Ophthalmology. Glaucoma最新文献_第7页

Early Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma 联合超声乳化和Ab Interno Tanito小钩小梁切除术治疗开角型青光眼的早期疗效。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.10.007

Devendra Maheshwari MD , Davinder S. Grover MD, MPH , Rengappa Ramakrishnan DO, MS , Madhavi Ramanatha Pillai DNB , Drishti Chautani MBBS , Mohideen Abdul Kader PMT, DNB

Purpose

To study the early postoperative efficacy and safety of an Ab Interno microhook trabeculotomy (microLOT) combined with cataract surgery in patients with open-angle glaucoma.

Methods

This prospective, randomized, interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate open-angle glaucoma. One hundred fourteen patients were included for analysis. The patients were randomized to undergo microhook trabeculotomy with phacoemulsification (group 1) or phacoemulsification alone (group 2). All patients were evaluated on postoperative day 1, 15, and 30, as well as 3, 6, and 12 months postoperatively. A P value < 0.05 was considered statistically significant. Baseline and follow-up visits were compared to determine significant differences in the number of antiglaucoma medications (AGMs), intraocular pressure (IOP), and best-corrected visual acuity.

Results

There were 57 patients in each group. The baseline characteristics were similar between the 2 groups, except the number of AGMs, which was greater in group 2. The mean preoperative IOP for group 1 (phaco-microLOT) was 26.5 mmHg ± 5.2 and group 2 (phaco-alone group) was 25.3 mmHg ± 3.1 which decreased to 12.5 mmHg ±3.6 (P < 0.001) and 20.0 mmHg ± 2.7(P < 0.001) at 12 months, respectively. Logarithm of the minimum angle of resolution visual acuity improved from 0.48 (interquartile range [IQR], 0.30–0.60) preoperatively to 0.00 (0.00–0.18) postoperatively (P < 0001) in group 1 and improved from 0.30 (IQR, 0.30–0.48) to 0.00 (0.00–0.00) in group 2 (P < 0.001). In group 1, the mean (standard deviation [SD]) AGM used preoperatively was 0.6 (0.9) which was significantly reduced to 0.2 (0.5) at 12 months postoperatively, whereas in group 2, at 12 months, the mean (SD) AGM used was reduced from 1.4 (0.6) to 1.1 (0.9). In group 1, 90.3% of eyes achieved complete success at the end of 1 year. The most common complication was hyphema, noted in 4 patients with 1 eye requiring an anterior chamber washout.

Conclusion

Ab interno microhook trabeculotomy (microLOT) combined with phacoemulsification in patients with open-angle glaucoma is an efficacious procedure with relatively minimal complications.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：研究Ab Interno微钩小梁切开术（microLOT）联合白内障手术治疗开角型青光眼的术后早期疗效和安全性。方法：这项前瞻性、随机、介入性研究是对连续的视力显著白内障和轻度-中度开角型青光眼患者进行的。纳入114名患者进行分析。将患者随机分为微钩小梁切开术联合超声乳化术（第1组）或单独进行超声乳化手术（第2组）。所有患者均在术后第1、15和30天以及术后3个月、6和12个月进行评估。A p值结果：每组57例。两组的基线特征相似，只是第2组的AGM数量更多。第1组（超声乳化微滴）术前平均眼压为26.5 mmHg±5.2，第2组（单独超声乳化组）术前眼压为25.3 mmHg士3.1，降至12.5 mmHg±3.6。

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引用次数: 0

Subepithelial Corneal Bullae after Posttrabeculectomy Ocular Digital Massage 小梁切除术后眼部数字按摩后的角膜上皮下囊泡

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2024.01.006

Hansen Dang BS, Nicole Radunzel BFA, CRA, Andrew Pouw MD

引用次数: 0

Interim Analysis of Clinical Outcomes with Open versus Closed Conjunctival Implantation of the XEN45 Gel Stent XEN45凝胶支架开放式和闭合式结膜植入术的中期临床结果分析。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.09.001

Elyse J. McGlumphy MD , Anna Do MD , Amy Du MD , Earl Randy Craven MD , Lawrence S. Geyman MD , Leo Shen MS , Joel S. Schuman MD , Joseph F. Panarelli MD

Objective

To examine the longitudinal postoperative outcomes of open versus closed conjunctiva implantation of the XEN45 gel stent.

