International journal of ophthalmology最新文献

Aim: To assess the relationship between dietary inflammatory index (DII) and prevalence of glaucoma among individuals aged 40y and above in the United States.

Methods: Participants were drawn from 2 cycles of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) for a cross-sectional study. DII was calculated from 24-hour dietary recall questionnaire conducted by experienced researchers and data analyzed in R according to the NHANES user guide, "Stratified Multi-stage Probability Sampling". The relationship between DII and glaucoma was evaluated by multi-factor logistic regression analysis and the existence of a non-linear association examined by restricted cubic spline (RCS) analysis.

Results: A total of 5359 subjects were included and the cross-sectional analysis weighted to represent the US population of 109 million. DII was elevated in glaucoma patients (P<0.001) and smoking and alcohol use contributed to significant differences (P<0.001). DII correlated negatively with Healthy Eating Index (HEI)-2015 (Spearman rank correlation coefficient, r=-0.49). RCS analysis showed a linear relationship between DII and glaucoma risk (P of non-linear relationship =0.575).

Conclusion: An increased DII is strongly associated with high risk of glaucoma and diet-induced inflammation should be controlled to delay glaucoma progression.

Glaucoma is a group of diseases characterized by progressive optic nerve degeneration, with the characteristic pathological change being death of retinal ganglion cells (RGCs), which ultimately causes visual field loss and irreversible blindness. Elevated intraocular pressure (IOP) remains the most important risk factor for glaucoma, but the exact mechanism responsible for the death of RGCs is currently unknown. Neurotrophic factor deficiency, impaired mitochondrial structure and function, disrupted axonal transport, disturbed Ca²⁺ homeostasis, and activation of apoptotic and autophagic pathways play important roles in RGC death in glaucoma. This review was conducted using Web of Science, PubMed, Project, and other databases to summarize the relevant mechanisms of death of RGCs in glaucoma, in addition to outlining protective treatments to improve the degradation of RGCs.

Aim: To identify topographic determinants of the anterior chamber angle (ACA) in patients with keratoconus (KCN).

Methods: Four hundred and ten eyes of 294 patients with KCN were recruited for this study. First, complete ocular examinations were performed for all patients, including visual acuity measurement, refraction, and slit-lamp biomicroscopy. Then, all participants underwent corneal imaging by the Oculus Pentacam HR.

Results: The mean age of the participants was 32.40±8.52y (15-60y) and 69.5% of them were male. The mean ACA was 38.47°±5.75° (range: 14.40° to 56.50°) in the whole sample, 38.24°±6.00° in males, and 38.98°±5.11° in females (P=0.447). The mean ACA was significantly different among different groups of cone morphology, as patients with nipple cones showed the lowest mean ACA. Moreover, there were statistically significant differences in the mean ACA among different groups of cone locations, with patients having central cones exhibiting the lowest mean ACA (P<0.001). Anterior and posterior Q values were significantly, directly correlated with ACA (anterior Q: r=0.122, P=0.014, posterior Q: r=0.192, P<0.001).

Conclusion: This study provides critical insights into the risk factors for ACA narrowing in KCN patients, which is essential for planning intraocular surgeries. Patients with nipple and central cones exhibited the most significant ACA narrowing. Additionally, more negative Q-values are associated with increased ACA narrowing, highlighting the need for targeted diagnostic and therapeutic strategies.

Aim: To quantify and compare longitudinal thickness changes of the ganglion cell complex (GCC) and the choroid in patients with different patterns of age-related macular degeneration (AMD) progression.

Methods: Retrospective cohort analysis of anonymized data from participants aged 50y or more and diagnosed with early/intermediate AMD in at least one eye (with no evidence of advanced AMD). A total of 64 participants were included from the Instituto de Retina de Lisboa (IRL) study (IPL/2022/MetAllAMD_ESTeSL) and divided into 4 groups according to the Rotterdam classification for AMD. Spectral domain optical coherence tomography (SD-OCT) was used to assess and quantify GCC and choroid thickness at two time points (first visit vs last visit) with a minimum interval of 3y.

