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Comparison of Corneal Epitheliotrophic Factors of Undiluted Autologous Platelet-Rich Plasma and Autologous Serum Eye Drops for Dry Eye Disease.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-20 DOI: 10.1007/s40123-024-01082-y
Passara Jongkhajornpong, Kaevalin Lekhanont, Sasivimol Rattanasiri, Prapaporn Pisitkun, Ammarin Thakkinstian

Introduction: The purpose of this study was to compare the growth factor concentrations in undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) eye drops.

Methods: This was a single-center, prospective trial conducted in a tertiary university hospital in Bangkok, Thailand. Ninety-six patients with moderate-to-severe dry eye disease, who were randomly assigned to receive either 100% APRP or 100% AS, were enrolled in the study. Primary outcome measures were the concentrations of epitheliotrophic factors, including epithelial growth factor (EGF), basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), β-nerve growth factor (β-NGF), platelet-derived growth factor (PDGF)-AA, PDGF-BB, transforming growth factor (TGF)-α, TGF-β1, and vascular endothelial growth factor (VEGF) in 100% APRP and 100% AS. Secondary outcome measures were the correlations between baseline patient characteristics and each growth factor concentration.

Results: Undiluted APRP contained more EGF, bFGF, and β-NGF than undiluted AS (P < 0.001, P < 0.001, P = 0.018, respectively). Meanwhile, undiluted AS yielded higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF compared with undiluted APRP (P < 0.001 all). There were no significant differences in TGF-α and TGF-β1 concentrations between the two groups. In the 100% APRP group, the platelet concentrations had positive correlations with the concentrations of EGF (P = 0.028) and VEGF (P = 0.020). In the 100% AS group, Sjögren's syndrome negatively correlated with the concentrations of PDGF-BB (P = 0.028) and VEGF (P = 0.023). Diabetes mellitus (DM) showed negative correlations with the concentrations of HGF (P = 0.001), TGF-α (P = 0.001), and VEGF (P = 0.002).

Conclusions: With our simple preparation protocols, 100% APRP contains higher concentrations of EGF, bFGF, and β-NGF, whereas 100% AS contains higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF. This could allow ophthalmologists to tailor treatments to individual patients by targeting growth factor supply based on their underlying pathophysiology.

Trial registration: ClinicalTrials.gov identifier, NCT04683796.

{"title":"Comparison of Corneal Epitheliotrophic Factors of Undiluted Autologous Platelet-Rich Plasma and Autologous Serum Eye Drops for Dry Eye Disease.","authors":"Passara Jongkhajornpong, Kaevalin Lekhanont, Sasivimol Rattanasiri, Prapaporn Pisitkun, Ammarin Thakkinstian","doi":"10.1007/s40123-024-01082-y","DOIUrl":"https://doi.org/10.1007/s40123-024-01082-y","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to compare the growth factor concentrations in undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) eye drops.</p><p><strong>Methods: </strong>This was a single-center, prospective trial conducted in a tertiary university hospital in Bangkok, Thailand. Ninety-six patients with moderate-to-severe dry eye disease, who were randomly assigned to receive either 100% APRP or 100% AS, were enrolled in the study. Primary outcome measures were the concentrations of epitheliotrophic factors, including epithelial growth factor (EGF), basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), β-nerve growth factor (β-NGF), platelet-derived growth factor (PDGF)-AA, PDGF-BB, transforming growth factor (TGF)-α, TGF-β1, and vascular endothelial growth factor (VEGF) in 100% APRP and 100% AS. Secondary outcome measures were the correlations between baseline patient characteristics and each growth factor concentration.</p><p><strong>Results: </strong>Undiluted APRP contained more EGF, bFGF, and β-NGF than undiluted AS (P < 0.001, P < 0.001, P = 0.018, respectively). Meanwhile, undiluted AS yielded higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF compared with undiluted APRP (P < 0.001 all). There were no significant differences in TGF-α and TGF-β1 concentrations between the two groups. In the 100% APRP group, the platelet concentrations had positive correlations with the concentrations of EGF (P = 0.028) and VEGF (P = 0.020). In the 100% AS group, Sjögren's syndrome negatively correlated with the concentrations of PDGF-BB (P = 0.028) and VEGF (P = 0.023). Diabetes mellitus (DM) showed negative correlations with the concentrations of HGF (P = 0.001), TGF-α (P = 0.001), and VEGF (P = 0.002).</p><p><strong>Conclusions: </strong>With our simple preparation protocols, 100% APRP contains higher concentrations of EGF, bFGF, and β-NGF, whereas 100% AS contains higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF. This could allow ophthalmologists to tailor treatments to individual patients by targeting growth factor supply based on their underlying pathophysiology.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT04683796.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Multicenter Study on Clinical Outcomes of Simultaneous Implantable Collamer Lens Removal and Phacoemulsification with Intraocular Lens Implantation in Eyes Developing Cataract.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-18 DOI: 10.1007/s40123-024-01078-8
Kazutaka Kamiya, Kimiya Shimizu, Yoshihiro Kitazawa, Takashi Kojima, Tomoaki Nakamura, Kazuo Ichikawa, Kahoko Fujimoto

