International Ophthalmology最新文献

Purpose: To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethysmography-based flow-mediated dilation (PPG-FMD) technique and examine associations between endothelial function and ophthalmic structural parameters.

Methods: In this prospective cross-sectional study, 55 participants were enrolled: POAG (n = 12), PEXG (n = 14), PEXS (n = 16), and controls (n = 13). Systemic endothelial function was measured noninvasively by PPG-FMD, quantifying vascular reactivity from pulse amplitude changes during reactive hyperemia. Ophthalmic parameters included intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness assessed by spectral-domain OCT. Group comparisons and correlation analyses were performed with Kruskal-Wallis and Dunn post-hoc tests, and Pearson or Spearman correlation analyses as appropriate.

Results: Mean PPG-FMD dilation index values were significantly lower in the POAG (85.4 ± 6.0%) and PEXG (82.5 ± 4.3%) groups compared to controls (124.5 ± 10.1%, p < 0.001). The PEXS group showed nonsignificant reduction. Endothelial function was positively correlated with GCC (r = 0.311, p = 0.027) and RNFL thickness (r = 0.378, p = 0.007) and negatively correlated with IOP (r = - 0.339, p = 0.013). No significant association was found with central corneal thickness.

Conclusions: Our findings highlight that systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, especially PEXG and POAG. The PPG-FMD method offers a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma.

Translational relevance: This study demonstrates, for the first time, that PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, offering a novel clinical marker that complements IOP and OCT metrics for identifying high-risk patients.

Purpose: To compare variations in choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ) and healthy subjects for at least one year.

Methods: Cross-sectional study enrolling patients between 30 and 55 years of age with SLE and treated with HCQ for at least one year, and aged-matched healthy subjects. Exclusion criteria included any other ophthalmological disorder or previous treatment, and systemic treatment with immunosuppressive drugs or a dose of corticosteroids higher than 5 mg/d. Macular CT was measured automatically in a grid of 30 × 30 cubes using Triton swept-source optical coherence tomography (Topcon). These were merged into 25 zones (each one comprising 6 × 6 cubes). Three-dimensional (3D) CT maps were created using Microsoft Excel and mean CT values in the grid of 30 × 30 cubes. One eye of each patient was randomly selected for the study.

Results: 60 patients and 54 healthy subjects were recruited. Mean age was 45.16 ± 6.43 and 43.79 ± 8.98 years (p = 0.346), respectively. Mean axial length was 23.52 ± 0.96 and 23.67 ± 0.87 mm (p = 0.137), respectively. Mean SLE duration was 125.58 ± 63.10 months, and mean duration of HCQ was 87.87 ± 52.13 months. There were no differences in intraocular pressure (p = 0.271) or spherical equivalent (p = 0.219). Choroidal zones number 9, 14, 15, 19 and 20 (central nasal locations) were thicker in SLE patients. Neither SLE duration, nor HCQ duration had any influence on CT (p > 0.05).

Conclusions: Patients with SLE treated with HCQ for one or more years present higher CT values than healthy subjects. Nasal zones seem to be the most sensitive to these changes, while the other choroidal locations remain similar apparently. However, neither duration of SLE nor duration or dose of HCQ treatment seemed to have any influence on CT.

Background: We aim to evaluate the effect of pharmacological pupil dilation on spherical and toric intraocular lens (IOL) power calculations using biometric measurements from the Anterion optical biometer.

Methods: This was a prospective observational study of adults undergoing cataract surgery. Pre- and post-dilation biometric measurements were obtained using the Anterion biometer. IOL power calculations, including both spherical and toric values, were performed using the following formulas: Barrett Universal II, Cooke K6, EVO, Hill-RBF, Hoffer® QST, Kane, and Pearl-DGS. Vector analysis was used to compare pre- and post-dilation corneal astigmatism and toric IOL magnitude and axis.

Results: A total of 74 eyes from 37 patients (17 male, 20 female; mean age 52.4 ± 7.8 years) were analysed. Pupil dilation resulted in a statistically significant increase in reported central corneal thickness (CCT, p < 0.05), while other biometric parameters remained unaffected. Both spherical and toric IOL power calculations showed no significant changes across formulas following dilation. Vector analysis revealed that the centroid difference in corneal astigmatism and toric IOL magnitude ranged from 0.09 D to 0.05, and axis orientation differences ranged from 3° to 6°, indicating no systematic bias due to dilation. Approximately 75% of eyes showed changes of < 0.50 D in spherical IOL power, while ~ 25% exceeded 0.50 D. For toric IOL power, ~ 90% of eyes showed changes < 0.50 D, with ~ 25% reaching or exceeding 0.50 D.

Conclusion: Most eyes show minimal IOL power variation with pupil dilation; however, a subset may experience clinically relevant differences, particularly in toric IOL calculations.

Background / purpose: Keratoconus is a progressive corneal ectasia characterized by stromal thinning and protrusion, leading to irregular astigmatism and visual impairment. To mitigate these issues, iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) was developed to enhance riboflavin penetration while preserving the epithelium, aiming for comparable biomechanical effects with fewer adverse events. This systematic review and meta-analysis aim to compare the efficacy and safety of iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) and standard epithelium-off corneal collagen cross-linking (S-CXL) in the management of keratoconus.

