International journal of ophthalmology最新文献

Aim: To investigate the association between functional outcomes and postoperative patient satisfaction 5y after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

Methods: This is a cross-sectional study. The patients underwent basic ophthalmic examinations, axial length measurement, wide-field fundus photography, and accommodation function testing. Behavioral habits data were collected using a self-administered questionnaire, and visual symptoms were assessed with the Quality of Vision (QoV) questionnaire. Postoperative satisfaction was also recorded.

Results: Totally 410 subjects [820 eyes, 160 males (39.02%) and 250 females (60.98%)] who had undergone SMILE or FS-LASIK 5y ago were enrolled. The mean (standard deviation, SD) age of all patients was 29.83y (6.69). The mean (SD) preoperative manifest SE was -5.80 (2.04) diopters (D; range: -0.88 to -13.75). Patient satisfaction at 5y after undergoing SMILE or FS-LASIK was 91.70%. Patients were categorized into two groups: dissatisfied group and satisfied group. Significant differences were observed between the two groups in terms of age (P=0.012), sex (P=0.021), preoperative degree of myopia (P=0.049), postoperative visual symptoms (frequency, P=0.043; severity, P<0.001; bothersome, P=0.018), difficulty driving at night (P=0.001), and accommodative amplitude (AMP, P=0.020). Multivariate analysis confirmed that female sex (P=0.024), severity of visual symptoms (P=0.009), and difficulty driving at night (P=0.006) were significantly associated with lower satisfaction. The dissatisfied group showed higher rates of starbursts, double or multiple images, and high myopia, but lower age. The frequency, severity, and bothersome of distortion exhibited decreased with increasing age.

Conclusion: Patient satisfaction 5y after SMILE and FS-LASIK is high and stable. Difficulty driving at night, sex, and severity of visual symptoms are important factors influencing patient satisfaction. Special attention should be paid to younger highly myopic female patients, particularly those with starbursts and double or multiple images. It is crucial to monitor postoperative visual outcomes and provide patients with comprehensive preoperative counseling to enhance long-term satisfaction.

Aim: To describe the technique and the outcomes of manual Bowman layer and stroma transplant-onlay (BLST-o) for 2 cases of radial keratotomy (RK).

Methods: Two patients with visual fluctuations and corneal irregularity due to RK were offered manual BLST-o as an alternative to penetrating keratoplasty (PKP). Visual acuity, refraction, corneal topography, corneal aberrometry, and corneal optical coherence tomography (OCT) pre- and postoperative were analyzed. Histology was obtained for 1 case.

Results: Both patients had corneal anatomical and morphological improvement, with elimination of the visual fluctuations. In one case, a subsequent excimer laser treatment improved corneal shape further, thus improving vision. The other case, whereas initially improved, developed epithelial ingrowth following suture removal. The latter was explanted and had a xenogeneic implant. The explanted sample was sent for histology, showing a viable graft of Bowman layer and anterior stroma.

Conclusion: Manual BLST-o is a potential option for the management of symptoms post RK. These grafts may facilitate subsequent treatments such as laser corrections, and may not preclude from other interventions after explantation.

Aim: To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant (DEX-I) versus anti-vascular endothelial growth factor (VEGF) injections in patients with diabetic macular edema (DME) and visually significant cataract.

Methods: This nonrandomized, retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I (DEX-I group) and 47 eyes receiving anti-VEGF injections (anti-VEGF group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured preoperatively and postoperatively at 1 and 3mo.

Results: The two groups had comparable baseline characteristics, with similar age (DEX-I: 66.83±7.27y; anti-VEGF: 66.81±6.79y) and gender distribution (51.9% vs 59.6% males). Both groups showed significant BCVA improvement at 1 and 3mo, with no significant intergroup differences. CMT reduction was significantly greater in the DEX-I group at 3mo (25.03% vs 14.07%; P=0.049), particularly in recalcitrant eyes (25.09% vs 11.10%; P=0.007). Postoperative intraocular pressure (IOP)>21 mm Hg was observed in 14.8% of DEX-I eyes and 4.25% of anti-VEGF eyes (P=0.08), normalizing by 3mo. DEX-I required no reinjection, while 29.79% of anti-VEGF eyes needed a fourth dose at 3mo. Complications were minimal, with one posterior capsular injury in the DEX-I group.

