Ophthalmology and Therapy最新文献

Introduction: This study aimed to apply a deep learning-based artificial intelligence (AI) system for quantitative analysis of retinal vascular morphology in patients with circumscribed choroidal hemangioma (CCH), and to explore differences based on lesion location.

Methods: This retrospective case-control study included 45 treatment-naive CCH eyes and their contralateral healthy eyes as controls, recruited from 45 patients (mean age: 44.91 ± 11.98 years; 10 female patients). Retinal photographs were analyzed using AI software to extract vascular parameters, including vessel density, caliber, tortuosity, and fractal dimension. Inter-group comparisons and conditional logistic regression were conducted. Subgroup analysis was performed based on the lesion's position relative to the optic disc.

Results: Compared with controls, CCH eyes showed significantly reduced vascular density (p < 0.005) within 3 mm and 5 mm of the fovea. Venular caliber was significantly increased across multiple concentric zones (1.0-2.5 papillary diameter, PD), while arteriole-to-venule ratio (AVR) was decreased (p < 0.001). Tortuosity and fractal dimension of both arterioles and venules were significantly reduced (all p < 0.05). Logistic regression confirmed vessel caliber (p = 0.001), AVR (p = 0.001), tortuosity (p = 0.006), and fractal dimension (p = 0.004) as significant parameters associated with CCH. Lesions within 1.0 PD of the optic disc were linked to lower arteriolar caliber and AVR (p < 0.05).

Conclusion: Retinal vascular morphological alterations are evident in CCH and vary with lesion location. Key parameters, such as vascular density, venular caliber, AVR, and fractal dimension, may serve as potential imaging biomarkers for evaluating and monitoring CCH-related retinal changes.

Introduction: To compare the U.S. Food and Drug Administration (FDA) premarket approval (PMA) trials of topography-guided laser in situ keratomileusis (TG-LASIK) and ray tracing-guided LASIK (RT-LASIK) for the treatment of myopia and myopic astigmatism.

Methods: This comparative study was conducted between TG-LASIK (P020050/S012; Alcon Laboratories, Inc., Fort Worth, TX, USA) with Allegretto Wave Eye-Q laser and topography-guided custom ablation treatment planning software, and "WaveLight Plus" RT-LASIK (P020050/S043; Alcon Laboratories, Inc.) using the WaveLight EX500 excimer laser and InnovEyes Sightmap. Clinical outcomes were compared, including visual and refractive measures, astigmatic correction, mesopic contrast sensitivity, higher-order aberrations, and patient-reported outcomes.

Results: This analysis included 249 eyes (212 patients) that underwent TG-LASIK and 336 eyes (168 patients) that underwent RT-LASIK. At 12 months, uncorrected distance visual acuity of 20/16 or better (64.8% TG-LASIK vs. 70.2% RT-LASIK) and 20/20 or better (92.6% TG-LASIK vs. 94.4% RT-LASIK) did not differ statistically between platforms. However, more TG-LASIK eyes had 20/10 or better (15.7% vs. 2.5%, P < 0.001) and 20/12.5 or better (34.4% vs. 26.4%, P = 0.044) than RT-LASIK eyes. Both platforms demonstrated comparable refractive predictability and stability (P > 0.05). For preoperative cylinder between - 1.00 to - 4.00 D, RT-LASIK showed greater astigmatic overcorrection (P < 0.05). At 3 months, RT-LASIK showed higher mesopic contrast sensitivity at 3, 6, and 12 cycles per degree under glare, with more eyes achieving clinically significant gains compared to TG-LASIK (P < 0.001). Both platforms induced changes in total higher-order aberrations, although not clinically significant. RT-LASIK also reduced spherical aberration from baseline. Both procedures showed a reduction in symptom severity for glare, halos, starburst, double vision, and dry eye.

Conclusions: While TG-LASIK showed superior visual acuity outcomes, RT-LASIK was associated with higher contrast sensitivity; however, both platforms demonstrate excellent visual and refractive outcomes. The majority of published studies are consistent with FDA PMA trends, showing potential reductions in spherical aberration and higher rates of 20/20 or better visual acuity with RT-LASIK.

Introduction: Thyroid eye disease (TED) is a rare, autoimmune, orbital inflammatory disorder that is disfiguring, debilitating, and potentially sight-threatening. There is an unmet need for a fast-acting, durable, systemic disease-modifying therapy in active TED, for which current options are associated with relapses and side effects, and for chronic inactive TED, which is largely managed with surgery. Satralizumab is a recombinant humanized anti-interleukin-6 receptor (IL-6R) monoclonal antibody that prevents IL-6 from binding to its receptor, thereby reducing proinflammatory and profibrotic signaling. The SatraGO-1 and SatraGO-2 trials evaluated the efficacy, safety, pharmacokinetics, and pharmacodynamics of satralizumab in participants with active, moderate-to-severe, and chronic inactive TED.