Methods: This systematic review and meta-analysis was registered with PROSPERO (ID: CRD420251091187). PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), ClinicalTrials.gov, Google Scholar, and DOJA were searched from inception until August 2025. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and Newcastle-Ottawa Scale (NOS) for observational cohort studies. Meta-analysis was conducted using Review Manager (RevMan) version 5.4 (Cochrane Collaboration). A random-effects model was used to assess heterogeneity across studies.

Results: 14 studies with a total of 629 patients were included, with10 incorporated into the quantitative analysis. Pooled analysis showed no significant difference between S-CXL and I-CXL in K-max reduction (mean difference MD = 0.52 D; 95% CI = [- 0.20, 1.23]; P = 0.16). I-CXL had more improvement in UCVA and BCVA, but without statistical significance (UCVA MD =  - 0.03 logMAR; P = 0.30; BCVA MD =  - 0.01 logMAR; P = 0.57). there was no significant difference between the two in terms of ECC, CCT, and TPT. I-CXL was associated with less adverse events and better patient comfort.

Conclusion: Both S-CXL and I-CXL are effective in halting keratoconus progression. S-CXL offered better corneal flatting, whereas I-CXL achieved better visual acuity parameters with less side effects and better patient comfort. Due to the high heterogeneity, lack of long-term trials, especially on pediatric population, further research is required.

Background: Vitreous hemorrhage is a serious ocular condition that requires accurate and timely diagnosis. Traditional methods for identifying affected areas in fundus images have limitations in precision and reliability. There is a need for advanced techniques to enhance the detection of vitreous hemorrhage and improve patient outcomes.

Problem: Detecting hemorrhages in color fundus images is difficult due to elements such as noise, feature intensity, and overlapping areas. In particular, the variation in feature intensity between different sections of the retina and lens leads to uniform (homogeneous) characteristics.

Methods: This study introduces a Feature Intensity Vision Transformer (FIVT) model utilizes vision transformer technology to detect high-intensity regions within segmented patches based on minimal pixel distributions. The model follows a systematic pipeline involving input image pre-processing, patch extraction (1 × 1-32 × 32), feature intensity estimation using the gray-level co-occurrence matrix (GLCM), and Vision Transformer-based intensity classification to produce a precise region detection mask. Feature distribution is analyzed to identify maximum intensity areas. High and low-intensity regions are classified, and pixels with significant feature content are matched with trained inputs. The model is trained using external images and high-feature regions until accuracy stabilizes.

Dataset: We utilize the "exudate-hemorrhage-health" retinal image dataset to evaluate the proposed FIVT. This dataset comprises over 3,000 fundus color images, which include both internal and external references. Out of these, 536 images showing infections are employed to examine the infected areas. For the training process, 3,000 images are categorized into healthy, hemorrhage, and exudate groups.

Results: Compared to other methods, the FIVT model achieved a 12.13% improvement in detection accuracy, a 12.55% increase in specificity, and a 12.32% enhancement in sensitivity, demonstrating robust performance across varying illumination and feature intensity conditions.

Conclusion and future scope: The model effectively handles varying illumination and intensity distributions, improving the precision of vitreous hemorrhage localization. However, its performance can be further enhanced with larger, multi-institutional datasets and integration of 3D volumetric data. Future work will focus on clinical validation and adaptation of the framework for related retinal disorders such as diabetic retinopathy and macular edema.

Objective: Minimally invasive glaucoma surgery (MIGS) has become increasingly popular for treating primary open-angle glaucoma (POAG). However, data regarding complications for patients with comorbid diabetic retinopathy (DR) are limited. This study aimed to compare complications after MIGS in POAG patients with and without DR.

Methods: This is a retrospective cohort study using the TriNetX global health network. Adult patients with POAG who underwent MIGS were identified, with one group having comorbid DR and the other without. Propensity score matching was applied, yielding 518 patients per group for analysis. Complications assessed included vision loss, hypotony, ocular hypertension, cataract formation, eye infection, and any ocular hemorrhage. The primary outcomes were post-procedure complication rates and their statistical significance. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.

Results: Patients with DR who underwent MIGS had a higher risk for vision loss (32.8% vs. 24.4%, HR 1.443, 95% CI 1.13-1.841) and ocular hemorrhage (13.4% vs. 4.3%, HR 3.194, 95% CI 1.929-5.288) compared to those without DR. Cataract formation rates were lower in DR patients at 3 months (44.4% vs. 50.6%, p = 0.046) and 6 months (53.3% vs. 59.5%, p = 0.048) post-surgery. No significant differences were observed in rates of hypotony, ocular hypertension, or eye infection.

Conclusion: MIGS in patients with DR is associated with an increased risk of post-procedure complications, particularly vision loss and ocular hemorrhage. These findings can aid in the clinical management and counseling of patients with both POAG and DR considering MIGS.

Purpose: To compare the clinical outcomes of circumferential (360°) versus hemi (180°) gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with primary open-angle glaucoma (POAG) over a 24-month follow-up.