Conclusion: Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME, with fewer required treatments. It is an effective strategy for managing cataract with DME, offering benefits, especially for recalcitrant cases. Both therapies have favourable safety profiles, but further long-term studies are needed for clinical guidance.

Aim: To investigate the clinical features and prognosis of patients with orbital inflammatory myofibroblastic tumor (IMT).

Methods: This retrospective study collected clinical data from 22 patients diagnosed with orbital IMT based on histopathological examination. The patients were followed up to assess their prognosis. Clinical data from patients, including age, gender, course of disease, past medical history, primary symptoms, ophthalmologic examination findings, general condition, as well as imaging, laboratory, histopathological, and immunohistochemical results from digital records were collected. Orbital magnetic resonance imaging (MRI) and(or) computed tomography (CT) scans were performed to assess bone destruction of the mass, invasion of surrounding tissues, and any inflammatory changes in periorbital areas.

Results: The mean age of patients with orbital IMT was 28.24±3.30y, with a male-to-female ratio of 1.2:1. Main clinical manifestations were proptosis, blurred vision, palpable mass, and pain. Bone destruction and surrounding tissue invasion occurred in 72.73% and 54.55% of cases, respectively. Inflammatory changes in the periorbital site were observed in 77.27% of the patients. Hematoxylin and eosin staining showed proliferation of fibroblasts and myofibroblasts, accompanied by infiltration of lymphocytes and plasma cells. Immunohistochemical staining revealed that smooth muscle actin (SMA) and vimentin were ‌positive in 100%‌ of cases, ‌while‌ anaplastic lymphoma kinase (ALK) showed ‌positivity in 47.37%‌. The recurrence rate of orbital IMT was 27.27%, and sarcomatous degeneration could occur. There were no significant correlations between recurrence and factors such as age, gender, laterality, duration of the disease, periorbital tissue invasion, bone destruction, periorbital inflammation, tumor size, fever, leukocytosis, or treatment (P>0.05). However, lymphadenopathy and a Ki-67 index of 10% or higher may be risk factors for recurrence (P=0.046; P=0.023).

Conclusion: Orbital IMT is a locally invasive disease that may recur or lead to sarcomatoid degeneration, primarily affecting young and middle-aged patients. The presence of lymphadenopathy and a Ki-67 index of 10% or higher may signify a poor prognosis.

Aim: To evaluate the potential of artificial intelligence (AI) for automating corneal topography interpretation in orthokeratology patients, aiming to enhance diagnostic precision, efficiency, and clinical decision-making in myopia management.

Methods: The 1469 corneal topography images from 582 eyes of 326 myopic children treated with orthokeratology lenses over 47mo were collected. Each sample was categorized by decentration, treatment zone size, shape variation, and eye laterality. A multi-task AI model was developed to predict these parameters, with performance measured using area under curve (AUC), accuracy, and F1 scores. We compared AI-only, human-only, and combined Human+AI approaches on a subset of 100 images. External validation with images from additional hospitals tested model generalizability.

Results: The model achieved high accuracy in eye-side prediction (AUC 0.95) and AUC values of 0.52-0.74 for decentration, treatment zone, and shape variation tasks. The combined Human+AI method outperformed AI-only and human-only approaches, achieving the highest accuracy (up to 87%) and fastest processing time (80ms). External validation confirmed robust performance in simple tasks, though accuracy was lower for complex classifications due to imaging variations.

Conclusion: AI provides efficient routine corneal topography assessments, while complex cases benefit most from a Human+AI approach, particularly in scenarios requiring nuanced clinical interpretation. The model currently functions as an assistive tool.

