Journal of Ophthalmology最新文献

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.

Purpose: To systematically review SMILE-based astigmatism correction and influencing factors.

Methods: Literature was screened across eight databases. Pre- and post-SMILE cylinder, difference vector (DV), correction index (CI), magnitude of error (ME), angle of error (AE), and index of success (IOS) were compared. Bias was assessed using Cochrane's Risk of Bias, Quality Assessment of Diagnostic Accuracy Studies, and the Newcastle-Ottawa Scale.

Results: Elevated ocular residual astigmatism (ORA) resulted in greater postoperative residual astigmatism, accompanied by increased DV and IOS (p < 0.05), whereas ME, AE, and CI remained unaffected by ORA levels. Postoperative cylinder, DV, ME, AE, CI, and IOS were comparable between eyes (p > 0.05). Correction outcomes were impacted by ocular rotation, astigmatism characteristics, spherical degree, corneal curvature, and patient age.

Conclusions: SMILE effectively corrects low, moderate, and high astigmatism, but high ORA patients tend to experience undercorrection. But accuracy requires vector planning.

The widespread use of single-use plastic eye drop bottles in ophthalmology presents a significant environmental challenge. While essential for preventing contamination and ensuring patient safety, these bottles contribute to plastic waste due to their small size, multimaterial composition, and inadequate recycling infrastructure. This review examines the environmental impact of eye drop packaging across various ophthalmic conditions, including dry eye disease, cataract surgery, and glaucoma, highlighting the substantial cumulative burden of plastic waste and carbon emissions. The manuscript explores innovative solutions to mitigate this environmental footprint without compromising clinical standards. Key strategies discussed include product redesign using biodegradable materials, the adoption of multidose preservative-free systems, and the development of alternative drug delivery technologies like punctal plugs. Additionally, the importance of advanced recycling initiatives, such as specialized take-back programs, is emphasized. The paper also underscores the need for behavioral, institutional, and policy interventions, including educational campaigns, sustainable procurement practices, and the implementation of Extended Producer Responsibility (EPR) policies. By integrating these multifaceted approaches, the field of ophthalmology can align the critical priorities of patient safety and environmental sustainability, fostering a transition towards greener practices while maintaining high standards of care.

Background and aims: To quantitatively measure eye movement behaviors in indoor, outdoor, and reading scenarios to understand their potential link to myopia.

Methods: Forty-one healthy adult subjects freely viewed indoor and outdoor scenes and performed reading activities using virtual reality (VR). Eye movement data were recorded with the built-in eye tracker of the VR headset (HTC Vive Pro Eye). Gaze and fixation data were calculated and reported for eight regions of the visual field.

Results: Indoor scenes exhibited a more pronounced downward gaze than outdoor environments. Significant differences (p < 0.05) in gaze and fixation behaviors were observed between reading and other scenarios. In Region 8 (peripheral inferior visual field), the median (1st quartile and 3rd quartile) number of gaze points was 816 (463, 1175), 1123 (743, 1497), and 1705 (966, 2382) for outdoor, indoor, and reading scenarios, respectively. Similarly, fixation behavior counts were 4 (1, 9), 7 (1, 11), and 39 (22, 54), respectively.

Conclusion: Downward gaze and fixation behaviors are more prevalent in reading and indoor environments. Given that downward eye movements can induce instantaneous axial elongation, our results suggested a potential biomechanical pathway for myopia progression through optic nerve traction and ocular tissue remodeling. This study underscores the need for further research to explore the specific role of eye movement behaviors in the progression of myopia, especially in real-life settings.

Objective: To evaluate the prevalence of astigmatism and its association with ocular biometrics in primary schoolchildren in Zibo City, China.

Methods: A cross-sectional study was conducted among 25,140 children aged 7-13 years from 19 primary schools in Linzi District, Zibo City, China, between April and May 2024. Refractive status was assessed via autorefractometry under natural pupil conditions, and astigmatism prevalence was determined using right-eye data. The study evaluated astigmatism severity (mild, moderate, or high), axis orientation (with-the-rule, against-the-rule, or oblique), visual acuity, and correlations with spherical refraction. A nested case-control analysis was performed to compare ocular biometric parameters, including axial length (AL), central corneal thickness (CCT), corneal diameter (white-to-white, WTW), and lens thickness (LT), among groups stratified by astigmatism severity.

