International journal of ophthalmology最新文献

Aim: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN) at the Philippine General Hospital.

Methods: This was a single-center, 11-year retrospective, cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023. The patient's demographics, presenting symptoms, tumor characteristics, histopathologic diagnosis, treatment, outcomes, and duration of follow-up were reviewed.

Results: Out of 33 identified cases of OSSN, only 18 were eligible for inclusion in the study. Mean age was 60.78y (range 31 to 80), with male predominance (66.67%). The left eye was most commonly affected (61.11%) with most presenting with fleshy mass (83.33%). Most tumors were located nasally (66.67%) and were predominantly papilliform (44.44%) in morphology with associated hyperpigmentation (38.89%). Squamous cell carcinoma (SCCA) was the most common histopathologic diagnosis (72.22%). The main primary treatment was surgical excision (94.44%) with or without adjunctive therapy, with only 1 patient undergoing first-line topical chemotherapy. Only 3 recurrences (16.67%) were noted with a median follow-up of 7.5mo. A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.

Conclusion: OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass, most commonly affecting elderly males. Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.

Biomechanical study of the visual system by ocular response analyzer investigates the inter-structural biological relationships, mechanics, and function of the visual system. This review aimed to investigate the changes in corneal biomechanical parameters with age and sex. The articles published in PubMed between 2000 and 2021 were investigated and critiqued, and valid scientific evidence was collected, reviewed and concluded according to the inclusion and exclusion criteria. Most studies showed that corneal biomechanical changes occur infrequently in children up to the age of 20y, and with increasing age and wider age range, there was a significant decrease in corneal biomechanical indices, especially corneal hysteresis. In children and adults, most studies have shown that these biomechanical indicators, especially corneal resistance factor, were higher in females. Although hormonal changes may contribute to this finding, the role of axial length and other biometric indicators should not be ignored. The axial length, the intraocular pressure, and the corneal thickness are other factors associated with biomechanical parameters that should be taken into account in clinical diagnosis and management especially for patients undergoing refractive surgery as well as keratoconus patients.

Aim: To evaluate the prevalence of early post-traumatic stress disorder (PTSD) among young and middle-aged patients who have suffered open globe injuries, and to identify the psychosocial factors influencing PTSD in these patients.

Methods: A total of 280 patients who underwent ocular trauma surgery between January 2023 and January 2024 were selected through convenience sampling. Data were collected using a custom-designed demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Cognitive Emotion Regulation Questionnaire (C-ERRI), and the PTSD Checklist-Civilian Version (PCL-C). Univariate analysis and stepwise multiple linear regression analysis were performed to determine the factors affecting PTSD in these patients.

Results: The average PTSD score for the patients was 33.22±13.48. The scores for individual PTSD dimensions, ranked from highest to lowest, were recurrent traumatic experiences, heightened arousal, avoidance reactions, and social dysfunction. Positive PTSD symptoms were observed in 85 patients (30.36%). Univariate analysis indicated that gender, postoperative vision, marital status, psychological resilience, and rumination were significant factors affecting PTSD symptoms (χ²/t=6.53, 17.88, 8.83, 2.17, and 14.1, respectively; all P<0.05). Pearson correlation analysis showed a positive correlation between rumination and PTSD symptoms (r=0.73, P<0.01) and a negative correlation between psychological resilience and PTSD symptoms (r=-0.14, P<0.05). Stepwise multiple linear regression analysis identified postoperative vision (notably eye removal), rumination levels, and psychological resilience (optimism) as major factors influencing PTSD in these patients (R²=0.57, P<0.001).

Conclusion: Young and middle-aged patients with open globe injuries have a high incidence of PTSD. Significant risk factors for early PTSD include primary enucleation, high levels of rumination, and low psychological resilience (optimism). Conversely, patients with good postoperative vision recovery, low rumination levels, and high levels of optimism are less likely to develop PTSD. Healthcare providers should pay special attention to patients who undergo primary enucleation, strive to reduce their rumination levels, and enhance their psychological resilience, thereby promoting a positive and optimistic attitude towards their condition and reducing the incidence of PTSD.