Design

Retrospective multicenter study.

Subjects

One hundred ninety-three patients with glaucoma underwent XEN45 implantation via an open or closed conjunctiva approach.

Methods

Data on patient demographics; diagnoses; preoperative and postoperative clinical data; outcome measures, including intraocular pressure (IOP); use of glaucoma medications; visual acuity; and complications were collected. Statistical analyses were performed with P < 0.05 as significant.

Main Outcome Measures

Failure was defined as < 20% reduction in IOP from the medicated baseline or a IOP of > 21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event, such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Overall success was defined as those who achieved success either with or without topical medications.

Results

Patients were followed for an average of 17 months. Complete success was achieved in 42.5% and 24.7% of the open and closed groups, respectively (P = 0.01). Overall success was achieved in 64.2% and 37.0% of the open and closed groups, respectively (P < 0.001) at the last follow-up. Bleb needling was performed in 12.4% of eyes in the open group compared with 40% of eyes in the closed group. An IOP spike of ≥ 10 mmHg was twice as likely to occur in the closed group compared with the open group during the postoperative period (40% vs. 18%; P = 0.001).

Conclusions

Implantation of XEN45 with opening of the conjunctiva resulted in a lower IOP with greater success and lower needling rate compared with those achieved with the closed conjunctiva technique. Similar rates of postoperative complications and vision loss were noted in each group. Although both procedures provide substantial IOP reduction, the open technique appears to result in higher success rates and fewer postoperative interventions.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：观察XEN45凝胶支架开放式和封闭式结膜植入术的纵向术后效果。设计：回顾性多中心研究。受试者：193名青光眼患者通过开放或闭合结膜方法接受XEN45植入术。方法：患者人口统计数据；诊断；术前和术后临床数据；结果测量，包括眼压；青光眼药物的使用；视力；并收集并发症。进行统计学分析，P＜0.05为显著性。主要结果指标：失败被定义为IOP比药物基线降低<20%，或在术后第1个月及以后连续2次访视时IOP>21mmHg，需要后续手术干预或额外的青光眼手术，或灾难性事件，如光感丧失。未达到这些标准且未服用青光眼药物的眼睛被视为完全成功。总体成功被定义为那些在使用或不使用局部药物的情况下取得成功的人。结果：患者平均随访17个月。开放组和封闭组的完全成功率分别为42.5%和24.7%（P=0.01）。最后一次随访时，开放组和闭合组的总成功率分别是64.2%和37.0%（P<0.001）。开孔组12.4%的眼睛进行了Bleb针刺，而闭孔组的这一比例为40%。术后，与开放组相比，封闭组出现≥10mmHg眼压峰值的可能性是开放组的两倍（40%对18%；P=0.001）。结论：与封闭结膜技术相比，开放结膜植入XEN45可降低眼压，成功率更高，针刺率更低。各组术后并发症和视力下降的发生率相似。尽管这两种手术都能显著降低眼压，但开放式技术似乎能带来更高的成功率和更少的术后干预。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Plate and Tube Rotation of the Glaucoma Drainage Implant: An Unusual Complication 青光眼引流植入物的板和管旋转：不寻常的并发症

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.12.001

Arnav Panigrahi MD, Siddhartha Rao BS, MBBS, Viney Gupta MD

引用次数: 0

Artifacts in OCT Retinal Nerve Fiber Layer Imaging in Patients with Boston Keratoprosthesis Type 1 波士顿1型角膜瓣患者的光学相干断层扫描视网膜神经纤维层成像中的伪影。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.09.004

Alexandra G. Castillejos MD , Julia Devlin BS , Chhavi Saini MD , Jessica A. Sun BA , Mengyu Wang PhD , Grace Johnson BA , James Chodosh MD, MPH , Lucy Q. Shen MD

Purpose

To determine the clinical utility of OCT retinal nerve fiber layer (OCT RNFL) imaging for glaucoma evaluation in patients with Boston keratoprosthesis type 1 (KPro) by investigating imaging artifacts.

