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Comparative Effects of GLP-1 Receptor Agonists and Metformin on Glaucoma Risk in Type 2 Diabetes Patients. GLP-1 受体激动剂和二甲双胍对 2 型糖尿病患者青光眼风险影响的比较。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-23 DOI: 10.1016/j.ophtha.2024.08.023
Jawad Muayad, Asad Loya, Zain S Hussain, Muhammad Z Chauhan, Amer F Alsoudi, Ticiana De Francesco, Iqbal Ike K Ahmed

Purpose: To compare effects of glucagon-like peptide-1 (GLP-1) receptor agonists and metformin on the risk of primary open-angle glaucoma (POAG), ocular hypertension, and the need for first-line glaucoma treatments in patients with type 2 diabetes.

Design: A retrospective cohort study was conducted using electronic medical records (EMR) data from the from an international electronic health record network, covering a period from May 2006 to May 2024.

Participants: Patients diagnosed with type 2 diabetes mellitus (T2DM) who were treated with either GLP-1 receptor agonists or metformin.

Methods: Data from 120 healthcare organizations across 17 countries were analyzed. Patient outcomes were assessed at 1, 2, and 3 years. Propensity score matching (PSM) was used to balance covariates such as demographics, comorbidities, and medication usage. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.

Main outcome measures: Incidence of POAG, ocular hypertension, and the need for first-line treatments including beta-blockers, prostaglandin analogues, brimonidine, brinzolamide, dorzolamide, netarsudil, and laser trabeculoplasty.

Results: After PSM, both groups included 61,998 patients at the 1-year follow-up, 27,414 at the 2-year follow-up, and 14,100 at the 3-year follow-up. Patients treated with GLP-1 receptor agonists had a significantly decreased risk of developing POAG compared to those on metformin at 1 year (RR 0.59, 95% CI 0.39-0.88), 2 years (RR 0.50, 95% CI 0.32-0.78), and 3 years (RR 0.59, 95% CI 0.37-0.94). Similar protective effects were observed for ocular hypertension with risk reductions of 56% at 1 year (RR 0.44, 95% CI 0.31-0.62), 57% at 2 years (RR 0.43, 95% CI 0.30-0.62), and 49% at 3 years (RR 0.51, 95% CI 0.34-0.75). The risk of first-line therapy initiation was also lower in the GLP-1 receptor agonists group at 1 year (RR 0.63, 95% CI 0.53-0.74), 2 years (RR 0.71, 95% CI 0.59-0.85), and 3 years (RR 0.75, 95% CI 0.62-0.91).

Conclusions: GLP-1 receptor agonists are associated with a significantly lower incidence of POAG, ocular hypertension, and the need for first-line glaucoma treatments compared to metformin in patients with type 2 diabetes. These findings highlight the potential ocular benefits of GLP-1 receptor agonists and their expanding role in the clinical management of diabetic patients.

