Ophthalmology最新文献

Objective: Achieving near normal vision following unilateral congenital cataract surgery is possible but requires early surgery, optical correction and consistent patching. Patching is often challenging for children and their caregivers. The goal of these analyses is to examine the association between reported consistency in patching during the first year after surgery and visual acuity.

Design: Data from the Infant Aphakia Treatment Study (IATS) are used in a cohort design.

Participants: 101 children whose caregivers completed a prospective, 7-day patching diary two months after surgery or at 13 months of age.

Methods: Consistent patching was defined as patching every day, and either an average patch start time before 9:00 am, or the interquartile range of the first time a patch was applied of 60 minutes or less.

Main outcome measures: Recognition visual acuity was assessed at ages 54 + 1 months and 10½ years. Near normal visual acuity was defined as visual acuity of 20/40 or better.

Results: Diary data were available for 101 children. Overall, 55% of children whose caregivers reported consistent patching at age 13 months had near normal vision at age 54+1 months and 45% had near normal vision at age 10.5 years compared to 14% and 18%, respectively, when caregivers reported less consistent patching (Relative risk 54 months of age 3.55, 95% CI 1.61,7.80; RR at 10.5 years of age 2.31, 95% CI 1.12,4.78).

Conclusion: Consistent patching in the first year following surgery for unilateral congenital cataract is associated with better visual acuity. These findings can be used to provide evidence-based guidance to caregivers to help improve visual acuity outcomes for their children.

Purpose: To investigate the association between epigenetic age acceleration and glaucoma progression.

Design: Retrospective cohort study.

Participants: 100 primary open-angle glaucoma (POAG) patients with fast progression and 100 POAG patients with slow progression.

Methods: Subjects were classified as fast or slow progressors based on rates of change in standard automated perimetry (SAP) mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness. Epigenetic age was calculated using the Horvath, Hannum, PhenoAge, and GrimAge clocks from DNA methylation profiles obtained from blood samples. Age acceleration (AgeAccel) was defined as the residual from a linear regression of epigenetic age on chronologic age, with positive values suggesting faster biological aging. Multivariable logistic regression models estimated the association between AgeAccel and likelihood of fast progression, adjusting for confounders.

Main outcome measures: Difference in epigenetic age acceleration between fast and slow glaucoma progressors.

Results: The mean rate of SAP MD change in the fastest progressing eye was -1.06 dB/year (95% CI: -1.28 to -0.85) for fast progressors compared to -0.10 dB/year (95% CI: -0.16 to -0.04) for slow progressors (P<0.001). For RNFL thickness, corresponding values were -1.60 μm/year (95% CI: -1.97 to -1.23) and -0.76 μm/year (95% CI: -1.04 to -0.48), respectively (P<0.001). Fast progressors demonstrated significantly greater age acceleration compared to slow progressors for the Horvath clock (mean difference = 2.93 years, 95% CI: 1.48 to 4.39, P<0.001) and Hannum clock (mean difference = 1.24 years, 95% CI: 0.03 to 2.46, P=0.045). In multivariable models, each year of Horvath AgeAccel was associated with 15% higher odds of fast progression (OR 1.15, 95% CI 1.07-1.23, P<0.001), after adjusting for sex, race, intraocular pressure, central corneal thickness, baseline disease severity, smoking status and follow-up time. Hannum and GrimAge clocks also showed significant associations with fast progression. The association between AgeAccel and fast progression was stronger in subjects with relatively low IOP during follow-up.

Conclusion: Accelerated epigenetic aging was associated with faster glaucoma progression. These findings suggest that faster biological age, as reflected in DNA methylation, may increase optic nerve susceptibility to damage, highlighting epigenetic age as a potential prognostic biomarker.