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

Purpose: To compare the precision of the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) in estimating SIA when predicting the power and axis of toric IOLs under different circumstances.

Methods: 120 eyes of 99 patients undergoing toric IOL replacement in a simple cataract surgery were included in the retrospective study. The predicted position of toric IOL was calculated by Z Calc online calculator and Barrett Toric Calculator with M-SIA (0.4D) or C-SIA (0.1D). Position prediction error (PPE, the difference between the predicted position of toric IOL and the ideal position of toric IOL), its absolute value (PPE-Abs) and △PPE (the difference between absolute value of PPE calculated by C-SIA and by M-SIA using the same toric calculator) were used to evaluate the precision in estimate of SIA.

Results: Statistical significance in mean PPE and mean PPE-Abs was found in the group M-Barrett. The orientation of corneal astigmatism and eye laterality were influential to mean PPE while gender was not. △PPE was below 0 in both toric calculators. Significant difference in △PPE was seen between groups with different corneal astigmatism when all eyes were OS, as well as between groups with different eye laterality when all eyes were with WTR astigmatism.

Conclusions: We did not find a significant difference between M-SIA and C-SIA in estimating the SIA of the patients undergoing small-incision cataract surgery combined with toric IOL implantation. M-SIA was not recommended in Barrett Toric Calculator. The orientation of corneal astigmatism and the incision on the cornea should be considered when choosing between M-SIA and C-SIA.

Key messages: WHAT IS KNOWN? : Either the arithmetic mean of surgically induced astigmatism (M-SIA) or the centroid of surgically induced astigmatism (C-SIA) of a cohort was used to estimate the position of toric IOLs before the surgery. The size and site of corneal incision could influence the orientation and the magnitude of SIA. WHAT IS NEW? : When calculating the axis of toric IOLs with Barrett Toric Calculator, arithmetic mean of SIA (M-SIA) was not recommended for estimate. The orientation of corneal astigmatism could influence the estimate of SIA. We created several novel variables that could be used to indirectly evaluate the stability of toric IOLs and the prognosis of patients.

Purpose: To investigate the relationship between the characteristics of optic disc rotation and visual field (VF) progression in patients with myopic open-angle glaucoma (OAG).

Methods: We included 53 eyes from 53 myopic OAG patients who were followed-up over a 3-year period. The characteristics of optic disc rotation including the degree of optic disc rotation, direction of optic disc rotation, and optic disc rotation-VF defect correspondence were investigated. The rates of global and regional VF progression were compared with different characteristics of optic disc rotation.

Results: Thirty-seven eyes (69.8%) showed inferior optic disc rotation and 41 (77.4%) eyes showed optic disc rotation-VF defect correspondence. The inferiorly rotated optic discs with corresponding superior VF defect had faster VF progression in the superior peripheral region (P = 0.028) and superiorly rotated optic discs with corresponding inferior VF defect had faster VF progression in the inferior peripheral region (P = 0.031). The VF progression was restricted to the superior hemifield in the eyes with inferiorly rotated optic discs and corresponding superior VF defects.

Conclusion: In myopic OAG patients, the direction of optic disc rotation might predict faster VF progression in the corresponding peripheral region.

Background: Diabetes poses a risk to diabetic keratopathy in up to two-thirds of patients. Insulin-degrading enzyme (IDE) is a protease that can break down insulin and several growth factors and may impair wound healing. Increased IDE levels have been found in fluid from diabetic skin ulcers. This study sought to determine the effect of IDE inhibitor on corneal wound healing in a rat model.

Methods: Thirty-four male Wistar rats were divided into two groups: no diabetes and streptozocin-induced diabetes. Six weeks later, a 4-mm central corneal erosion was created under anesthesia in the right eye of all rats. In each group, half the rats were treated with ADT21 drops (IDE inhibitor) and half with NaCl 0.9% (sham) drops, four times daily. Image J analysis was performed to evaluate the area of erosion and healing rate.

