International journal of ophthalmology最新文献

Aim: To identify risk factors for postoperative blindness in patients with primary rhegmatogenous retinal detachment (RRD) at their first presentation to a tertiary center, using a large clinical database to improve understanding of this adverse outcome.

Methods: Electronic health records of patients with primary RRD from the Eye Hospital of Wenzhou Medical University were retrospectively analyzed. Postoperative blindness was defined according to the World Health Organization (WHO) criteria for legal blindness. Potential risk factors included demographic characteristics, preoperative clinical features, and surgical variables. Univariable and multivariable logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor.

Results: A total of 532 patients were included in the cohort, of whom 62 (12.0%; 28 males, 34 females) developed postoperative blindness at the final follow-up. Among these 62 patients, 30 had high myopia and 32 did not. The mean age of participants was 49.0±16.4y, with 275 subjects (52%) being male and 133 patients (25%) having the condition in the right eye. In the multivariable model for all patients, the following factors were associated with an increased risk of postoperative blindness: higher preoperative logarithm of the minimum angle of resolution visual acuity (logMAR VA; OR=1.09 per 0.1 logMAR unit increase, 95%CI 1.03-1.15); inferior or superior retinal breaks (OR=2.42, 95%CI 1.12-5.24); and macular holes or superior retinal breaks (OR=8.46, 95%CI 3.45-20.75). In the subgroup of patients with high myopia, risk factors for postoperative blindness included: pseudophakia/aphakia versus phakia (OR=6.33, 95%CI 1.41-28.31); macular holes or superior retinal breaks (OR=15.15, 95%CI 3.07-74.85); and proliferative vitreoretinopathy (PVR; OR=21.41, 95%CI 2.14-214.57). In the subgroup of patients without high myopia, increased risk of postoperative blindness was associated with: higher preoperative logMAR VA (OR=1.11 per 0.1 logMAR unit increase, 95%CI 1.04-1.18); and inferior or superior retinal breaks (OR=2.90, 95%CI 1.19-7.06).

Conclusion: Using a large real-world clinical database, we identified distinct risk factors for postoperative blindness in patients with primary RRD-including differences between those with and without high myopia. These findings emphasize the need to target specific risk factors in clinical practice to mitigate and reduce the incidence of postoperative blindness in this patient population.

Aim: To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.

Methods: A retrospective review was conducted on the medical records of patients with basic-type strabismus. Demographic data, refractive error, best-corrected distance visual acuity (BCVA), and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared.

Results: Among the 7129 patients (mean age 22.98±14.81y) evaluated, 44.7% (3185 cases, 54.9% male) exhibited basic-type esotropia, while 55.3% (3944 cases, 53.9% male) presented with basic-type exotropia. Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes (right: 0.53±3.07 vs left: 0.56±2.98 D) than those with basic exotropia (right eye: -0.33±2.84 vs left eye: -0.24±2.68 D, P<0.001 for both eyes). Patients with basic esotropia had significantly greater horizontal deviation angles (near: 36.08±18.87 PD and far: 35.56±18.75 PD) compared to those with basic exotropia (near: 33.75±16.11 PD and far: 33.26±15.90 PD, P<0.001). Conversely, patients with basic exotropia had slightly higher vertical deviation angles (near: 1.67±5.80 PD and far: 1.72±5.89 PD) compared to those with basic esotropia (near: 1.12±4.57 PD and far: 1.12±4.58 PD, P<0.001). Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals (19.68±15.99 vs 25.66±13.20, P<0.001).

Conclusion: Basic esotropia patients present more hyperopic refractive errors, better visual acuity, larger horizontal yet smaller vertical ocular misalignments, and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.

Aim: To investigate the outcome of combined anterior corneal elastic sublaminectomy, conjunctival flap, and prosthetic eyepiece for ocular atrophy following foldable capsular vitreous body (FCVB) implantation in severe trauma.

Methods: This study conducted a retrospective analysis of 38 patients who underwent conjunctival flap coverage followed by prosthetic eyepiece fitting after developing ocular atrophy secondary to FCVB surgery. Anterior corneal elastic sublaminectomy combined with conjunctival coverage was performed on the FCVB-implanted atrophic eyes. Prosthetic lenses were fitted after complete healing of the stroma and conjunctiva and suture removal. Corneal irritation, eyeball protrusion, axial length, lid height, cosmetic satisfaction, and pain numerical rating scale scores were observed before the conjunctival flap covering and after the prosthetic eyepiece surgery.

Results: The ocular protrusion was 11 mm preoperatively and 14 mm postoperatively, with the difference being statistically significant (Z=-5.459, P<0.001). The ocular axis length was 20.82±0.94 mm in the experimental group and 23.57±0.33 mm in the control group, showing a statistically significant difference (t=-20.207, P<0.05). The lid height was 6 mm in the experimental group and 9 mm in the control group, a difference that was statistically significant (Z=-5.326, P<0.001). The appearance satisfaction score was 1 in the experimental group and 4 in the control group, with this difference being statistically significant (Z=-5.447, P=0.001). Regarding the pain numerical rating scale score, the ranges were 0-2 in the experimental group and 0 in the control group. No discomfort was reported after wearing the prosthetic eyepiece, and the difference was not statistically significant (Z=-1.100, P>0.05). There was no statistically significant difference between pre- and post-treatment satisfaction.

