Journal of Ophthalmology最新文献

Many interventions aiming to improve medication adherence in primary open-angle glaucoma (POAG) have yielded equivocal findings. This equivocacy has been attributed to several factors, including limited incorporation of health behavior theory and patient preference into intervention design. In this study, we performed a literature review of interventions aiming to improve medication adherence in POAG to develop a taxonomy of behavior change techniques (BCTs). Eligible studies measured medication adherence using electronic monitors for a minimum of 3 months. For each study, we evaluated the effectiveness of the BCTs, their basis in health behavior theory, and their usefulness in day-to-day management of POAG by surveying a sample of patients and providers. Twelve studies were included. BCTs included knowledge shaping (education), prompts (reminders), behavioral rehearsal (eye drop instillation training), and pharmacological support (combination monotherapy vs. polytherapy). Knowledge shaping, prompts, health coaching, and motivational interviewing led to an improvement in medication adherence and were perceived as being most useful in day-to-day management of POAG. Taxonomies of BCTs can help researchers to improve the design and effectiveness of interventions for improving medication adherence in POAG.

Diabetic retinopathy (DR) is a common complication of diabetes and the main cause of vision loss in the middle-aged and elderly people. miRNAs play vital roles in the development of DR. This study aimed to explore the effects of miR-16-5p on high glucose (HG)-stimulated human retinal microvascular endothelial cells (HRECs) by modulating vascular endothelial growth factor A (VEGFA) and transforming growth factor beta receptor 1 (TGFBR1). HRECs were treated with 5 mM, 10 mM, 20 mM, and 30 mM of HG to induce the DR cell model. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression of miR-16-5p and mRNAs of VEGFA and TGFBR1. Western blot was used to examine VEGFA and TGFBR1 protein levels. The 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide assay was conducted to test cell proliferation. Flow cytometry with Annexin V-FITC/PI double staining was carried out to assess cell apoptosis ratio. Dual-luciferase assay was used to identify the target relationship between miR-16-5p and VEGFA and TGFBR1. Results found that the expression of miR-16-5p in HG-treated HRECs was reduced, and VEGFA and TGFBR1 expressions were upregulated. Knockdown of miR-16-5p increased VEGFA and TGFBR1 mRNA and protein levels, promoted cell proliferation, and inhibited apoptosis in HG-treated HRECs. VEGFA and TGFBR1 inhibition reversed the effect of knocking down miR-16-5p on HRECs. Dual-luciferase reporter assay revealed that VEGFA and TGFBR1 were the target of miR-16-5p. Overall, knockdown of miR-16-5p enhances proliferation and inhibits apoptosis of HRECs by upregulating VEGFA and TGFBR1 expression.

Purpose: To evaluate a modified minimally invasive technique for trans-scleral repositioning of dislocated Akreos Adapt intraocular lenses (IOLs) without scleral flaps. Methods: This retrospective case series included 17 eyes with subluxated or dislocated IOLs that underwent repositioning using a suture-in-needle, closed-loop technique. The procedure involved passing an 8-0 polypropylene suture through the IOL's four fenestrated haptics using a bent 30-gauge needle. The exterior suture knot was buried into the sclera without creating scleral flaps or dissecting the conjunctiva. Data on pre- and postoperative intraocular pressure, best-corrected visual acuity, IOL position, corneal endothelial cell counts, and intra-/postoperative complications were collected and analyzed. The follow-up period lasted at least 6 months. Results: All 17 cases demonstrated stable and well-centered IOLs with improved visual acuity. No significant complications, including IOL tilt, decentration, vitreous hemorrhage, hypotony, iris capture, or suture erosion, were observed during the follow-up. Conclusion: The suture-in-needle, closed-loop technique for trans-scleral refixation of dislocated Akreos Adapt IOLs is minimally invasive, achieves excellent anatomical and functional outcomes, and reduces the risk of complications.

Purpose: To evaluate the role of adjuvant mitomycin-C (MMC) use in cases of recurrent rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR) managed by relaxing retinotomy and retinectomy (RR). Methods: A retrospective analysis of consecutive patients undergoing vitreoretinal surgery with RR for RD and PVR was conducted. Patients were divided into two groups: those receiving 20 μg/0.1 mL MMC via the MMC sandwich method (Group 1) and those who did not (Group 2).Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analysed. Results: A total of 28 patients (14 eyes per group) were included in the study. Differences in baseline variables between groups were not significant (p > 0.05). The mean follow-up was 15.2 ± 12.2 months. In Group 1, mean preoperative best-corrected visual acuity (BCVA) improved from 2.72 ± 0.70 logMAR to 1.59 ± 0.61 logMAR postoperatively (p=0.001). In Group 2, mean preoperative BCVA increased from 2.06 ± 0.80 logMAR to 1.77 ± 0.94 logMAR (p=0.261). Re-surgery rates were significantly lower in Group 1 (21.4%) than in Group 2 (92.8%, p=0.001). Final retinal attachment was achieved in 100% of eyes in both groups. Postoperative mean intraocular pressure (IOP) was 16.29 ± 4.46 mmHg in Group 1 and 13.92 ± 1.44 mmHg in Group 2 (p=0.081). No MMC-related toxicity was observed clinically. Conclusions: MMC, applied via the sandwich technique, appears safe and is associated with high anatomical and functional success rates while reducing re-operations.

