International Ophthalmology最新文献

Background: Keratoconus (KCN) is a progressive degenerative corneal disorder characterized by corneal thinning and cone-shaped protrusion, leading to significant visual impairment if not detected early. Accurate staging of KCN using corneal topographic maps is critical for timely diagnosis and effective treatment planning.

Methods: This study proposes an enhanced deep learning framework for KCN stage classification based on corneal topographic images. The model employs a Dual Vision Transformer (DViT) to effectively capture both local and global spatial features. To optimize model performance, the Electric Eel Foraging Optimizer (EEFO) is utilized for tuning attention weights and hyperparameters of the DViT architecture. Additionally, model interpretability is enhanced through Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP), enabling visualization of corneal regions influencing classification decisions.

Results: Experimental evaluations conducted on a keratoconus dataset demonstrate that the proposed DViT-EEFO model outperforms existing approaches, achieving an accuracy of 99.2%, recall of 99.3%, and precision of 99.5%. Interpretability analyses confirm that the model focuses on clinically relevant corneal regions during decision-making.

Conclusion: The proposed DViT-EEFO framework delivers high classification performance and improved interpretability, highlighting its strong potential as a reliable clinical decision support tool for early keratoconus diagnosis and treatment planning.

Purpose: To evaluate subclinical retinal microvascular changes in long-term hydroxychloroquine (HCQ) users (≥ 5 years) using optical coherence tomography angiography (OCTA), comparing retinal parameters with a healthy control group.

Method: This single-center, case-control study involved 118 participants (comprising of 59 HCQ users and 59 controls) who underwent comprehensive ophthalmic evaluations, including OCTA to assess the foveal avascular zone (FAZ), macular vessel density (VD) in superficial and deep capillary plexus (SCP and DCP), and retinal thickness. Statistical tests included independent t, Mann-Whitney U, and Spearman's rank correlation tests, with significance set at p < 0.05.

Results: Most HCQ users were female (88.14%) with a median age of 47 years, primarily treated for systemic lupus erythematosus (SLE), receiving a mean HCQ dose of 5.14 mg/kg/day. FAZ area and central foveal thickness (CFT) did not differ significantly between groups. However, parafoveal and perifoveal retinal thickness was significantly reduced in the HCQ group (p < 0.001). Macular VD was significantly higher in the foveal and parafoveal DCP among HCQ users (p < 0.001).

Conclusion: Long-term HCQ use is associated with significant parafoveal and perifoveal retinal thinning, with variable OCTA microvascular changes. These findings highlight the potential role of OCTA in early detection of HCQ-induced retinal alterations.

Purpose: To synthesize recent (2020-2025) advances on how gut, oral, and ocular-surface microbiota contribute to major blinding eye diseases, dry eye disease (DED), non-infectious uveitis, glaucoma, optic neuropathy, age-related macular degeneration (AMD), and diabetic retinopathy (DR), and to evaluate the therapeutic potential of microbiome-based interventions.

Methods: PubMed and Web of Science were searched (January 2020-October 2025) using the terms "gut microbiota", "ocular diseases", and "immunomodulatory therapies". Eligible studies included original human and animal research demonstrating microbial dysbiosis or testing microbiome-directed therapies. Data were synthesized thematically across microbial composition, immune-metabolic mechanisms, and intervention outcomes.

Results: Across all six diseases, dysbiosis was consistently characterized by depletion of anti-inflammatory taxa such as Akkermansia, Ruminococcaceae, and other short-chain fatty acid (SCFA) producers, with enrichment of pro-inflammatory bacteria including Proteobacteria, Staphylococcus, and Porphyromonas gingivalis. These changes were associated with increased intestinal permeability, systemic lipopolysaccharide (LPS) and trimethylamine N-oxide (TMAO), Th17 (T helper 17)/Treg (regulatory T cell) imbalance, and loss of SCFA-mediated neuroprotection. Probiotics containing Lactobacillus or Bifidobacterium improved tear stability and reduced inflammation in preclinical and pilot clinical studies, while high-fiber diets ameliorated lesions in age-related macular degeneration (AMD) and diabetic retinopathy (DR). Fecal microbiota transplantation confirmed microbial causality but revealed donor-dependent effects, and engineered Lactobacillus expressing angiotensin-converting enzyme 2 (ACE2) or Ang-(1-7) preserved retinal integrity in diabetic models.

Conclusions: Microbial dysbiosis acts as a common driver of immune-metabolic dysfunction in blinding eye diseases. Microbiome-targeted strategies show promising efficacy in experimental systems, but large, longitudinal human trials are needed for clinical translation.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease with a strong genetic component, frequently accompanied by extra-articular manifestations such as acute anterior uveitis (AAU). This study aimed to evaluate the association of the rs11362 and rs1800972 (DEFB1), and rs3806268 and rs10754558 (NLRP3) gene variants in AS patients with and without AAU.

