Journal of Ophthalmology最新文献

Purpose: Diving is an intense physical activity under hyperbaric and hyperoxic conditions. The aim of this study is to evaluate the long-term effects of diving on the thicknesses of retinal layers and retinal anatomy in professional deep and scuba divers. Methods: The study included 52 eyes of deep divers who dive to depths of more than 130 feet (ft), 49 eyes of scuba divers who dive up to 130 ft, and 66 eyes of the control group, consisting of nondiving but regularly exercising males. Measurements of macular retinal layer thicknesses, peripapillary nerve fiber layer thickness, subfoveal choroidal thickness, and peripheral retinal examinations with scleral indentation were performed and statistically compared between the groups. Results: The mean diving duration was 455.00 ± 318.88 h in deep divers and 451.67 ± 281.10 h in scuba divers. The retinal pigment epithelium (RPE) was statistically significantly thicker in deep divers than in scuba divers and the control group on the 3 mm ring of the Early Treatment Diabetic Retinopathy Study grid. Subfoveal choroidal thickness was significantly thicker in deep divers than in scuba divers (p < 0.05). RPE abnormalities showed a significant increase in both the deep and scuba diver groups (p=0.01). Conclusion: An increased thickening of the subfoveal choroid and RPE, resembling pachychoroid pigment epitheliopathy, was detected in deep divers over a long-term duration.

Purpose: Assess the comparative accuracy and reliability of postoperative toric intraocular lens (TIOL) alignment measurement methods: Casia2 and Adobe Photoshop with digital slit lamp images (PS method). Methods: In a study of 41 subjects with 58 eyes postimplantation of TIOL, we independently measured TIOL alignment with Casia2 and PS methods. The intraclass correlation coefficient (ICC_1,1) was employed to assess the repeatability of the Casia2 method. While ICC_2,1 for absolute agreement and Bland-Altman analysis were utilized to determine the interdevice agreement between the two methods, the regression analysis was conducted to identify any proportional bias. Results: Casia2 demonstrated excellent intradevice repeatability with an ICC_1,1 of 0.998. The absolute agreement between Casia2 and PS was very high with an ICC_2,1 of 0.999. The average discrepancy between the two measurement methods was -0.828°, with a 95% confidence interval (CI) ranging from -1.623° to -0.032°. The 95% limits of agreement (LoA) were between -6.761° and 5.105°, indicating a strong concordance in TIOL alignment measurements. Casia2 was capable of accurately measuring the TIOL axis alignment under conditions of pupil diameters (PDs) of 4 mm or greater. Conclusion: Casia2 and PS demonstrated significant concordance in measuring postoperative TIOL alignment, with Casia2 offering a more straightforward and accessible alternative, particularly beneficial for patients with suboptimal pupil dilation.

Background: To report the refractive outcomes of StreamLight transepithelial photorefractive keratectomy (PRK). Methods: A retrospective case series was conducted which included a total of 205 eyes of 109 patients who underwent StreamLight transepithelial PRK using the Alcon Wavelight EX500 excimer laser. All eyes had myopia or myopic astigmatism, and the preoperative spherical equivalent (SEQ) ranged from -0.63D to -7.25D. The primary postoperative outcomes were UDVA, CDVA and subjective refraction measured at least 3 months postoperatively. Results: Postoperatively, 196 eyes (95.6%) had a UDVA of 20/20 or better. The mean SEQ was -0.05 ± 0.31D and 189 eyes (92.2%) were within ±0.50D of the target SEQ. The mean refractive astigmatism was -0.28 ± 0.27D, and 181 eyes (88.3%) had ≤ 0.50D of astigmatism. The mean safety and efficacy indices were 1.01 ± 0.08 and 0.97 ± 0.12, respectively. Eight eyes lost 1 line of CDVA. Six of these were noted to have significant dry eyes and 2 had corneal haze. No eye lost two or more lines of CDVA. Conclusions: StreamLight transepithelial PRK results in excellent refractive outcomes for myopia and myopic astigmatism.

iStent (Glaukos, San Clemente, CA, USA), a minimally invasive glaucoma device, reduces intraocular pressure (IOP) by enhancing aqueous humor outflow when implanted into Schlemm's canal. Although it has demonstrated effectiveness in lowering IOP and slowing glaucoma progression, its applicability to the Taiwanese population, known for a higher incidence of normal-tension glaucoma (NTG) cases, requires validation. This retrospective case-control study, conducted from January 2018 to December 2020, aimed to assess the effectiveness of combining first-generation iStent with phacoemulsification (phaco-iStent) compared to phacoemulsification alone in Taiwanese patients diagnosed with primary open-angle glaucoma (POAG) and NTG, involving 71 eyes (iStent group: POAG 16 and NTG 8; control group: POAG 28 and NTG 19). The primary outcomes included changes in IOP and the number of antiglaucoma medications, with subgroup analyses for POAG and NTG. Over the 18-month follow-up, the iStent group achieved a significantly greater reduction in antiglaucoma medications compared with the control group (p value = 0.003∼<0.001) without significant IOP rebound. After adjusting for confounding factors, the reduction in the number of antiglaucoma medications with iStent remained significant (β = -0.8, p < 0.001) according to the generalized estimating equation. At 18 months, the iStent group demonstrated higher qualified and complete success rates than the control group (73.3% vs. 16.7%, p value = 0.001% and 53.3% vs. 0%, p value = 0.002, respectively). Notably, the NTG-iStent subgroup achieved the highest complete success rate (85.7% at 18 months). In conclusion, phaco-iStent emerges as an effective standalone treatment for Taiwanese patients with POAG and NTG, providing substantial IOP reduction and higher success rates, especially in NTG cases. These findings propose that phaco-iStent could be a promising intervention for managing POAG and NTG within the Taiwanese population. Trial Registration: ClinicalTrials.gov identifier: NCT06630546.