Methods: SatraGO-1 and SatraGO-2 were two identically designed, 72-week, double-masked, placebo-controlled, multicenter, two-stage randomization, phase 3 trials in adults with active, moderate‑to‑severe TED or chronic inactive TED. Participants were randomized 1:1 to receive satralizumab or matching placebo. Based on the proptosis response assessed at week 24, nonresponders received satralizumab every 4 weeks (Q4W), while responders were rerandomized in a 1:1 ratio to receive satralizumab or placebo Q4W through week 44. The primary end point was the proportion of participants with active, moderate-to-severe TED who achieved ≥ 2-mm reduction in proptosis in the study eye from baseline at week 24.

Results: SatraGO-1 and SatraGO-2 enrolled 131 and 127 participants, respectively.

Conclusions: The SatraGO-1 and SatraGO-2 trials investigated IL-6R inhibition via satralizumab in TED. Satralizumab offers a potential disease-modifying treatment option for TED while minimizing safety risks associated with current treatments.

Trial registration: SatraGO-1 (NCT05987423) and SatraGO-2 (NCT06106828).

Introduction: Short-term side effects often hinder the adoption of low-dose atropine in myopia management. Evidence from long-term observations and guidance on optimal dosing frequency is needed to inform clinical practice. This study aims to evaluate the effects of 0.05% atropine on near-work-related effects, accommodation, and binocular vision over 1 year of treatment.

Methods: Chinese children with myopia (aged from 6 to 14 years, cycloplegic spherical equivalent ≤ -1.00 D in both eyes) were enrolled between March 2021 and August 2023 at Changsha Aier Eye Hospital. Participants were randomly assigned to three regimen groups of 0.05% atropine: once daily (Qd), twice per week (Tw), and once per week (Qw) groups. Reported visual quality related side effects, the change of near work parameters, including visual acuity, reading distance, accommodation and binocular vision under the use of 0.05% atropine during 12 months were the main study outcomes.

Results: A total of 205 children were included in the study, 76 in Qd group, 70 in Tw group, and 59 in Qw group. Self-reported side-effects remained low in all groups, but showed frequency dependence. No cases of strabismus were reported or diagnosed. The most complaint side-effect was photophobia and blur at near (7.9% and 7.9%) at week 2 in Qd group, and both dropped to 3.9% at month 12. Pupil size under both photopic and mosopic, and viewing distance when reading consistently enlarged compared with baseline. All groups showed short-term changes in accommodation, and binocular vision, but gradually returned to baseline level by month 12. Mean (SE) of accommodation convergence to accommodation ratio (AC/A) in Qd group was 5.13(0.15), 5.82(0.16), 5.33(0.17), 5.22(0.17) Δ/D at baseline, week 2, month 6, and month 12, respectively; 5.09(0.16), 5.48(0.19), 5.42(0.19), 5.22(0.16) Δ/D in Tw group; and 4.90(0.19), 5.32(0.20), 5.17(0.19), 5.17(0.18) Δ/D in Qw group.

Conclusions: Long-term use of 0.05% atropine appears to be safe in children with myopia. Although short-term visual function changes and side effects were associated with higher dosing frequency, these effects were largely transient and resolved over time.

Introduction: Accurate ophthalmic imaging reports, including fundus fluorescein angiography (FFA) and ocular B-scan ultrasound, are essential for effective clinical decision-making. The current process, involving drafting by residents followed by review by ophthalmic technicians and ophthalmologists, is time-consuming and prone to errors. This study evaluates the effectiveness of ChatGPT-4o in auditing errors in FFA and ocular B-scan reports and assesses its potential to reduce time and costs within the reporting workflow.

Methods: Preliminary 100 FFA and 80 ocular B-scan reports drafted by residents were analyzed using GPT-4o to identify the errors in identifying left or right eye and incorrect anatomical descriptions. The accuracy of GPT-4o was compared to retinal specialists, general ophthalmologists, and ophthalmic technicians. Additionally, a cost-effective analysis was conducted to estimate time and cost savings from integrating GPT-4o into the reporting process. A pilot real-world validation with 20 erroneous reports was also performed between GPT-4o and human reviewers.

