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Reversal of Pharmacologically Induced Mydriasis with Phentolamine Ophthalmic Solution 用酚妥拉明眼药水逆转药理诱导的瞳孔散大。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.09.010
Jay S. Pepose MD, PhD , David Wirta MD , David Evans OD , Barbara Withers PhD , Kavon Rahmani BS , Audrey Lazar BS , Drey Coleman BS , Ronil Patel MS , Reda Jaber MD , Mina Sooch MBA , Mitchell Brigell PhD , Konstantinos Charizanis PhD

Purpose

To evaluate the safety and efficacy of 0.75% phentolamine ophthalmic solution (POS), an α-adrenergic antagonist, in reversal of pharmacologically induced mydriasis.

Design

Two phase 3, multicenter, placebo-controlled, randomized, double-masked clinical trials in healthy participants.

Participants

Five hundred fifty-three healthy 12- to 80-year-old participants were randomized 1:1 (MIRA 2) and 2:1 (MIRA 3) to receive either POS or placebo eye drops in both eyes.

Methods

Participants received POS or placebo administered 1 hour after mydriasis, induced by instillation of either 2.5% phenylephrine, 1% tropicamide, or 1% hydroxyamphetamine / 0.25% tropicamide.

Main Outcome Measures

Percent of participants returning to within 0.2 mm of baseline pupil diameter in study eye 90 minutes after POS administration. Safety measures included treatment-emergent adverse events and tolerability measures, including conjunctival hyperemia.

Results

A total of 553 participants were randomized to treatment with placebo (n = 215) or POS (n = 338). A statistically significant greater percentage of participants treated with POS showed reversal of mydriasis at 90 minutes compared to placebo (MIRA 2: 48.9% vs. 6.6% [P < 0.0001]; MIRA 3: 58% vs. 6% [P < 0.0001]) and as early as 60 minutes (MIRA 2: 27.7% vs. 2.2% [P < 0.0001]; MIRA 3: 42% vs. 2% [P < 0.0001]). Between 28% and 34% of participants receiving placebo did not returned to baseline PD at 24 hours after pharmacologic dilation compared with 8% to 11% of patients treated with POS (P < 0.0001).

Conclusions

Treatment with POS reduced PD within 60 to 90 minutes, with a statistically significant time savings of 5 to 6 hours to return to baseline PD compared with placebo. One or 2 drops of POS rapidly reversed mydriasis in all participants regardless of mydriatic agent or iris color. More participants receiving POS reported a benefit in the resolution of visual symptoms caused by pharmacologically induced mydriasis compared with placebo, with statistically significant differences noted as early as 1 hour. The safety profile was favorable, with the most common adverse effects being mild transient conjunctival hyperemia (11.2%), instillation site discomfort (10.9%), and dysgeusia (3.6%).

