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

Aims: To construct a diabetic retinopathy (DR) prediction nomogram based on optical coherence tomography angiography (OCTA) parameters. Ophthalmologists can then use this nomogram to assess the risk of early-stage DR.

Methods: In this retrospective study, patients with type 2 diabetes mellitus who completed DR screening were enrolled and divided into training and validation sets. Fifteen parameters, including OCTA parameters, axial length (AL), age, and sex, were selected via least absolute shrinkage and selection operator (LASSO) in the training set. The chosen parameters were used to construct the model. Model performance was evaluated for both the training and validation sets via receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). A corresponding nomogram was created.

Results: A total of 464 eyes from 464 patients were divided into a training set (324, 69.83%) and a validation set (140, 30.17%). The superficial parafoveal capillary density (CD), deep parafoveal CD, foveal CD in the 300 µm-wide area surrounding the foveal avascular zone (FD- 300 area), AL, and patient ages were included in the final model. The area under curve of the model was 0.825 in the training set and 0.831 in the validation set. The calibration curves showed good alignment between the actual and predicted outcomes in both datasets. DCA demonstrated that the nomogram was clinically useful.

Conclusions: A model with good performance for predicting DR via OCTA parameters was developed. The superficial parafoveal CD, deep parafoveal CD, and FD- 300 area were important predictive parameters in this model. The corresponding nomogram may serve as a convenient tool for early DR risk prediction and lay the foundation for developing OCTA-based automated diagnostic software for early DR detection.

Macular fibrosis is an end-stage complication of neovascular Age-related Macular Degeneration (nAMD) with a complex and multifactorial pathophysiology that can lead to significant visual impairment. Despite the success of anti-vascular endothelium growth factors (anti-VEGF) over the last decade that revolutionised the management and visual prognosis of nAMD, macular fibrosis develops in a significant proportion of patients and, along with macular atrophy (MA), is a main driver of long-term vision deterioration. There remains an unmet need to better understand macular fibrosis and develop anti-fibrotic therapies. The use of imaging biomarkers in combination with novel Artificial Intelligence (AI) algorithms holds significant potential for improving the accuracy of diagnosis, disease monitoring, and therapeutic discovery for macular fibrosis. In this review, we aim to provide a comprehensive overview of the current state of knowledge regarding the various imaging modalities and biomarkers for macular fibrosis alongside outlining potential avenues for AI applications. We discuss manifestations of macular fibrosis and its precursors with diagnostic and prognostic significance on various imaging modalities, including Optical Coherence Tomography (OCT), Colour Fundus Photography (CFP), Fluorescein Angiography (FA), OCT-Angiography (OCTA) and collate data from prospective and retrospective research on known biomarkers. The predominant role of OCT for biomarker identification is highlighted. The review coincides with a resurgence of intense research interest in academia and industry for therapeutic discovery and clinical testing of anti-fibrotic molecules.

Purpose: This study investigated the relationship between changes in the position and thickness of the peak circumpapillary retinal nerve fiber layer (cpRNFL) and axial elongation in schoolchildren.

Methods: This prospective cohort study involved the right eyes of 75 elementary school students examined over a period of six years (from the age of 8-9 years to 14-15 years). During the first and final years, all participants underwent optical axial length measurements, color fundus photography, and cpRNFL thickness measurements using optical coherence tomography. The supratemporal (ST) and infratemporal (IT) peak angles (ST and IT angle) were defined as those formed by the ST/IT peak position of the cpRNFL curve, the center of the optic disc, and the fovea. The RNFL thickness at the peaks (ST and IT thicknesses) was also determined. The Wilcoxon signed-rank test was used to compare the cpRNFL parameters and axial lengths in the first and final years.

Results: The mean axial length was significantly longer in the final year (24.82 mm) than in the first year (23.34 mm). The mean ST and IT angles were significantly lower in the final year (67.6° and 58.2°) than in the first year (74.2° and 64.0°). The mean IT thickness was significantly greater in the final year (195.1 μm) than in the first year (185.0 μm); however, no significant changes in ST thickness were observed.

Conclusion: The ST and IT peaks shifted toward the line connecting the fovea and the center of the optic disc between ages 8-9 and 14-15 years, and IT thickness increased. These changes indicate that nerve fibers are concentrated on the temporal side of the optic disc, especially in the IT area.

Key messages: WHAT IS KNOWN : The circumpapillary retinal nerve fiber layer (cpRNFL) in normal eyes exhibits a double-hump pattern, with individual variability in the position of the peaks. Additionally, the mechanisms underlying these differences remain unclear.

