International Ophthalmology最新文献

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.

Background: To investigate the relationships between chord α and chord μ with age, ocular biometric indices, and wavefront aberrations in pre-operative refractive surgery candidates.

Methods: This cross-sectional study included 111 right eyes of 111 patients. Ocular biometrics and chord values were measured using the ZEISS IOLMaster 700. Corneal and ocular aberrations were assessed with the PERAMIS pyramidal aberrometer. Data were analyzed using Pearson's correlation, ANOVA, and simple linear regression to evaluate the interplay between variables.

Results: A moderate positive correlation was found between chord α and chord μ (r = 0.60, p < 0.001). Chord α demonstrated moderate positive correlations with subjective spherical refraction (r = 0.45) and spherical equivalent (r = 0.41), and moderate negative correlations with anterior chamber depth (r = - 0.53) and axial length (r = - 0.40) (all p < 0.001). In contrast, correlations involving chord µ were exclusively weak, though it showed significant associations with several higher-order aberrations, including corneal trefoil (r = 0.35) and ocular coma (r = 0.31). Refractive status significantly affected both chord values (p ≤ 0.02), with severely myopic eyes showing the lowest values. Regression analysis identified anterior chamber depth as the strongest anatomical predictor for chord α (R² = 0.28).

Conclusion: Chord α serves as a more robust indicator of the eye's anatomical characteristics than the more variable chord µ. Our findings underscore the clinical importance of optical decentration in surgical planning, as larger chord values may indicate a greater risk of pre-existing aberrations and potential impacts on visual quality.

Introduction: This study aims to evaluate the long-term outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) at a tertiary care center in Saudi Arabia over a 15-year period, focusing on the graft survival, visual improvement, complications rates, and graft insertion techniques.

Methods: This is a retrospective study that included all patients who underwent DSAEK at King Abdulaziz University Hospital (KAUH), Riyadh, between 2009 and 2024. Data were collected on demographics, surgical details, visual acuity, graft survival, and complications. Primary and secondary graft failures were clarified, and risk factors were analyzed using univariate and multivariate Cox regression. Kaplan-Meier survival curves were used to represent the grafts survival, and surgical techniques (Lens Glide vs. Busin Glide) were compared.

Results: A total of 179 eyes from 163 patients were included. The overall graft survival rate was 69.3%, with cumulative survival of 81.0% at 1 year, 63.8% at 3 years, and 51.7% at 5 years. Visual acuity improved in 46.9% of patients, and 22.0% achieved 20/40 or better. Postoperative complications occurred in 38.5% of cases, with endothelial rejection being the leading cause of graft failure (49.1%). In multivariate analysis, postoperative complications were the only independent risk factor for failure (HR = 2.67, 95% CI: 1.71-4.18, p < 0.001). Although not statistically significant, a trend toward decreasing survival rates was evident with repeated DSAEK. Among surgical techniques, the lens glide group had no primary failures in the single-surgeon subgroup and demonstrated higher success rates than busin glide (p = 0.026).

Conclusions: DSAEK provides favorable long-term outcomes, though prior surgeries, glaucoma, and postoperative complications, specifically endothelial rejection, can negatively impact graft survival. Surgical technique may influence early failure rates, emphasizing the importance of gentle tissue handling and surgeon expertise.

Purpose: To evaluate the anatomical and refractive outcomes of secondary in-the-bag intraocular lens (IOL) implantation following phacovitrectomy with anterior capsule polishing, by comparing it with primary IOL implantation.

Methods: Fifty-two patients who underwent phacovitrectomy were included in this prospective study and divided into two groups based on IOL implantation timing. Postoperative IOL tilt, decentration, objective optical quality, and refractive prediction error were compared between the secondary and primary groups at 3 months postoperatively.