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 0.75% 酚妥拉明眼药水(POS)(一种α-1 拮抗剂)逆转药理诱导的眼球震颤的安全性和有效性:设计:在健康受试者中进行两项第 3 阶段、多中心、安慰剂对照、随机、双掩蔽临床试验:553名12至80岁的健康受试者按1:1(MIRA-2)和2:1(MIRA-3)的比例随机接受POS或安慰剂眼药水滴眼:方法:受试者在接受2.5%苯肾上腺素、1%托吡卡胺或Paremyd(1%羟基苯丙胺/0.25%托吡卡胺)眼药水引起的眼球震颤1小时后,滴用POS或安慰剂:主要终点是在注射 POS 90 分钟后,研究用眼的瞳孔直径恢复到比基线大≤0.2 毫米的受试者百分比。安全性指标包括治疗突发不良事件(TEAEs)和耐受性指标,包括结膜充血:在 MIRA-2 中,185 名受试者随机接受了安慰剂(94 人)或 POS(91 人)治疗。在 MIRA-3 中,368 名受试者随机接受了安慰剂(124 人)或 POS(244 人)治疗。与安慰剂治疗相比,使用 POS 治疗的受试者在 90 分钟(主要终点)时出现眼球震颤逆转的比例明显更高(MIRA-2 为 48.9% 对 6.6%;P 结论:POS 治疗能迅速缓解眼球震颤,并能在 90 分钟内逆转眼球震颤:POS 治疗可在 60 至 90 分钟内迅速减少眼球屈光度,与安慰剂相比,可节省 3 至 4 个小时恢复到基线眼球屈光度,具有显著的统计学意义。在所有受试者中,无论使用何种眼药水或虹膜颜色,滴用 1 滴或 2 滴 POS 均可迅速逆转眼球震颤。与安慰剂相比,更多接受 POS 治疗的受试者表示在缓解药物性眼球震颤引起的视觉症状方面感受到了益处,并且在 1 小时内就发现了显著的统计学差异。该药的安全性良好,最常见的不良反应是轻微的一过性结膜充血(11.2%)、灌注部位不适(10.9%)和吞咽困难(3.6%)。
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引用次数: 0
Cardiovascular and Cerebrovascular Adverse Events Associated with Intravitreal Anti-VEGF Monoclonal Antibodies 与玻璃体内抗血管内皮生长因子单克隆抗体相关的心脑血管不良事件:世界卫生组织药物警戒研究。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.07.008
Jee Myung Yang MD, PhD , Se Yong Jung MD , Min Seo Kim MD , Seung Won Lee MD, PhD , Dong Keon Yon MD , Jae Il Shin MD, PhD , Joo Yong Lee MD, PhD
<div><h3>Purpose</h3><div>To analyze cardiovascular and cerebrovascular adverse drug reactions (ADRs) after intravitreal anti–VEGF (aflibercept, bevacizumab, brolucizumab, and ranibizumab) treatment.</div></div><div><h3>Participants</h3><div>VigiBase, a World Health Organization (WHO) global safety report database.</div></div><div><h3>Design</h3><div>Pharmacovigilance study.</div></div><div><h3>Methods</h3><div>The individual case safety reports (ICSRs) of cardiovascular and cerebrovascular ADRs after intravitreal anti-VEGF treatment were compared with those reported in the full database. From 2004 to 2023, there were 23 129 ADRs after intravitreal anti-VEGF therapy and 25 015 132 ADRs associated with any drug (full database).</div></div><div><h3>Main Outcome Measures</h3><div>The reporting odds ratio (ROR) and information components (ICs) were calculated, and the 95% lower credibility interval end point of the information component (IC<sub>025</sub>) was used for disproportionate Bayesian reporting. Inter-drug comparisons were performed using the ratio of odds ratio (rOR).</div></div><div><h3>Results</h3><div>Compared with the full database, anti-VEGFs were associated with an increased reporting of myocardial infarction (IC<sub>025</sub> 0.75; ROR: 1.78 [95% CI, 1.70–1.86]), angina pectoris (IC<sub>025</sub> 0.53; ROR: 1.61 [95% CI, 1.47–1.77]), arrhythmias including atrial fibrillation, atrial flutter, ventricular fibrillation, supraventricular tachycardia (all IC<sub>025</sub> > 0, ROR>1), hypertension (IC<sub>025</sub> 2.22; ROR: 4.91 [95% CI, 4.82–5.01]), and