Design

Case-control study.

Subjects

Patients with KPro and without KPro (controls) matched for age, gender, and glaucoma diagnosis.

Methods

The most recent Cirrus OCT RNFL scan from 1 eye was categorized as having good signal strength (SS; ≥ 6 out of 10) or poor SS (< 6). Those with good SS were analyzed by 2 independent reviewers for artifacts. Images with good SS and no artifacts affecting the scanning circle were considered useful for glaucoma evaluation.

Main Outcome Measures

The incidence of poor SS and artifacts in OCT RNFL images; patient characteristics associated with useful scans.

Results

Sixty-five patients with KPro and 75 controls were included; 89.2% of KPro patients and 89.3% of control subjects had glaucoma (P = 0.98). Forty percent of KPro patients and 5.3% of controls had poor SS (P < 0.001). The proportion of images with either poor SS or artifacts was similar in KPro (76.9%) vs. controls (72.0%, P = 0.51). The most common artifacts in both groups were missing data (43.6%, 53.2%, respectively, P = 0.32) and motion artifact (25.6%, 19.7%, respectively, P = 0.47). Images were useful for glaucoma evaluation in 43.1% of KPro patients and in 69.3% of controls (P = 0.002). In the KPro group, patients with useful OCT scans, compared with those without, had better visual acuity (0.4 ± 0.3 vs. 0.9 ± 0.7 logarithm of the minimum angle of resolution, P = 0.004), and did not have congenital corneal pathologies (0.0% vs. 24.3%, P = 0.008). A multivariate analysis showed that KPro patients with older age had higher odds of useful OCT images (odds ratio, 1.05; P = 0.03). Among KPro patients with useful OCT scans, retinal nerve fiber layer thickness correlated with observed cup-to-disc ratio (Pearson correlation: r = −0.42, P = 0.03).

Conclusions

The rate of OCT RNFL images with either poor signal strength or artifacts in the KPro and control population was comparable. In patients with KPro, where intraocular pressure measurements are difficult and glaucoma is highly prevalent and often severe, OCT RNFL imaging can be useful for glaucoma evaluation.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：通过研究成像伪影，确定光学相干断层扫描视网膜神经纤维层（OCT-RNFL）成像在波士顿1型角膜假体（KPro）患者青光眼评估中的临床应用。设计：病例对照研究。受试者：患有KPro和未患有KPro的患者（对照组）的年龄、性别和青光眼诊断相匹配。方法：一只眼睛最近的Cirrus OCT RNFL扫描被归类为信号强度良好（SS；≥6/10）或SS较差（主要结果指标：OCT RNFL图像中SS不良和伪影的发生率；与有用扫描相关的患者特征（p结论：在KPro和对照人群中，OCT RNFL图像信号强度差或伪影的发生率相当。在KPro患者中，眼压测量困难，青光眼非常普遍且往往很严重，OCT RN FL成像可用于青光眼评估。

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引用次数: 0

Re: Castillejos et al.: Artifacts in OCT retinal nerve fiber layer imaging in patients with Boston Keratoprosthesis Type 1 (Ophthalmol Glaucoma. 2024;7:206-215) Re：Castillejos et al：波士顿角膜前膜 1 型患者 OCT 视网膜神经纤维层成像中的伪影（Ophthalmol.Glaucoma.doi: 10.1016/j.ogla.2023.09.004.Online ahead of print.).

