Journal of Ophthalmology最新文献

Purpose: To compare the aqueous cytokine profile in polypoidal choroidal vasculopathy (PCV) with or without massive hemorrhage and typical neovascular age-related macular degeneration (nAMD).

Methods: The present comparative study included 81 treatment-naïve eyes from 75 patients (PCV with massive hemorrhage 20 eyes, PCV without massive hemorrhage 19 eyes, typical nAMD 19 eyes, and cataract control 23 eyes). 10 cytokines (VEGF, IL-6, IL-8, MCP-1, ICAM-1, VCAM-1, IP-10, G-CSF, and IFN-γ, IL-10) in the aqueous humor were measured by cytometric bead array.

Results: VEGF levels in PCV with massive hemorrhage (median 5.20 pg/mL) were significantly lower than that in PCV without massive hemorrhage (median 34.76 pg/mL, p = 0.003) and typical nAMD (median 43.88 pg/mL, p < 0.001). They were even lower than that in normal cataract controls (median 22.02 pg/mL, p = 0.037). Multiple inflammatory cytokines were dramatically elevated in PCV with massive hemorrhage. IL-6, IL-8, MCP-1, ICAM-1, and IP-10 levels were significantly higher in PCV with massive hemorrhage than that in the other three groups. VCAM-1 levels were significantly higher in PCV with massive hemorrhage than that in typical nAMD and in control. G-CSF and IFN-γ levels were significantly higher in PCV without massive hemorrhage than that in control. IL-10 levels were significantly higher in PCV with massive hemorrhage than that in typical nAMD.

Conclusions: This pilot study showed that PCV with massive hemorrhage had a lower-than-normal VEGF level in aqueous humor and inflammation may be actively involved in the pathogenesis of massive hemorrhage in PCV.

Objectives: Cycloplegic refraction, the gold standard for detecting myopia, is not available to everyone, even in hospital-based scenarios. Nevertheless, the conclusions of previous studies investing in noncycloplegic indicators for myopia detection were inconsistent. We aimed to explore noncycloplegic indicators for detecting myopia in children from southwestern China.

Methods: This retrospective cross-sectional study collected data from 562 children aged 6-14 who visited the optometry clinic at Chongqing Shapingba District People's Hospital in southwestern China between October 2023 and September 2024. The key noncycloplegic indicators, such as gender, age, uncorrected visual acuity (UCVA), intraocular pressure (IOP), average corneal curvature (ACC), noncycloplegic spherical equivalent refraction (NCSER), axial length (AL), AL to average corneal radius of curvature (AL/ACRC), height and weight, were estimated via logistic regression and receiver operating characteristic (ROC) curves to evaluate the efficacy of various indicators for detecting myopia (defined as cycloplegic spherical equivalent refraction ≤ -0.50 D).

Results: A total of 562 subjects were included, with 72.2% diagnosed with myopia via cycloplegic refraction. Univariate logistic regression identified age, UCVA, NCSER, AL, and AL/ACRC ∗ 100 as predictors of myopia (CSER ≤ -0.50 D). The multiple logistic regression analysis revealed that UCVA, NCSER, and AL/ACRC ∗ 100 were significant indicators for myopia (CSER < -0.50 D). Although the area under the ROC curve (AUC) of the combined use of UCVA, NCSER, and AL/ACRC (AUC = 0.982) was the largest among the indicators under exploration, there was no significant difference from that of NCSER alone (AUC = 0.975) (p = 0.120). The cutoffs for NCSER were -0.815 D in the 6-8 year age range, -0.804 D in the 9-11 year age range, and -0.687 D in the 12-14 year age range.

Conclusions: Our study of children (6-14 years) in southwestern China established NCSER as the most robust noncycloplegic indicator for myopia. Consequently, applying age-specific NCSER thresholds may provide a practical clinical tool to guide decisions on both the necessity for cycloplegic refraction and the early implementation of myopia prevention strategies without initially requiring cycloplegia.

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.