Ophthalmologica最新文献

Introduction: The aim of the study was to report the phenotype and progression pattern of RP1 retinitis pigmentosa carrying the variant c.2613dupA (p.Arg872Thrfs*2).

Methods: This is a retrospective cohort study from 13 families with confirmed RP1 c.2613dupA (p.Arg872Thrfs*2) variant. Analysis was performed on clinical data including multimodal imaging and visual function tests. Progression rate (PR) was defined as the length of ellipsoid zone (EZ) lost per year and was calculated for all patients. Linear mixed model to predict the diameter of EZ loss as a function of age was applied.

Results: Twenty-one patients were included in the study. EZ loss in all patients ranged from 3.8 to 576.0 µm/year (median PR 76.5, IQR 97.6) in right eyes and from 26.6 to 340.7 µm/year (median PR 96.6, IQR 70.3), in left eyes, respectively, with a linear slope of progression for both eyes. The linear mixed model using age as an explanatory variable explained 25% of the variability in PR and showed that male patients had on average a statistically significant smaller EZ diameter at baseline.

Conclusion: The rate of progression of RP1 as measured by loss of EZ appears to be linear, independent of the age of onset. Furthermore, it appears that male subjects may present with earlier onset of disease as they showed a statistically significant smaller EZ diameter at baseline. Monitoring of EZ loss could be a valid clinical surrogate marker for clinical trials, but possibly sex differences and high variability of phenotypes need to be considered.

Introduction: The aim of our study was to assess the outcome of Gore-Tex sutures in minimally invasive scleral fixation of subluxated posterior chamber intraocular lenses (PCIOLs) and to demonstrate a method for validating the lens position.

Methods: Retrospective study of patients who underwent lasso in-the-bag scleral fixation of a subluxated PCIOL using the snare technique with Gore-Tex suture from 2019 to 2021 in a single tertiary medical center. Functional outcome was analyzed by clinical assessment, and anatomical outcome, by ultrasound biomicroscopy (UBM).

Results: A total of 18 eyes were included. The mean duration of follow-up was 140 days (range 23-659), and the median time from PCIOL implantation to fixation was 8.5 years (IQR 6.25-10.75). All patients had ocular comorbidities, mainly glaucoma (n = 6) and pseudoexfoliation syndrome (n = 5). Best corrected visual acuity improved from a median of 6/30 (0.7 logMAR) to a median of 6/12 (0.35 logMAR) (p = 0.06); postoperative astigmatism measured 0.91 ± 2.19 diopters. UBM demonstrated well-balanced PCIOL fixation with no difference between the horizontal and vertical tilt measurements (p = 0.84; p = 0.94; p = 0.62; p = 0.085). The fixated PCIOL showed <10% decentration with reference to the visual axis. There was a high negative correlation between BCVA improvement and residual lens tilt (r = -0.76, p = 0.037). Postoperative complications included transient ocular hypertension (n = 3), corneal decompensation with subsequent keratoplasty (n = 3), temporary hypotony (n = 2), cystoid macular edema (n = 1), suture exposure (n = 1), and endophthalmitis (n = 1).

Conclusions: Subluxated PCIOLs are amenable to treatment with minimally invasive fixation using Gore-Tex suture with good anatomic outcomes. UBM image analysis may serve as a valuable method for assessing PCIOL position following scleral fixation.

Introduction: The aims of the study were to assess the long-term anatomic and functional outcomes in giant retinal tear (GRT)-associated retinal detachment (GRT-RD) and identify factors associated with recurrence.

Methods: This is a retrospective monocentric study of the patients treated for GRT-RD between 2017 and 2022 at Rothschild Foundation Hospital, Paris, France.

