International Ophthalmology Clinics最新文献

Purpose: To evaluate outcomes of ultracomplex retinal detachment (UCRD) repairs performed at a large county hospital.

Materials and methods: Retrospective chart review of patients who underwent a UCRD repair, defined as a funnel retinal detachment (RD), RD associated with ocular trauma, or RD requiring retinectomy, 5000 centistoke silicone oil or perfluorocarbon heavy liquid (PFO). The outcomes examined were visual acuity (VA), anatomic success, and phthisis development.

Results: Fifty eyes met inclusion criteria; 7 (14%) had a funnel RD, 14 (28%) had a history of ocular trauma, 34 (68%) had a retinectomy, 19 (38%) used 5000 centistoke silicone oil, and 12 (24%) used PFO. The mean follow-up time was 10.9±6.9 months. At 3 months, vision had remained stable or improved for 64% of eyes and the macula was attached for 66% of eyes. The mean preoperative VA was 2.5±0.5 logMAR, and the mean VA at 3 months was 2.4±0.7 logMAR with no statistically significant difference (P=0.30). With multivariate regression, preoperative VA was a statistically significant predictive factor of postoperative VA at 3 months. Nine (18%) of eyes developed phthisis, a mean of 11.4±5.1 months after UCRD repair.

Conclusions: Surgical intervention for UCRD can stabilize vision and achieve anatomic success.

"The eyes are a window to the brain," prompting the investigation of whether retinal biomarkers can indicate Alzheimer disease (AD) and cognitive impairment. AD is a neurodegenerative condition with a lengthy preclinical phase where pathologic changes in the central nervous system (CNS) occur before clinical symptoms. Mild cognitive impairment (MCI) often precedes AD. As part of the CNS, the retina exhibits similar pathologic changes related to AD as those seen in the brains of patients with MCI. Noninvasive imaging technologies such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) allow high-resolution visualization of the retina, providing an opportunity to screen and monitor AD noninvasively. In this review, we summarize the relationship between AD and retinal pathology detected by OCT and OCTA. The most common findings in patients with AD include peripapillary retinal nerve fiber layer thinning, decreased macular thickness, an enlarged foveal avascular zone, and decreased vascular densities in the superficial and deep capillary plexuses. These retinal changes correlate with magnetic resonance imaging (MRI) findings of cerebral atrophy, positron emission tomography (PET) findings of increased amyloid load, and neuropsychological testing results suggesting cognitive dysfunction. We conclude that retinal microstructural and microvascular abnormalities may serve as biomarkers for the early detection and clinical monitoring of AD and as tools for evaluating potential treatment effects. Future studies should focus on standardizing protocols for in vivo ophthalmic imaging to measure retinal pathology in AD and MCI.

Purpose: Diabetic retinopathy and diabetic nephropathy are two major life-altering complications of diabetes mellitus. Identifying permissive and protective factors for diabetic retinopathy and nephropathy is imperative so that diabetic quality of life can be optimized and downstream complications can be minimized.

Methods: We performed a large retrospective chart review of 997 patients at a county medical center with a majority Hispanic population. Through multivariable regression analysis, we identified significant factors associated with the presence of diabetic retinopathy or diabetic nephropathy. We also identified patients with a discordance between diabetic control and the severity of diabetic retinopathy and nephropathy.

Results: Chronic kidney disease, baseline HbA1c, and systolic blood pressure were found to be positive risk factors for both diabetic retinopathy and diabetic nephropathy. Beta-blocker use and insulin use were identified as positive risk factors for diabetic retinopathy but not diabetic nephropathy. A higher body metabolic index (BMI) was found to be protective for diabetic retinopathy. We identified 7 patients with poor diabetic control (HbA1c >10%) but no diabetic retinopathy. There were no outlier patients found in the low glycemic exposure group.

Conclusions and importance: Our results are similar to other large-cohort reviews identifying factors associated with diabetic retinopathy and nephropathy. We identified a small cohort with discordance between diabetic control and the development of diabetic retinopathy or nephropathy. Future studies should be conducted looking into reasons for the anomalous progression of disease in certain patients.

Aim: Determine the follow-up rate for patients referred following an abnormal teleretinal imaging (TRI) screening and examine patient characteristics predictive of follow-up nonadherence.

Materials and methods: A cross-sectional study of patients screened between August 2014 and July 2016 in the Harris Health System (HHS) in Houston, TX. All diabetic patients referred for in-person examination, who had data for all study variables, and who did not have established ophthalmic care in the HHS within the previous 2 years were included. Data collected included TRI findings, clinic location, age, race, gender, hemoglobin A1C (HbA1c), and insulin use. The primary outcome was whether or not a patient attended an in-person follow-up visit. Attendance was the dependent variable in a multivariable logistic regression with the aforementioned exposures used as independent variables.

Results: There were 1695 patients included in the study. The follow-up rate (ie, the percentage of patients who went for an in-person examination with an ophthalmologist following a positive screening test and referral) was 54.9%. TRI findings of proliferative diabetic retinopathy (PDR) + referable diabetic macular edema (DME) predicted poorer compliance with follow-up recommendations compared to patients with PDR alone (OR 0.64, 95% CI 0.42-0.99; P=0.046). Age, race, gender, glycemic control, and insulin use did not predict compliance.

