Journal of Ophthalmology最新文献

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.

Objective: This study aims to evaluate the clinical effectiveness of combining lentectomy, vitrectomy, and trabeculectomy in treating secondary glaucoma caused by lens dislocation.

Methods: We retrospectively analyzed data from 20 cases (20 eyes) of traumatic lens dislocation accompanied by secondary glaucoma. The patients underwent standard 3-port pars plana vitrectomy and the upper trabeculectomy. Mitomycin C (MMC) was applied below scleral flap during surgery. We evaluated preoperative and postoperative visual acuity, intraocular pressure (IOP), and any complications.

Results: Postsurgery, visual acuity improved in 18 of the 20 eyes (90%). The operation was considered successful if postsurgery, the use of topical antiglaucoma drugs was no longer necessary or reduced, and the IOP was controlled within the range of 6-21 mmHg. Of the cases studied, 18 eyes (90%) had a successful outcome, while 2 eyes (10%) were unsuccessful, with an IOP of less than 6 mmHg. All 20 eyes (100%) developed follicles postoperatively. Complications included intraocular hemorrhage in 3 eyes, low intraocular pressure in 6 eyes, choroidal detachment in 4 eyes, and hyperfiltration in 2 eyes.

Conclusion: The combination of lentectomy, vitrectomy, and trabeculectomy presents a safe and effective method for reducing intraocular pressure and improving visual acuity in patients with secondary glaucoma resulting from lens dislocation.

Purpose: To assess the visual outcomes, refractive accuracy, and visual disturbances in patients with a history of myopic laser-assisted in situ keratomileusis (LASIK) who underwent cataract surgery with extended depth of focus intraocular lens (IOL).

Methods: This prospective interventional study included 26 eyes of 13 patients who had previously undergone myopic LASIK surgery. All the participants underwent bilateral phacoemulsification and implantation of the AcrySof IQ Vivity IOL between May 2023 and March 2024. Inclusion criteria included patients > 50 years of age with corneal higher-order aberrations < 0.6 and coma < 0.4. Exclusion criteria included glaucoma, macular disease, retinal detachment, and corneal disease. Visual acuity examinations were performed 1 and 3 months postoperatively.

Results: Before surgery, the mean uncorrected distance visual acuity (UDVA) was 0.3 ± 0.08 logMAR, and the mean corrected distance visual acuity (CDVA) was 0.1 ± 0.03 logMAR. At 3 months follow-up, significant improvements in UDVA (0.04 ± 0.05 logMAR), intermediate (0.1 ± 0.09), and near visual acuity (0.27 ± 0.1) were noted. Postoperatively, 65.4% of the eyes achieved refractive outcomes within ±0.5 D of emmetropia, and 92.3% were within ±1 D. Quality of Vision (QoV) scores revealed no considerable changes following surgery.

Conclusion: The AcrySof IQ Vivity IOL demonstrated good uncorrected distance and intermediate visual outcomes in patients with prior myopic LASIK, along with functionally acceptable near vision and good refractive predictability. These findings support the use of this extended-depth-of-focus lens as a viable solution for presbyopia correction in postrefractive surgery patients, with minimal impact on visual disturbances.

Cataract and refractive surgery are integral to improving vision health and quality of life; however, their growing environmental impact poses significant concerns. These procedures contribute notably to medical waste, excessive energy consumption, and pharmaceutical overuse, amplifying the carbon footprint of health care. Key environmental challenges include the dependence on single-use surgical instruments, high energy demands from laser and phacoemulsification systems, and the waste associated with medication disposal and packaging. Although some sustainable initiatives, such as reusable surgical tools, biodegradable packaging, and optimized pharmaceutical usage, have been introduced, widespread implementation remains limited. This review investigates the environmental impact of ophthalmic surgery, assesses current sustainable practices, and highlights emerging eco-friendly innovations. Notable advancements include energy-efficient surgical devices, electronic instructions for use, optimized postoperative protocols, and regulatory policies aimed at promoting green hospital systems. However, further research into life cycle assessments, carbon footprint evaluations, and regulatory reforms will be crucial to advancing global sustainable practices without compromising patient care and surgical outcomes.

Purpose: To compare the Active Sentry and OZil handpieces regarding their ability to prevent postocclusion surge.

Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design: Experimental study.