目的:比较胰高血糖素样肽-1(GLP-1)受体激动剂和二甲双胍对2型糖尿病患者原发性开角型青光眼(POAG)、眼压过高和青光眼一线治疗需求的影响:设计:利用国际电子病历网络的电子病历(EMR)数据开展了一项回顾性队列研究,研究时间跨度为 2006 年 5 月至 2024 年 5 月:被诊断为 2 型糖尿病(T2DM)并接受 GLP-1 受体激动剂或二甲双胍治疗的患者:分析了来自 17 个国家 120 家医疗机构的数据。方法:分析了来自 17 个国家 120 家医疗机构的数据,评估了患者 1 年、2 年和 3 年的疗效。采用倾向评分匹配法(PSM)平衡人口统计学、合并症和用药情况等协变量。计算风险比(RR)及 95% 置信区间(CI):POAG、眼压升高的发生率以及一线治疗的需求,包括β-受体阻滞剂、前列腺素类似物、溴莫尼定、布林佐胺、多佐胺、奈达唑地尔和激光小梁成形术:经过 PSM 治疗后,两组患者中分别有 61 998 人接受了为期 1 年的随访,27 414 人接受了为期 2 年的随访,14 100 人接受了为期 3 年的随访。与服用二甲双胍的患者相比,接受 GLP-1 受体激动剂治疗的患者在 1 年(RR 0.59,95% CI 0.39-0.88)、2 年(RR 0.50,95% CI 0.32-0.78)和 3 年(RR 0.59,95% CI 0.37-0.94)时罹患 POAG 的风险显著降低。在眼压方面也观察到了类似的保护作用,1 年时风险降低 56%(RR 0.44,95% CI 0.31-0.62),2 年时降低 57%(RR 0.43,95% CI 0.30-0.62),3 年时降低 49%(RR 0.51,95% CI 0.34-0.75)。GLP-1受体激动剂组在1年(RR 0.63,95% CI 0.53-0.74)、2年(RR 0.71,95% CI 0.59-0.85)和3年(RR 0.75,95% CI 0.62-0.91)时开始一线治疗的风险也较低:结论:与二甲双胍相比,GLP-1 受体激动剂可显著降低 2 型糖尿病患者的 POAG、眼压升高和青光眼一线治疗需求。这些发现凸显了 GLP-1 受体激动剂对眼部的潜在益处,以及它们在糖尿病患者临床治疗中不断扩大的作用。
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引用次数: 0
En Breve 书信
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-20 DOI: 10.1016/j.ophtha.2024.07.006
Sandeep Ravindran PhD
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引用次数: 0
This Issue at a Glance 本期概览
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-20 DOI: 10.1016/j.ophtha.2024.07.001
Sandeep Ravindran PhD
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引用次数: 0
Issue at a Glance 问题概览
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-20 DOI: 10.1016/j.ophtha.2024.07.012
Sandeep Ravindran PhD
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引用次数: 0
Radiologic Predictors of Visual Outcome in Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis. 髓鞘少突胶质细胞糖蛋白相关性视神经炎视力预后的放射学预测因素。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-14 DOI: 10.1016/j.ophtha.2024.08.018
Armin Handzic, Jim Shenchu Xie, Nanthaya Tisavipat, Roisin Maire O'Cearbhaill, Deena A Tajfirouz, Kevin D Chodnicki, Eoin P Flanagan, John J Chen, Jonathan Micieli, Edward Margolin
<p><strong>Purpose: </strong>This study aimed to determine whether magnetic resonance imaging (MRI) biomarkers are associated with visual prognosis in myelin oligodendrocyte protein (MOG)-associated optic neuritis (ON).</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Participants: </strong>Patients meeting 2023 international diagnostic criteria for MOG antibody-associated disease who were seen for first episodes of MOG-associated ON at 3 tertiary neuro-ophthalmology practices between January 2017 and July 2023 were enrolled. Patients who received < 3 months of neuro-ophthalmic follow-up and did not demonstrate visual recovery (visual acuity [VA] ≥ 20/20 and visual field mean deviation [VFMD] > -5.0 dB) during this time were excluded.</p><p><strong>Methods: </strong>Patients underwent contrast-enhanced, fat-suppressed MRI of the brain and orbits within 1 month of symptom onset.</p><p><strong>Main outcome measures: </strong>The associations between radiologic biomarkers and poor VA outcome (< 20/40), incomplete VA recovery (< 20/20), and poor VFMD outcome (VFMD < -5.0 dB) were assessed using multivariable logistic regression adjusting for time from symptom onset to treatment and nadir VA or VFMD. Radiologic biomarkers included length of optic nerve enhancement (> 25% vs. < 25%; > 50% vs. < 50%; and > 75% vs. < 75%); degree of orbital, canalicular, and intracranial or chiasmal optic nerve enhancement (mild vs. moderate to severe compared with the lacrimal gland); and absence versus presence of optic nerve sheath enhancement on baseline T1-weighted MRI.</p><p><strong>Results: </strong>A total of 129 eyes of 92 patients (median age, 37.0 years [interquartile range, 20.8-51.3 years]; 65.2% female) were included. Poor VA outcome was seen in 6.2% of patients, incomplete VA recovery was seen in 19.4% of patients, and poor VFMD outcome was seen in 16.9% of patients. Compared with eyes with moderate to severe enhancement, eyes with mild orbital optic nerve enhancement were more likely to have poor VA outcome (odds ratio [OR], 8.57; 95% confidence interval [CI], 1.85-51.14; P = 0.009), incomplete VA recovery (OR, 7.31, 95% CI, 2.42-25.47; P = 0.001), and poor VFMD outcome (adjusting for time to treatment: OR, 6.81; 95% CI, 1.85-28.98; P = 0.005; adjusting for nadir VFMD: OR, 11.65; 95% CI, 1.60-240.09; P = 0.04). Lack of optic nerve sheath enhancement additionally was associated with incomplete VA recovery (OR, 3.86; 95% CI, 1.19-12.85; P = 0.02) compared with the presence of enhancement. These associations remained consistent in subgroup logistic regression analysis of MRIs performed before initiation of treatment but were not seen in pairwise analysis of MRIs performed after treatment.</p><p><strong>Conclusions: </strong>In eyes with first MOG-associated ON episodes, milder enhancement in the orbital optic nerve was associated with poorer VA and visual field recovery. Prospective and mechanistic studies are needed to confirm the prog
研究目的本研究旨在确定磁共振成像(MRI)生物标志物是否与髓鞘少突胶质细胞蛋白(MOG)相关性视神经炎(MOG-ON)的视觉预后相关:设计:横断面分析:2017年1月至2023年7月期间在三家三级神经眼科诊所就诊的符合2023年国际MOG抗体相关疾病诊断标准的首次发作MOG-ON患者入选。排除接受神经眼科随访少于3个月且在此期间未显示视力恢复(视力[VA]≥20/20且视野平均偏差[VFMD]>-5.0 dB)的患者:方法:患者在症状出现后一个月内接受对比增强、脂肪抑制的脑部和眼眶 MRI 检查:主要结果测量:放射学生物标志物与不良视力评估结果之间的关联(结果:92 例患者的 129 只眼睛接受了核磁共振成像:共纳入92名患者的129只眼睛(中位数[IQR]年龄为37.0 [20.8-51.3],65.2%为女性)。6.2%的病例视力结果不佳,19.4%的病例视力未完全恢复,16.9%的病例VFMD结果不佳。与中度-重度强化的眼睛相比,轻度眼眶视神经强化的眼睛更容易出现视力不良(OR 8.57;95% CI [1.85,51.14],P=0.009)、视力不完全恢复(OR 7.31,95% CI [2.42,25.47],P=0.001)和 VFMD 不良(根据治疗时间调整:调整治疗时间:OR 6.81,95% CI [1.85,28.98],P=0.005;调整最低 VFMD:OR 11.65,95% CI [1.60,240.09],P=0.04)。与存在视神经鞘强化相比,视神经鞘无强化与视力恢复不完全也有关系(OR 3.86,95% CI [1.19,12.85],P=0.02)。在对开始治疗前进行的磁共振成像进行的亚组逻辑回归分析中,这些相关性保持一致,但在对治疗后进行的磁共振成像进行的配对分析中则未发现这些相关性:结论:在首次MOG-ON发作的患者中,眼眶视神经的轻度强化与较差的VA和VF恢复有关。需要进行前瞻性和机理研究,以确定 MRI 在 MOG-ON 中的预后作用。
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引用次数: 0
Disease Activity and Therapeutic Response to Pegcetacoplan for Geographic Atrophy Identified by Deep Learning-Based Analysis of OCT. 通过基于深度学习的光学视网膜成像(OCT)分析,确定治疗地理性萎缩的疾病活动和对培高康的治疗反应。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-14 DOI: 10.1016/j.ophtha.2024.08.017
Ursula Schmidt-Erfurth, Julia Mai, Gregor S Reiter, Sophie Riedl, Wolf-Dieter Vogl, Amir Sadeghipour, Alex McKeown, Emma Foos, Lukas Scheibler, Hrvoje Bogunovic

