International Ophthalmology最新文献

Purpose: To analyze environmental sustainability in vitreoretinal surgery and evaluate evidence-based strategies for reducing carbon footprint while maintaining optimal patient outcomes.

Methods: Literature review using PubMed and Google Scholar databases focusing on vitreoretinal surgery's environmental impact and sustainable practices.

Results: Vitreoretinal surgery generates significant carbon emissions through disposable equipment, building energy consumption, and tamponade gas utilization. Fluorinated gases represent the most environmentally damaging component, with SF₆ demonstrating 22,800 times greater global warming potential than CO₂. Despite being used in only 38.6% of procedures, SF₆ was responsible for 68.8% of total emissions in vitreoretinal surgery, demonstrating a 4.4-fold greater environmental impact compared to C₂F₆. Air tamponade offers up to 47% emission reductions for appropriate cases, while alternative gas selection achieves 50% reductions when longer-acting tamponades are necessary. Energy optimization protocols, waste segregation improvements, and packaging modifications provide additional reduction opportunities.

Conclusion: Sustainable vitreoretinal surgery is feasible through evidence-based strategies that significantly reduce environmental impact without compromising patient safety. Key interventions include implementing air tamponade for appropriate cases and selecting alternative fluorinated gases with lower environmental impact. Implementation requires addressing regulatory barriers and cultural resistance through education programs and policy reform. The specialty should adopt the "5 R" framework for sustainable practice.

Background: Global childhood myopia is rising, with longer axial length increasing ocular risks. Orthokeratology corrects vision and may slow axial elongation via peripheral defocus, but the efficacy of newer OK lens designs and long-term persistence of effect remain to be comprehensively evaluated.

Methods: Adhering to PROSPERO and PRISMA 2020, PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched through 18 April 2025. Included studies prospectively compared axial-length changes in children (6-18 years) with OK versus single-vision spectacles, soft contact lenses, or conventional OK. Hartung-Knapp-adjusted random-effects meta-analyses were performed, with subgroup, sensitivity, and leave-one-out analyses addressing heterogeneity.

Results: Fifteen trials (1,065 participants) met inclusion criteria. At 12 ± 2 months, OK slowed axial elongation by a pooled mean difference (MD) of - 0.15 mm (95% CI - 0.20 to - 0.10; I2 = 90.8%). Five studies with ≥ 24-month follow-up showed a sustained benefit (MD - 0.19 mm, - 0.32 to - 0.06; I2 = 79%). Four head-to-head trials suggested modified OK designs (e.g., smaller optical zones, higher compression factors) provided an additional - 0.12 mm (- 0.23 to - 0.01) at one year, after excluding one discordant soft-lens study. Funnel plots and Egger's tests indicated no small-study bias. Most studies had low risk of bias; limitations included lack of masking and predominantly East-Asian samples.

Conclusions: Axial elongation in myopic children is reduced by approximately 0.15 mm in the first year with OK, and this effect persists for up to three years. Modified lens designs may offer additional benefit. Larger, multi-ethnic trials with long-term follow-up and standardised safety reporting are needed.

Purpose: To present an overview of emerging pharmacological strategies for the prevention and treatment of proliferative vitreoretinopathy (PVR).

Methods: This review critically examines recent experimental and clinical evidence on pharmacological agents targeting key pathogenic mechanisms of PVR, including epithelial-mesenchymal transition, profibrotic cytokine signaling (TGF-β, PDGF, VEGF), and inflammation-driven tissue remodeling. Investigated compounds include clinically tested substances such as daunorubicin, 5-fluorouracil, corticosteroids, anti-VEGF agents, methotrexate, isotretinoin, decorin and infliximab, as well as newer experimental approaches including Topotecan, Melphalan, ROCK-Inhibitors and gene-regulated therapies. Mechanistic insights into receptor crosstalk, intracellular signaling cascades, and cell survival pathways are integrated with findings from preclinical models and clinical studies.

Results: Several agents have shown anti-proliferative and anti-inflammatory effects in vitro and in vivo, with methotrexate and infliximab emerging as particularly promising candidates. However, clinical data remain heterogeneous, and no pharmacological agent has yet received regulatory approval for PVR treatment. Risk stratification based on preoperative PVR, vitreous hemorrhage, or ocular trauma may help optimize patient selection in future trials.

Conclusion: Pharmacological modulation of PVR is conceptually well supported by preclinical data, but clinical translation remains limited. Well-designed randomized trials in clearly defined high-risk populations are needed to validate efficacy, determine optimal treatment windows, and develop standardized protocols for both prophylaxis and therapy.