Methods: This retrospective, comparative study included 90 eyes of 90 patients with POAG who underwent either standalone circumferential GATT (n = 46) or hemi-GATT (n = 44). Inclusion criteria required uncontrolled intraocular pressure (IOP) (≥ 20 mmHg) despite maximal medical therapy or intolerance to medications. Main outcomes included surgical success (complete and qualified), IOP, number of anti-glaucoma medications, and postoperative complications. Complete success was defined as achieving a target IOP of 6-18 mmHg with ≥ 20% reduction from baseline without medications or further surgery. Qualified success allowed medication use.

Results: At 24 months, mean IOP reduction was greater in the circumferential GATT group (- 10.1 ± 5.3 mmHg; 39.7%) than the hemi-GATT group (- 8.0 ± 3.8 mmHg; 32%) (p < 0.05). Complete success was achieved in 58.7% and 34.1% of eyes in the circumferential and hemi-GATT groups, respectively (p = 0.006). Qualified success rates were 78.2% (circumferential GATT) vs. 61.3% (hemi-GATT) (p = 0.051). The most common complication was transient hyphema, observed more frequently after circumferential GATT (54.6%) than hemi-GATT (31.8%) (p = 0.03). IOP spikes (> 30 mmHg) occurred in 10.8% of circumferential and 9% of hemi-GATT eyes (p = 0.71), all managed conservatively.

Conclusions: Both circumferential and hemi-GATT effectively lowered IOP in patients with POAG. Circumferential GATT achieved greater IOP reduction and higher complete success, while hemi-GATT was associated with fewer hyphema events. Hemi-GATT may be preferable in patients at higher bleeding risk, whereas circumferential GATT may provide superior IOP control.

Purpose: To determine the aetiological, clinical, and therapeutic features of children diagnosed with uveitis in a tertiary referral centre in Northern Italy.

Methods: Evaluation of medical data of all new paediatric (≤ 16 years old) referrals to the Ocular Immunology Unit of Reggio Emilia (Northern Italy) between November 2015 and December 2023. An interdisciplinary diagnostic-therapeutic pathway-based approach was adopted for all patients.

Results: Among a pool of 263 patients, the male-to-female ratio was 1:1.32. Anterior uveitis was the most common diagnosis (45.2%), followed by pan-(23.6%), intermediate (16.7%), and posterior (14.5%) uveitis. The most identifiable specific diagnoses were juvenile idiopathic arthritis (JIA) (27.8%), Vogt-Koyanagi-Harada disease (8.7%), and toxoplasmosis (6.8%). Non-infectious systemic disease aetiologies were the most frequent (47.5%), followed by infectious uveitis (15.2%) and non-infectious ocular-specific conditions (2.7%). Idiopathic uveitis accounted for 34.6% of cases. Immunosuppressants were administered in 58.5% of patients. Antimetabolites, calcineurin inhibitors, and biologics were prescribed in 52.5%, 4.6% and 31.6% of cases, respectively. Methotrexate, adalimumab, and azathioprine were the most commonly prescribed immunosuppressants (29.3%, 26.6%, and 21.7% of patients, respectively). JIA-associated uveitis is the type most associated with surgical procedures (39.7%).

Conclusions: The patterns of uveitis in children differ from those in adults, with infectious aetiologies being less common and idiopathic uveitis accounting for the majority of cases. However, the frequency of idiopathic uveitis in Italy is decreasing. Nowadays, a wide range of immunosuppressants are used for the treatment of paediatric uveitis.

Objective: To compare the efficacy and safety of phacoemulsification combined with goniosynechialysis versus phaco-trabeculectomy in patients with PACG complicated by cataract.

Methods: We conducted a retrospective analysis of clinical data from 80 eyes of patients with PACG and cataract, treated at Jianhu County People's Hospital between January 2023 and January 2025. P Patients underwent either phacoemulsification plus goniosynechialysis (n = 40) or phacoemulsification plus trabeculectomy (n = 40). We measured ACD, ACA, IOP, and corneal astigmatism both preoperatively and at 12 months postoperatively. We also evaluated visual acuity outcomes and the incidence of postoperative complications.

Results: Baseline characteristics were comparable between groups. At 12 months post-surgery, two groups showed marked improvements in ACD and ACA, with a significant reduction in IOP compared to baseline (all P < 0.05). The goniosynechialysis group demonstrated a significantly greater increase in ACA (38.43° vs. 33.13°, P < 0.001) and better control of corneal astigmatism (1.18D vs. 2.31D, P < 0.001). The visual improvement rates were similar between groups (82.5% vs. 67.5%, P = 0.126). The incidence of postoperative complications was significantly lower in the goniosynechialysis group (7.5% vs. 27.5%, P = 0.019).

Conclusion: In PACG patients with cataract and extensive PAS, phacoemulsification combined with goniosynechialysis achieved better anterior chamber angle opening, less postoperative astigmatism, and fewer complications than phaco-trabeculectomy, while providing comparable improvements in ACD, IOP, and visual outcomes at 12 months.