Journal of Ophthalmic & Vision Research最新文献

Purpose: To evaluate the influence of preoperative ocular and systemic variables on intraocular pressure (IOP) change following phacoemulsification cataract extraction with intraocular lens (CEIOL) implantation in eyes without glaucoma.

Methods: This retrospective cohort study included adults who underwent standalone CEIOL at a single academic center between 2017 and 2020. Preoperative demographic, ocular, and systemic health data were extracted from electronic health records using an informatics-based approach and validated by chart review. Eyes with glaucoma or other preoperative ocular conditions known to affect IOP were excluded. Postoperative IOP data were collected for up to 2 years and censored at the time of any subsequent diagnosis or treatment likely to influence IOP. A linear mixed-effects model was used to assess associations between IOP change and preoperative ocular (e.g., IOP, axial length, central corneal thickness) and systemic variables (e.g., diabetes, body mass index [BMI], smoking status), accounting for inter-eye correlation.

Results: A total of 1992 eyes from 1755 patients were included. Higher preoperative IOP ( $\beta$ = -0.563, P $<$ 0.001) and female gender ( $\beta$ = -0.229, P = 0.005) predicted greater postoperative IOP reduction. Longer axial length ( $\beta$ = 0.201, P $<$ 0.001), diabetes mellitus ( $\beta$ = 0.291, P = 0.019), thicker cornea ( $\beta$ = 0.008, P $<$ 0.001), and higher BMI ( $\beta$ = 0.022, P = 0.005) were associated with a relative increase in postoperative IOP.

Conclusion: Both ocular and systemic variables significantly influenced postoperative IOP change following CEIOL in non-glaucomatous eyes. Understanding these associations may improve clinical decision-making and help tailor IOP-related counseling for patients undergoing cataract surgery.

Intraocular lymphoma (IOL) is a rare form of non-Hodgkin lymphoma that primarily presents in two distinct types. The first type, known as primary intraocular lymphoma (PIOL), is mainly recognized as a subtype of primary central nervous system lymphoma (PCNSL). Recent classifications have emphasized the primary ocular sites affected, with vitreoretinal lymphoma emerging as the most common variant linked to PCNSL. Despite its rarity, the incidence of PIOL is rising among both immunocompromised and immunocompetent populations. Most cases of PIOL are identified as diffuse large B-cell lymphoma, although rare T-cell variants have also been reported. Secondary intraocular lymphoma (SIOL) originates from metastatic spread of non-CNS lymphomas to the ocular structures, including the retina, uvea, vitreous body, Bruch's membrane, and optic nerve. Diagnosis of IOL is challenging for ophthalmologists and pathologists, as it can easily mimic other ocular conditions. Advancements in laboratory diagnostics, such as immunocytochemistry, flow cytometry, and the evaluation of interleukin ratios (specifically IL-10:IL-6 $>$ 1), along with polymerase chain reaction (PCR) amplification for clonality, have enhanced diagnostic accuracy. Multimodal imaging approaches and molecular analyses can serve as valuable indicators of visual prognosis, recurrence rates, and the likelihood of progression to central nervous system involvement. Given that misdiagnosis or delayed diagnosis can result in serious treatment delays and potentially life-threatening outcomes for patients with IOL, this review seeks to provide a comprehensive understanding of the clinical manifestations of IOL and the diagnostic methods employed.

Purpose: To evaluate the systemic immune-inflammation index (SII) and unconjugated bilirubin levels in patients with pseudoexfoliation syndrome (PEX) and compare them with those of healthy individuals (controls).

Methods: The PEX group (n = 48) and the control group (n = 88) were retrospectively evaluated. The results of ophthalmic examinations and routine laboratory parameters were analyzed, and the SII was calculated as follows: SII = platelet count $\times$ (neutrophil/lymphocyte).

Results: The neutrophil-to-lymphocyte ratio (NLR) (P = 0.04) and SII (P = 0.03) were higher, and unconjugated bilirubin levels (P = 0.03) were significantly lower in the PEX group than in the control group. Univariate regression analysis showed that the unconjugated bilirubin levels (OR = 0.26; 95% CI, 0.07 to 0.95; P = 0.04) and SII (OR = 1.01; 95% CI, 1.00 to 1.01; P = 0.04) were correlated with PEX. Multivariate logistic regression analysis revealed that the correlation between bilirubin levels (OR = 0.02; CI, 0.01 to 0.25; P = 0.002) and SII (OR = 1.01; CI, 1.00 to 1.02; P = 0.001) remained statistically significant when adjusted for age, gender, and Charlson comorbidity index score.

Conclusion: High SII and low bilirubin values in patients with PEX were found to be correlated.

Purpose: To evaluate the effect of wearing an N95 mask on intraocular pressure.

Methods: This cross-sectional study enrolled 34 medical staff volunteers. After baseline eye examinations, all participants were asked to wear an N95 mask for 1 hour. Then, O ${}_2$ saturation, pulse rate, and blood pressure were evaluated, and sequential IOP measurements were performed using both iCare and Goldmann applanation tonometers. All measurements were taken again 1 hour after the mask was removed. Finally, all information was collected for statistical analysis.