Introduction: This study evaluated the clinical outcomes of simultaneous implantable collamer lens (ICL) removal and phacoemulsification with intraocular lens (IOL) implantation in a multicenter study.

Methods: We retrospectively investigated 83 eyes of 72 patients requiring ICL extraction and cataract surgery at five institutions. Preoperatively and 3 months postoperatively, we determined visual acuity (logMAR), spherical equivalent refraction, and endothelial cell density (ECD), in addition to the preoperative backgrounds and the postoperative complications.

Results: The patients' age at the time of cataract surgery was 49.8 ± 6.8 years, and the axial length was 28.49 ± 1.97 mm. The most prevalent type of cataract was anterior subcapsular cataract, followed by nuclear and cortical cataract. Uncorrected and corrected visual acuities significantly improved to 0.09 ± 0.30 and - 0.12 ± 0.12 logMAR, respectively (p < 0.001). Sixty-three (76%) and 78 (94%) eyes were within ± 0.5 D and 1.0 D, respectively, of the targeted correction. The mean percentage of ECD loss was 1.3 ± 11.3%. No vision-threatening complications were observed in any case.

Conclusions: Our multicenter study showed that simultaneous ICL removal and phacoemulsification with IOL implantation is a safe, effective, and predictable procedure, with no significant complications, making it a feasible option for ICL-implanted eyes developing cataracts.

{"title":"A Multicenter Study on Clinical Outcomes of Simultaneous Implantable Collamer Lens Removal and Phacoemulsification with Intraocular Lens Implantation in Eyes Developing Cataract.","authors":"Kazutaka Kamiya, Kimiya Shimizu, Yoshihiro Kitazawa, Takashi Kojima, Tomoaki Nakamura, Kazuo Ichikawa, Kahoko Fujimoto","doi":"10.1007/s40123-024-01078-8","DOIUrl":"https://doi.org/10.1007/s40123-024-01078-8","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the clinical outcomes of simultaneous implantable collamer lens (ICL) removal and phacoemulsification with intraocular lens (IOL) implantation in a multicenter study.</p><p><strong>Methods: </strong>We retrospectively investigated 83 eyes of 72 patients requiring ICL extraction and cataract surgery at five institutions. Preoperatively and 3 months postoperatively, we determined visual acuity (logMAR), spherical equivalent refraction, and endothelial cell density (ECD), in addition to the preoperative backgrounds and the postoperative complications.</p><p><strong>Results: </strong>The patients' age at the time of cataract surgery was 49.8 ± 6.8 years, and the axial length was 28.49 ± 1.97 mm. The most prevalent type of cataract was anterior subcapsular cataract, followed by nuclear and cortical cataract. Uncorrected and corrected visual acuities significantly improved to 0.09 ± 0.30 and - 0.12 ± 0.12 logMAR, respectively (p < 0.001). Sixty-three (76%) and 78 (94%) eyes were within ± 0.5 D and 1.0 D, respectively, of the targeted correction. The mean percentage of ECD loss was 1.3 ± 11.3%. No vision-threatening complications were observed in any case.</p><p><strong>Conclusions: </strong>Our multicenter study showed that simultaneous ICL removal and phacoemulsification with IOL implantation is a safe, effective, and predictable procedure, with no significant complications, making it a feasible option for ICL-implanted eyes developing cataracts.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-18 DOI: 10.1007/s40123-024-01081-z
Piriya Soomsawasdi, Kulawan Rojananuangnit, Eakkachai Arayangkoon, Ratchada Chantiwas, Sureeporn Pengrungreungwong, Nontakorn Preawsampran, Natnaree Tinpowong, Rujira Samakhararaksakul, Kanokwan Katkingkaew, Natthapuch Seekhum, Wanwisa Sathim