Glaucoma is a common eye disease affecting several people worldwide. Blindness can be avoided with proper treatment and regular examination. Delayed diagnosis of eye disease causes serious damage to the optic nerve, resulting in loss of vision and blindness. As a result, early disease detection is crucial, and the current research has employed time-consuming machine-learning techniques. It is also difficult to detect eye diseases using computer-aided diagnostic systems because they rely on manually designed features to assess the disease. In order to detect glaucoma, the proposed work presented a novel hybrid deep learning-based GD Pooled Attention assisted Transformer model. The initial step in the proposed detection method is to remove noise and enhance the contrast of the fundus image from the databases using a cross-guided bilateral filter (Cr-GBF). The glaucoma-affected images are collected from ORIGA and RIMONE datasets. Glaucoma is primarily identified by structural deformation in the optic disc region. Thus, significant features are extracted from the images using improved channel spatial attention with AlterNet-K (Im-ChspAN), and disease detection is performed using the proposed Optimized hybrid GD pooled attention former (OpHGpoTr) model. The proposed model's performance is evaluated using the following metrics: accuracy of 98.68%, precision of 97.06%, sensitivity of 97.07%, specificity of 98.57%, and f-score of 98.31%. The classifier showed better performance than the existing studies.

Purpose: This study aimed to determine the efficacy of various types of topical anesthesia prior intravitreal injection in an effort to lessen adverse effects such as pain and subconjunctival bleeding.

Methods: This randomized controlled study included 239 patients. All patients were randomly assigned to either receive: (1) Lidocaine gel 3% (Anaesthetic BL 3% gel), (2) Lidocaine gel 10% (Anaesthetic BL 10% gel), (3) Oxybuprocaine 0.4% eye drops (Localin), (4) Tetracaine HCl 1%, eye drops (Tetracaine) (5) A combined Oxybuprocaine 0.4% eye drops (Localin) and an ice patch. Patients' discomfort, itching, burning and pain (using Visual Analog Scale), and bleeding size (using images) were measured one and ten minutes post-injection. Tolerability was calculated by averaging patients' pain, discomfort, itching, and burning scores.

Results: In the one- and ten-minute post-injection analyses, the groups receiving Tetracaine (0.60 ± 0.63, 0.50 ± 0.61) and the combined Oxybuprocaine and ice patch anesthesia (0.55 ± 0.66, 0.38 ± 0.58) had the lowest mean tolerability scores. In most parameters (discomfort burning, and pain scores) the Tetracaine and the combined Oxybuprocaine and ice patch anesthesia demonstrated the lowest mean scores. All subjective criteria assessed by the surgeon immediately following the injection were not found to be significantly different at any group, such as movements during injection (p = 0.19), complaints during injection (p = 0.56), complaints following injection (p = 0.21). Bleeding size (area or circumference) was not statistical different between groups.

Conclusion: This study demonstrated a considerable reduction in pain and overall tolerability with Tetracaine or a combination of ice patch and Oxybuprocaine anesthesia. These findings may lessen patients' discomfort and improve their tolerance.

Purpose: Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the anterior chamber using intraoperative rebound tonometry.

Methods: The study included 261 eyes allocated to six groups according to three ophthalmic viscoelastic device (OVD) conditions-hyaluronic acid (HA), hydroxypropylmethylcellulose (HPMC), and their combination via the soft-shell technique (SST)-and two instruments (Utrata forceps UF and a 26-G cystotome RN). Intraocular pressure (IOP) was measured before and after CCC using rebound tonometry with sterilized probes.

Results: IOP reached 78.6 mmHg in the RN group and 76.5 mmHg in the UF group after OVD instillation and after the creation of the CCC. The mean IOP drop during capsulorhexis was significantly greater with UF (67.1 ± 12.3 mmHg; n = 117) compared to RN (56.5 ± 11.6 mmHg; n = 144) (P < 0.001).

Conclusion: The results of this study showed a statistically significant difference in the stability of the anterior chamber depending on the instrument used. The use of different OVDs had no statistically significant influence on anterior chamber stability. Maintaining a more stable IOP with a 26-gauge cystotome may be advantageous in complex cases, such as increased posterior vitreous pressure, zonular weakness or heightened intracapsular pressure.

Purpose: To evaluate the visual outcomes with scleral lens (SL) wear in patients who have undergone surgical repair for open globe injuries (OGI).

Methods: The medical records of patients with a history of OGI at the Department of Ophthalmology, Marmara University School of Medicine, between 2017 and 2023 were retrospectively reviewed. Eleven patients (8 male, 3 female) with corneal scar and/or irregular corneal astigmatism, and intolerance to corneal rigid lenses (CRLs) were included in the study. Demographics, type and extent of injury were assessed. Best corrected visual acuity (BCVA) before SL trial and with SLs wear were measured.

Results: The median age of the patients was 40.0 years (IQR, 24-42). The patients were followed up for a median duration of 22.0 months (IQR, 17-59) months. Central scarring was observed in 45.5% of cases, and paracentral scarring in 54.5% of cases. Aphakic correction was performed in one patient. The median BCVA improved from 0.50 (logMAR) to 0.10 (logMAR) after SL wear (p = 0.003).

Conclusions: The significant improvement in BCVA observed after SL wear indicates that SLs are an effective option for visual rehabilitation in patients with corneal scarring and irregular astigmatism following OGI repair.

Purpose: To evaluate the visual outcomes, dysphotopsia profile, and patient satisfaction following bilateral implantation of the AcrySof IQ Vivity intraocular lens (IOL) in patients with early or intermediate age-related macular degeneration (AMD).

