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

Purpose: Research on the correlation between ocular dominance and macular structure and function is inconsistent. This clinical observational study explored the effect of ocular dominance on retinal structure and the correlation between binocular structural asymmetry and ocular dominance.

Methods: Forty healthy young adults (aged 20-29 years) were enrolled. Ocular dominance, refractive error, pattern visual evoked potential (PVEP), multifocal electroretinography (mfERG), swept-source optical coherence tomography (SS-OCT), and optical coherence tomography angiography (OCTA)tests were performed.

Results: Among the 40 subjects, 24 (60%) were right-eye dominant. The dominant eye had a larger amplitude density of Ring 1 in the mfERG (198.52 ± 51.43 vs. 175.92 ± 50.17, p = 0.003), larger density of the superficial capillary plexus of the macula within the 4-12 mm diameter range (dominant eyes vs. nondominant eyes: 4-6 mm: 80.89 (78.24,83.58) vs. 78.93 (74.85,81.77), p < 0.001; 7-9 mm: 73.01 (69.22,75.90) vs. 71.75 (69.43,74.37), p = 0.009; 10-12 mm: 55.79 ± 5.40 vs. 54.46 ± 7.03, p = 0.033), and a thicker choroidal layer (dominant eyes vs. nondominant eyes: 7-9 mm: 289.70 ± 58.85 vs. 279.86 ± 59.16, p = 0.045; 10-12 m: 270.05 ± 44.87 vs. 259.64 ± 43.50, p = 0.014). The right eye had a higher choroidal vascular density (right eyes vs. left eyes: 0-1 mm: 95.45 (84.56,98.67) vs. 91.04 (79.79,97.04), p = 0.018) and lower superficial retinal vascular density (right eyes vs. left eyes: 10-12 mm: 54.29 ± 5.98 vs. 55.82 ± 6.34, p = 0.027) and choroidal vascular density (right eyes vs. left eyes: 7-9 mm: 90.98 ± 2.89 vs. 92.18 ± 2.61, p = 0.041).

Conclusion: Ocular dominance influenced macular foveal function, parafoveal vessel density and choroidal thickness. The functional and morphological differences in ocular dominance and laterality are inconsistent.

Background: To analyze corneal topographic and biomechanical parameters in keratoconus patients before undergoing accelerated corneal collagen cross-linking (A-CXL) surgery and use machine learning models to identify prognostic factors for disease progression after treatment.

Methods: This was a retrospective, single-center study on 95 eyes from 69 keratoconus patients (mean age 21.46 ± 7.07 years) undergoing A-CXL, with 3-22 months follow-up. Corneal tomography (Pentacam) and biomechanical measurements (Corvis ST) were performed at baseline and follow-up visits. Changes in the E-stage were used to define progression. LASSO, XGBoost, and random forest machine learning models were applied to identify prognostic factors. A nomogram was developed to predict progression probabilities.

Results: 42.1% of eyes showed progression based on E-stage change. Maximal keratometry (Kmax) and index of surface variance (ISV) were significantly higher in the progression group. The nomogram incorporating Kmax and ISV predicted progression better than individual parameters. The progression rate was 51.4% in high-risk eyes versus 16% in low-risk eyes stratified by the nomogram.

Conclusions: Kmax and ISV are important prognostic factors for keratoconus progression after A-CXL. The nomogram can improve prediction accuracy compared to single parameters. It enables personalized risk assessment to guide treatment decisions.

Purpose: To investigate the impact of biomechanical changes in the optic nerve head on glaucoma progression during ocular rotation in highly myopic eyes with primary open-angle glaucoma.

Methods: This study retrospectively enrolled 147 patients with primary open-angle glaucoma, including 57 with high myopia and 90 with non-high myopia. Personalized optic nerve head models were designed, and simulations were performed using finite element analysis to evaluate the effect of ocular rotation on the optic nerve head. Biomechanical changes in the optic nerve head were analyzed and compared between the groups.

