Ophthalmology and Therapy最新文献

Introduction: This study investigated the effectiveness, repeatability, and safety of retreatments with micropulse transscleral cyclophotocoagulation (MP-TSCPC).

Methods: A retrospective cohort study was conducted on 76 eyes of patients with glaucoma who underwent standardized MP-TSCPC at the University Eye Clinic Maastricht between November 2016 and February 2019. Patients with at least one retreatment and a follow-up of 6 months or more were included and divided into four groups on the basis of their response to the primary treatment: nonresponder (NR), early attrition (EA), late attrition (LA), and enhancement (EH). Intraocular pressure (IOP) and IOP lowering medication use were recorded, and complications were assessed. Treatment success was defined as an IOP reduction of ≥ 20% compared with baseline or a decrease in the number of IOP-lowering medications with stable target IOP.

Results: Three months after retreatment, the NR, EA, LA, and EH groups experienced significant IOP reductions of 24.7%, 35.3%, 24.7%, and 28.2%, respectively. Significant medication reduction was observed only in the EH group. At the last follow-up, treatment success was achieved in 39.4% (NR), 33.3% (EA), 41.7% (LA), and 60.0% (EH) of the patients. Among patients receiving a second retreatment, the EH group demonstrated the most favorable and sustained outcomes. Early postoperative complications after retreatment (5.26%) were mild and reversible. A late complication of persistent hypotony developed in one patient (1.3%). Additional glaucoma surgery was required in 28.9% of the eyes.

Conclusions: Retreatment with micropulse TSCPC is a safe and effective option for (further) lowering IOP in patients with glaucoma. Especially patients who responded well to the primary treatment and patients who initially showed a good response but in whom the effect of the primary treatment has worn off have shown to be good candidates for retreatment. Repeatability and treatment success are most evident in initial responders and the primary benefit of retreatment is IOP reduction, with a less consistent effect on reducing IOP lowering medications.

Introduction: To report the 1-year efficacy of Myofix Defocus spectacles, designed to control the progression of myopia in childhood.

Methods: A total of 47 children with myopia aged 7-15 years were enrolled. Cycloplegic objective refraction (spherical equivalent refraction, SE) and axial length (AL) were measured at baseline, 6 months, and 12 months. Linear regression models were used to identify risk factors of 12-month changes in SE and AL. For comparison, two virtual control groups of children were included. Tolerance was assessed through a questionnaire at each follow-up visit.

Results: Of the initial cohort, 11 participants were lost to follow-up after 6 months due to reasons unrelated to lens design (77.1% retention rate). Over 12 months, the mean SE change in all eyes was - 0.21 ± 0.30 D, and AL change was 0.19 ± 0.13 mm. Progression was significantly different in participants who reported good compared to poor compliance (p < 0.001). At the 12-month follow-up, participants with good compliance had a mean SE progression of - 0.12 ± 0.25 D and a mean AL change of 0.17 ± 0.11 mm. In virtual controls, the mean annual SE progression was - 0.47 ± 0.36 D, and AL change was 0.26 ± 0.17 mm (both p < 0.001). In compliant participants, Myofix Defocus lens demonstrated a 75% reduction in SE and 37% reduction in AL compared to virtual controls.

Conclusions: After 1 year, Myofix Defocus spectacles slowed myopia progression in children, demonstrating comparable efficacy to other defocus-incorporated spectacle designs. Greater compliance resulted in better treatment effect. Further long-term studies are warranted to confirm these findings.

Trial registration: ClinicalTrials.gov identifier: NCT07092072. Registered retrospectively on July 29, 2025.

Introduction: Anti-vascular endothelial growth factor (VEGF) therapy suppresses neovascularization in neovascular age-related macular degeneration (nAMD) but may reduce ocular blood flow. However, its relationship with choroidal thickness remains unclear. This study evaluated 1-month outcomes after switching from intravitreal aflibercept or ranibizumab to intravitreal brolucizumab (IVBr) in patients with refractory nAMD.

Methods: This prospective, single-center study included 50 eyes of 50 patients with nAMD. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choroidal stromal area (SA), choroidal luminal area (LA), optic nerve head (ONH) mean blur rate (MBR), and choroidal (CHOR) MBR were evaluated before and 1 month after switching to IVBr, with blood flow measured using laser speckle flowgraphy. Univariate analyses were performed to identify potential predictors of changes in CHOR-MBR, and variables with P < 0.1 were entered into a multiple regression model.

Results: BCVA was maintained. CRT decreased from 371.6 ± 118.7 to 288.8 ± 89.7 µm (P < 0.001). SFCT decreased from 231.9 ± 118.7 to 196.0 ± 117.4 µm (P < 0.001). CVI showed no significant changes, while SA and LA exhibited significant reductions. ONH-MBR and CHOR-MBR decreased (P = 0.004 and P < 0.001, respectively). The baseline SFCT was the only significant predictor of change in CHOR-MBR. Older age correlated with thinner baseline SFCT and a greater decrease in CHOR-MBR.

Conclusions: IVBr is associated with significant reductions in CRT and SFCT and may decrease choroidal blood flow, particularly in older patients and those with thinner SFCTs.

