Journal of Ophthalmology最新文献

Purpose: To investigate the influence of intraoperative corneal debridement on postoperative outcomes in Descemet Membrane Endothelial Keratoplasty (DMEK).

Methods: This retrospective comparative study analyzed 3168 eyes that underwent DMEK between 2012 and 2024. Intraoperative corneal debridement was performed in 215 eyes (6.8%) to improve visualization during the procedure. Survival time analyses with Kaplan-Meier curves and log-rank test and multifactorial Cox regression were conducted to assess the impact of corneal debridement on postoperative graft survival.

Results: Bivariate survival analyses suggested that intraoperative corneal debridement during DMEK may be associated with worse postoperative outcomes in terms of visual acuity, endothelial cell density, graft survival, and perioperative complications. Using the log-rank test, significant differences were observed in endothelial cell density, postoperative regrafting, and visual acuity (p < 0.005), while the need for rebubbling was not statistically significant (p = 0.5). However, multifactorial Cox regression analysis, controlling for potential confounding factors, revealed that the difference in hazard ratios between the debridement and no-debridement groups had no statistically significant effect on graft survival (HR = 0.74, 95% CI: 0.49-1.11, p = 0.141). Patients with Fuchs' endothelial dystrophy had a significantly lower risk of graft failure compared to other indications (HR 0.41, p < 0.001).

Conclusions: In bivariate analyses, intraoperative corneal debridement was associated with worse postoperative outcomes, including reduced visual acuity, endothelial cell density, and graft survival. However, these differences likely reflect the more severe cases in the debridement group. When adjusting for potential confounders, multifactorial Cox regression analysis showed that corneal debridement did not have a significant impact on graft survival. This suggests that while debridement may be associated with poorer outcomes in unadjusted analyses, it does not appear to adversely affect graft survival when accounting for other factors. Corneal debridement may therefore be a safe and viable option in DMEK, though further research is needed to confirm its impact on long-term outcomes.

Objectives: To characterize tear cytokine profiles in patients with idiopathic orbital inflammation (IOI) and analyze the expression of altered cytokines in blood and involved tissues.

Methods: This case-control study enrolled 18 IOI patients and 11 age-/sex-matched controls. Ocular Surface Disease Index (OSDI), corneal fluorescent staining, tear film breakup time (TBUT), Schirmer I test, and other clinical and laboratory parameters were obtained from all participants. Concentrations of cytokines in tear fluid, blood, and tissues were determined using a multiplex bead immunoassay system, enzyme-linked immunosorbent assay, and immunohistochemistry.

Results: Significantly elevated levels of interleukin (IL)-8 and monocyte chemoattractant protein (MCP)-1 (both p < 0.05) were found in IOI tear fluid. The area under receiver operating characteristic curve was 0.73 and 0.74 for IL-8 and MCP-1, respectively. IL-8 and MCP-1 were overexpressed in orbital tissues from patients with IOI, while the plasma levels of IL-8 and MCP-1 in the IOI group were parallel to the control group.

Conclusions: The dysregulation of tear cytokine profiles provides a new insight into the potential immunologic mechanism for IOI. The elevated IL-8 and MCP-1 may represent candidate biomarkers of IOI.

Purpose: To assess changes in retinal vascular calibre following intravitreal ranibizumab treatment in patients with diabetic macular oedema (DMO).

Methods: A post hoc analysis of data from a prospective clinical study assessing patients treated with ranibizumab for DMO was conducted. 76 eyes of 67 treatment naive patients were recruited. Patients received three, monthly, ranibizumab injections. From months 3 to 12, ranibizumab injections were administered PRN. Retinal vascular calibre was measured from digital fundus photographs with a semiautomated computer programme (SIVA) and summarised as central retinal artery (CRAE) and vein (CRVE) equivalent. Artery to vein ratio (AVR) was derived from CRAE/CRVE. The primary and secondary outcomes were change in CRAE, CRVE, AVR, CMT and BCVA from baseline to month 2 and 12, respectively.