Results: In the GCC inner ring, a thinner thickness (P=0.001) was observed in the atrophic AMD group (51.3±21.4 µm) compared to the early AMD (84.3±11.5 µm), intermediate AMD (77.6±16.1 µm) and neovascular AMD (88.9±16.3 µm) groups. Choroidal thickness quantification showed a generalized reduction in the central circle (P=0.002) and inner ring (P=0.001). Slight reductions in retinal thickness were more accentuated in the inner ring in the atrophic AMD (-13%; P<0.01).

Conclusion: The variation of the analyzed structures could be an indicator of risk of progression with neurodegenerative (GCC) or vascular (choroid) pattern in the intermediate and atrophic AMD. The quantification of both structures can provide important information about the risk of disease progression in the early and intermediate stages but also for the evolution pattern into late stages (atrophic or neovascular).

Aim: To investigate whether interleukin-17A (IL-17A) gets involved in the mechanisms of inflammation-related retinal pigment epithelium (RPE) cells injury and its significance in age-related macular degeneration (AMD).

Mrthods: A sodium iodate (NaIO₃) mouse model as well as IL-17A ^-/- mice were established. The effects of inflammatory cytokines in RPE cells and retinal microglia before and after NaIO₃ modeling in vivo and in vitro, were investigated using immunofluorescence, immunoprotein blotting, and quantitative real-time fluorescence polymerase chain reaction (qRT-PCR), respectively. Interventions using recombinant IL-17A protein (rIL-17A) or IL-17A neutralizing antibody (IL-17A NAb) were used to observe the subsequent differences in fundus, fundus photography and optical coherence tomography (OCT), cell viability, and expression of oxidative stress-related markers before and after modeling, and to screen for key signaling pathways.

Results: In the scenario of NaIO₃ stimulation, RPE cells obviously tended to degenerate. Simultaneously proliferation and activation of retinal microglia was confirmed in NaIO₃-stimulated mice, whereas such effects induced by NaIO₃ were significantly ameliorated with IL-17A NAb intervention or in IL-17A ^-/- mice. In addition, IL-17A promoted the proliferation and activation of microglia as well as oxidative damage and the secretion of inflammatory cytokines alongside NaIO₃-induced damage in RPE cells in vivo and ex vivo. Meanwhile, the extracellular signal-regulated kinase (ERK) signaling pathway was shown to be participated in the regulation of NaIO₃-induced RPE cells injury mediated by IL-17A in vivo and ex vivo, as IL-17A-induced inflammatory cytokines release in the NaIO₃ model was alleviated after blocking the ERK pathway.

Conclusion: IL-17A probably promotes the NaIO₃-induced RPE cells injury through exacerbating inflammation in terms of retinal microglia activation and inflammatory cytokines release via ERK signaling pathway. Inhibition of IL-17A may be a new potential target for dry AMD treatment.

Aim: To measure the optimal anterior chamber pressure (ACP) for safe phacoemulsification using a new tube chamber system with internal pressure measurement function in the porcine eye.

Methods: The 20-gauge and 21-gauge straight tips with yellow and orange sleeves, respectively, were covered by a test chamber combined with a pressure sensor for measuring ACP. This was measured for 20s from 10s after starting aspiration in the linear mode using vacuum levels of 200 and 150 mm Hg with a 20-gauge tip, and 300 and 250 mm Hg with a 21-gauge tip. Using a porcine eye, a pressure sensor fixed with a 0.9 mm corneal incision measured ACP. For the posterior capsule contact assay, porcine eyes were treated as described above, and the ultrasonic needle tip was held at the height of the iris and aspirated for 30s in linear mode at a vacuum of 200 and 150 mm Hg for the 20-gauge tip, and 300 and 250 mm Hg for the 21-gauge tip. The bottle height at which the posterior capsule accidentally contacted the ultrasonic tip was recorded, and the estimated ACP was calculated.

