Journal of Ophthalmology最新文献

Aims: To investigate the impact of horizontal markings on the VisuMax surgical bed headrest on the accuracy of astigmatism correction in small incision lenticule extraction (SMILE). Methods: This retrospective study categorized preoperative astigmatism severity into low-astigmatism (-0.25 to -1.75 D) and moderate-to-high astigmatism (-2.00 to -4.50 D). A preoperative patient fixation training regimen coupled with applying horizontal markings on the VisuMax surgical bed headrest was introduced to improve the precision of astigmatism correction. The effectiveness of SMILE was compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in correcting astigmatism by using Alpins vector analysis, as well as the higher-order aberrations were measured. Results: This study included 170 patients (56 eyes in the low-astigmatism group and 31 eyes in the moderate-to-high astigmatism group of SMILE; 47 eyes in the low-astigmatism group and 36 eyes in the moderate-to-high astigmatism group of FS-LASIK). At 6 months postoperatively, safety and efficacy indices between SMILE and FS-LASIK showed no significant differences for either astigmatism group (p > 0.05). However, significant differences were observed in surgically induced astigmatism (SIA), magnitude of error (ME), and correction index (CI). A considerable difference in equivalent spherical (SE) was found in the low-astigmatism group (p < 0.05). No significant differences were noted in the angle of error (AE) and its absolute value (|AE|) between the two procedures (p > 0.05). Both techniques increased total higher-order aberrations, spherical aberration, and vertical coma, with SMILE associated with a significantly higher increase in vertical coma than FS-LASIK (p < 0.05). Conclusions: Augmented by precise preoperative strategies, including headrest marking and fixation training, SMILE achieves astigmatism axis correction efficacy comparable to FS-LASIK. SMILE and FS-LASIK are effective and comparable in correcting moderate-to-high astigmatism, highlighting their safety, efficacy, and predictability as corrective measures for myopic astigmatism.

Purpose: To evaluate the performance of the anterior segment optical coherence tomography (AS-OCT) and Scheimpflug-Placido tomographic (SPT) indices in differentiating suspect keratoconus (SKC) from normal (N). Methods: In this cross-sectional study, one eye of each patient was scanned on AS-OCT and SPT. Following, 5 regression analysis models were developed: Model 1: combined AS-OCT corneal thickness (CT); Model 2: combined AS-OCT epithelial thickness (ET); Model 3: Models 1 + 2; Model 4: SPT indices (symmetry index front [SIf], symmetry index back [SIb], keratoconus vertex back [KVb], and minimum CT [ThkMin]); Model 5: Models 3 + 4. The areas under the curve (AUC) of receiver operator characteristic (ROC) curves were compared across groups to estimate their performance accuracy. Results: Two hundred and five N eyes, 56 SKC eyes, and 89 keratoconus (KC) eyes were scanned with AS-OCT and SPT. For Models 1 and 2, no individual metric yielded an AUC > 0.84. For Model 3, the AUC was 0.96 (R2 Nagelkerke: 0.69) with 90.28% cases correctly identified as SKC. For Model 4, the AUC was 0.99 (R2 Nagelkerke: 0.87), with 95.58% of cases correctly classified as SKC. For Model 5, the diagnostic accuracy did not improve compared to Model 4. Conclusion: Both combined AS-OCT indices and combined SPT indices provided excellent diagnostic power to differentiate SKC from N eyes. The combined SPT model showed a superior value compared to the AS-OCT model. Furthermore, combined AS-OCT and SPT data did not perform better than the combined SPT data alone.

