International journal of ophthalmology最新文献

Aim: To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.

Methods: A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W. Kenya, amongst a semi-nomadic tribe (Maasai). Students in Grades 1-8 were included. Visual acuity was measured using the Snellen "tumbling E" chart at 6 m. Children with symptoms of refractive error underwent non-cycloplegic refraction.

Results: A total of 2036 children (1084 males) between the ages of 4-20y were examined. Conjunctival actinic changes were present in 22% (442/2036). Nine cases were seen with a potential squamous carcinoma. No overt classical ocular signs of vitamin A deficiency were noted, although 181 (8.9%) children complained of nyctalopia. Three hundred thirty-six (16.5%) children had a visual acuity worse than 6/12 in either eye, were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error. Refractive data led to an estimate of hyperopia of +1.00 D or more in 3.9% and of myopia of -0.50 D or more in either eye in 3.0% of the study population.

Conclusion: Solar exposure- and dust-related conjunctival pathology is common. As this may develop into potentially sight- or even life-threatening conditions, it warrants further study, and preventive strategies may be needed. Complaints of nyctalopia were common and could suggest vitamin A deficiency. The prevalence of refractive errors is low in this rural African population.

Aim: To examine the ocular toxicity linked to sildenafil usage and the possible protective benefits of adenosine triphosphate (ATP) against this toxicity in rats.

Methods: Twenty-four male albino Wistar-type rats were divided into four equal groups (n=6/group) as follows: healthy group (HG), ATP-only group (ATPG), sildenafil-only group (SILG), and ATP+sildenafil group (ATP+SLD). ATPG and ATP+SLD groups were injected intraperitoneally with ATP (4 mg/kg), while SILG and HG groups were injected with saline (0.9% NaCl) by the same route as a solvent. One hour after the administration of ATP and solvent, sildenafil (10 mg/kg) was administered orally to the SILG and ATP+SLD groups. This procedure was repeated once a day for 4wk. The animals were then sacrificed, eyeballs were removed and oxidant and antioxidant parameters were measured biochemically. Additionally, the ocular tissues were evaluated histopathologically.

Results: Sildenafil increased oxidant (malondialdehyde) levels and decreased antioxidant levels (total glutathione, superoxide dismutase, catalase) in rat ocular tissues and caused severe oxidative stress. In addition, sildenafil has been shown histopathologically to cause oxidative damage in retinal layers. ATP treatment suppressed oxidative stress and attenuated histopathological damage in the retinal layers.

Conclusion: ATP protects retinal tissue against sildenafil-induced ocular oxidative damage in rats and may contribute to the development of novel approaches to prevent or treat this damage.

Overt and harmful diabetes mellitus (DM) has detrimental effects on individuals and, by extension, the community. Among the microvascular DM complications is diabetic retinopathy (DR). DR may cause irreversible vision deterioration in cases of poor blood glucose regulation. Changes in vascular permeability are key trigger points for diabetic macular edema (DME), a condition characterized by the accumulation of fluid in the macula. The development of vascular endothelial growth factor (VEGF) pathway inhibitors has provided a pathogenesis-based treatment approach for DME. Optical coherence tomography (OCT) provides high-resolution imaging of the anatomy, including the aging of DME and its structural damage, in distinct morphologic subtypes of macular edema, thereby supporting the assessment of macular edema treatment. The availability of repeated OCT monitoring provides clinical reassurance through the treatment. OCT angiography (OCTA) provides retinal blood flow maps with high spatial resolution. The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods. This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME, as well as their respective therapeutic applications.

Aim: To identify metastasis-associated prognostic genes and construct a robust molecular signature for survival prediction in uveal melanoma (UVM) patients.

Methods: Transcriptomic data and clinical information from 80 UVM patients in the Cancer Genome Atlas (TCGA)-UVM cohort and an external Gene Expression Omnibus (GEO) microarray dataset (GSE73652; 8 non-metastatic vs 5 metastatic cases) were analyzed to identify differentially expressed genes (DEGs). Functional enrichment, protein-protein interaction (PPI) network construction, and survival analyses identified seven metastasis- and prognosis-related genes. Their expression was further examined using public single-cell RNA-seq data (GSE139829; 11 tumors). Experimental validation was performed in UVM cell lines (92.1, OMM1, MEL270) and adult retinal pigment epithelial (ARPE-19) cells using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting to confirm transcriptomic trends. A LASSO Cox model was applied to construct a metastasis-related risk Score signature. Tumor immune microenvironment characteristics were evaluated via single-sample gene set enrichment analysis (ssGSEA) and ESTIMATE. Somatic mutation and copy number variation (CNV) profiles were also examined.

