Ophthalmologica最新文献

Purpose: To evaluate the efficacy and safety of vitrectomy-peeling for idiopathic epiretinal membrane (iERM) in patients with preserved preoperative best corrected visual acuity (BCVA) compared to those with reduced BCVA, and determine the optimal preoperative VA threshold for intervention.

Methods: This single-center retrospective cohort study analyzed 415 eyes from 368 patients who underwent iERM surgery between January 2019 and July 2023. Epidemiological, surgical, and spectral domain-optical coherence tomography (SD-OCT) data were collected preoperatively and at each follow-up visit. Patients were divided into three groups based on preoperative BCVA: poor (≤ 60 Early Treatment Diabetic Retinopathy Study (ETDRS) letters), moderate (61-76 ETDRS), and good (≥ 77 ETDRS). The primary outcome was final BCVA at the last visit, while secondary outcomes included analyzing surgical complications and preoperative predictive factors to develop a predictive model of postoperative BCVA.

Results: Median preoperative BCVA was 75 ETDRS letters (IQR 70-80), improving significantly postoperatively to 80 ETDRS (IQR 75-85) (p<0.001). BCVA improved across all groups: from 60 to 67.5 (IQR 60-77) in the poor group (p<0.001), from 70 to 80 (IQR 75-83.5) in the moderate group (p<0.001), and from 80 to 82 (IQR 80-85) in the good group (p<0.001). The optimal preoperative BCVA threshold was 75 letters, through an iterative process increasing in 5 ETDRS letters increments, with no significant differences in complications between groups (p=0.81).

Conclusion: Patients with good preoperative BCVA achieved better final BCVA. Performing vitrectomy-peeling for idiopathic ERM at BCVA > 75 ETDRS letters leads to optimal visual outcomes without increasing complications.

Introduction: This study aimed to characterize the inflammatory cytokine profile within silicone oil-associated fluid (SOAF) from eyes with complex rhegmatogenous retinal detachment (RRD) treated with silicone oil (SO) tamponade, comparing groups according to tamponade duration. Additionally, we aimed to assess in vitro the emulsification stability of SO in the presence of biological surfactant agents.

Methods: This prospective multicenter study included 65 patients with complex RRD who underwent pars plana vitrectomy (PPV) with SO tamponade, divided into two groups according to tamponade duration (<6 months vs ≥6 months), and 30 control eyes that underwent PPV for epiretinal membrane or full-thickness macular hole without SO. SOAF and undiluted vitreous samples were collected and analyzed for cytokine levels (IL-1α, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, IP-10/CXCL10, IFNγ, TNFα, TGFβ1-3, and MCP-1) using multiplex bead-based immunoassays and ELISA. In vitro emulsification assays were performed using SOs of different viscosities and various biological surfactants.

Results: The inflammatory composite score (mean z-score of log10-transformed IL-6, IL-8, and MCP-1) was significantly higher in RRD eyes than in controls (0.78 [0.35-1.16] vs -0.52 [-0.88-0.01]; p < 0.0001), with no significant differences between tamponade-duration groups (0.82 [0.41-1.24] vs 0.76 [0.33-1.13]; p = 0.62). In SOAF, IL-6, IL-8, MCP-1, and TGF-β isoforms were elevated compared with vitreous controls. In vitro assays showed that stable emulsions formed in the presence of proteins (albumin or cell-culture supernatants), whereas lipidic or vitaminic surfactants produced unstable emulsions.

Conclusion: Eyes with complex RRD exhibit a sustained pro-inflammatory and pro-fibrotic microenvironment within the perisilicone compartment, independent of tamponade duration. Proteins, particularly albumin, appear to act as key biological surfactants linking inflammation to SO emulsification. These findings highlight the need for targeted anti-inflammatory and anti-fibrotic strategies, as well as standardized tools for detecting subclinical emulsification.

