Journal of Ophthalmology最新文献

Purpose: Several studies have suggested that blue-light filtering (BLF) can enhance the perception of brightness. Evidence for this effect, however, in pseudophakic patients, particularly using natural images, is lacking. The present study tested whether a common BLF spectral profile, often used in intraocular lens (IOL) designs, would influence brightness perception of natural images in pseudophakic individuals.

Methods: Forty pseudophakic participants (M = 71.15 ± 2.27 years) with 20/40 or better best-corrected visual acuity implanted with clear IOL implants completed a brightness matching task. Participants viewed a series of natural images through both a clear extraocular filter and a BLF test lens. The test lens was designed to approximate a typical BLF IOL transmission profile. Filter conditions were counterbalanced and randomized. Participants adjusted a short-wave deficient comparison field until the natural scene and the comparison fields were perceived as equally bright. Matched luminance values (log relative energy, LRE) were recorded across six trials per image. Images were achromatic or short-, mid-, and long-wave dominant.

Results: Averaged across all images, the clear lens ( $\overline{X}$  = 2.74 ± 0.14) resulted in significantly lower (t _[78] = -2.529, p = 0.007) LRE values compared to the BLF test lens ( $\overline{X}$  = 2.82 ± 0.15) indicating a modest (∼17%) increase in perceived brightness with the BLF lens. This effect was observed for four of five natural images tested and was not dependent on image contrast or chromatic content.

Conclusions: The BLF produced a significant and consistent increase in perceived brightness in pseudophakic adults. These findings provide direct psychophysical evidence that clinically relevant BLF profiles can influence brightness under natural viewing conditions. Information of this type is necessary for the evaluation of BLF IOL designs and their effects on functional visual experiences following cataract surgery.

Introduction: To assess the efficacy and safety of topography-guided LASIK (TG-LASIK) in correcting myopia and astigmatism and to evaluate clinical outcomes and visual quality postoperatively.

Methods: We conducted a prospective study including patients aged 18-40 years with stable refraction for over 12 months. The outcomes measured were uncorrected distance visual acuity (UDVA), contrast sensitivity, higher-order aberrations (HOAs), and patient-reported visual quality using a validated Quality of Vision (QoV) questionnaire.

Results: A total of 86 eyes of 43 patients were analyzed. At 12 months postoperatively, 97% of the eyes achieved a UDVA of 20/20 or better, and 99% maintained or improved their corrected distance visual acuity (CDVA). The mean UDVA remained stable over time (p > 0.05). The correction index for astigmatism was 0.99, with a strong correlation between target-induced astigmatism (TIA) and surgically induced astigmatism (SIA) (R ² = 0.9751). Contrast sensitivity improved significantly at all spatial frequencies postoperatively (p < 0.05) and remained stable after 6 months. The QoV questionnaire revealed that blurred vision and fluctuations in vision were the most frequently reported symptoms, with fluctuation being the most bothersome. HOAs and coma increased significantly after surgery (p < 0.05), whereas lower-order aberrations (LOAs) and spherical aberration remained unchanged (p > 0.05).

Conclusions: TG-LASIK is an effective approach in personalized refractive surgery, demonstrating safety and efficacy in improving visual quality for myopia and astigmatism. The improvement in visual quality, despite an increase in HOAs, suggests the effectiveness of personalized ablation profiles.

Aim: To compare the surgical outcomes and assess the effectiveness of a three-dimensional digital visualization system (3DVS) versus traditional microscope-assisted pars plana vitrectomy in the management of infectious endophthalmitis.

Methods: A retrospective case series study was conducted on 29 patients diagnosed with infectious endophthalmitis who underwent 23-gauge transconjunctival vitrectomy between 1 Jan. 2020 and 31 Aug. 2023. Of all these patients, 16 cases underwent vitrectomy-assisted by the 3DVS (3D group), and the other 13 cases by traditional microscope (eyepiece group). The main comparison focuses on the differences between the two systems in terms of operation time, the brightness of the endoillumination, complications, and preoperative and final best-corrected visual acuity (BCVA, logMAR).

