Ophthalmology and Therapy最新文献

Introduction: This study aims to summarize the retinal and choroidal microvascular features detected by optical coherence tomography angiography (OCTA) in the affected and fellow eyes of patients with retinal vein occlusion (RVO).

Methods: A comprehensive search of the PubMed, Embase, and Ovid databases was conducted to identify studies comparing OCTA metrics among RVO, RVO-fellow, and control eyes. Outcomes of interest included parameters related to foveal avascular zone (FAZ) and fovea- and optic nerve head (ONH)-centered perfusion measurements of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris layer. Pooled results were presented as mean differences or standardized mean differences with 95% confidence intervals.

Results: Fifty-three studies, comprising 2119 RVO, 1393 fellow, and 1178 control eyes, were included in the quantitative meta-analysis. RVO eyes exhibited larger FAZ areas, increased FAZ acircularity, and reduced macular retinal and choriocapillaris perfusion compared to RVO-fellow and control eyes (P < 0.05). RVO eyes also demonstrated significantly lower perfusion density (PD) in the inside-disk and peripapillary regions of the radial peripapillary capillary layer (RPC), as well as lower retinal and choriocapillaris PD in the 4.5 × 4.5 mm² field of view (FOV) of ONH-centered scans (P < 0.05). RVO-fellow eyes showed decreased SCP-PD and DCP-PD in the parafoveal region and the 3 × 3 mm² FOV, reduced inside-disk and 4.5 × 4.5 mm² FOV RPC-PD (P < 0.05), and a diminished choriocapillaris flow area in the 3 × 3 mm² FOV (P < 0.05).

Conclusions: Both RVO-affected and RVO-fellow eyes exhibited retinal and choriocapillaris microvascular impairment around the fovea and ONH. OCTA represents a promising tool for comprehensively assessing vascular alterations in RVO and providing evidence of fellow eye involvement.

Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences-in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle-are important considerations in treatment selection for patients with DED.

Introduction: This study compared the clinical outcomes of allogenic cultured limbal epithelial transplantation (ACLET) and cultivated oral mucosal epithelial transplantation (COMET) in the management of limbal stem cell deficiency (LSCD).

Methods: Forty-one COMET procedures in 40 eyes and 69 ACLET procedures in 54 eyes were performed in the Corneoplastic Unit of Queen Victoria Hospital, East Grinstead. Data were examined for demographics, indications, ocular surface stability, absence of epithelial defect, ocular surface inflammation, visual outcomes, and intra- and postoperative complications.

Results: Kaplan-Meier analysis showed that patients in the ACLET group with longer follow-up had a significantly higher graft survival rate (81.7%, n = 56) than the COMET group (60.7%, n = 25) and the difference was statistically significant (p = 0.01). In the COMET group, there was no statistically significant improvement in the visual acuity (VA) while in the ACLET group there was statistically significant improvement in the final VA. Elevated intraocular pressure (IOP) developed in 9 eyes (22.0%) in the COMET group and in 18 eyes (26.1%) in the ACLET group; infection developed in 4 eyes (9.8%) in the COMET group and in 10 eyes (14.5%) in the ACLET group; and perforation or melting happened in 4 eyes (9.8%) in the COMET group and in 1 eye (1.4%) in the ACLET group. Postoperative immunosuppression complications were noted in 9 eyes (13.0%) in the ACLET group. No graft rejection was observed in either group.

Conclusion: Both ACLET and COMET are effective therapeutic procedures for managing advanced and bilateral cases of LSCD. Although COMET has lower graft survival rate than ACLET, it does not mandate systemic immunosuppression therapy to protect against potential graft rejection.

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.

Introduction: Screening diabetic retinopathy (DR) for timely management can reduce global blindness. Many existing DR screening programs worldwide are non-digital, standalone, and deployed with grading retinal photographs by trained personnel. To integrate the screening programs, with or without artificial intelligence (AI), into hospital information systems to improve their effectiveness, the non-digital workflow must be transformed into digital. We developed a cloud-based digital platform and implemented it in an existing DR screening program.

Methods: We conducted the following processes in the platform for prospective DR screening at a community hospital: capturing patients' retinal photographs, uploading them for grading by AI or trained personnel on alternate weeks for 32 weeks, and referring vision-threatening DR to a referral center. At this center, the platform was applied for the assessment of potential missed referrals via remote over-reading by a retinal specialist and tracking referrals. Implementational outcomes, such as detecting positive cases, agreement between AI and over-reading, and referral adherence were assessed.

Results: Of 645 patients screened by AI, 201 (31.2%) were referrals, 129 (64.2%) of which were true positives agreeable by over-reading; 115 of these true positives (89.1%) had referral adherence. False negatives judged by over-reading were 1.1% (5/444). Of 730 patients in manual screening, 175 (24.0%) were potential referrals, 11 (6.3%) of which were referred at the point-of-screening; eight of these (72.7%) adhered to referral. The remaining 164 cases were appointed for later examination by a visiting general ophthalmologist; 11 of these 116 examined (9.5%) were referred for non-DR-related eye conditions with 81.8% (9/11) referral adherence. No system failure or interruption was found.

Conclusions: The digital platform can be practically integrated into the existing non-digital DR screening programs to implement AI and monitor previously unknown but important indicators, such as referral adherence, to improve the effectiveness of the programs.

Trial registration: ClinicalTrials.gov. (registration number: NCT05166122).

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.

Introduction: Congenital aniridia is increasingly recognized as part of a complex syndrome with numerous ocular developmental anomalies and non-ocular systemic manifestations. This requires comprehensive care and treatment of affected patients. Our purpose was to analyze systemic diseases in patients with congenital aniridia within the Homburg Aniridia Registry.

Methods: Our retrospective, monocentric study included patients who underwent a comprehensive ophthalmic examination at Saarland University Medical Center beginning in June 2003. Age, gender, genetic test results, and information on systemic anomalies were recorded. In addition, parents and affected patients were interviewed about developmental and other disease-related conditions.

Results: Data from 337 patients (mean age 22 ± 20 [0.3-90] years; 181 women [53.7%]) were analyzed. Genetic testing was performed in 187 (55.5%) patients. A PAX6 mutation was detected in 174 of 187 (93%) cases, of which 20 (10.7%) had WAGR(O) syndrome. Systemic diseases were detected in 155 of 337 (46%) patients, with the most common being obesity (29 [8.6%]), thyroid disease (28 [8.3%]), hypertension (26 [7.7%]), intellectual disability (22 [6.5%]), diabetes mellitus (19 [5.6%]), auditory perception disorder/speech development delay (16 [4.7%]), and epilepsy (12 [3.6%]).

Conclusions: A comprehensive analysis of patients with aniridia and systemic effects reveals the complexity of this rare disorder, which goes beyond ocular symptoms and can have profound effects on metabolic balance, cardiovascular health, and the central nervous system. Therefore, early genetic diagnosis, early systemic checkup, and adequate treatment, as well as cooperation with pediatrists, neurologists, and audiologists, is suggested in congenital aniridia, which should be considered a syndrome and not an isolated ocular disease.

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.

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.

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.