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.11.003

André S. Pollmann MD, FRCSC, Chloé Akl, Mona Harissi-Dagher MD, FRCSC

引用次数: 0

Six-Year Incidence and Risk Factors for Primary Open-Angle Glaucoma and Ocular Hypertension 原发性开角型青光眼和眼压升高的六年发病率和风险因素

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.08.003

Sahil Thakur MBBS, MS , Raghavan Lavanya MRCS , Marco Yu PhD , Yih-Chung Tham PhD , Zhi Da Soh BOptom, MPH , Zhen Ling Teo MBBS, MRCS , Victor Koh MBBS, MMed , Shivani Majithia OD , Chaoxu Qian MD, PhD , Tin Aung FRCSEd, PhD , Monisha E. Nongpiur MD, PhD , Ching-Yu Cheng MD, PhD

Objective

To determine the incidence and risk factors for primary open-angle glaucoma (POAG) and ocular hypertension (OHT) in a multiethnic Asian population.

Design

Population-based cohort study.

Participants

The Singapore Epidemiology of Eye Diseases study included 10 033 participants in the baseline examination between 2004 and 2011. Of those, 6762 (response rate = 78.8%) participated in the 6-year follow-up visit between 2011 and 2017.

Methods

Standardized examination and investigations were performed, including slit lamp biomicroscopy, intraocular pressure (IOP) measurement, pachymetry, gonioscopy, optic disc examination and static automated perimetry. Glaucoma was defined according to a combination of clinical evaluation, ocular imaging (fundus photo, visual field, and OCT) and criteria given by International Society of Geographical and Epidemiological Ophthalmology. OHT was defined on the basis of elevated IOP over the upper limit of normal; i.e., 20.4 mmHg, 21.5 mmHg, and 22.6 mmHg for the Chinese, Indian, and Malay cohort respectively, without glaucomatous optic disc change.

Main Outcome Measures

Incidence of POAG, OHT, and OHT progression.

Results

The overall 6-year age-adjusted incidences of POAG and OHT were 1.31% (95% confidence interval [CI], 1.04–1.62) and 0.47% (95% CI, 0.30–0.70). The rate of progression of baseline OHT to POAG at 6 years was 5.32%. Primary open-angle glaucoma incidence was similar (1.37%) in Chinese and Indians and lower (0.80%) in Malays. Malays had higher incidence (0.79%) of OHT than Indians (0.38%) and Chinese (0.37%). Baseline parameters associated with higher risk of POAG were older age (per decade: odds ratio [OR], 1.90; 95% CI, 1.54–2.35; P < 0.001), higher baseline IOP (per mmHg: OR, 1.20; 95% CI, 1.12–1.29; P < 0.001) and longer axial length (per mm: OR, 1.22; 95% CI, 1.07–1.40, P = 0.004).

Conclusion

Six-year incidence of POAG was 1.31% in a multiethnic Asian population. Older age, higher IOP, and longer axial length were associated with higher risk of POAG. These findings can help in future projections and guide public healthcare policy decisions for screening at-risk individuals.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

目标确定多种族亚洲人群中原发性开角型青光眼（POAG）和眼压过高症（OHT）的发病率和风险因素。方法进行标准化的检查和检验，包括裂隙灯显微镜检查、眼压测量、眼底测量、眼底镜检查、视盘检查和静态自动周边测量。青光眼是根据临床评估、眼部成像（眼底照片、视野和 OCT）以及国际地理和流行病学眼科学会给出的标准综合定义的。眼压升高症的定义是眼压升高超过正常值上限，即结果经年龄调整后，POAG 和 OHT 的 6 年总发病率分别为 1.31%（95% 置信区间 [CI]，1.04-1.62）和 0.47%（95% 置信区间 [CI]，0.30-0.70）。基线 OHT 在 6 年后发展为 POAG 的比率为 5.32%。华人和印度人的原发性开角型青光眼发病率相似（1.37%），而马来人的发病率较低（0.80%）。马来人的开角型青光眼发病率（0.79%）高于印度人（0.38%）和中国人（0.37%）。与较高的 POAG 风险相关的基线参数是年龄较大（每十年：几率比 [OR]，1.90；95% CI，1.54-2.35；P <；0.001）、基线眼压较高（每毫米汞柱：OR，1.20；95% CI，1.12-1.29；P <；0.001）和较长的轴向长度（每毫米：OR，1.22；95% CI，1.07-1.40，P = 0.004）。年龄越大、眼压越高、轴向长度越长，患 POAG 的风险越高。这些发现有助于未来的预测，并为筛查高危人群的公共医疗政策决策提供指导。

