International Ophthalmology最新文献

Purpose: This study aimed to compare the effects of trifocal (TF) and monofocal intraocular lenses (Mono-IOL) on microperimetry outcomes in patients who underwent uncomplicated cataract surgery.

Methods: A total of 44 Mono-IOL and 38 TF-IOL recipients were evaluated six months postoperatively. Corrected distance visual acuity (CDVA) was assessed using a standard logMAR chart. Microperimetry assessments were performed using the MP-1 microperimeter to measure retinal sensitivity (RS) at 2°, 6°, and 10°, fixation points (FP) within 2° and 4°; and fixation stability. Fixation stability was quantified using the Bivariate Contour Ellipse Area (BCEA). Contrast sensitivity was assessed separately using the Pelli-Robson chart.

Results: The Mono-IOL group exhibited significantly higher CS (1.80 ± 0.10 vs. 1.70 ± 0.11, p < 0.01) and better CDVA (p = 0.044). Retinal sensitivity was also greater at RS-2° (p = 0.036), RS-6° (p = 0.014), and RS-10° (p = 0.01). Fixation stability was better in the Mono-IOL group, with significantly smaller BCEA values at 1SD (1292 ± 1128 vs. 2027 ± 1637 min arc², p = 0.013), 2SD (3551 ± 3164 vs. 5416 ± 4454 min arc², p = 0.032), and 3SD (6361 ± 5685 vs. 9654 ± 7929 min arc², p = 0.029). FP-2° was also higher in the Mono-IOL group (p = 0.012), while FP-4° and fixation location showed no significant differences.

Conclusion: Mono-IOLs provided superior contrast sensitivity, retinal sensitivity, and fixation stability compared to TF-IOLs, indicating better postoperative visual function.

Purpose: To evaluate the effects of upper eyelid blepharoplasty on corneal topography and higher-order optical aberrations (HOAs).

Methods: Seventy-seven patients (154 eyes) who underwent upper eyelid blepharoplasty for dermatochalasis and had complete preoperative and 3-month postoperative corneal topography and aberrometry data were included. All measurements were obtained using the Sirius topography system. Aberrometric parameters-including total RMS, HOA RMS, coma, trefoil, and spherical aberration-as well as advanced topographic indices such as EIf, EIb, TSI, and TImax were analyzed. As this was a retrospective observational study, trial registration was not applicable.

Results: No statistically significant change was observed in total RMS values. At a 6 mm pupil diameter, HOA RMS decreased from 0.53 ± 0.25 to 0.49 ± 0.17 (p = 0.014), and coma decreased from 0.31 ± 0.20 to 0.27 ± 0.14 (p = 0.002). Spherical aberration also showed a postoperative reduction (0.23 ± 0.10 to 0.21 ± 0.10; p = 0.008). Significant improvements were detected in trefoil (p < 0.001), TImax (p < 0.001), EIf (p < 0.001), EIb (p = 0.008), and TSI (p = 0.005). No significant postoperative differences were observed in keratometric values or secondary astigmatism (p > 0.05).

Conclusion: Upper eyelid blepharoplasty appears to produce beneficial changes in corneal surface morphology and optical aberrations. Given its potential to enhance visual quality and patient satisfaction, the functional implications of blepharoplasty should be considered alongside its aesthetic goals during surgical planning.

Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness among middle-aged and older adults, bringing a heavy health burden. Understanding the patterns of AMD disease burden and the risk factors associated with early AMD development is crucial for formulating targeted public health policies.

Methods: We estimated the prevalence of AMD and disability-adjusted life year (DALY) using data from the 2021 Global Burden of Disease (GBD). Our analysis examined trends in prevalence and DALY by age, sex, and sociodemographic index (SDI) at global, regional, and national levels from 1990 to 2021. We performed data analysis using two Mendelian randomization (MR) samples to explore the causal relationship between lipid metabolism, nutrients, and early AMD risk. The primary analysis was conducted using the inverse variance weighting method, along with a range of sensitivity analyses.