Results: There were no significant differences in baseline characteristics between the two groups, with trauma being the most prevalent cause of infection (10 vs 8). The positive detection rate of pathogenic bacteria exceeded 40% in both groups (43.75% vs. 46.15%). The results showed that the incidence of complications, including high intraocular pressure (3 vs. 4) and retinal detachment (4 vs. 3), did not differ significantly between the groups (chi-square = 0.2857, p = 0.5930). The mean operation time was slightly shorter in the 3D group (75.94 ± 25.70 min) compared to the eyepiece group (82.31 ± 25.38 min, p = 0.5102). However, the 3D group exhibited significantly lower endoillumination (25%-35%) than the eyepiece group (40%-50%, p < 0.0001). Both groups demonstrated significant improvement in BCVA at the end of follow-up (p = 0.0006, t = 4.321). The mean final BCVA for the 3D group was 1.373 ± 0.9824 logMAR, which was modestly superior to the eyepiece group's mean of 1.805 ± 0.9549 logMAR.

Conclusion: The 3DVS provides comparable surgical outcomes to the traditional microscope, with the advantages of clearer intraoperative visualization, lower required illumination, and optimized ergonomic design. It is suitable for complex and prolonged endophthalmitis surgery, offering excellent safety and efficacy.

Background: An alternative glaucoma treatment is selective laser trabeculoplasty (SLT) that can effectively reduce intraocular pressure (IOP) and decrease the burden of glaucoma management. With newly published randomized controlled trials (RCTs) comparing SLT and medication, an updated systematic review and meta-analysis was needed.

Methods: A literature search of RCTs comparing SLT and medication in open-angle glaucoma patients was conducted until January 12, 2024 in CINAHL, Cochrane Library, EMBASE, MEDLINE, Web of Science, ClinicalTrials.gov, and Dissertations and Theses databases. Cochrane Risk of Bias 2 (ROB2) was used to assess the quality of the included RCTs.

Results: The included 16 RCTs comprised 2412 patients. At 26 weeks, the combination treatment of SLT and medication had a significant IOP reduction (SMD = 0.78, 95% CI = [0.56, 1.01], p < 0.01, I ² = 0.00%). At 52 weeks or longer, both the SLT group (SMD = 1.91, 95% CI = [1.55, I ² = 73.99%) and the medication group (SMD = 1.70, 95% CI = [1.01, 2.38], p < 0.01, I ² = 92.87%) had significant IOP reduction. At 6 months, the combination treatment significantly reduced the mean number of medications used by 0.78 (SMD = 0.78, 95% CI = [0.56, 1.01], p < 0.01, I ² = 0.00%) where the medication treatment had no significant decrease (SMD = -0.01, 95% CI = [-0.23, 0.21], p = 0.93, I ² = 0.00%). Quality of life between participants in the SLT and medication groups was found to be similar.

Conclusion: Long-term IOP reduction was greater in the SLT treatment compared to medication. SLT treatment significantly reduced the number of medications used by participants whereas medication group had no significant change.

Purpose: This study evaluated the impact of clear corneal incision (CCI) morphology on corneal endothelial cell density (ECD), astigmatism, and higher-order aberrations (HOAs) following implantable collamer lens (ICL) implantation.

Design: Prospective study.

Methods: Sixty-five patients (65 eyes) undergoing ICL implantation were included. CCI characteristics were assessed with the AS-OCT CASIA 2, and HOAs were measured using the Pentacam. Corneal astigmatism changes were analyzed using Aplin's vector analysis.