{"title":"Six-Year Incidence and Risk Factors for Primary Open-Angle Glaucoma and Ocular Hypertension","authors":"Sahil Thakur MBBS, MS , Raghavan Lavanya MRCS , Marco Yu PhD , Yih-Chung Tham PhD , Zhi Da Soh BOptom, MPH , Zhen Ling Teo MBBS, MRCS , Victor Koh MBBS, MMed , Shivani Majithia OD , Chaoxu Qian MD, PhD , Tin Aung FRCSEd, PhD , Monisha E. Nongpiur MD, PhD , Ching-Yu Cheng MD, PhD","doi":"10.1016/j.ogla.2023.08.003","DOIUrl":"10.1016/j.ogla.2023.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the incidence and risk factors for primary open-angle glaucoma (POAG) and ocular hypertension (OHT) in a multiethnic Asian population.</p></div><div><h3>Design</h3><p>Population-based cohort study.</p></div><div><h3>Participants</h3><p>The Singapore Epidemiology of Eye Diseases study included 10 033 participants in the baseline examination between 2004 and 2011. Of those, 6762 (response rate = 78.8%) participated in the 6-year follow-up visit between 2011 and 2017.</p></div><div><h3>Methods</h3><p><span><span><span><span>Standardized examination and investigations were performed, including slit lamp biomicroscopy<span>, intraocular pressure (IOP) measurement, </span></span>pachymetry<span>, gonioscopy<span>, optic disc examination and static automated </span></span></span>perimetry. Glaucoma was defined according to a combination of </span>clinical evaluation, </span>ocular imaging<span> (fundus photo, visual field, and OCT) and criteria given by International Society of Geographical and Epidemiological Ophthalmology. OHT was defined on the basis of elevated IOP over the upper limit of normal; i.e., 20.4 mmHg, 21.5 mmHg, and 22.6 mmHg for the Chinese, Indian, and Malay cohort respectively, without glaucomatous optic disc change.</span></p></div><div><h3>Main Outcome Measures</h3><p>Incidence of POAG, OHT, and OHT progression.</p></div><div><h3>Results</h3><p>The overall 6-year age-adjusted incidences of POAG and OHT were 1.31% (95% confidence interval [CI], 1.04–1.62) and 0.47% (95% CI, 0.30–0.70). The rate of progression of baseline OHT to POAG at 6 years was 5.32%. Primary open-angle glaucoma incidence was similar (1.37%) in Chinese and Indians and lower (0.80%) in Malays. Malays had higher incidence (0.79%) of OHT than Indians (0.38%) and Chinese (0.37%). Baseline parameters associated with higher risk of POAG were older age (per decade: odds ratio [OR], 1.90; 95% CI, 1.54–2.35; <em>P</em> < 0.001), higher baseline IOP (per mmHg: OR, 1.20; 95% CI, 1.12–1.29; <em>P</em> < 0.001) and longer axial length (per mm: OR, 1.22; 95% CI, 1.07–1.40, <em>P</em> = 0.004).</p></div><div><h3>Conclusion</h3><p>Six-year incidence of POAG was 1.31% in a multiethnic Asian population. Older age, higher IOP, and longer axial length were associated with higher risk of POAG. These findings can help in future projections and guide public healthcare policy decisions for screening at-risk individuals.</p></div><div><h3>Financial Disclosure(s)</h3><p>The authors have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 2","pages":"Pages 157-167"},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anterior Segment OCT for Detection of Narrow Angles 用于检测窄角度的前段光学相干断层扫描：基于社区的诊断准确性研究。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.08.005