Aims: To investigate the impact of horizontal markings on the VisuMax surgical bed headrest on the accuracy of astigmatism correction in small incision lenticule extraction (SMILE). Methods: This retrospective study categorized preoperative astigmatism severity into low-astigmatism (-0.25 to -1.75 D) and moderate-to-high astigmatism (-2.00 to -4.50 D). A preoperative patient fixation training regimen coupled with applying horizontal markings on the VisuMax surgical bed headrest was introduced to improve the precision of astigmatism correction. The effectiveness of SMILE was compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in correcting astigmatism by using Alpins vector analysis, as well as the higher-order aberrations were measured. Results: This study included 170 patients (56 eyes in the low-astigmatism group and 31 eyes in the moderate-to-high astigmatism group of SMILE; 47 eyes in the low-astigmatism group and 36 eyes in the moderate-to-high astigmatism group of FS-LASIK). At 6 months postoperatively, safety and efficacy indices between SMILE and FS-LASIK showed no significant differences for either astigmatism group (p > 0.05). However, significant differences were observed in surgically induced astigmatism (SIA), magnitude of error (ME), and correction index (CI). A considerable difference in equivalent spherical (SE) was found in the low-astigmatism group (p < 0.05). No significant differences were noted in the angle of error (AE) and its absolute value (|AE|) between the two procedures (p > 0.05). Both techniques increased total higher-order aberrations, spherical aberration, and vertical coma, with SMILE associated with a significantly higher increase in vertical coma than FS-LASIK (p < 0.05). Conclusions: Augmented by precise preoperative strategies, including headrest marking and fixation training, SMILE achieves astigmatism axis correction efficacy comparable to FS-LASIK. SMILE and FS-LASIK are effective and comparable in correcting moderate-to-high astigmatism, highlighting their safety, efficacy, and predictability as corrective measures for myopic astigmatism.

Purpose: To evaluate the performance of the anterior segment optical coherence tomography (AS-OCT) and Scheimpflug-Placido tomographic (SPT) indices in differentiating suspect keratoconus (SKC) from normal (N). Methods: In this cross-sectional study, one eye of each patient was scanned on AS-OCT and SPT. Following, 5 regression analysis models were developed: Model 1: combined AS-OCT corneal thickness (CT); Model 2: combined AS-OCT epithelial thickness (ET); Model 3: Models 1 + 2; Model 4: SPT indices (symmetry index front [SIf], symmetry index back [SIb], keratoconus vertex back [KVb], and minimum CT [ThkMin]); Model 5: Models 3 + 4. The areas under the curve (AUC) of receiver operator characteristic (ROC) curves were compared across groups to estimate their performance accuracy. Results: Two hundred and five N eyes, 56 SKC eyes, and 89 keratoconus (KC) eyes were scanned with AS-OCT and SPT. For Models 1 and 2, no individual metric yielded an AUC > 0.84. For Model 3, the AUC was 0.96 (R2 Nagelkerke: 0.69) with 90.28% cases correctly identified as SKC. For Model 4, the AUC was 0.99 (R2 Nagelkerke: 0.87), with 95.58% of cases correctly classified as SKC. For Model 5, the diagnostic accuracy did not improve compared to Model 4. Conclusion: Both combined AS-OCT indices and combined SPT indices provided excellent diagnostic power to differentiate SKC from N eyes. The combined SPT model showed a superior value compared to the AS-OCT model. Furthermore, combined AS-OCT and SPT data did not perform better than the combined SPT data alone.

Background: Down syndrome (DS) is the most common genetic cause of intellectual disability. Ocular manifestations occur frequently in people with DS (pwDS) but to date, there is no systematic review or meta-analysis of these conditions across the lifespan. Methods: PubMed, Medline, Embase, Web of Science and Scopus were searched for observational studies reporting ocular manifestations in pwDS, without limiting publication date. The proportion of pwDS with specific ocular manifestations were meta-analysed to obtain a pooled incidence using a random effects model. Sources of heterogeneity were assessed using a meta-regression analysis. For manifestations reported, but without sufficient prevalence data available, a narrative approach was adopted. Results: The search identified 1208 papers. Reviewers independently screened the abstracts, and 54 studies were found to fit the criteria. The age range of the individuals was birth to 88.7 years. Ocular manifestations from highest to lowest prevalence included refractive errors (69.97%, 95% CI 59.95%-79.13%), strabismus (31.41%, 95% CI 24.66%-38.57%), lens opacities (13.79%, 95% CI 8.61%-19.86%), nystagmus (12.72%, 95% CI 9.02%-16.92%) and keratoconus (9.34%, 95% CI 2.47%-19.26%). Alterations of lens and corneal morphology, posterior segment anomalies (including glaucoma) and Brushfield spots were also identified. Conclusions: The ocular manifestations of pwDS are common but varied. Age and/or ethnicity may influence the prevalence of certain ocular manifestations. The level of intellectual disability may also affect the prevalence of ocular manifestations as the prevalence of ocular disorders is known to increase with the severity of intellectual disability in pwDS.