Results: A total of 34 participants (68 eyes) with a mean $\pm$ SD age of 38.97 (12.41) years were included. The mean value of IOP/GAT increased significantly by 1.20 mmHg after wearing the mask (12.50 to 13.70 mmHg, P-value $<$ 0.001) and then decreased significantly by 1.27 mmHg after removing the mask (13.70 to 12.43 mmHg, P-value $<$ 0.001). The mean O ${}_2$ saturation increased significantly from 96.4 with the mask to 97.05 after mask removal (P-value $<$ 0.001). Although the mean pulse rate decreased by about 1.5 units after removing the mask, the difference was not significant. The mean blood pressure decreased after removing the mask; however, the change was not statistically significant. Additionally, no significant relationship was found between the change in IOP and O ${}_2$ saturation.

Conclusion: The use of N95 face masks could substantially increase IOP and reduce O ${}_2$ saturation.

Purpose: To determine the optimal cut-offs for Pelli-Robson (PR) and Spaeth/Richman contrast sensitivity (SPARCS) test scores for diagnosing glaucoma and to compare PR and SPARCS scores (total and individual quadrants) for assessing contrast sensitivity in patients with glaucoma.

Methods: This study was a single-center, cross-sectional, two-group analysis of 87 glaucomatous eyes and 87 non-glaucomatous control eyes. We assessed visual acuity, refraction, intraocular pressure (IOP), cup disc ratio (CDR), and anterior chamber depth in these patients. The PR score for central contrast sensitivity was obtained, and the SPARCS scores were generated for four outer zones and the central region.

Results: The mean IOP [SD] was significantly higher in the glaucoma group (19.3 [5.2] mm Hg) compared with the control group (17.5 [3.6] mm Hg; P = 0.008). The mean CDR [SD] was significantly higher in the glaucoma group compared with the control group (0.73 [0.14] vs. 0.46 [0.12]; P $<$ 0.001). The mean [SD] PR score (1.48 [0.17] vs. 1.23 [0.19]; P $<$ 0.001) and total SPARCS score (78.2 [5.1] vs. 62.4 [11.2]; P $<$ 0.001) were significantly higher in the control group compared with the glaucoma group. The optimal cut-off for identifying glaucoma was 1.35 for the PR score and 70 for the total SPARCS score. At this value of SPARCS score, the sensitivity for identifying glaucoma was 83.9% (95% CI, 74.5 to 90.9), specificity was 96.6% (95% CI, 90.3 to 99.3), positive predictive value (PPV) was 96.1% (95% CI, 88.9 to 99.2), and negative predictive value (NPV) was 85.7% (95% CI, 77.2 to 92.0). The area under the curve (AUC) value was significantly higher for the total SPARCS score compared with the PR score (0.92 vs. 0.83; P = 0.001). All individual SPARCS scores (superior nasal, superior temporal, central, inferior nasal, and inferior temporal) had lower AUC, sensitivity, specificity, PPV, and NPV values compared with the total SPARCS score.

Conclusion: At the optimal cut-offs, the total SPARCS score offers significantly better diagnostic test properties for identifying glaucoma compared with the PR score.

Hyperreflective choroidal foci (HCF) are a finding on optical coherence tomography that may serve as a biomarker in various retinal and choroidal pathologies. These discrete hyperreflective spots, identified in various layers of the choroid, have been linked to inflammatory, vascular, and degenerative conditions. This review examines the clinical significance, histopathological correlation, and implications of HCF in various diseases, including diabetic retinopathy, age-related macular degeneration, Stargardt disease, choroideremia, Vogt-Koyanagi-Harada disease (VKH), idiopathic posterior uveitis, retinitis pigmentosa, and central serous chorioretinopathy (CSR), as well as non-pathological states. Although further studies are required to validate the findings in each pathology described herein, HCF may be used as a background prognostic marker of disease progression and therapeutic response, albeit with caution.

Purpose: To report on the diagnostic and therapeutic approach in a patient with retinitis pigmentosa (RP), hypovitaminoses, and bilateral corneal involvement.

Case report: A 62-year-old woman, diagnosed with RP, presented with photophobia, sudden bilateral visual decline, and known long-term night blindness. Ophthalmic examination showed corneal perforation in the right eye, corneal ulcer in the left eye, and bilateral corneal hypoesthesia. She had undergone bariatric surgery and recently suspended vitamin supplementation. Blood tests revealed hypovitaminoses A, D, D3, and E. The patient underwent tectonic keratoplasty in the right eye and received topical therapy in the left eye, and then restarted vitamin supplementation as recommended by the nutritionist. Significant functional recovery was documented in both eyes at 1-, 3-, and 10-month follow-ups.

Conclusion: The case highlights the importance of an integrative approach that includes comprehensive history taking, targeted laboratory work-up, as well as accurate differential diagnosis, especially given the potential multifactorality of ocular symptoms and signs.

Purpose: To evaluate the intrasession repeatability and agreement in keratometric and wavefront measurements among three different instruments (Pentacam HR, Nidek OPD-Scan III [OPD], and Zeiss i-Profiler ${}^{\text{Plus}}$ [IPROF]) in a pediatric population with various clinical features.