Results: The mean strain on the lamina cribrosa was significantly higher in the high myopia group compared to the non-high myopia group during ocular rotation. The stress ratio, indicating asymmetric stress distribution, was higher in the high myopia group than in the non-high myopia group. The stress ratio increased significantly as axial length increased. Both stress ratio and mean lamina cribrosa strain were correlated with rate of retinal nerve fiber layer thickness reduction (stress ratio: partial coefficient = -0.171, P = 0.040; mean lamina cribrosa strain: partial coefficient = -0.196, P = 0.018).

Conclusion: High myopia leads to increased lamina cribrosa strain and asymmetric stress distribution during ocular rotation. These findings underscore the importance of considering optic nerve head biomechanics in patients with high myopia. Additionally, the stress ratio may serve as a novel indicator for predicting glaucoma progression.

Key messages: What is known Biomechanical changes in the optic nerve head differ between patients with high myopia and those with non-high myopia. What is new Asymmetric stress distribution on the lamina cribrosa during ocular movement was higher in the high myopia group and was associated with structural progression of glaucoma. A longer axial length increased the asymmetric stress on the lamina cribrosa during ocular movement.

Purpose: Basal cell carcinoma (BCC) is the most frequent malignant tumor of the eyelid and recurrences of BCC may lead to massive destruction of the orbital region. The objective of this study was to evaluate predictors for surgically difficult-to-control or uncontrollable recurrences.

Methods: All BCCs of the periorbital region treated in the Department of Dermatology or Ophthalmology between 2011 and 2021 were included in a retrospective single center study and divided into a group of primary BCCs (pBCCs) and a group of recurrent BCCs (rBCCs). The following risk factors were compared between the two groups using the Chi² test: tumor localization, histological subtype and presence of R1 situation. Furthermore, difference in severity of reconstruction between pBCCs and rBCCs was analyzed. P-value < 0.05 was considered statistically significant.

Results: Data from 474 pBCCs and 33 rBCCs were included in this retrospective analysis. Both R1 status (p < 0.001) and aggressive subtype (p = 0.028) were significant risk factors for recurrence. The two most frequent reasons for R1 were the patient's rejection of further surgical intervention (n = 4) and the fact that the surgery was not performed at a specialized center (n = 6). In 10 of the 33 rBCCs, a further recurrence occurred despite R0 status and all 10 cases showed an aggressive subtype (p = 0.020). In all BCCs with R1 status, there was no significant difference in the recurrence rate regarding the subtype.

Conclusion: Our results show the impact of incomplete tumor resection and aggressive subtype on patient outcome after BCC surgery. We suggest that the aggressiveness of the BCC may be the precondition for multiple recurring BCCs. Furthermore, especially patients who underwent surgery outside our Departments showed R1 situations and rBCCs. Therefore, personalized treatment and follow-up care as well as efforts to avoid high-risk recurrences with aggressive subtypes are necessary to improve long-term success after surgery and should be conducted by a specialized center.

Background: To analyze intraorbital Hydroxyapatite(HA) implant exposure occurring beyond ten years of implantation and suggest potential contributing factors.

Design: A retrospective cohort study based in the Shanghai Ninth People's Hospital.

Methods: One hundred and one Chinese patients with HA implant exposure were identified, from which 38 patients with implants exposure after ten years of insertion were selected and analyzed for demographic and medical records, clinical manifestations, surgery type, implant size, exposure area, follow-up duration, complications, details regarding prosthesis care, and treatment methods. All of the removed implants were sent for an HE pathologic examination.

Results: The 38 cases experienced exposure 10 to 19 years after implantation and presented to the clinic with increased secretions, proliferation of granulation tissue, visible suture exposure, and difficulty in wearing the external prosthesis. Other complications included implant forward position in 3 patients, eyelid retraction in 4 patients, and all the patients presented with post-enucleation socket syndrome. Reviewing the medical history, HA implant sizes ranged from 18 to 22 mm. Fourteen patients underwent implant repair surgery, of which 2 experienced recurrence, and ultimately, 26 implants were removed. Of the 26 removed implants, histologic examination showed that 17 exhibited chronic infection, and 12 had limited fibrovascular ingrowth. The questionnaires indicated that 26 patients did not renew the external prosthesis regularly.