Results: The study divided the eyes into two groups: intact incision (29 eyes, with well-aligned wound architecture) and defective incision (36 eyes, with misaligned incision planes or endothelial gaps). At 3 months postoperatively, corneal thickness at the incision exit (CT-Ex) was significantly different between the groups (p = 0.038). The incision exit angle (Angle-Ex) also differed significantly at 1 month (p = 0.023) and 3 months (p = 0.022). The defective incision group showed increases in incision length (IL) and the distance from the entry incision to the center (Dis-En) between 1 and 3 months (p = 0.006 and p = 0.034, respectively). Both groups showed significant reductions in CT-Ex, CT-En, and Angle-Ex at 3 months. In the defective incision group, trefoil, quadrafoil, and spherical aberrations increased significantly (p < 0.05) while ECD decreased significantly (p < 0.05).

Conclusions: Shorter IL and smaller exit angle during ICL surgery increase the risk of forming defective incisions, leading to more HOAs and greater ECD loss within the 3-month postoperative period.

Purpose: To compare clinical and corneal epithelial changes between preservative and preservative-free artificial tear therapy using the MS-39 in patients with dry eye disease (DED).

Methods: This prospective interventional comparative study included 88 eyes of 44 patients. Preserved artificial tears were given for the left eye (group A) and preservative-free artificial tears for the right eye (group B). They were evaluated before and 3 months after treatment using MS-39. The dry eye parameters and corneal epithelial thickness were recorded.

Results: There was an increase in the NIBUT and improvement in the severity by OSDI score (p-value < 0.001) in each group. There was no significant difference in the mean NIBUT between the two groups (p-value = 0.470). Improvement in the OSDI score (p-value = 0.026) and mean post-treatment epithelial thickness in the central, paracentral superior, and peripheral inferior epithelial areas were significant in the preservative-free group than the preservative one (p-value = 0.033, 0.034, and 0.023, respectively).

Conclusion: Although both preservative-free and preserved artificial tears show an increase in epithelial thickness using MS-39 and improvement in OSDI, preservative-free artificial tears show superiority, subjectively and objectively, compared to preserved artificial tears using even lighter preservatives, being a safer option for long-term application.

Background: To investigate the impact of refractive and ocular residual astigmatism (ORA) on stereopsis after photorefractive keratectomy (PRK) for the correction of myopic astigmatism.

Methods: This prospective observational study was conducted on patients who underwent PRK for the treatment of myopia and myopic astigmatism using a Schwind Amaris 1050RS excimer laser system. Stereoacuity was measured using the Stereo Fly Test before and after the surgery. We evaluated the impact of pre-op refractive and internal astigmatic components on stereopsis outcome after surgery. To calculate ORA, we calculated the vectorial difference between corneal plane refractive astigmatism and keratometric astigmatism.

Results: Ninety-six eyes from 96 patients including 70 females (72.9%) with a mean age of 29.83 ± 7.39 years were enrolled. The average stereoacuity measured in log units before and after PRK was 1.65 ± 0.09 and 1.63 ± 0.07, respectively (p = 0.17). Patients who showed stereopsis improvement had a higher mean cylindrical error compared to those who did not (p = 0.04). The average pretreatment ORA was 0.84 ± 0.37 in patients who experienced deterioration in stereopsis, 0.77 ± 0.35 in patients who maintained the same level, and 0.80 ± 0.35 in patients who showed improvement (p = 0.77).

Conclusion: This study showed the potential relationship between higher astigmatism and the enhancement of stereopsis after PRK. Furthermore, our study found no significant impact of ORA on the outcomes of stereopsis following PRK.

Purpose: This article aims to determine the efficacy of a modified technique by a positive rotational internal limiting membrane (ILM) covering for the treatment of large idiopathic macular holes (IMHs).

Methods: A prospective analysis was conducted on a cohort of 13 patients with large IMH (> 400 μm). The ILM was dissected in approximately one diameter width of the optic disc from the inferior and temporal sides. Subsequently, a pedicled ILM flap connected to the optic disc was grasped and peeled from the superior edge of the residual ILM with a width of at least 2 papilla diameters (PDs). The pedicled ILM flap was then directly rotated to cover the IMH in a positive way. Some peeled-off ILM samples were collected for scanning electron microscopy (SEM) examinations. During each follow-up, best-corrected visual acuity (BCVA), SD-OCT scans, and M-CHARTS were performed.