Results: BCVA improved significantly from 60.71 ± 8.24 letters by 6.76 ± 6.40 (P < 0.001) at month 2 and 10.12 ± 10.86 (P < .001) at 12. CMT, 470.58 μm ± 106.91 μm, significantly reduced by 81.41 μm ± 99.73 μm (P  < 0.001) at month 2 and 132.48 ± 141.79 μm (P < 0.001) at month 12. There was a statistically significant CRVE decrease by -8.44 μm ± 11.27 μm (P < 0.0001) at month 2 and -4.68 ± 12.41 μm (P = 0.03) at month 12, whilst AVR increased by +0.02 μm ± 0.04 μm (P = 0.02) at month 2 and +0.02 μm ± 0.04 μm (P = 0.01) at month 12.

Conclusion: Ranibizumab treatment was associated with a significant reduction in CRVE and increase in AVR. It is possible that the positive effect of ranibizumab therapy on improvements in BCVA and CMT may be related to reduction of retinal venous calibre and hydrostatic pressure.

Objective: To examine the clinical characteristics of tear film and ocular surface parameters in schoolchildren with myopia.

Methods: This prospective study included 224 myopic schoolchildren aged 7-14 years. The Ocular Surface Disease Index (OSDI) questionnaire was administered, and tear volume was assessed using a strip meniscometry tube (SMTube) and Schirmer I test. An IDRA ocular surface analyzer (SBM Sistemi, Inc., Torino, Italy) measured the noninvasive first break time (NIBUTf), mean break time (NIBUTav), tear meniscus height (TMH), mean lipid layer thickness (LLTav), meibomian gland atrophy (MGA), blink frequency (BF), and blink quality (BQ). Differences in ocular surface parameters by sex, age, spherical equivalent (SE), and OSDI scores were analyzed.

Results: Median values of ocular surface parameters were SMTube 6.0 mm, Schirmer I 17.0 mm, NIBUTf 7.4 s, NIBUTav 10.1 s, TMH 0.21 mm, LLTav 64 nm, superior MGA (Sup-MGA) 33%, inferior MGA (Inf-MGA) 21.5%, BF 4.1s, and BQ 100%. Significant differences in NIBUTf, NIBUTav, and LLTav were observed between the sexes (p < 0.05), while TMH differed by the age group (p = 0.001). Age, SMTube, and Schirmer values varied significantly with OSDI scores (p < 0.05). No significant differences in tear parameters were found among myopia groups. Correlation analysis revealed that SMTube positively correlated with Schirmer (r = 0.6236), NIBUTf (r = 0.1585), NIBUTav (r = 0.1931), and TMH (r = 0.0093) (all p < 0.005).

Conclusion: Nearly one-fourth of myopic schoolchildren have dry eye symptoms, primarily due to the reduced tear volume. Age and sex significantly influenced tear film quality and quantity, while myopia severity showed no significant association.

Purpose: To evaluate changes in choroidal thickness (CT) and their association with refractive outcomes after phacoemulsification combined with goniosynechialysis (Phaco-GSL) in patients with primary angle-closure/glaucoma (PAC/PACG).

Methods: This study involved 79 eyes from 54 patients with PAC/PACG who underwent Phaco-GSL. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and CT were measured preoperatively and at 1 week (W1), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. In addition, anterior chamber depth (ACD), axial length (AL), visual field mean deviation (MD), and mean refractive error (MRE) were recorded preoperatively and at the final follow-up visit. Correlations between ocular biometric parameters and MRE were analyzed using appropriate statistical methods.

Results: Within 6 months after Phaco-GSL, CT measured at 13 predefined locations showed an initial postoperative increase, followed by a gradual decline, eventually returning to baseline levels. IOP decreased at W1 and stabilized at M6. In addition, subfoveal choroidal thickness (SFCT) was negatively correlated with IOP preoperatively (p < 0.05) and AL both preoperatively and at M6 (p < 0.01) but positively related to MD at M6. Moreover, CT changes were positively correlated with MRE (p < 0.05), while changes in ACD, AL, and IOP were not associated with MRE (all, p > 0.05).