Introduction: Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections.

Methods: This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group.

Results: The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001.

Conclusion: Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion.

Trial registration: TCTR20241005001, retrospectively registered.

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引用次数: 0
Long-Term Treatment Outcomes of Micropulse Transscleral Cyclophotocoagulation in Primary and Secondary Glaucoma: A 5-Year Analysis. 微脉冲经巩膜环形光凝术对原发性和继发性青光眼的长期治疗效果:五年分析。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-16 DOI: 10.1007/s40123-024-01080-0
Ronald M P C de Crom, Stefani Kujovic-Aleksov, Carroll A B Webers, Tos T J M Berendschot, Henny J M Beckers

Introduction: To investigate 5-year outcomes on intraocular pressure (IOP) and safety of micropulse transscleral cyclophotocoagulation (TSCPC) in patients with glaucoma.

Methods: Patients with mild to advanced glaucoma who underwent a standardized micropulse TSCPC procedure at the University Eye Clinic Maastricht from November 2016 to February 2019 were included.

Results: A total of 165 eyes were included, with outcomes for 112 eyes available after 5-year follow-up. Mean age was 67.3 ± 13.9 years; 58.2% were male. Glaucoma subtypes were primary glaucoma (n = 108) and secondary glaucoma (n = 57). Prior glaucoma surgery was performed in 65 of 165 eyes (39.4%). In the primary glaucoma group, mean preoperative IOP was 20.7 ± 7.1 mmHg. Mean postoperative IOP at 1, 2, 3, 4, and 5 years significantly reduced to 15.2 ± 6.5, 14.3 ± 5.0, 14.0 ± 4.9, 13.5 ± 4.1, and 12.9 ± 4.3 mmHg, respectively. Preoperatively, the mean number of IOP-lowering medications was 3.3 ± 1.3, which changed to 2.8 ± 1.3, 2.8 ± 1.2, 2.8 ± 1.2, 2.9 ± 1.2, and 2.7 ± 1.3 at 1, 2, 3, 4, and 5 years, respectively. In the secondary glaucoma group, mean preoperative IOP was 28.7 ± 10.3 mmHg, dropping significantly to 19.3 ± 10.4, 18.6 ± 11.3, 17.8 ± 9.8, 18.1 ± 12.0, and 15.5 ± 7.6 mmHg at the same intervals. The number of IOP-lowering medication was significantly reduced from 3.5 ± 1.1 to 2.5 ± 1.5, 2.2 ± 1.5, 2.6 ± 1.4, 2.6 ± 1.5, and 2.5 ± 1.7. In the total group, mean IOP reduction was 32.5% after 5 years. Postoperative complications included cystic macular edema (n = 3), fibrinous/uveitic reaction (n = 1), and rejection of corneal graft (n = 2), all reversible after treatment. One patient developed late and persisting hypotony. Other adverse events were retinal venous occlusion (n = 1) and retinal vasculitis (n = 1), unrelated to the laser treatment. In patients with a preoperative Central Distance Visual Acuity (CDVA) > 0.05 on the Snellen chart, more than two lines of visual acuity (VA) loss were attributed to cataract (n = 10), retinal disease (n = 5), glaucoma progression (n = 3), corneal decompensation (n = 2), or other factors (n = 11).