Trial registration: UMIN-CTR Registration ID, UMIN000041382.

Introduction: This work aims to monitor the stability of composite descriptors of uncorrected distance (UCDVA), intermediate (UCIVA), and near (UCNVA) logMAR acuities after uneventful phacoemulsification and presbyopia correcting intra-ocular lenses (PCIOLs) implantation.

Methods: Patients implanted with AcrySof IQ PanOptix (group 1, n = 32), TECNIS Symfony (group 2, n = 35), TECNIS bifocal (group 3, n = 34), or TECNIS monofocal (comparative, group 4, n = 32) were followed up for 12 months. In each case, the errors in the composite descriptor of [I] UCDVA and UCNVA doublets (EDN = √[(UCDVA)² + (UCNVA)²]) and [II] UCDVA, UCIVA and UCNVA triplets (EDIN = √[(UCDVA)² + (UCIVA)² + (UCNVA)²]) were monitored for targeted postoperative uncorrected logMAR acuities of zero. EDN and EDIN values were subjected to 2D and 3D graphical treatments to identify the absolute changes (ΔEDN and ΔEDIN) occurring between 1 week and 1 month, 1 and 6 months, and 6 and 12 months.

Results: There were small changes in residual refractive errors, UCDVA, UCIVA, UCNVA, EDN, EDIN, ΔEDN, and ΔEDIN values within, or between, groups 1-3. In groups 1 to 4, respectively. (i) Between 1 week and 1 month postop, the mean (± SD, 95% CI) ΔEDN values were 0.03 (± 0.05, 0.01-0.05), 0.05 (± 0.08, 0.02-0.08), 0.04 (± 0.07, 0.02-0.06), 0.19 (± 0.14, 0.14-0.24) and the ΔEDIN values were 0.04 (± 0.06, 0.01-0.05), 0.06 (± 0.10, 0.03-0.09), 0.04 (± 0.08, 0.01-0.07), 0.23 (± 0.14, 0.18-0.28). Differences were significant (one-way ANOVA for ΔEDN, F = 20.65, p < 0.001; for ΔEDIN, F = 25.03, p < 0.001), but not after excluding group 4. (ii) Between 6 and 12 months, postop ΔEDIN values > 0.1 logMAR occurred in 3 (10%), 6 (17%), 4 (12%), and 1 (3%) of cases.

Conclusions: The changes in uncorrected distance, intermediate, and near visual acuities were small and remained relatively stable 1 week following implantation with PCIOLs. Fewer than 20% of cases experienced a change in composite description of acuities > 0.1 logMAR between 6 and 12 months postop.

Trial registration: ClinicalTrials.gov identifier: NCT07008768.

Diabetic macular edema (DME; diabetic macular oedma in some countries), which can be associated with diabetic retinopathy, is characterized by macular thickening and accumulation of pathologic fluid in the portion of the retina responsible for central vision. DME is a leading cause of vision loss in individuals with diabetes and can severely impact their daily activities and quality of life. Standard DME treatment involves intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents, and some patients receive laser photocoagulation and/or intravitreal corticosteroid injections. Anti-VEGF injections can pose considerable burdens for patients and caregivers, with the need for frequent injections and face-to-face clinic appointments, and have limited effectiveness or durability in some patients. To highlight challenges for patients with current treatment options and support a basis for research on new treatments, two people with DME and two expert physicians collaborated on this patient-led manuscript. Together, they explored the real-world experiences and perspectives of the patient authors and reviewed the relevant DME literature. Many of the experiences with current injectable DME treatments of our patient authors and other patients they know aligned with the literature. They noted the benefits of face-to-face clinician contact for injections and the substantial burdens associated with appointments, difficulties caused by comorbid eye conditions, pain and anxiety related to injections, treatment effectiveness limitations, and the need for novel therapies. These insights and perspectives will enable patients and clinicians to better understand current challenges around injectable anti-VEGF treatments in DME, how future developments might address patients' treatment needs, and how best to support patients with DME receiving anti-VEGF treatment to minimize its impact and burdens.

Introduction: This study aimed to assess the in vivo positioning, tilt, and decentration of the second-generation implantable miniature telescope (SING-IMT™; Samsara Vision, Inc., Far Hills, NJ, USA) using swept-source anterior segment optical coherence tomography (AS-OCT).

Methods: This was a multicentric retrospective observational study conducted at two tertiary referral centers (Palagi Hospital, Florence, Italy, and Royal Victoria Infirmary Hospital, Newcastle upon Tyne, UK). Eleven eyes from 11 patients with end-stage age-related macular degeneration (AMD) underwent secondary SING IMT™ implantation at these two tertiary centers. Using high-resolution AS-OCT (CASIA2 system [Tomey, Nagoya, Japan] and Anterion system [Heidelberg Engineering, Heidelberg, Germany]), telescope alignment was assessed after 12 months. Decentration and tilt were calculated and reported in both Cartesian and polar coordinates. Telescope configuration relative to the iris plane and corneal-telescope (C-T) distance and endothelial cell count was also evaluated.