Results: There was a trend for more rapid healing in rats treated with IDEI than NaCl drops, regardless of the diabetic condition. Comparison of erosion closure over time revealed that the wounds closed significantly more quickly in the non-diabetic rats treated with IDEI than in the non-diabetic rats treated with NaCl (p = 0.045), overall mean closure time 56.00 h, 95% CI [50.54, 61.46]. No such difference was seen in the diabetic group.

Conclusions: To our knowledge, this is the first study to test ADT21 drops as a novel treatment for corneal wound repair. Our results suggest a potential benefit of IDE inhibitor for treating corneal injury.

Purpose: Safety glasses are an important measure to prevent blindness, especially in one- eyed patients. However, patient compliance with eye protection is often limited. Unlike previous studies that described protective eyewear wearing in anophthalmic patients, this study analyzed their usage in functionally one-eyed children, having a significantly reduced visual acuity in one eye, determining common obstacles to their use.

Methods: A survey-based study analyzing protective eyewear usage in children with one eye vision loss (mean logarithm of the Minimum Angle of Resolution (logMAR) visual acuity ≤ 0.7).

Results: This study included 83 functionally one-eyed children (44 males), who received a recommendation to wear safety glasses. Ninety-nine percent of their caregivers were aware of this recommendation; however, 31% of them did not know the glasses' true purpose. Regarding actual usage, only 29 (35%) children wore safety glasses at least 90% of the day, 26 (31%) children wore them part-time (10-90% of the day) and 28 (34%) wore them rarely or never at all (< 10% of the day). Compliance was higher when glasses provided optical correction. Reasons provided for non-compliance included: discomfort, appearance, cost and vision reduction. Many respondents recollected incidents in which the glasses prevented an eye injury, and less commonly an eye injury occurring while the child was not wearing eye protection.

Conclusions: Compliance with safety glasses in functionally one-eyed children is limited. Emphasizing that numerous gaps and barriers need to be bridged to improve eyewear protection in these children to prevent trauma in the better-seeing eye with its devastating lifestyle effect.

Key messages: WHAT IS KNOWN : Anophthalmic patients often do not wear protective glasses, which are needed to prevent trauma to their only remaining eye.

What is new: Non-anophthalmic children with reduced visual acuity in one eye use protective glasses even less often, even when doing sports. Common reasons for not wearing safety glasses include: discomfort, dislike of self-appearance with glasses, and lens-induced vision reduction.

Purpose: To perform association analyses between the measurements of photopic negative response (PhNR) evoked by two ISCEV protocols.

Methods: A total of 172 eyes from 72 post-operative pediatric cataract patients and 24 healthy children were enrolled. The amplitude and peak time of PhNR were analyzed in three eye groups, 1. healthy controls; 2. fellow eyes of unilaterally affected patients; 3. affected eyes. PhNR responses were measured with skin-electrodes and evoked by the ISCEV standard protocols of PhNR and light-adapted 3.0, referred to as PhNR1 and PhNR2. The correlation coefficients between PhNR1 and PhNR2 measurements were calculated. The generalized estimating equation (GEE) model of PhNR1, with PhNR2 as a predictor, was evaluated after adjusting for correlation between paired eyes.

Results: Both the amplitude (P = 0.025) and the peak time (P = 0.036) of PhNR1 showed a significant difference among the three eye groups, which was not observed in PhNR2. The four correlation coefficients (Pearson, Intraclass, Lin's and Kendall's) between z-score transformed PhNR1 and PhNR2 measurements were generally moderate: 0.52, 0.52, 0.52, 0.36 for amplitude (P < 0.001), and 0.57, 0.57, 0.57, 0.36 for peak time (P < 0.001). The amplitude of PhNR1 cannot be precisely predicted by PhNR2, with a mean absolute percentage error (MAPE) of 36.7%, while the peak time of PhNR1 can be precisely predicted with a MAPE of 3.9%.

Conclusions: PhNR1 appears to be a more sensitive measure than PhNR2 for detecting eye group differences. Further research is needed to confirm this and explore its clinical applications. PhNR1 may not be entirely replaced by PhNR2 due to moderate correlation and low prediction precision in amplitude.