Purpose: To quantify morphological changes of the photoreceptors (PRs) and retinal pigment epithelium (RPE) layers under pegcetacoplan therapy in geographic atrophy (GA) using deep learning-based analysis of OCT images.

Design: Post hoc longitudinal image analysis.

Participants: Patients with GA due to age-related macular degeneration from 2 prospective randomized phase III clinical trials (OAKS and DERBY).

Methods: Deep learning-based segmentation of RPE loss and PR degeneration, defined as loss of the ellipsoid zone (EZ) layer on OCT, over 24 months.

Main outcome measures: Change in the mean area of RPE loss and EZ loss over time in the pooled sham arms and the pegcetacoplan monthly (PM)/pegcetacoplan every other month (PEOM) treatment arms.

Results: A total of 897 eyes of 897 patients were included. There was a therapeutic reduction of RPE loss growth by 22% and 20% in OAKS and 27% and 21% in DERBY for PM and PEOM compared with sham, respectively, at 24 months. The reduction on the EZ level was significantly higher with 53% and 46% in OAKS and 47% and 46% in DERBY for PM and PEOM compared with sham at 24 months. The baseline EZ-RPE difference had an impact on disease activity and therapeutic response. The therapeutic benefit for RPE loss increased with larger EZ-RPE difference quartiles from 21.9%, 23.1%, and 23.9% to 33.6% for PM versus sham (all P < 0.01) and from 13.6% (P = 0.11), 23.8%, and 23.8% to 20.0% for PEOM versus sham (P < 0.01) in quartiles 1, 2, 3, and 4, respectively, at 24 months. The therapeutic reduction of EZ loss increased from 14.8% (P = 0.09), 33.3%, and 46.6% to 77.8% (P < 0.0001) between PM and sham and from 15.9% (P = 0.08), 33.8%, and 52.0% to 64.9% (P < 0.0001) between PEOM and sham for quartiles 1 to 4 at 24 months.