Background: Down syndrome (DS) is the most common genetic cause of intellectual disability. Ocular manifestations occur frequently in people with DS (pwDS) but to date, there is no systematic review or meta-analysis of these conditions across the lifespan. Methods: PubMed, Medline, Embase, Web of Science and Scopus were searched for observational studies reporting ocular manifestations in pwDS, without limiting publication date. The proportion of pwDS with specific ocular manifestations were meta-analysed to obtain a pooled incidence using a random effects model. Sources of heterogeneity were assessed using a meta-regression analysis. For manifestations reported, but without sufficient prevalence data available, a narrative approach was adopted. Results: The search identified 1208 papers. Reviewers independently screened the abstracts, and 54 studies were found to fit the criteria. The age range of the individuals was birth to 88.7 years. Ocular manifestations from highest to lowest prevalence included refractive errors (69.97%, 95% CI 59.95%-79.13%), strabismus (31.41%, 95% CI 24.66%-38.57%), lens opacities (13.79%, 95% CI 8.61%-19.86%), nystagmus (12.72%, 95% CI 9.02%-16.92%) and keratoconus (9.34%, 95% CI 2.47%-19.26%). Alterations of lens and corneal morphology, posterior segment anomalies (including glaucoma) and Brushfield spots were also identified. Conclusions: The ocular manifestations of pwDS are common but varied. Age and/or ethnicity may influence the prevalence of certain ocular manifestations. The level of intellectual disability may also affect the prevalence of ocular manifestations as the prevalence of ocular disorders is known to increase with the severity of intellectual disability in pwDS.

Objects: To assess the safety and effectiveness of subnuclear phacoemulsification (SNP), a new technique for reducing corneal injury in nuclear cataract surgery. Methods: This randomized controlled trial (RCT) was designed in March 2020 and carried it out from April 1 to September 30, 2020, including a 3 months' follow-up. We recruited 256 age-related hard nucleus cataract patients and randomly assigned them to two groups: the experimental group receiving SNP, and the control group receiving conventional phacoemulsification (CP). A single surgeon performed all the surgeries. We compared the two groups on the cumulative dissipated energy (CDE), phacoemulsification ultrasound time (UST), and complications for safety, as well as at multiple postsurgery follow-up timepoints on three major outcomes for effectiveness: visual acuity, central corneal thickness, and central corneal endothelial cell density. Results: The two groups were well-matched in terms of demographics, nuclear density, and safety measures (ultrasound energy, phacoemulsification time, and complications). For effectiveness after surgery, compared to the CP group, the SNP group had better visual acuity and thinner central cornea postsurgery within 1 week and had higher central corneal endothelial cell density at the 1- and 3-month follow-up. Conclusions: Compared to CP, SNP is more effective for reducing corneal injury in cataract surgery. The widespread application of this technology will greatly improve the safety of cataract surgery, especially hard cataract surgery. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000031114.

Diabetic retinal neurodegeneration (DRN) is an early manifestation of diabetic retinopathy (DR) characterized by neurodegeneration that precedes microvascular abnormalities in the retina. DRN is characterized by apoptosis of retinal ganglion cells (involves alterations in retinal ganglion cells [RGCs], photoreceptors, amacrine cells and bipolar cells and so on), reactive gliosis, and reduced retinal neuronal function. Tau, a microtubule-associated protein, is a key mediator of neurotoxicity in neurodegenerative diseases, with functions in phosphorylation-dependent microtubule assembly and stabilization, axonal transport, and neurite outgrowth. The hyperphosphorylated tau (p-tau) loses its ability to bind to microtubules and aggregates to form paired helical filaments (PHFs), which further form neurofibrillary tangles (NFTs), leading to abnormal cell scaffolding and cell death. Studies have shown that p-tau can cause degeneration of RGCs in DR, making tau pathology a new pathophysiological model for DR. Here, we review the mechanisms by which p-tau contribute to DRN, including insulin resistance or lack of insulin, mitochondrial damage such as mitophagy impairment, mitochondrial axonal transport defects, mitochondrial bioenergetics dysfunction, and impaired mitochondrial dynamics, Abeta toxicity, and inflammation. Therefore, this article proposes that tau protein hyperphosphorylation plays a crucial role in the pathogenesis of DRN and may serve as a novel therapeutic target for combating DRN.