Results: The study successfully detected IMH closure in all cases. The mean BCVA (logMAR) showed a decrease from 1.18 ± 0.209 to 0.58 ± 0.202 (p < 0.001). Postoperatively, there was a significant reduction in the diameter of the ellipsoid zone (EZ) and external limiting membrane (ELM) defects compared to preoperative values (p < 0.001). Additionally, the defect size decreased further at the 3-month follow-up compared to the 1-month follow-up. Both horizontal and vertical deformations postoperatively showed significant improvements (p = 0.001, p < 0.001). At the final follow-up, 7 eyes exhibited U-shaped closure while 6 eyes showed V-shaped closure.

Conclusion: This technique is an effective treatment for larger IMHs. This technique has the potential to improve vision outcomes. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2300068411.

Introduction: Primary idiopathic epiretinal membrane (iERM) is a common finding in people aged 50 years or over. It is treated with vitrectomy. There are no definite criteria for when to conduct surgery, and outcomes are variable. This systematic review assessed the effectiveness and cost-effectiveness of vitrectomy surgery for iERM.

Material and methods: Medline, Embase, Cochrane Library and Scopus were searched. Prospective cohort studies, randomised controlled trials (RCTs) and health economics studies published from 2000 to May 2024 were included. The efficacy endpoint was the mean change in best-corrected visual acuity (BCVA) from baseline. Summarising effect estimates were used to synthesise results.

Results: Twelve included studies (11 case series and 1 RCT) met the eligibility criteria. The length of the follow-up ranged from 1 week to 2 years after surgery. The majority of studies were carried out in Asia. Vitrectomy showed improvement in BCVA from baseline. The studies exhibited a wide range in the mean change of BCVA, with the greatest median change 12 months after surgery (0.29, IQR: 0.065). The RCT showed no significant difference between surgery and watchful waiting. Three studies used the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25) as their only patient-reported outcome to measure vision-related quality of life for iERM. The composite scores of NEI-VFQ-25 were significantly improved at 3 and 12 months after surgery. Vitrectomy surgery was found to be cost-effective in one included study, with an incremental cost-effectiveness ratio of $4680 per quality-adjusted life year gained.

Conclusion: Vitrectomy surgery demonstrated improvement in BCVA from baseline, but the RCT with a watchful waiting group showed no significant difference. Vitrectomy surgery was cost-effective. An RCT comparing iERM vitrectomy surgery and either delayed surgery or no surgery, and a health economics evaluation of the intervention are needed to confirm the effectiveness and cost-effectiveness of iERM vitrectomy surgery.

Background: To evaluate visual acuity outcome after excimer laser phototherapeutic keratectomy (PTK) for epithelial basement membrane dystrophy (EBMD) and to provide new insights into higher-order aberrations (HOAs) and corneal density changes.

Methods: In this single-center cohort, 92 eyes from 80 individuals underwent PTK for EBMD, with follow-up durations reaching up to 7.5 years (mean 332 ± 526.5 days).

Results: Mean BCVA in EBMD improved by 0.17 ± 0.17 logMAR (p < 0.001) for patients without visual acuity limitations and by 0.14 ± 0.31 (p = 0.004) logMAR if patients had additional visual acuity limitations. Refraction remained stable after PTK. HOA reduced by 0.16 ± 0.23 μm (p < 0.001), corneal density by 6.73 ± 11.83 gray scale units (p < 0.001), and K _max by 1.02 dpt (±2.73) (p = 0.006) after PTK. A correlation before and after PTK between HOA (p = 0.014 and 0.002), corneal density (p < 0.002), and K _max (p = 0.010) with BCVA was observed. Light haze occurred in 10% of the cases. Re-PTK was necessary for 1 patient (1.1%).

Conclusion: PTK significantly enhances visual acuity in patients with EBMD, independently of additional visual acuity limitations. The significant reduction of HOA, corneal density, and K _max as well as the correlation of these parameters with visual acuity prove an effective therapy on an objective level.