Aim: To investigate the effect of 0.01% low-concentration atropine (LA) on quantitative contrast sensitivity function (qCSF) in children with myopia.

Methods: This paired case-control study included 90 eyes of 58 children who were sex-, age-, and refraction-matched and equally divided into two groups: the 0.01% LA group had undergone 6mo use of daily 0.01% atropine and control group was naïve to LA. Routine ophthalmic examinations and qCSF test without refractive correction were performed. Two groups were compared in monocular and binocular qCSF parameters, including the area under logCSF, CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cycle per degree (cpd).

Results: In the monocular comparison, the CSF acuity of the LA group was significantly higher than that of the control group (7.58±5.51 vs 6.37±4.22 cpd, P<0.05). The subgroup analysis showed that in the 6-9y group, CSF acuity was significantly higher in the LA group than the control group (8.76±6.19 vs 6.54±4.25 cpd, P<0.05), and in the Female group, low refraction sphere group, and high refraction cylinder group, the CS at high spatial frequencies (12.0 and 18.0 cpd) were significantly higher in the LA group than in the control group (all P<0.05). In the binocular test, CSF acuity and CS at 12.0 cpd were significantly higher in the LA group than in the control group (10.95±7.00 vs 8.65±5.12 cpd; 0.17±0.33 vs 0.06±0.16, respectively; both P<0.05).

Conclusion: Use of LA may result in improved CS in children with early onset myopia.

Aim: To investigate the influence of postoperative intraocular lens (IOL) positions on the accuracy of cataract surgery and examine the predictive factors of postoperative biometry prediction errors using the Barrett Universal II (BUII) IOL formula for calculation.

Methods: The prospective study included patients who had undergone cataract surgery performed by a single surgeon from June 2020 to April 2022. The collected data included the best-corrected visual acuity (BCVA), corneal curvature, preoperative and postoperative central anterior chamber depths (ACD), axial length (AXL), IOL power, and refractive error. BUII formula was used to calculate the IOL power. The mean absolute error (MAE) was calculated, and all the participants were divided into two groups accordingly. Independent t-tests were applied to compare the variables between groups. Logistic regression analysis was used to analyze the influence of age, AXL, corneal curvature, and preoperative and postoperative ACD on MAE.

Results: A total of 261 patients were enrolled. The 243 (93.1%) and 18 (6.9%) had postoperative MAE<1 and >1 D, respectively. The number of females was higher in patients with MAE>1 D (χ ² = 3.833, P=0.039). The postoperative BCVA (logMAR) of patients with MAE >1 D was significantly worse (t=-2.448; P=0.025). After adjusting for gender in the logistic model, the risk of postoperative refractive errors was higher in patients with a shallow postoperative anterior chamber [odds ratio=0.346; 95% confidence interval (CI): 0.164, 0.730, P=0.005].

Conclusion: Risk factors for biometry prediction error after cataract surgery include the patient's sex and postoperative ACD. Patients with a shallow postoperative anterior chamber are prone to have refractive errors.

Aim: To evaluate the efficacy and safety of microcatheter-assisted 360-degree trabeculotomy combined with trabeculectomy (MATT-Trab) for treating refractory glaucoma.

Methods: Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined. Efficacy indicators for research statistics included the intraocular pressure (IOP) level, degree of decrease, changes in medication dosage, and success rate. Safety indicators included the best-corrected visual acuity and incidence of complications.

Results: This study comprised 31 patients, including 11 males and 20 females, with ages ranging from 8mo to 67y (mean age: 29.40±22.10y). The average postoperative IOP at 1d, 1wk, 1mo, 3mo, 6mo, 1y, and the last follow-up was significantly lower than the average preoperative IOP (31.33±9.24 mm Hg, P<0.05). The average number of postoperative medications at 1y was 0.48±1.51, which was significantly reduced compared to that used preoperatively (3.77±0.99, P=0.00). The absolute and qualified success rates were 45.16% and 83.87%, respectively. Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points, except for the first day after surgery. The most common postoperative complications were anterior chamber hemorrhage (25 cases, 86.21%) and high IOP (10 cases, 34.48%).