Conclusion: Micropulse TSCPC is a safe and effective treatment for reducing IOP and the number of IOP-lowering medications after a 5-year follow-up period. It is a viable alternative for patients after failed incisional glaucoma surgery or high-risk patients.

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引用次数: 0
The Relevance and Potential Role of Orbital Fat in Inflammatory Orbital Diseases: Implications for Diagnosis and Treatment.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-16 DOI: 10.1007/s40123-024-01079-7
Prince Dadson, Peter Ngum, Luis Eduardo Juarez-Orozco, Michael Ntodie, Piotr Loba

The orbit is an important structure within the skull that houses the eye, optic nerve, and extraocular muscles. It also contains adipose/fat tissue, which provides a protective cushion for these components. Inflammatory orbital disease can affect any or all components of the orbit, often arising from various underlying pathologic conditions, including autoimmune, infectious, and vascular diseases. Typical signs and symptoms of orbital inflammation include swelling, redness, pain, discomfort, and potential loss of function. The role of orbital fat in the pathogenesis of inflammatory orbital diseases has not been fully explored. This review aims to provide a comprehensive description of orbital fat, its relevance and the potential role in inflammatory diseases of the orbit, and the use of radiologic imaging studies for evaluating this fat depot in cases of as inflammatory orbital diseases. Additionally, this review discusses the various procedures available for the treatment and management of these conditions. A range of interventions, including pharmacotherapy and surgical procedures, will be evaluated as promising therapeutic options. This review also explores the characteristics and potential applications of orbital fat-derived stem cells, with an emphasis on their regenerative abilities and anti-inflammatory effects. Understanding the role of orbital fat and its contribution to inflammatory orbital diseases is essential for optimizing diagnostic and treatment strategies.

眼眶是颅内的一个重要结构,是眼睛、视神经和眼外肌的所在。它还包含脂肪组织,为这些组成部分提供保护垫。炎症性眼眶疾病可影响眼眶的任何或所有组成部分,通常由各种潜在的病理情况引起,包括自身免疫性疾病、感染性疾病和血管性疾病。眼眶炎症的典型症状包括肿胀、发红、疼痛、不适和潜在的功能丧失。眼眶脂肪在眼眶炎症性疾病发病机制中的作用尚未得到充分探讨。本综述旨在全面描述眼眶脂肪、其在眼眶炎症性疾病中的相关性和潜在作用,以及在眼眶炎症性疾病病例中使用放射成像检查评估眼眶脂肪库的情况。此外,本综述还讨论了治疗和控制这些疾病的各种方法。包括药物治疗和手术治疗在内的一系列干预措施将作为有前景的治疗方案进行评估。本综述还探讨了眼眶脂肪干细胞的特点和潜在应用,重点是其再生能力和抗炎作用。了解眼眶脂肪的作用及其对眼眶炎症性疾病的影响对于优化诊断和治疗策略至关重要。
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引用次数: 0
Improving Clinical Management of Diabetic Macular Edema: Insights from a Global Survey of Patients, Healthcare Providers, and Clinic Staff.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-14 DOI: 10.1007/s40123-024-01060-4
Focke Ziemssen, Michelle Sylvanowicz, Winfried M Amoaku, Tariq Aslam, Bora Eldem, Robert P Finger, Richard P Gale, Laurent Kodjikian, Jean-François Korobelnik, Xiaofeng Lin, Anat Loewenstein, Paul Mitchell, Moira Murphy, David R Owens, Nick Parker, Ian Pearce, Francisco J Rodríguez, Jude Stern, S James Talks, David T Wong, Tien Yin Wong, Jane Barratt

Introduction: In contrast with patients receiving therapy for retinal disease during clinical trials, those treated in routine clinical practice experience various challenges (including administrative, clinic, social, and patient-related factors) that can often result in high patient and clinic burden, and contribute to suboptimal visual outcomes. The objective of this study was to understand the challenges associated with clinical management of diabetic macular edema from the perspectives of patients, healthcare providers, and clinic staff, and identify opportunities to improve eye care for people with diabetes.