Aim: To assess the refractive and functional outcomes of a novel trifocal intraocular lens (IOL) with smooth micro phase technology.

Methods: This prospective, single-arm, single-center, observational study included patients who underwent cataract surgery with the implantation of the AT ELANA 841P (Carl Zeiss Meditec, Berlin, Germany) IOL. Visual acuity (VA) at distance, intermediate, and near were evaluated 1- and 3-month postop as well as refractive outcomes. Monocular and binocular defocus curve, binocular contrast sensitivity (M&S® Technologies) and patient satisfaction with the Catquest-9SF questionnaire were measured at 3-month postop.

Results: In total, 46 eyes (23 patients) were bilaterally implanted with the IOL. Mean patient age was 59.86±5.55y. At 1-month postop, monocular corrected VA for distance, intermediate, and near were -0.15±0.09, 0.11±0.10, and 0.15±0.12 logMAR, respectively. These outcomes remained stable at the 3-month follow-up (P>0.05). Spherical equivalent (SE) at 1- and 3-month postop remained stable (P>0.05). Following surgery, 91% of the eyes at 1mo and 95% of the eyes at 3mo were within ±0.5 D of SE. Monocular defocus curve showed that the lens can be categorized as a steep transition IOL. The contrast sensitivity function revealed high values at low spatial frequencies and decreased values at high spatial frequencies. The results of the Catquest-9SF questionnaire showed that all patients were fairly or very satisfied with their vision after surgery.

Conclusion: The AT ELANA 841P IOL offers excellent visual outcomes across distance, intermediate, and near ranges, along with satisfactory contrast sensitivity. Additionally, the lens is associated with high patient satisfaction and minimal visual difficulties during daily activities.

Aim: To describe the alterations of the vitreous pathology and anterior chamber (AC) angle structures following transscleral cyclophotocoagulation (TSCP) and better understand the mechanism of post-laser intraocular pressure (IOP) reduction in angle-closure glaucoma (ACG).

Methods: Porcine eyes ex vivo and rabbit eyes in vivo were used. In porcine eyes, permeability rates of the anterior vitreous cortex (AVC) and anterior hyaloid membrane (AHM) were assessed using Schirmer's strips. Permeability rates in the circumlental space were compared with or without TSCP bursts. Fluorescein diffusion times from the vitreous to the AC were compared between eyes with and without TSCP. In rabbit eyes, changes in IOP and AC angle structures under ultrasound biomicroscopy (UBM) were evaluated at intervals of 30min, 7d, and 14d after TSCP. Vitreous pathology was examined using scanning electron microscopy (SEM) immediately and 14d after TSCP.

Results: In porcine eyes (n=20), the median (range) permeability rates were 10.3 (range 9.8-10.8) mm/min for the AVC and 4.3 (range 3.9-4.9) mm/min for the AHM (P=0.009). Permeability rates in the circumlental space were 4.2 (range 3.8-4.9) mm/min in areas without TSCP, 6.2 (range 5.7-6.8) mm/min in areas with non-burst TSCP, and 11.3 (range 10.9-11.8) mm/min in areas with burst TSCP (P=0.002). The median (range) fluorescein diffusion time was 5 (range 3-8)min in eyes undergoing TSCP, whereas it was 40min (range 35-68) in eyes without TSCP (P<0.001). In rabbit eyes (n=20), SEM showed immediate localized damage to the AHM, AVC, and posterior lens zonules in areas subjected to TSCP bursts, and obvious lens zonule loss with cellular infiltration and possible vitreous liquefaction by post-op day 14. Persistent widening of AC angles was noted at postoperative days 7 and 14, although a significant reduction in IOP was only observed at postoperative day 7.

Conclusion: TSCP-induced damage on the zonules, AHM, and AVC potentially enhances fluid outflow from the vitreous, leading to a widened AC angle and vitreous liquefaction in rabbits. These observations offer insights into mechanisms of TSCP in lowering IOP and pathogenic roles of vitreous in ACG.