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

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 investigate the clinical characteristics of early-onset optic neuritis (ON) following the corona virus disease 2019 (COVID-19) Omicron variant and explore the possible pathophysiological mechanisms.

Methods: This was a retrospective, observational study. All enrolled patients with ON following the COVID-19 Omicron variant were followed for at least 6 weeks to observe their clinical characteristics and prognostic factors and to analyze the factors influencing earlier or later occurrence of ON following the COVID-19 Omicron variant.

Results: A total of 47 eyes from 47 patients (22 males [46.8%] and 25 females [53.2%]) were enrolled in this study and divided into late- and early-onset groups. Compared to the late-onset group, the early-onset group had a higher dual-seronegative antibody status (21.43% vs. 63.16%, P = 0.004) and a higher CD8 + /lymphocyte percentage (23.3% [20.1%, 28.3%] vs. 31.0% [29.8%, 34.2%], P = 0.008). Furthermore, Pearson's partial correlation analysis showed that dual-seronegative antibody status (adjusted r = 0.800, adjusted P = 0.001) and CD8 + /lymphocyte percentage (adjusted r = 0.747, adjusted P = 0.002) were independently associated with early-onset ON following the COVID-19 Omicron variant. Further partial correlation analysis also showed that a swollen optic disc (r = -0.347, P = 0.035) was the only factor independently associated with final best-corrected visual acuity (BCVA).

Conclusions: Earlier onset of ON following COVID-19 Omicron variant indicated a higher CD8 + /lymphocyte percentage in the serum and a greater possibility of dual-seronegative antibody status. Whether ON following the COVID-19 Omicron variant occurred earlier or later did not independently affect final BCVA, and the only independent factor predicting better final BCVA was a swollen optic disc.

Purpose: The aim of this study is to describe ophthalmological care of adults with diabetes in France and its evolution between 2010 and 2022.

Methods: In this study, we used the ESND, a representative permanent random sample of 2/100th of the entire French population. Ophthalmological care was defined by the combination of ophthalmological procedures (fundus examination, color fundus photography, Optical Coherence Tomography..) and/or ophthalmological treatment (intravitreal injection or laser treatment) during the year. Changes in annual rates during the study period were assessed using linear regression models excluding 2020.

Results: From 2010 to 2022, the number of adults treated for diabetes in the ENSD increased from 48 329 patients (mean age 65.3 ± 13.0, 46.3% women) to 68 397 patients (mean age 67.0 ± 13.2, 44.8% women). Among them, the annual rate of ophthalmological care was stable (46.5% in 2010 and 48.5% in 2022) and the difference was not significant (β = 0.10% per year, p = 0.11). The yearly ophthalmological treatment rate increased significantly (3.3% in 2010 and 5.3% in 2022, β = 0.2% per year, p < 0.0001). Rates were lower during the COVID-19 outbreak in 2020.Women, individuals aged between 66-80 years, those living in the least deprived areas and those treated with combined insulin and non-insulin treatment had higher yearly ophthalmological care rate.

Conclusion: In this large nationwide representative study with recent and updated data, although ophthalmological treatment rate has increased over the decade mainly due to intravitreal injections, less than half of the diabetic patients receive yearly ophthalmological care.

Purpose: Incisional glaucoma surgery is indicated in advanced glaucoma or glaucoma refractory to less invasive therapies, and can be performed with implants to lower IOP including glaucoma drainage or filtration devices. The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) represents the largest U.S. publicly-available repository of device-related incisional glaucoma surgery complications, enabling insight into complications experienced with incisional glaucoma surgery in real-world practice to develop a risk profile for the use of each device.

Methods: MAUDE database was searched between January-2012 and December-2021 for Brand Name: Ahmed ClearPath, Ahmed Glaucoma Valve, Baerveldt, Ex-PRESS, and Molteno. Reports were categorized by complication;when multiple were present, multiple categories were attributed. Reports with identical text and dates were counted as duplicate and excluded. Literature reports comparing multiple devices without clear device specification per complication were excluded.

Results: The search yielded 1538 reports, of which 1379 reports describing 2429 adverse events met inclusion criteria. The most common events for were hypotony/hypotony maculopathy (284), device-iris touch (282), device occlusion (213), elevated IOP (210), and device explanted due to possible exclusion (176). Delivery system failures occurred (166). Patients also experienced flat/shallow anterior chambers (147) and corneal edema/bullous keratopathy/endothelial cell count reduction/corneal decompensation/Descemet's membrane tears (128).

Conclusion: By drawing on the real-world complications collected in the MAUDE database, this study identifies adverse events of greatest clinical pertinence for device-related incisional glaucoma surgery overall and by brand. Understanding the most common adverse events may support surgeons in counseling patients and preparing for device implantation.

