Ophthalmology. Glaucoma最新文献

英文中文

A Rare Presentation of Intraocular Lens Opacification as Phacolytic Glaucoma 一例罕见的晶状体混浊表现为溶解性青光眼。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.10.005

Madhuri Manapakkam MS, DNB, Rishika Lakshminarayanan MS, Deepa Ramamoorthy MS

引用次数: 0

Charles Bonnet Syndrome Adversely Affects Vision-Related Quality of Life in Patients with Glaucoma 查尔斯-博奈综合征对青光眼患者与视力有关的生活质量产生不利影响

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.07.001

Patrik Randeblad MD , Amardeep Singh MD, PhD , Dorothea Peters MD, PhD

Purpose

To investigate the impact of Charles Bonnet syndrome (CBS) on vision-related quality of life (VRQoL) in patients with glaucoma.

Design

Cross-sectional cohort study.

Participants

Twenty-four patients with CBS and 42 matched controls without CBS out of 337 patients with open-angle glaucoma (OAG) with visual field (VF) loss.

Methods

A matching technique was used to identify control patients with similar disease stage, best-corrected visual acuity (BCVA) and age to patients with CBS. Patients’ VRQoL was determined using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25). Rasch-calibrated NEI VFQ-25 scores of the CBS group and the control group were compared. Uni- and multivariable regression analysis was used to evaluate the impact of different factors on VRQoL.

Main Outcome Measures

Vision-related quality of life in patients with glaucoma with CBS and without CBS.

Results

Vision-related quality of life scores were significantly lower in the CBS group than in the control group on both the visual functioning scale with 39 points (95% confidence interval (CI): 30–48) vs. 52 points (95% CI: 46–58) (P = 0.013) and on the socioemotional scale with 45 points (95% CI: 37–53) vs. 58 points (95% CI: 51–65) (P = 0.015). Univariable regression analysis showed that integrated visual field mean deviation (IVF-MD) (r² = 0.334, P < 0.001), BCVA in the better eye (r² = 0.117, P = 0.003), and the presence of CBS (r² = 0.078, P = 0.013) were significantly correlated to VRQoL scores on the visual functioning scale. Integrated visual field mean deviation (r² = 0.281, P < 0.001), age (r² = 0.048, P = 0.042), and the presence of CBS (r² = 0.076, P = 0.015) were significantly correlated to VRQoL scores on the socioemotional scale. Multivariable regression analysis showed that IVF-MD and the presence of CBS accounted for nearly 40% of the VRQoL score on the visual functioning scale (R² = 0.393, P < 0.001) and for 34% of the VRQoL score on the socioemotional scale (R² = 0.339, P < 0.001).

Conclusions

Charles Bonnet syndrome had a significant negative association to VRQoL in patients with glaucoma. Presence of CBS should be considered when evaluating VRQoL in patients with glaucoma. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

目的探讨查尔斯-博奈综合征（CBS）对青光眼患者视力相关生活质量（VRQoL）的影响。方法采用配对技术确定与 CBS 患者疾病分期、最佳矫正视力（BCVA）和年龄相似的对照组患者。采用美国国家眼科研究所视觉功能问卷 25（NEI VFQ-25）测定患者的 VRQoL。比较了 CBS 组和对照组的 Rasch 校正 NEI VFQ-25 分数。采用单变量和多变量回归分析评估不同因素对 VRQoL 的影响。结果CBS组视觉相关生活质量评分明显低于对照组，在视觉功能量表上，CBS组为39分（95%置信区间（CI）：30-48），对照组为52分（95%置信区间（CI）：46-58）（P = 0.013）；在社会情感量表上，CBS组为45分（95%置信区间（CI）：37-53），对照组为58分（95%置信区间（CI）：51-65）（P = 0.015）。单变量回归分析显示，综合视野平均偏差（IVF-MD）（r2 = 0.334，P <0.001）、较好眼睛的BCVA（r2 = 0.117，P = 0.003）和是否存在CBS（r2 = 0.078，P = 0.013）与视觉功能量表中的VRQoL得分显著相关。综合视野平均偏差（r2 = 0.281，P <0.001）、年龄（r2 = 0.048，P = 0.042）和是否存在 CBS（r2 = 0.076，P = 0.015）与社会情感量表中的 VRQoL 评分明显相关。多变量回归分析显示，IVF-MD 和 CBS 的存在占视觉功能量表 VRQoL 得分的近 40%（R2 = 0.393，P <0.001），占社会情感量表 VRQoL 得分的 34%（R2 = 0.339，P <0.001）。在评估青光眼患者的 VRQoL 时，应考虑是否存在 CBS。财务披露：作者对本文讨论的任何材料均无所有权或商业利益。

