Journal of Ophthalmology最新文献

Purpose: To explore the long-term (13-year) outcomes associated with keratorefractive lenticule extraction (KLEx) among patients with myopia up to -10 dioptres. Methods: This prospective, nonconsecutive case series included 29 patients (29 eyes) who underwent KLEx procedures from May, 2010, through March, 2013, at the Fudan University Eye and ENT Hospital. Analyses performed preoperatively and at the 1-month, 1-year, 5-year, 10-year, and 13-year postoperative time points included measures of uncorrected and corrected distance visual acuity (UDVA and CDVA), objective and manifest refractions, intraocular pressure, axis length, slit-lamp examination, and corneal tomography. Results: All surgeries were performed without any complications. A UDVA of at least 20/25 was achieved in 29 eyes (100%), while 10 eyes (43.4%) exhibited unchanged CDVA, and no lines were lost for any eyes. Additionally, 21 eyes (72%) and 28 eyes (97%) were, respectively, within ±0.5 D and ±1.00 D of the target refraction. The mean refractive regression from 1 month to 13 years after surgery was -0.26 ± 0.41 D. No significant changes in posterior central elevation (PCE) or △PCE were noted at the follow-up time points (all p > 0.05). Significant postoperative increases in higher-order aberrations and vertical coma were observed postoperatively (p < 0.001), and these remained largely stable over the follow-up period (all p > 0.05). Conclusion: These 13-year follow-up results highlight the safety, stability, and predictability of KLEx as an approach to treating myopia up to -10 dioptres.

Purpose: To compare efficacy and safety for deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) for macular corneal dystrophy. Methods: Following PRISMA guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to January 2024. Using STATA 17, we reported outcomes as log risk ratios (log RRs) or mean difference (SMD) and confidence intervals (CIs). A p value ≤ 0.05 is considered statistically significant. Results: DALK was superior to PK in terms of BCVA (Hedge's g: -0.32 with 95% CI [-0.64, -0.01], p=0.05), PK was associated with a higher risk of graft rejection in comparison with DALK (log RR: 1.21 with 95% CI [0.25, 2.18], p=0.01), and there was no difference between PK and DALK in terms of risk of glaucoma, cataract (log RR: -0.02 with 95% CI [-1.00, 0.95], p=0.96), and (log RR: 0.09 with 95% CI [-0.53, 0.71], p=0.78). The pooled data were homogeneous (I ² = 0%; p=0.84), respectively. Conclusion: This study suggests that PK, compared to DALK, is associated with worse visual outcomes, with a lower risk of recurrence and a higher risk of graft rejection in macular corneal dystrophy patients.

Glaucoma is a leading cause of irreversible blindness globally, affecting millions of individuals. It encompasses a group of progressive optic neuropathies characterized by retinal ganglion cell loss and visual field deterioration, often associated with elevated intraocular pressure. Despite advances in understanding the disease, glaucoma management remains challenging due to its complex pathophysiology, heterogeneous presentations, and the need for lifelong treatment. Given the rapidly evolving nature of glaucoma research and its multidisciplinary scope, there is a compelling need for a comprehensive review that synthesizes the latest findings, highlights key advancements, and identifies areas requiring further investigation. This review aims to serve as a comprehensive resource for ophthalmologists, researchers, and healthcare providers by offering an overview of glaucoma classification, pathophysiology, risk factors, diagnostic tools, and management options.

Purpose: To report the visual outcomes following bilateral implantation of a new trifocal intraocular lens (IOL) in patients with age-related cataracts. Methods: This prospective, noncomparative, multicenter study assessed 126 patients undergoing cataract extraction followed by AT ELANA 841P IOL implantation. At 4-6 months postoperatively, refractive error and predictability, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and binocular contrast sensitivity were measured. The binocular defocus curve was evaluated at 3 months postoperatively. Results: Postoperatively, most of the eyes (84.9%) were within ±0.5 D of spherical equivalent (SE) refraction and almost all eyes (98.9%) within ±1.0 D, with a mean SE value of -0.11 ± 0.37 D. Mean monocular CDVA was -0.06 ± 0.08 logMAR and UDVA was -0.01 ± 0.10 logMAR. Mean monocular uncorrected (UIVA and UNVA) and distance-corrected visual acuities (DCIVA and DCNVA) were 0.1 logMAR or better at intermediate (80 cm) and near (40 cm) distances. In the mean defocus curve, a continuous range of 0.1 logMAR or better vision from distance to near was observed. Percentages of eyes achieving CDVA, DCIVA, and DCNVA of 0.1 logMAR or better were 97.2%, 59.1% and 59.1%, respectively. Uncorrected visual acuity of 0.1 logMAR or better was achieved in 88.9% of the eyes at far, 57.1% at intermediate, and 44.4% at near distances. Contrast sensitivity was in the normal range of a phakic population at all spatial frequencies in all light conditions tested, photopic with glare and mesopic with and without glare. Conclusion: Implantation of the new AT ELANA 841P IOL following cataract extraction is safe and effective. Visual acuities at all distances, refractive outcomes, and contrast sensitivity were favorable at 4-6 months postoperatively, providing patients with satisfactory far, intermediate, and near vision. Trial registration: ClinicalTrials.gov identifier: NCT06247683.