Sangita Pradhan MD , Ranjeet K. Sah MD, MS , Gopal Bhandari M Optom , Sadhan Bhandari PCLGM , Raghunandan Byanju MD , Ram P. Kandel MPH , Isabel J.B. Thompson MPH , Valerie M. Stevens MPH , Krisianne M. Aromin BS , Julius T. Oatts MD , Yvonne Ou MD , Thomas M. Lietman MD , Kieran S. O’Brien PhD, MPH , Jeremy D. Keenan MD, MPH

Purpose

To assess the diagnostic accuracy of anterior segment OCT (AS-OCT) screening for detecting gonioscopically narrow angles.

Design

Population-based cross-sectional study.

Participants

A stratified random sample of individuals aged ≥ 60 years, selected from a door-to-door census performed in low-lying Nepal.

Testing

Participants underwent AS-OCT, posterior segment OCT, and intraocular pressure (IOP) testing in the community. Those meeting referral criteria in either eye were invited to have a comprehensive eye examination including gonioscopy. Referral criteria included (i) the lowest 2.5% of AS-OCT measurements, (ii) retinal OCT results suggestive of glaucomatous optic neuropathy, diabetic retinopathy, or age-related macular degeneration, and (iii) elevated IOP.

Main Outcome Measures

Sensitivity and specificity of 5 semiautomated AS-OCT parameters relative to gonioscopically narrow angles, defined as the absence of visible trabecular meshwork for ≥ 180° on nonindentation gonioscopy.

Results

Of 17 656 people aged ≥ 60 years enumerated from 102 communities, 12 633 (71.6%) presented for AS-OCT testing. Referral was recommended for 697 participants based on AS-OCT criteria and 2419 participants based on other criteria, of which 858 had gonioscopy performed by a glaucoma specialist. Each of the 5 AS-OCT parameters offered good diagnostic information for predicting eyes with gonioscopically narrow angles, with areas under the receiver operating characteristic curve ranging from 0.85 to 0.89. The angle opening distance at 750 μm from the scleral spur (AOD750) provided the most diagnostic information, providing an optimal sensitivity of 87% (95% confidence interval [CI], 75%–96%) and specificity of 77% (71%–83%) at a cutpoint of 367 μm, and a sensitivity of 65% (95% CI, 54%–74%) when specificity was constrained to 90% (cutpoint, 283 μm).

Conclusions

On AS-OCT, the AOD750 parameter detected approximately two-thirds of cases of gonioscopically narrow angles when test specificity was set to 90%. Although such a sensitivity may not be sufficient when screening solely for narrow angles, AS-OCT requires little additional effort if posterior segment OCT is already being performed and thus could provide incremental benefit when performing OCT-based screening.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

