International Ophthalmology最新文献

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.

Purpose: To examine the existence of idiopathic epiretinal membranes (ERM) in the peripheral retina in patients with or without macular pucker.

Methods: The presence of the peripheral idiopathic epiretinal membranes was sought using 200-degree widefield OCT (OPTOS Silverstone Swept source-OCT (SS-OCT) in two age, sex, and ocular comorbidities-matched groups consisting of 38 patients (24 with macular ERM and 14 without macular ERM). The significance of the correlation between the presence of macular and peripheral ERM was determined using Fisher's exact test and unpaired t-test.

Results: Seven out of 24 patients (29%) with idiopathic macular ERM had a peripheral ERM. In contrast, none of the patients without macular ERM had a peripheral ERM. Individuals with a history of idiopathic macular ERM showed a significantly higher incidence of idiopathic peripheral ERM (p = 0.03).

Conclusions: Peripheral idiopathic ERM can be found in patients with macular ERM. All eyes with peripheral ERM were found in eyes with macular ERM. No patient was found to have a peripheral ERM unless a macular ERM was present. The macula seems more predisposed to developing an epiretinal membrane than the peripheral retina. A relatively higher density of Müller cells and tighter vitreoretinal attachments may predispose the posterior pole to idiopathic ERM development.

Purpose: The current study aimed to optimize the measurement design for each quantity of interest, determine critical limits for clinically distinguishing glaucoma-suspect eyes from non-suspect eyes in the UGDS using the optimized design, and compare the efficiency of the measured quantities in estimating sensitivity METHODS: Data from non-glaucoma suspect eyes in the UGDS were analyzed for age and sex dependence, sources of variation, frequency distribution, and assessment of critical limits for glaucoma detection. Critical limit was defined as the extreme 95% confidence limit for the 95% one-sided tolerance. Intraocular pressure (IOP) and visual field contract sensitivity (Mean Deviation, MD), linear cup-to-disc ratio (C/D-linear), neuro-retinal rim area (NRA), nerve fiber layer thickness (cpRNFLT-Global and GDx-TSNIT) were examined RESULTS: Analysis revealed no significant age or sex dependence for the measured quantities. Variability among subjects was found to dominate, affecting the precision of measurements. Frequency distributions approximated normal distributions, enabling the estimation of tolerance limits for critical assessment. The critical limits to distinguish pathological from non-pathological were estimated as 22 mmHg, -3.7 dB, 0.84, 0.6 mm², 56 µm and 33 µm for IOP, MD, C/D-linear, NRA, cpRNFLT-Global and GDx-TSNIT respectively CONCLUSION: It appears preferable to estimate critical limits for small samples using the extreme confidence limit of the tolerance limit. The critical limits obtained here are consistent with previously reported values for the same device models. C/D-linear and NRA-Global metrics estimated with HRT show lower sensitivity-estimation efficiency compared with the other parameters assessed. Individualized intra-patient critical limits require a small increase of the measured quantity to identify glaucoma in the patient who has the disease.

Purpose: Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder involving recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, oxidative stress, and systemic inflammation. Although OSAS has been linked to several ocular disorders, its specific impact on ocular surface health, particularly in relation to dry eye disease (DED) and corneal sensitivity, is not fully understood. This study aimed to assess how OSAS severity influences dry eye parameters and corneal sensitivity, and to explore associations with systemic and demographic factors.

Methods: In this cross-sectional study, 174 patients diagnosed with OSAS via overnight polysomnography were divided into normal-mild OSAS and moderate-severe OSAS groups. Ocular surface assessments included non-invasive tear break-up time (NIBUT), Schirmer II test (ST), Ocular Surface Disease Index (OSDI), and corneal sensitivity measured in five corneal regions using a Cochet-Bonnet esthesiometer. Statistical analyses involved group comparisons, correlation assessments, and multivariable linear regression to identify predictors of dry eye parameters.

Results: Moderate-severe OSAS (AHI ≥ 15; n = 85) patients were older, had higher BMI, and lower minimum oxygen saturation (p < 0.001). No significant differences were observed between groups in NIBUT, ST, or regional corneal sensitivity. Interestingly, OSDI scores were lower in the moderate-severe group, nearing statistical significance (p = 0.055). ST was positively correlated with corneal sensitivity (r = 0.22-0.26), whereas OSDI was negatively correlated (r =  - 0.14- - 0.18). Regression analyses identified age and smoking as significant predictors of NIBUT, and gender and oxygen saturation as predictors of OSDI.

Conclusions: Although OSAS severity did not significantly affect objective dry eye measures or corneal sensitivity, subtle associations between tear production and corneal nerve function suggest possible subclinical ocular changes. Routine eye evaluations may benefit OSAS patients, especially those with risk factors like aging, smoking, and hypoxemia.

Introduction: Early detection of vitreoretinal diseases (VRDs) is critical for preventing vision loss, and currently relies on the examination and interpretation of multimodal imaging techniques. Artificial intelligence (AI) is emerging as a powerful tool to detect abnormalities in vitreoretinal morphology and ideally detect changes at earlier stages to allow for intervention. This meta-analysis evaluates and summarizes the diagnostic performance of AI models in the detection of VRDs using retinal imaging systems.

Methods: This study was registered in PROSPERO (CRD42023450207). A comprehensive electronic search of PubMed/MEDLINE, EMBASE, and Web of Science was conducted by three independent reviewers up to August 2023. Study validity was assessed using the QUADAS-2 tool, which evaluates risk of bias across four domains and applicability concerns across three domains. Eligible articles were categorized into nine VRD subgroups-age related macular degeneration, diabetic retinopathy, retinal vascular diseases, retinal dystrophies, Cystoid macular edema, vitreoretinal interface disorders, retinal detachment, Central serous chorioretinopathy, and myopic retinopathy-and included in the meta-analysis. Pooled estimates of accuracy (PEA), sensitivity (PESen), and specificity (PESpe) were calculated for all selected studies.

Results: A total of 195 studies were included in the final analysis, yielding an overall PEA of 95.76% (95% CI: 95.0-96.47), PESen of 91.94% (95% CI: 90.72-93.08) and PESpe of 96.09% (95% CI: 95.27-96.79). In the subgroup analysis, most AI models had a PEA > 90%, especially convolutional neural networks (CNN), followed by support vector machine (SVM) and random forest (RF).

Conclusions: AI diagnostic tools, particularly CNNs, have demonstrated robust performance in VRDs detection. However, results from studies with limited generalizability should be applied cautiously in real-world settings. Further exploration of emerging models, such as large language models (LLMs), is recommended.