Journal of Ophthalmology最新文献

Background: Dry age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly, yet effective treatments remain limited. This study aimed to identify putative causal plasma proteins linked to dry AMD through proteome-wide Mendelian randomization (MR) and genetic pleiotropy analyses.

Methods: We performed proteome-wide MR analyses using protein quantitative trait loci (pQTL) data from the UK Biobank Pharma Proteomics Project (UKB-PPP) and genetic summary statistics for dry AMD from FinnGen R11. Replication analyses were conducted using pQTL data from the deCODE Genetics cohort and dry AMD GWAS data from the Million Veteran Program (MVP), all in individuals of European ancestry. To enhance robustness, we conducted additional sensitivity analyses using colocalization and summary data-based MR (SMR) approaches. Cell-type-specific expression profiles derived from single-cell RNA sequencing (scRNA-seq) data were used to prioritize candidate drug targets based on tissue relevance and druggability.

Results: Discovery MR analysis identified 22 plasma proteins putatively associated with dry AMD. Replication MR tests and genetic pleiotropy analyses prioritized 12 proteins. Two retinal cell-specific genes were validated through scRNA-seq analysis. Druggability assessment confirmed C3 as an established AMD target and identified MASP1 and CFHR2 as complement pathway components with partial druggability. Notably, the remaining nine proteins represent novel pathways in dry AMD pathogenesis, four of which offer immediate drug-repurposing opportunities with approved agents, while five represent previously unexplored therapeutic candidates with high mechanistic plausibility.

Conclusions: This study provides genetically supported therapeutic candidates for dry AMD and prioritizes candidates with high clinical potential, advancing therapeutic strategies for dry AMD.

The relationship between coronavirus disease 2019 (COVID-19) infection or vaccination and retinal vein occlusions (RVOs) remains controversial. RVOs include central and branch RVOs. Previous studies have indicated a link between RVOs and COVID-19. RVOs develop when the retinal blood vessels are clogged by thrombin or lipid deposition. The retina, an important component of the visual apparatus, relays the visual information to the brain after light stimulation. When retinal veins are clogged, the damage can range from slightly reduced vision to complete blindness. SARS-CoV-2, the causative agent for COVID-19, leads to endothelial dysfunction and increased von Willebrand factor (VWF) antigen levels in the blood, which activate the coagulation process and platelet aggregation. Activation of tissue factors initiates the coagulation cascade, leading to fibrin formation through thrombin. Because arteries and veins sometimes cross in the retina, the vein, with its thin vessel wall, may be compressed. As a result, blood flow slows due to venous constriction, and clotting is more likely to occur at the crossing point. RVO ultimately develops through these processes. Patients with COVID-19 have significantly elevated levels of VWF antigen and activity, which likely contribute to the increased risk of thrombosis observed in COVID-19-associated coagulopathy. As RVOs align with conventional approaches, ophthalmologists should consider COVID-19 as a potential etiological factor when evaluating patients presenting with acute vision loss. Enhanced awareness of this association may facilitate timely diagnosis and tailored patient care in affected populations.

Background: Conflicting studies suggest that myopia may both increase and decrease the risk of developing glaucomatous visual field loss. To provide appropriate treatment, one must distinguish between visual field fluctuation, where variability occurs over days to weeks not due to pathological change, and true visual field progression. Objective: A retrospective, observational clinical study tests the hypothesis that myopic glaucoma patients demonstrate more long-term visual field fluctuation than emmetropic glaucoma patients. Methods: Four or more Humphrey visual field tests over several clinic visits were analyzed in 156 eyes. The visual field index (VFI) plot, mean deviation (MD), and threshold sensitivity on the glaucoma progression analysis were collected to quantify fluctuation. The sample had two groups: (1) emmetropic glaucoma eyes with a spherical equivalent refraction between +2 and -2 diopters and (2) high myopic glaucoma eyes with a spherical equivalent refraction ≤ -5 diopters. Two sample -tests and one-way analysis of variance (ANOVA) tests with random effect on subject using root mean square error of approximation (RMSEA) were used to compare fluctuation. Results: RMSEA two sample -tests between 78 myopic and 78 emmetropic glaucoma eyes found that myopic glaucoma eyes demonstrated significant fluctuation for MD (p = 0.006) and VFI (p = 0.035) compared with emmetropic eyes. Although myopic eyes showed greater fluctuation in MD (1.504 ± 1.016) and VFI (0.037 ± 0.045) compared with emmetropic glaucoma eyes (MD = 1.125 ± 0.652) (VFI = 0.026 ± 0.019), threshold sensitivity analyses did not reach statistically significant differences (p = 0.054) between myopic (1.609 ± 1.022) and emmetropic glaucoma eyes (1.339 ± 0.687). One-way ANOVA tests found statistically significant MD and VFI fluctuation difference (MD = -0.29, p value = 0.01) (VFI = -0.30, p value = 0.03) but not threshold sensitivity fluctuation difference = -0.19 (p value = 0.11). Conclusion: The results for MD and VFI, but not threshold sensitivity, are consistent with the hypothesis that myopic patients demonstrate more visual field fluctuation than emmetropic glaucoma patients.

