Ophthalmology and Therapy最新文献

Introduction: Diffractive trifocal intraocular lenses (IOLs) provide good vision at distance, intermediate, and near, but can also cause positive dysphotopsias. This meta-analysis pooled published evidence on visual disturbances after bilateral implantation of the PanOptix (TFNTXX) IOL for patients undergoing cataract surgery.

Method: A systematic literature search was conducted in PubMed and congress presentations from April 2021 to December 2022 to identify studies with patient-reported outcomes on the incidence of visual disturbances (starbursts, halos, glare) post bilateral implantation of PanOptix IOL during cataract surgery. Random-effects meta-analysis was performed to generate pooled proportions for patient-reported visual disturbances with a 95% confidence interval [CI].

Results: Eleven unique studies were included, spanning 580 patients with bilateral implantation of PanOptix IOL from 10 countries with 1 to 12 months follow-up. In summary, 33.6% of patients with bilateral PanOptix implantation experienced glare, 43.9% experienced halos, and 30.4% experienced starbursts. Among these patients, small percentages reported severe glare (2.9%), severe halos (5.4%), and severe starbursts (3.4%). Only 0.8%, 1.4%, and 2.6% of patients found glare, halos, and starbursts, respectively, to be very bothersome.

Conclusion: Halos are the most frequently reported visual disturbances. However, the likelihood of experiencing severe and/or very bothersome visual disturbances (halos, glare, starbursts) is approximately 5% and 3%, respectively, after bilateral implantation of PanOptix IOL. These findings should inform clinical decision-making and treatment choices when selecting the most appropriate IOL implant for cataract surgery.

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.

Introduction: Combined uveitis-rheumatology clinics (combined clinics) are a relatively recent clinical care model. Here we report the demographics, ocular and systemic disease characteristics, and medications utilized in patients seen in a combined clinic at a tertiary care hospital in the USA.

Methods: Medical records were reviewed of patients seen at the Combined Clinic at the University of Colorado Hospital between January 1, 2016 and November 1, 2023. Data including age, sex, referral indication, ocular and systemic inflammatory disease diagnosis, and therapies utilized were obtained.

Results: A total of 171 patients were included in the study, of which 122 were diagnosed with a systemic inflammatory disease, the most common of which were spondyloarthritis and rheumatoid arthritis. Nearly half of patients referred to the combined clinic with a known ocular inflammatory disease (OID) and suspicion for a systemic process were eventually diagnosed with a systemic disease. The most common associations in patients with both OID and systemic disease were anterior uveitis with spondyloarthritis, and scleritis with rheumatoid arthritis. The most common systemic immunomodulatory therapies (IMT) used were adalimumab, methotrexate, and rituximab. Over 40% of patients underwent a change in IMT during their first evaluation.

Conclusions: Most patients seen in the combined clinic had both ocular and systemic inflammatory disease and were treated with IMT. Many patients were diagnosed with a systemic inflammatory disease upon evaluation in the combined clinic, and nearly half were recommended to initiate or change IMT at their first visit. This highlights the utility of a combined clinic in the management of these complex patients, in addition to providing logistical benefits to patients and educational opportunities for trainees.

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.

Introduction: Lotilaner ophthalmic solution (0.25%) is the first United States Food and Drug Administration (US FDA)-approved drug for treating Demodex blepharitis. In pivotal trials, it was found to be well tolerated and demonstrated a significant reduction in collarettes and mite density after a 6-week treatment regimen. This study aimed to report the safety and efficacy profile of lotilaner ophthalmic solution (0.25%) from a pooled analysis of two pivotal trials in patients with Demodex blepharitis.

Methods: Pooled data were analyzed from two randomized, double-masked, vehicle-controlled clinical trials [phase 2b/3 Saturn-1 (NCT04475432) and phase 3 Saturn-2 (NCT04784091)] in which patients with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution (0.25%) (study group) or the vehicle formulation without lotilaner (control group), twice daily for 6 weeks. The outcome measures were the proportion of patients with 0-2 collarettes (grade 0 collarettes), mite eradication, erythema cure, and the proportion of patients with ≤ 10 collarettes (grade 0 or 1 collarettes) at day 43.

Results: Overall, 833 participants were randomized to receive either the study drug (N = 415) or vehicle (N = 418). On day 43, 49.8% of patients in the study group vs. 9.9% in the control group (p < 0.0001) had collarette grade 0 (0-2 collarettes). A reduction to ≤ 10 collarettes (grade 0 or 1 collarettes) was achieved in 85.1% of patients in study group vs. 28.0% in control group (p < 0.0001). The proportion of patients achieving mite eradication (60.2% vs. 16.1%, p < 0.0001) and erythema cure (24.9% vs. 7.9%, p < 0.0001) were also statistically significantly higher in the study group compared to the control group. The rates of adverse events were low in both studies, with no serious drug-related ocular adverse events reported. As many as 92% of patients rated the study drop as neutral to very comfortable.