hypertensive crisis (IC<sub>025</sub> 1.97; ROR: 4.49 [95% CI, 4.07–4.97]). Moreover, anti-VEGFs were associated with a higher reporting of cerebrovascular ADRs such as cerebral infarction (IC<sub>025</sub> 4.34; ROR: 23.19 [95% CI, 22.10–24.34]), carotid artery stenosis (IC<sub>025</sub> 1.85; ROR: 5.24 [95% CI, 3.98–6.89]), cerebral hemorrhage (IC<sub>025</sub> 2.29; ROR: 5.38 [95% CI, 5.03–5.76]), and subarachnoid hemorrhage (IC<sub>025</sub> 1.98; ROR: 4.81 [95% CI, 4.14–5.6]). Inter-drug comparison indicated that compared with ranibizumab, patients receiving aflibercept showed overall under-reporting of cardiovascular and cerebrovascular ADRs such as myocardial infarction (rOR 0.55 [95% CI, 0.49–0.52]), atrial fibrillation (rOR 0.28 [95% CI, 0.23–0.35]), cerebrovascular accident (rOR, 0.15 [95% CI, 0.14–0.17]), and cerebral hemorrhage (rOR, 0.51 [95% CI, 0.40–0.65]).</div></div><div><h3>Conclusions</h3><div>In this pharmacovigilance case-noncase study, there was significantly increased reporting of cardiovascular and cerebrovascular ADRs after intravitreal anti-VEGF treatment. Although ranibizumab may exhibit superior systemic safety regarding its biological characteristics, it is crucial not to overlook the occurrence of cardiovascular and cerebrovascular ADRs considering its higher reporting rate than bevacizumab or aflibercept.</div></div><div><h3>Financial Disclosure(s)</
目的:分析玻璃体内抗血管内皮生长因子(VEGF;aflibercept、贝伐单抗、brolucizumab和ranibizumab)治疗后的心脑血管不良事件(ADRs):世界卫生组织(WHO)全球安全报告数据库 VigiBase 设计:药物警戒研究 方法:将玻璃体内抗血管内皮生长因子治疗后心脑血管 ADR 的单个病例安全报告(ICSR)与完整数据库中的报告进行比较。从 2004 年到 2023 年,玻璃体内抗 VEGF 治疗后的 ADR 为 23,129 例,与任何药物相关的 ADR 为 25,015,132 例(完整数据库):计算报告几率(ROR)和信息成分(IC),并使用信息成分的 95% 可信区间下限(IC025)进行贝叶斯不对称报告。使用奇异比(rOR)进行药物间比较:77])、心律失常,包括心房颤动、心房扑动、心室颤动、室上性心动过速(IC025 均>0,ROR>1)、高血压(IC025 2.22;ROR:4.91 [95% CI 4.82-5.01])和高血压危象(IC025 1.97;ROR:4.49 [95% CI 4.07-4.97])。此外,抗血管内皮生长因子与较高的脑血管 ADR 相关,如脑梗塞(IC025 4.34;ROR:23.19 [95% CI 22.10-24.34])、颈动脉狭窄(IC025 1.85;ROR:5.24 [95% CI 3.98-6.89])、脑出血(IC025 2.29;ROR:5.38 [95% CI 5.03-5.76])和蛛网膜下腔出血(IC025 1.98;ROR:4.81 [95% CI 4.14-5.6])。药物间比较显示,与雷尼珠单抗相比,使用阿夫利百普的患者在心肌梗死等心脑血管 ADRs 方面总体报告不足(rOR 0.55 [95% CI 0.49-0.52])、心房颤动(rOR 0.28 [95% CI 0.23-0.35])、脑血管意外(rOR,0.15 [95% CI 0.14-0.17])和脑出血(rOR,0.51 [95% CI 0.40-0.65]):在这项药物警戒病例-非病例研究中,发现玻璃体内抗血管内皮生长因子治疗后心血管和脑血管不良反应的报告显著增加。虽然雷尼珠单抗的生物特性可能显示出更高的全身安全性,但考虑到其报告率高于贝伐珠单抗或阿弗利贝赛普,因此不应忽视心脑血管不良反应的发生。
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引用次数: 0
The Rate of Re-treatment in Patients Treated with Teprotumumab 接受替普鲁单抗治疗患者的再治疗率:一项对 119 名患者进行为期一年随访的多中心研究。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.07.018
Shoaib Ugradar MD , Emanuil Parunakian BS , Emil Malkhasyan BS , Carolina A. Chiou MD , Hannah L. Walsh BS , Joseph Tolentino BS , Sara T. Wester MD , Suzanne K. Freitag MD , Raymond S. Douglas MD, PhD