Purpose: This study aimed to compare the donor-recipient interface changes between non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) and assess their correlation with the postoperative best spectacle-corrected visual acuity (BCVA). Methods: This retrospective study collected clinical data on patients with corneal endothelial decompensation who underwent either nDSEK or DSEK between August 2019 and April 2023. The donor-recipient interface particle density, interface haze, visual outcome, and graft dislocation were compared between nDSEK and DSEK groups. Results: A total of 66 eyes from 66 patients (nDSEK n: 31 eyes and DSEK n: 35 eyes) were included. At 12 months postoperatively, nDSEK had a mean interface particle density of 631.97 ± 143.95 particles/mm², significantly higher than DSEK's 518.20 ± 121.72 particles/mm² (p=0.001). The interface haze was also greater in nDSEK (78.16 ± 13.74) compared with DSEK (64.21 ± 14.78) (p < 0.001). BCVA improved similarly in both groups, with nDSEK changing from 1.92 ± 0.26 to 0.37 ± 0.11 and DSEK from 1.85 ± 0.24 to 0.34 ± 0.10 (p=0.149). Correlation analysis revealed a significant association between interface particle density and interface haze in both the nDSEK (correlation coefficient: 0.716, p < 0.001) and DSEK (correlation coefficient: 0.618, p < 0.001) groups. However, there was no significant correlation between interface particle density and postoperative BCVA for either the nDSEK (correlation coefficient: -0.028, p=0.883) or DSEK (correlation coefficient: 0.111, p=0.525) group. Similarly, no significant correlation was found between interface haze and postoperative BCVA in both groups (nDSEK: correlation coefficient: -0.080, p=0.670 and DSEK: correlation coefficient: -0.210, p=0.227). Graft dislocation rates were comparable: 3.2% in nDSEK and 2.9% in DSEK (p=0.931). Conclusion: nDSEK exhibited more interface particles and haze than standard DSEK, but visual outcomes and graft attachment were similarly effective.

Purpose: To assess the potential of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as novel diagnostic and prognostic biomarkers in fungal keratitis (FK). Methods: This study was carried out retrospectively in 77 FK patients and 77 matched cataract controls from Henan Eye Hospital. Peripheral venous blood samples were collected via venipuncture and analyzed using complete blood count for routine clinical evaluation. FK patients were classified into three subgroups: Fusarium, Aspergillus, and Candida groups. Inflammation severity was quantified using standardized clinical scoring. The treatment modalities were used to divide the FK patients into enucleation and nonenucleation groups. Results: NLR and PLR were significantly elevated in FK versus controls (p < 0.001). NLR correlated strongly with inflammation scores (r = 0.535, p < 0.0001), exceeding PLR's moderate correlation (r = 0.311, p=0.0059). FK patients in the enucleation group had significantly higher NLR (p=0.012) and PLR (p=0.021) values than those in the nonenucleation group. There were no significant biomarker differences across fungal species (p > 0.05). Conclusion: Elevated NLR and PLR values during routine laboratory testing might serve as supplementary indicators for early suspicion of FK and monitoring inflammatory progression, particularly in resource-limited settings where specialized ophthalmic diagnostics are unavailable.

Purpose: To propose a conceptual framework for an AI-driven personalized glaucoma progression prediction system that integrates diverse data sources to enhance clinical decision-making and improve patient outcomes. This framework is specifically designed to address healthcare disparities in glaucoma care through scalable AI technology that can function across diverse resource settings, from tertiary care centers to remote clinics. The system aims to democratize access to expert-level glaucoma care while addressing challenges of bias, equity, and accessibility. Methods: The paper outlines a comprehensive framework consisting of four main components: (1) data integration and preprocessing, (2) AI model architecture and training, (3) personalized prediction generation, and (4) a clinical decision support interface. The framework leverages multimodal neural networks to analyze structural imaging data, functional test results, clinical measurements, and patient demographics. Results: The proposed framework addresses current limitations in glaucoma progression prediction by capturing complex interactions between various risk factors. Potential benefits include early detection of rapid progressors, optimized treatment strategies, improved patient counseling, and support for clinical research. Implementation challenges such as data quality, model interpretability, workflow integration, regulatory approval, and ethical considerations are discussed along with strategies to address them. Conclusions: The AI-driven framework for glaucoma progression prediction represents a significant advancement in personalized glaucoma management. While challenges remain, the potential benefits in terms of preserved vision, improved quality of life, and more efficient healthcare delivery are substantial. Future research directions include incorporating genetic data, advanced imaging modalities, and federated learning techniques to further enhance the system's capabilities and impact.