Conclusions: Twice-daily treatment with lotilaner ophthalmic solution (0.25%) for 6 weeks demonstrated statistical significance for all outcome measures compared to the vehicle control, with low rates of adverse events and a high rate of drop comfort.

The prevailing narrative in scientific literature has long overemphasized the role of ocular axes in intraocular lens (IOL) implantation, perpetuating misconceptions that have led to unnecessary exclusions of patients. Historical assumptions, coupled with inconsistent terminology and statistical inaccuracies, have muddled clinical decision-making. This review delves into these misconceptions, offering a critical reassessment of their relevance. Drawing from a non-systematic search across PubMed, the IOLEvidence App Database, and additional sources through snowballing, the review includes diverse studies exploring the relationship between ocular axes (angles, chords, kappa, alpha, lens, …) and IOL implantation. The findings reveal widespread confusion in terminology, particularly the interchangeable use of terms like 'angles' and 'chords', and highlight device-specific variability in parameters such as Chord-mu, Chord-alpha, and Chord-lens. Despite these inconsistencies, no robust evidence supports using these measures as grounds for excluding patients from IOL procedures. Interestingly, postoperative IOL centration (Chord-iol) emerged as a more critical factor for visual outcomes than preoperative ocular axes. The evidence suggests that values for Chord-mu, Chord-alpha, and Chord-lens should prompt further evaluation of atypical cases but are not reliable exclusion criteria. Moreover, a shift in focus toward aligning the IOL slightly temporal to the vertex normal appears to optimize visual acuity and minimize photic phenomena, challenging the established paradigm of knowledge about IOL centration.

Introduction: This study aimed to compare changes in retinal oxygen saturation 1 month after femtosecond-assisted laser in situ keratomileusis (FS-LASIK) in Chinese adults with myopia using retinal oximetry.

Methods: In this prospective, observational, single-center cohort study, Chinese adults aged 18-45 years with myopia were categorized into four groups according to spherical equivalent (SE), with 66 eyes characterized as low myopia (LM -3.00D < SE ≤ -0.50D), 68 eyes as moderate myopia (MM -6.00D < SE ≤ -3.00D), 68 eyes as high myopia (HM -9.00D < SE ≤ -6.00D), and 65 eyes as super-high myopia (SHM: SE ≤ -9.00D). The following were measured before and 1 month after FS-LASIK: SE, intraocular pressure (IOP), average keratometry (Km), and axial length (AL). Other ocular biological parameters included retinal arterial oxygen saturation (SaO₂) and retinal venous oxygen saturation (SvO₂); parameter difference values are expressed as ∆.

Results: Of the 267 participants, 63.30% were female and 36.70% were male. The mean SE, AL, SaO₂, and SvO₂ were -5.93 ± 3.24 D, 26.01 ± 1.35 mm, 93.49% ± 1.67%, and 62.97% ± 4.52%, respectively. Before FS-LASIK, SaO₂ was significantly correlated with AL and SE (r_s = -0.305, P < 0.001; r_s = 0.385, P < 0.001). Significant differences were found in SaO₂ across myopia categories (P < 0.001). The changes in the retinal arterial oxygen saturation decreased significantly after FS-LASIK (F = 24.948, P < 0.001). After surgery, SaO₂ demonstrated a statistically significant but weak negative relationship with refractive correction (ΔSE) (r_s = -0.380, P < 0.001) and axial length (r_s = -0.404, P < 0.001), a significant but weak positive correlation with average keratometry cutting value (ΔKm) (r_s = 0.354, P < 0.001), and no correlation with the change in IOP (ΔIOP) (P > 0.05).

Conclusion: Ruling out the influence of refractive error, SaO₂ was significantly decreased 1 month after FS-LASIK, while there was no significant change in SvO₂. We conjecture that retinal amplification may affect differences in retinal oxygen saturation.

Introduction: This retrospective, consecutive, real-world case series assessed the efficacy and safety of third-generation trabecular micro-bypass stent implantation (iStent infinite) with phacoemulsification in patients with mild-to-moderate primary open-angle glaucoma (POAG).