Purpose

To determine the rate of re-treatment in patients who receive a full course of teprotumumab therapy for thyroid eye disease (TED) and drivers of re-treatment.

Design

Multicenter retrospective study.

Participants

All patients who received a full course of treatment and had available data at 1 year after initial treatment were included.

Methods

Charts were reviewed for the following information: age, sex, months since diagnosis of TED, smoking status, and prior treatments. Further, the clinical activity score (CAS), proptosis, and the Gorman diplopia score were reviewed at baseline, at the end of the first course, and at baseline for the second course in those who received it. A logistic regression model was created to review the drivers of re-treatment.

Main Outcome Measures

Rate of re-treatment and the drivers of re-treatment.

Results

One hundred nineteen patients were included from 3 centers across the United States. The overall re-treatment rate was 24% (29/119). No difference was found among the 3 sites (P = 0.6). In univariable analyses, at baseline, no difference was found in proptosis (P = 0.07), diplopia score (P = 0.4), or duration of TED (P = 0.4) between patients who were re-treated and those not re-treated. From the re-treated group, 82% showed a significant proptosis response (≥ 2-mm reduction from baseline) after the initial course, whereas 68% of patients who were not re-treated showed a clinically significant proptosis response (P = 0.16). The mean ± standard deviation difference between the end of the first treatment and at baseline before the second treatment (in those who received it) was 2 ± 2 for CAS, 2 ± 4 mm for proptosis, and 1 ± 1 for diplopia score. Age was the only significant driver of re-treatment (P < 0.05). Re-treated patients were 7 years older than patients who were not re-treated (60 years vs. 53 years; P < 0.05).

Conclusions

In patients receiving a full course of teprotumumab therapy, the rate of re-treatment was 24%. Age was the only driver of re-treatment.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目标或目的:确定甲状腺眼病(TED)患者接受完整疗程的替普鲁单抗治疗后的再治疗率以及再治疗的驱动因素:设计:多中心、回顾性研究 对象:所有接受全疗程泰泊单抗治疗的患者:纳入所有接受完整疗程治疗的患者,并提供首次治疗后 1 年的数据:方法:对病历进行审查,以了解以下信息:年龄、性别、确诊 TED 的月份、吸烟状况、之前的治疗情况。此外,在基线、第一个疗程结束时和第二个疗程的基线,对接受治疗者的临床活动评分(CAS)、突眼和戈尔曼复视评分进行复查。建立了一个逻辑回归模型来审查再治疗的驱动因素:主要结果测量:再治疗率和再治疗的驱动因素:结果:纳入了来自美国 3 个中心的 119 名患者。总的再治疗率为 24%(29/119)。3个中心之间没有差异(P = 0.6)。在单变量分析中,接受过再治疗和未接受再治疗的患者在基线眼球突出(p = 0.07)、复视评分(p = 0.4)或 TED 持续时间(p = 0.4)方面没有差异。在重新治疗组中,82%的患者在初始疗程后有明显的突眼反应(与基线相比减少≥2 mms),而在非重新治疗组中,68%的患者有明显的突眼反应(p = 0.16)。在首次输注替普鲁单抗前使用其他治疗方法和基线甲状腺功能障碍方面,治疗组和非治疗组之间没有显著差异(p = 0.06 和 0.09)。第一次治疗结束时与第二次治疗前基线时(接受治疗者)的平均(标度)差异为:CAS为2(2),突眼为2毫米(4),复视为1(1)。年龄是影响再治疗的唯一重要因素(P < 0.05)。接受再治疗的患者比未接受再治疗的患者大 7 岁(60 岁对 53 岁(P < 0.05)):结论:在接受全疗程替普鲁单抗治疗的患者中,再治疗率为24%。结论:在接受全疗程替普鲁单抗治疗的患者中,再治疗率为 24%,年龄是导致再治疗的唯一因素。
{"title":"The Rate of Re-treatment in Patients Treated with Teprotumumab","authors":"Shoaib Ugradar MD ,&nbsp;Emanuil Parunakian BS ,&nbsp;Emil Malkhasyan BS ,&nbsp;Carolina A. Chiou MD ,&nbsp;Hannah L. Walsh BS ,&nbsp;Joseph Tolentino BS ,&nbsp;Sara T. Wester MD ,&nbsp;Suzanne K. Freitag MD ,&nbsp;Raymond S. Douglas MD, PhD","doi":"10.1016/j.ophtha.2024.07.018","DOIUrl":"10.1016/j.ophtha.2024.07.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the rate of re-treatment in patients who receive a full course of teprotumumab therapy for thyroid eye disease (TED) and drivers of re-treatment.</div></div><div><h3>Design</h3><div>Multicenter retrospective study.</div></div><div><h3>Participants</h3><div>All patients who received a full course of treatment and had available data at 1 year after initial treatment were included.</div></div><div><h3>Methods</h3><div>Charts were reviewed for the following information: age, sex, months since diagnosis of TED, smoking status, and prior treatments. Further, the clinical activity score (CAS), proptosis, and the Gorman diplopia score were reviewed at baseline, at the end of the first course, and at baseline for the second course in those who received it. A logistic regression model was created to review the drivers of re-treatment.</div></div><div><h3>Main Outcome Measures</h3><div>Rate of re-treatment and the drivers of re-treatment.</div></div><div><h3>Results</h3><div>One hundred nineteen patients were included from 3 centers across the United States. The overall re-treatment rate was 24% (29/119). No difference was found among the 3 sites (<em>P</em> = 0.6). In univariable analyses, at baseline, no difference was found in proptosis (<em>P</em> = 0.07), diplopia score (<em>P</em> = 0.4), or duration of TED (<em>P</em> = 0.4) between patients who were re-treated and those not re-treated. From the re-treated group, 82% showed a significant proptosis response (≥ 2-mm reduction from baseline) after the initial course, whereas 68% of patients who were not re-treated showed a clinically significant proptosis response (<em>P</em> = 0.16). The mean ± standard deviation difference between the end of the first treatment and at baseline before the second treatment (in those who received it) was 2 ± 2 for CAS, 2 ± 4 mm for proptosis, and 1 ± 1 for diplopia score. Age was the only significant driver of re-treatment (<em>P</em> &lt; 0.05). Re-treated patients were 7 years older than patients who were not re-treated (60 years vs. 53 years; <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>In patients receiving a full course of teprotumumab therapy, the rate of re-treatment was 24%. Age was the only driver of re-treatment.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"132 1","pages":"Pages 92-97"},"PeriodicalIF":13.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationship between Blood Pressure and Rates of Glaucomatous Visual Field Progression 血压与青光眼视野进展率之间的关系:青光眼血管成像研究。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.07.026
Richard Donkor MSc, PhD, Alessandro A. Jammal MD, PhD, David S. Greenfield MD