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引用次数: 0

Deep Learning Classification of Angle Closure based on Anterior Segment OCT 基于前段 OCT 的闭角深度学习分类

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.06.011

Jing Shan MD, PhD , Zhixi Li MD , Ping Ma MD, PhD , Tin A. Tun MD , Sean Yonamine , Yangyan Wu MS , Mani Baskaran DO, PhD , Monisha E. Nongpiur MD, PhD , Dake Chen PhD , Tin Aung MMed, PhD , Shuning Li MD , Mingguang He MD, PhD , Yangfan Yang MD , Ying Han MD, PhD

Purpose

To assess the performance and generalizability of a convolutional neural network (CNN) model for objective and high-throughput identification of primary angle-closure disease (PACD) as well as PACD stage differentiation on anterior segment swept-source OCT (AS-OCT).

Design

Cross-sectional.

Participants

Patients from 3 different eye centers across China and Singapore were recruited for this study. Eight hundred forty-one eyes from the 2 Chinese centers were divided into 170 control eyes, 488 PACS, and 183 PAC + PACG eyes. An additional 300 eyes were recruited from Singapore National Eye Center as a testing data set, divided into 100 control eyes, 100 PACS, and 100 PAC + PACG eyes.

Methods

Each participant underwent standardized ophthalmic examination and was classified by the presiding physician as either control, primary angle-closure suspect (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG). Deep Learning model was used to train 3 different CNN classifiers: classifier 1 aimed to separate control versus PACS versus PAC + PACG; classifier 2 aimed to separate control versus PACD; and classifier 3 aimed to separate PACS versus PAC + PACG. All classifiers were evaluated on independent validation sets from the same region, China and further tested using data from a different country, Singapore.

Main Outcome Measures

Area under receiver operator characteristic curve (AUC), precision, and recall.

Results

Classifier 1 achieved an AUC of 0.96 on validation set from the same region, but dropped to an AUC of 0.84 on test set from a different country. Classifier 2 achieved the most generalizable performance with an AUC of 0.96 on validation set and AUC of 0.95 on test set. Classifier 3 showed the poorest performance, with an AUC of 0.83 and 0.64 on test and validation data sets, respectively.

Conclusions

Convolutional neural network classifiers can effectively distinguish PACD from controls on AS-OCT with good generalizability across different patient cohorts. However, their performance is moderate when trying to distinguish PACS versus PAC + PACG.

Financial Disclosures

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

目的评估卷积神经网络（CNN）模型的性能和可推广性，以客观、高通量地识别原发性闭角型角膜病（PACD），并根据前节扫源OCT（AS-OCT）进行PACD分期。来自中国两个眼科中心的 841 只眼睛被分为 170 只对照眼、488 只 PACS 眼和 183 只 PAC + PACG 眼。方法每位参与者都接受了标准化眼科检查，并由主治医生将其分为对照组、原发性疑似闭角（PACS）组、原发性闭角（PAC）组或原发性闭角型青光眼（PACG）组。深度学习模型用于训练 3 种不同的 CNN 分类器：分类器 1 用于区分对照组与 PACS、PAC + PACG；分类器 2 用于区分对照组与 PACD；分类器 3 用于区分 PACS 与 PAC + PACG。所有分类器均在来自同一地区（中国）的独立验证集上进行了评估，并使用来自不同国家（新加坡）的数据进行了进一步测试。结果分类器 1 在来自同一地区的验证集上的 AUC 为 0.96，但在来自不同国家的测试集上的 AUC 降为 0.84。分类器 2 的通用性最强，在验证集上的 AUC 为 0.96，在测试集上的 AUC 为 0.95。结论卷积神经网络分类器能在 AS-OCT 上有效区分 PACD 和对照组，在不同患者群中具有良好的普适性。然而，在试图区分 PACS 与 PAC + PACG 时，它们的表现一般。