Results: A total of 65 eyes from 64 patients were analyzed with a mean follow-up of 21.5 months. The mean age was 52.7 years and 89.2% of them were men. 69.3% of eyes were phakic, the mean axial length was 25.4 mm, and 15 eyes had high myopia. The mean size of the GRT was 147.7°. Macula was attached in 33 cases. All the patients underwent pars plana vitrectomy. Perfluorocarbon liquids were used in almost all cases. Retinopexy was then performed. Silicone oil tamponade was used in 47 eyes and gas tamponade was used in 18 eyes (27.7%). Recurrence of RD occurred in 15 eyes. Factors associated with a recurrence of the RD were macula-off detachment and the presence of another retinal tear. No significant differences were made between silicone oil or gas tamponade in terms of recurrence. No significant difference was shown in postoperative outcomes between the two groups of tamponades.

Conclusion: GRT-RD remains serious with a recurrence rate of 23% in this series. Whereas gas tamponade is less frequently used, its use showed no significant difference compared to silicone oil in terms of postoperative outcomes, and no difference in risk of recurrence of RD in this study.

Introduction: Generative artificial intelligence (AI) technologies like GPT-4 can instantaneously provide health information to patients; however, the readability of these outputs compared to ophthalmologist-written responses is unknown. This study aimed to evaluate the readability of GPT-4-generated and ophthalmologist-written responses to patient queries about ophthalmic surgery.

Methods: This retrospective cross-sectional study used 200 randomly selected patient questions about ophthalmic surgery extracted from the American Academy of Ophthalmology's EyeSmart platform. The questions were inputted into GPT-4, and the generated responses were recorded. Ophthalmologist-written replies to the same questions were compiled for comparison. Readability of GPT-4 and ophthalmologist responses was assessed using six validated metrics: Flesch Kincaid Reading Ease (FK-RE), Flesch Kincaid Grade Level (FK-GL), Gunning Fog Score (GFS), SMOG Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Descriptive statistics, one-way ANOVA, Shapiro-Wilk, and Levene's tests (α = 0.05) were used to compare readability between the two groups.

Results: GPT-4 used a higher percentage of complex words (24.42%) compared to ophthalmologists (17.76%), although mean (standard deviation) word count per sentence was similar (18.43 [2.95] and 18.01 [6.09]). Across all metrics (FK-RE; FK-GL; GFS; SI; CLI; and ARI), GPT-4 responses were at a higher grade level (34.39 [8.51]; 13.19 [2.63]; 16.37 [2.04]; 12.18 [1.43]; 15.72 [1.40]; 12.99 [1.86]) than ophthalmologists' responses (50.61 [15.53]; 10.71 [2.99]; 14.13 [3.55]; 10.07 [2.46]; 12.64 [2.93]; 10.40 [3.61]), with both sources necessitating a 12th-grade education for comprehension. ANOVA tests showed significance (p < 0.05) for all comparisons except word count (p = 0.438).

Conclusion: The National Institutes of Health advises health information to be written at a 6th- to 7th-grade level. Both GPT-4- and ophthalmologist-written answers exceeded this recommendation, with GPT-4 showing a greater gap. Information accessibility is vital when designing patient resources, particularly with the rise of AI as an educational tool.

Introduction: To analyze and correlate the topographic distribution of atrophic areas at the posterior pole and peripheral retina in subjects with geographic atrophy (GA) using ultra-widefield fundus autofluorescence (FAF) imaging.

Methods: This multicenter observational study included 15 patients (9 males, 19 eyes) with coexisting GA and peripheral atrophy. All eyes were imaged with Ultra-widefield Optos California (Optos, PLC, Dunfermline, Scotland) to acquire ultra-widefield (200°) color and FAF images centered on the fovea, superior, inferior, nasal, and temporal sectors. The extent of GA in the central FAF image and the peripheral atrophic areas in the peripheral FAF images were measured by manually defining the boundaries of the atrophic regions using the "ROI free" function integrated into the device software. The values obtained were then analyzed and correlated.

Results: The mean ± standard deviation (SD) GA size was 13.9 ± 15.0 mm2 (range: 1.8-71.3 mm2) and the total peripheral atrophy was 51.0 ± 68.3 mm2 (range: 1.4-292.1 mm2). The topographic analysis showed that the mean ± SD of superior peripheral atrophy was 9.0 ± 20.6 mm2, temporal atrophy was 30.5 ± 55.9 mm2, inferior atrophy was 9.3 ± 16.3 mm2, and nasal atrophy was 1.8 ± 3.9 mm2. GA size was significantly correlated with total peripheral atrophy (Rho = 0.463, p = 0.046) and temporal peripheral atrophy (Rho = 0.474, p = 0.040), whereas no correlations were found with peripheral atrophy in the remaining sectors.