What is new: Eyes with greater axial elongation tended to have narrower supratemporal (ST) and infratemporal (IT) angles and increased IT thickness. Greater axial elongation during childhood growth caused a significant shift of the cpRNFL peaks toward the fovea and increased IT thickness. Based on the plate hypothesis, the shift and compression of nerve fibers during growth may serve as a potential predictor of normal-tension glaucoma onset in the future.

Eyedrop instillation constitutes the most commonly used ocular drug delivery method that serves for both diagnostic and therapeutic purposes. Ocular disposition and bioavailability of instilled drugs depend on the anatomy and physiology of the ocular surface as well as the physicochemical properties of the active agent. Intraocular bioavailability is positively associated with the amount of drug available onto the ocular surface and the precorneal residence time. Concerns are raised regarding systemic absorption of the instilled drugs intraocularly, percutaneously, via the conjunctiva, through the nasolacrimal system, or through the nasal, oral, and gastrointestinal mucosa. Special considerations exist regarding the anatomical features and the limited pharmacokinetic data on the pediatric population that complicate further the efficacy and systemic toxicity of the instilled medications. Both preclinical and clinical studies propose the reduction of the instilled drop volume, in the form of microdrops, as a means to enhance intraocular bioavailability of topically applied drugs, while minimizing patient discomfort and systemic adverse events. We summarize existing data on the clinical application of microdrops in a wide age range, from preterm infants to elderly adults. Studies regarding microdrops of mydriatics and ocular hypotensives show promising results in optimizing the provided everyday care.

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: Primary epiretinal, or more precisely termed pre macular membranes (PMM) and glaucomatous optic neuropathy are both common conditions affecting a predominantly elderly population. There are several relevant clinical and pathological considerations when they are both diagnosed in the same eye.

Methods: We systematically searched the literature to review the challenges clinicians must address when dealing with patients with co-existing PMM and glaucoma.

Results: Although the current literature is limited there appears to be a link between the occurrence of glaucomatous optic neuropathy and idiopathic PMM. The presence of PMM can confound glaucomatous progression detection on optical coherence tomography (OCT). Vitrectomy and membrane peeling may improve vision in some patients with co-existing disease but there may be an increased risk of glaucoma progression particularly in eyes with advanced glaucoma and more extensive neuronal loss. Peeling of the retinal inner limiting membrane in addition to PMM peeling may result in an increased risk of visual loss. Inner nuclear layer hypo-reflective spaces on OCT are particularly prevalent in eyes with glaucoma and PMM and may be a negative prognostic sign for outcome.

Conclusion: Patients should be counseled regarding the guarded prognosis, and careful consideration given to the benefits of PMM surgery. Further research is needed to guide clinical practice.

Background: The sustained-release intravitreal 0.7 mg dexamethasone implant (DEX implant) (Ozurdex®, Allergan®, an AbbVie Company, North Chicago, Illinois, USA) is widely used to treat various inflammatory retinal disorders. Notably, its application is expanding in the field of vitreoretinal surgery.

Methods: We conducted a comprehensive literature search across the Web of Science, PubMed, EMBASE, and ScienceDirect databases for articles related to Ozurdex and its applications in vitreoretinal disorders. Additionally, relevant studies were identified from the reference lists of retrieved articles. Our search was limited to studies written in English or those in other languages that provided an English abstract with sufficient information.

Results: Multiple studies have demonstrated the efficacy and safety of the DEX implant across a broad spectrum of vitreoretinal and post-surgical conditions. Notably, the implant's unique pharmacokinetics remain largely unaffected by the vitrectomized status of the eye, ensuring consistent effectiveness in vitreoretinal surgery. Our research highlights the primary off-label applications of the DEX implant, which include epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), post-surgical cystoid macular edema (PSCME), and refractory diabetic macular edema (DME).

Conclusion: This review highlights the increasing role of the DEX implant in vitreoretinal surgery, emphasizing its effectiveness and safety in various surgical and post-surgical settings, while also addressing associated complications.

Purpose: To construct a deep learning (DL) algorithm for automatic prediction of sulcus-to-sulcus diameter (STS) and distance between STS plane and anterior crystalline lens surface (STSL) from ultrasound biomicroscopy (UBM) images based on YOLOv8 and verify its accuracy and reliability.

Methods: This study used data from 100 eyes of 100 myopic patients treated with ICL from March 2023 to August 2024. UBM was used for the measurements of the STS and STSL (4 images for each eye). The data set (400 images) was randomly split at the patient level into a train, validation and test sets at the ratio of 8:1:1. The ciliary sulci on both sides and the anterior capsule of the lens in the UBM images were located with the YOLOv8 algorithm, and then the distances were calculated and compared with the manual labeled values and compared against an external expert with ANOVA, the YOLOv8 algorithm was tested in 26 eyes (104 images ) independent UBM data sets. Bland-Altman tests and intergroup correlation coefficients (ICCs) were used to assess the agreement between the labeled and YOLOv8 predicted values.