Methods: We conducted a survey of patients with diabetic macular edema, providers, and clinic staff in 78 clinics across 24 countries on six continents, representing a diverse range of individuals, healthcare systems, settings, and reimbursement models. Surveys comprised a series of single- and multiple-response questions completed anonymously. Data gathered included patient personal characteristics, challenges with appointment attendance, treatment experiences, and opportunities to improve support. Provider and clinic staff surveys asked similar questions about their perspectives; and clinic characteristics were also captured.

Results: Overall, 5681 surveys were gathered: 3752 from patients with diabetic macular edema, 680 from providers, and 1249 from clinic staff. Too many appointments, too short treatment intervals, difficulties in traveling to the clinic or arranging adequate support to travel, out-of-pocket costs, office/parking fees, and long waiting times were noted by all as contributing to increase the burden on the patient and caregiver. Patients generally desired more in-depth discussions with their provider, which would help with information exchange and better expectation-setting.

Conclusions: The wealth of systematic data generated by this global survey highlights the breadth and scale of challenges associated with the clinical management of patients with diabetic macular edema. Addressing the opportunities for improvement raised by patients, providers, and clinic staff could increase patient adherence to treatment, reduce appointment burden, and improve clinic capacity.

{"title":"Improving Clinical Management of Diabetic Macular Edema: Insights from a Global Survey of Patients, Healthcare Providers, and Clinic Staff.","authors":"Focke Ziemssen, Michelle Sylvanowicz, Winfried M Amoaku, Tariq Aslam, Bora Eldem, Robert P Finger, Richard P Gale, Laurent Kodjikian, Jean-François Korobelnik, Xiaofeng Lin, Anat Loewenstein, Paul Mitchell, Moira Murphy, David R Owens, Nick Parker, Ian Pearce, Francisco J Rodríguez, Jude Stern, S James Talks, David T Wong, Tien Yin Wong, Jane Barratt","doi":"10.1007/s40123-024-01060-4","DOIUrl":"https://doi.org/10.1007/s40123-024-01060-4","url":null,"abstract":"<p><strong>Introduction: </strong>In contrast with patients receiving therapy for retinal disease during clinical trials, those treated in routine clinical practice experience various challenges (including administrative, clinic, social, and patient-related factors) that can often result in high patient and clinic burden, and contribute to suboptimal visual outcomes. The objective of this study was to understand the challenges associated with clinical management of diabetic macular edema from the perspectives of patients, healthcare providers, and clinic staff, and identify opportunities to improve eye care for people with diabetes.</p><p><strong>Methods: </strong>We conducted a survey of patients with diabetic macular edema, providers, and clinic staff in 78 clinics across 24 countries on six continents, representing a diverse range of individuals, healthcare systems, settings, and reimbursement models. Surveys comprised a series of single- and multiple-response questions completed anonymously. Data gathered included patient personal characteristics, challenges with appointment attendance, treatment experiences, and opportunities to improve support. Provider and clinic staff surveys asked similar questions about their perspectives; and clinic characteristics were also captured.</p><p><strong>Results: </strong>Overall, 5681 surveys were gathered: 3752 from patients with diabetic macular edema, 680 from providers, and 1249 from clinic staff. Too many appointments, too short treatment intervals, difficulties in traveling to the clinic or arranging adequate support to travel, out-of-pocket costs, office/parking fees, and long waiting times were noted by all as contributing to increase the burden on the patient and caregiver. Patients generally desired more in-depth discussions with their provider, which would help with information exchange and better expectation-setting.</p><p><strong>Conclusions: </strong>The wealth of systematic data generated by this global survey highlights the breadth and scale of challenges associated with the clinical management of patients with diabetic macular edema. Addressing the opportunities for improvement raised by patients, providers, and clinic staff could increase patient adherence to treatment, reduce appointment burden, and improve clinic capacity.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Global Insights from Patients, Providers, and Staff on Challenges and Solutions in Managing Neovascular Age-Related Macular Degeneration.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-14 DOI: 10.1007/s40123-024-01061-3
Anat Loewenstein, Michelle Sylvanowicz, Winfried M Amoaku, Tariq Aslam, Chui Ming Gemmy Cheung, Bora Eldem, Robert P Finger, Richard P Gale, Laurent Kodjikian, Adrian Koh, Jean-François Korobelnik, Xiaofeng Lin, Paul Mitchell, Moira Murphy, Mali Okada, Ian Pearce, Francisco J Rodriguez, Jude Stern, S James Talks, David T Wong, Tien Yin Wong, Focke Ziemssen, Jane Barratt