Results: The overall prevalence of astigmatism was 46.21% (95% CI: 45.6%-46.8%), increasing with advancing age and school grade. Astigmatism severity distribution was as follows: mild (37.16%), moderate (6.81%), and high (2.24%) among all participants. Among the 11,616 children with astigmatism, 62.86% had with-the-rule astigmatism, 27.48% exhibited against-the-rule astigmatism, and 9.66% presented oblique astigmatism. Visual acuity exhibited a significant decline with increasing astigmatism severity (p < 0.001). Higher astigmatism severity was inversely associated with myopia prevalence (p=0.04). Ocular biometric parameters, including AL, CCT, WTW, and LT, showed significant differences across severity groups (p < 0.05).

Conclusion: Astigmatism is highly prevalent among primary school children in Linzi District, with significant associations between severity, ocular biometrics, and visual outcomes. These findings emphasize the need for early screening and tailored management strategies for childhood astigmatism.

The significance and contributions of corneal biomechanics in the study of chronic elevated intraocular pressure are multifaceted. Not only does it enhance our understanding of how chronic elevated intraocular pressure affects corneal structure and function, but it also offers new perspectives for the early diagnosis of glaucoma. Analysis of the cornea's biomechanical properties enables earlier identification of high-risk glaucoma patients and potential development of personalized treatment plans, thereby improving treatment outcomes. Moreover, changes in corneal biomechanics can serve as a new metric for assessing glaucoma treatment effectiveness, providing precise clinical feedback. Continued research on the role of corneal biomechanics in chronic elevated intraocular pressure and glaucoma is crucial for improving the diagnosis, treatment, and prognosis. Understanding associations between these biomechanical changes and glaucoma development can elucidate disease mechanisms, enabling more effective treatment strategies and preventive measures. This review explores the latest research developments on corneal biomechanical changes associated with chronic elevated intraocular pressure and their impact on glaucoma management, highlighting the importance of these changes in clinical practice.

Purpose: Topical povidone iodine (PI) has been shown to reduce the risk of endophthalmitis following intravitreal injections (IVIs). However, PI is a known ocular irritant and can result in significant eye discomfort. Currently, 5% PI is the most used concentration for ocular surface disinfection prior to IVI. 2.5% PI has been proposed as an alternative IVI preparation to lessen PI-associated ocular irritation. The purpose of this study is to compare the efficacy of topical PI 2.5% to PI 5% in preventing post-IVI endophthalmitis at a single academic institution location.

Methods: A retrospective chart review was conducted at a single academic institution location of patients receiving IVI from August 1st, 2017, to June 15th, 2022. IVIs were performed using PI 2.5% or PI 5%. PI 5% was applied to the ocular surface 60 s before IVI. PI 2.5% was applied over the ocular surface and then reapplied 4-5 min later over the injection site and fornices before IVI.

Results: A total of 7360 IVIs were performed in 773 patients (473 patients on 2.5% and 300 on 5% PI). 52.0% of IVIs were performed with 2.5% PI (n = 3826) and 48.0% were performed with 5% PI (n = 3534). The mean age of patients was 66.8 years for the 2.5% PI group and 69.1 years for the 5% PI subgroup (p=0.044). Three cases of endophthalmitis were identified in the 5% PI subgroup (0.08%), and no cases of endophthalmitis were identified in the 2.5% PI subgroup. All cases of endophthalmitis were treated with prompt intravitreal antimicrobial injection.

Conclusion: In this retrospective study, we found that 2.5% and 5% PI had similar results in preventing post-IVI endophthalmitis. This study adds to the literature by further supporting the antiseptic effect of 2.5% PI for IVI. Larger prospective studies are needed to further clarify the antiseptic effect and ocular surface irritation associated with 2.5% PI use.