International Ophthalmology最新文献

Purpose: To compare visual, refractive, and vector-based astigmatic outcomes between Small Incision Lenticule Extraction (SMILE) and toric Implantable Collamer Lens (ICL) implantation in patients with myopic oblique astigmatism.

Methods: In this retrospective, matched cohort study, 140 eyes (70 SMILE, 70 toric ICL) with oblique astigmatism were treated at a single center. Groups were matched preoperatively for refractive cylinder and spherical equivalent within ± 0.50 D. Postoperative outcomes at six weeks were assessed, including uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SEQ), astigmatism correction using vector analysis (Alpins method), and safety and efficacy indices. A post hoc power analysis was performed for the astigmatic correction index.

Results: The efficacy index was 0.97 ± 0.17 in the ICL group and 0.94 ± 0.15 in the SMILE group. The safety index was 1.02 ± 0.11 (ICL) versus 1.01 ± 0.09 (SMILE). UDVA equal to or better than preoperative CDVA was achieved in 83% of ICL eyes and 79% of SMILE eyes. SEQ within ± 0.50 D was observed in 85.7% (ICL) versus 81.4% (SMILE). The astigmatic correction index was 0.97 for ICL and 1.04 for SMILE. Linear regression showed stronger correlation between target and achieved astigmatism in the ICL group (slope = 1.04, R² = 0.77) compared to SMILE (slope = 0.76, R² = 0.67). Power analysis confirmed 80.5% power to detect clinically meaningful differences.

Conclusions: Both SMILE and toric ICL are effective and safe for correcting myopic oblique astigmatism. However, toric ICL demonstrated slightly greater precision in axis alignment and refractive predictability, supporting its use in cases of high oblique astigmatism where rotational accuracy is critical.

Purpose: To evaluate blepharoptosis (BP), meibomian gland (MG) morphology, and dry eye parameters in older individuals diagnosed with sarcopenia.

Methods: This cross-sectional, case-control study included 52 patients with sarcopenia and 30 age-matched healthy controls. Sarcopenia was diagnosed according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. BP was assessed by measuring palpebral fissure (PF), margin reflex distance 1 (MRD1), and levator function (LF). Dry eye evaluation included the Ocular Surface Disease Index (OSDI) questionnaire, noninvasive tear break-up time (NITBUT), meibography, and Schirmer I test.

Results: PF, MRD1, and LF values were significantly lower in the sarcopenia group compared to that in the controls (p = 0.044, p = 0.001, and p < 0.001, respectively). Body mass index (BMI) showed a negative correlation with PF (r = -0.383, p = 0.036). BP was observed in 10.9% of the sarcopenia group and 3.3% of controls (p = 0.077). MG loss and meiboscore were significantly higher in the sarcopenia group (p = 0.001 and p < 0.001), while NITBUT was significantly lower (p = 0.031). No significant differences were found in OSDI scores or Schirmer test results between the two groups.

Conclusions: Older individuals with sarcopenia exhibited reduced LF and changes in MG morphology and tear film stability. BP and tear film instability may be underrecognized manifestations of sarcopenia and should be considered in comprehensive geriatric and ophthalmologic assessments. Further studies are needed to better understand the relationship between sarcopenia, eyelid functions, and dry eye.

Purpose: This study aimed to investigate the role of systemic inflammation in patients diagnosed with idiopathic intracranial hypertension (IIH) and to evaluate the relationship of various hematological inflammatory markers with retinal nerve fiber layer (RNFL) thickness.

Methods: The study included 30 newly diagnosed IIH patients and 30 age- and sex-matched healthy individuals. Neutrophil, lymphocyte, monocyte, platelet, immature granulocyte, and RDWSD levels were recorded in all cases; derived inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), were calculated from these parameters. RNFL thickness was measured by optical coherence tomography, and the relationships between lumbar puncture (LP) opening pressures and inflammatory parameters were analyzed.

Results: In the IIH group, neutrophil, platelet, and immature granulocyte levels, as well as SII and SIRI values, were significantly higher compared to healthy controls (p < 0.05). RNFL thickness correlated positively with platelet, neutrophil, immature granulocyte counts, and SII (p < 0.05), whereas LP opening pressure and Frisen grade showed no association with inflammatory parameters (p > 0.05).Among the evaluated markers, immature granulocyte count demonstrated the highest diagnostic accuracy for distinguishing IIH, with an AUC of 0.824 in ROC analysis.