Methods: This cross-sectional study included 217 eyes from 114 patients aged 6 to 17 years with different clinical features. The patients were divided into five groups: one control group (C) and four other groups, each presenting with keratoconus (KC), ocular allergy (OA), high astigmatism, or Down syndrome (DS). Statistical analyses included the intraclass correlation coefficient (ICC) for repeatability and Bland-Altman plots for agreement.

Results: The findings demonstrated excellent repeatability of keratometric parameters across all devices (e.g., K1 ICC: 99.53% for Pentacam, 98.10% for OPD, and 98.31% for IPROF). The Pentacam showed superior repeatability for aberrometry indices in the KC group, with ICC values exceeding 98% for high-order aberration root mean square (HOA RMS) and Zernike polynomials. However, in the DS group, repeatability was significantly reduced for certain parameters, such as the index of surface variance (ICC: 40.13%) and HOA RMS (ICC: 42.86%). Bland-Altman plots revealed variations among devices in asphericity, vertical coma, and HOA RMS, with the KC group exhibiting broader limits of agreement compared to the control group.

Conclusion: All three instruments showed good repeatability, with the Pentacam demonstrating superior reliability across all parameters, including aberrometry. However, agreement between devices was poor for key indices in patients with KC and DS.

Purpose: To compare the refractive accuracy of different intraocular lens (IOL) power calculation formulas in eyes with keratoconus (KCN) undergoing cataract surgery.

Methods: This retrospective case series included the medical records of patients with KCN who underwent optical biometry and cataract surgery with IOL implantation. The predicted spherical equivalent (SE) values were calculated using the Holladay 1, Hoffer Q, SRK/T, and SRK II formulas. Additionally, a subgroup analysis was performed for eyes with available data on anterior chamber depth to compare the accuracy of Haigis, Barrett Universal II, Barrett True-K, EVO 2.0, Kane, and Kane KCN formulas. The mean prediction error (PE), mean absolute error (MAE), median absolute error, and the percentage of eyes within a PE of $\pm$ 0.25 diopters (D), $\pm$ 0.50 D, $\pm$ 0.75 D, and $\pm$ 1.00 D were calculated.

Results: Forty-seven eyes of 30 patients were included. The MAE was significantly different among the Holladay 1, Hoffer Q, SRK/T, and SRK II formulas. The Holladay 1 and Hoffer Q formulas led to a hyperopic refractive shift. The SRK/T and SRK II formulas tended toward a myopic refractive outcome. The MAE was lowest for the SRK/T formula (0.39 D), followed by the Holladay 1 (0.48 D), Hoffer Q (0.59 D), and SRK II (0.87 D). Statistical analysis revealed a significantly lower MAE for the SRK/T formula compared to the Hoffer Q and SRK II formulas (P $<$ 0.05). The percentage of eyes within a PE of $\pm$ 0.50 D was 70.2% for SRK/T, 57.44% for Holladay 1, 48.93% for Hoffer Q, and 29.78% for SRK II. The subgroup analysis comprising 11 eyes showed no significant difference among six other formulas (Haigis, Barrett Universal II, Barrett True K, EVO 2.0, Kane, and Kane KCN), with Barrett True-K having the least MAE.

Conclusion: The SRK/T was the most accurate IOL power calculation formula in this study, and Holladay 1 could be an alternative choice. SRK II had the lowest accuracy in predicting refractive outcomes. Among modern formulas, Barrett True-K demonstrated the highest accuracy in eyes with KCN.

Ocular surface diseases (OSDs) are conditions that affect the eye's surface layers, including the cornea, conjunctiva, and glandular network, causing discomfort, visual disturbances, and tear film instability. OSDs include dry eye disease (DED), blepharitis, meibomian gland dysfunction, keratitis, conjunctivitis, and related disorders. These diseases represent a leading cause of ocular morbidity and are often accompanied by chronic inflammation, irritation, redness, and pain. Royal Jelly (RJ), a substance produced by worker bees, has been widely studied in ophthalmology for its therapeutic properties, including its ability to restore tear secretion, treat glaucoma and DED, and inhibit the production of reactive oxygen species (ROS). RJ is rich in proteins, fatty acids, and phenolic compounds, which contribute to its anti-inflammatory, antioxidant, antibacterial, vasodilatory, antitumor, and cholesterol-lowering properties. This review examines the pharmacological benefits of RJ, strategies to optimize its formulation, and methods for developing eye drop formulations-such as microemulsions and eye gels-for the treatment of OSDs. The literature supports RJ as a complementary therapy for OSDs due to its reported anti-inflammatory, antioxidant, and antimicrobial properties. Although preliminary studies are promising, more extensive clinical trials are required to establish standardized treatment protocols and confirm the efficacy and safety of RJ. The therapeutic potential of RJ components lies in their immunomodulatory properties, making them a compelling option for the treatment of OSDs. Further research is necessary to clarify their role in ocular regenerative medicine and expand their applications in clinical practice.