Methods: Patients underwent phacoemulsification combined with implantation of iStent infinite (containing three stents) by a single U.S. glaucoma surgeon. Outcomes through 12 months included mean intraocular pressure (IOP) and medications; proportions of eyes with IOP ≤ 18 mmHg, ≤ 15 mmHg, or ≤ 12 mmHg; proportions of eyes on 0, 1, 2, or ≥ 3 topical glaucoma medications; adverse events; and secondary glaucoma procedures. Data are presented for the observed cohort of all available eyes at each time point and the consistent cohort of eyes with data at 12 months postoperative.

Results: A total of 121 eyes with mild (66.1%) or moderate (33.9%) POAG underwent iStent infinite implantation between February 2023 and June 2024. In eyes with 12-month follow-up data (n = 32), mean IOP reduced from 18.1 ± 3.3 mmHg preoperatively to 13.8 ± 3.4 mmHg at 12 months (23.8% reduction, p < 0.001), while mean number of medications reduced from 1.38 ± 0.91 to 1.06 ± 1.13 medications (23.2% reduction, p = 0.023). The proportions of eyes achieving IOP ≤ 18/15/12 mmHg increased from 53.1%/21.9%/3.1% preoperatively to 87.5%/75.0%/43.8% at 12 months, respectively (all p < 0.01). Adverse events were largely mild and transient; three eyes (< 3%) had secondary laser or micro-invasive glaucoma interventions due to IOP and/or medications above goal.

Conclusions: iStent infinite implantation with cataract surgery resulted in clinically and statistically significant IOP and medication reductions through 12 months postoperative, with favorable safety. This cohort constitutes one of the first and largest published datasets for this device in combination with cataract surgery in real-world usage.

Introduction: Persistent fetal vasculature (PFV) is a congenital anomaly associated with significant surgical challenges, including a high risk of postoperative retinal detachment (RD). This study aimed to evaluate the impact of surgical approach and axial length (AL) on RD risk and visual outcomes in pediatric PFV management.

Methods: A retrospective cohort study was conducted involving 76 eyes of 74 patients who underwent cataract surgery for PFV between 2014 and 2022. Patients were categorized by RD status postoperatively (14 with RD, 62 without RD). Key predictors, including surgical approach (corneal vs. pars plicata), AL, and age at surgery, were analyzed. The primary outcomes were RD incidence and final best-corrected visual acuity (BCVA).

Results: Compared to the pars plicata approach, the corneal approach was associated with a significantly lower risk of RD, as indicated by a multivariate odds ratio of 0.08 (95% CI 0.01-0.6, P = 0.011). A shorter AL increased the risk of RD (median 17 vs. 20 mm, P = 0.002). The RD group showed poorer visual outcomes (P < 0.001), with a 71% loss of light perception. Surgery before 3 months improved outcomes, regardless of RD. Visible ciliary processes were strongly correlated with RD (P < 0.001).

Conclusions: Corneal surgical approach and longer AL are associated with a lower RD risk in PFV cataract surgery. Early intervention and thorough preoperative assessment of the AL and ciliary processes are crucial for optimal outcomes.

Introduction: This study aims to investigate the incidence and risk factors of visual impairment and eye diseases in patients with moyamoya disease (MMD), a rare cerebrovascular disorder. Understanding these associations is crucial for improving patient management and outcomes.

Methods: This study utilized International Classification of Diseases (ICD) codes from both the 9th edition (ICD-9-CM) and 10th edition (ICD-10-CM) to define diagnoses, complications, and procedures within the National Inpatient Sample (NIS) Database. Data elements were extracted from discharge summaries. Statistical analysis was performed using IBM SPSS Statistics software version 25. Chi-square tests were employed for univariate analysis to assess the relationships between visual impairment, eye diseases, and MMD. Subsequently, multivariate logistic regression was utilized to calculate odds ratios (OR) and their corresponding 95% confidence intervals (CI) over a 10-year period to further investigate these relationships.

Results: The incidence of visual impairment and eye diseases in MMD was 3.7%. Visual impairment and eye diseases in MMD were associated with Asian or Pacific Islander race (OR = 1.538, 95% CI 1.058-2.237), self-pay insurance (OR = 1.796, 95% CI 1.503-3.061), and hospitalization in the Midwest or North Central region (OR = 1.466, 95% CI 1.035-2.076). Visual impairment and eye diseases in moyamoya disease were associated with ischemic stroke (OR = 2.001, 95% CI 1.564-2.560), hypertension (OR = 1.508, 95% CI 1.089-2.088), headache (OR = 2.834, 95% CI 1.968-4.081), migraine (OR = 2.156, 95% CI 1.544-3.011), memory loss (OR = 3.866, 95% CI 1.493-10.012), and dizziness (OR = 1.322, 95% CI 0.549-3.182).

Conclusions: Our analysis of a large, population-based sample in the US reveals a notable association between MMD and the presence of visual impairment and eye diseases.