Results: The mean IOL tilt and decentration were 4.93 ± 1.52° and 0.23 ± 0.21 mm in the secondary group, and 4.75 ± 1.82° and 0.23 ± 0.14 mm in the primary group (P > 0.05 for both). For objective optical quality, no significant differences were found in intraocular and ocular higher-order aberrations, higher-order modulation transfer function, and Strehl ratio between the two groups for 3 mm and 5 mm pupils. The primary group exhibited a slight hyperopic shift, with a mean prediction error of 0.54 ± 0.41 D, which was significantly higher than that of the secondary group (- 0.05 ± 0.70 D; P = 0.001). However, there was no difference in mean absolute error between the two groups.

Conclusion: Secondary in-the-bag IOL implantation is a viable option following phacovitrectomy with anterior capsule polishing, offering a good IOL position and satisfactory refractive outcomes.

Purpose: We aim to assess epiretinal membrane (ERM) prevalence in pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG) eyes and examine its correlation with choroidal thickness (CT) in these individuals.

Methods: In this retrospective, observational study, we examined 165 eyes of 94 PXG patients, 157 eyes of 82 POAG patients, and 150 eyes of 75 healthy individuals. We conducted a comprehensive ophthalmological assessment, including measurements of retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and macular CT using swept-source optical coherence tomography. We also evaluated and categorized posterior vitreous detachment (PVD) presence. ERM staging was performed for eyes with ERM. Lastly, we analyzed the association between ERM presence and CT across all groups.

Results: BCVA and mean RNFL were lower in PXG and POAG groups compared to controls (both p < 0.001). Mean CMT was significantly thinner in PXG versus controls (p < 0.001) and POAG (p = 0.002). ERM prevalence was higher in POAG versus controls and highest in PXG versus both groups. PVD was least in controls, more in POAG, and most in PXG. In PXG with ERM, temporal and nasal CT were higher (p = 0.022, p = 0.016). In the POAG subgroup, eyes receiving prostaglandin analogue therapy had significantly greater subfoveal CT (SFCT) compared with those not undergoing this treatment (p = 0.032).

Conclusion: According to our study, CMT is thinner in PXG eyes. ERM and PVD frequencies increase in POAG and PXG, with higher prevalence in PXG. PXG eyes with ERM exhibit increased nasal and temporal choroidal thickness, and in POAG eyes receiving prostaglandin analogue therapy, SFCT is higher compared to those not receiving this treatment.

Purpose: To present anatomical and functional outcomes of human amniotic membrane (hAM) grafting for the repair of chronic and refractory macular holes (MH).

Methods: Twenty-four eyes with chronic or persistent MH were included. Eleven patients had a history of failed pars plana vitrectomy (PPV) to repair the MH and underwent secondary hAM grafting (Group 1). Thirteen patients underwent primary PPV combined with hAM grafting (Group 2). Chronic MH was defined as symptom duration > 12 months or persistence after previous unsuccessful PPV. A cryopreserved hAM graft was placed underneath the MH edges with the chorionic side facing the retinal pigment epithelium (RPE). Air tamponade was used for all patients, with 24-h face-down positioning.

Results: The mean age of the patients was 68.8 ± 6.1 (55-78) years; male/female ratio was 8/16. The mean best-corrected visual acuity (BCVA) improved from 1.3 ± 0.1 (2-0.7) LogMAR preoperatively to 0.7 ± 0.8 (2-0.2) LogMAR postoperatively (p < 0.01). Median basal MH diameter was 1501.8 ± 351.1 (1043-2550) µm; minimum MH diameter was 727.8 ± 198.7 (517-1230) µm. Type 1 closure was achieved in 79.2% and type 2 closure in 20.8% of cases; several type 2 closures evolved into type 1 over time. Closure rate was 100% with a single surgery in both groups.

Conclusion: hAM grafting is an effective technique for closure of chronic or persistent MH, achieving 100% anatomic success. Type 2 closures may evolve into type 1 over time, suggesting dynamic postoperative healing. Further studies with larger cohorts and longer follow-up are warranted.