Purpose

To examine the relationship between systemic arterial blood pressure (BP) and the rate of change in standard automated perimetry (SAP) in eyes with glaucoma and suspected glaucoma.

Design

Prospective cohort study.

Participants

One hundred twenty-four eyes (91 eyes with glaucoma, 33 eyes with suspected glaucoma) of 64 patients (mean age, 68.4 ± 7.6 years) followed up at the Bascom Palmer Eye Institute, Palm Beach Gardens, Florida.

Methods

Participants underwent ophthalmic examination, BP measurement, and SAP at 4-month intervals. At the baseline visit, 24-hour ambulatory blood pressure monitoring (ABPM) was acquired. Linear mixed models (adjusted for inclusion of both eyes, age, sex, race, intraocular pressure, baseline severity, and central corneal thickness) were used to investigate the effect of BP on the rates of SAP mean deviation (MD) change over time.

Main Outcome Measures

Effect of baseline 24-hour and follow-up mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP on change in SAP MD.

Results

Eyes underwent an average of 8.9 ± 1.5 SAP examinations over 28.3 ± 6.0 months of follow-up. The median rate of MD change was 0.14 dB/year (range, –1.21 to 0.96 dB/year) with 9 eyes (7%) showing moderate to fast progression (MD change, ≤ –0.50 dB/year). Each 10 mmHg lower in 24-hour average MAP and SBP were associated with –0.171 dB/year (P = 0.045) and –0.137 dB/year (P = 0.023) faster rates of MD loss. Lower mean SBP during follow-up was associated significantly (P = 0.003) with MD progression.