Background: Corneal ulcer is one of the most common causes of corneal opacities. This study compared the effects of topical 1% povidone-iodine (PI) and corneal collagen cross-linking in patients with therapy-resistant corneal ulcers. Methods: This single-blind randomized clinical trial included patients referred to Al-Zahra Ophthalmology Hospital in Zahedan, Iran, from 2022 to 2024, who had corneal ulcers resistant to standard therapy. Participants were divided into two groups using stratified permuted block randomization method: one group received 1% PI and the other underwent corneal collagen cross-linking. Signs and symptoms were recorded before treatment and on days 1, 3, 7, and 28 posttreatment. Statistical analysis was performed using generalized estimating equations and repeated measures analysis of variance (ANOVA). Results: Thirty patients, with a mean age of 52.23 ± 2.34 years, participated in this study. Both corneal collagen cross-linking and 1% PI treatments significantly reduced the wound area, stromal infiltration, hypopyon, corneal edema, eye itching, eye burning, and eye pain (p < 0.05). However, no statistically significant differences were observed between the two treatments (p > 0.09). The improvement rate was 73.3% in the 1% PI group and 60% in the corneal collagen cross-linking group. Conclusions: Corneal collagen cross-linking and 1% PI demonstrated comparable efficacy in promoting healing of refractory corneal ulcers. Therefore, both methods may be considered for managing corneal ulcers that are resistant to standard therapy. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20221230056988N1.

Purpose: To evaluate the long-term efficacy of laser photocoagulation (LP) subsequent to intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) twins. Methods: In this matched case-control retrospective study, ELBW (birth weight < 1000 g) twins developed Type I ROP or AROP who received IVR and LP consecutively (IVR + LP) grouped between July 2019 and May 2022 were reviewed. Primary structural outcome was assessed at 12 months postoperatively. Physical assessments, comprising ophthalmic, systemic, and neurodevelopmental evaluations were performed at a chronological age of 24-36 months. Children with spontaneous regression of ROP, matched by sex and age (±3 months) to the IVR + LP group in a 1:1 ratio, were defined as the control group. The independent t-test and Wilcoxon rank-sum test were used to analyze and describe the demography, morphology, and treatment outcomes. Results: Twenty-four twins (48 eyes) with the mean gestational age (GA) and body weight (BW) at birth of 27.5 ± 1.7 weeks and 831.4 ± 140.9 g, respectively, were analyzed. Aggressive ROP in Zone I was observed in 8 eyes (16.7%). Stage 3+ disease was observed in 2 eyes (4.1%) in Zone I and 17 eyes (35.4%) in Zone II posterior. The median duration between IVR and LP was 197.5 days (range: 28-237 days). The reduction of cumulative clock hours (CCH) of ROP lesion showed a statistically significant difference after IVR (p < 0.05). The median laser spots count was 204 (range: 139-503), and the laser power ranged from 100 to 130 mW. Long-term follow-up physical examinations, including ophthalmic, systemic, and neurodevelopmental assessments, revealed no statistically significant differences between the IVR + LP and control groups. Notably, there were no differences in axial length (AL) and spherical equivalent (SE) (p < 0.05). Conclusion: LP following IVR treatment provides long-term effective outcomes for ROP in ELBW twins, without affecting ophthalmic, systemic, or neurological development, and reduces the risk of myopia compared to LP monotherapy.

Purpose: With degeneration of the photoreceptors in retinitis pigmentosa (RP), the reflectivity of the ellipsoid zone (EZ) decreases. We aimed to study characteristics of the EZ and its reflectivity in a cohort of patients with PRPF31-associated autosomal-dominant RP (PRPF31-adRP) and a possible relationship to EZ width and best-corrected visual acuity (BCVA). Methods: EZ width and relative EZ reflectivity (rEZR) were assessed in 32 patients with PRPF31-adRP. EZ width was measured on a horizontal SD-OCT scan through the fovea of the right eye. On the same OCT scans, rEZR was measured at the foveola, temporal and nasal parafoveola and fovea. Results: Total EZ width revealed a significant negative correlation with age (r _s  = -0.418, p=0.017). Foveolar rEZR revealed a significant negative correlation with age (r _s  = -0.403, p=0.022), but was not significantly correlated with BCVA (foveolar: r _s  = -0.151, p=0.410), in contrast to parafoveolar rEZR (r _s  = -0.365, p=0.0399), which was significantly correlated with BCVA. The ratio of foveal and parafoveolar rEZR correlated significantly with total EZ width (r _s  = 0.358, p=0.044). Conclusions: The EZ reflectivity (EZR) can be measured reliably using freely available software. The correlation we observed between rEZR and BCVA leads us to the conclusion that rEZR may be an additional marker in observational and therapeutic trials.

