Journal of Ophthalmology最新文献

This study examines corneal densitometry recovery and influencing factors following accelerated corneal cross-linking (CXL) for progressive keratoconus. Corneal densitometry, measured using Scheimpflug tomography, provides an objective assessment of corneal clarity, especially in tracking the resolution of postoperative haze. We conducted a retrospective case-control analysis of 24 patients (31 eyes) who underwent CXL with 0.25% riboflavin and 18 mW/cm² irradiation between 2021 and 2023. Variables included patient age, maximum keratometry (K _max), central corneal thickness (CCT), and demarcation line depth (DLD), defined as the depth of the CXL region. Results revealed a significant increase in densitometry values across most corneal zones at 1-month postoperation, followed by a gradual return to baseline by 12 months. Notably, younger patients exhibited a faster recovery, with mean densitometry values returning to baseline in 11.4 months compared to 14.9 months in older patients (p=0.02). Similarly, corneas with deeper DLDs demonstrated faster densitometry recovery, suggesting a potentially more efficient corneal remodeling process. Additional analysis indicated a trend toward higher densitometry values in shallower DLDs at 1 month, although this difference was not statistically significant. These findings support the use of densitometry as a reliable measure of post-CXL healing. While DLD depth and patient age were associated with a faster recovery, they did not directly predict final corneal clarity. Our study suggests that factors such as age and DLD depth should be considered in patient prognosis, although further research is needed to confirm these findings across varying CXL protocols.

Purpose: To identify the structural and vascular features of the macula related to the recurrence of macular edema (ME) in central retinal vein occlusion (CRVO) after intravitreal anti-VEGF injections. Methods: This was a cross-sectional study including CRVO patients without ME and age-matched individuals. CRVO patients were divided into the ME-resolved group and the ME-recurrence group on the basis of whether ME recurred within 3 months. All subjects provided a detailed history and underwent a comprehensive ophthalmological examination. Measurements of the macula by swept-source optical coherence tomography angiography (SS-OCTA) were recorded. We also created the Δparameter, which represents the difference in OCTA parameters between CRVO-affected eyes and their fellow eyes. Results: The study included 13 ME-resolved CRVO patients, 20 ME-recurrence CRVO patients, and 24 age-matched controls. Compared with the ME-recurrence group, the ME-resolved group had a longer CRVO duration, more previous intravitreal anti-VEGF injections, and a higher proportion of previous retinal photocoagulation (all p < 0.05). Additionally, retinal thickness (RT) and choroidal thickness (CT) were thinner in the ME-resolved group than in the ME-recurrence and control groups (all p < 0.01). The ME-resolved group also had significantly lower vessel density (VD) in both superficial and deep vascular complexes (SVC/DVC) and larger foveal avascular zone area (FAZa) in SVC and DVC than the ME-recurrence group and the control group (all p < 0.01). The results were the same with the Δparameters. Multivariate logistic regression revealed that ΔVD and ΔFAZa in SVC and DVC were independently associated with ME recurrence after adjusting for the effects of CRVO duration, previous anti-VEGF injections, and retinal photocoagulation (all p < 0.05). Conclusion: With prolonged CRVO duration, more anti-VEGF injections, and more retinal photocoagulation procedures, retinal, choroidal, and vascular atrophy in the macula occurs in CRVO eyes, making ME less likely to recur. Macular vascular atrophy is vital for the resolution of ME and might be a manifestation of capillary remodeling.