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引用次数: 0

Imaging Angle Recession Using Anterior Segment OCT 利用OCT前段成像角度凹陷。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.10.002

Khaled Ali Elubous MD, Hady Saheb MD, MPH

引用次数: 0

Iris Bombé, Hypotony, and Silicone Oil after Complex Retinal Detachment Surgeries 复杂视网膜脱离手术后虹膜爆破、低眼压和硅油。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.10.008

Ibrahim Saleh MD , Monica Patel BS , Karanjit Kooner MD, PhD

引用次数: 0

Bull’s Eye Hyperoleon 牛眼Hyperoleon。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.10.003

Priyanka Prasad MD , Amber Amar Bhayana MD , Shivam Garg MD

引用次数: 0

Techniques and Preferences for Nonvalved Aqueous Shunts 无阀水箱分流器的技术和偏好

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.07.006

Jason Y. Zhang BS , Mary Qiu MD

Purpose

To assess practice patterns and opinions of glaucoma specialists regarding indications, surgical technique, and postoperative management for nonvalved aqueous shunts.

Design

Anonymous online survey study.

Participants

American Glaucoma Society (AGS) members.

Methods

An anonymous online survey was distributed to glaucoma specialists via the AGS forum from June to August 2022.

Main Outcome Measures

Survey questions and responses were assessed in 4 sections: (1) general demographics and practice patterns; (2) nonvalved tubes vs. trabeculectomy; (3) nonvalved tubes vs. valved tubes; and (4) nonvalved tube techniques.

Results

There were 132 respondents; nonvalved tubes were reported to be performed more often than trabeculectomy by 61% of respondents within 5 years of completing training and 23% of respondents with more than 15 years since completing training. The most frequently preferred types of nonvalved tubes were Baerveldt-350 (41%), Baerveldt-250 (27%), and ClearPath-250 (18%). In patients with lower target intraocular pressure (IOP), 92% of respondents preferred trabeculectomy over nonvalved tube; 33% cited a cutoff of < 12 mmHg, and 31% cited a cutoff of < 15 mmHg. In patients with higher preoperative IOP, 50% of respondents preferred valved over nonvalved tubes; 29% cited a cutoff of > 40 mmHg, and 38% cited a cutoff of > 30 mmHg. The most frequently used ligature was 7-0 Vicryl (69%). The most frequently used strategies for early IOP lowering were fenestrations without wicks (70%) and with wicks (22%), with one 10-0 Nylon being the most used wick technique (22%). Overall, 37% of respondents use a ripcord; among ripcord users, 55% use it for hypotony prevention (3-0 Prolene most common for this purpose at 35%), and 40% use it for optional early IOP lowering (4-0 Nylon most common for this purpose at 21%). If IOP is too high at postoperative week 4, 38% of respondents do not open the tube early.

Conclusions

We demonstrate significant heterogeneity regarding specific indications, surgical technique, and postoperative management for nonvalved tubes. Future work is needed to identify and develop standardized guidelines alongside best practices.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

目的评估青光眼专家对无阀水囊分流术的适应症、手术技术和术后管理的实践模式和意见。方法2022 年 6 月至 8 月，通过 AGS 论坛向青光眼专家发布匿名在线调查。结果132名受访者中，61%完成培训后5年内的受访者和23%完成培训后15年以上的受访者表示，非阀管比小梁切除术更常实施。最常选择的无阀眼管类型是 Baerveldt-350（41%）、Berveldt-250（27%）和 ClearPath-250（18%）。在目标眼压（IOP）较低的患者中，92% 的受访者首选小梁切除术而不是无阀导管；33% 的受访者认为目标眼压的临界值为 12 mmHg，31% 的受访者认为目标眼压的临界值为 15 mmHg。在术前眼压较高的患者中，50% 的受访者选择瓣膜管而不是无瓣膜管；29% 的受访者选择的截止值为 40 mmHg，38% 的受访者选择的截止值为 30 mmHg。最常用的结扎方法是 7-0 Vicryl（69%）。最常用的早期降低眼压策略是无灯芯（70%）和有灯芯（22%）的瓣膜缝合，其中 10-0 Nylon 是最常用的灯芯技术（22%）。总体而言，37% 的受访者使用裂隙灯；在使用裂隙灯的受访者中，55% 的人使用裂隙灯来预防眼压过低（3-0 Prolene 最常用，占 35%），40% 的人使用裂隙灯来选择性地降低早期眼压（4-0 尼龙最常用，占 21%）。如果术后第 4 周眼压过高，38% 的受访者不会提前打开导管。结论我们发现，在无阀导管的具体适应症、手术技巧和术后管理方面存在显著的异质性。未来的工作需要确定和制定最佳实践的标准化指南。