Conclusions: Deep learning-based OCT analysis objectively identifies and quantifies PR and RPE degeneration in GA. Reductions in further EZ loss on OCT are even higher than the effect on RPE loss in phase 3 trials of pegcetacoplan treatment. The EZ-RPE difference has a strong impact on disease progression and therapeutic response. Identification of patients with higher EZ-RPE loss difference may become an important criterion for the management of GA secondary to AMD.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

目的:利用基于深度学习的光学相干断层扫描(OCT)图像分析方法,量化地理萎缩(GA)患者在培高康治疗下感光器(PR)和视网膜色素上皮(RPE)层的形态学变化:事后纵向图像分析:方法:基于深度学习对 SD-OCT 图像上 24 个月的 RPE 损失和 PR 退化(定义为 OCT 上椭圆形区 (EZ) 层的损失)进行分割:假治疗组和每月(PM)/每隔一个月(PEOM)治疗组的 RPE 和 EZ 平均损失面积随时间的变化 结果:共纳入了 897 名患者的 897 只眼睛。24 个月时,与假性治疗相比,OAKS 和 DERBY 的 PM/PEOM 治疗分别减少了 22%/20% 和 27%/21% 的 RPE 损耗增长。在24个月时,与假性疗法相比,OAKS和DERBY治疗PM/PEOM的EZ水平下降幅度分别为53%/46%和47%/46%。基线 EZ-RPE 差异对疾病活动性和治疗反应有影响。PM 与假体相比,随着 EZ-RPE 差异四分位数从 21.9%、23.1%、23.9% 到 33.6%(所有 pConclusion)的增大,RPE 损失增长的治疗获益也随之增加:基于 OCT 的 AI 分析客观地识别和量化了 GA 中的 PR 和 RPE 退化。OCT 上与 EZ 损失一致的 PR 退化的进一步减少甚至高于培加氯铵治疗 3 期试验中对 RPE 损失的影响。EZ-RPE 差异对疾病进展和治疗反应有很大影响。识别 EZ-RPE 损失差异较高的患者可能成为治疗继发于 AMD 的 GA 的一个重要标准。
{"title":"Disease Activity and Therapeutic Response to Pegcetacoplan for Geographic Atrophy Identified by Deep Learning-Based Analysis of OCT.","authors":"Ursula Schmidt-Erfurth, Julia Mai, Gregor S Reiter, Sophie Riedl, Wolf-Dieter Vogl, Amir Sadeghipour, Alex McKeown, Emma Foos, Lukas Scheibler, Hrvoje Bogunovic","doi":"10.1016/j.ophtha.2024.08.017","DOIUrl":"10.1016/j.ophtha.2024.08.017","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify morphological changes of the photoreceptors (PRs) and retinal pigment epithelium (RPE) layers under pegcetacoplan therapy in geographic atrophy (GA) using deep learning-based analysis of OCT images.</p><p><strong>Design: </strong>Post hoc longitudinal image analysis.</p><p><strong>Participants: </strong>Patients with GA due to age-related macular degeneration from 2 prospective randomized phase III clinical trials (OAKS and DERBY).</p><p><strong>Methods: </strong>Deep learning-based segmentation of RPE loss and PR degeneration, defined as loss of the ellipsoid zone (EZ) layer on OCT, over 24 months.</p><p><strong>Main outcome measures: </strong>Change in the mean area of RPE loss and EZ loss over time in the pooled sham arms and the pegcetacoplan monthly (PM)/pegcetacoplan every other month (PEOM) treatment arms.</p><p><strong>Results: </strong>A total of 897 eyes of 897 patients were included. There was a therapeutic reduction of RPE loss growth by 22% and 20% in OAKS and 27% and 21% in DERBY for PM and PEOM compared with sham, respectively, at 24 months. The reduction on the EZ level was significantly higher with 53% and 46% in OAKS and 47% and 46% in DERBY for PM and PEOM compared with sham at 24 months. The baseline EZ-RPE difference had an impact on disease activity and therapeutic response. The therapeutic benefit for RPE loss increased with larger EZ-RPE difference quartiles from 21.9%, 23.1%, and 23.9% to 33.6% for PM versus sham (all P < 0.01) and from 13.6% (P = 0.11), 23.8%, and 23.8% to 20.0% for PEOM versus sham (P < 0.01) in quartiles 1, 2, 3, and 4, respectively, at 24 months. The therapeutic reduction of EZ loss increased from 14.8% (P = 0.09), 33.3%, and 46.6% to 77.8% (P < 0.0001) between PM and sham and from 15.9% (P = 0.08), 33.8%, and 52.0% to 64.9% (P < 0.0001) between PEOM and sham for quartiles 1 to 4 at 24 months.</p><p><strong>Conclusions: </strong>Deep learning-based OCT analysis objectively identifies and quantifies PR and RPE degeneration in GA. Reductions in further EZ loss on OCT are even higher than the effect on RPE loss in phase 3 trials of pegcetacoplan treatment. The EZ-RPE difference has a strong impact on disease progression and therapeutic response. Identification of patients with higher EZ-RPE loss difference may become an important criterion for the management of GA secondary to AMD.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found after the references.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":null,"pages":null},"PeriodicalIF":13.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996241","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 Clinical Usefulness of a Glaucoma Polygenic Risk Score in 4 Population-Based European Ancestry Cohorts. 青光眼多基因风险评分在四个欧洲裔人群队列中的临床实用性。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-14 DOI: 10.1016/j.ophtha.2024.08.005
Victor A de Vries, Akiko Hanyuda, Joëlle E Vergroesen, Ron Do, David S Friedman, Peter Kraft, Constance Turman, Yuyang Leo Luo, Jessica H Tran, Bart Liefers, Sze H Wong, Rachel H Lee, Nazlee Zebardast, Caroline C W Klaver, Ayellet V Segrè, Louis R Pasquale, Janey L Wiggs, Jae H Kang, Wishal D Ramdas