Results: The internal pressure of the new tube chamber system and ACP from the porcine eye closely matched proportional changes at vacuum levels of 200 and 150 mm Hg with 20-gauge tips. Similarly, proportional changes at vacuum levels of 300 and 250 mm Hg with the 21-gauge tip were nearly equal. The bottle height at which the posterior capsule contacted with the tip and estimated ACP were 57.5±12.6 cm (20.2±7.9 mm Hg) at 200 mm Hg with a 20-gauge tip, 35.0±10.0 cm (16.6±6.3 mm Hg) at 150 mm Hg with a 20-gauge tip, 47.5±12.6 cm (18.7±8.7 mm Hg) at 300 mm Hg with a 21-gauge tip, and 32.5±5.0 cm (15.7±3.5 mm Hg) at 250 mm Hg with a 21-gauge tip.

Conclusion: A comprehensive understanding of this chamber system's characteristics and usage can resolve anterior chamber instability caused by changing preoperative settings on the phaco machine.

Aim: To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography (OCTA) in normal eyes of Egyptian (Caucasians) and South Asian (Asians) volunteers.

Methods: Cross-sectional analytical OCTA study performed on 90 eyes of South Asian (n=45) and Egyptians (n=45) were analyzed. All participants underwent best-corrected visual acuity test, slit lamp, and fundus examination. OCTA images; macular 6×6 mm² grid and optic nerve 4.5×4.5 mm² grid were used to examine the parafoveal and peripapillary regions, respectively.

Results: The mean capillary vessel density (CVD) in macular sectors among South Asians and Egyptians participants were (50.31%±2.53%, 51.2%±5.93%) and (49.71%±3.6%, 51.94%±4.79%) in superficial (SCP) and deep capillary plexuses (DCP), respectively (P>0.05). Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant (P>0.05). Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP (P<0.001), among both groups. Mean area of the foveal avascular zone (FAZ) was 0.28±0.09 and 0.27±0.08 mm² in South Asian and Egyptians, respectively. FAZ area decreases with an increase in the thickness and foveal CVD (P<0.001). Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers. The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females (P<0.05).

Conclusion: No significant racial disparity is found in this study. The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.

Aim: To assess the possibility of using different large language models (LLMs) in ocular surface diseases by selecting five different LLMS to test their accuracy in answering specialized questions related to ocular surface diseases: ChatGPT-4, ChatGPT-3.5, Claude 2, PaLM2, and SenseNova.

Methods: A group of experienced ophthalmology professors were asked to develop a 100-question single-choice question on ocular surface diseases designed to assess the performance of LLMs and human participants in answering ophthalmology specialty exam questions. The exam includes questions on the following topics: keratitis disease (20 questions), keratoconus, keratomalaciac, corneal dystrophy, corneal degeneration, erosive corneal ulcers, and corneal lesions associated with systemic diseases (20 questions), conjunctivitis disease (20 questions), trachoma, pterygoid and conjunctival tumor diseases (20 questions), and dry eye disease (20 questions). Then the total score of each LLMs and compared their mean score, mean correlation, variance, and confidence were calculated.

Results: GPT-4 exhibited the highest performance in terms of LLMs. Comparing the average scores of the LLMs group with the four human groups, chief physician, attending physician, regular trainee, and graduate student, it was found that except for ChatGPT-4, the total score of the rest of the LLMs is lower than that of the graduate student group, which had the lowest score in the human group. Both ChatGPT-4 and PaLM2 were more likely to give exact and correct answers, giving very little chance of an incorrect answer. ChatGPT-4 showed higher credibility when answering questions, with a success rate of 59%, but gave the wrong answer to the question 28% of the time.

Conclusion: GPT-4 model exhibits excellent performance in both answer relevance and confidence. PaLM2 shows a positive correlation (up to 0.8) in terms of answer accuracy during the exam. In terms of answer confidence, PaLM2 is second only to GPT4 and surpasses Claude 2, SenseNova, and GPT-3.5. Despite the fact that ocular surface disease is a highly specialized discipline, GPT-4 still exhibits superior performance, suggesting that its potential and ability to be applied in this field is enormous, perhaps with the potential to be a valuable resource for medical students and clinicians in the future.