This retrospective, real-life cohort was analyzed to detect the frequency of different HRM evolution patterns and their correlation with MNV types, morphological and functional changes in exudative nAMD under long-term anti-VEGF therapy. We evaluated optical coherence tomography (OCT) volume scans in 143 eyes of 94 nAMD patients (start of anti-VEGF therapy 2009-2018, therapy until the last visit) and recorded the VA at all visits. HRM evolution patterns were differentiated: pattern 1 = no HRM, pattern 2 = subretinal HRM resolved during follow-up, pattern 3 = persistent subretinal HRM with new HRM-boundary remodeling [BR], pattern 4 = persistent subretinal HRM without HRM-BR. Pattern 1 was observed in 58 eyes (40.6%), 33 eyes (23.1%) showed pattern 2, 39 eyes (27.3%) pattern 3 and 13 eyes (9.1%) pattern 4. HRM pattern correlated with type 1-3 MNV (p = 0.02), especially pattern 1 with type 1 MNV and pattern 3 with type 2 MNV. Over time, a change of MNV types could be observed only from type 2 into type 1 MNV (p = 0.0001). Some eyes with HRM pattern 3 changed during follow-up into pattern 4, which was often associated with the presence of macular atrophy (p = 0.0001) and demonstrated a reduced mean VA compared to pattern 1-3 at baseline (p = 0.0001), year 1 (p = 0.0001) and final visit (p = 0.02).In this study, we characterized different HRM evolution patterns in a real-world dataset and demonstrated their associations with MNV transformation during long term anti-VEGF therapy. The HRM patterns may provide prognostic value with morphological and functional implications.

Anti-vascular endothelial growth factor (VEGF) therapies have transformed the treatment of retinal diseases. However, VEGF signaling is only one component of the complex, multifactorial pathophysiology of retinal diseases, and many patients have residual disease activity despite ongoing anti-VEGF treatment. The angiopoietin/tyrosine kinase with immunoglobulin and epidermal growth factor receptor-2 (Ang/Tie2) signaling pathway is critical to endothelial cell homeostasis, survival, integrity, and vascular stability. Ang-2 can interfere with Ang-1/Tie2 signaling and is increased in several retinal diseases. Lack of Tie2 signaling due to elevated Ang-2 levels drives vascular instability through pericyte dropout, neovascularization, vascular leakage, inflammation, and fibrosis. Although Ang-2 and VEGF can synergistically promote vascular instability and neovascularization, Ang-2 may also mediate vascular instability independently of VEGF. Faricimab is a bispecific antibody designed for intraocular use that inhibits two distinct pathways via Ang-2 and VEGF-A blockade. Clinical biomarkers of vascular instability are important for evaluating disease control and subsequent treatment decisions. These biomarkers include measurement/evaluation with optical coherence tomography (OCT) of intraretinal fluid, subretinal fluid, central subfield thickness, and pigment epithelial detachments (PEDs), and fluorescein angiography imaging of macular leakage and PEDs. Hyperreflective foci (HRF), thought to be representative of activated microglia, indicating an inflammatory microenvironment, and epiretinal membranes (ERMs), a marker for retinal fibrotic proliferation in diabetic macular edema (DME), are both also identified using OCT. Here we summarize data (secondary endpoint and prespecified exploratory analyses as well as post hoc analyses) from six Phase III trials suggest that dual therapy Ang-2/VEGF-A inhibition with faricimab (6 mg) has a greater effect on reducing/resolving biomarkers of vascular instability than aflibercept (2 mg), by both controlling neovascularization and vascular leakage (with resultant resolution of exudation associated with DME, neovascular age-related macular degeneration, and retinal vein occlusion), as well as by targeting inflammation (reduction of HRF in DME) and retinal fibrotic proliferation (reducing the risk of ERMs in eyes with DME). Modulation of both the Ang-2 and VEGF-A pathways with faricimab may therefore provide greater disease control than anti-VEGF monotherapy, potentially leading to extended treatment durability and improved long-term outcomes.

