International Ophthalmology最新文献

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.

Background: This study aimed to develop and validate a competing risk nomogram to predict overall survival (OS) in uveal Melanoma(UM) patients.

Methods: This study divided 14,688 UM patients from the SEER database from 2000 to 2020 into training cohorts and internal test cohorts after excluding cases with incomplete information. Univariate and multivariate cox regression analyses were used to identify potential risk factors for UM and construct the clinical predictive model nomogram. The predictive capacity was evaluated using calibration curves, receiver operating characteristic curves (ROCs), and decision curve analysis (DCA).

Results: A total of 4184 eligible patients were included for analysis, with 2929 cases (70%) in the training group and 1255 cases (30%) in the internal test group. Multivariable cox regression analysis confirmed six independent risk factors (chemotherapy, radiation, total number of malignant tumors, pathological type, grade, diagnostic confirmation). The nomogram demonstrated excellent discriminative ability, with AUCs in the training and internal test groups at 1 year, 3 years, and 5 years being 0.89 and 0.88, 0.93 and 0.93, 0.91 and 0.9, respectively. The calibration plot indicated that predictions based on the nomogram were well-matched to actual clinical practice, and the DCA plot showed good clinical utility for the nomogram. Additionally, Kaplan-Meier curve analysis indicated that, in both the train set and the test set, the high score group had significantly poorer survival outcomes than the low score group (P < 0.001).

Conclusion: Employing the nomogram method for survival prognosis assessment in UM patients yields high accuracy. This can further enhance the precise evaluation of UM patient survival prognosis, providing guidance for personalized treatment.

Purpose: Epiretinal membrane (ERM) is a common condition causing visual deterioration. However, the indication and timing for the surgical treatment of this condition have not been standardized. In this study we aimed to evaluate the anatomical and functional outcomes of mild vs severe epiretinal membrane surgery across different stages and determine the optimal timing for surgical intervention using Govetto's OCT-based classification.

Methods: This retrospective study included 46 eyes undergoing pars plana vitrectomy for ERM. Patients were stratified according to severity into Stage 2 (n = 10), Stage 3 (n = 25), and Stage 4 (n = 11) based on SD-OCT findings. Pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were analyzed. A short patient questionnaire was used to assess the subjective outcomes of the surgery.

Results: Stage 4 patients had significantly worse preoperative and postoperative BCVA compared to milder stages (p = 0.007). Structural OCT abnormalities such as ectopic inner foveal layers (EIFL), inner retinal irregularity (IRI), COST (cone outer segment tip) line defects and inner segment/outer segment (IS/OS) junction disruption were significantly more frequent in Stage 4. Stage 2 showed thinner CMT and significantly better visual outcomes postoperatively. Subjective visual improvement was most notable in Stage 3 (p = 0.032).

Conclusions: ERM surgery in severe cases (stage 4) is associated with inferior anatomical and visual outcomes. Surgical intervention in milder cases particularly in stage 2, results in more favorable postoperative BCVA and reduced anatomical disruption. These findings support considering surgery in milder cases before the development of advanced OCT changes such as IS/OS disruption, EIFL and IRI.

Purpose: This review paper is a sightseeing on the molecular pathways of the DED, which culminate in the cascades of inflammatory cytokines, apoptosis, oxidative stress, as well as the breakdown of homeostasis of the ocular surface. The article also discusses complications, and it explains the connection between conjunctivitis, keratitis, corneal ulcers, blepharitis, dysfunction of meibomian glands, recurrent corneal erosion, ocular neuropathic pain, and accentuating the systemic effects of conditions, such as Sjögren syndrome. Within the directions of such molecular pathways, the article analyzes diagnostic biomarkers, as HLA-DR, MMP-9, cytokine profile, and innovations in technologies testing. Associating clinical exercise with the molecular frontier will add a new dimension to how we style, achieve, and eventually treat complications associated with DED.

Methods: Using PubMed, Scopus, Web of Science, and SpringerLink, an extensive appraisal of recent experimental and clinical literature was carried out. To offer mechanistic and translational understanding, studies explaining inflammatory signaling cascades, oxidative and mitochondrial stress, extracellular matrix remodeling, neurosensory changes, and immune-epithelial interaction in DED were assessed.