Conclusion: Age, race, gender, glycemic control, and insulin use were not found to be predictive of follow-up compliance rates; the most severe disease (PDR + DME) predicted noncompliance. Diabetic retinopathy screening programs may consider more aggressive measures in emphasizing compliance in patients with the worst disease as these patients are more likely to miss follow-up appointments. More studies are needed to characterize risk factors for noncompliance.

Head-mounted devices (HMDs) are wearable electronic tools designed to augment the visual experience of low-vision patients who have a decrease in vision not improved by refractive correction. They do so by addressing various principles of visual enhancement, including magnification, illumination, increased field of view, and contrast sensitivity enhancement, among others. Since the introduction of the first HMD 3 decades ago, advancements in technology have made these devices more lightweight and practical for everyday use. More sophisticated features have been developed, including augmented reality, virtual reality, text-to-speech, and blind spot remapping. However, despite these advancements, HMDs still face a host of challenges, including cost, customizability to specific patient factors, and social stigma. In this paper, we present a broad overview of HMDs, review major products available commercially, and discuss the challenges and future directions for this rapidly growing field.

Tyrosine kinase inhibitors (TKIs) serve to inhibit the phosphorylation cascade that usually leads to abnormal processes such as vascular leakage and tumorigenesis. Within retinal diseases specifically, dysregulation of the vascular endothelial growth factor receptor tyrosine kinases can lead to age-related macular degeneration and diabetic macular edema. These diseases have a growing prevalence and are leading causes of vision loss. The current standard of care requires repeated administration of anti-vascular endothelial growth factor injections, which poses a significant burden on patients. Novel TKIs provide an opportunity to reduce injection frequency by targeting a broader range of molecules involved in angiogenesis and exudation. This review will cover TKIs in development and how their use of different technologies and targets may enhance visual and anatomic outcomes for patients with exudative retinal disease.

Retinitis pigmentosa (RP) is a class of inherited retinal dystrophies (IRDs) that involves the degeneration of retinal photoreceptor cells and results in progressive vision loss. It was identified and named in 1857. For over 100 years, treatment of RP was generally limited to modifications in diet, management of cystoid macular edema, and supportive care for low vision. Over the last several decades, advances in technology and our understanding of the human genome have led to a host of new therapeutic candidates for the treatment of RP. This includes gene and cell therapy, optogenetics, neuroprotective agents, and electronic retinal implants. In this article, we summarize both the traditional and novel therapeutic modalities for the treatment of retinitis pigmentosa.

Retinopathy of prematurity (ROP) remains a significant health care concern in neonatal care as advances in neonatal intensive practices have improved the survival rates of premature infants. The management and screening of ROP have evolved significantly, with notable trends and advancements aimed at improving outcomes. The use of intravitreal antivascular endothelial growth factor injections has emerged as a prominent initial treatment for ROP in addition to laser photocoagulation. Screening practices have also seen enhancements, with a shift toward efficiency and tele-screening to optimize ROP management. This review aims to discuss available treatment and screening methods and explore new potential therapeutic tools for ROP.

Purpose: To report visual and refractive outcomes and intraoperative and postoperative complications after pars plana vitrectomy (PPV) with retropupillary implantation of an iris clip intraocular lens (IOL).

Methods: This is a retrospective case series of patients who underwent secondary retropupillary intraocular lens insertion combined with pars plana vitrectomy to treat aphakia secondary to a dislocated nucleus lens (group A); or IOL dislocation (group B). Patient demographics, preoperative visual and refractive outcomes, intraoperative factors, postoperative visual and refractive outcomes, and complications within the follow-up period ranging from 6 months up to 3 years postoperative, were recorded.

Results: In total, 57 eyes of 50 patients were included with a follow-up range of 6 months to 3 years. The overall mean age was 77.0 years (range 28 to 99 years), with 26/50 (52%) of patients being male. There were 13/57 (22.8%) patients in group A and 44/57 (77.2%) patients in group B. The single most common identifiable cause for lens dislocation was pseudoexfoliation, which was seen in 13/57 (22.8%) of eyes. The mean improvement in visual acuity (baseline and final follow) was 0.72 logMAR (1.09 logMAR to 0.37 logMAR) in all patients, 1.12 logMAR (1.64 logMAR to 0.52 logMAR) in group A, and 0.60 logMAR (0.91 logMAR to 0.31 logMAR) in group B. In 46 eyes (80.7%), postoperative refractive errors were within ±1.00 dioptres (D) of the target refraction, with a mean difference of 0.36D from target refraction. Complications included corneal edema (35.1%), hyphema (26.3%), anterior chamber inflammation (26.3%), vitreous hemorrhage (14%), elevated intraocular pressure (IOP, 12.3%) and cystoid macular edema (CME, 5.3%). All these complications were managed with topical medical therapy and did not require further surgical intervention. One eye from group A was the only eye that developed retinal detachment (RD) or endophthalmitis. No patients had IOL dislocation in the postoperative follow-up period, which ranged from 6 months to 3 years.

Conclusions: Retropupillary implantation of an iris clip IOL with pars plana vitrectomy is an efficient, predictable, and stable surgical option for aphakic eyes without capsular support. Postoperative corneal edema, hyphema, and anterior chamber inflammation are common but usually resolve without the need for further surgical intervention.