Conclusion: These findings suggest that CT initially increases and then decreases over a 6-month period following Phaco-GSL. CT is associated with IOP, AL, and MD reductions. Furthermore, CT changes are associated with an increase in MRE, offering valuable insights into the refractive shifts in PAC/PACG patients after Phaco-GSL.

Purpose: Despite managing glycemic levels and other risk factors, individuals with type 2 diabetes (T2DM) may still experience diabetic retinopathy (DR) progression. This study investigated clinical predictors of DR progression in T2DM patients following bariatric surgery.

Methods: This study was a retrospective post hoc analysis of participants from a clinical randomized controlled trial of bariatric surgery patients with T2DM (ACTRN12611000751976) who had complete DR screening and blood data at baseline and 5 years post-bariatric surgery. Plasma cytokine concentrations were also examined.

Results: DR progression was strongly associated with a postoperative decrease in serum albumin (OR = 0.461, 95% CI: 0.221-0.962, p = 0.039). This decrease also predicted postoperative increases in IL-6 (OR = infinity, sensitivity = 100.00%, p = 0.0162) and IL-1β (OR = 11.250, sensitivity = 81.82%, p = 0.0154), known to be linked to NLRP3 inflammasome activation. In addition, individuals who progressed in DR severity showed greater month-to-month HbA1c variability compared to stable individuals (mean difference: 0.6583%, 95% CI: 0.1821-1.134%, p = 0.0115).

Conclusions: Decreases in serum albumin and increased glycemic variability may influence DR progression through the NLRP3 inflammasome and inflammatory pathways. Further research is needed to clarify the role and mechanism of albumin loss in DR progression.

Objective: To review COVID-19 infection and COVID-19 vaccine-related ocular lesions.

Methods: We carried out a systematic search in PubMed, Web of Science, Embase, and the Cochrane Library on COVID-19 and ophthalmology and reviewed the incidence, specific manifestations, and risk factors for COVID-19-related eye diseases and the relationship between the detection of COVID-19 in the conjunctiva and tears and eye involvement.

Results: Conjunctivitis was the most common ocular lesion caused by 2019-nCoV infection, followed by uveitis and retinopathy. Conjunctivitis can be the first manifestation of COVID-19 infection and may be clinically related to the severity of pneumonia caused by COVID-19. In particular, conjunctivitis that occurs after pneumonia suggests that the patient has severe systemic disease. COVID-19 infection can cause uveitis, but the infection rate of COVID-19 in patients with uveitis is similar to that of the general population. Patients with uveitis need to reduce the dosage of systemic hormones and discontinue biological agents after being infected with COVID-19. Retinopathy caused by COVID-19 infection is mainly manifested as retinal microvascular disease, and the prognosis is good. SARS-CoV-2 detection in the conjunctiva and tears has high sensitivity and is of great value for disease diagnosis. Eye lesions caused by the COVID-19 vaccine, similar to other vaccines, have a low incidence and a good prognosis.

Conclusion: COVID-19-related ocular lesions are mainly manifested as conjunctivitis, uveitis, and retinal microvascular changes. These diseases are somewhat self-limiting and have a good prognosis.

Vitreoretinal surgery, while clinically advanced and increasingly prevalent, presents a substantial environmental burden due to the widespread use of disposable instruments, fluorinated gases, and energy-intensive infrastructure. This narrative review explores sustainability in vitreoretinal practice, identifying key contributors to its carbon footprint and outlining strategies for mitigation. The environmental impact of tamponade agents-particularly sulfur hexafluoride (SF₆), with its extremely high global warming potential-is emphasized through data from recent multicenter studies. Additional contributors include inefficient gas delivery systems, single-use surgical instruments, and the disposal of persistent toxic substances. The article also addresses how expanding surgical indications and reliance on single-use technologies have compounded ecological costs. Evidence-based strategies for improving sustainability are discussed, including the use of air tamponade in selected cases, gas dilution protocols, adoption of single-use canisters, reusable instrumentation, optimized OR workflows, and teleophthalmology pathways that reduce unnecessary postoperative visits. Sustainable vitreoretinal surgery is presented not only as a possibility but as a clinical, ethical, and environmental imperative, achievable without compromising patient outcomes.