Results: The deep learning-predicted STS and STSL demonstrated a high level of accuracy and reduced contouring time (by savings of 98.80% of work time) when compared with manual labeling contours in the testing set and showed a good accuracy when compared with external ophthalmologist manual labeling contours and in the external evaluation. The prediction error of the STS being 3.27 ± 2.01% and STSL being 67.95 ± 140.09% for the YOLOv8 algorithm at testing set, 4.10 ± 3.00 (%), and 49.66 ± 42.73 (%) in the external test set. The ICC was 0.312 between the predicted and labeled STS (P = 0.01) and 0.086 between the predicted and labeled STSL (P > 0.05).

Conclusions: The deep learning-predicted STS and STSL demonstrated high accuracy and reduced measurement time, which could have a positive impact on the clinical setting.

Key messages: What is known: ICL implantation remains challenging because of difficulties in determining the appropriate lens size. There is a wide variation in the values of ciliary sulcus-to-sulcus (STS) diameter measurements.

What is new: This is the first study to automatically measure the STS-related distance based on YOLOv8 and assess the accuracy compared to the conventional manual labeling. The YOLOv8 algorithm proposed advantages in high accuracy, automatic prediction of posterior chamber STS-related parameters from ultrasound biomicroscope images.

Purpose: This study aimed to investigate longitudinal changes in best-corrected visual acuity (BCVA) and refraction in patients following vitrectomy for stage 4 retinopathy of prematurity (ROP).

Methods: We conducted a retrospective review of 42 eyes from 25 patients (35 eyes with stage 4A, 7 eyes with stage 4B) who had successful vitrectomy for stage 4 ROP and were followed for at least 8 years. Postoperative BCVAs and refractive errors between ages 5 and 8 years were compared. Factors related to BCVA at ages 5 and 8, as well as their differences, were analyzed.

Results: In stage 4A ROP eyes, the mean logMAR BCVA improved significantly from 0.83 (20/135) to 0.63 (20/85) (p < 0.001) and a myopic shift of 1 D or more occurred in 21 eyes (61.8%) between ages 5 and 8. In the poor BCVA group at age 5 in the stage 4A eyes, dominant eyes showed a trend of BCVA improvement by ages 5-8 (p = 0.06). Multiple regression analysis of the patients with stage 4A ROP showed that phakic and dominant eyes at age 5 were independently associated with better BCVA at ages 5 and 8 (p = 0.006 and 0.016 for age 5; p = 0.009 and 0.002 for age 8). No significant BCVA improvement was noted in stage 4B ROP eyes during the same period.

Conclusion: This study indicated the possibility of continued visual improvement beyond age 5 in patients who underwent vitrectomy for stage 4A ROP, although a myopic shift occurred concurrently.

Key messages: What is known Previous studies have reported long-term visual prognosis and refractive errors at specific time points after vitrectomy for ROP in small case series, but there has been limited research on serial changes. What is new This study demonstrates the potential for ongoing visual improvement beyond age 5 and highlights longitudinal myopic changes between ages 5 and 8 in patients who underwent vitrectomy for stage 4A ROP. In patients with poor visual acuity at age 5, being the dominant eye was significantly associated with improved visual acuity by age 8. The findings indicate that postoperative visual acuity in ROP patients gradually improves, even as myopia progresses, underscoring the need for long-term follow-up.

Purpose: To evaluate the outcomes of localized crosslinking (L-CXL) for progressive keratoconus utilizing a standard CXL device.

Design: This retrospective cohort study.

Methods: included patients diagnosed with progressive keratoconus and treated with a localized cone-centered CXL (based on corneal topography) using the accelerated CXL protocol with a standard CXL device.

Results: We Identified 24consecutive eyes. The average BDVA before CXL was 0.282 ± 0.35 LogMar, remained overall stable at 12-month post-surgery at 0.204 ± 0.173 LogMar (P = 0.395). Ten eyes (of eight patients) (42%) demonstrated an improvement in BDVA at 12 months of 1-4 lines and none of the other eyes lost BDVA. These eyes had significantly lower pre-operative BDVA than the stable eyes (P = 0.034). Ten eyes (of eight patients) (42%) demonstrated an improvement in K-max at 12 months post-operatively, of at least 1D; six of these eyes had improvement in both BDVA and Kmax. None of the eyes developed an increase in Kmax throughout the follow-up.

Conclusion: In this series, cone-centered L-CXL, using a conventional CXL device resulted in significant stabilization and even improvements in BDVA and Kmax in almost half of the eyes, without significant adverse events. Addressing the CXL application onto the affected area results in beneficial results.