Purpose: We used a polygenic risk score (PRS) to identify high-risk groups for primary open-angle glaucoma (POAG) within population-based cohorts.

Design: Secondary analysis of 4 prospective population-based studies.

Participants: We included four European-ancestry cohorts: the United States-based Nurses' Health Study, Nurses' Health Study 2, and the Health Professionals Follow-up Study and the Rotterdam Study (RS) in The Netherlands. The United States cohorts included female nurses and male health professionals ≤ 55 years of age. The RS included residents ≤ 45 years of age living in Rotterdam, The Netherlands.

Methods: Polygenic risk score weights were estimated by applying the lassosum method on imputed genotype and phenotype data from the UK Biobank. This resulted in 144 020 variants, single nucleotide polymorphism and insertions or deletions, with nonzero βs that we used to calculate a PRS in the target populations. Using multivariable Cox proportional hazard models, we estimated the relationship between the standardized PRS and relative risk for POAG. Additionally, POAG prediction was tested by calculating these models' concordance (Harrell's C statistic). Finally, we assessed the association between PRS tertiles and glaucoma-related traits.

Main outcome measures: The relative risk for POAG and Harrell's C statistic.

Results: Among 1046 patients and 38 809‬ control participants, the relative risk (95% confidence interval) for POAG for participants in the highest PRS quintile was 3.99 (3.08-5.18) times higher in the United States cohorts and 4.89 (2.93-8.17) times higher in the RS, compared with participants with median genetic risk (third quintile). Combining age, sex, intraocular pressure of more than 25 mmHg, and family history resulted in a meta-analyzed concordance of 0.75 (95% CI, 0.73-0.75). Adding the PRS to this model improved the concordance to 0.82 (95% CI, 0.80-0.84). In a meta-analysis of all cohorts, patients in the highest tertile showed a larger cup-to-disc ratio at diagnosis, by 0.10 (95% CI, 0.06 0.14), and a 2.07-fold increased risk of requiring glaucoma surgery (95% CI, 1.19-3.60).