Results: Seven key genes (UBE2T, KIF20A, DLGAP5, KLC3, TPX2, UBE2C, AURKA) were significantly associated with overall survival and used to construct a metastasis-related riskScore signature, which effectively stratified patients into high- and low-risk groups and served as an independent prognostic factor. qRT-PCR and Western blot results confirmed that the expression levels of selected key genes in UVM cell lines showed significant differences compared to ARPE-19 cells, which were largely consistent with the transcriptomic findings. The high-risk group exhibited reduced immune infiltration and stromal activity. Single-cell analysis revealed these genes were predominantly expressed in a tumor cell cluster characterized by BAP1 loss and high metastatic potential. Mutation and CNV analyses further supported the relevance of these genes to UVM progression.

Conclusion: This study establishes and validates a seven-gene signature associated with metastasis and prognosis in UVM. The findings provide a framework for understanding molecular determinants of tumor progression and immune microenvironment alterations, and may offer guidance for future mechanistic studies and therapeutic exploration.

Aim: To explore the causal relationship between several possible behavioral factors and high myopia (HM) using multivariable Mendelian randomization (MVMR) approach and to find the mediators among them with mediation analysis.

Methods: The causal effects of several behavioral factors, including screen time, education time, time spent outdoors, and physical activity, on the risk of HM using univariable Mendelian randomization (MR) and MVMR analyses were first assessed. Genome-wide association study summary statistics of serum metabolites were also used in mediation analysis to determine the extent to which serum metabolites mediate the effects of behavioral factors on HM.

Results: MR analyses indicated that both increased time spent outdoors and a higher frequency of moderate physical activity significantly reduced the risk of HM. Further MVMR analysis confirmed that moderate physical activity independently contributed to a lower risk of HM. Additionally, MR analyses identified 13 serum metabolites significantly associated with HM, of which 12 were lipids and one was an amino acid derivative. Mediation analysis revealed that six lipid metabolites mediated the protective effects of moderate physical activity on HM, with the highest mediation proportion observed for 1-(1-enyl-palmitoyl)-GPC (p-16:0; 30.83%).

Conclusion: This study suggests that in addition to outdoor time, moderate physical activity habits may have an independent protective effect against HM and pointed to lipid metabolites as priority targets for the prevention due to low physical activity. These results emphasize the importance of physical activity and metabolic health in HM and underscore the need for further study of these complex associations.

Aim: To define the prevalence and anatomical patterns of paranasal sinus abnormalities (PSA) in thyroid-associated ophthalmopathy (TAO) and to test the hypothesis that TAO is partially driven by contiguous orbital inflammation rather than systemic autoimmunity or generalized orbital pressure.

Methods: Data included ophthalmic assessments and a panel of thyroid function and autoimmune biomarkers. Blinded radiological analysis of orbital computed tomography (CT) scans was performed to quantify sinus abnormalities and extraocular muscles (EOMs) involvement. Patients were categorized into two groups based on CT findings, those with no radiological evidence of sinus abnormalities (non-PSA control group) and those with identifiable PSA. Furthermore, ethmoid sinus mucosal biopsies from a subset of TAO patients and non-inflammatory controls were subjected to histopathological analysis.

Results: Totally 121 TAO patients (mean age 42.4±12.8y, range 10-78y), male:female=42:79, were included. PSA was identified in 44.6% (n=54) of patients, with a distribution anatomically restricted to the maxillary (50.0% isolated) and ethmoid sinuses (18.5% isolated; 29.6% combined). Compared to the non-PSA group (n=67), patients with PSA were significantly older (45.1±11.8 vs 40.3±13.2y; P=0.040) and were more likely to be male (55.6% vs 17.9%; P<0.001). They also had significantly higher proptosis (22.1±3.2 vs 20.7±2.9 mm; P<0.001). Medial/inferior rectus involvement was most frequent (88.4% vs 89.3%). Histopathological analysis of sinus mucosa from PSA patients provided direct evidence of pathology, revealing a dense, chronic lymphoplasmacytic infiltrate and submucosal edema, validating the radiological findings as a true inflammatory process. No significant correlation was found with systemic autoimmune markers, including thyroid-stimulating hormone (TSH) receptor antibodies (TRAb, median 4.86 vs 2.71 IU/L, P=0.104).

Conclusion: TAO is associated with a high prevalence of PSA in a pattern consistent with the orbital anatomy. The correlation with ipsilateral muscle thickening combined with the lack of association with proptosis laterality or systemic biomarkers lend strong support to a model of contiguous inflammation over systemic autoimmunity, a hypothesis that warrants further validation through longitudinal and mechanistic studies.

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.