The maintenance of corneal transparency and normal vision is dependent on preservation of epithelial and endothelial cell layer homeostases. Different types of corneal injury can induce swelling and losses in transparency. Fuchs endothelial corneal dystrophy (FECD) is one type of injury that is commonly treated with rho-associated coiled-coil-containing protein kinase (ROCK) inhibitors. While their clinical benefit is apparent, certain aspects of their mechanism of action require clarification. Specifically, although topical eye drops containing ROCK inhibitors have been employed to treat corneal endothelial dysfunction-associated corneal edema, it remains unclear whether interactions between both corneal epithelial and endothelial cell contribute to mitigating clinical signs that compromise normal vision. To address this question, we first review the intricate ROCK signaling pathways and their role in modulating a variety of functions that are related to the maintenance of corneal transparency and normal vision. We also review the results of ongoing clinical trials employing current FDA-approved ROCK inhibitors, highlighting the prominent role of Y-27632 in the treatment of a variety of ocular conditions, particularly FECD, and its promising results in reversing losses in normal vision through facilitating cell proliferation and suppressing apoptosis. This review shows that the ROCK inhibitor clinical benefit is affected by their interactions between the epithelium and the endothelium. This realization makes it likely that ROCK inhibitors will be approved for use in a clinical setting to treat FECD.

Purpose: To retrospectively analyze clinical outcomes of patients with "treatment-resistant" neovascular age-related macular degeneration or diabetic macular edema who were switched to intravitreal faricimab injections (IFIs) using a "real-world" treat-and-extend (TAE) protocol. Methods: Seventy-one eyes from 62 patients receiving antivascular endothelial growth factor injections were evaluated before and after switching to IFI. Demographic and clinical data were collected. Primary endpoints were treatment interval extension and presence of intraretinal or subretinal fluid on spectral-domain optical coherence tomography (OCT) after switching to IFI. Secondary endpoints included best-corrected visual acuity, average OCT central subfield thickness, and presence of a pigment epithelium detachment and pigment epithelium detachment height. Results: The average treatment interval after switching to IFI significantly increased from 37.6 ± 10.8 days to 45.2 ± 16.6 days (p = 0.0016). At the last follow-up, 35% of eyes were able to achieve a fluid-free status post-IFI. A chi-square test of independence validated this finding by showing a significant difference in the OCT findings trending towards less or no fluid on follow-up (X ² [3, N = 71] = 13.0705; p = 0.0003). The average central subfield thickness decreased from 327.2 ± 89.1 μm to 294.8 ± 86.5 μm (p = 0.0294). Best-corrected visual acuity, intraocular pressure, pigment epithelium detachment presence, and height had no significant difference after switching to IFI. Conclusions: In "treatment-resistant" patients receiving anti-VEGF therapy for neovascular age-related macular degeneration or diabetic macular edema, switching to IFI in a "real-world" TAE protocol led to statistically significant improvements in treatment interval and retinal fluid on spectral domain OCT.

Background: Glaucoma stands as a prominent contributor to irreversible vision impairment on a global scale. For decades, the Baerveldt Glaucoma Implant (BGI) has been used to treat refractory glaucoma. Yet, the cost-effective Aurolab Aqueous Drainage Implant (AADI) has gained clinical attention as a viable alternative for managing glaucoma. Objective: The purpose of this study was to evaluate and compare the efficacy and safety of AADI and BGI in the treatment of refractory glaucoma. Methods: Following PRISMA guidelines, we conducted a systematic search of multiple databases, identifying relevant comparative studies assessing AADI versus BGI in patients with refractory glaucoma. Key outcomes included postoperative IOP, surgical success rates, antiglaucoma medication reduction (AGMR), and complication rates. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Results: Three studies comprised a total of 176 individuals with refractory glaucoma, with 107 patients receiving the AADI and 69 patients receiving the BGI. The meta-analysis revealed a statistically borderline significant reduction in postoperative IOP favoring the AADI at 3 months (mean difference [MD] = -2.74, p=0.05). There was no significant difference in the MD of AGMR between the AADI and BGI groups. The rates of total complications and surgical success did not differ significantly between the AADI and BGI groups. Conclusion: AADI demonstrates promising results in reducing IOP at 3 months compared to BGI, with comparable surgical outcomes and complication rates over the long term. Further studies with larger samples are warranted to validate these findings and assess cost-effectiveness, particularly in developing countries.