Conclusions

Lower baseline 24-hour ABPM measurements, as well as low SBP during follow-up, were associated significantly with faster rates of glaucomatous SAP progression and may be used as a predictor of risk of glaucomatous progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:研究青光眼患者和青光眼疑似患者的全身动脉血压(BP)与标准自动眼压计(SAP)变化率之间的关系:前瞻性队列研究:64名受试者(平均年龄为68.4±7.6岁)的124只眼睛(91只青光眼,33只疑似青光眼)在佛罗里达州棕榈滩花园的巴斯科姆-帕尔默眼科研究所接受随访:受试者每 4 个月接受一次眼科检查、血压测量和 SAP 检查。24 小时动态血压监测(ABPM)是在基线访问时采集的。线性混合模型(根据双眼、年龄、性别、种族、眼压、基线严重程度和中央角膜厚度进行调整)用于研究血压对 SAP 平均偏差(MD)随时间变化率的影响:基线24小时和随访平均动脉压(MAP)、收缩压(SBP)和舒张压(DBP)对SAP MD变化的影响:在 28.3±6.0 个月的随访过程中,患者平均接受了 8.9±1.5 次 SAP 检查。MD 变化的中位速率为 0.14dB/年(范围为-1.21 至 0.96dB/年),其中有 9 只眼睛(7%)出现中度至快速进展(MD 变化≤ -0.50dB/年)。24 小时平均血压(MAP)和血压(SBP)每降低 10 mmHg,MD 下降速度就会加快 -0.171 dB/年(P=0.045)和 -0.137 dB/年(P=0.023)。随访期间较低的平均 SBP 与 MD 进展显著相关(P=0.003):结论:较低的基线 24 小时 ABPM 测量值以及随访期间较低的 SBP 与青光眼 SAP 进展速度较快有显著相关性,可用作青光眼进展风险的预测指标。
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引用次数: 0
期刊一览
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.11.009
Sandeep Ravindran PhD
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引用次数: 0
Severe, Rebound Mpox in an Immunocompromised Man 一名免疫力低下男子的严重反弹性麻风病
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.01.026
Adam J. Neuhouser MD, Alisha Kamboj MD, MBA
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引用次数: 0
Vascular Aneurysm in Persistent Pupillary Membrane 瞳孔膜持续存在的血管瘤
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.01.019
Yuta Nariya MD, Takashi Ono MD, PhD, Takashi Miyai MD, PhD
{"title":"Vascular Aneurysm in Persistent Pupillary Membrane","authors":"Yuta Nariya MD,&nbsp;Takashi Ono MD, PhD,&nbsp;Takashi Miyai MD, PhD","doi":"10.1016/j.ophtha.2024.01.019","DOIUrl":"10.1016/j.ophtha.2024.01.019","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"132 1","pages":"Page e10"},"PeriodicalIF":13.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of Racial, Ethnic, and Socioeconomic Differences on Visual Impairment before Cataract Surgery 种族/族裔和社会经济差异对白内障手术前视力损伤的影响。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.07.021
Abdelhalim A. Awidi MD , Fasika A. Woreta MD, MPH , Ahmed Sabit MS , Haihong Hu MS , Niteesh Potu MS , Eva Devience MD , Jiangxia Wang MA, MS , Suma Vupputuri PhD, MPH

Purpose

To compare the associations of race, ethnicity, and socioeconomic status (SES) with visual impairment (VI) before surgical removal of cataracts across 2 health systems in the United States Mid-Atlantic region.

Design

Multi-institutional cross-sectional study.

Participants

Patients ≥ 65 years of age who underwent cataract surgery at Johns Hopkins Hospital (JHH) and Kaiser Permanente (KP) between January 1, 2017, and December 31, 2019.

Methods

Covariates included patient age, sex, smoking status, surgery laterality, Charlson comorbidity index, and ocular comorbidities. Multivariable generalized estimating equation models were used to examine the association of race, ethnicity, and area deprivation index (ADI) with visual acuity.

Main Outcome Measures

Visual acuity before cataract surgery was assessed using logarithm of minimum angle of resolution values. Race, ethnicity, and ADI were the main exposures of interest.