Purpose: Little is known about the effects of ambient atmospheric pressure (AP) on intraocular pressure (IOP) under ordinary conditions. This study aimed to investigate the effects of AP on Goldmann applanation tonometer-measured IOP (GAT-IOP) in normal eyes under everyday atmospheric conditions adjusting for effects of possible confounding factors including other climatic factors.

Methods: Data obtained from 2,431 normal healthy eyes of 2,431 subjects (mean age: 56.9 years) who participated in this population-based glaucoma survey in Japan were analyzed via multivariable linear regression analysis, where the GAT-IOP was the response variable; explanatory variables were the ocular and systemic factors and calendar factors reportedly correlated with GAT-IOP as well as AP, relative humidity, temperature, wind speed, and weather. The Bonferroni correction was adopted to obtain P values.

Results: Only AP of the outside air when each subject was examined was positively correlated with GAT-IOP (regression coefficient (RC) = 0.0460; P = 0.0051). Central corneal thickness, body mass index, and systolic blood pressure were positively correlated (RC = 0.0133, 0.0754, 0.0131; P < 0.0001, P < 0.0001, P = 0.0016, respectively), and corneal curvature radius and age were negatively correlated (RC=-0.7017, -0.0225; P = 0.0144, P = 0.0111, respectively) with GAT-IOP. The seasonal effect on GAT-IOP was also significant (P < 0.0001), and in reference to winter, summer was correlated with lower GAT-IOP and spring was correlated with higher GAT-IOP (RC=-0.5133, 0.4590; P = 0.0087, P = 0.0001, respectively).

Conclusions: AP was found to have a significantly positive correlation with GAT-IOP in normal healthy eyes under ordinary conditions, though the actual impact of AP on IOP in normal individuals under ordinary conditions would be minimal.

Introduction: This study investigates the short-term effects of prolene gonioscopy-assisted transluminal trabeculotomy (GATT) on anterior segment parameters and corneal endothelium in patients with open-angle glaucoma.

Methods: This retrospective study included 30 eyes from 30 patients who underwent GATT surgery. Demographic data, ophthalmological examination findings, and intraocular pressure (IOP) measurements using a Goldman applanation tonometer were recorded. Scheimpflug images were acquired at the pre-operative stage, as well as on the 1st day, 1st week, and 1st month postoperatively. Corneal endothelial cell counts were obtained via specular microscopy.

Results: The mean age of patients was 60.3 ± 15.5 years. Anterior chamber depth and central corneal thickness increased on the 1st postoperative day (p:0.002, p < 0.001, respectively). Changes in anterior chamber depth values at the postoperative 1st week and 1st month compared to baseline were not statistically significant. Central corneal thickness decreased significantly at the 1st postoperative month compared to baseline (p:0.007). Corneal endothelial cell counts at the 1st month were comparable to baseline values (p:0.936).

Conclusion: Our findings reveal that prolene gonioscopy-assisted transluminal trabeculotomy induces temporary changes in anterior segment parameters but preserves corneal endothelial cell count within the first month, suggesting a promising profile for GATT in glaucoma management.

Background: This work tackles the growing problem of early identification of diabetic retinopathy and diabetic macular edema. The deep neural network design utilizes multi-scale feature fusion to improve automated diagnostic accuracy. Methods This approach uses convolutional neural networks (CNN) and is designed to combine higher-level semantic inputs with low-level textural characteristics. The contextual and localized abstract representations that complement each other are combined via a unique fusion technique.

Results: Use the MESSIDOR dataset, which comprises retinal images labeled with pathological annotations, for model training and validation to ensure robust algorithm development. The suggested model shows a 98% general precision and good performance in diabetic retinopathy. This model achieves an impressive nearly 100% exactness for diabetic macular edema, with particularly high accuracy (0.99).

Conclusion: Consistent performance increases the likelihood that the vision will be upheld through public screening and extensive clinical integration.