Purpose: To analyse the outcomes of deep anterior lamellar keratoplasty (DALK) in cases with intraoperative Descemet membrane (DM) perforation. Methods: This is a literature review reporting outcomes of DALK with DM perforation. Studies where DALK was performed in the event of intraoperative DM perforation were included. Studies that did not separate analysis between those with and without DM perforation were excluded. The primary outcome was best-corrected distance visual acuity (BCVA). Secondary outcomes were endothelial cell density (ECD), graft survival, rejection rates, double anterior chamber and conversion to penetrating keratoplasty (PK). Data from the included studies were collated to compare the outcomes of DALK with intraoperative DM perforation vs. DALK without DM perforation. Results: Eleven retrospective case series (357 eyes) were included. DM perforations were classified as micro- (n = 236) or macroperforations (n = 106). Mean weighted preoperative BCVA was 1.11 ± 0.36 logMAR and 1.13 ± 0.52 logMAR in perforation and nonperforation groups, respectively (p=0.53), improving to 0.35 ± 0.37 logMAR and 0.39 ± 0.07 logMAR at 12 months postoperatively (p=0.02). Graft rejection rates were 1.25% and 1.6% in the perforated and nonperforated groups, respectively, and primary graft failure rates were 4% and 3.74%, respectively. The mean postoperative ECD was 1662.41 ± 319.16 cells/mm² in the perforation group. Amongst those cases with DM perforation, double anterior chamber requiring rebubbling occurred in 22.4% of cases, and conversion to PK was 4.23%. Conclusion: DALK can achieve comparable long-term outcomes in the presence of DM perforation. Micro- and some macroperforations can often be managed without conversion to PK, with good long-term outcomes.

Purpose: To evaluate the feasibility of using ChatGPT-4, a large language model (LLM), to develop a customized nomogram calculator for small-incision lenticule extraction (SMILE) surgery based on institution-specific data, without requiring any coding expertise. Customized nomograms are essential due to variations in surgical practices, patient populations, and diagnostic equipment across vision correction centers. Methods: A retrospective analysis of consecutive patients was performed on data of 1268 eyes that underwent SMILE. Preoperative measurements and postoperative refractive errors at 6 months were collected and analyzed. The entire dataset was divided into a training set and validation set at a ratio of 3:1. After data anonymization, ChatGPT-4 was instructed to perform a linear regression analysis to predict postoperative refractive errors using preoperative data. Subsequently, we instructed ChatGPT-4 to generate HTML code for a webpage-based nomogram calculator that inputs preoperative data and calculates surgical parameters using the derived formulas. The results of the regression analysis performed using ChatGPT-4 were compared with those obtained using two conventional statistical software programs, R and SPSS. Results: ChatGPT-4 successfully performed SMILE nomogram regression analysis. The predicted SMILE parameters were not significantly different from those obtained using the statistical software. The nomogram showed a higher predictive ability for postoperative refractive error than the simple empirical nomogram (p < 0.001). We successfully created a webpage-based calculator using ChatGPT-4 through multiple prompt instructions without coding. Conclusion: ChatGPT-4 not only provides a statistical model for SMILE nomograms but also creates a calculator for user convenience. Clinicians can easily build their own nomogram calculators using only the collected data without coding. The advanced LLM will allow clinicians to conveniently create customized nomogram tools.

The healthcare sector contributes significantly to greenhouse gas emissions and global warming. There is an increasing prevalence of glaucoma, and glaucoma surgeries, nonsurgical treatment, and clinic follow-up contribute to these emissions. Some of the main sources of emissions associated with glaucoma care are related to transportation to and from surgical centers and clinic, single use equipment and eye drops, excessive device packaging, and waste produced in the operating room. There are several changes we can make to our practice patterns to help mitigate these emissions while maintaining safe and effective care for our glaucoma patients. We should emphasize disinfecting equipment properly rather than purchasing single-use items. We should perform procedures that utilize equipment that is locally available and recommend manufacturers to use smaller packages for glaucoma devices. We should strive to perform bilateral procedures when safe for patients. Finally, we should integrate telehealth into our regular practice.

