Ophthalmology and Therapy最新文献

Introduction: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent ocular surface disease of childhood that often requires long-term anti-inflammatory therapy beyond topical corticosteroids. This study aimed to identify the clinical predictors of suboptimal treatment response with 0.1% cyclosporine A cationic emulsion (CsA CE) in a real-world pediatric cohort.

Methods: This was a retrospective, single-center study including patients aged 4-18 years with moderate or severe VKC, evaluated at a multidisciplinary ophthalmology clinic between January 2021 and December 2024. All patients received 0.1% CsA CE (administered four times daily). Demographic, clinical, and anamnestic data were collected. Disease severity was assessed using the Bonini grading scale, which provides a semiquantitative evaluation of ocular signs and symptoms. Statistical analysis was performed using univariate and multivariate Cox regression. For significant parameters, ROC curves were generated and optimal cut-off values were identified using the Youden's Index.

Results: A total of 101 patients were included (mean age 8.86 ± 3.31 years; 27 females). Over a mean follow-up period of 1.44 ± 1.13 years, 18 patients (17.8%) required escalation to 1% CsA galenic eye drops, of whom seven were further switched to 0.1% tacrolimus galenic eye drops. On multivariate analysis, the baseline composite clinical score was the strongest predictor of suboptimal treatment response. Notably, the clinical signs score alone demonstrated superior discriminative ability (AUC 0.732) compared to the total score (AUC 0.714). Optimal cut-off values were identified as 7 for clinical signs and 15 for the overall score.

Conclusions: Baseline disease severity, particularly the score for clinical signs, is a reliable predictor of response to 0.1% CsA CE. In patients exceeding the identified thresholds, early therapeutic escalation may be warranted to improve disease control and prevent structural complications.

Introduction: A newly developed diffractive continuous range of vision (CRV) intraocular lens (IOL) (TECNIS Odyssey) was introduced to reduce photic phenomena compared to the previous model (Synergy). This brief report is the first to evaluate the early postoperative outcomes of the new CRV IOL in a Japanese population.

Methods: This retrospective review included 50 eyes of 25 patients with cataracts who underwent bilateral implantation of modified CRV IOLs (models DNR00V and DRT150-375, TECNIS Odyssey). Clinical records of the patients were obtained. One month postoperative assessments included monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) at 5 m, 60 cm, and 40 cm. Additionally, binocular photopic contrast sensitivity, defocus curve, spectacle independence, incidence of photic phenomena, and overall patient satisfaction were evaluated.

Results: The mean patient age was 65.2 ± 8.4 years, with a mean IOL power of 17.4 ± 4.7 D. Postoperative binocular UCVA/DCVA (logMAR) at 5 m, 60 cm, and 40 cm was - 0.18 ± 0.06/ - 0.21 ± 0.06, - 0.01 ± 0.08/ - 0.01 ± 0.08, and 0.00 ± 0.08/0.00 ± 0.07, respectively. Contrast sensitivity remained within normal limits at all spatial frequencies. The binocular defocus curve showed DCVA of 0.0 logMAR or better across a range from + 0.5 to - 2.0 D. Spectacle independence was achieved in 64% of patients, whereas the remainder required reading glasses. Reports of glare and starburst were minimal (84% and 76% of patients reported none or minimal, respectively), whereas 52% experienced moderate to severe halos. Overall, 96% of the patients were satisfied or very satisfied with their distance and intermediate vision, and 68% were satisfied with their near vision.

Conclusions: The new diffractive CRV IOL offers simultaneous vision across a broad range, with improved tolerance to photic phenomena, while maintaining comparable visual acuity at far, intermediate, and near distances compared to the previous model.

Introduction: To investigate distinct neurodegeneration mechanisms in pachychoroid pigment epitheliopathy (PPE) versus age-related macular degeneration (AMD) using quantitative optical coherence tomography (OCT) with age-matched controls.

Methods: This cross-sectional study of 184 subjects included 50 age-matched controls (25 young: 47-63 years; 25 elderly: 67-83 years), 57 PPE patients (47-63 years), 39 AMD drusen patients (64-80 years), and 38 AMD reticular pseudodrusen patients (67-83 years). Primary outcomes included ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, subfoveal choroidal thickness, and choroidal volume using swept-source OCT.

Results: All pathologic conditions showed significant neurodegeneration versus age-matched controls (p < 0.001). PPE demonstrated choroidal thickening (410.5 ± 32.9 μm vs. 306.0 ± 10.8 μm controls) with inverse choroidal-neural correlations (r = -0.52 to -0.61, p < 0.001). AMD variants showed choroidal thinning (187-238 μm vs. 277 μm elderly controls) with positive correlations (drusen: r = +0.43, p = 0.006; RPD: r = +0.68, p < 0.001).

Conclusions: Two distinct pathways cause neurodegeneration: compressive (PPE: choroidal thickening → choriocapillaris compression → neurodegeneration) and ischemic (AMD: choroidal thinning → hypoperfusion → neurodegeneration).