目的：评估眼前段OCT（AS-OCT）筛查用于检测角度狭窄的诊断准确性。设计：基于人群的横断面研究。参与者：年龄≥60岁的分层随机样本，选自尼泊尔低洼地区的挨家挨户人口普查。测试：参与者在社区接受了AS-OCT、后段OCT和眼压（IOP）测试。任何一只眼睛都符合转诊标准的患者都被邀请进行全面的眼部检查，包括角镜检查。转诊标准包括（i）最低2.5%的AS-OCT测量，（ii）视网膜OCT结果提示青光眼性视神经病变、糖尿病视网膜病变或年龄相关性黄斑变性，以及（iii）眼压升高。主要结果测量：5个半自动AS-OCT参数相对于角镜窄角的敏感性和特异性，定义为在非齿状物角度镜检查中，≥180°的可见小梁网缺失。结果：在102个社区的17556名年龄≥60岁的人中，12333人（71.6%）接受了as-OCT检测。根据AS-OCT标准，推荐697名参与者转诊，根据其他标准推荐2419名参与者，其中858名参与者由青光眼专家进行了角镜检查。5个AS-OCT参数中的每一个都为预测角度狭窄的眼睛提供了良好的诊断信息，受试者工作特性曲线下的面积在0.85到0.89之间。距巩膜棘750μm处的开角距离（AOD750）提供了最多的诊断信息，在367μm的切点处提供了87%（95%置信区间[CI]，75%-96%）的最佳灵敏度和77%（71%-83%）的特异性，当特异性限制在90%（切点，283μm）时提供了65%（95%CI，54%-74%）的灵敏度。结论：在AS-OCT上，当测试特异性设置为90%时，AOD750参数检测到大约三分之二的角度狭窄的病例。尽管当仅对窄角度进行筛查时，这种灵敏度可能不够，但如果已经进行了后段OCT，AS-OCT几乎不需要额外的努力，因此在进行基于OCT的筛查时可以提供增量益处。财务披露：作者对本文中讨论的任何材料都没有所有权或商业利益。

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引用次数: 0

Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma 青光眼光学相干断层扫描血管造影术黄斑血管密度诊断准确性的种族差异。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.09.003

Gopikasree Gunasegaran MD, Sasan Moghimi MD, Takashi Nishida MD, PhD, Evan Walker MS, Alireza Kamalipour MD, MPH, Jo-Hsuan Wu MD, Golnoush Mahmoudinezhad MD, MPH, Linda M. Zangwill PhD, Robert N. Weinreb MD

Purpose

To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma.

Design

Observational, cross sectional study.

Participants

A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study.

Methods

Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes.

Main Outcome Measures

Macular VD and wiGCC measurements.

Results

Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants.

Conclusions

Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：评估和比较光学相干断层扫描血管造影术（OCTA）测量的黄斑血管密度（VD）对非洲裔（AD）和欧洲裔（ED）开角型青光眼患者的诊断准确性。设计：观察、横断面研究。参与者：来自青光眼诊断创新研究的123名青光眼患者共176眼，88名健康参与者共140眼。方法：通过6*6次黄斑扫描获得全图像神经节细胞复合体（wiGCC）厚度和黄斑VD（中央凹旁VD和中央凹周围VD）。在校正了年龄、视野平均偏差（VF-MD）、信号强度指数（SSI）、轴长（AL）、自我报告的高血压和糖尿病等混杂因素后，使用受试者操作特征下面积（AUROC）曲线来评估AD和ED参与者黄斑VD和GCC厚度的诊断准确性。主要结果测量：黄斑VD和wiGCC测量。结果：ED患者的中心凹旁和中心凹周围VD明显低于AD青光眼患者。与ED参与者相比，AD参与者的中心凹旁和中心凹周围VD在青光眼检测方面的表现明显较差（调整后的AUROC分别为0.75[95%CI，0.62，0.87]，0.85[95%CI，0.79，0.90]，P=0.035；和0.82[95%CI分别为0.70，0.92]，0.91[95%CI、0.87，0.94]；P=0.020）。与VD相比，在AD和ED患者中，GCC厚度的诊断准确性相似（调整后的AUROC分别为0.89[95%CI，0.79，0.96]，0.92[95%CI，0.86，0.96]；P=0.313）。黄斑VD和GCC厚度在区分青光眼和健康眼睛方面的诊断准确性随着AD和ED参与者VF-MD的增加而增加。结论：OCTA黄斑VD（而非GCC厚度）对青光眼检测的诊断性能因种族而异。此外，黄斑VD参数在AD患者中检测青光眼的准确性低于ED患者。黄斑VD的诊断性能取决于种族，因此，在解释黄斑OCTA结果时应考虑种族。