Results

At JHH, 11 509 patients (17 731 eyes) were included, whereas KP included 7143 patients (10 542 eyes). After adjusting for covariates, Black patients (β = 0.49), Asian patients (β = 0.83), and Hispanic patients (β = 0.95) were more likely to have worse visual acuity at JHH (P < 0.001 for all) compared with White patients. Similarly, at KP, Black patients (β = 0.56), Asian patients (β = 0.70), and Hispanic patients (β = 0.89) were more likely to have worse visual acuity (P < 0.001 for all) compared with White patients. Compared with those living in the least disadvantaged neighborhoods at JHH, higher ADI quartiles (more deprived) were more likely to have worse visual acuity (β = 0.27 [P < 0.001] for quartile 2; β = 0.40 [P = 0.001] for quartile 3; β = 0.95 [P < 0.001] for quartile 4). No significant association was found between ADI and VI at KP.

Conclusions

Among older adults, non-White race or ethnicity was associated independently with VI secondary to cataracts in 2 large health systems in the United States Mid-Atlantic region, after adjustment for ADI. Area deprivation also was associated with VI but only in the JHH system. Our study suggests that non-White patients and those with lower SES are at greater risk of VI secondary to cataracts possibly because of social, structural, and institutional barriers.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:比较美国大西洋中部地区两个大型医疗系统中种族/民族和社会经济地位(SES)与白内障手术切除前视力损伤(VI)的关系:设计:多机构横断面数据研究:2017年1月1日至2019年12月31日期间在约翰霍普金斯医院(JHH)和凯撒医疗集团(KP)接受白内障手术的65岁及以上患者:协变量包括患者年龄、性别、吸烟状况、手术侧位、Charlson合并症指数(CCI)和眼部合并症。采用多变量广义估计方程模型研究种族/民族和地区贫困指数(ADI)与视力的关系:白内障手术前的视力使用最小分辨角度对数(logMAR)进行评估。种族/民族和 ADI 是主要的研究对象:JHH共纳入11509名患者(17731只眼),而KP共纳入7143名患者(10542只眼)。调整协变量后,与白人患者相比,黑人患者(β,0.49)、亚裔患者(β,0.83)和西班牙裔患者(β,0.95)在 JHH 更有可能因白内障而导致视力下降(P < 0.001)。同样,与白人患者相比,黑人患者(β,0.56)、亚裔患者(β,0.70)和西班牙裔患者(β,0.89)的视力更差(P < 0.001)。与居住在 JHH 最贫困社区(ADI 四分位数 [Q] 1)的患者相比,ADI 四分位数越高(越贫困)的患者视力越差(β,0.27;Q2,P = 0.001;β,0.40;Q3,P = 0.001;β,0.95;Q4,P < 0.001)。在 KP 发现,ADI 与继发于白内障的 VI 之间没有明显关联:结论:在美国大西洋中部地区的两个大型医疗系统中,在调整 ADI 后,老年人中的非白人种族/族裔与继发性白内障 VI 有独立关联。地区贫困也与白内障相关,但仅限于 JHH 系统。我们的研究表明,非白人患者和社会经济地位较低的患者因白内障而继发视力丧失的风险更大,这可能是由于社会、结构和体制障碍造成的。
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引用次数: 0
Optic Disc Melanocytoma: Apparent Shrinkage after Posterior Vitreous Detachment 视盘黑色素细胞瘤:玻璃体后脱离后明显缩小。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.01.021
Michael Balas BHSc , Mark Mandell MD, FRCSC , Parnian Arjmand MD, FRCSC
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引用次数: 0
Re: Potter et al.: Concordance between self-reported visual difficulty and objective visual impairment: The National Health and Aging Trends Study (Ophthalmology. 2024;131:1447-1456) Re:波特等人自我报告的视觉困难与客观视觉损伤之间的一致性:国家健康与老龄化趋势研究》(Ophthalmology.2024 Jun 12:S0161-6420(24)00363-4.doi: 10.1016/j.ophtha.2024.06.009.Online ahead of print.)。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ophtha.2024.09.018
Yating Zhou MD, Fei Xue MD
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引用次数: 0
期刊
Ophthalmology
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