Conclusion: A conjunctival flap covering and a prosthetic eyepiece after FCVB postoperative atrophy can reduce the number of surgeries, alleviate patients' economic burdens, satisfy patients' psychological eyeball retention requirements, and provide better cosmetic efficacies for patients desiring eyeball retention or silicone-oil dependence.

The global prevalence of myopia is becoming increasingly severe, with epidemiological models predicting that by 2050, approximately 50% of the world's population will be affected by myopia, and about 10% will suffer from high myopia. The incidence of high myopia is projected to increase fivefold, making it the leading cause of irreversible vision impairment. Myopia often leads to various complications and has been associated with other ocular diseases, including early-onset cataracts, age-related macular degeneration, and primary open angle glaucoma. As a result, the control and management of myopia have become ongoing and long-term research priorities. The pathogenesis of myopia involves complex multisystem interactions. Current mainstream theories focus primarily on choroidal hypoxia-induced scleral remodeling, with neurotransmitters such as acetylcholine and dopamine playing regulatory roles. However, recent studies have increasingly suggested that changes in nutritional intake, including proteins, fats, and cholesterol, may also be related to myopia development. The role of lipid metabolism in the onset and progression of myopia has gradually attracted growing attention. Therefore, this review aims to systematically elucidate the molecular mechanisms of lipid metabolism regulatory networks in axial myopia, integrating multidimensional factors to provide a theoretical foundation for precision intervention strategies.

Aim: To evaluate the short-term efficacy and safety of ultrasound cycloplasty (UCP) procedure in Chinese patients with angle-closure glaucoma (ACG), and the mechanisms of its intraocular pressure (IOP) lowering effects.

Methods: Fifty-six patients (56 eyes) diagnosed with primary and/or secondary ACG were enrolled in this prospective study. Visual acuity, IOP, slit-lamp examinations, structural parameters of anterior segments including anterior chamber depth (ACD), pupillary diameter (PD), anterior chamber area (ACAr), anterior chamber angle (ACAn), and side effects were evaluated. Seven rhesus macaques (Macaca Mulatta) were used for the analyses of IOP lowering effects, including inflammatory reactions, pathohistological evaluation, scanning electron microscopy (SEM), and aqueous outflow pathway via 1% basic fuchsin perfusion.

Results: Fifty six eyes of 24 male and 32 female patients with an average age of 58.93±15.97 years old were recruited in primary and secondary ACG affected 31 and 25 eyes, respectively. Clinically, the mean IOP was 17.89±7.93 mm Hg (n=53, 53.63% reduction, P<0.001) at 1wk and 22.47±12.00 mm Hg at 12mo (n=16, 18.67% reduction, P<0.01) after UCP, compared to the baseline of 39.08±14.75 mm Hg (n=56). Postoperative tolerance was favorable in 94.64% of cases, with visual acuity unchanged or improved in 96.43% of patients. Mild and transient inflammatory reactions were observed post UCP. UBM analysis revealed statistically significant changes in anterior chamber parameters: increased ACD (n=22, P<0.05), enlarged PD (n=22, P<0.05), expanded ACAr (n=16, P<0.01), and widened ACAn (n=19, P<0.05) compared to preoperative measurements. As in normal monkey eyes, IOP was also reduced upon UCP. Mild inflammatory reactions were seen 1-7d post treatment. Hematoxylin and Eosin (H&E) staining showed enlarged spaces among ciliary muscle bundles. Ciliary process stromal edema was evident, but significant loss of two layers of ciliary epitheliums was not seen. SEM confirmed ciliary muscle fibers concentrated. Fuchsin anterior chamber perfusion showed the whole ciliary body staining in UCP group, but only surface staining in controls.

Conclusion: UCP is efficient and safe to lower the IOP of patients with ACG. Changed anterior chamber structure and increased aqueous humour outflow via uveoscleral pathway may significantly attribute to IOP lowering effects of UCP.

Aim: To analyze the environmental impact of patient travel for cataract surgery at a German ophthalmology center.

Methods: All cataract surgeries performed between October 23 and October 27, 2023, were analyzed, and all patient records were reviewed for follow-up visits. All travel distances were calculated, and the associated emissions were quantified. Additionally, patients' utilization of geographically closer branch practices for follow-up care was evaluated, along with the corresponding effects on travel-related emissions.

Results: A total of 69 patients underwent unilateral cataract surgery. The average one-way travel distance was 40.1 km (24.9 mi; SD = 23.6 km). Corresponding emissions were 1284.8 kg of greenhouse gas (GHG), 2.477 kg of nitrogen oxides, and 0.101 kg of particulates. All patients attended at least two follow-up visits. Conducting follow-up visits at branch practices reduced travel distance by 49.1%. The associated GHG emissions from all travel were 1984.3 kg. Emissions from follow-up visits were 54.4% higher than those from the surgery itself. Total GHG emissions amounted to 3269.1 kg, with an average of 47.4 kg of GHG per patient for all travel associated with cataract surgery.