Conclusion: Ultra-widefield autofluorescence is a valuable technique for visualizing and assessing the extent of macular and peripheral atrophy. Macular atrophy correlates significantly with total and temporal peripheral atrophy but demonstrates no significant correlation with atrophy in the remaining sectors.

Introduction: Bilateral vision threatening vitreoretinal disease requiring urgent surgery such as proliferative diabetic retinopathy, vitreous haemorrhage and retinal detachment are not uncommon presentations. Accepted practice has been to address each eye in separate, staged procedures. However, there are specific circumstances in which operating on both eyes in the same anaesthetic sitting may be preferable. Immediate sequential bilateral vitreoretinal surgery (ISBVS) has rarely been described in the literature. We present a series of cases and discuss the indications, risks and relative merits of this approach.

Method: Multicentre retrospective case series of patients undergoing ISBVS. We circulated a proforma to surgeons across the UK to collate a series of cases of this rarely performed approach to collate indications, operative approach and post-operative results.

Results: Seventeen patients (34 eyes) underwent ISBVS from 8 centres. Twenty eyes had rhematogenous retinal detachments, 12 eyes had diabetic vitreous haemorrhage or tractional detachment and 2 had full-thickness macular hole. Principal pathology was the same bilaterally in each case. Indications for bilateral surgery included bilateral disease requiring urgent surgical intervention, high-risk general anaesthetic, anticipated difficulty with follow-up, convenience in post-operative care and patient preference. Visual acuity improved in 22 eyes and worsened in 2. Post-operative complications included four eyes with elevated intraocular pressure, three vitreous haemorrhages, one cystoid macular oedema, and one with a macular fold. One required re-operation for non-clearing vitreous haemorrhage.

Conclusion: ISBVS is a useful approach which may be underutilised, but further studies are required to validate its safety.

Introduction: The COVID-19 pandemic prompted ophthalmology conferences to transition to virtual platforms. The impact of these changes on attendance and research productivity remains underexplored. The objective of this study was to evaluate the effects of virtual platforms on attendance and research inclusion at ophthalmology conferences during the COVID-19 pandemic.

Methods: This cross-sectional study analyzed data from 5 ophthalmology conference organizations conducted from 2019 to 2021. Conference meetings were categorized as in-person, virtual, or hybrid. Data included total attendance, trainee participation, and research submissions, obtained directly from each respective organization.

Results: Conference meetings integrating a virtual component experienced a cumulative 7% increase in total attendance and a 28% rise in trainee participation. Research submissions rose by 31%, while research acceptances showed variability, with increases observed in some conferences during the virtual years. These trends highlight the potential for virtual platforms to enhance accessibility and engagement, particularly for trainees.

Conclusion: Virtual platforms had an overall positive impact on ophthalmology conference attendance and research engagement during the COVID-19 pandemic. Continued integration of virtual components is recommended to enhance accessibility and inclusivity.

Introduction: Treatment-resistant choroidal neovascularization (CNV) remains a major challenge despite anti-VEGF therapy. Faricimab, with dual inhibition of VEGF-A and Ang-2, offers a novel approach. The purpose of this study was to evaluate its effect using advanced OCTA-based vascular analysis and AI-assisted anatomical assessment, providing new insights into therapeutic response in resistant CNV.

Methods: This retrospective study analyzed OCTA and OCT biomarkers before and after treatment switch in patients with CNV that was resistant to prior anti-VEGF therapy. Quantitative vascular analysis of CNV lesions was performed using AngioTool 2.0 software. Anatomical response was evaluated by retinal fluid biomarkers, including central retinal thickness (CRT), intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED) volume using the RetinAI software.

