International Ophthalmology最新文献

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.

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.

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.

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.

Purpose: The aim of this study was to assess choroidal vascularization in individuals with new diagnoses of polycystic ovary syndrome(PCOS) using optical coherence tomography(OCT).

Methods: This prospective study included 46 patients with newly diagnosed PCOS and 40 healthy controls. Demographic and ocular examination characteristics of all participants were recorded. Retinal layers, choroidal thickness, and optic disc morphology (rim area, disc area, cup volume, and average and vertical cup/disc ratio) were assessed via OCT. High-line OCT sections were analyzed using the open-source image processing software ImageJ to determine luminal choroidal area (LCA),stromal choroidal area (SCA), and total choroidal area (TCA) in both macular(m) and peripapillary(p) regions. The ratio of LCA to TCA was defined as the choroidal vascularity index(CVI).The relationship between hormonal profile parameters (LH,FSH,TSH, estradiol, and prolactin) and choroidal vascular metrics was analyzed using multiple regression.

Results: The two groups were matched for age and sex. Refractive error, axial length, body mass index, and intraocular pressure were comparable between groups(all p > 0.05). No statistically significant differences were found between groups in terms of retinal layers, choroidal thickness, or optic disc morphology parameters (all p > 0.05). Similarly, LCA, SCA, and TCA values did not significantly differ between groups(all p > 0.05). Although both macular CVI(mCVI) and peripapillary CVI(pCVI) values were higher in the PCOS group, the differences were not statistically significant (all p > 0.05). No significant correlations were found between hormonal parameters and choroidal vascular indices(all p > 0.05).

Conclusion: This study is the first to evaluate choroidal vascularization in PCOS patients using OCT-based methods. Our findings indicate that choroidal vascular parameters, which provide direct insight into choroidal vascularization, are similar between PCOS patients and healthy controls.

Purpose: Human umbilical cord mesenchymal stem cell lysates (UCML) have crucial bioactivities, including tissue regeneration, wound healing, and immune regulation, showing great potential for treating eye diseases. This study investigates the therapeutic efficacy of UCML loaded in artificial tears (AT@UCML) on dry eye syndrome (DES) and retinal injury.

Methods: This study first evaluated the safety, antioxidant properties, and tissue-repairing effects of AT@UCML in disease-relevant ocular cells. Then, we treated DES and ischemia/reperfusion (I/R) retinal injury mouse models by AT@UCML. To assess the effects in DES mice, we measured tear secretion, corneal damage, and goblet cell numbers. For I/R mice, we examined retinal ganglion cell numbers and retinal thickness.

Results: Experiments showed that AT@UCML reduced oxidative stress and protected ocular cells. In DES mice, it increased tear secretion, repaired corneal damage, and restored goblet cell counts. In I/R mice, it reduced retinal ganglion cell loss and restored retinal thickness.

Conclusions: AT@UCML effectively treated DES and I/R injuries by protecting key ocular cells. This study expands the application of stem cell therapy in ophthalmology and provides a basis for developing related treatments.

Purpose: To evaluate the efficacy and safety of contact lens-assisted accelerated corneal cross-linking (A-CACXL) using a UV-filter-free nelfilcon A daily hydrogel lens in thin corneas (≤ 400 µm).

Methods: Retrospective single-center series of 28 eyes (23 patients) with progressive keratoconus and post-debridement pachymetry ≤ 400 µm; minimum follow-up 6 months. A-CACXL employed a 100-µm nelfilcon A lens. Outcomes at Baseline, Month 1, Month 3, and Month 6 included UCVA/BCVA (logMAR), refraction, K1, K2, Kmean, Kmax (D), minimum corneal thickness (MCT, µm), and endothelial cell count (ECC, cells/mm²). Longitudinal changes were analyzed with repeated-measures ANOVA (Greenhouse-Geisser when required) or Friedman, with Bonferroni-adjusted pairwise tests only if the omnibus test was significant; correlations were pre-specified for ΔBCVA vs ΔK (Δ = month 6-Baseline).

Results: BCVA improved significantly (p = 0.005), whereas UCVA showed a non-significant favorable trend (p = 0.246). K2 and Kmean decreased over time (p < 0.001 and p < 0.001), and Kmax decreased with Greenhouse-Geisser correction (p = 0.033); K1 remained stable (p = 0.233). MCT demonstrated an early thinning at Month 1 and Month 3 with partial rebound by Month 6 (omnibus p < 0.001; Bonferroni-significant vs Baseline). Manifest cylinder decreased modestly (p = 0.048), whereas manifest sphere was unchanged (p = 0.495). ECC remained stable across visits (p = 0.124). Adverse events were limited to transient, clinically insignificant haze in 2/28 eyes (7.1%), resolving by Month 3. All eyes satisfied the intraoperative functional thickness ≥ 400 µm threshold.

Conclusions: A-CACXL with a nelfilcon A lens appears to be a pragmatic, safe, and effective option for thin corneas, yielding early BCVA improvement, modest anterior flattening, and preserved endothelium through six months.