Methods: Prospective, single-center study. 24 patients (48 eyes) with bilateral cataract and early or intermediate AMD who underwent bilateral implantation of the AcrySof IQ Vivity IOL. The primary outcome was monocular corrected distance visual acuity (mCDVA). Secondary endpoints were distance-corrected and unaided monocular and binocular visual acuity at 4 m, 66 cm, and 40 cm, monocular defocus curve, subjective dysphotopsia (McAlinden QoV questionnaire) and haloes perception (Aston Halometer), visual function (Catquest-9SF), and spectacle independence (IOLSAT).

Results: At 3 months postoperatively, mCDVA improved significantly from 0.30 to 0.00 logMAR (p < 0.001). Binocular uncorrected distance and intermediate visual acuities of ≤ 0.2 logMAR were achieved by 23 (95.8%) and 17 (70.8%) patients, respectively. The defocus curve showed visual acuity of 0.2 logMAR across a range of + 1.40 D to -1.72 D. Bothersome dysphotopsias significantly decreased, with QoV scores improving from 58.5 (IQR: 26.1-66.5) to 0.00 (IQR: 0.00-14.3) (p < 0.05). The mean halo eccentricity was 0.50 ± 0.08 degrees. Spectacle independence was reported by 22 (91.7%), 20 (83.3%), and 13 (54.2%) patients for distance, intermediate, and near tasks, respectively. Overall, 22 (91.7%) patients reported postoperative satisfaction.

Conclusion: The AcrySof IQ Vivity IOL demonstrated favourable outcomes in patients with early or intermediate AMD, offering a meaningful range of spectacle-free vision with minimal photic phenomena.

Introduction: Glaucoma, the primary cause of permanent blindness, occurs frequently, progresses aggressively, and more challenging to treat among Blacks. In South-East Nigeria, Igbos who have ancestral ties to blacks in the Barbados eye study are more likely to have primary open-angle glaucoma and are at risk of blindness. This study aims to evaluate glaucoma patients' awareness, care-seeking pathway and identify policy areas for planning and advocacy.

Method: This cross-sectional survey was performed at three referral ophthalmology facilities. 303 eligible and consented participants were enrolled. Data collected with semi-structured researcher-administered questionnaire were imported into Stata v15.0. Charts and maps were used for descriptive percentages and proportions. At p-value < 0.05, statistically significant risks were determined using multiple logistic regression models.

Results: Over half of the participants (56.6%; 87/151) who had heard of glaucoma before diagnosis were early presenters. Social interactions between friends and family (57%), mass media-radio, television and print (31%) and internet (4%) were the three most common ways that participants learned about glaucoma. Fifty-one percent who presented late had been previously screened for glaucoma; a greater percentage of them spent more time visiting a spiritual home, optical store, or traditional healer compared to those who presented earlier. Basic literacy (0.18: CI 0.07-0.47) and the ability to pay rent (0.52: CI 0.31 - 0.91) were socio-economic factors independently associated with lower odds of presenting late to the glaucoma referral facility.

Conclusion: Glaucoma awareness was linked to early presentation, although delays persist due to reliance on non-medical providers. Predictors of timely presentation suggest that socioeconomic empowerment may be a crucial lever for improving glaucoma health-seeking behaviour.

Aim: To assess peripapillary intervortex venous anastomoses in patients with central serous chorioretinopathy (CSCR) and in healthy individuals and its association with the clinical characteristics of CSCR.

Methods: All participants received multimodal imaging, including a 12-mm optical coherence tomography angiography (OCTA) scan pattern centered on the optic disc for assessment of intervortex venous anastomoses in en face mode. Index of Vortex Anastomoses Number (IVAN) was defined as the number of quadrants of the peripapillary area with apparent vascular connectivity between neighboring quadrants of the eye fundus. IVAN was assessed in accordance with conventional and multimodal-based classifications of CSCR, as well as with laterality of the disease, its course, best-corrected visual acuity, subfoveal choroidal thickness, and central retinal thickness.

Results: One hundred twenty eyes of 60 CSCR patients (46 males (76.7%), 41.7 ± 7.9 years) and 47 eyes of 47 healthy individuals (36 males (76.6%), 42.2 ± 11.8 years) were included. IVAN was higher in chronic CSCR (median 4.0) compared to acute CSCR (median 2.0), and in chronic and acute CSCR compared to healthy eyes (median 1.0) (p < 0.001). IVAN was higher in the eyes of patients with bilateral CSCR (median 4.0), than in the active eye of unilateral CSCR patients (median 2.0) (p = 0.0002). The area of retinal pigment epithelium alteration and subfoveal choroidal thickness showed a statistically significant correlation with IVAN (r = 0.45, p < 0.001 and r = 0.35, p = 0.006).

Conclusion: Semiquantitative analysis of intervortex venous anastomoses in peripapillary area based on en face OCTA showed their variable prevalence in eyes with CSCR, which correlates with clinical classifications of CSCR.