Conclusion: This study identified late complications and potential risk factors for implant exposure beyond ten years of implantation, including chronic infection, non-absorbable sutures, and low and delayed vascularization.

Purpose: To determine the scleral thickness of inactive scleritis characterized by a violaceous hue (violaceous sclera) using anterior segment optical coherence tomography (AS-OCT).

Methods: Retrospective observational case series of patients with inactive unilateral anterior scleritis featuring a violaceous hue. Mean scleral thickness was measured by AS-OCT in violaceous areas and compared with the same region in the contralateral unaffected eye. Measurements were performed by two masked graders.

Results: Nine patients with median age of 52 ± 12.8 years were assessed. Eight patients were female. Rheumatoid arthritis and history of treated latent tuberculosis (33.3%) were the most common causes of anterior scleritis. Mean scleral thickness was 582.93 ± 124.03 µm and 648.59 ± 103.61 µm for violaceous sclera and the corresponding unaffected areas of the contralateral eye, respectively (mean difference = -65.65 µm, 95% CI: -143.73 to 12.42, p = 0.0885). The mean image contrast percentage of scleral hyperreflectivity as assessed by image conversion in an area of violaceous hue was 65.07 µm ± 6.49 µm compared to 42.70 µm ± 5.46 µm of unaffected areas (mean difference = 22.37 µm, 95% CI: 14.72 µm to 30.03 µm, p = 0.0001).

Conclusion: Using AS-OCT, the thicknesses of violaceous sclerae were not significantly thinner than the contralateral unaffected areas, despite a mean difference of approximately 65 microns. The increased scleral hyperreflectivity observed in the violaceous sclera may suggest collagen remodeling in these areas. Such remodeling could play a role in the sclera reflecting violaceous hues while still preventing direct visualization of the underlying choroid.

Purpose: This study aims to investigate the clinical characteristics of rhegmatogenous retinal detachment (RRD) in patients aged over 90 years, a demographic that has been underrepresented in previous research.

Method: Retrospective, single-center, observational case series. The study included patients over 90 years old, excluding those with significant ocular trauma or other specific eye diseases affecting the retina. Data on demographic characteristics, RRD extent, surgical interventions, and postoperative outcomes were collected and analyzed.

Results: The study included 24 patients (24 eyes, 75% female) where the median age was 93 years (range: 91-98). Most patients displayed macular involvement, and about one-third experienced proliferative vitreoretinopathy. Surgical interventions primarily involved pars plana vitrectomy, with a noted delay from symptom onset to surgery averaging ten days. Postoperative improvements in visual acuity were significant, yet the final visual acuity remained low. Baseline median BCVA was 2.30 logMAR, and 1.0 (0.30-2.30) log MAR at the last visit (p = 0.017). RRD was in 52% of the eyes over two quadrants, in 83.3% with macula involvement, and in 37.5% with proliferative vitreoretinopathy (PVR) at baseline. Of these patients, 61.9% were pseudophakic. Twenty-one eyes of 21 patients underwent treatment and postoperative follow-up was available in 47.6% (n = 10) of the patients. Four of the 10 patients with follow-up had redetachment at the last visit.

Conclusion: The high rate of macular involvement and the complexities associated with PVR highlight the challenges of treating RRD in the elderly. Delayed hospital presentation, impaired adherence to posturing and low postoperative follow-up rates may significantly impact the treatment success. This study underscores the need for tailored management strategies to improve outcomes in this age group.

Key messages: What is known An increase in retinal detachments has occurred mainly due to earlier lens surgery in the younger age group but will also occur in the old-aged group as a result of demographic changes. What is new Elderly patients show variable symptoms of retinal detachments and management is complicated by frequent ocular and systemic comorbidities. The clinical characteristics of detachments at age over 90 years include proliferative vitreoretinopathy and late presentation. Like vitreoretinal surgery at the end of life, the decision to operate presents a particular challenge.