Introduction: Neovascular age-related macular degeneration is a global public-health concern, associated with a considerable burden to individuals, healthcare systems, and society. The objective of this study was to understand different perspectives on the challenges associated with the clinical management of neovascular age-related macular degeneration, which could elucidate measures to comprehensively improve clinical care and outcomes.

Methods: A survey was carried out of patients with neovascular age-related macular degeneration, their providers, and clinic staff in 77 clinics across 24 countries on six continents, from a diverse range of healthcare systems, settings, and reimbursement models. Surveys comprised a series of single/multiple-response questions completed anonymously. Data gathered included patient personal characteristics, appointment attendance challenges, treatment experiences, and opportunities to improve support. Provider and clinic staff surveys asked similar questions about their perspectives; clinic characteristics were also captured.

Results: There were 6425 responses; 4558 patients with neovascular age-related macular degeneration, 659 providers, and 1208 clinic staff. Challenges identified included concern about patient burden to family/friends, high frequency of treatment, difficulties in traveling to appointments, long waiting times, and insufficient comprehension of neovascular age-related macular degeneration. Participants identified logistical (improved financial assistance with treatment and out-of-pocket costs, and appointment reminders), operational (addressing clinic set up to reduce waiting times and improving the amount of time providers spend with patients), and educational (improving quality and provision of patient information and expectation-setting) opportunities to improve care.

Conclusions: The wealth of data generated by this global survey highlights the breadth of challenges associated with clinical management of patients with neovascular age-related macular degeneration. Addressing the opportunities raised could improve patient adherence to treatment and potentially outcomes, reduce appointment burden, and increase clinic capacity.

导言:新生血管性老年黄斑变性是一个全球性的公共卫生问题,给个人、医疗系统和社会带来了巨大负担。本研究旨在了解与新生血管性老年黄斑变性临床管理相关的挑战的不同观点,从而阐明全面改善临床护理和结果的措施:对六大洲 24 个国家 77 家诊所的新生血管性老年黄斑变性患者、其医疗服务提供者和诊所工作人员进行了调查,这些诊所来自不同的医疗保健系统、环境和报销模式。调查由一系列匿名完成的单一/多重回答问题组成。收集的数据包括患者的个人特征、就诊挑战、治疗经验以及改善支持的机会。医疗服务提供者和诊所工作人员的调查也询问了类似的问题;诊所的特点也被纳入其中:共收到 6425 份回复;其中包括 4558 名新生血管性老年黄斑变性患者、659 名医疗服务提供者和 1208 名诊所员工。发现的挑战包括患者对家人/朋友的负担、治疗频率高、赴约困难、等待时间长以及对新生血管性老年黄斑变性的理解不足。与会者提出了后勤(改善治疗和自付费用方面的经济援助,以及预约提醒)、操作(解决诊所设置问题以减少等候时间,并增加医疗服务提供者与患者共处的时间)和教育(提高质量,提供患者信息并设定期望值)方面的改进机会:这项全球调查所产生的大量数据凸显了与新生血管性老年黄斑变性患者临床管理相关的挑战的广泛性。抓住所提出的机遇可以提高患者对治疗的依从性,改善治疗效果,减轻预约负担,并提高诊所的服务能力。
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引用次数: 0
Safety and Efficacy of Hydroxypropyl Guar-Hyaluronic Acid Dual-Polymer Lubricating Eye Drops in Indian Subjects with Dry Eye: A Phase IV Study.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-14 DOI: 10.1007/s40123-024-01069-9
Deborah Awisi-Gyau, Neha Kapur, Rajesh Parekh, Umesh Yeddula, Shreesha Kumar Kodavoor

Introduction: This work aimed to evaluate the safety and efficacy of hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricating drops in Indian subjects with dry eye disease (DED).