Conclusion: This study shows that inflammatory markers, including immature granulocyte count, SII, and SIRI, are significantly elevated in patients with IIH. Among these parameters, immature granulocyte count demonstrated the strongest associations with disease-related structural findings, suggesting its potential role as an inflammatory indicator in IIH. These findings highlight associations between systemic inflammatory parameters and IIH, without causality.

Purpose: Open globe injuries (OGIs) impose a significant burden on patients and the healthcare system. This study reports outpatient visits and secondary surgeries associated with OGIs METHODS: A retrospective chart review of OGI repairs at a Level 1 Trauma Center from 2015-2023 was conducted. Two areas of resource utilization, outpatient office visits and secondary surgeries required within a year of the injury were recorded and predictors were identified RESULTS: Of 619 patients (mean age 46±22 years; 76.7% male), most had OGIs from blunt traumatic etiology (57.0%) with injury in zone I (65.9%). On average, patients had 5.3±4.7 office visits, where 8% of patients had no follow-up, 76% had 1-9 visits, and 16% had 10 or more visits. Thirty-five percent required at least one secondary surgery (mean 0.5±0.8). Clinical factors, including presenting best-corrected visual acuity (BCVA), predicted utilization. Predictors for office visits included injury zone (p=0.02), retinal detachment (p<0.001), vitreous hemorrhage (p=0.014), and traumatic cataract (p=0.011). Retinal detachment (p<0.001), and traumatic cataract (p<0.001) were predictive of secondary surgeries. The most common surgeries were pars plana vitrectomy (n=124), cataract extraction (n=46), enucleation (n=33), and corneal transplant (n=21) CONCLUSION: OGI management often requires additional procedures with significant follow-up. Overall trends suggest greater utilization among eyes with significant injury that still maintain potential for visual recovery.

Purpose: Choroidal alterations are implicated in the pathophysiology of retinal vein occlusion (RVO), yet comprehensive spatial analysis has been limited by conventional imaging. This study aims to leverage ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) to quantitatively assess spatial changes in the choroidal vascularity index (CVI) and choroidal thickness (CT) in patients with RVO.

Methods: This cross-sectional study included 38 patients with unilateral RVO and 40 healthy controls. Using ultra-widefield SS-OCTA, volumetric CVI and CT were quantified across a 24 × 20 mm area. Data from nine anatomical grids were compared among RVO-affected, contralateral fellow, and healthy control eyes. The correlation between central macular thickness (CMT) and choroidal parameters in RVO eyes was also analyzed.

Results: Compared to controls, RVO-affected eyes showed significantly decreased CVI in the nasal-superior and optic disc grids, and reduced CT in the nasal-superior, optic disc, and nasal-inferior grids. No significant differences in CVI or CT were found between RVO-affected and fellow eyes. In RVO eyes, CMT was negatively correlated with CVI in the nasal-superior and macular grids, but showed no significant correlation with CT.

Conclusion: Ultra-widefield SS-OCTA reveals specific spatial patterns of reduced CVI and CT in RVO, predominantly in the nasal and peripapillary regions. These findings suggest choroidal involvement in RVO includes both vascular and stromal components, and that CVI may serve as a sensitive biomarker for monitoring disease-related choroidal alterations.

Purpose: To compare safety, efficacy and patient experience when treated with intravitreal injections of a 30-gauge needle compared to a 34-gauge needle.

Methods: A Prospective Randomized controlled study in a single tertiary medical center. Patients were randomly assigned to receive prescheduled intravitreal injection with either a 30 or a 34-gauge needle. Intravitreal injections were performed by a senior vitreoretinal surgeon or by a resident. After the intravitreal injection was performed, patients were asked to grade pain sensation on a Visual Analog Scale (VAS score). In addition, the presence or absence of subconjunctival hemorrhage (SCH) was recorded, as well as any post-injection complications in the following month.

Results: Our cohort included 91 patients with a total of 114 injections. Mean age was 72.8 ± 12, with 51 females and 40 males. The mean pain score in the 30-gauge group was 3.17 ± 2.11 vs 3.05 ± 2.45 in the 34-gauge group. There was no statistically significant difference in the mean pain score among the two groups (p = 0.571) nor in gender (p = 0.563) overall. However, when the injections performed by a senior vitreoretinal surgeon, 34-gauge needles were statistically significantly less painful than 30-gauge needles (2.5 ± 2.0 vs. 3.4 ± 1.8; p = 0.04). Additionally, no difference was recorded in formation of SCH among the groups (p = 1).

Conclusion: The use of a 34-gauge needle was found to be less painful when used by a senior vitreoretinal surgeon and with similar safety profile as the 30 gauge needle. This may further improve patient satisfaction and increase treatment adherence.

