eight differentially expressed miRNAs (miRNA-15a, miRNA-23b, miRNA-34a, miRNA-124, miRNA-125a, miRNA-221, miRNA-222, and miRNA-378a) may serve as biomarkers for ARC. Our bioinformatics analysis identified various potential roles for each miRNA, which could guide future research on ARC.

Purpose: Our study presents a virtual reality-based tangent screen test (VTS) to measure subjective ocular deviations including torsion in nine directions of gaze. The test was compared to the analogous Harms tangent screen test (HTS).

Methods: We used an Oculus Go^® controller and head-mounted-display with rotation sensors to measure patient's head orientation for the VTS. The software was developed with Unity^®. We assessed subjective squint angles of adult patients with eye motility disorders of different origin in nine positions of gaze by means of HTS and VTS. We calculated mean difference, 95% limits of agreement and intraclass correlations (ICC) for horizontal, vertical and torsional deviations.

Results: We included 85 patients. Measured horizontal and vertical deviations showed very good agreement between the two methods in all gaze directions (horizontal and vertical ICC: 0.93-0.98). Agreement was lower for torsional deviations (ICC: 0.79-0.93). The mean difference in primary position was 1.5° (95% limits of agreement -3.5° to 6.5°) for horizontal, 0° (-2,7° to 2,7°) for vertical, and 0.3° (-4.0° to 3.0°) for torsional deviations. The average examination time was 6 min with the VTS compared to 15 min with the HTS.

Conclusions: Vertical and horizontal deviations showed good agreement between both tests measuring a slightly higher esodeviation with VTS probably due to an increased vergence demand. Measurement of torsional misalignment would benefit from a controller with more holding stability, such as a PC-mouse with central wheel, facilitating fine adjustments. VTS allowed automatic documentation, required less time and was easier to use than HTS.

Key messages: What is known The incidence of neurogenic diplopia increases in the ageing population. The Harms tangent screen test (HTS) reliably measures subjective ocular deviations in patients with diplopia. The HTS requires staff well-trained in orthoptics limiting its use. What is new A novel virtual reality-based tangent screen test (VTS) enables measurement of horizontal, vertical and torsional ocular misalignment and shows a good comparability to the HTS. VTS uses commercially available head-mounted-display and controller, and specifically developed software, requires less time than HTS and allows automatic documentation. VTS administration does not require orthoptic training and can eventually be implemented in a clinical setting to provide a wider availability of subjective squint angle measurements.

Purpose: Graves' disease (GD) and Graves' orbitopathy (GO) are multifactorial disorders with links to the gut microbiome and autoimmunity. It is observed that patients with GD exhibit altered gut microbiome diversity. However, little is known about the role of oral microbiota in GD and GO. This study aims to investigate the impact of oral health and oral sanitation on the clinical course of GO in patients disqualified from glucocorticoid treatment due to oral infections.

Methods: We reviewed 188 admissions of 127 patients with GO, hospitalized in a tertiary university hospital. Clinical, biochemical, imaging, ophthalmological, and oral health assessment data from each admission were analyzed. Patients excluded from the glucocorticoids (GCs) therapy due to oral foci of infection had the clinical activity score (CAS) reassessed after three months, and they were divided into two groups: with and without improvement.

Results: Finishing dental treatment in the meantime was the only factor significantly correlated with improvement in these patients (p = 0.041). The secondary finding was that anti-thyroid peroxidase antibodies titer was significantly higher in the group with oral foci of infection considered as a contraindication for GCs (medians 28.50 vs 128.00; p = 0.026), and those patients were more likely to smoke than the group without oral issues (p = 0.024).

Conclusions: The results of our study suggest that monitoring and treating oral diseases may be pertinent in patients with GO and might serve as a supportive treatment strategy for managing the condition.

Key messages: What is known: There is a recognized link between gut dysbiosis and the autoimmune processes in Graves' Disease (GD) and Graves' Orbitopathy (GO).

What is new: Elevated levels of TPOAb have been observed in patients with GO who also have oral foci of infection. Dental treatment has been shown to lead to significant clinical improvements in patients with GO. Maintaining oral hygiene might serve as a supportive treatment strategy for managing GO.