Results: GPT-4o demonstrated a detection rate of 79.0% (158 of 200; 95% CI 73.0-85.0) across all examinations, which was comparable to the average detection performance of general ophthalmologists (78.0% [155 of 200; 95% CI 72.0-83.0]; P ≥ 0.09). Integration of GPT-4o reduced the average report review time by 86%, completing 180 ophthalmic reports in approximately 0.27 h compared to 2.17-3.19 h by human ophthalmologists. Additionally, compared to human reviewers, GPT-4o lowered the cost from $0.21 to $0.03 per report (savings of $0.18). In the real-world evaluation, GPT-4o detected 18 of 20 errors with no false positives, compared to 95-100% by human reviewers.

Conclusions: GPT-4o effectively enhances the accuracy of ophthalmic imaging reports by identifying and correcting common errors. Its implementation can potentially alleviate the workload of ophthalmologists, streamline the reporting process, and reduce associated costs, thereby improving overall clinical workflow and patient outcomes.

Introduction: Diabetic retinopathy (DR) often causes vision loss and functional impairment. Standard low vision rehabilitation improves visual function but many patients cannot access it because of cost, travel, and limited specialist availability. We aimed to compare a home-based digital vision rehabilitation program to standard in-clinic rehabilitation in patients with DR.

Methods: We conducted a retrospective matched cohort study at a tertiary eye center in China. Adults with moderate to severe visual impairment from DR were included. A total of 380 patients were analyzed after 1:1 propensity score matching (190 per group). One group underwent a 12-week home-based digital physiotherapeutic vision training program delivered via a mobile app with daily exercises and weekly telehealth supervision, while the other group received standard in-person low vision rehabilitation over 12 weeks. The primary outcome was change in visual functional status measured by the Veterans Affairs Low-Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes included visual acuity, vision-related quality of life, depressive symptoms, mobility, metabolic control, and cost. Outcomes were assessed at baseline, 12, 24, and 48 weeks.

Results: Both the home-based digital training and standard in-clinic rehabilitation groups achieved substantial improvements in vision-specific functional status over 48 weeks. VFQ-48 scores increased by 22-26 points in each group, indicating clinically meaningful gains, and the digital program's improvement was comparable to standard care (demonstrating non-inferiority for the primary outcome). All secondary outcomes improved comparably in both groups, with no significant between-group differences. The digital intervention cost 7791 Chinese yuan (CNY) per patient over 48 weeks compared to 10,305 CNY with standard care, providing a net savings of 2514 CNY per patient. Both approaches were well tolerated, with no major safety concerns.

Conclusions: Home-based digital rehabilitation was non-inferior to standard in-clinic rehabilitation in improving functional vision, while substantially reducing costs and maintaining safety. These findings support implementing home-based or hybrid telerehabilitation models to broaden access to vision rehabilitation services.

Level of evidence: Level III retrospective cohort study.

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition. As an ophthalmologist, having ADHD presents both unique opportunities and considerable challenges, with eye institutions such as the Royal College of Ophthalmologists and the General Medical Council recognizing having ADHD as a protected characteristic. In light of a significant lack of literature specific to ophthalmologists with ADHD, this commentary is written by an expert multidisciplinary panel of ophthalmologists, psychologists and pharmacists, drawing upon evidence from wider medical literature and applied to the field of ophthalmology. ADHD traits can have an important impact, both positive and negative, on ophthalmologists' professional functioning. Creativity, visual-spatial intelligence, the ability to hyperfocus, and intuitive pattern recognition are all powerful skills for a successful microsurgeon. Skills such as adaptability and lateral problem-solving also help with innovation and research in the field. Additionally, having a diverse workforce enhances patient engagement and rapport, and is optimal for serving a diverse population. However, there are specific features of the ophthalmic environment which can be challenging, such as sensory overload or rapid turnover of clinical tasks, while self-regulation difficulties, including time and task management, may impact clinical efficiency, organization, and personal professional development. Other ADHD features such as emotional dysregulation, rejection sensitivity, and "masking" behaviours increase the risk of burnout and having ADHD is associated with a higher risk of having mental health conditions. Targeted adjustments and strategies such as flexible work patterns, personalized action plans, targeted coaching, and improved awareness education for supervisors and colleagues can mitigate these barriers and maximize performance and wellbeing in ophthalmologists with ADHD. This is an important and underrecognized area that would benefit from a body of research to inform specific individual and institutional recommendations for supporting and maximizing the potential of ophthalmologists with ADHD.

Introduction: This study aims to evaluate the short-term safety and efficacy of the Loong Crystal^®PR lens, a novel posterior chamber phakic intraocular lens (PIOL) that utilizes advanced optical and material designs.