Results: In 2021, AMD's DALY was 570,000, the age-standardized prevalence rate (ASPR) was 94.00/100,000 (95% UI, 78.32-114.42), and the age-standardized disability rate (ASDR) was 6.78/100,000 (95% UI, 4.70-9.32). The burden of AMD showed a downward trend during the study period. The disease burden is closely related to socioeconomic development and is unevenly distributed, with a heavier burden in low sociodemographic index (SDI) regions, especially in southern and central sub-Saharan Africa. Age-specific DALYs showed a gradual increasing trend, with female DALYs higher than male DALYs in all age groups. Decomposition analysis showed that population growth led to an increase in AMD DALYs. Projections from the Bayesian Age-Period Cohort (BAPC) model indicate that global AMD DALYs may continue to rise by 2045. Additionally, multivariate Mendelian randomization (MVMR) evaluation results showed that triglycerides (TG) (OR, 0.82; 95% CI, 0.73-0.92; p = 0.001) and high-density lipoprotein (HDL) (OR, 1.15; 95% CI, 1.04-1.28; p = 0.009) were significantly associated with early AMD. For every one standard deviation increase in TG levels, the risk of AMD decreases by an average of 18%. Higher TG levels are a protective factor for early AMD. However, the effect of HDL on AMD is the opposite of that of TG. For every one standard deviation increase in HDL levels, the risk of AMD increases by an average of 15%. Higher HDL levels are a risk factor for AMD.

Conclusions: AMD remains a major health problem worldwide, especially in low SDI regions. Population growth and aging have the most significant impact on AMD DALYs. HDL was identified as a risk factor, while TG was identified as a protective factor. These findings highlight the need for targeted interventions in low SDI regions, including dietary control, early screening, and addressing socioeconomic factors through balanced dietary plans.

Purpose: To evaluate the efficacy and durability of intravitreal Faricimab (Vabysmo) in patients with neovascular age-related macular degeneration (NVAMD) and diabetic macular edema (DME).

Methods: A retrospective study was conducted at a tertiary ophthalmology center. Eyes with NVAMD or DME which had received previous Anti-vascular endothelial growth factor (A-VEGF) treatment before switching to Faricimab were included. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and injection intervals were recorded at baseline and follow-up visits of up to 2.5 years.

Results: A total of 192 eyes (160 with NVAMD and 32 with DME) from 155 patients were included. The mean patient age was 79.5 ± 9.6 years, with an average follow-up duration of 468.1 ± 120.4 days from baseline. In the NVAMD cohort, BCVA improved from 0.43 ± 0.33 logMAR at baseline to 0.34 ± 0.30 at 1.5 years (p < 0.05). CST decreased significantly from a mean of 308.3 ± 65.3 Micrometers to 242.4 ± 44.8 Micrometers at two years (p < 0.001). The mean interval between injections increased from a mean of 33.9 ± 9.6 days at baseline to 77.6 ± 42.6 days at two years, reflecting a significant extension throughout the observation period (p < 0.001). In eyes with DME, CST declined from 403.6 ± 121.9 Micrometers at baseline to 303.2 ± 105.2 Micrometers at one year (p < 0.001), while BCVA remained stable. Injection intervals extended from 34.4 ± 10.3 to 60.9 ± 20.5 days at one year (p < 0.001).

Conclusion: In this study of previously treated eyes with NVAMD and DME, Faricimab demonstrated sustained anatomical and functional benefits alongside meaningful injection interval extension.

Purpose: This study aimed to compare the clinical presentation, treatment, and prognosis of two patients with high myopia who suffered rhegmatogenous retinal detachment (RRD) associated with spontaneous suprachoroidal hemorrhage (SSCH) with similar cases discussed in the literature.

Methods: The clinical data of two high myopia patients with RRD associated with SSCH were extracted. A systematic review of the literature was conducted using various databases. The clinical characteristics, treatments, and prognoses of the two cases treated at our hospital were compared with the case reports described in the literature.

Results: Both patients presented at our hospital with elongated axial eye lengths and hypotony. The patients underwent 23G recombinant tissue plasminogen activator (r-tPA)-assisted vitrectomy combined with silicone oil (SO) injection. The literature review identified seven similar cases. The intraocular pressure (IOP) in the literature cases ranged from 2 to 10 mmHg. Seven patients discussed in the literature had elongated axial lengths, of whom six had axial eye lengths measuring over 30 mm. All cases were managed with vitrectomy, and five out of the seven cases subsequently developed proliferative vitreoretinopathy (PVR).