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引用次数: 0

Risk Factors for Glaucoma Diagnosis and Surgical Intervention following Pediatric Cataract Surgery in the IRIS® Registry IRIS®注册中心儿童白内障手术后青光眼诊断和手术干预的风险因素。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-03-01 DOI: 10.1016/j.ogla.2023.08.009

Daniel M. Vu MD , Tobias Elze PhD , Joan W. Miller MD , Alice C. Lorch MD, MPH , Deborah K. VanderVeen MD , Isdin Oke MD

Purpose

To compare demographic and clinical factors associated with glaucoma following cataract surgery (GFCS) and glaucoma surgery rates between infants, toddlers, and older children using a large, ophthalmic registry.

Design

Retrospective cohort study.

Participants

Patients in the IRIS® Registry (Intelligent Research in Sight) who underwent cataract surgery at ≤ 17 years old and between January 1, 2013 and December 31, 2020.

Methods

Glaucoma diagnosis and procedural codes were extracted from the electronic health records of practices participating in the IRIS Registry. Children with glaucoma diagnosis or surgery before cataract removal were excluded. The Kaplan–Meier estimator was used to determine the cumulative probability of GFCS diagnosis and glaucoma surgery after cataract surgery. Multivariable Cox regression was used to identify factors associated with GFCS and glaucoma surgery.

Main Outcome Measures

Cumulative probability of glaucoma diagnosis and surgical intervention within 5 years after cataract surgery.

Results

The study included 6658 children (median age, 10.0 years; 46.2% female). The 5-year cumulative probability of GFCS was 7.1% (95% confidence interval [CI], 6.1%–8.1%) and glaucoma surgery was 2.6% (95% CI, 1.9%–3.2%). The 5-year cumulative probability of GFCS for children aged < 1 year was 22.3% (95% CI, 15.7%–28.4%). Risk factors for GFCS included aphakia (hazard ratio [HR], 2.63; 95% CI, 1.96–3.57), unilateral cataract (HR, 1.48; 95% CI, 1.12–1.96), and Black race (HR, 1.61; 95% CI, 1.12–2.32). The most common surgery was glaucoma drainage device insertion (32.6%), followed by angle surgery (23.3%), cyclophotocoagulation (15.1%), and trabeculectomy (5.8%).

Conclusions

Glaucoma following cataract surgery diagnosis in children in the IRIS Registry was associated with young age, aphakia, unilateral cataract, and Black race. Glaucoma drainage device surgery was the preferred surgical treatment, consistent with the World Glaucoma Association 2013 consensus recommendations for GFCS management.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：通过大型眼科登记，比较白内障手术后与青光眼相关的人口统计学和临床因素，以及婴儿、学步儿童和年龄较大儿童的青光眼手术率。设计：回顾性队列研究。参与者：IRIS®注册中心（视力智能研究）的患者，他们在≤17岁时于2013年1月1日至2020年12月31日期间接受了白内障手术。方法：从参与IRIS注册中心的机构的电子健康记录中提取青光眼诊断和程序代码。排除白内障摘除前被诊断为青光眼或手术的儿童。Kaplan-Meier估计量用于确定白内障手术后GFCS诊断和青光眼手术的累积概率。多变量Cox回归用于确定与GFCS和青光眼手术相关的因素。主要结果指标：白内障手术后5年内青光眼诊断和手术干预的累积概率。结果：该研究包括6658名儿童（中位年龄10.0岁；46.2%为女性）。GFCS的5年累积概率为7.1%（95%置信区间[CI]，6.1%-8.1%），青光眼手术为2.6%（95%CI，1.9%-3.2%，和黑人（HR，1.61；95%CI，1.12-2.32）。最常见的手术是青光眼引流装置插入术（32.6%），其次是角形手术（23.3%）、睫状体光凝术（15.1%）和小梁切除术（5.8%）。青光眼引流装置手术是首选的手术治疗方法，符合世界青光眼协会2013年关于GFCS管理的共识建议。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

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