Conclusions: Incorporating a PRS into a POAG predictive model improves identification concordance from 0.75 up to 0.82, supporting its potential for guiding more cost-effective screening strategies.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:我们使用多基因风险评分(PRS)在人群队列中识别原发性开角型青光眼(POAG)的高风险群体:我们使用多基因风险评分(PRS)在基于人群的队列中识别原发性开角型青光眼(POAG)的高风险人群:设计:对四项前瞻性人群研究进行二次分析:我们纳入了四项欧洲人群队列研究:基于美国的护士健康研究(NHS)、NHS2、卫生专业人员随访研究以及荷兰的鹿特丹研究(RS)。美国队列包括 55 岁以上的女护士和男性保健专业人员。RS 包括居住在荷兰鹿特丹的 45 岁或以上的居民:PRS权重是通过对来自英国生物库(UK-Biobank)的估算基因型和表型数据应用Lassosum方法进行估算的。这样就得到了 144,020 个变体,包括单核苷酸多态性(SNP)和嵌合体,我们用这些变体计算目标人群的 PRS,其 Betas 均不为零。我们使用多变量 Cox 比例危险模型估算了标准化 PRS 与 POAG 相对风险之间的关系。此外,我们还通过计算这些模型的一致性(Harrell's C 统计量)对 POAG 预测进行了检验。最后,我们评估了 PRS tertiles 与青光眼相关特征之间的关联:POAG 的相对风险和 Harrell 的 C 统计量(相当于纵向模型的曲线下面积):在 1,046 例病例和 38,809 例对照中,与遗传风险中位数(第 3 个五分位数)的参与者相比,PRS 最高五分位数参与者的 POAG 相对风险(95% 置信区间)在美国队列中为 3.99(3.08,5.18),在鹿特丹研究中为 4.89(2.93,8.17)。在限制性立方样条分析中,连续 PRS 与 POAG 风险之间的关系在美国和鹿特丹队列中呈指数增长(Pspline25 mmHg),家族史导致荟萃分析的一致性为 0.75(0.73,0.75)。将 PRS 加入该模型后,一致性提高到 0.82(0.80,0.84)。在对所有队列进行的荟萃分析中,最高三分位数的病例在确诊时杯盘比值较大,增加了 0.11 (0.07, 0.15),需要进行青光眼手术的风险增加了 2.07 倍 (1.19, 3.60):将 PRS 纳入 POAG 预测模型可将识别一致性从 0.75 提高到 0.82,从而支持其在指导更具成本效益的筛查策略方面的潜力。
{"title":"The Clinical Usefulness of a Glaucoma Polygenic Risk Score in 4 Population-Based European Ancestry Cohorts.","authors":"Victor A de Vries, Akiko Hanyuda, Joëlle E Vergroesen, Ron Do, David S Friedman, Peter Kraft, Constance Turman, Yuyang Leo Luo, Jessica H Tran, Bart Liefers, Sze H Wong, Rachel H Lee, Nazlee Zebardast, Caroline C W Klaver, Ayellet V Segrè, Louis R Pasquale, Janey L Wiggs, Jae H Kang, Wishal D Ramdas","doi":"10.1016/j.ophtha.2024.08.005","DOIUrl":"10.1016/j.ophtha.2024.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>We used a polygenic risk score (PRS) to identify high-risk groups for primary open-angle glaucoma (POAG) within population-based cohorts.</p><p><strong>Design: </strong>Secondary analysis of 4 prospective population-based studies.</p><p><strong>Participants: </strong>We included four European-ancestry cohorts: the United States-based Nurses' Health Study, Nurses' Health Study 2, and the Health Professionals Follow-up Study and the Rotterdam Study (RS) in The Netherlands. The United States cohorts included female nurses and male health professionals ≤ 55 years of age. The RS included residents ≤ 45 years of age living in Rotterdam, The Netherlands.</p><p><strong>Methods: </strong>Polygenic risk score weights were estimated by applying the lassosum method on imputed genotype and phenotype data from the UK Biobank. This resulted in 144 020 variants, single nucleotide polymorphism and insertions or deletions, with nonzero βs that we used to calculate a PRS in the target populations. Using multivariable Cox proportional hazard models, we estimated the relationship between the standardized PRS and relative risk for POAG. Additionally, POAG prediction was tested by calculating these models' concordance (Harrell's C statistic). Finally, we assessed the association between PRS tertiles and glaucoma-related traits.</p><p><strong>Main outcome measures: </strong>The relative risk for POAG and Harrell's C statistic.</p><p><strong>Results: </strong>Among 1046 patients and 38 809‬ control participants, the relative risk (95% confidence interval) for POAG for participants in the highest PRS quintile was 3.99 (3.08-5.18) times higher in the United States cohorts and 4.89 (2.93-8.17) times higher in the RS, compared with participants with median genetic risk (third quintile). Combining age, sex, intraocular pressure of more than 25 mmHg, and family history resulted in a meta-analyzed concordance of 0.75 (95% CI, 0.73-0.75). Adding the PRS to this model improved the concordance to 0.82 (95% CI, 0.80-0.84). In a meta-analysis of all cohorts, patients in the highest tertile showed a larger cup-to-disc ratio at diagnosis, by 0.10 (95% CI, 0.06 0.14), and a 2.07-fold increased risk of requiring glaucoma surgery (95% CI, 1.19-3.60).</p><p><strong>Conclusions: </strong>Incorporating a PRS into a POAG predictive model improves identification concordance from 0.75 up to 0.82, supporting its potential for guiding more cost-effective screening strategies.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":null,"pages":null},"PeriodicalIF":13.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917276","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
A 1-Year-Old Child with Peripheral T-cell Lymphoma of the Orbit. 一名患有眼眶周围 T 细胞淋巴瘤的 1 岁儿童。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-13 DOI: 10.1016/j.ophtha.2024.07.017
Jiaqi Guan, Ye Jiang, Huasheng Yang
{"title":"A 1-Year-Old Child with Peripheral T-cell Lymphoma of the Orbit.","authors":"Jiaqi Guan, Ye Jiang, Huasheng Yang","doi":"10.1016/j.ophtha.2024.07.017","DOIUrl":"https://doi.org/10.1016/j.ophtha.2024.07.017","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":null,"pages":null},"PeriodicalIF":13.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976288","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
Facedown Positioning in Macular Hole Surgery: A Systematic Review and Individual Participant Data Meta-Analysis. 黄斑孔手术中的面朝下体位:系统回顾与个体参与者数据元分析
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-13 DOI: 10.1016/j.ophtha.2024.08.012
Raffaele Raimondi, Nikolaos Tzoumas, Steven Toh, Gurkaran S Sarohia, Mark R Phillips, Varun Chaudhary, David H Steel