Methods: A case control-study was conducted on 58 patients with AS and 70 healthy controls. Genotyping was performed using the TaqMan® SNP Genotyping Assay. Genotype frequencies were compared between studied groups and subgroups, and associations were estimated by logistic regression models. Interactions between these variants were also evaluated.

Results: In the case-control analysis after adjusment, the TT (rs11362) and CC (rs1800972) genotypes of the DEFB1 gene were significantly associated with an increased risk of AS (OR = 6.89, 95% CI = 1.66-28.4, p = 0.008 and OR = 3.43, 95% CI = 1.02-11.5, p = 0.046, respectively). Then, in the subanalysis, the GC (rs1800972) genotype was associated with an increased risk of AAU (OR = 9.93, 95% CI = 1.76-55.7, p = 0.009). No significant associations were observed for NLRP3 polymorphisms individually. However, a strong interaction between rs1800972 and rs3806268 polymorphisms was observed (entropy = 22.95%).

Conclusions: These results suggest that DEFB1 gene variants (rs11362 and rs1800972) are associated with an increased risk of developing AS. Specifically, rs1800972 is associated with increased susceptibility to AAU. While NLRP3 variants did not show significant associations independently, their interaction with DEFB1 variants suggests a possible synergistic effect on AAU development.

Purpose: This study evaluates the impact of medical versus combined medical and surgical glaucoma treatments on patients' quality of life (QoL). While both approaches reduce intraocular pressure, research shows mixed effects on QoL. Given updated clinical guidelines and the gap in QoL-focused glaucoma management, this study applies validated QoL measures to assess treatment effects and inform patient-centered care.

Methods: From June to October 2023, 180 patients at Augusta University Eye Care Center completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Glaucoma Profile Instrument (GPI) surveys. Chart reviews provided demographic and clinical data, including glaucoma status and treatment. QoL scores were calculated using validated algorithms. Associations between clinical variables and QoL outcomes were analyzed using ANOVA and t-tests in R 4.4.1.

Results: Among 180 patients, 103 had glaucoma or were suspects. 64% of glaucoma patients received medical treatment only, and 34% received combined medical and surgical treatment. VFQ-25 scores differed significantly by race (p = 0.0489), severity (p = 0.0001), and age (p = 0.0459), but not by gender, glaucoma status, or treatment. Severe glaucoma patients had the lowest QoL. Severity strongly impacted GPI scores (p = 0.0092) and multiple VFQ-25 domains. Differences by treatment modality were observed only in the driving subscale (p = 0.0378). No significant differences were observed in overall QoL scores between treatment groups.

Conclusion: No significant vision-related QoL differences were found between treatment groups. Most patients were medically managed, possibly reflecting limited QoL benefit from surgery. QoL correlated more with disease severity than treatment modality or demographics. These findings highlight a disconnect between current treatment strategies and patient-perceived outcomes, underscoring the need for innovative strategies to improve QoL in glaucoma care.

Purpose: This study aims to systematically evaluate the consistency of total keratometry (TK) and posterior keratometry (PK) measurements obtained by the IOL Master 700 and Pentacam in cataract patients with varying axial lengths (AL).

Methods: A total of 240 cataract patients (240 eyes) were recruited from Beijing Tongren Hospital between February and April 2025. Participants were categorized into six groups based on AL: < 22 mm, 22-24 mm, 24-26 mm, 26-28 mm, 28-30 mm, and ≥ 30 mm. All patients underwent preoperative examinations using the IOL Master 700 and Pentacam systems to obtain measurements of TK and PK. The paired t-test or Wilcoxon signed-rank test was employed to evaluate intergroup differences. The Bland-Altman analysis was conducted to assess the 95% limits of agreement (LoA), with calculation of the mean difference.

Results: Except for the subgroup with AL < 22 mm, the TK measured by the IOL Master 700 was significantly higher than that obtained using the Pentacam across all AL subgroups. The mean difference ranged from 0.005D to 0.406 D, with the width of the 95% LoA varying between 1.071D and 2.382D. For PK, measurements obtained by the IOLMaster 700 were significantly flatter compared to those from the Pentacam across all subgroups. The mean differences ranged from 0.442 to 0.478 D, with the width of the 95% LoA ranging from 0.244 to 0.319 D.

Conclusion: Regardless of AL, the measurement discrepancies in TK and PK between the two devices exceed the clinically acceptable limits, suggesting that these devices are not interchangeable across patients with varying AL.

Purpose: To evaluate the long-term efficacy of corneal crosslinking using the standard protocol (S-CXL) and the accelerated protocol (A-CXL) over a period of 8 years.