Introduction Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure in rhegmatogenous retinal detachment (RRD) and is associated with poor visual prognosis. We aimed to report changes in VFQ-25 and SF-36 tests following surgery for PVR-RRD and identify clinical and demographic factors associated with recovery. Methods This is a post-hoc analysis of a phase IIIb randomised, participant-masked clinical trial evaluating slow-release dexamethasone in PVR-RRD. Patients underwent pars plana vitrectomy with silicone oil tamponade. Vision-related QOL was assessed using VFQ-25, and SF-36 test, at baseline, 6 months, and 12 months postoperatively. VFQ-25 subscales and SF-36 domains were analysed descriptively and with non-parametric paired tests; associations with best-corrected visual acuity (BCVA, logMAR) and other variables were assessed using Spearman correlation and non-parametric tests. Results A total of 139 patients were included (mean age 61 years; 60% male). VFQ-25 total score improved from a median of 65.5 at baseline to 70 at 12 months (p=0.0004). SF-36 total score improved from 68 to 77.5 at 12 months (p=0.006). Worse 12-month BCVA correlated with lower VFQ-25 (p<0.001) and showed a borderline association with SF-36 (p=0.054). In univariable analyses, women reported lower 12-month QOL; however, gender associations were attenuated in multivariable models (VFQ-25: β=-4.39, p=0.073; SF-36: β=-4.71, p=0.199). Retinal anatomical status and number of surgeries were not associated with QOL outcomes. Subscale/domain analyses showed the largest improvements in psychosocial domains: VFQ-25 mental health increased from 50.0 to 68.8 (p=3.35×10⁻⁵), and SF-36 mental health increased from 68.0 to 80.0 (p=2.38×10⁻⁶), while most physical health domains were stable. Conclusions Despite the complexity of PVR-RRD, significant improvements in both visual function and general QOL were observed postoperatively driven largely by psychosocial recovery. Final BCVA and baseline QOL had a greater influence on perceived recovery than anatomical success or number of surgeries. These findings highlight the importance of personalised care and rehabilitation in managing PVR-RRD patients.

Purpose: Describe the design and rationale of the MAGIC (ClinicalTrials.gov identifier, NCT05681884) trial assessing change in retinal non-perfusion (RNP) among eyes with non-proliferative diabetic retinopathy (NPDR) in sham and treated patients.

Design: Phase 2 prospective, randomized, multicenter, open-label, clinical trial.

Participants: Adults with NPDR and substantial RNP (> 5 disc areas) on ultra-widefield fluorescein angiography (UWFA) images.

Methods: Patients will be randomized (1:1) into 1 of 2 arms: Group 1 receiving intravitreal faricimab 6 mg every 4 weeks (Q4W) and Group 2 being observed Q16W. At 48 weeks, Group 1 will receive faricimab Q16W and Group 2 will initiate faricimab Q4W through the final trial endpoint at year 2. The primary endpoint is change in RNP area through week 48. Secondary endpoints include change in RNP area through week 96; percentage of neovascularization, vitreous hemorrhage, DME, and/or PDR development; change in best-corrected visual acuity (BCVA); change in central subfield thickness (CST); contrast sensitivity (CS) measured using the quantitative Contrast Sensitivity Function (qCSF); detection of apoptosing retinal cells (DARC) analysis; and proportion of subjects with ≥ 2-step improvement in Diabetic Retinopathy Severity Score (DRSS). Safety outcomes include incidence and severity of adverse events.

Main outcome measures: Study design rationale.

Results: Recruitment commenced in May 2023 and was completed in May 2024. Group 1 will be dosed Q4W to maximize detection of an impact on RNP progression compared to the untreated Group 2. During year 2, Group 1 will be dosed Q16W to assess for maintenance of any changes in RNP trajectory achieved during year 1. Group 2 will assess the natural history of RNP progression through year 1, then transition to maximal dosing to evaluate for a potential change in trajectory of RNP progression. Additional assessments, including CS and DARC, will address the unmet need for a better understanding of visual dysfunction among patients with NPDR and investigate the potential role of apoptosis in RNP, respectively.

Conclusions: MAGIC is a randomized clinical trial that assesses RNP progression among eyes with NPDR, including its natural history and the impact of faricimab. Its innovative study design also explores the utility of novel assessments of retinal physiology and function.

Introduction: To compare association of anxiety disorder in patients with CSCR and age-gender-matched healthy controls in a prospective study.

Methods: This prospective cross-sectional case-control questionnaire-based survey included participants in the age group of 18 to 55 years, presenting with treatment naïve CSCR, as Group A. Age and gender matched normal controls were included as Group B. For assessment of anxiety, the Hamilton Anxiety Rating Scale (HAM-A) was administered to both groups by a trained study coordinator. The anxiety scores were graded as follows: No/minimal anxiety <7, Mild 8-14, Moderate 15-23, Severe >24. The scoring was assessed using Chi Square / Fischer's exact test.