Purpose: To evaluate the short- and long-term effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on visual acuity and macular morphology in myopic foveoschisis (MF) patients and to identify potential prognostic factors. Methods: We retrospectively analyzed the clinical data of patients with MF who underwent PPV with ILM peeling by the same senior fundus surgeon at Beijing Friendship Hospital from January 2016 to December 2022. The peeling was strategically centered on the macular fovea, extending to encompass the superotemporal and inferotemporal vascular arcades. Univariate analysis and multivariate logistic regression analysis were conducted to screen out the prognostic factors. Results: 36 eyes of 36 consecutive patients were analyzed in total. Best-corrected visual acuity (BCVA) improved significantly from 1.10 ± 0.61 logMAR to 0.78 ± 0.58 logMAR (p=0.031). 23 eyes (63.89%) had postoperative BCVA improved ≥ 2 Snellen lines. The mean central fovea thickness (CFT) decreased from 427.14 ± 255.91 μm to 155.85 ± 67.33 μm (p < 0.001). 18 and 16 eyes achieved partial and complete retinal reattachment, respectively, as follows. The twelfth month postoperatively was a threshold to influence the resolution of MF significantly, but it did not affect the visual outcome. Multiple logistic regression showed CFT (OR = 1.007, 95% CI = 1.001, 1.013, p value = 0.034) remained significant to predict the complete retina resolution. For visual acuity, integrated ellipsoid zone (EZ) band (OR = 0.239, 95% CI = 0.073, 0.783, p value = 0.018) might be a significant predictive factor. Subgroup analysis further indicated that in eyes with an intact EZ band, a poorer baseline BCVA was associated with an increase in postoperative BCVA (p=0.015). Conversely, in those with disrupted EZ band, all included factors showed no significant difference. Conclusion: The study observed trends in the recovery pattern of the retina following surgery and suggested potential factors that may be associated with improvements in both visual acuity and retinal reattachment. The findings may offer some guidance to ophthalmic surgeons in considering the timing of surgery, although further research is needed to confirm these trends as definitive predictors.

Purpose: To assess the efficacy of the Defocus Incorporated Multiple Segments (DIMS) spectacle lens for myopia control and its impact on vision-related quality of life in Chinese children over a 1-year period. Methods: This randomized double-blind prospective controlled clinical trial enrolled 176 myopic subjects aged between seven and 14 years who were randomly assigned into the DIMS group or the control single-vision (SV) group. Refractive error and axial length measurements at baseline, three-, six-, nine-, and 12-month follow-up visits were monitored. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire was used to evaluate the vision-related quality of life at baseline and at 12 months postintervention. Results: Of the initial cohort, a total of 151 children successfully completed the study (DIMS n = 72; SV n = 79). Baseline characteristics were similar between both groups. Average axial elongation and myopia progression after 1 year were 0.17 (95% CI 0.13-0.20) mm and -0.27 (95% CI -0.36 to -0.18) D in the DIMS group and 0.30 (95% CI 0.26-0.33) mm and -0.55 (95% CI -0.64 to -0.47) D in the SV group. The mean differences in axial elongation and myopia progression were 0.13 mm (95% CI 0.08-0.18 mm, p < 0.001) and -0.28 D (95% CI -0.41 to -0.15 D, p < 0.001) between the two groups. No significant difference in the QIRC score was found between the DIMS and SV groups (55.30 (95% CI 53.17-56.90) versus 54.20 (95% CI 51.99-56.41), p=0.854)). Conclusion: The use of DIMS lenses in children was found to slow down myopia progression compared to SV lenses, without negatively affecting their overall quality of life. Trial Registration: Clinical Trial Registry identifier: ChiCTR2000037443.

Purpose: To develop a prediction model for postoperative axial length (AL) in Asian children with congenital cataracts undergoing primary/secondary intraocular lens (IOL) implantation. Design: Retrospective observational study. Methods: Data were collected from children who underwent cataract surgery for congenital cataracts at the Eye Hospital of Wenzhou Medical University between 2006 and 2020. All participants completed preoperative and at least 1-year of postoperative follow-up. SPSS 26.0 software was used to analyze the variable factors affecting AL growth and the interactions among these factors. A generalized estimating equation (GEE) was employed to assess the correlation between the AL and related univariates over time. The univariate model was applied to build a multivariate model to predict the postoperative AL. Two validation sets were used to verify the accuracy of the formula. Results: The study involved 86 children, accounting for 148 eyes. The median age at the time of surgery was 3.00 years, with a median age of 9.50 years at the final follow-up visit. The median duration of follow-up was 5.00 years. The preoperative and final follow-up mean ALs were 21.79 ± 1.77 and 23.36 ± 1.90 mm, respectively. Taking the predicted AL (Y) as the dependent variable and the age at surgery (X ₁), age at review (X ₂), and preoperative AL (X ₃) as the independent variables, the prediction model was established as Y = 0.20 - 0.473 × X ₁ + 0.446 × X ₂ + 0.993 × X ₃ - 0.014 × (X ₂ - X ₁)∗X ₂. Conclusions: This model predicts AL growth in children following congenital cataract surgery and IOL implantation, helping ophthalmologists select appropriate IOL power.