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引用次数: 0

A Previsit Intervention’s Influence on Glaucoma Topics Discussed between Black Patients and Providers 就诊前干预对黑人患者和医务人员讨论青光眼话题的影响

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.07.002

Betsy Sleath PhD , Delesha M. Carpenter PhD, MSPH , Donald L. Budenz MD, MPH , Kelly W. Muir MD , Maria S. Romero MD , Abena A. Adjei BS , Bethany Beznos PharmD , Gail Tudor PhD , Nacire Garcia MS , Alan L. Robin MD

Purpose

The objectives of this study were to conduct a randomized controlled trial testing the effectiveness of a previsit glaucoma video/question prompt list intervention, and to examine the impact on how often providers educate Black patients about glaucoma and glaucoma medication topics during visits.

Design

A randomized controlled trial of a glaucoma question prompt list/video intervention.

Participants

Black patients with a diagnosis of glaucoma who are taking 1 or more glaucoma medications and report being nonadherent.

Methods

One hundred eighty-nine Black patients with glaucoma were enrolled and assigned to either a usual care or an intervention group where they watched a video emphasizing the importance of asking questions and received a glaucoma question prompt list to complete before clinic visits. Visits were audio-taped and patients were interviewed after visits.

Main Outcome Measures

Whether the provider educates about different glaucoma and glaucoma medication topics.

Results

Patients in the intervention group were significantly more likely to ask providers 1 or more questions about glaucoma and its treatment. Providers were significantly more likely to educate intervention patients about their diagnosis (P = 0.001), intraocular pressure (P = 0.03), the likelihood of the need for long-term therapy (P = 0.001), and the physical changes associated with glaucoma (P = 0.001) than usual-care patients. Providers were also significantly more likely to educate intervention patients about the purpose of their medications (P = 0.03) and side effects (P = 0.001) than usual-care patients. Providers only educated 29% of patients about adherence (33% of intervention group patients and 25% of usual-care patients). Few providers educated patients about barriers and fears/concerns in using glaucoma medications, the cost of medications and insurance coverage, how to administer eye drops, and nasolacrimal occlusion.

Conclusions

The intervention significantly increased provider education about many glaucoma and glaucoma medication topics.

Financial Disclosure(s)

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

目的本研究的目的是进行一项随机对照试验，测试就诊前青光眼视频/问题提示清单干预措施的有效性，并研究其对医疗人员在就诊期间向黑人患者进行青光眼和青光眼用药主题教育的频率所产生的影响.设计一项青光眼问题提示清单/视频干预措施的随机对照试验.方法 189 名患有青光眼的黑人患者入选，并被分配到常规护理组或干预组，在干预组中，他们观看了一段强调提问重要性的视频，并收到了一份青光眼问题提示单，供他们在就诊前填写。主要结果测量医疗服务提供者是否就不同的青光眼和青光眼药物主题进行教育。结果干预组患者向医疗服务提供者提出 1 个或更多有关青光眼及其治疗的问题的可能性显著增加。医护人员向干预组患者讲解诊断（P = 0.001）、眼压（P = 0.03）、需要长期治疗的可能性（P = 0.001）以及与青光眼相关的身体变化（P = 0.001）的可能性明显高于普通护理患者。医疗服务提供者对干预患者进行药物治疗目的（P = 0.03）和副作用（P = 0.001）教育的可能性也明显高于常规治疗患者。医疗服务提供者仅对 29% 的患者进行了坚持用药教育（干预组患者为 33%，常规护理患者为 25%）。很少有医疗服务提供者向患者讲解使用青光眼药物的障碍和恐惧/顾虑、药物费用和保险范围、如何滴用眼药水以及鼻泪管闭塞等问题。结论干预措施显著提高了医疗服务提供者对许多青光眼和青光眼药物主题的教育水平。

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引用次数: 0

Profile of Newly Diagnosed Childhood Glaucoma in India 印度新诊断的儿童青光眼概况

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.07.004

Sushmita Kaushik MD , Sirisha Senthil MD, FRCS , Viney Gupta MD , Shantha Balekudaru MD , Suneeta Dubey MD , Hasnat Ali MSc , Anil K. Mandal MD

Objective

To report the profile of newly diagnosed childhood glaucoma using the Childhood Glaucoma Research Network (CGRN) classification, presenting over 1 year from across centers in India.

