International journal of ophthalmology最新文献

Aim: To compare the tear film quantity and stability parameters in keratoconus (KCN) and normal eyes using test breakup time (TBUT), noninvasive TBUT (NITBUT), and Schirmer test.

Methods: All participants (n=166), including patients with KCN and age-matched healthy individuals with normal corneas, were recruited from those referred to Farabi Eye Hospital, Iran, in 2023. To better account for genetic and environmental factors, the control group comprised healthy individuals who were relatives of KCN patients and had normal corneal topography. Tear quantity parameters were evaluated in the following order: NITBUT, TBUT, and Schirmer tests.

Results: The mean age of cases in KCN (61.7% males) and normal (63.5% males) participants was 27.54±5.44y (range 19 to 38) and 27.52±5.63y (range 20 to 38), respectively (P=0.976). NIBUT, TBUT, and Schirmer's tests were significantly lower in KCN group compared to normal controls (all P<0.001). The mean difference for NIBUT was -7.81s (P<0.001), and for TBUT was -7.61s (P<0.001). Schirmer test values were also significantly lower in the KCN group, with a mean difference of -5.61 mm compared to normal people (P<0.001).

Conclusion: Our findings demonstrate significant tear film impairment in KCN. The reductions in NIBUT, TBUT and Schirmer scores highlight an underlying tear film dysfunction in KCN that extends beyond the morphological changes of the cornea.

Aim: To report and analyze cases of sterile intraocular inflammation (IOI) following intravitreal faricimab injections in patients treated for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME).

Methods: This double-center case series included nine eyes of six patients who developed uveitis after faricimab therapy. Comprehensive clinical evaluation was performed, including slit-lamp examination, intraocular pressure (IOP) measurement, fluorescein and indocyanine green angiography (ICGA), and laboratory tests. Inflammatory responses were treated with topical or systemic corticosteroids, and patients were monitored for visual acuity and inflammatory activity.

Results: The incidence of IOI was 0.8% per patient (Innsbruck) and 0.23% (Czechia), with inflammation typically occurring between the third and sixth injection (mean interval: 10d post-injection). Inflammatory presentations ranged from anterior uveitis to posterior segment involvement. One notable case demonstrated novel choroidal hypofluorescent lesions on angiography, suggesting deeper ocular involvement. The mean patient age was 76y; five of six affected patients were female. All cases responded to local and systemic corticosteroids, with full recovery of initial visual acuity.

Conclusion: Sterile IOI after faricimab appears to be a rare but relevant adverse event. Although the incidence falls within expected ranges for anti-vascular endothelial growth factor (anti-VEGF) agents, the observed choroidal involvement represents a potentially new safety signal. Prompt diagnosis and corticosteroid therapy are effective in all cases. Our findings support the need for vigilant post-marketing surveillance and further studies to better understand the underlying mechanisms and risk factors of faricimab-associated inflammation.

Aim: To investigate the effects of shortening the duration of silicone oil tamponade on retinal structure and function in patients undergoing silicone oil removal (SOR) after surgery for primary rhegmatogenous retinal detachment (RRD).

Methods: A total of 58 eligible patients were enrolled and randomly assigned to two groups based on tamponade duration: the short-term group (30-45d) and the conventional group (≥90d). Comprehensive evaluations were performed before and after SOR, including slit-lamp examination, best-corrected visual acuity (BCVA) measurement, intraocular pressure (IOP) testing, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), microperimetry, electroretinography (ERG), and visual evoked potential (VEP) assessment.

Results: A total of 33 patients (23 males and 10 females; 33 eyes) were enrolled in the short-term SO tamponade group with mean age of 52.45±9.35y, and 25 patients (15 males and 10 females; 25 eyes) were enrolled in the conventional SO tamponade group with mean age of 50.80±12.06y. Compared with the conventional group, the short-term silicone oil tamponade group had a significantly lower incidence of silicone oil emulsification and cataract progression, with no significant difference in retinal reattachment success rate. Structurally, short-term tamponade was associated with increased thickness of the retinal ganglion cell layer (RGCL) in the nasal and superior macular regions and improved recovery of superficial retinal vascular density in these areas. Functionally, the short-term group showed better BCVA and retinal sensitivity both before and 1mo after SOR; additionally, the P100 amplitude in VEP tests was significantly increased in this group.

Conclusion: Shortening the duration of silicone oil tamponade effectively reduces damage to retinal structure and function without compromising the success rate of retinal reattachment in patients with primary RRD.

Aim: To identify early biomarkers associated with glaucomatous visual field (VF) progression in patients with normal-tension glaucoma (NTG).

Methods: This study included patients were divided into two groups based on disease progression status. Tear samples were collected for proteomic analysis. Data-independent acquisition (DIA) mass spectrometry combined with bioinformatic analyses was performed to identify and validate potential protein biomarkers for NTG progression. Additionally, differentially expressed proteins (DEPs) were evaluated using mediating effect models and receiver operating characteristic (ROC) curve analysis.