Results: The study recruited a total of 100 participants in each arm. There was a male preponderance in both groups, with a mean age of 39.61 + 6.07 years in group A and 40.07 + 8.74 years in group B. Amongst those with CSCR 16% had mild anxiety, 46% moderate, 36% had severe and 2% did not have any anxiety, while in the control population 13% had moderate anxiety, and 1 had severe anxiety. The odds of those with CSCR having anxiety was five times more than the controls [OR 5.71 (4.20-7.22) p<0.0001].

Conclusion: This study highlights the strong association of anxiety with CSCR compared to healthy controls. Anxiety alters the internal hormonal milieu leading to excess endogenous steroid secretion that contributes to the occurrence of CSCR. Addressing anxiety and encouraging lifestyle modifications in patients with CSCR can be a potential avenue to manage these cases.

Purpose: This study aimed to assess the impact of early vitrectomy on visual outcomes one month after surgery in patients with open ocular trauma.

Methods: A historical cohort study analyzed 180 eyes from patients who underwent primary vitrectomy between 2017 and 2023. Data collected included the Birmingham Eye Trauma Terminology for injury assessment, the Ocular Trauma Score for clinical findings, and visual acuity measured on the logMAR scale. Visual outcomes were compared between early surgery (within 4 days) and delayed surgery (after 4 days) using a linear mixed-effects model with a random effect for the surgeries performed.

Results: Most cases had an OTS of 1 and underwent pars plana vitrectomy (PPV) and phacoemulsification (PHACO). OTS 2 cases underwent PPV with PHACO and air tamponade, while OTS 3-4 cases involved additional tamponades. One month after surgery, OTS 2 eyes with early surgery showed significantly better visual outcomes (p= 0.003). There were no statistically significant differences in complications regarding time of surgery.

Conclusion: Early vitrectomy, particularly within four days of injury, seems to improve both functional and anatomical outcomes in patients with severe open ocular trauma, especially for OTS 2.

Introduction: The associations of dietary patterns and age-related macular degeneration (AMD) have been reported using mostly Western and Japanese populations and evidence in multi-ethnic Asian populations, with potentially different dietary patterns, is lacking. In this study, we aimed to identify dietary patterns in a multi-ethnic older Singaporean population and examine their associations with AMD.

Methods: This was a cross-sectional analysis of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. Dietary intake was assessed using a 110-item interviewer-administered food frequency questionnaire validated in a Singaporean population. Presence and stage of AMD were categorized using fundus photographs and an established AMD classification. Dietary patterns were generated by applying exploratory factor analysis, and their associations with presence of AMD and stage of AMD were evaluated using adjusted logistic regression models and adjusted multinomial logistic regression models, respectively.

Results: Of 1480 Chinese, Malay, and Indian individuals aged≥60 years (mean 71.3±7.7), age-standardized prevalence of any, early, and late AMD were 7.1%, 4.8%, and 2.2%. Three dietary patterns were generated: "Snacks, Fried Foods, and Refined Carbohydrates"; "Poultry, Meat and Fish"; and "Wholemeal Bread, Legumes and Nuts". After adjusting for covariates, higher "Snacks, Fried Foods, and Refined Carbohydrates" pattern scores was associated with higher odds of any AMD (OR=1.41, 95%CI: 1.02-1.96) and early AMD (OR=1.63, 95%CI: 1.12-2.37). "Snacks, Fried Foods, and Refined Carbohydrates" pattern scores in the highest quartile were associated with higher odds of any AMD (OR=2.18, 95%CI: 1.01-4.72), compared to the lowest quartile.

Conclusion: Only the "Snacks, Fried Foods, and Refined Carbohydrates" pattern was associated with AMD in this multi-ethnic older Singaporean population. These findings may inform the development of dietary guidelines in Singapore for more targeted AMD management, although prospective, longitudinal data are needed.

Introduction: Diabetic retinopathy (DR) persists as a predominant cause of preventable vision loss globally, with its prevalence escalating in conjunction with the diabetes epidemic. Efficient, automated screening is needed to enable earlier detection of DR at scale. Artificial intelligence (AI)-driven platforms, such as EyeArt® (Eyenuk Inc.), offer a scalable solution with potential to alleviate the burden on healthcare systems.