Methods: This prospective, open-label, single-arm, phase IV study was conducted in India.

Inclusion criteria: Adults (18-65 years) with an average total ocular surface staining (TOSS) score ≥ 4, best-corrected visual acuity of ≥ 20/40 in each eye, tear break-up time (TBUT) ≤ 10 s, and dry eye questionnaire (DEQ-5) score ≥ 6. Subjects received the first dose of HPG-HA eye drops on day 1 and self-administered 1-2 drops four times daily for 90 ± 5 days.

Primary endpoints: Frequency and characteristics of treatment-emergent adverse events (TEAEs) throughout the study and TOSS score at day 90. Secondary/other endpoints: Dry eye symptoms score (through dry eye questionnaire [DEQ-5]) and TBUT.

Results: Of 175 subjects, 36 (20.6%) had ≥ 1 TEAE, and 27 (15.4%) of this reported ≥ 1 mild drug-related TEAE (eye irritation [n = 9], eye pruritus [n = 8], blurred vision [n = 6], increased lacrimation [n = 4], ocular hyperemia [n = 3], and ocular discomfort [n = 1]). One subject discontinued due to TEAEs, and none led to drug interruptions. No serious adverse events were reported. The mean TOSS score reduced from day 1 (6.12 ± 1.69, OU [both eyes]) to day 90 (2.40 ± 1.97, OU). The mean DEQ-5 score reduced from day 1 (11.50 ± 2.27) to day 90 (5.50 ± 2.50). TBUT increased from day 1 (right eye [OD], 5.70 ± 1.94; left eye [OS], 5.70 ± 1.96) to day 90 (OD, 9.51 ± 3.08; OS, 9.63 ± 3.01).

Conclusions: HPG-HA dual-polymer eye drop was safe and effective in relieving signs and symptoms of DED over 90 days in Indian subjects.

Trial registration: Clinical Trial Registry India, CTRI/2022/03/041175.

简介:本研究旨在评估羟丙基瓜儿胶-透明质酸(HPG-HA)双聚合物润滑滴眼液对印度干眼症(DED)患者的安全性和有效性:这项前瞻性、开放标签、单臂、IV 期研究在印度进行:纳入标准:平均眼表染色(TOSS)总分≥ 4 分、每只眼最佳矫正视力≥ 20/40、泪液破裂时间(TBUT)≤ 10 秒、干眼症问卷调查(DEQ-5)得分≥ 6 分的成年人(18-65 岁)。受试者在第1天滴入第一剂HPG-HA眼药水,并自行滴入1-2滴,每天4次,持续90±5天:主要终点:整个研究过程中治疗突发不良事件(TEAEs)的频率和特征,以及第 90 天时的 TOSS 评分。次要/其他终点:干眼症状评分(通过干眼症状问卷 [DEQ-5])和 TBUT:175名受试者中有36人(20.6%)出现≥1次TEAE,其中27人(15.4%)报告出现≥1次轻度药物相关TEAE(眼刺激[n = 9]、眼瘙痒[n = 8]、视力模糊[n = 6]、流泪增多[n = 4]、眼部充血[n = 3]和眼部不适[n = 1])。一名受试者因 TEAEs 而停药,没有人因此而中断用药。无严重不良事件报告。平均 TOSS 评分从第 1 天(6.12 ± 1.69,OU [双眼])降低到第 90 天(2.40 ± 1.97,OU)。DEQ-5 平均得分从第 1 天(11.50 ± 2.27)降低到第 90 天(5.50 ± 2.50)。TBUT从第1天(右眼[OD],5.70 ± 1.94;左眼[OS],5.70 ± 1.96)增加到第90天(OD,9.51 ± 3.08;OS,9.63 ± 3.01):HPG-HA双聚合物滴眼液对印度受试者90天内缓解DED症状安全有效:试验注册:印度临床试验注册中心,CTRI/2022/03/041175。
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引用次数: 0
Capsular Bag Performance of a Novel Hydrophobic Single-Piece Intraocular Lens.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-12 DOI: 10.1007/s40123-024-01075-x
Klemens Waser, Klaus Straßmair, Leon Pomberger, Haidar Khalil, Peter Laubichler, Matthias Bolz, Nino Hirnschall