Objects: To assess the safety and effectiveness of subnuclear phacoemulsification (SNP), a new technique for reducing corneal injury in nuclear cataract surgery. Methods: This randomized controlled trial (RCT) was designed in March 2020 and carried it out from April 1 to September 30, 2020, including a 3 months' follow-up. We recruited 256 age-related hard nucleus cataract patients and randomly assigned them to two groups: the experimental group receiving SNP, and the control group receiving conventional phacoemulsification (CP). A single surgeon performed all the surgeries. We compared the two groups on the cumulative dissipated energy (CDE), phacoemulsification ultrasound time (UST), and complications for safety, as well as at multiple postsurgery follow-up timepoints on three major outcomes for effectiveness: visual acuity, central corneal thickness, and central corneal endothelial cell density. Results: The two groups were well-matched in terms of demographics, nuclear density, and safety measures (ultrasound energy, phacoemulsification time, and complications). For effectiveness after surgery, compared to the CP group, the SNP group had better visual acuity and thinner central cornea postsurgery within 1 week and had higher central corneal endothelial cell density at the 1- and 3-month follow-up. Conclusions: Compared to CP, SNP is more effective for reducing corneal injury in cataract surgery. The widespread application of this technology will greatly improve the safety of cataract surgery, especially hard cataract surgery. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000031114.

Diabetic retinal neurodegeneration (DRN) is an early manifestation of diabetic retinopathy (DR) characterized by neurodegeneration that precedes microvascular abnormalities in the retina. DRN is characterized by apoptosis of retinal ganglion cells (involves alterations in retinal ganglion cells [RGCs], photoreceptors, amacrine cells and bipolar cells and so on), reactive gliosis, and reduced retinal neuronal function. Tau, a microtubule-associated protein, is a key mediator of neurotoxicity in neurodegenerative diseases, with functions in phosphorylation-dependent microtubule assembly and stabilization, axonal transport, and neurite outgrowth. The hyperphosphorylated tau (p-tau) loses its ability to bind to microtubules and aggregates to form paired helical filaments (PHFs), which further form neurofibrillary tangles (NFTs), leading to abnormal cell scaffolding and cell death. Studies have shown that p-tau can cause degeneration of RGCs in DR, making tau pathology a new pathophysiological model for DR. Here, we review the mechanisms by which p-tau contribute to DRN, including insulin resistance or lack of insulin, mitochondrial damage such as mitophagy impairment, mitochondrial axonal transport defects, mitochondrial bioenergetics dysfunction, and impaired mitochondrial dynamics, Abeta toxicity, and inflammation. Therefore, this article proposes that tau protein hyperphosphorylation plays a crucial role in the pathogenesis of DRN and may serve as a novel therapeutic target for combating DRN.

Purpose: This study aimed to compare the donor-recipient interface changes between non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) and assess their correlation with the postoperative best spectacle-corrected visual acuity (BCVA). Methods: This retrospective study collected clinical data on patients with corneal endothelial decompensation who underwent either nDSEK or DSEK between August 2019 and April 2023. The donor-recipient interface particle density, interface haze, visual outcome, and graft dislocation were compared between nDSEK and DSEK groups. Results: A total of 66 eyes from 66 patients (nDSEK n: 31 eyes and DSEK n: 35 eyes) were included. At 12 months postoperatively, nDSEK had a mean interface particle density of 631.97 ± 143.95 particles/mm², significantly higher than DSEK's 518.20 ± 121.72 particles/mm² (p=0.001). The interface haze was also greater in nDSEK (78.16 ± 13.74) compared with DSEK (64.21 ± 14.78) (p < 0.001). BCVA improved similarly in both groups, with nDSEK changing from 1.92 ± 0.26 to 0.37 ± 0.11 and DSEK from 1.85 ± 0.24 to 0.34 ± 0.10 (p=0.149). Correlation analysis revealed a significant association between interface particle density and interface haze in both the nDSEK (correlation coefficient: 0.716, p < 0.001) and DSEK (correlation coefficient: 0.618, p < 0.001) groups. However, there was no significant correlation between interface particle density and postoperative BCVA for either the nDSEK (correlation coefficient: -0.028, p=0.883) or DSEK (correlation coefficient: 0.111, p=0.525) group. Similarly, no significant correlation was found between interface haze and postoperative BCVA in both groups (nDSEK: correlation coefficient: -0.080, p=0.670 and DSEK: correlation coefficient: -0.210, p=0.227). Graft dislocation rates were comparable: 3.2% in nDSEK and 2.9% in DSEK (p=0.931). Conclusion: nDSEK exhibited more interface particles and haze than standard DSEK, but visual outcomes and graft attachment were similarly effective.