Methods: This study used the Alcon Centurion surgical platform, with both OZil handpieces fitted with balanced tips. The quad preset was used with a vacuum of 500 mmHg, an aspiration flow of 50 mmHg, and an intraocular pressure (IOP) of 70 mmHg. A rubber disk was fixed within a sealed chamber fitted with an electric pressure sensor to monitor pressure changes. The phaco tip was inserted through a small opening, and the foot pedal was set to position two. The tip was put in contact with the fixed rubber disk to replicate tip occlusion and then pulled from the disk to simulate occlusion break. 10 trials were performed with each handpiece, and pressure changes were recorded electronically.

Results: A significant difference (p < 0.01) was found between the magnitude of postocclusion surge, as well as between the duration of postocclusion surge.

Conclusion: The Active Sentry handpiece was found to have a decreased magnitude and shorter duration of postocclusion surge compared with the OZil, signifying that having the pressure sensor in the handpiece allows it to react to post-occlusion surge more quickly and to decrease surge magnitude.

Background: A debilitating corneal ectasia, designated as keratoconus, often leads to distorted and obscured vision, and greater reactivity to light. Inevitably, the cornea becomes thinner and protrudes outward forming a cone-like configuration. The research hypothesis is initiated to estimate the reliability of the mirror symmetry and the dimensions of keratoconus severity, prospecting that mirror octant possessed a significant impact on the trajectory of the disorder.

Methods: This study included patients with clinically diagnosed with bilateral keratoconus and bilateral astigmatism. Mirror symmetry or enantiomorphism was quantified employing the refractive cylindrical notations of yoke eye. Pentacam enable the observation of keratoconus severity utilizing corneal thickness, average corneal thinning, and asphericity coefficient. Multiple R was performed to analyze the model fit along with descriptive statistics. One-way ANOVA, guided by F-statistics, was solicited to analyze group variability, while a scatter plot was exploited to forecast the direction of mirror octant association of the variables. SPSS 29.0 software was utilized to perform the statistical analysis, with a p value of less than 0.05 was considered statistically significant.

Result: With a significant (p < 0.05) F-statistic, the mirror symmetry remains the statistically significant predictor in the regression model. Average corneal diopter for both eyes exhibit a positive correlation. Conversely, corneal thickness and asphericity coefficient for both eyes demonstrate a negative correlation with mirror symmetry.

Conclusions: Mirror symmetry's applicability may be inadequate by its subservience on corneal contour analysis, which, although obliging, may abstruse other salient clinical considerations. With 35.6% of the model variability, it indicates a room for improvement by adding nonlinear predictors to enhance the model.

[This corrects the article DOI: 10.1155/2024/7645490.].

Background: This study analyzed changes in the vessel densities (VDs) and hemorheological parameters of patients with central retinal vein occlusion (CRVO). Methods: A prospective randomized case-control study was conducted, which included 80 CRVO patients (the study group) and 80 participants with normal fundus (the normal control group). Best-corrected visual acuity (BCVA), optic disc and macular VD, and other structural parameters (C/D ratio, RNFL thickness, etc.) were measured with optical coherence tomography angiography. Hemorheological parameters, including whole blood viscosity at low shear rate (LSR-WBV; 5/s) and high shear rate (HSR-WBV; 200/s), and erythrocyte aggregation index (AI), were also measured. Results: LSR-WBV, HSR-WBV, and AI were significantly higher in CRVO patients (9.009 ± 1.595 mPa·s, 4.981 ± 0.617 mPa·s, and 3.405 ± 1.679) than in participants with normal fundus (8.409 ± 1.110 mPa·s, 4.523 ± 0.597 mPa·s, and 2.880 ± 1.517) (all p < 0.05). CRVO eyes had significantly lower visual acuity, smaller C/D and cup volume, thicker peripapillary RNFL, and lower optic disc and macular VD than unaffected eyes and normal eyes (all p < 0.05). VD inside the optic disc and deep capillary plexus in unaffected eyes was markedly decreased when compared with that in normal eyes (all p < 0.05). BCVA in CRVO eyes was particularly correlated with VD inside disc (p=0.001 and r = -0.391). Conclusion: CRVO patients presented with more serious thrombophilia and higher hemorheological parameters, and the blood perfusion was significantly decreased in the optic disc and macula of CRVO eyes and was partially reduced in unaffected eyes. Moreover, optic disc blood perfusion exerted greater impacts on visual acuity, and inside-disc VD might be the greatest risk factor.