Results: A total of 19 patients (20 eyes) with NTG participated in this study, including 10 patients (4 males and 6 females; 10 eyes) in the progression group with mean age of 67.70±9.03y and 10 patients (4 males and 6 females; 10 eyes) in the non-progression group with mean age of 68.60±7.58y. A total of 158 significantly differentially expressed proteins were detected. UniProt database annotation identified 3 upregulated proteins and 12 downregulated proteins. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that these DEPs were mainly enriched in pathways such as oocyte meiosis. Gene Ontology (GO) enrichment analysis revealed functional clusters related to cellular processes. Weighted gene co-expression network analysis (WGCNA) indicated that the core proteins were primarily involved in the neurodegeneration-multiple diseases pathway and cellular processes. Mediating effect analysis identified PRDX4 (L) as a potential protein biomarker. ROC curve analysis showed that GNAI1 had the largest area under the curve (AUC=0.889).

Conclusion: This study identifies 15 differentially expressed proteins in the tear fluid of NTG patients, including PRDX4 (L). PRDX4 (L) plays a key role in oxidative stress.

Aim: To evaluate the efficacy and safety of decellularized conjunctival stroma (DCS) as a novel biomaterial by comparing its grafting outcomes with amniotic membrane (AM) when used for conjunctival reconstruction after primary pterygium excision.

Methods: This randomized, parallel-controlled study with allocation concealment enrolled 40 patients with primary pterygium. Participants were randomly assigned to two groups using the sealed envelope method: the DCS group (n=20) and the AM group (n=18), receiving DCS and AM grafts respectively. Slit-lamp photography of the operative eyes was performed preoperatively and at 1, 3, 5, 7, 10, 30, 90, and 180d postoperatively. Best-corrected visual acuity (BCVA) and symptom scores were recorded simultaneously. In vivo confocal microscopy was conducted at 3 and 6mo postoperatively.

Results: All participants exhibited improved postoperative symptoms. The mean age was 60±9y (male/female ratio: 6/14) in the DCS group and 56±12y (male/female ratio: 7/11) in the AM group. The average epithelial healing time was 9.89±3.54d in the DCS group and 8.17±1.34d in the AM group (P=0.084). One recurrence case was observed in each group. Postoperative graft hemorrhage was significantly more severe in the DCS group than in the AM group only at 30d postoperatively (P=0.011). In vivo confocal microscopy revealed conjunctival epithelial cell growth in both groups at 90d postoperatively, while clear corneo-conjunctival cell boundaries were observed until 180d postoperatively.

Conclusion: DCS used in primary pterygium surgery has a safety profile comparable to AM. It promotes rapid postoperative conjunctival healing, achieves a relatively low pterygium recurrence rate, and yields outcomes similar to AM. DCS provides a novel biomaterial option for conjunctival reconstruction after pterygium excision and the treatment of other conjunctival injuries.

Aim: To comprehensively assess the relationship between asthma and myopia based on the National Health and Nutrition Examination Survey (NHANES) database combined with Mendelian randomization (MR).

Methods: Initially, 20 497 subjects from the complete questionnaire cycle in the NHANES database from 2005 to 2008 were included. By exclusion criteria, 8460 subjects were screened with 1676 myopia samples and 6784 control samples. Subsequently, baseline characteristics, association analyses, risk stratification analyses, and receive operating characteristic curve (ROC) were used to investigate the associations between covariates and myopia. Then, the causal relationship was explored in depth by MR analysis, and was estimated the reliability by sensitivity analyses and directionality tests.

Results: Baseline characteristics illustrated a significant difference between myopia and controls for both asthma and covariates (excluding gender; P<0.05). The results in all three models indicated that asthma was strongly associated with myopia and the effect on myopia was not significantly confounded by other covariates [model 3: odd ratio (OR)=1.31; 95%CI=1.07-1.62; P=0.0133]. The risk stratification analysis again verified that asthma remained strongly associated with myopia and was a risk factor for myopia (P<0.05, OR>1). ROC proved that the model was accurate in its prediction [area under curve (AUC)=0.7]. Subsequently, the causal relationship between them was statistically significant (P<0.05) according to the inverse variance weighted (IVW) method in MR. Scatterplot showed that asthma and myopia had significant positive causality and were not affected by confounders. Forest plot displayed an increasing risk of myopia on asthma (OR>1). The funnel plot demonstrated compliance with Mendel's second law. Sensitivity analysis and directional analysis further confirmed the confidence of the MR analysis results and a unidirectional causal relationship between them.

Conclusion: A significant association and causality between asthma and myopia is found through the NHANES database and MR analysis, which is important implications for public health policy development and clinical practice.

Aim: To investigate the etiology and clinical characteristics of hospitalized secondary glaucoma (SG) patients in northwestern China.