Topic: To assess the anatomic and visual effects of facedown positioning (FDP) advice in patients undergoing vitrectomy with gas tamponade for idiopathic full-thickness macular holes (FTMHs) and to explore differential treatment effects by macular hole size and FDP duration.

Clinical relevance: The necessity and duration of FDP for FTMH closure remain contentious, with no consensus guidelines.

Methods: Prospectively registered systematic review and individual patient data (IPD) meta-analysis of randomized controlled trials comparing FDP with no FDP (nFDP) across the MEDLINE, Embase, and Cochrane Library databases and clinical trial registries from January 2000 to March 2023 (CRD42023395152). All adults with idiopathic FTMHs undergoing vitrectomy with gas tamponade were included. The main outcomes were primary macular hole closure and postoperative visual acuity at 6 months or nearest time point.

Results: Of 8 eligible trials, 5 contributed IPD for 379 eyes and were included in our analysis. The adjusted odds ratio (OR) for primary closure with FDP versus nFDP was 2.41 (95% confidence interval [CI], 0.98-5.93, P = 0.06; low-certainty evidence), translating to a risk ratio (RR) of 1.08 (1.00-1.11) and a number needed to treat (NNT) of 15. The FDP group exhibited a mean improvement in postoperative visual acuity of -0.08 logarithm of the minimum angle of resolution (logMAR) (-0.13 to -0.02, P = 0.006; low-certainty evidence) compared with the nFDP group. Benefits were more certain in participants with larger holes of minimum linear diameter ≥ 400 μm: adjusted OR for closure ranged from 1.13 to 10.12 (P = 0.030) (NNT 12), with a mean visual acuity improvement of -0.18 to -0.01 logMAR (P = 0.022). Each additional day of FDP was associated with improved odds of anatomic success (adjusted OR, 1.02-1.41, RR, 1.00-1.02, P = 0.026) and visual acuity improvement (-0.02 logMAR, -0.03 to -0.01, P = 0.002), possibly plateauing at 3 days.

Conclusions: This study provides low-certainty evidence that FDP improves the anatomic and visual outcomes of macular hole surgery modestly and indicates that the effect may be more substantial for macular holes exceeding 400 μm. The findings support recommending FDP for patients with macular holes exceeding 400 μm pending further investigation.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

