Journal of Ophthalmology最新文献

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.

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.