Ophthalmology最新文献

Purpose: To compare the early exposure and surgical revision rates between a new synthetic tissue substitute (CorNeat EverPatch) with that of human donor cornea following placement onto the scleral surface during ophthalmic surgery, and to study the biomaterial properties of the synthetic patch material.

Design: Retrospective comparison study; biomaterial analyses of new and explanted synthetic patch material.

Patients: All consecutive patients who underwent ophthalmic surgery with implantation of the CorNeat EverPatch at the Wilmer Eye Institute (occurring from February to August 2024) and a comparison group who underwent ophthalmic surgery with implantation of irradiated donor cornea, matched 1:2 with patients receiving EverPatch for age, type of glaucoma, and surgeon.

Methods: Retrospective review of clinical electronic medical records of patients who underwent surgery at the Wilmer Eye Institute. Materials characterization of EverPatch including morphology, surface roughness, wettability, thermal stability, elemental analysis, and physical properties.

Main outcome measures: Early exposure (within 5 months of surgery) and surgical revision rates following CorNeat EverPatch or irradiated human donor cornea implantation during ophthalmic surgery.

Results: Thirty patients undergoing ophthalmic surgery in 2024 received EverPatch implantation during primary tube shunt placement (N=27), tube shunt revision (N=2), or covering of exposed suture used for scleral fixation of an intraocular lens (N=1). During the early postoperative period, the rate of EverPatch exposure was 48.3% and the rate of surgical revision was 27.9%. In case-matched control patients (N=58), the rate of patch graft exposure was 1.7% (p<0.0001) and the rate of surgical revision was 1.7% (p<0.0001). EverPatch devices were comprised of a randomly aligned fibrous mesh with an average fiber diameter of 1.36 ± 0.78 μm, surface roughness of 1.3 ± 0.1 μm, pore size of 3.7 ± 0.4 μm², and percent porosity of 37 ± 3%. Explanted EverPatch devices demonstrated varying degrees of tissue integration with significantly increased wettability and changes in thermal stability and elemental composition.

Conclusions: The rate of early conjunctival complications leading to exposure of the CorNeat EverPatch was higher than in cases involving irradiated human donor corneal patch grafts.

Objective: Pseudoexfoliation syndrome (PEX) is a known risk factor for glaucoma, but its individual clinical course ranges from no glaucoma to total blindness. This study investigated whether polygenic risk scores (PRS) built from variants collectively associated with open-angle glaucoma, intraocular pressure (IOP) and vertical cup:disc ratio (VCDR) can stratify individuals with pseudoexfoliation for their risk of glaucoma development.

Design: Retrospective multicohort study of two glaucoma registries and one population-based cohort.

Participants: For the primary analysis, participants (n=828) were classified as PEX-Glaucoma, PEX-Glaucoma Suspect, and PEX-No Glaucoma. For the secondary analysis, a cohort of participants (n=2459) were classified as PEX-Glaucoma, PEX-No Glaucoma, and Unaffected, and an independent cohort of participants (n=3360) were classified as primary open-angle glaucoma (POAG) and POAG-Suspect.

Methods: Previously published and validated PRS for open-angle glaucoma, IOP and VCDR were expressed as a percentile, decile or tertile of an ancestrally-matched normal population. Multivariable logistic and linear regressions, and survival analyses were performed.

Main outcome measures: Odds of pseudoexfoliative glaucoma, and odds of clinically-relevant outcomes.

Results: Participants in the top tertile of the Glaucoma-PRS had greater odds of pseudoexfoliative glaucoma diagnosis (adjusted OR 4.22, 95% CI 2.62 - 6.88, p<0.001), greater odds of bilateral central vision loss (adjusted OR 3.43, 95% CI 1.49 - 8.99, p=0.007), and greater odds of bilateral incisional surgery (adjusted OR 3.35, 95% CI 1.33 - 10.24, p=0.018). Age of pseudoexfoliative glaucoma diagnosis was 1 year younger with each increasing Glaucoma-PRS decile (1.06 years, 95% CI 0.59-1.53, p<0.001). Manifest glaucoma participants with pseudoexfoliation had a comparatively lower Glaucoma-PRS than primary open-angle glaucoma counterparts.

Conclusion: PRS for open-angle glaucoma, IOP and VCDR stratify risk of glaucoma development and disease severity amongst individuals with pseudoexfoliation syndrome.