Methods: A cross-sectional study was conducted involving SG patients hospitalized between July 2024 and January 2025. Clinical data were collected, including medical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, gonioscopic findings, and fundus examination. Demographic characteristics, etiological factors, and treatment modalities were analyzed.

Results: A total of 67 patients (82 eyes) were enrolled, aged 7 to 90y. Males accounted for 54.0% (36/67), and 22.4% (15/67) of patients had bilateral involvement. The predominant etiologies of SG were neovascular glaucoma (NVG; 25.4%), traumatic glaucoma (23.9%), uveitic glaucoma (20.9%), and lens-induced glaucoma (14.9%), collectively accounting for 85.1% of all cases. The peak age-specific incidence occurred in the 50-59 years age group (32.8%, 22/67), while NVG was prevalent across the 40-79 years age range. IOP of the 82 affected eyes was stratified into five severity tiers: 22-29 mm Hg (15 eyes, 18.3%), 30-39 mm Hg (14 eyes, 17.1%), 40-49 mm Hg (13 eyes, 15.9%), 50-59 mm Hg (20 eyes, 24.4%), and ≥60 mm Hg (20 eyes, 24.4%). The overall mean IOP was 45.2±12.3 mm Hg, indicating a significant pathological elevation. Surgical intervention was required in 46.3% of cases, predominantly for NVG, lens-induced glaucoma, and traumatic glaucoma-conditions prone to rapid IOP elevation. The etiologies with the highest surgical intervention rates were malignant glaucoma, pigmentary glaucoma, lens-induced glaucoma, and NVG. In contrast, uveitic glaucoma cases were primarily managed with targeted anti-inflammatory therapy, which effectively controlled IOP in the early disease stages and potentially obviated the need for surgery.

Conclusion: This study identifies NVG, traumatic glaucoma, uveitic glaucoma, and lens-induced glaucoma as the four leading etiologies of SG in Northwestern China. These findings emphasize the critical need for targeted prevention strategies and evidence-based health education programs among high-risk populations. Implementation of such initiatives will improve early detection, enable ophthalmologists to deliver timely therapeutic interventions, and ultimately reduce preventable vision loss in this region.

Aim: To evaluate long-term visual field (VF) prediction using K-means clustering in patients with primary open angle glaucoma (POAG).

Methods: Patients who underwent 24-2 VF tests ≥10 were included in this study. Using 52 total deviation values (TDVs) from the first 10 VF tests of the training dataset, VF points were clustered into several regions using the hierarchical ordered partitioning and collapsing hybrid (HOPACH) and K-means clustering. Based on the clustering results, a linear regression analysis was applied to each clustered region of the testing dataset to predict the TDVs of the 10^th VF test. Three to nine VF tests were used to predict the 10^th VF test, and the prediction errors (root mean square error, RMSE) of each clustering method and pointwise linear regression (PLR) were compared.

Results: The training group consisted of 228 patients (mean age, 54.20±14.38y; 123 males and 105 females), and the testing group included 81 patients (mean age, 54.88±15.22y; 43 males and 38 females). All subjects were diagnosed with POAG. Fifty-two VF points were clustered into 11 and nine regions using HOPACH and K-means clustering, respectively. K-means clustering had a lower prediction error than PLR when n=1:3 and 1:4 (both P≤0.003). The prediction errors of K-means clustering were lower than those of HOPACH in all sections (n=1:4 to 1:9; all P≤0.011), except for n=1:3 (P=0.680). PLR outperformed K-means clustering only when n=1:8 and 1:9 (both P≤0.020).

Conclusion: K-means clustering can predict long-term VF test results more accurately in patients with POAG with limited VF data.

Aim: To conduct a genetic analysis of Han-Chinese patients with isolated congenital ptosis (ICP) and identify the genetic variants related to the condition.

Methods: Sixty-five unrelated patients with ICP were enrolled. Comprehensive clinical examinations, whole exome sequencing (WES), and Sanger sequencing were used to reveal the potential genetic causes. Combined with public and in-house control databases, multiple bioinformatics prediction tools, and conservation analysis, the potential variants were further analyzed. AlphaFold 3, an accurate modelling prediction tool, was utilized to generate three-dimensional structural models of both wild-type and mutated proteins.

Results: Three novel heterozygous variants in the zinc finger homeobox 4 gene (ZFHX4), c.5145C>A (p.N1715K), c.10382C>T (p.A3461V), and c.10795G>A (p.A3599T), were identified in three patients, respectively. Bioinformatics analyses suggested that these variants are likely to exert deleterious effects, supporting their potential involvement in the pathogenesis of ptosis.

Conclusion: The novel heterozygous ZFHX4 variants are identified as disease-associated variants in three patients with ptosis, suggesting that ZFHX4 may be a disease-causing gene for autosomal dominant ICP with incomplete penetrance or a susceptibility gene. These findings expand the variant spectrum of ZFHX4, improve understanding of the pathogenesis of ZFHX4-related ptosis, and may contribute to the genetic counseling and disease management, as well as the development of experimental treatments.