Purpose: This study aims to explore the visual quality and characteristics of higher order aberrations (HOAs) in patients with early posterior capsule opacification (PCO), providing a theoretical basis for the clinical assessment of early PCO and the potential benefits of Nd:YAG posterior capsulotomy. Methods: This cross-section observational study included 73 patients (73 eyes) diagnosed as PCO at a tertiary hospital from September 2022 to September 2023. All subjects underwent optometric examinations, OQAS, and iTrace measurements, followed by posterior capsule retroillumination photography after full mydriasis. Images were imported into ImageJ software, selecting a 3-mm diameter central area of the intraocular lens (IOL), and the mean gray value (MGV) of this area was recorded. Statistical analyses were conducted on baseline data, the first PCO follow-up time, logMAR corrected distance visual acuity (CDVA), MGV, objective visual quality parameters, dysfunctional lens index (DLI), and various HOAs parameters. Results: Compared to the control group, the PCO group exhibited statistically significant differences in parameters such as OSI, MTF cutoff, SR, trefoil, Z18, and Z24 (p < 0.05); however, logMAR CDVA, HOs total, coma, and spherical aberration did not show significant differences (p > 0.05). Compared to the monofocal IOL (MoIOL) group, the multifocal IOL (MfIOL) group had earlier PCO follow-ups, with significantly better MTF cutoff and SR, and significantly lower Z7 and Z10 (p < 0.05). Subgroup analysis based on OSI showed significant differences between the two groups in parameters such as logMAR CDVA, MTF cutoff, SR, DLI, HOs total, and coma (p < 0.05). Conclusions: Early PCO significantly impacts objective visual quality and HOAs in patients. Early intervention may provide greater visual benefits for patients implanted with MfIOL.

Purpose: To measure and compare the extent of retinal neovascularization using optical coherence tomography angiography (OCTA) between patients with good postoperative outcomes for proliferative diabetic retinopathy (PDR) requiring surgical treatment and patients with vitreous hemorrhage (VH). Methods: This retrospective study included patients who were diagnosed with PDR between January 2022 and December 2023 and underwent vitreous surgery. Cases that developed postoperative VH were classified as the VH group, and cases with good postoperative progress were classified as the control group. The extent of retinal neovascularization was measured from preoperative and postoperative images of the two groups taken by OCTA measured with a widefield optical coherence tomography (Canon, Xephilio OCT-A1), and a comparative study was conducted. Results: The VH group consisted of 8 patients with 11 eyes (4 men and 4 women) with a mean age of 49.7 ± 14.2 years, while the control group consisted of 23 patients with 26 eyes (19 men and 4 women) with a mean age of 56.9 ± 11.8 years. The preoperative retinal neovascular area was 50,233.7 ± 38,581.1 (pixels) in the VH group and 17,155.4 ± 27,950.2 (pixels) in the control group, showing a significant difference (p=0.046). The postoperative retinal neovascular area was 36,315.7 ± 44,311.8 (pixels) in the VH group and 2261.0 ± 9072.2 (pixels) in the control group, showing a significant difference (p=0.046), but there was no significant difference in the reduction rate of the neovascular area before and after surgery (p=0.30). Conclusions: In PDR developing VH after vitrectomy surgery, the appearance of neovascularization seen on pre- and postoperative OCTA is significantly more extensive than in cases that do not develop postoperative VH, and OCTA may be useful for preoperative evaluation.

Background and Objective: Corneal collagen cross-linking (CXL) is a treatment which arrests keratoconus (KC) progression, but its effectiveness differs radically among patients. Herein, we report preoperative diagnostic findings that reflect CXL outcomes and allow physicians to prognosticate treatment efficiency. Methods: In a medical centre, we retrospectively analysed pre- and postoperative data about 107 patients (112 eyes) treated with CXL from January 2018 to December 2022. Exclusion criteria were age below 16 years, a corneal thickness below 400 microns, severe dry eye, other corneal diseases/infections, re-CXL, pregnancy and missing follow-up examinations. All the subjects (79 males and 28 females) were followed for a minimum of 4 and a maximum of 40 months. The study dataset was comprised of 796 cases of clinical assessment, pachymetry, visiometry, refractometry and topography examinations. With these data, we modelled maximum anterior keratometry (K _max) and curvature power of the flat and steep meridians of the corneal anterior surface (K ₁ and K ₂). Results: Two years after the invasion, corneal curvature coefficients decreased progressively. Then, they remained stable for four months and rose afterwards. In the most accurate K ₁, K ₂ and K _max models, the proportion of mean absolute error to the range of values was 1.72, 3.66 and 2.37%, respectively. Pronounced corneal thinning, low best-corrected visual acuity and high K _max levels predict unfavourable outcomes. Conclusions: The high accuracy of the models advocates for a personalised approach to candidate selection for CXL.