Conclusion: RRD associated with SCH is an exceptionally rare condition, often leading to poor final visual outcomes. Long axial length appears to be the primary risk factor. Most patients present with hypotony, reflecting the underlying pathogenesis. r-tPA-assisted vitrectomy performed within 7 days following diagnosis may help reduce SCH and improve the likelihood of successful retinal reattachment.

Purpose: To evaluate the precision, safety, and efficacy of congenital cataract surgery performed using the 27-gauge vitrectomy system in infants.

Methods: This retrospective study analyzed 44 eyes from 22 pediatric patients (aged 3-5 months) with bilateral congenital cataracts. The following parameters were assessed: intraocular pressure, corneal diameters, axial length, and the occurrence of intraoperative and postoperative complications. Visual function was evaluated based on visual behavior in response to various stimuli. All patients were followed for a minimum of 6 months.

Results: A significant reduction in intraocular pressure was observed (from 15.8 ± 5.7 mmHg preoperatively to 12.2 ± 1.1 mmHg postoperatively, p = 4.64 × 10⁻⁷). The average duration of the surgical procedure was 30 ± 5 min. Postoperative complications were minimal and transient, including conjunctival hyperemia in 30% of eyes (resolved within one week) and mild anterior chamber reaction in 12% of eyes. No significant complications, such as retinal detachment or glaucoma, were observed during follow-up.

Conclusion: The use of the 27-gauge vitrectomy system for congenital cataract surgery in infants provides high surgical precision, low complication rates, and effective postoperative outcomes. Further prospective studies with longer follow-up are needed to confirm the long-term safety and efficacy of this approach.

Purpose: To analyze adverse events related to the Ex-Press® Glaucoma Filtration Device reported in the FDA's MAUDE database over a 10-year period.

Study design: A retrospective case series.

Methods: We retrospectively reviewed 533 unique adverse event reports submitted between January 1, 2015, and November 8, 2024. Data collected included patient demographics, reporter details, device model, event type (injury vs. malfunction), problem codes, and device availability for manufacturer evaluation. Descriptive statistics summarized patterns of device and patient problems.

Results: The median patient age was 72 years (range 20-94), with sex reported in 2.3% of cases. The P-50 PL model accounted for 98% of reports, followed by the P-200 PL (2%). Devices were available for evaluation in 36.8% of cases, but only 19.3% were evaluated. Reports were 61% injuries and 39% malfunctions. A total of 440 device-related and 457 patient-related problems were identified. The most common device problems were displacement (31.4%) and flow obstruction (26.8%). Among patient problems, increased intraocular pressure (27.6%) and iris contact (22.3%) were most frequent. Injuries predominated in 2015-2016 (73.7%), shifting to malfunctions from 2020 to 2024 (76.9%).

Conclusions: Adverse events involving the Ex-Press® device primarily include injuries and malfunctions, with device displacement and flow obstruction being most common. The observed shift likely reflects changes in device use and surveillance rather than true safety changes. Despite limitations of passive reporting, these findings offer valuable real-world insights that complement clinical trial data and highlight the utility of the FDA's MAUDE database as a tool for post-market surveillance. This approach can be replicated for other ophthalmic devices to enhance long-term safety monitoring and inform clinical decision-making.

Purpose: To evaluate the incidence, timing, and clinical characteristics of posterior capsule opacification (PCO) and Nd:YAG laser capsulotomy after uneventful cataract surgery with implantation of the ENOVA GF3 single-piece hydrophobic acrylic intraocular lens (IOL).

Methods: In this retrospective study, the medical records of patients with a minimum of 6 months follow-up who underwent uncomplicated phacoemulsification with in-the-bag implantation of the ENOVA GF3 hydrophobic monofocal IOL between January 2022 and December 2024 were reviewed. Standardized phacoemulsification was performed by a single surgeon, including posterior capsule polishing and verification of capsulorhexis-optic overlap. Postoperative best-corrected visual acuity (BCVA), refractive outcomes, and slit-lamp findings were recorded. Nd:YAG capsulotomy was performed when BCVA declined to 20/50 or worse or when central PCO impaired visual function or fundus visualization. The primary outcomes were the rates of PCO and Nd:YAG capsulotomy and the time intervals from surgery to PCO detection and capsulotomy.