Purpose: To objectively evaluate ocular cycloposition using conventional color fundus photography (CFP) and Spectralis optical coherence tomography (OCT) in exotropic patients undergoing horizontal strabismus surgery and to assess the agreement between these methods. Additionally, we aimed to determine whether surgery alters ocular torsion in pure exotropia. Methods: In this prospective, single-center study, 42 eyes from 21 patients with exotropia requiring bilateral lateral rectus muscle recession were evaluated. The disc-center fovea angle (DFA) was measured pre- and postoperatively using CFP (Topcon fundus camera) and Spectralis OCT with fovea-to-disc (FoDi) alignment software. Results: The angle of exodeviation improved significantly postoperatively, from 35.10 ± 7.89 to 3.76 ± 3.73 prism diopters (p < 0.001). Both CFP- and OCT-derived DFA values remained stable in both eyes at 6 months (p > 0.05 for all comparisons). No significant differences were observed between CFP and OCT measurements at baseline or postoperatively (p > 0.05). Preoperative intraclass correlation coefficient (ICC) between methods was strong (right eye: 0.765; left eye: 0.750), decreasing postoperatively to moderate levels (right eye: 0.618; left eye: 0.661). Conclusion: Horizontal strabismus surgery does not significantly alter ocular torsion in pure exotropia. Spectralis OCT reliably quantifies cyclotorsion but may yield marginally lower DFA values compared to CFP, despite no statistical difference.

Purpose: To assess the impact of various body and head positions on intraocular pressure (IOP) in cataract patients aged over 40 years with limited mobility. Methods: This cross-sectional study was conducted between August and December 2023 at Aier Eye Hospital of Wuhan University. The IOP was measured using a handheld tonometer (iCare IC200 rebound tonometer) in various head positions (forward, tilted left, and tilted right) and body positions: supine, semirecumbent, sitting, and prone. Results: In the supine position, the IOP measurements for the head positioned forward, right, and left were (13.80 ± 3.62) mmHg, (14.25 ± 3.66) mmHg, and (13.78 ± 3.40) mmHg, respectively. In the semirecumbent position, the corresponding IOPs were (12.08 ± 3.34) mmHg, (12.12 ± 3.22) mmHg, and (12.04 ± 3.38) mmHg. In the sitting position, the IOPs were recorded as (11.73 ± 3.29) mmHg, (11.73 ± 3.22) mmHg, and (11.59 ± 3.17) mmHg. Lastly, in the prone position, the IOPs were (14.19 ± 3.73) mmHg, (14.42 ± 3.93) mmHg, and (14.74 ± 3.81) mmHg, respectively. In each position group, there was no statistically significant difference in IOP among the three head positions. Regardless of the head position, the IOP is lowest in the sitting position, followed by semirecumbent and supine positions, with the prone position having the highest IOP. The analyses revealed that central corneal thickness (CCT) was correlated with an IOP value (p < 0.05) when patients were in different positions. Conclusion: IOP is influenced by body position. As the body transitions from upright to horizontal, IOP tends to increase. The position of the head, however, has no effect on IOP.

Purpose: To investigate whether supplementation with dietary antioxidants has an effect on the yearly progression rate of atrophic lesions in autosomal recessive Stargardt disease (STGD1), as derived from fundus autofluorescence (FAF). Methods: Retrospective study of patients with molecularly confirmed STGD1 aged ≥ 6 years at baseline and presence of an atrophic lesion of ≥ 250 μm in diameter, who underwent FAF imaging between 01/01/2010 and 10/31/2023. Patients were grouped into supplement takers and nontakers based on the daily intake of lutein, zeaxanthin, saffron, and N-acetylcysteine. Baseline and follow-up FAF images were graded by two readers. Variables assessed included total area of decreased FAF (DAF) and effective lesion size of total DAF, calculated as a square root transformation. Annual atrophy growth rates were calculated for both subgroups and compared. Results: A total of 53 eyes of 53 patients were enrolled. Thirty-three patients were categorized as supplement takers (mean age 34 ± 20.3 years, 57.6% female) and 20 patients as nontakers (mean age 29.5 ± 16.6 years, 65% female). Mean growth rates of DAF were 0.61 ± 0.72 mm²/year for supplement takers and 0.49 ± 0.55 mm²/year for nontakers (p=0.9). The mean observation period was 2 years (range 0.5-5.6) and 4.5 years (range 1-10.3), for supplement takers and for nontakers, respectively. Conclusion: Supplementation with dietary antioxidants did not result in a slower progression rate of DAF lesions in STGD1. Further investigation with randomized trials is needed for evidence-based use of antioxidant supplements for the disease.

[This corrects the article DOI: 10.1155/joph/5594701.].