Conclusion: A dense network of branch practices contributes to reducing the carbon footprint of cataract surgery-related patient travel; however, the development of digital health approaches for follow-up care is necessary to further optimize the environmental sustainability of cataract surgery.

Aim: To establish a risk prediction model for secondary cataract within 2y after pars plana vitrectomy (PPV) in patients with primary rhegmatogenous retinal detachment (RRD).

Methods: Clinical data of patients with primary RRD treated at the Shenzhen Eye Hospital were retrospectively collected. Twenty-four potential influencing factors, including patient characteristics and surgical factors, were selected for analysis. Independent risk factors for secondary cataract were identified through univariate comparisons and multivariate logistic regression analysis. A risk prediction model was constructed and evaluated using receiver operating characteristic (ROC) curves, area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA) curves.

Results: The 386 cases (389 eyes) of patients who underwent PPV and had complete surgical records were ultimately included. Within a 2-year longitudinal observation, 41.39% of patients developed cataract secondary to PPV. Logistic regression results identified a history of hypertension [odds ratio (OR)=1.78, 95%CI: 1.002-3.163, P=0.049], silicone oil tamponade (OR=3.667, 95%CI: 2.373-5.667, P=0.000), and lens thickness (OR=1.978, 95%CI: 1.129-3.464, P=0.017) as independent risk factors for cataract secondary to PPV. The constructed nomogram achieved AUC=0.6974. Calibration plots indicated good agreement between predicted and observed outcomes, while DCA curves demonstrated the model's clinical utility.

Conclusion: By incorporating a history of hypertension, vitreous substitute type, and lens thickness, this study constructs a prediction model with moderate discriminative ability. This model offers a valuable tool for clinicians to identify high-risk patients early, potentially allowing for more timely interventions and improved patient outcomes.

Aim: To evaluate the effect of different monochromatic lights on the refractive status and the secretion levels of neurotransmitters in the progressive myopic model of guinea pigs.

Methods: Guinea pigs (n=90) underwent different monochromatic lights irradiation for two weeks were randomly divided into 6 groups: white light (control), ultraviolet (UV), blue, green, red, and simulative sunlight (simSUN). The refractive status and axial length (AL) were measured. Transmission electron microscopy, Masson's trichrome staining and hematoxylin-eosin staining were performed to observe the structural changes of retina and sclera. High-performance liquid chromatography (HPLC), western blotting and immunofluorescence were used to measure neurotransmitters and their receptors.

Results: Myopia models were established successfully. When compared the degrees of change in myopic eyes of control group, the UV group showed a minor decrease in AL and refraction, along with a significant increase in scleral thickness. In contrast, the red and green groups revealed a net increase in AL and refraction, coupled with a net decrease in scleral thickness (all, P<0.01). The dopamine concentration increased in the UV group, while concentrations of serotonin and melatonin significantly decreased (all, P<0.01). The groups that were exposed to UV, blue and simSUN, the expression of dopamine receptor D2 (DRD2) increased, and the expression of hydroxytryptamine receptor 2A (HTR2A) and melatonin receptor type 2 (MT2) decreased significantly when compared to the control group (all P<0.01).

Conclusion: Exposure to short-wavelength light could slow the development of myopia by promoting the production of dopamine and suppressing the serotonin and melatonin concentration. The neurotransmitter receptors MT2, DRD2, and HTR2A in the sclera appear to play different roles by different color lights in myopic guinea pigs.

Aim: To propose a novel classification system for late postoperative capsular block syndrome (CBS) based on the turbidity of intracapsular fluid, and to investigate the imaging and refractive changes before and after Nd:YAG laser posterior capsulotomy for each subtype.

Methods: A retrospective analysis was performed on 5 eyes from 5 patients with late postoperative CBS. Patients were categorized into turbid (3 eyes) or clear (2 eyes) types based on the turbidity of intracapsular fluid. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive status, slit-lamp images, Pentacam Scheimpflug data, and ultrasound biomicroscopy (UBM) images were evaluated before and 1mo after successful Nd:YAG laser posterior capsulotomy.

Results: Nd:YAG laser posterior capsulotomy significantly improved UCVA and BCVA in all 5 late CBS eyes. Pentacam imaging: turbid intracapsular fluid showed hyperreflection between posterior capsule and intraocular lens (IOL); clear fluid showed hyporeflection. UBM: posterior capsule was clear in turbid type but poorly defined in clear type. Capsulotomy increased aqueous depth only in clear type. Refractive changes: turbid fluid induced myopic shift. Clear type myopic shift was due to anterior IOL displacement and clear fluid-induced concave lens effect.

Conclusion: Nd:YAG laser posterior capsulotomy is effective for late CBS. Turbid and clear late CBS types differ in imaging (Pentacam/UBM) and refractive mechanisms, supporting the proposed classification's clinical value.