Introduction: Retina and choroid, given their high metabolic demands, are vulnerable to ischemic injury during the hemodynamic instability associated with heart failure (HF). Despite this, posterior segment ocular changes in HF remain understudied. This systematic review and meta-analysis consolidates optical coherence tomography (OCT) and OCT angiography (OCT-A) findings in HF.

Methods: We conducted a comprehensive search of Web of Science, PubMed/MEDLINE, and EMBASE on March 15, 2025. A random-effects meta-analysis of six studies was performed using Hedges' g to estimate effect sizes, with six additional studies included for qualitative synthesis (total n = 1139 eyes). The meta-analysis was limited to studies on heart failure with reduced ejection fraction (HFrEF), as this was the only heart failure subtype with sufficient data for quantitative analysis.

Results: Key findings revealed significant reductions in parafoveal superficial capillary plexus vessel density (SCP VD) (Hedges' g = - 0.42, 95% CI - 0.78 to - 0.05, p = 0.03) and subfoveal choroidal thickness (Hedges' g = - 0.75, 95% CI - 1.31 to - 0.18, p = 0.01) in patients with HFrEF. Furthermore, severity-dependent thinning of retinal nerve fiber layer and significant correlations between whole macular vessel density and both left ventricular EF and New York Heart Association functional class emphasize the potential of these parameters in stratifying disease severity. Additionally, one study revealed thinning of ganglion cell-inner plexiform layer in patients with HF with preserved ejection fraction (HFpEF). Those with acute decompensated HF showed macular VD attenuation in superficial layers and decreased subfoveal choroidal thickness. Pediatric cases demonstrated central macular thinning, selective decreases in SCP VD, and choroidal thinning.

Conclusions: Collectively, OCT and OCT-A metrics provide useful information regarding systemic microvascular dysfunction, suggesting potential for disease detection and improved risk stratification. However, it is important to note that these findings are based on observational studies, which limits the ability to draw definitive causal conclusions. This highlights the need for prospective, longitudinal research to establish temporal relationships and validate these observations.

Purpose: To highlight the clinical benefits of preservative-free topical therapies in the management of glaucoma, with a focus on preservative-free latanoprost, and their role in improving ocular surface health and long-term treatment outcomes.

Methods: A targeted literature search was conducted through May 30, 2024, to identify studies evaluating the efficacy, safety, and patient outcomes associated with preservative-free latanoprost (Monoprost^®/Iyuzeh™, Laboratoires Théa, France).

Results: Glaucoma is a chronic, progressive disease and the leading cause of irreversible blindness globally, with prevalence expected to rise as the US population ages. Most patients begin with topical eye drops-primarily prostaglandin analogs-to reduce intraocular pressure, often requiring lifelong treatment. However, chronic use of preserved formulations, especially those containing benzalkonium chloride, is associated with ocular surface disease, discomfort, and reduced adherence. Preservative-free topical therapies offer equivalent intraocular pressure-lowering efficacy to preserved alternatives, while significantly improving tolerability, reducing ocular surface disease symptoms, and minimizing conjunctival inflammation that may complicate future surgical interventions. In Europe, preservative-free therapies are well established in treatment guidelines. In the US, preservative-free latanoprost 0.005% (Iyuzeh) was approved in 2022, providing a new option for patients sensitive to preservatives or with coexisting ocular surface conditions. Advancements in multidose preservative-free packaging and sustained-release delivery systems further enhance the potential for improved adherence and long-term disease control.

Conclusions: This review highlights the benefits of preservative-free topical glaucoma therapies and includes a targeted review of preservative-free latanoprost 0.005%. Recent technologic advancements including multidose preservative-free delivery systems and sustained-release drug delivery approaches are also discussed.

Introduction: Optical coherence tomography (OCT) and OCT angiography (OCT-A) are valuable tools for detecting retinal and choroidal changes in systemic diseases. This systematic review evaluates the current evidence on retinal and choroidal alterations associated with transthyretin-related amyloidosis (ATTR).

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines across PubMed, Scopus, Web of Science, and Embase up to December 2024 to investigate structural and microvascular alterations in the retina and choroid of patients with genetically confirmed ATTR, aiming to evaluate their potential as imaging biomarkers for disease monitoring.

Results: Nine eligible studies were identified, encompassing a total of 246 individuals, including both symptomatic patients and pre-symptomatic carriers. Reported findings included thinning of the outer nuclear layer (ONL), reduced vessel density in the superficial and deep capillary plexuses, enlargement of the foveal avascular zone (FAZ), and a decreased choroidal vascularity index (CVI).

Conclusions: Thinning of ONL was the most consistent structural finding, suggesting photoreceptor degeneration. Decreased CVI, reduced vascular density, and enlargement of the FAZ further indicate impaired vascular integrity. Although OCT and OCT-A show promise for early detection and monitoring of ocular involvement in ATTR, most studies were case-control studies with small sample sizes and possible confounding from ongoing treatments. These limitations highlight the need for standardized imaging protocols and longitudinal studies to confirm findings and clarify the link between ocular and systemic disease severity.

Introduction: Chronic ocular surface pain (COSP) is defined as ocular pain that is perceived to originate from the ocular surface and persists for more than 3 months. Clear epidemiological data on COSP prevalence are lacking.