Purpose: Diabetic retinopathy (DR) is a major cause of vision impairment worldwide. Widefield optical coherence tomography angiography (WF-OCTA) is a non-invasive alternative to widefield fluorescein angiography (WF-FA) that provides high-resolution imaging of retinal vasculature. This systematic review evaluates the diagnostic performance of WF-FA and ultra-widefield (UWF)-FA vs. WF-OCTA and UWF-OCTA in detecting DR-related retinal vascular changes.

Methods: A systematic search was conducted, following PRISMA guidelines. Studies reporting quantitative or qualitative findings on microaneurysms (MAs), intra-retinal microvascular abnormalities (IRMAs), and neovascularization (NV), or foveal avascular zone (FAZ) changes were analyzed.

Results: A total of 12 studies (648 eyes) met the inclusion criteria. Findings suggest that WF-OCTA detect NV with high sensitivity (96.55%) and specificity (94.74%), comparable to WF-FA. However, WF-FA showed potential in certain qualitative aspects, suggesting a possible complementary role.

Conclusion: WF-OCTA and UWF-OCTA are promising non-invasive alternatives to WF-FA and UWF-FA, offering high diagnostic accuracy, rapid imaging, and depth-resolved vascular analysis.

Purpose: To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethysmography-based flow-mediated dilation (PPG-FMD) technique and examine associations between endothelial function and ophthalmic structural parameters.

Methods: In this prospective cross-sectional study, 55 participants were enrolled: POAG (n = 12), PEXG (n = 14), PEXS (n = 16), and controls (n = 13). Systemic endothelial function was measured noninvasively by PPG-FMD, quantifying vascular reactivity from pulse amplitude changes during reactive hyperemia. Ophthalmic parameters included intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness assessed by spectral-domain OCT. Group comparisons and correlation analyses were performed with Kruskal-Wallis and Dunn post-hoc tests, and Pearson or Spearman correlation analyses as appropriate.

Results: Mean PPG-FMD dilation index values were significantly lower in the POAG (85.4 ± 6.0%) and PEXG (82.5 ± 4.3%) groups compared to controls (124.5 ± 10.1%, p < 0.001). The PEXS group showed nonsignificant reduction. Endothelial function was positively correlated with GCC (r = 0.311, p = 0.027) and RNFL thickness (r = 0.378, p = 0.007) and negatively correlated with IOP (r = - 0.339, p = 0.013). No significant association was found with central corneal thickness.

Conclusions: Our findings highlight that systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, especially PEXG and POAG. The PPG-FMD method offers a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma.

Translational relevance: This study demonstrates, for the first time, that PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, offering a novel clinical marker that complements IOP and OCT metrics for identifying high-risk patients.

Purpose: To compare variations in choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ) and healthy subjects for at least one year.

Methods: Cross-sectional study enrolling patients between 30 and 55 years of age with SLE and treated with HCQ for at least one year, and aged-matched healthy subjects. Exclusion criteria included any other ophthalmological disorder or previous treatment, and systemic treatment with immunosuppressive drugs or a dose of corticosteroids higher than 5 mg/d. Macular CT was measured automatically in a grid of 30 × 30 cubes using Triton swept-source optical coherence tomography (Topcon). These were merged into 25 zones (each one comprising 6 × 6 cubes). Three-dimensional (3D) CT maps were created using Microsoft Excel and mean CT values in the grid of 30 × 30 cubes. One eye of each patient was randomly selected for the study.

Results: 60 patients and 54 healthy subjects were recruited. Mean age was 45.16 ± 6.43 and 43.79 ± 8.98 years (p = 0.346), respectively. Mean axial length was 23.52 ± 0.96 and 23.67 ± 0.87 mm (p = 0.137), respectively. Mean SLE duration was 125.58 ± 63.10 months, and mean duration of HCQ was 87.87 ± 52.13 months. There were no differences in intraocular pressure (p = 0.271) or spherical equivalent (p = 0.219). Choroidal zones number 9, 14, 15, 19 and 20 (central nasal locations) were thicker in SLE patients. Neither SLE duration, nor HCQ duration had any influence on CT (p > 0.05).

Conclusions: Patients with SLE treated with HCQ for one or more years present higher CT values than healthy subjects. Nasal zones seem to be the most sensitive to these changes, while the other choroidal locations remain similar apparently. However, neither duration of SLE nor duration or dose of HCQ treatment seemed to have any influence on CT.