Introduction: We conducted an evaluation of capsular bag performance of the Clareon CNA0T0 intraocular lens (IOL), focusing on postoperative anterior chamber depth (ACD), IOL tilt, and IOL decentration.

Methods: Inclusion criteria were bilateral age-related cataract and the ability to provide informed consent. Exclusion criteria were prior surgeries, combined surgeries, and conditions posing a risk for postoperative capsular bag instability. Preoperative and 8-week postoperative assessments included optical biometry and high-resolution anterior segment optical coherence tomography (OCT). Subjective refraction was conducted only at 8 weeks postoperative visit.

Results: In the first analysis, 49 right eyes of 49 patients were included. Mean preoperative and postoperative ACD were 3.10 and 4.69 mm, respectively. Mean preoperative tilt was 4.77°, increasing to 5.06° postoperatively. Preoperative decentration was 0.16 mm, increasing to 0.26 mm postoperatively. Absolute refractive error (ARE) was + 0.31D, with 81% of eyes within ± 0.5D limits. In analysis II (98 eyes of 49 patients), both eyes showed a moderate correlation in IOL tilt (Pearson correlation coefficient: 0.27, p = 0.061) and a low correlation in IOL decentration (Pearson correlation coefficient: 0.02, p = 0.892) and ARE (Spearman: 0.15, p = 305) between right and left eyes of the same patient.

Conclusions: The Clareon CNA0T0 IOL demonstrated high mechanical stability, with low postoperative tilt and decentration values, resulting in excellent refractive outcomes and visual acuity. These findings confirm the IOL's high stability within the capsular bag and effectiveness in minimizing postoperative refractive error, requiring only minor A-constant adjustments for optimal cataract surgery outcomes.

Trial registration: NCT06595693.

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引用次数: 0
Preserflo MicroShunt Implantation: A Narrative Review of Its Standalone Benefits vs. Combined Use with Phacoemulsification in Managing Open-Angle Glaucoma.
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-12-05 DOI: 10.1007/s40123-024-01068-w
Małgorzata Chilmonczyk, Kinga Gołaszewska, Emil Saeed, Joanna Konopińska

Glaucoma and cataract often coexist. Patients with both conditions who qualify for surgical treatment may undergo either a combined surgical procedure or sequential treatments such as cataract surgery followed by an antiglaucoma procedure. A combined procedure with phacoemulsification is related to an increased risk of fibrosis of the filtering bleb; however, it is a rational approach for patients with high intraocular pressure and clinically significant lens opacification. Trabeculectomy has been a traditional filtration procedure for decades, effectively lowering intraocular pressure. It is highly effective; however, it may cause sight-threatening complications. The Preserflo MicroShunt, introduced less than a decade ago in the field of glaucoma surgery, has shown similar hypotensive efficacy to trabeculectomy, and is a less invasive procedure with a better safety profile. Despite their shared mechanism of action to reduce intraocular pressure, the two procedures differ in the extent of scleral incision and filtration bleb morphology, which may influence the extent of the post-surgery inflammation process. This review evaluated and compared reports on the efficacy and safety of Preserflo MicroShunt implantation as a standalone procedure versus combined with cataract removal in surgical treatment for patients with open-angle glaucoma and concomitant cataract.

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Ophthalmology and Therapy
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