Methods: A systematic review (SR) and meta-analysis were conducted following PRISMA and MOOSE guidelines. This review was prospectively registered in PROSPERO (CRD42024571137). Observational studies published between 2016 and 2024 assessing the diagnostic performance of the EyeArt® system for DR detection were retrieved from PubMed, Scopus, and Embase. Data on sensitivity, specificity, and diagnostic odds ratio (DOR) were extracted, and pooled estimates were calculated using a random-effects model. Study quality was assessed using QUADAS-2 and GRADE frameworks.

Results: Seventeen studies, met the inclusion criteria. The pooled log diagnostic odds ratio (LDOR) was 3.96 (95% CI 3.54-4.39), and the area under the summary receiver operating characteristic (SROC) curve was 0.932 (95% CI 0.885-0.985), indicating high overall diagnostic accuracy. No significant heterogeneity was observed in the pooled diagnostic OR, although sensitivity and specificity varied across studies.

Conclusions: EyeArt® demonstrates high diagnostic accuracy for detecting any-grade and referable DR across diverse clinical and geographical settings. Its integration into DR screening programs could improve early detection, optimize healthcare resource allocation, and expand access to ophthalmic care, particularly in resource-limited environments.

Key messages: • EyeArt®demonstrated high diagnostic accuracy for detecting referable or any-grade DR across diverse settings. • Its consistent performance supports its integration into routine DR screening workflows. • Deployment of EyeArt®for DR may optimize resource allocation, streamline diagnostic pathways, and expand access, particularly in resource-limited environments.

Rhegmatogenous Retinal Detachment (rRD) can cause irreversible damage to the outer retina, leading to loss of visual acuity despite successful surgery. Postoperative complications, such as retinal folds, particularly macular Outer Retinal Folds (mORFs), can affect vision with distortions and visual field defects when the macula is involved. ORFs are characterized as vertical hyperreflective lesions on SD-OCT, whereas on en face SD-OCT they appear as single or multiple linear or curvilinear hyperreflective bands surrounded by a hyporeflective halo. Our study was conducted to assess the time to resolution of mORFs after rRD repair through pars plana vitrectomy. The study included 26 non-consecutive patients with mORFs observed via SD-OCT after surgery. The mean time for mORFs resolution was 3.7 months, with all mORFs fully absorbed within six months. Factors such as mORFs length influenced resorption speed, but no significant association with other variables (e.g., tamponade agent or retinotomy) was found. The study concludes that mORFs after rRD surgery generally resolve without requiring additional interventions and that precise monitoring using SD-OCT is essential for tracking their resolution.

Introduction: This article aimed to evaluate the prognostic significance of different optical coherence tomography (OCT) imaging biomarkers in predicting visual outcomes in patients with retinal vein occlusion (RVO).

Methods: This was a retrospective study conducted on consecutive patients diagnosed with RVO, who were referred to or treated at a third-level university hospital. The primary endpoints were the mean change in best corrected visual acuity (BCVA) from baseline to the month 6, month 12, and month 18 follow-up visits, and the influence of OCT imaging biomarkers, including ellipsoid zone (EZ) alterations, disorganization of the retinal inner layers (DRILs), hyperreflective foci, neurosensorial detachment, and fibrosis on functional outcomes, defined as a BCVA improvement of ≥5 ETDRS letters.

Results: One hundred and sixty-three eyes were included. In the overall study sample, mean (standard error) BCVA increased significantly from 49.6 (1.8) letters at diagnosis to 54.6 (1.8) letters at month 6 (p = 0.0069), 54.3 (1.9) letters at month 12 (p = 0.0071), and 53.6 (1.9) letters at month 18 (p = 0.0313). In multivariate analysis, the presence of EZ alterations at diagnosis (OR: 0.19; p = 0.0008) and their persistence to month 12 (OR: 0.34; p = 0.0043) were associated with a reduced probability of achieving a BCVA improvement of ≥5 ETDRS letters at month 12. By month 18, significant predictors of visual outcomes included EZ alterations at diagnosis (OR: 0.19; p = 0.0008), sustained EZ alterations through 18 months (OR: 0.34; p = 0.0043), and DRIL at month 18 (OR: 0.38; p = 0.0321).

Conclusions: The presence of EZ alterations at diagnosis and their persistence at 12 and 18 months, along with DRIL at 18 months, were adverse prognostic markers for BCVA outcomes in patients with RVO.