Ophthalmology最新文献

Objective: To evaluate the published literature on the efficacy of amniotic membrane grafting (AMG) in the management of acute chemical and thermal ocular surface burns with respect to the rate of corneal re-epithelialization and improvement of visual acuity or corneal clarity.

Methods: Literature searches were conducted in the PubMed database in May 2023 and updated in January 2024 and were limited to the English language without date restrictions. The searches yielded 474 citations; 58 were reviewed in full text, and 9 met the inclusion criteria. Four studies were rated level II, and 5 studies were rated level III. This assessment focuses on 3 level II articles that provided consistent primary and secondary outcomes but demonstrated suboptimal study design with respect to power calculations and lacked a priori sample-size calculations.

Results: Amniotic membrane grafting significantly improved corneal re-epithelialization compared with medical therapy alone in eyes with moderate-grade burns. For severely burned eyes, AMG demonstrated no advantage over medical therapy. Additionally, AMG demonstrated no significant advantage over medical therapy for improved visual acuity or corneal clarity for moderate or severe ocular surface burns.

Conclusions: The best available level II evidence suggests that AMG in the setting of acute ocular surface burns has efficacy in hastening re-epithelialization in moderate burns. As an adjuvant to medical therapy, it did not demonstrate a benefit in improving re-epithelialization in severe burns or visual acuity or corneal clarity in either moderate or severe burns.

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

Purpose: Technology-based Eye Care Services (TECS) is a tele-ophthalmology program operating in the Veterans' Health Administration since 2015. This study explores characteristics of the national TECS population, evaluates implementation and sustainability of TECS, and analyzes possible associations and effects of demographic characteristics and social determinants of health on being diagnosed with a vision-threatening (VT) disease.

Design: Implementation and sustainability of TECS from 2015 to 2022 were examined along with the sociodemographic characteristics of veterans served through TECS in 2021.

Participants: Veteran patients seen in TECS nationwide.

Main outcome measures: Characteristics, disease prevalence and diagnoses, implementation success rate, sustainability rate, and preliminary analysis of outcomes and disparity.

Methods: Per quarter from 2015 to 2022, TECS sites were classified as implementing, active, or sustained. Standard query language was used to determine sociodemographic data, and logistic regression models were used to identify risk factors associated with VT eye diagnosis.

Results: A total of 21 712 Veterans, 52.1% rural or highly rural, were served by TECS in 2021. The average age was 64.7 years, with women comprising 10.9% of the population served. From 2015 to 2022, of the 67 TECS sites initiated, 6 were implementing with 51 of 61 initiated sites still operational in the first quarter (Q1) of 2022 (83.6% success rate). Age-related macular degeneration (AMD) and cataracts were more prevalent in rural and highly rural populations (7.6% and 11.3%, and 48.8% and 55.0%, respectively) versus urban populations (5.8% and 47.8%); glaucoma and diabetic retinopathy (DR) had the opposite association. The prevalence of any type of VT eye disease was lowest in the Mountains/Central region (0.54%) and highest in the Southeast region (3.2%) of the United States. Rural and highly rural residents were 1.3 and 2.5 times as likely, respectively, to be diagnosed with a VT eye disease than urban residents.

Conclusions: Implementation and sustainability of TECS have been promising. The data provide key information that can be used to improve the deployment of TECS and similar programs, along with the possible future direction of TECS. Moreover, experience from one national ocular telehealth program clearly illustrates that telemedicine can address eye care disparities in the Veteran population and may be used for other vulnerable groups as well.

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

Purpose: To evaluate the published literature to compare intraoperative aberrometry (IA) with preoperative biometry-based formulas with respect to intraocular lens (IOL) power calculation accuracy for various clinical scenarios.

Methods: Literature searches in the PubMed database conducted in August 2022, July 2023, and February 2024 identified 157, 18, and 6 citations, respectively. These were reviewed in abstract form, and 61 articles were selected for full-text review. Of these, 29 met the criteria for inclusion in this assessment. The panel methodologists assigned a level of evidence rating to each of the articles; 4 were rated level I, 19 were rated level II, and 6 were rated level III.

Results: Intraoperative aberrometry performed better than traditional vergence formulas, including the Haigis, HofferQ, Holladay, and SRK/T, and similarly to the Barrett Universal II and Hill-RBF with respect to minimization of spherical equivalent (SE) refractive error. For toric IOLs, IA outperformed formulas that only considered anterior corneal astigmatism and was similar to formulas like the Barrett Toric Calculator (BTC), which empirically account for the contribution from the posterior cornea. In eyes with a history of corneal refractive surgery, IA performed similarly to the Barrett True-K and slightly better than other tested methods, including the Haigis-L, Shammas, and Wang-Koch-Maloney formulas.

Conclusions: Intraoperative aberrometry corresponds well with modern vergence formulas, including the Barrett Universal II, Hill-RBF, BTC, and Barrett True-K. It has greater accuracy than traditional vergence-based IOL power calculation formulas in eyes with and without a history of corneal refractive surgery.

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