Methods: In 2025, a total of 100 eye care providers were surveyed, including 50 optometrists and 50 ophthalmologists. The survey aimed to assess the percentage of their weekly patient volume diagnosed with COSP, the diagnostic methods used, contributing etiologies, and current management strategies. Additionally, practitioners identified key indicators of successful treatment and attributes they believed would have the greatest impact on patient outcomes. Lastly, they rated their satisfaction with current therapeutic options.

Results: An estimated 33% of optometrists' patients and 29% of ophthalmologists' patients had COSP. Of those diagnosed with dry eye disease (DED), 63% also had COSP. Providers managed COSP with over-the-counter (OTC) artificial tears (97% of respondents), OTC gels and ointments (90%), hot compresses (86%), and prescription therapies indicated for DED (30-88%), while a minority routinely used amniotic membranes (37%), serum tears (26%), intense pulsed light (18%), and LipiFlow (16%). The proportions of providers who were satisfied or very satisfied with these therapies were as follows: 64% for amniotic membranes and serum tears, 63% for device-based therapies, 40% for prescription medications, and 21% for OTC drops, ointments, and hot compresses.

Conclusions: This survey provides initial insight into the prevalence of COSP among patients in US eye care clinics, along with perspectives on managing this condition from both optometrists and ophthalmologists. The most common therapeutic strategies for COSP (OTC artificial tears, gels, and ointments) were associated with the lowest levels of provider satisfaction. COSP and dry eye disease are distinct but closely linked conditions. These results demonstrate an unmet need for new treatment options to address COSP.

Introduction: This study investigated the long-term natural history of peripapillary pachychoroid syndrome (PPS), analyzing both morphological and functional outcomes.

Methods: This retrospective study included 24 eyes from 14 participants diagnosed with PPS. No interventions were administered. Baseline and follow-up assessments comprised best-corrected visual acuity (BCVA), measured on the LogMAR scale, inner nasal (IN) and outer nasal (ON) macular thickness measured using the ETDRS (Early Treatment Diabetic Retinopathy Study) subfields. To account for repeated measures and the hierarchical structure of eyes nested within participants, and to appropriately handle incomplete longitudinal data, linear mixed-effects models were utilized for all statistical analyses.

Results: The mean age was 74 ± 7 years, and 71% of patients had bilateral PPS. All patients had peripapillary atrophy at baseline. The mean baseline BCVA was 0.05 and showed only small variations over time. ON macular thickness showed a significant decrease at 2 years (Δ = - 36.9 µm, p = 0.034), whereas IN macular thickness decreased significantly at both 2 years (Δ = - 40.75 µm, p = 0.023) and 3 years (Δ = - 39.97 µm, p = 0.042). One-quarter of participants developed a serous pigment epithelium detachment with subretinal fluid, suggesting an overlapping PPS/CSC (central serous chorioretinopathy) phenotype.

Conclusions: Peripapillary atrophy appears to be an important anatomical predisposition for PPS. Waxing and waning of intraretinal fluid were observed during the natural course of PPS, with a significant reduction at 2 years. Most patients remained asymptomatic and maintained stable BCVA throughout long-term follow-up, indicating a generally favorable prognosis in the absence of intervention.

Introduction: This study aims to describe complications of pediatric-onset uveitis and their predictors among baseline and treatment-related factors.

Methods: This registry-based observational study included patients with noninfectious uveitis with disease onset < 18 years.

Results: A total of 309 patients were enrolled (535 eyes). Uveitis was anterior in 290 eyes (54.2%), panuveitis in 121 (22.6%), intermediate in 88 (16.4%), and posterior in 24 (4.5%). Over a median follow-up of 49.0 months (interquartile range [IQR] 101.0), 137 children (44.3%) developed ≥ 1 complication (14.4 per 100 patient-years). Idiopathic uveitis (p < 0.001), longer topical glucocorticoid (GC) monotherapy (p < 0.001) and longer delay of immunosuppressive therapy (IST) (p = 0.03) were associated with a higher frequency of complications. In multivariate analysis, anterior uveitis was protective against complications (odds ratio [OR] 0.10, 95% confidence interval [CI] - 4.1 to - 1.6, p < 0.001), whereas a chronic course of uveitis significantly increased the risk (OR 6.13, 95% CI 1.0-2.6, p < 0.001). Older age at onset was protective against cataract (OR 0.91, 95% CI - 0.2 to - 0.02, p = 0.020) and band keratopathy (OR 0.8, 95% CI - 0.4 to - 0.1, p = 0.003). Final best-corrected visual acuity (BCVA) (Snellen decimals) was inversely correlated with the duration of topical GC monotherapy (ρ = - 0.23; p = 0.001). In multivariate analysis, panuveitis was linked to a 0.142 decimal reduction (95% CI - 0.219 to - 0.066, p < 0.001), and cataract to a 0.295 reduction (95% CI - 0.372 to - 0.217, p < 0.001) in the final BCVA.

Conclusions: Children with chronic, idiopathic, early-onset, and non-anterior uveitis are at greatest risk for complications. Structured screening for these children, along with early initiation of systemic IST, is essential to prevent visual impairment.