Introduction: Caffeine, the most widely consumed psychoactive drug globally, has been associated with vascular changes in various organs, including the retina. Researchers have reported vascular constriction in the retina in response to caffeine, although data on its effects remain limited and somewhat contradictory. Further research is needed to clarify the specific impact of caffeine on retinal blood vessels and its potential implications for ocular health. Purpose: To investigate the effects of 200 mg of caffeine on systolic and diastolic blood pressure (SBP and DBP) and retinal vessel density (VD) assessed by optical coherence tomography angiography (OCTA). Methods: Prospective randomized, double-blind placebo-controlled, IRB-approved study in 59 healthy low caffeine users (< 136 mg of caffeine daily). Baseline 3 × 3 and 6 × 6 mm OCTA scans centered on the fovea as well as a 6 × 6 mm scans centered on the optic nerve head (ONH) were obtained. Participants were randomly assigned into caffeine group (CG, n = 42) receiving 200 mg caffeine pill or placebo group (PG, n = 17). OCTA scans were repeated at 60 and 120 min after intervention. VD was measured with Advanced Retina Imaging (ARI) network software (Carl Zeiss Meditec, Dublin, CA) for superficial capillary plexus (SCP) and deep capillary plexus (DCP). SBP/DBP readings were recorded before each imaging session. Ordinary one-way analysis of variance (ANOVA) of each group was performed using GraphPad Prism Version 9.3.0. Results: Both groups had comparable demographics and OCTA parameters at baseline. Two hours after intervention, the CG had a significantly higher SBP (123 ± 7 mmHg) and DBP (81 ± 5 mmHg) compared to the control group (118 ± 7 mmHg, 77 ± 6 mmHg) (p value = 0.012, 0.023). Regarding the OCTA VD metrics, there were no significant differences in VD between the caffeine and placebo groups, regardless of whether the scans were centered on the macula or ONH. Additionally, the comparison across different OCTA scan modalities, specifically the 3 × 3 mm and 6 × 6 mm scans, showed no discernible differences among groups. Conclusion: In conclusion, 200 mg of caffeine elevated blood pressure after 2 h but did not impact the retinal VD. This underscores the intricate relationship between caffeine, blood pressure, and retinal vascular dynamics, prompting further exploration of their implications for ocular health, especially in subjects with vascular disease.

Background: No consensus has been reached on the adequate dose of mitomycin C (MMC) in XEN45 gel stent implantation. Lower doses have the potential to reduce MMC-linked side effects. This study aimed to evaluate treatment efficacy of ab interno XEN45 gel stent in primary open-angle glaucoma (POAG) with three different MMC doses. Methods: This retrospective single-centre nonrandomised trail included 54 patients (56 eyes) who underwent XEN45 gel stent implantation for POAG with above-target intraocular pressure (IOP) under medical therapy. Eyes were grouped according to the received MMC dose: Group 1 (20 μg; n = 21), Group 2 (10 μg; n = 14) and Group 3 (5 μg; n = 21). The primary endpoint was the mean IOP change in the three MMC dose groups after 6, 12 and 24 months. Secondary endpoints included the success rate defined as lowering of baseline IOP ≥ 20% and below a cut-off IOP set at three different levels: ≤ 18, ≤ 16 and ≤ 14 mmHg (Criteriums 1, 2 and 3), the mean number of ocular hypotensive medications and the frequency of needling procedures. Results: After 24 months, the overall mean (standard error) IOP was significantly reduced from 24.7 (0.9) mmHg to 15.2 (0.7) mmHg (p < 0.0001). The average IOP change (standard error) in MMC dose groups 1, 2 and 3 was -8.6 (2) mmHg, -10.1 (2.1) mmHg and -10.4 (2.8) mmHg. Complete success (Criterium 1) was achieved in 50%, 62% and 43% of the eyes in groups 1, 2 and 3. No statistically significant difference was found within the first 24 months between the three MMC dose groups for IOP change, success rate, number of ocular hypotensive medications and the frequency of needling procedures. Conclusions: XE45 was effective in all three dose groups. As the success rate did not significantly differ between the MMC doses, these results may support the use of the lowest dose. Trial Registration: ClinicalTrials.gov identifier: 559/2016BO2.

Schlemm's canal (SC) is a small circular canal in the deep part of the sclera at the junction of the sclera and cornea. As an integral component of the aqueous humor outflow, its structure and function are essential in regulating intraocular pressure (IOP). If SC develops lesions, the drainage of aqueous humor would be obstructed, leading to increased intraocular pressure and injury to the optic nerve. With the rapid development of minimally invasive glaucoma surgery, an increasing number of surgeons became familiar with SC, and the area generated substantial academic attention. The pathological mechanism and the therapy for SC that had been studied in recent years are summarized in this article, hoping to provide ideas for the treatment of glaucoma in the future.