Methods: This retrospective cohort study included 61 eyes from 61 patients with progressive keratoconus (KC). They were treated with either the S-CXL (3*30, N = 16) or the A-CXL (9*10, N = 45). Visual acuity and corneal parameters, including higher-order aberrations (HOAs), corneal tomography, and corneal densitometry, were recorded prior to the intervention and at four follow-up visits using Scheimpflug tomography. A linear mixed model with Bonferroni correction was used to analyze the longitudinal data.

Results: Anterior corneal curvature parameters were significantly reduced in both groups at 3 and 8 years (all p ≤ 0.019). Central and thinnest corneal thickness decreased significantly after 12 and 36 months (p < 0.001). Surface variance and vertical asymmetry indices remained unchanged postoperatively, despite the significant reduction at 8 years in the A-CXL group (p < 0.001). The greatest increase in corneal optical density was observed in both groups at 6 months in the anterior layer up to a diameter of 10 mm, which roughly normalized at 12 months. HOA coma was reduced in both groups at 36 and 96 months (all p ≤ 0.012). In contrast, only the S-CXL group showed a borderline significant improvement in visual acuity after 96 months (p = 0.049) which should be interpreted cautiously due to differences in sample size and baseline characteristics. The rate of postoperative complications was comparable in both protocols.

Conclusion: In an 8-year long-term follow-up, both S-CXL and A-CXL successfully halted KC progression. Non-inferiority of the accelerated protocol was demonstrated.

This study discusses four cases of fungal keratitis (FK) caused by uncommon fungal pathogens. It's important to note that FK caused by these species is either rare or has not been reported before. Rare fungal pathogens including Subramaniula lateralis, Inocutis levis, Neoscytalidium dimidiatum, and Bipolaris panini-miliacei were identified in corneal scraping specimens. Patients were treated with systemic and topical antifungal agents, and surgical intervention was performed when necessary. This report emphasizes the importance of considering rare fungal species in cases of keratitis, highlighting the necessity of recognizing and awareness of these less common fungal species.

Purpose: The extraocular muscles (EOM) within the orbit provide ocular motility. Knowing the morphometric properties of these muscles is of clinical importance because various pathologies can affect the orbit and its structures. This study aims to compare normative EOM thickness values across gender and age groups and to investigate the potential relationship between refractive errors caused by the eye's axial length (AL).

Methods: A retrospective study was conducted on 120 males and 125 females over 20 years of age who underwent orbital magnetic resonance imaging (MRI) in the Department of Radiology. Interzygomatic line length (IZL) in 245 individuals, axial length in 490 eyes, and long-short diameters of the EOM in coronal sections were measured, and variations were investigated.

Results: Three of the 11 EOM measurements were significantly larger on the left and one was significantly larger on the right (p  <  0.05). AL was not significantly different between the sides (p˃0.05). AL, IZL, and 8 of the 11 EOM lengths were significantly larger in men (p < 0.05). Among the individuals divided into 20-year age groups, the EOM short diameters were smaller in individuals aged 20-39 compared to those in older age groups (p < 0.05).

Conclusion: While normative EOM lengths may vary depending on gender, side of eyelid, and age, they have been shown to be unchanged in axial myopia or hyperopia. The information obtained may contribute to the diagnosis and treatment of orbital pathologies.

Purpose: To investigate the neuroprotective effects of N-acetylcysteine (NAC) in comparison with brimonidine in an experimental glaucoma model.

Methods: Thirty-two adult female Wistar albino rats were randomly assigned to five groups: Control, Sham, NAC, Brimonidine, and Combination (NAC + Brimonidine). Glaucoma was induced in the right eye by optic nerve crush in all groups except Control. Treatments were administered intraperitoneally every 72 h for 30 days. Neuroprotection was assessed histopathologically by measuring ganglion cell layer (GCL) thickness and total retinal thickness. Apoptotic activity and glial activation were evaluated by quantifying B-cell lymphoma/leukemia-2 (BCL-2), BCL-2-associated X protein (BAX) and glial fibrillary acidic protein (GFAP) expression. Oxidative stress and antioxidant capacity were assessed using malondialdehyde (MDA), total oxidant status (TOS), glutathione (GSH) and total antioxidant capacity (TAC) levels.

Results: NAC significantly preserved GCL and total retinal thickness compared with the Sham group (P < 0.001), with neuroprotective efficacy comparable to brimonidine (P > 0.05). The combination therapy group demonstrated the most pronounced neuroprotective effects. NAC treatment increased antiapoptotic BCL-2 and GSH levels while reducing BAX, GFAP, MDA, and TOS levels (P < 0.001).

Conclusions: NAC exhibited substantial neuroprotective effects in an intraocular pressure-independent glaucoma model, likely mediated through its antioxidant properties and modulation of apoptotic pathways. These findings suggest that NAC may serve as a promising adjunctive therapy for glaucomatous optic neuropathy and other retinal neurodegenerative disorders characterized by oxidative stress and apoptosis.