Results: Following the switch to Faricimab, OCTA analysis revealed reductions in vessel area (p = 0.011), vessel percentage area (p = 0.002), total vessel length (p = 0.011), and total number of junctions (p = 0.006). Lacunarity significantly increased (p = 0.009), indicating notable vascular remodeling. Moreover, AI-assisted imaging analysis showed that the CRT decreased by 9.94% (p = 0.0001), and PED volume decreased by 20.94% (p = 0.011). Total retinal fluid, including IRF and IRF, was reduced by 84.06% (p = 0.007), reflecting substantial anatomical improvement. Additionally, the mean injection interval increased by 3.19 ± 2.47 weeks, indicating enhanced disease stability and a reduced treatment burden.

Conclusion: This study highlights the role of OCTA vascular analysis in assessing CNV treatment response. The significant vascular and AI-assisted anatomical improvements observed after switching to faricimab suggest its potential efficacy for treating resistant CNV cases. Given the scarcity of literature on OCTA vascular changes in this context, our findings provide novel insights into treatment response assessment. Further studies with larger cohorts are needed to validate these observations.

Introduction: Submacular hemorrhage (SMH) is a severe complication of neovascular age-related macular degeneration (nAMD), often causing profound vision loss. The aim of this study was to assess the long-term outcomes of SMH patients managed with anti-VEGF monotherapy (MT) versus surgical displacement (SD) and to identify prognostic factors for visual acuity.

Methods: This multicenter retrospective study included patients with SMH secondary to nAMD treated in three hospitals in Lyon between 2018 and 2023. Patients were treated with MT or underwent pneumatic displacement (PD) or SD. The best-corrected visual acuity (BCVA) and clinical parameters were assessed at baseline (time of SMH onset), months 1, 3, 9, and 12.

Results: Sixty-six eyes were included: 33 received MT, 6 underwent PD, and 27 underwent SD. The baseline VA was strongly reduced (mean BCVA: 0.14). The VA improved to 0.21 at M1, 0.29 at M3, and 0.33 at M6 but was stabilized at 0.28 at M12. At M12, VA did not significantly differ between MT and SD groups (0.27 vs. 0.32, p = 0.624). However, multivariate analysis revealed a significantly greater VA gain in the SD group (p = 0.025), despite more severe baseline characteristics. SMH thickness was significantly associated with a poorer VA (p = 0.02).

Conclusion: SD may offer greater visual improvement in cases of large and thick SMH. Maximum SMH thickness appears to be a key prognostic factor. Treatment decisions should consider initial hemorrhage severity.

Introduction: This study evaluated the effect of panretinal photocoagulation (PRP) or combined both anti-VEGF therapy and PRP in proliferative diabetic retinopathy (PDR) on the risk of diabetic macular edema (DME) or vitreous hemorrhage (VH) and compared functional, anatomical outcomes and additional treatments in the two groups.

Methods: This retrospective analysis involves patients treated for PDR with either PRP alone or in combination with three consecutive anti-VEGF injections, followed for at least 12 months. Treatment effects and other factors associated with the risk of first DME and VH were assessed.

Results: We identified 95 eyes from 69 patients (combined group: 37 eyes from 25 patients; PRP group: 58 eyes from 44 patients). At 1 year, the cumulative incidences of the first DME and VH were 8% and 19% (combined group) and 31% and 19% (PRP group), respectively. Combined treatment reduced the risk of first DME after adjusting for age, HbA1c level, PDR severity, and baseline CRT (csHR: 0.211, 95% CI: 0.064-0.700, p = 0.011). Increased DME risks correlated with poor blood sugar control (HbA1c ≥8.4%), thicker baseline CRT in non-high-risk PDR, and baseline CRT <232 μm in high-risk PDR. The risk of first VH decreased with age (csHR: 0.966, 95% CI: 0.933-0.999, p = 0.045). The combined group exhibited superior best-corrected visual acuity at the third and twelfth months. The combined group were less likely to require additional treatment within 1 year (adjusted OR: 0.254, 95% CI: 0.088-0.739, p = 0.011).

Conclusion: Combining anti-VEGF agents with PRP effectively reduced the risk of DME, yielding improved visual outcomes and fewer additional treatments within 1 year.