Design

Prospective observational multicentric study.

Subjects

Newly diagnosed children aged < 18 years diagnosed with childhood glaucoma according to CGRN criteria presenting between January and December 2019 to 13 centers across India.

Methods

All children underwent a comprehensive ocular examination, including examination under anesthesia for younger children, and were diagnosed with childhood glaucoma as per CGRN. Data were entered in a standard Excel chart. Refraction and visual acuity assessments were done when feasible.

Main Outcome Measures

The profile of newly diagnosed childhood glaucoma in different parts of India and the severity of glaucoma at presentation.

Results

A total of 1743 eyes of 1155 children fulfilled the definition of glaucoma and were analyzed. Primary congenital glaucoma (PCG) comprised the single largest group (34.4%), most of which were infantile onset (19%). Neonatal-onset PCG comprised 6.2% of all glaucoma. Secondary glaucoma constituted 53.4% of all glaucoma, one-half of which were acquired conditions (28%), followed by isolated ocular anomalies (14.7%), glaucoma after cataract surgery (6.7%), and glaucoma with nonacquired systemic diseases (4.5%). Of the 1743 eyes with glaucoma, all 3 parameters for severity grading were available in 842 eyes, of which 501 (59.5%) eyes presented with mild, 320 (38%) with moderate, and 21 (2.5%) with severe glaucoma. Nearly one-third of the children (28.5%) were not brought back for follow-up after the initial treatment given.

Conclusions

Our study has one of the largest numbers of consecutive children with glaucoma classified according to the CGRN classification. Despite a widely diverse population, the profile of childhood glaucoma was relatively uniform across India. Childhood glaucoma is a significant problem in India, primarily treated in tertiary care hospitals. The data presented may be the tip of the iceberg because we have only reported the children who reached the hospitals offering treatment for this challenging disease.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

目的报告使用儿童青光眼研究网络（CGRN）分类，在印度各中心就诊超过1年的新诊断儿童青光眼的概况.设计前瞻性观察性多中心研究.研究对象2019年1月至12月期间在印度13个中心就诊的根据CGRN标准诊断为儿童青光眼的18岁新诊断儿童。方法所有儿童都接受了全面的眼部检查，包括年龄较小儿童的麻醉下检查，并根据CGRN诊断为儿童青光眼。数据输入标准 Excel 图表。在可行的情况下进行屈光度和视力评估。主要结果测量印度不同地区新诊断出的儿童青光眼的概况以及发病时青光眼的严重程度。原发性先天性青光眼（PCG）是最大的一个群体（34.4%），其中大部分是婴儿期发病（19%）。新生儿发病的 PCG 占所有青光眼的 6.2%。继发性青光眼占所有青光眼的 53.4%，其中二分之一为后天性青光眼（28%），其次是孤立性眼部异常（14.7%）、白内障手术后青光眼（6.7%）和非后天性全身性疾病引起的青光眼（4.5%）。在患有青光眼的 1743 只眼睛中，有 842 只眼睛获得了严重程度分级的所有 3 项参数，其中 501 只眼睛（59.5%）为轻度青光眼，320 只眼睛（38%）为中度青光眼，21 只眼睛（2.5%）为重度青光眼。近三分之一的患儿（28.5%）在接受初步治疗后未再复诊。尽管印度的人口具有广泛的多样性，但儿童青光眼的特征在印度各地却相对一致。儿童青光眼是印度的一个重大问题，主要在三级医院接受治疗。本文提供的数据可能只是冰山一角，因为我们只报告了前往医院治疗这种具有挑战性疾病的儿童。

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引用次数: 0

Anterior Segment OCT Image after Laser Iridotomy 激光虹膜切开术后前段OCT图像。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.10.001

Ganesh V. Raman MD, Rohan Daniel MD, Premanand Chandran MD

引用次数: 0

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