主题目的:评估对特发性全厚黄斑孔(FTMHs)接受玻璃体切除术并进行气体填塞的患者进行面朝下定位(FDP)建议的解剖学和视觉效果,并探讨黄斑孔大小和FDP持续时间对治疗效果的不同影响:临床相关性:FTMH闭合时FDP的必要性和持续时间仍存在争议,目前尚无一致的指导原则:方法:2000年1月至2023年3月期间,在MEDLINE、Embase和Cochrane图书馆数据库以及临床试验登记处(CRD42023395152)对比较FDP与无FDP(nFDP)的随机对照试验进行前瞻性系统回顾和个体患者数据(IPD)荟萃分析。所有接受玻璃体切除术和气体填塞术的特发性 FTMH 成人患者均被纳入研究范围。主要结果是原发性黄斑孔闭合和术后6个月或最近时间点的视力:在 8 项符合条件的试验中,有 5 项提供了 379 只眼睛的 IPD,并纳入了我们的分析。FDP 与 nFDP 相比,一次闭合的调整后比值比 (OR) 为 2.41(95% CI 0.98 至 5.93,P = 0.06)[GRADE:低],即相对风险 (RR) 为 1.08(1.00 至 1.11),治疗需要量 (NNT) 为 15。与 nFDP 组相比,FDP 组的术后视力平均提高了-0.08 logMAR(-0.13 至-0.02,P = 0.006)[GRADE:低]。对于最小线性直径≥ 400 μm的较大眼洞患者,其获益更为确定:调整后的闭合OR值从1.13到10.12不等(P = 0.030)(NNT 12),平均视力改善幅度为-0.18到-0.01 logMAR(P = 0.022)。FDP每增加一天,解剖成功的几率(调整后 OR 1.02 至 1.41,RR 1.00 至 1.02,P = 0.026)和视力改善的几率(-0.02 logMAR,-0.03 至 -0.01,P = 0.002)都会增加,可能在 3 天时达到峰值:本研究提供的低确定性证据表明,FDP 能适度改善黄斑孔手术的解剖和视力效果,并表明对超过 400 μm 的黄斑孔的效果可能更显著。研究结果支持建议对黄斑孔超过 400 μm 的患者进行 FDP,但有待进一步研究。
{"title":"Facedown Positioning in Macular Hole Surgery: A Systematic Review and Individual Participant Data Meta-Analysis.","authors":"Raffaele Raimondi, Nikolaos Tzoumas, Steven Toh, Gurkaran S Sarohia, Mark R Phillips, Varun Chaudhary, David H Steel","doi":"10.1016/j.ophtha.2024.08.012","DOIUrl":"10.1016/j.ophtha.2024.08.012","url":null,"abstract":"<p><strong>Topic: </strong>To assess the anatomic and visual effects of facedown positioning (FDP) advice in patients undergoing vitrectomy with gas tamponade for idiopathic full-thickness macular holes (FTMHs) and to explore differential treatment effects by macular hole size and FDP duration.</p><p><strong>Clinical relevance: </strong>The necessity and duration of FDP for FTMH closure remain contentious, with no consensus guidelines.</p><p><strong>Methods: </strong>Prospectively registered systematic review and individual patient data (IPD) meta-analysis of randomized controlled trials comparing FDP with no FDP (nFDP) across the MEDLINE, Embase, and Cochrane Library databases and clinical trial registries from January 2000 to March 2023 (CRD42023395152). All adults with idiopathic FTMHs undergoing vitrectomy with gas tamponade were included. The main outcomes were primary macular hole closure and postoperative visual acuity at 6 months or nearest time point.</p><p><strong>Results: </strong>Of 8 eligible trials, 5 contributed IPD for 379 eyes and were included in our analysis. The adjusted odds ratio (OR) for primary closure with FDP versus nFDP was 2.41 (95% confidence interval [CI], 0.98-5.93, P = 0.06; low-certainty evidence), translating to a risk ratio (RR) of 1.08 (1.00-1.11) and a number needed to treat (NNT) of 15. The FDP group exhibited a mean improvement in postoperative visual acuity of -0.08 logarithm of the minimum angle of resolution (logMAR) (-0.13 to -0.02, P = 0.006; low-certainty evidence) compared with the nFDP group. Benefits were more certain in participants with larger holes of minimum linear diameter ≥ 400 μm: adjusted OR for closure ranged from 1.13 to 10.12 (P = 0.030) (NNT 12), with a mean visual acuity improvement of -0.18 to -0.01 logMAR (P = 0.022). Each additional day of FDP was associated with improved odds of anatomic success (adjusted OR, 1.02-1.41, RR, 1.00-1.02, P = 0.026) and visual acuity improvement (-0.02 logMAR, -0.03 to -0.01, P = 0.002), possibly plateauing at 3 days.</p><p><strong>Conclusions: </strong>This study provides low-certainty evidence that FDP improves the anatomic and visual outcomes of macular hole surgery modestly and indicates that the effect may be more substantial for macular holes exceeding 400 μm. The findings support recommending FDP for patients with macular holes exceeding 400 μm pending further investigation.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found after the references.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":null,"pages":null},"PeriodicalIF":13.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988426","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
Ultrawidefield Swept-Source OCT Angiography of Retinopathy of Prematurity. 早产儿视网膜病变的超宽视场扫源 OCT 血管造影。
IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-08-12 DOI: 10.1016/j.ophtha.2024.07.023
Ioanna Ploumi, Nimesh A Patel, John B Miller
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Ophthalmology
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