Methods: The single-center retrospective case series included 67 eyes of 34 patients with moderate and high myopia who underwent the PR implantation from February to July 2025. Corrected distant visual acuity (CDVA) and anterior chamber depth (ACD) were measured preoperatively. Uncorrected distant visual acuity (UDVA), refractive errors, higher-order aberrations (HOAs), intraocular pressure (IOP), and endothelial cell density (ECD) were measured preoperatively, at 1 week, and at 1 month postoperatively. The central and peripheral vault were measured on the operating day, at 1 week, and at 1 month after surgery.

Results: At 1 month postoperatively, 95.5% of eyes achieved UDVA equal to or better than the preoperative CDVA. The efficacy index was 1.17 ± 0.19 at 1 month postoperatively. Also, 94.0% of eyes achieved UDVA of 20/20 or better and 94.0% of eyes had residual spherical equivalent (SE) refraction within ± 1.00 D at 1 month postoperatively, demonstrating excellent visual outcomes and refractive predictability. No significant difference in ECD was observed 1 month postoperatively (3118.27 ± 180.95 cells/mm²) compared to the preoperative value (3081.12 ± 288.08 cells/mm²). Stable central and peripheral vaults remained at 376.27 ± 168.95 μm and 485.72 ± 179.62 μm, at postoperative 1 month, respectively, compared to the surgery-day values of 373.51 ± 182.41 μm and 486.24 ± 172.41 μm, respectively. There were no significant differences of HOAs at postoperative 1 month compared to the preoperative outcomes.

Conclusions: The Loong Crystal^® PR lens demonstrates good, predictable efficacy and stability in correcting myopia, with a low risk of adverse events and complications at 1 month postoperatively, indicating its short-term safety and efficacy.

Introduction: Pediatric patients with noninfectious uveitis refractory to standard therapies have limited options. Efficacy and safety of systemic tacrolimus, a calcineurin inhibitor used successfully in adult noninfectious uveitis as an adjuvant immunomodulatory treatment, was investigated in the pediatric population at our institution.

Methods: This was a retrospective chart review of patients ≤ 18 years old diagnosed with noninfectious uveitis who were intolerant to or failed conventional systemic immunosuppressants between January 2014 and June 2025 at a tertiary referral center. The primary outcome was treatment success, defined as two or more of the following: ≤ 0.5+ anterior chamber cell, ≤ 2 drops of topical steroids per day per eye, improvement or resolution of vitritis, macular edema, papillitis, and angiographic leakage without addition of systemic therapy at 6 and 12 months after tacrolimus initiation. Secondary outcomes included need for dose reduction or discontinuation owing to adverse effects. Descriptive statistics were used to analyze the data.

Results: Data from 11 patients, with median age of 10 years, were analyzed. Treatment success was achieved in 88.9% and 63.6% of patients at 6 and 12 months, respectively. Although seven patients experienced laboratory abnormalities, tacrolimus was not discontinued. An average tacrolimus dose of 0.16 mg/kg/day divided every 12 h achieved therapeutic tacrolimus levels. Median duration (range) of tacrolimus therapy was 24 months (4-93 months).

Conclusions: Tacrolimus may potentially be a well-tolerated, safe, and effective option for refractory cases of pediatric noninfectious uveitis.

Introduction: This study aimed to evaluate choroidal nevi (CN) volume as assessed by widefield optical coherence tomography (WF-OCT) and by ultrasound (US)-based mathematical approximations.

Methods: In a prospective, exploratory study, CN of consecutive patients were imaged with WF-OCT (VG 200D, Intalight Inc., San Jose, California, USA) and US (Quantel Absolu, Cournon, D'Auvergne Cedex, France). Volume was assessed by CN annotation on 64 B-scans on WF-OCT and two approximations based on US measurements (thickness, largest and perpendicular basal diameter (LBD; PBD)): (a) π/6 × thickness × LBD × PBD and (b) 2π/3 × [(LBD + PBD)/4]² × thickness.

Results: Eighteen nevi of 18 patients were included in the study. Mean volume evaluated on WF-OCT was 15.1 ± 24.1 mm³. US approximations resulted in (a) 23.0 ± 35.0 mm³ and (b) 23.5 ± 35.5 mm³. Intraclass correlation coefficients showed very good agreement between WF-OCT and US measurements (a) of 0.947 (CI 0.860-0.980) and (b) of 0.945 (CI 0.853-0.979). Stepwise backward elimination multivariable linear regression showed an association between difference of volume measurements and lesion thickness and LBD for approximations (a) and (b).

Conclusion: WF-OCT and US-based approximations show good interdevice reliability for CN volume in this exploratory study. Thickness and LBD have significant impact on discrepancy of volume measurements with a tendency that small CN are underestimated and large CN are overestimated with US. This potentially limits interchangeable use of US and WF-OCT.