Background: Autophagy regulates intracellular metabolism and is crucial in the development of age-related macular degeneration (AMD). Despite the growing number of studies on AMD and autophagy in recent years, bibliometric analyses in this field remain scarce. Therefore, a bibliometric analysis was applied to explore the research trends and hot spots of this field in this study.

Methods: We collected publications on autophagy in AMD from the MEDLINE database, covering the period from January 2010 to October 2024. The "bibliometrix" R package (Version R 4.2.3) was utilized for bibliometric analysis, and WPS Excel, PowerPoint, and Word (12.1.0.18276) were used to manage data and create related tables.

Results: A total of 349 articles were included. The amount of literature was on the rise from 2010 to 2024. China leads in article quantity, whereas the United States holds the most influence. Although Finland ranks the third position in publication volume, followed by China and the United States, Finland led research in this field, with the University of Eastern Finland being the most active and prolific institution and Kaarniranta Kai as the most productive and influential author. International Journal of Molecular Sciences and Autophagy is the journal with the most volume. The three most referenced studies primarily examine the interplay between inflammation, oxidative stress, and autophagy in retinal pigment epithelial cells. The analysis for keywords found that mitophagy has also received increasing attention in this field.

Conclusions: This bibliometric analysis identifies current research hotspots in autophagy related to AMD and informs future research directions. Future trends in this field may involve identifying and developing novel autophagy-targeted therapies for the prevention and treatment of AMD.

Background: The PreserFlo MicroShunt is an effective surgical procedure for intraocular pressure (IOP) control in glaucoma. This study focuses on the rate of reinterventions after PreserFlo implantation, as well as exploring possible risk factors for reintervention.

Methods: This retrospective study included all patients undergoing PreserFlo implantation in our center between March 2021 and March 2023. Surgery was performed as per the manufacturer's recommendations and combined with mitomycin C (MMC) application (0.2 mg/mL, 2 min). Clinical data before the surgical procedure, surgical reinterventions, IOP, the use of hypotensive drugs, and the results of visual field testing were recorded and analyzed.

Results: 91 eyes of 84 patients undergoing PreserFlo implantation were included. 48 eyes had primary open-angle glaucoma (POAG), 23 eyes pseudoexfoliation glaucoma, and the rest myopic, pigmentary or secondary glaucoma. At least one additional surgical procedure was required in 31 eyes (34.1%); 13 eyes required more than one procedure. Approximately 45% of the additional procedures had to be performed in the first 3 months after PreserFlo implantation. The additional procedures performed were 35 bleb revision surgeries, four vitrectomies, eight iStent implantations, four conjunctival sutures due to bleb leak, five nonpenetrating deep sclerotomies, and two PreserFlo tube repositioning surgeries. There was a statistically significant higher rate of reinterventions in eyes with pigmentary or pseudoexfoliative glaucoma (14/26, 53.8%) compared to eyes with POAG (12/48, 25%) (p=0.013, chi square). The rate of reintervention was higher in eyes using ≥ 3 drugs before surgery (29/69 eyes, 42.0%) than in eyes treated with ≤ 2 drugs (2/22 eyes, 9%) (p=0.005, chi square).

Conclusions: Surgical reinterventions were required in a third of the eyes implanted with PreserFlo. Reintervention rate was higher in eyes treated with ≥ 3 drugs. Surgeons should consider adding additional measures to prevent fibrosis when implanting PreserFlo in these eyes.