Purpose: To analyze the refractive accuracy of a novel swept-source optical coherence biometer (SS-OCT), that uses individual refractive indices to measure axial length, in short and long eyes implanted with monofocal intraocular lenses (IOLs). Methods: This retrospective comparative study considered eyes with short axial length (AL) (< 22.5 mm) or long AL (> 26 mm) bilaterally implanted with the Acrysof IQ monofocal IOL. All eyes were preoperatively analyzed with the Argos biometer and IOL calculations were made using the Barrett Universal II (BUII). One month after the surgery, refractive and visual outcomes and refractive prediction errors were calculated. Furthermore, a back calculation of the prediction errors based on the Barrett True Axial Length (BTAL) formula was also performed and the results of both formulas were compared. Results: Sixty eyes of 60 patients (30 with AL < 22.5 mm (short) and 30 with AL > 26 mm (long)) were included. After surgery, monocular UDVA was 0.03 ± 0.10 and 0.10 ± 0.15 logMAR for short-eye and long-eye groups, respectively. For short eyes, mean prediction error (MPE) with BUII and BTAL were 0.19 ± 0.34 D and 0.00 ± 0.35 D, respectively (p  <  0.001). Mean absolute error (MAE) was 0.32 ± 0.22 D with the BUII and 0.29 ± 0.20 D with the BTAL formula (p=0.21). For long eyes, MPE with BUII was -0.15 ± 0.35 D and -0.13 ± 0.36 D with BTAL (p=0.08), while MAE was 0.31 ± 0.21 D and 0.32 ± 0.20 D with BUII and BTAL, respectively (p=0.33). The percentage of eyes with a prediction error within ±0.5 D predicted postop spherical equivalent was > 75% for both groups and both formulas (p > 0.05 for all situations). Conclusions: The novel SS-OCT biometer using individual refractive indices to measure AL showed an overall good refractive accuracy using the BUII. The results were similar or better with the optimized BTAL formula, suggesting that formulas purposely designed for biometric measurements with this novel technology are a promising tool for eyes with extreme AL.

Purpose: Dry eye disease (DED) is a multifactorial disorder affecting millions worldwide. Inflammation plays a central role in DED. The aim of this review is to critically evaluate the literature concerning the efficacy and safety of lifitegrast, a small molecule immunomodulator that blocks the action of lymphocyte function-associated antigen-1. Methods: Studies were identified using PubMed and ClinicalTrials.gov. Fourteen studies met the inclusion criteria, six of which were randomized controlled trials. The articles were assessed regarding the effect of lifitegrast on symptoms and signs of DED, its usefulness compared to other treatments, and potential adverse events. Results: The analysis demonstrated positive effects of lifitegrast on subjective and objective parameters of DED in the selected studies. However, despite promising results, the included studies did not provide enough evidence to conclude that lifitegrast could outperform other treatments of DED. No major side effects were reported. Conclusions: Based on the current literature, we conclude that lifitegrast could improve various parameters of DED. Still, larger controlled trials are required to establish additional benefits of this medication beyond those of other DED treatments.

Purpose: The effect of the Rho-kinase inhibitor ripasudil on the retinal optic nerve fiber layer (RNFL) remains unclear. We aimed to determine this effect in patients with primary open-angle glaucoma (POAG) using optical coherence tomography (OCT) measurements and linear mixed analysis. Methods: This study prospectively included outpatients from a single center with POAG without a history of vitreoretinal or glaucoma surgery from December 2014 to June 2020, in whom the circumpapillary RNFL thickness (cpRNFLT) was measured more than three times before and after ripasudil initiation, without additional medication or surgery during the period. Measurements were performed using OCT in the follow-up mode. The cpRNFLT change rates were compared before and after treatment using linear mixed models with adjustments for intraocular pressure (IOP) changes. Results: Thirty eyes of 20 patients (12 males and eight females) were included. Upon ripasudil prescription, the average cpRNFLT was 60.2 ± 2.1 μm. The average IOP was 15.1 ± 0.5 and 13.5 ± 0.5 mmHg, respectively, before and after treatment initiation, with a difference of -1.6 ± 0.3 mmHg. Analysis of 343 cpRNFLT measurements using linear mixed models revealed that the cpRNFLT change rate was -0.91 ± 0.15 and -0.40 ± 0.14 μm/year, respectively, before and after treatment onset, with an increase of 0.51 ± 0.21 μm/year. After adjusting for IOP changes, the improvement in cpRNFLT change rate was 0.33 ± 0.23 μm/year, albeit not statistically significant. Conclusion: The cpRNFLT change rate significantly increased after ripasudil administration, whereas the contribution of the IOP decline was not significant.