With the rapid global rise of myopia, glaucoma, AMD, and dry eye disease, red light therapy (RLT) is quickly emerging as a non-invasive, breakthrough approach with extraordinary potential to transform eye health management. Originally applied for wound healing and pain relief, RLT has shown remarkable, multi-faceted effects in ophthalmology: slowing myopia progression, protecting retinal cells in glaucoma, reducing inflammation in AMD, and relieving symptoms of dry eye disease. However, alongside the surge in research interest, questions regarding optimal dosing, safety, and standardization remain pressing. This review summarizes the latest advances of RLT in eye health, explores its mechanisms of action, analyzes safety concerns in clinical applications, and discusses its synergistic potential with existing treatment methods as well as the integration of RLT with artificial intelligence and wearable technologies. In the future, RLT is expected to play a significant role in the management of chronic ocular diseases, but its long-term effects and safety need careful evaluation, with challenges also remaining in regulatory policies and clinical standardization.

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 patient and surgical characteristics associated with higher patient, surgeon, or anesthesia provider satisfaction with oral sedation in ophthalmic procedures.

Design: This was a secondary analysis of a prospective, randomized, double-masked, non-inferiority clinical trial measuring patient satisfaction comparing oral versus intravenous (IV) sedation for ophthalmic surgeries.

Methods: Data was collected from a validated 6-point satisfaction survey from patients, surgeons, and anesthesia providers. We focused on the oral sedation arm and used multivariate regression analysis to investigate the relationship between satisfaction scores and patients' characteristics, surgery duration, and need for additional anesthesia during the ophthalmic procedure.

Results: In total, 142 patients receiving initial oral triazolam with IV placebo were included in this study. Non-White (p = 0.02) and non-English speaker patients (p = 0.003) had higher satisfaction scores with oral sedation. Shorter surgery duration was associated with higher satisfaction scores for both patients (p = 0.01) and surgeons (p = 0.03) but not for anesthesia providers (p = 0.21). The need for supplemental IV sedation intraoperatively was significantly associated with lower satisfaction scores among patients (p < 0.001), surgeons (p < 0.001), and anesthesia providers (p < 0.001).

Conclusions: Shorter length of surgery was positively associated with higher patient and surgeon satisfaction with oral sedation. Other factors including non-White race and non-English primary language were associated with higher patient satisfaction. Additional IV sedation needed during surgery was associated with worse patient, surgeon, and anesthesia provider satisfaction. Tailoring oral sedation to procedures that are shorter in duration may help maximize the success of oral sedation as an alternative to intravenous sedation.

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: This study aimed to identify prognostic factors for retinal detachment (RD) and final best corrected visual acuity (BCVA) in acute retinal necrosis (ARN) patients using ultrawide-field (UWF) fundus imaging.

Methods: This retrospective study included 29 eyes of 25 patients diagnosed with ARN. Clinical data, including symptom duration before presentation, initial and final BCVA, anterior chamber (AC) cell grade, and vitreous opacity grade, were collected. Based on the UWF fundus imaging, the presence of arterial obliteration and the extent of retinal necrosis were analyzed to identify risk factors for RD by categorizing patients into the RD and no RD groups.

Results: The mean final BCVA was 0.72 ± 0.77 logarithm of the minimum angle of resolution (logMAR), and RD occurred in 20 eyes (70.0%). Final BCVA showed a significant difference between the RD and no RD groups. AC cell grade was significantly associated with both RD development and final BCVA (p = 0.035, p = 0.015, respectively). Arterial obliteration, fan-shaped necrotic lesions, and greater clock hours of retinitis were significantly related to RD development (p = 0.016, p = 0.001, p = 0.018, respectively). The retinitis zone was significantly correlated with final BCVA (p = 0.007). Additionally, BCVA before and at RD diagnosis showed a significant association with final BCVA.

Conclusions: UWF imaging is useful for the prognosis prediction in ARN patients. Identifying characteristic UWF findings, such as arterial obliteration and extent of necrosis, can aid in predicting RD risk and visual outcomes, improving clinical management of ARN.

Key messages: WHAT IS KNOWN : Acute retinal necrosis (ARN) is a rapidly progressing inflammatory condition characterized by necrotizing retinitis and vasculitis. Retinal detachment (RD) is a common late complication of ARN, often leading to poor visual prognosis.

What is new: Ultrawide-field (UWF) imaging is useful for the prognosis prediction of ARN. UWF image analysis identified arterial obliteration, fan-shaped necrotic lesions, and an increased number of clock hours affected by retinitis as significant risk factors for the development of RD in ARN. Additionally, the zone of necrotic retinitis was strongly associated with the final best corrected visual acuity (BCVA) in ARN patients.