Journal of Ophthalmology最新文献

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.

Introduction: We aimed to investigate the incidence and prognosis of retinal injury in patients with lens dislocation caused by blunt eye trauma. Methods: We retrospectively analyzed 53 patients who underwent lensectomy and vitrectomy for contusive lens dislocation and had no preoperative retinal injuries. Patients were categorized according to the presence of retinal injury discovered intraoperatively. The clinical features of 53 eyes were assessed during a 3-month postoperative follow-up. Results: Retinal injuries were observed intraoperatively in 28 patients (52.8%), predominantly in peripheral regions, with a single retinal tear being the most common type. Total lens dislocation was more frequent than subluxation in the group with retinal injuries. The intraocular pressure (IOP) at the 3-month follow-up was significantly lower than the initial IOP in both groups, with no significant differences between them. The corrected distance visual acuity (CDVA) significantly improved in both groups without significant differences. Conclusion: Half of the patients without preoperative retinal injuries were found to have injuries during surgery. Total lens dislocation carried a greater risk of retinal injuries than subluxation. The improvement in CDVA after prompt retinal injury treatment did not significantly differ from that in patients without retinal injury, highlighting the importance of prompt intervention.

Purpose: To find whether the CHA₂DS₂-VASc score, a system for stratifying stroke risk among patients with atrial fibrillation, correlates with visual acuity prognosis following retinal vein occlusion (RVO). Participants and Methods: This retrospective study included 83 eyes of 83 patients with a diagnosis of branch or central RVO between June 2017 and August 2022 with at least 12 months of follow-up in Assuta Ashdod Medical Center, Ashdod, Israel. The patients were divided into three groups, with CHA₂DS₂-VASc scores of 0-2 (N = 31), 3-5 (N = 45), or 6-9 (N = 7). The change in best-corrected visual acuity (BCVA) between the groups was examined about 1 year after the presentation of RVO. Results: The patient mean age was 67.9 ± 13.8 years; 38.6% were women. The mean visual acuity was 0.83 ± 0.67 LogMAR units at the first admission and 0.78 ± 0.80 LogMAR units at the last visit. Patients with a CHA₂DS₂-VASc score from 6 to 9 had a significantly poorer BCVA prognosis at 1-year (+0.60 ± 0.94 [-0.27, 1.47] LogMAR units) compared to groups with a CHA₂DS₂-VASc score from 3 to 5 (-0.01 ± 0.65 [-0.20, 0.19] LogMAR units) and a CHA₂DS₂-VASc score from 0 to 2 (-0.12 ± 0.59 [-0.33, 0.10] LogMAR units) (p = 0.038). Conclusions: Following RVO, patients with a CHA₂DS₂-VASc score of 6 or higher had a worse prognosis in their visual acuity than patients with a lower score.

Background: To determine if cross-linking (CXL) treatment modifies any pre-existing association between corneal optical density (COD) and age in keratoconus free of corneal scarring. Methods: COD was monitored in two groups (i) before and after standard CXL treatment for keratoconus (de-epithelization with a crescent blade, n = 69 eyes) and (ii) age/gender-matched cases without any signs of keratoconus (n = 24 eyes). Seven different markers of COD were quantified using a 0-100 grey scale, supplied with Pentacam™ software. Results: Mean age (±sd, range) in Group I (19 females and 50 males) was 24.2 years (±7.2, 11-44) and in Group II (9 females and 15 males), it was 24.7 years (±7.6, 17-45). COD over the apex and along the depth of the cornea (y, arbitrary scale units) was associated with age (x, in years) in Group I at preop (y = 0.08x + 13.12, r _s  = 0.350 and p=0.003), at 12 months postop (y = 0.08x + 15.15, r _s  = 0.295 and p=0.014) and in Group II, at the start (y = 0.16x + 11.28, r _s  = 0.474 and p=0.019) and 12 months later (y = 0.24x + 8.63, r _s  = 0.600 and p=0.002). The change in COD following CXL was significantly associated with the preop value. Conclusion: CXL initially breaks down the pre-existing relationship between COD and age. This is re-established by 12 months postop. The CXL induced change in COD depends on the preop value but not on the patient's age.

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance-corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p=0.003 and p < 0.001, respectively). The TIOL group achieved a better-than-0.15-logMAR VA from +0.5 D to -2.5 D (40 cm). VAs of the TIOL group from -1 D (100 cm) to -4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near-vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p=0.039). Conclusion: Compared with EDF, TIOL leads to better near-vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558.

Purpose: To study the safety and effectiveness of subthreshold micropulse (SML) 577 nm laser therapy with an individual power titration in treating patients with chronic central serous chorioretinopathy (CSC).

Methods: The study was a prospective, single-centre observation of 30 patients (30 eyes) with chronic CSC. All patients with chronic CSC were treated with a 577 nm micropulse laser. Individual power parameters for each patient were titrated in a micropulse mode. The primary outcome measure was best-corrected visual acuity (BCVA) at 6-month follow-up. The secondary outcome measures were as follows: central retinal thickness (CRT) and maximum subretinal fluid height (SRFH) according to optical coherence tomography, number of laser sessions, and treatment safety at 6-month follow-up.

Results: Before treatment, the mean BCVA was 0.35 ± 0.16, the mean CRT was 285 ± 76 µm, and the mean SRFH was 311 ± 85 µm. Six months after 577 nm SML therapy, there was a statistically significant increase in the mean BCVA with the maximum correction to 0.45 ± 0.15 (p = 0.001). The mean CRT and SRFH decreased significantly to 236 ± 45 μm (p = 0.003) and 45 ± 25 μm (p = 0.001), respectively. At the end of the follow-up, complete resorption of the subretinal fluid was noted in 50% (15 eyes), and in 43% (13 eyes), a decrease in the SRFH was observed. During the entire observation period, 25 patients underwent 1 session of 577 nm SML therapy, 2 patients underwent 2 sessions, and 3 patients underwent the intervention three times.

Conclusion: SML 577 nm therapy with individual selection of laser power in a micropulse mode is a safe and effective method of treating patients with chronic CSC. Further studies are needed to test the long-term safety and efficacy of 577 nm SML therapy with individual power settings in chronic CSC.

Purpose: We evaluated the optic disc microvasculature in healthy subjects and patients with optic nerve head drusen (ONHD), active papilledema, and acute nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA).

Methods: This prospective, comparative case series included sixteen eyes with ONHD, thirty-one eyes with active papilledema, sixteen eyes with acute NAION, and thirty-two healthy eyes. The Optovue AngioVue OCT and OCTA Imaging System recorded peripapillary retinal nerve fiber layer (RNFL) thickness and vessel density maps from the radial peripapillary capillary (RPC) slab.

Results: Average RNFL thicknesses were greater in eyes with ONHD, papilledema, and NAION compared to control eyes (all Ps < 0.001), but this parameter did not differ among patient groups. The mean peripapillary vessel density did not differ between the ONHD and control groups (P=1.000), nor between the NAION and papilledema groups (P=0.216). However, this value in the ONHD and control groups was significantly higher than in the NAION and papilledema groups (all Ps < 0.05).

Conclusion: RPC density is influenced during the progression of conditions such as ONHD, papilledema, and NAION. Although a decrease in vessel density values has been observed in cases of true disc edema, further research is necessary to assess the potential of OCTA in differentiating between true and pseudo-optic disc edema.