Conclusion: Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.

Aim: To assess visual outcomes and satisfaction of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in individuals with ocular hypertension (OHT) and well-controlled mild glaucoma undergoing cataract surgery.

Methods: An investigator-initiated, single-center, prospective, interventional, noncomparative study conducted in Montreal, Canada. The study enrolled 31 patients (55 eyes) with OHT or mild glaucoma who received a non-diffractive EDOF IOL (Acrysof IQ Vivity). Participants underwent sequential cataract surgery with the Vivity IOL. Follow-up evaluations occurred at 1d, 1, and 3mo postoperatively, assessing uncorrected distance, intermediate, and near visual acuity. Questionnaires (QUVID: Questionnaire for visual disturbances and IOLSAT: Intraocular lens satisfaction) were administered pre and post-operatively to measure visual disturbances and spectacle independence in various lighting. Safety parameters included intraocular pressure (IOP), glaucoma medications, spherical equivalence, mean deviation and pattern standard deviation or square root of lost variance on Octopus visual field.

Results: At 1 and 3mo postoperatively, significant improvements were observed in uncorrected distance and intermediate visual acuity. Spectacle independence was enhanced for distance and intermediate vision, especially in bright light settings. Spectacle-free intermediate vision was improved even in dim lighting. Visual disturbances, particularly glare symptoms, were reduced, and there was a notable decrease in IOP and glaucoma medication burden at 3mo. There was more hazy vision postoperatively with no impact on visual acuity and visual satisfaction.

Conclusion: The non-diffractive EDOF lens improves distance and intermediate spectacle-free visual function in patients with OHT and well-controlled glaucoma. The findings highlight significant improvements in visual acuity, reduced glare, enhanced spectacle independence, and improved visual performance in different lighting conditions.

Aim: To evaluate the short-term efficacy of XEN45 Gel Stent (XEN) implantation for primary open angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma across two university eye clinics, aiming to assess the impact of varying center-specific protocols during the first postoperative year.

Methods: We retrospectively examined 282 patients (183 in center 1, 99 in center 2), who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma. Parameters including intraocular pressure (IOP), IOP-lowering medication count, best corrected visual acuity (BCVA), and postoperative complications were evaluated over 12mo.

Results: Post-implantation, center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg (P<0.01) and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3 (P<0.01). Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg (P<0.01) and medication decrease from 3.0±1.1 to 1.2±1.0 (P<0.01). BCVA remained stable in both cohorts. The most common complications were hypotony (center 1: 32; center 2: 20) and choroidal detachment (center 1: 22, center 2: 15), with nearly identical needling rates (40% in center 1, 41% in center 2).

Conclusion: XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime. These findings underscore XEN's short-term effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.

Aim: To evaluate the effect of femtosecond laser small incision lenticule extraction (SMILE) on the binocular visual function in myopic patients with glasses-free three-dimensional (3D) technique.

Methods: Totally 50 myopic patients (39 females and 11 males) with SMILE were enrolled in this prospective study. The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis, dynamic stereopsis, foveal suppression, and binocular balance point of signal to noise ratio (s/n ratio). All subjects received measurements in 1d before operation, and 1d, 1wk, and 1mo postoperatively.

Results: Both static and dynamic stereopsis showed no significant difference after SMILE. The foveal suppression improved significantly 1wk and 1mo after SMILE (P=0.005 and P=0.007 respectively). The binocular balance point of signal to noise ratio showed a significant improvement 1d, 1wk and 1mo after SMILE for both eyes (P<0.001 for each eye respectively).

Conclusion: Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively, and SMILE can improve both foveal suppression and binocular imbalance in these patients.