Purpose: To investigate the correlation between corneal biomechanical characteristics and refractive status in adolescents aged 5-13 years. Methods: A cross-sectional study involved 339 children aged 5-13 with a spherical equivalent (SE) range from -6.00 to +2.00 diopters. Axial length (AL) was measured by IOL Master, corneal biomechanical parameters by Corvis ST, and anterior segment parameters by Pentacam. According to SE of right eye, the subjects were divided into moderate myopia, mild myopia, and emmetropia group. The correlation between AL and SE and corneal biomechanical parameters was analyzed. The corneal biomechanical parameters of the three groups were also compared. Results: The A2V value in the moderate myopia group was significantly lower than that in both the mild group and emmetropia group (p < 0.001). PD in the moderate group was higher than that in the mild group (p < 0.05), while PD in mild myopia was higher than that in emmetropia (p < 0.05). The SSI in the emmetropia group was significantly higher than that in the other two groups (all p < 0.001), and the SSI in the mild group was higher than that in the moderate group (p < 0.01). The A2V value in the 11-13 years old group was lower than that in the 5-7 years old group (p < 0.001) and 8-10 years old group (p < 0.01). PD in the 11-13 years old group was significantly higher than that in the 8-10 years old group (p < 0.001), and PD in the 8-10 years old group was significantly higher than that in the 5-7 years old group (p < 0.01). The SSI in the 5-7 years old group was significantly higher than that in the 8-10 years old group (p < 0.001), and the SSI in the 8-10 years old group was significantly higher than that in the 11-13 years old group (p < 0.05). AL was positively correlated with PD and negatively correlated with SSI and A2V. SE was positively correlated with A2V and SSI and negatively correlated with PD. Conclusions: Corneal stiffness seems to decrease with the increase of SE. The changes of SSI, PD, and A2V were statistically significant and can be predictors of myopia progression in adolescents aged 5-13 years.

Severe dry eye disease (DED) is an inflammatory condition characterized by a lack of sufficient moisture or lubrication on the surface of the eye, significantly impacting the quality of life and visual function. Since detrimental immune response is crucially responsible for the development and aggravation of DED, therapeutic agents which modulate phenotype and function of eye-infiltrated inflammatory immune cells could be used for the treatment of severe DED. Due to their potent immunomodulatory properties, mesenchymal stem cells (MSCs) represent potentially new remedies for the treatment of inflammatory eye diseases. The majority of MSC-sourced bioactive factors are contained within MSC-derived exosomes (MSC-Exos), nano-sized extracellular vesicles which, due to their nanosize dimension and lipid envelope, easily by pass all biological barriers in the body and deliver their cargo directly into the target immune cells. MSC-Exos contain a variety of bioactive proteins (growth factors, immunoregulatory molecules, cytokines, and chemokines) lipids, and microRNAs (miRNAs) which affect viability, proliferation, phenotype, and function of eye-infiltrated immune cells. Accordingly, MSC-Exos may modulate the progression of inflammatory eye diseases, including DED. Therefore, in this review article, we summarized the current knowledge regarding molecular and cellular mechanisms which were responsible for trophic, anti-inflammatory, immunoregulatory, and regenerative properties of MSC-Exos in the treatment of severe DED. For this purpose, an extensive literature review was carried out in February 2024 across several databases (Medline, Embase, and Google Scholar), from 2000 to the present. Eligible studies delineated molecular and cellular mechanisms responsible for the MSC-Exos-based modulation of immune cell-driven eye inflammation in DED, and their findings were analyzed in this review. Results obtained in these studies demonstrated beneficial effects of MSC-Exos in the treatment of severe DED, paving the way for their future clinical use in ophthalmology. Trial Registration: ClinicalTrials.gov identifier: NCT04213248, NCT06475027, NCT06543667, NCT05738629.