Journal of Ophthalmology最新文献

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.

Background: Surgical excision of tumors near the lacrimal punctum presents challenges due to the risk of damaging the lacrimal duct, leading to chronic epiphora. Effective reconstruction is essential to preserve lacrimal function and maintain esthetic outcomes. This study discusses the short- to mid-term results of nine cases using conjunctival flap transposition and artificial lacrimal duct placement for repair, considering the duct's anatomical and functional aspects. Case Report: We report on nine patients with benign lesions involving the lacrimal punctum at our hospital from August 2019 to September 2022. A conjunctival flap with a reasonable design based on the defect area was used to cover the defect, and double-tube placement of artificial lacrimal ducts was performed along with suturing of the remaining lacrimal point and lacrimal canaliculus epithelium. Pathological examination of all nine patients after surgery showed "melanocytic nevus." The conjunctival flap survived in the first phase, the lacrimal point remained unblocked, there were no abnormalities in the lower eyelid or medial canthus, the appearance was aesthetically pleasing, lacrimal duct irrigation was unobstructed, and there was no tearing after surgery. All patients were followed up for more than 1 year, and no tumor recurrence or obstruction in the lacrimal duct was observed. Conclusions: Conjunctival flap transposition and artificial lacrimal duct placement is an effective surgical approach for the repair of defects following lacrimal punctum tumor excision. The method not only preserves lacrimal duct function but also achieves satisfactory esthetic results, making it a reliable choice for clinical application.

Purpose: The correlations between different parameters and the positioning of the EVO ICL were analyzed. Significant correlations were observed, highlighting the relationship between the endothelium and the anterior surface of the phakic ICL lens. However, it is important to note that GAP is only a postoperative measure and cannot be used to directly define the correct positioning of the EVO ICL. The study emphasizes these correlations, without drawing conclusions regarding the causal relationships between the parameters. Methods: In this retrospective, observational, transversal analytic study, patients who underwent refractive surgery with implanted EVO ICL pIOL were analyzed. The distance between corneal endothelium and anterior surface of ICL (GAP) was measured postoperatively at 1 week and 1 month using ANTERION AS-OCT. Results: 35 eyes of 35 patients were analyzed. The mean GAP values at 1 week and 1 month were 2.5 ± 0.2 mm and 2.6 ± 0.2 mm, respectively (p = 0.002), increasing its value. The GAP value correlated positively with preoperative anterior chamber volume, white-to-white, lens vault, spur-spur distance, anterior chamber angle distance, and anterior chamber angles values. Conclusions: The correlations between GAP and pre- and postoperative variables highlight its relationship with anterior segment anatomy after EVO ICL implantation. However, as a postoperative measurement, GAP does not determine the correct positioning of the lens.

Inherited retinal dystrophies (IRDs) constitute a heterogeneous group of primarily monogenic orphan diseases caused by mutations in over 300 genes, collectively affecting millions of individuals worldwide with visual impairment. Despite significant advances, the development of gene replacement therapy for IRDs has predominantly focused on single-gene approaches, lacking a unified strategy driven by factors such as global prevalence, disease burden, and feasibility of therapeutic delivery. In this review, we propose a comprehensive protocol integrating multifaceted methodologies to refine the identification of suitable gene therapy candidates. We assessed gene prevalence, transcript size compatibility with vector packaging, and cell-type-specific expression, enabling the prioritization of promising therapeutic targets. Our approach focuses on assessing enzyme-coding genes as prime, more suitable candidates for therapeutic intervention due to their relatively similar replacement mechanism. Our findings provide a framework for identifying additional genes that may benefit from similar translational pipelines. This approach revealed a spectrum of potential candidates, including several underexplored genes with high therapeutic potential. Our findings underscore the necessity of adopting a strategic, data-driven framework to prioritize clinically impactful and scalable gene therapy targets, paving the way for broader and more effective therapeutic applications in the field of IRDs. Trial Registration: ClinicalTrials.gov identifier: NCT01482195, NCT03316560, NCT06333249, NCT06275620, NCT04850118, NCT05926583.

Purpose: High myopia is a feature of several inherited retinal diseases, including X-linked retinitis pigmentosa (XLRP) which is characterized by childhood onset, centripetal photoreceptor degeneration, and rapid progression to blindness by the fourth decade. Mutations in the retinitis pigmentosa GTPase regulator (RPGR) gene cause over 90% of XLRP cases. It presents with a varied clinical phenotype, categorized into the predominant rod-cone, cone-rod, and cone dystrophy. This case-series study examines the clinical characteristics of patients with RPGR-related retinal dystrophy to identify associations with refractive error. Methods: Data collected between October 2023 and April 2024 from retinal imaging, clinical ophthalmic examination, and genetic analysis were retrospectively analyzed. Results: Twenty-four male patients were identified, with a mean age of 30 years (range 7-57). The median (IQR) best-corrected visual acuity was 60 (55-66) letters in the cone-rod/cone phenotype and 65 (49-73) letters in the rod-cone phenotype. High axial myopia showed preponderance in cone-dominated degenerations. Estimated mean refractive error was -7.92DS (95% CI: [-11.39, -4.44]) in the cone-rod phenotype and -3.52DS (95% CI: [-5.87, -1.17]) in the rod-cone phenotype, adjusting for age and genetic mutation. This difference between phenotype was significant (p=0.041). In a subanalysis, no significant association was found between refractive error and nucleotide position. Evaluation of disease progression found that all patients with a fast-progressing, rod-cone phenotype had high myopia. Conversely, one patient who presented with a slow-progressing, cone-rod phenotype did not have high myopia. Conclusions: Refractive trends in this cohort suggest that cone photoreceptor degeneration occurring during early childhood is associated with high myopia. Image degradation primarily due to cone photoreceptor dysfunction may act as a stimulus to drive myopia development in early childhood. These observations advocate for the earlier treatment of myopia in cone-dominated RPGR-related retinal dystrophy to preserve retinal function and minimize the risks of retinal gene therapy surgery for patients enrolling in clinical trials. Trial Registration: ClinicalTrials.gov identifier: NCT03116113.