Results: A total of 151 eyes of 150 patients with mean age of 65.4±9.2 years were included. Significant improvement was observed in both uncorrected and corrected distance visual acuity at all postoperative visits (p 0.05). Postoperative refractive outcomes showed stability toward emmetropia with progressive reduction in spherical and cylindrical error (p 0.05). PCO developed in 5 eyes (3.3%). Of these, 3 cases (60%) were identified at postoperative month 1 and 2 cases (40%) at month 3. All PCO cases required Nd:YAG capsulotomy, performed at month 3 in 2 eyes (40%) and month 6 in 3 eyes (60%). No Nd:YAG-related complications were documented.

Conclusion: The ENOVA GF3 single-piece hydrophobic acrylic IOL demonstrated a low 1-year incidence of PCO (3.3%) requiring Nd:YAG capsulotomy, which may be attributed to its hydrophobic acrylic material, sharp posterior optic edge, and stable in-the-bag positioning. These findings support the favorable posterior capsular performance and optical stability of the ENOVA GF3 IOL. Longerterm, comparative, and prospective studies are warranted to further assess modifiable factors influencing PCO development.

Background: To analyze the global scientific output, research trends, and thematic evolution related to choroidal thickness and choroidal vascularity index (CVI) using bibliometric methods and science mapping.

Methods: This bibliometric study analyzed research outputs on choroidal thickness and CVI retrieved from in the Web of Science database from 1990 up to 2025. The Science Mapping Analysis Tool (SciMAT) was used to visualize thematic structures and predict research trends in this field.

Results: The annual distribution of publications showed a marked increase in research output starting from 2010, with the highest number of publications observed in 2021 (n = 174). Turkey was the most productive country in this field (n = 411). The total number of citations was 41,929, with an average of 25.46 citations per publication. The most prolific author was Chhablani J (n = 29), while "Optical Coherence Tomography" was identified as the most frequently used keyword.

Conclusions: The growing body of literature on choroidal thickness and CVI reflects increasing interest in their clinical and research significance. This study not only identifies key contributors and trends but also reveals the thematic evolution and emerging research areas in the field. These insights may help researchers better understand the current landscape and guide future investigations.

Purpose: Accurate segmentation of tumor-infected regions in retinal Optical Coherence Tomography (OCT) images is critical for early diagnosis and clinical decision-making. However, conventional deep learning and transformer-based models often struggle to delineate overlapping and inter-dependent pixel features, leading to reduced segmentation precision. This study proposes a novel Dependent Inter-Feature Segmentation Method (DIFSM) to improve the localization and segmentation of retinal tumor regions in OCT images.

Methods: The proposed DIFSM framework integrates advanced image preprocessing, inter-feature dependency analysis, and a Vision Transformer (ViT) architecture to distinguish differentiable and non-differentiable features. Overlapping pixel regions are identified through inter-feature intensity and gradient analysis, which are indicative of tumor-affected areas. The Vision Transformer is trained using matched and unmatched inter-feature representations to enhance contextual learning and resolve feature ambiguities. Experiments were conducted on the OCTID dataset comprising high-resolution retinal OCT images, and performance was evaluated using Dice coefficient, Intersection over Union (IoU), precision, sensitivity, specificity, and Mean Square Matching Error (MSME). Comparative analysis was performed against state-of-the-art segmentation models.

Results: The proposed DIFSM model achieved a Dice coefficient of 96.2% and an IoU of 94.8%, demonstrating excellent spatial overlap with expert-validated tumor regions. Precision, sensitivity, and specificity reached 96.8%, 96.6%, and 96.7%, respectively, while MSME was reduced to 6.11%. Compared to existing methods, DIFSM improved segmentation accuracy by 14.39%, precision by 14.11%, and reduced MSME by 13.5%. The model consistently outperformed benchmark approaches in detecting macular hole and central serous retinopathy-associated tumor regions while maintaining robustness to noise and structural variability.

Conclusion: The proposed DIFSM framework effectively addresses the limitations of existing OCT segmentation methods by explicitly modeling inter-feature dependencies and resolving overlapping pixel ambiguities using a Vision Transformer. The significant improvements in segmentation accuracy and error reduction highlight its potential as a reliable and clinically applicable tool for automated retinal tumor detection in ophthalmic imaging. DIFSM offers a promising direction for enhancing OCT-based diagnostic systems and supporting ophthalmologists in early disease identification and treatment planning.