This study examines corneal densitometry recovery and influencing factors following accelerated corneal cross-linking (CXL) for progressive keratoconus. Corneal densitometry, measured using Scheimpflug tomography, provides an objective assessment of corneal clarity, especially in tracking the resolution of postoperative haze. We conducted a retrospective case-control analysis of 24 patients (31 eyes) who underwent CXL with 0.25% riboflavin and 18 mW/cm² irradiation between 2021 and 2023. Variables included patient age, maximum keratometry (K _max), central corneal thickness (CCT), and demarcation line depth (DLD), defined as the depth of the CXL region. Results revealed a significant increase in densitometry values across most corneal zones at 1-month postoperation, followed by a gradual return to baseline by 12 months. Notably, younger patients exhibited a faster recovery, with mean densitometry values returning to baseline in 11.4 months compared to 14.9 months in older patients (p=0.02). Similarly, corneas with deeper DLDs demonstrated faster densitometry recovery, suggesting a potentially more efficient corneal remodeling process. Additional analysis indicated a trend toward higher densitometry values in shallower DLDs at 1 month, although this difference was not statistically significant. These findings support the use of densitometry as a reliable measure of post-CXL healing. While DLD depth and patient age were associated with a faster recovery, they did not directly predict final corneal clarity. Our study suggests that factors such as age and DLD depth should be considered in patient prognosis, although further research is needed to confirm these findings across varying CXL protocols.

Purpose: To identify the structural and vascular features of the macula related to the recurrence of macular edema (ME) in central retinal vein occlusion (CRVO) after intravitreal anti-VEGF injections. Methods: This was a cross-sectional study including CRVO patients without ME and age-matched individuals. CRVO patients were divided into the ME-resolved group and the ME-recurrence group on the basis of whether ME recurred within 3 months. All subjects provided a detailed history and underwent a comprehensive ophthalmological examination. Measurements of the macula by swept-source optical coherence tomography angiography (SS-OCTA) were recorded. We also created the Δparameter, which represents the difference in OCTA parameters between CRVO-affected eyes and their fellow eyes. Results: The study included 13 ME-resolved CRVO patients, 20 ME-recurrence CRVO patients, and 24 age-matched controls. Compared with the ME-recurrence group, the ME-resolved group had a longer CRVO duration, more previous intravitreal anti-VEGF injections, and a higher proportion of previous retinal photocoagulation (all p < 0.05). Additionally, retinal thickness (RT) and choroidal thickness (CT) were thinner in the ME-resolved group than in the ME-recurrence and control groups (all p < 0.01). The ME-resolved group also had significantly lower vessel density (VD) in both superficial and deep vascular complexes (SVC/DVC) and larger foveal avascular zone area (FAZa) in SVC and DVC than the ME-recurrence group and the control group (all p < 0.01). The results were the same with the Δparameters. Multivariate logistic regression revealed that ΔVD and ΔFAZa in SVC and DVC were independently associated with ME recurrence after adjusting for the effects of CRVO duration, previous anti-VEGF injections, and retinal photocoagulation (all p < 0.05). Conclusion: With prolonged CRVO duration, more anti-VEGF injections, and more retinal photocoagulation procedures, retinal, choroidal, and vascular atrophy in the macula occurs in CRVO eyes, making ME less likely to recur. Macular vascular atrophy is vital for the resolution of ME and might be a manifestation of capillary remodeling.