Results: Pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), dysregulated matrix metalloproteinases (MMP-2/9), oxidative stress-induced epithelial damage, and abnormal neuro-immune signaling mediated by substance P and calcitonin gene-related peptide are all closely linked molecular pathways that contribute to DED complications. Corneal epithelial fragility, poor regeneration, neurotrophic keratopathy, ulceration, secondary infection, and visual impairment are the results of these processes. Refined illness categorization and risk prediction are made possible by developments in molecular diagnostics, such as tear osmolarity, MMP-9, neurosensory biomarkers, and lipidomic and proteomic signatures.

Conclusion: With the passage of research and progress in diagnosis with biomolecular science and technology, biomarkers such as MMP-9, lactoferrin, interleukin, and HLA-DR have brought the possibility of following the evolution, subtyping, and diagnosis of diseases. The recent revelations of the molecular biology of dry eye diseases raise the concern for a specific therapeutic approach that not only brings symptomatic relief but modulates molecular expressions as well. A vibrant combination of ophthalmology, pharmacology, immunology, bioengineering, and material sciences with regard to new therapeutic strategies and more refined delivery platforms. Such leveraging of molecular insight to provide specific interventions is needed clinically.

Purpose: This systematic review explores the relationship between tobacco smoking and the development of primary open-angle glaucoma (POAG). Glaucoma is the leading cause of irreversible blindness worldwide. Prior literature investigating the link between tobacco smoking and glaucoma has reported contradictory findings on the association between tobacco smoking and POAG.

Methods: Systematically EMBASE, MEDLINE, and Web of Science were searched, encompassing articles published up until April 2025. The inclusion criteria comprised observational and randomised controlled studies that provided a statistical analysis exploring the association between tobacco smoking and POAG in adult populations. The ROBINS-E tool was utilised to assess the risk of bias of studies and meta-analyses were completed using RevMan software. The main outcomes were effect estimates that measured the association between tobacco smoking and POAG.

Results: Across 26 eligible studies and 289,930 participants, there was a prevalence of 6,454 cases of POAG. The meta-analyses revealed that current smokers (OR = 1.00, 95%CI 0.76-1.33, p = 0.97, n = 11), past smokers (OR = 0.92, 95%CI 0.75-1.11, p = 0.38, n = 6) as well as both current and past tobacco smoking combined (OR = 1.00, 95%CI 0.84-1.19, p = 1.00, n = 17) exhibited no statistically significant association with POAG when compared to individuals who had never smoked. Heterogeneity ranged from low to substantial across comparisons, and risk of bias was frequently rated as high among included observational studies. The lack of an associative effect was sustained, on exclusion of studies with a high risk of bias.

Conclusion: Although the results suggest no significant statistical association between tobacco smoking and POAG, given the substantial morbidity and mortality associated with tobacco smoking and the detrimental impact on systemic and ocular health, tobacco smoking cessation should remain at the forefront of health promotion. PROSPERO registration ID: CRD42023409440.

Purpose: This study aimed to investigate the potential link between age-related macular degeneration (AMD) and systemic lupus erythematosus (SLE), exploring whether AMD may share underlying autoimmune mechanisms with SLE. The objective was to identify shared core genes and potential diagnostic biomarkers for both diseases.

Methods: We utilized GEO datasets to develop diagnostic models and performed differential gene expression analysis, weighted gene co-expression network analysis (WGCNA), and three machine learning techniques-LASSO regression, random forest (RF), and support vector machine recursive feature elimination (SVM-RFE)-to identify common key genes between AMD and SLE. Mendelian randomization analysis was conducted to validate the potential causal relationship between AMD and the identified essential genes. Single-cell RNA sequencing data were analyzed to explore the expression patterns of shared biomarkers at the cellular level. The expression level of the identified biomarker was validated using reverse transcription quantitative polymerase chain reaction and Western blotting.

Results: Several shared core genes were identified as associated with both AMD and SLE. The Mendelian randomization study confirmed a potential correlation between AMD and these essential genes. Single-cell transcriptomic analysis revealed distinct expression profiles of these markers across relevant cell types, supporting their role in disease pathology.

Conclusion: Our findings suggest that AMD and SLE share key genetic features, supporting the hypothesis that AMD may have an autoimmune component. These shared genes hold promise as potential therapeutic targets and diagnostic biomarkers for both diseases.