Purpose: To investigate the interocular differences in the peripapillary retinal nerve fiber layer (RNFL) thickness and retinal vasculature in non-pathological myopic patients with anisometropia.

Methods: This retrospective cross-sectional study included 100 eyes from 50 participants aged 11 to 40 with anisometropic myopia. All participants underwent comprehensive ocular examinations, and then the RNFL thickness, ONH parameters, macular vessel density (MVD), optic disc vessel density (OVD), and optic disc perfusion density (OPD) were obtained using the Cirrus spectral domain optical coherence tomography (SD-OCT). The participants were divided into two groups based on the degree of anisometropia: Group 1 had the interocular difference of spherical equivalent (SE) over 1.50 diopters (D), and Group 2 had the interocular difference of SE between 1.00 D and 1.50 D. The interocular differences in retinal parameters were analyzed and compared between the two studied groups.

Results: The superior and inferior RNFL were thinner, and the temporal RNFL was thicker in the more myopic eyes. The interocular differences of the temporal RNFL thickness, nasal MVD, temporal and inferior OVD, and temporal OPD were correlated with the interocular differences of SE and AL. The interocular differences of the temporal RNFL thickness, OVD, and OPD in Group 1 were more significant than in Group 2.

Conclusion: This study revealed that the temporal peripapillary RNFL was thicker in more myopic eyes, accompanied by higher OVD and OPD. These regional retinal alterations in the temporal peripapillary area may occur before the decrease in RNFL thickness and the onset of myopic pathological changes.

Purpose: To investigate the morphological characteristics of dome-shaped macula (DSM) and inferior staphyloma complicated by serous retinal detachment (SRD).

Methods: Electronic medical records and multimodal images of patients diagnosed with DSM and inferior staphyloma were retrospectively reviewed. Morphological features, including axial length, curvature height, orientation of the dome, presence of retinal pigment epithelial detachment, choroidal vascular features such as subfoveal choroidal thickness, variations in choroidal thickness, presence of abrupt changes in choroidal thickness and presence of large choroidal vessels were analyzed.

Results: Fifty-three eyes of 37 patients were included, of which 33 eyes had DSM and 20 eyes had inferior staphyloma, and 15 (28.3%) were complicated with SRD. Four (12.1%) of the DSM and 11 (55.0%) of the inferior staphyloma eyes had SRD. On univariate analysis of risk factors for SRD, shorter axial length (p = 0.002), presence of inferior staphyloma (p = 0.004), higher subfoveal curve height (p = 0.009), thicker subfoveal choroidal thickness (p = 0.038), greater variation in choroidal thickness (p = 0.005), presence of both abrupt changes in choroidal thickness (p < 0.001) and large choroidal vessels (p = 0.001) showed a significantly higher risk. On multivariate analysis, shorter axial length (p = 0.038) and presence of abrupt changes in choroidal thickness (p = 0.008) were identified as significant risk factors for SRD.

Conclusion: SRD was more prevalent in eyes with inferior staphyloma compared to DSM. Shorter axial length and abrupt changes in choroidal thickness were associated risk factors for SRD.

The topic of neuroprotection in glaucoma and age-related macular degeneration (AMD) is well disseminated in the literature. However, the problem is providing ophthalmologists with clear, evidence-based messages to draw on. This review examines the landscape of neuroprotective therapies for glaucoma and AMD. While promising neuroprotective agents, such as citicoline and nicotinamide, have been explored for their potential to mitigate neurodegeneration in glaucoma, robust clinical evidence validating their efficacy remains limited and there is a need for further large-scale, long-term studies to substantiate the neuroprotective effects of these agents. Maintaining low intraocular pressure plays a vital role in preventing neuronal death in glaucoma. AMD has traditionally been considered a disease affecting the outer retinal layers; however, growing evidence suggests that the inner layers are also involved. Neuroprotection is an emerging area of research, with strategies focusing on alleviating oxidative stress, inflammation and apoptosis. A reassessment of clinical endpoints and methodologies in neuroprotection research is critical to better evaluate the efficacy of these therapies in glaucoma and AMD.