Results: The mean (± standard deviation) follow-up was 15.7 ± 2.8 months. The mean decentration was 0.33 ± 0.12 mm, with a predominant superior and nasal displacement. Mean tilt was 3.28 ± 1.31°, oriented mainly in the supero-temporal direction. Three positional configurations were observed: anterior to the iris plane (36.4%), at the iris plane (36.4%), and posterior to the iris plane (27.3%). The mean C-T distance was 2.71 ± 0.48 mm. Mean endothelial cell loss at 12 months was 13.21% ± 3.57%.

Conclusions: After 12 months of follow-up, the SING IMT™ maintained stable in-the-bag fixation, with tilt and decentration values within the ranges previously reported for conventional in-the-bag intraocular lenses.

The purpose of this manuscript is to report the state-of-the-art advances and consensus proposed by an Italian Dry Eye Consensus Group (IDEC) for the diagnosis of dry eye disease (DED). A targeted review of the literature was carried out, not intended as a meta-analysis or systematic review, but as a selection of authoritative evidence-based guidelines and consensus papers issued by scientific societies or expert panels, which provided the basis for structured group discussion. The diagnostic criteria reported in these publications were organized in tables with a subdivision into levels, from basic to more complex tests, and were discussed in light of both the published data and daily clinical experience. The IDEC consensus highlights a pragmatic, stepwise diagnostic workflow: careful documentation of symptoms (using validated questionnaires where possible), identification of risk factors, slit-lamp assessment with vital stains (fluorescein and lissamine green), and measurement of tear film stability by tear break-up time (TBUT)-or by noninvasive TBUT measurement (NIBUT) where available, and corneal sensitivity-represent the minimum cost-effective core set. A series of second-level targeted tests can then be selectively applied to refine the diagnosis, including corneal sensitivity, osmolarity, meibography, Schirmer I test or meniscometry, and ocular surface imaging. The group also discussed the potential role of all-in-one high-tech devices and digital tools (e.g., smartphone-based applications) as these become more accessible. Grounded in real-life clinical experience, the IDEC consensus offers a pragmatic and cost-effective diagnostic workflow that complements international guidelines and can be readily applied in daily practice.

Subepithelial corneal haze remains a clinical risk after excimer laser-based surface ablation (ELSA), especially with deep ablations, high myopia or retreatments, with downstream effects on vision and quality of life. Mitomycin C (MMC) is widely used intraoperatively for haze prophylaxis and has multi-study support; however, its antiproliferative, anti-fibrotic action does not directly address early inflammation, epithelial barrier restoration or neuroregeneration, and use remains off-label with heterogeneous protocols. This narrative review synthesises preclinical, early clinical (non-randomised/small trials) and established clinical evidence (randomised trials/systematic reviews or guidelines) on amniotic membrane transplantation (AMT) as a complementary adjunct in ELSA. We emphasise modern, sutureless, dehydrated AMT (dAM), including vision-preserving formats suited to peri-operative workflows. Across adjacent ocular-surface indications, AMT demonstrates multi-modal properties: anti-inflammatory/immunomodulatory, antioxidant, anti-proteinase (including matrix metalloproteinase-9 suppression) and support of epithelial and nerve recovery. In ELSA-specific work, preclinical photorefractive keratectomy (PRK) models show reduced haze and faster epithelialisation with patch-AMT; one prospective laser-assisted sub-epithelial keratectomy (LASEK) human study reports faster healing and lower opacity versus standard care. By contrast, small fellow-eye studies using ring-mounted cryopreserved-AMT devices showed no superiority for routine myopic PRK, underscoring the importance of format and protocol. This review outlines a complementary paradigm: MMC targets downstream fibrosis, whilst patch-AMT acts earlier on inflammation, epithelial repair, protease imbalance (including MMP-9) and neurotrophic support. With major international guidelines now recognising sutureless patch-AMT for regeneration and inflammation/oxidative stress control in dry eye, prospective refractive-cohort trials with standardised product/placement protocols, long-term follow-up, patient-reported outcomes and embedded health-economic evaluation are warranted to define AMT's role alongside MMC in routine ELSA.

Introduction: This work compares the tolerability of 0.6% povidone-iodine (PI) and 0.5% liposomal ozonated oil (LOZ) as antiseptic prophylaxis in patients undergoing intravitreal injections (IVI), aiming to optimize preventive strategies against injection-related endophthalmitis.

Methods: This multicenter cohort study was conducted at the University Paris Est, Créteil, and the University of Trieste between November 2024 and June 2025. A total of 691 patients with maculopathies (329 in the PI group, 362 in the LOZ group) were enrolled. Patients received either 0.6% PI or 0.5% OZ topical prophylaxis three times daily for 3 days before and after IVI. Clinical tolerability was assessed by slit-lamp examination, grading conjunctival hyperemia, discharge, tarsal papillae, corneal changes, burning, and foreign body sensation (0-4 scale). Patient-reported discomfort was evaluated using a Visual Analogue Scale (VAS), classified into four categories: 0-10 mm (score 0), 11-40 mm (score 1), 41-70 mm (score 2), and 71-100 mm (score 3). Statistical analyses included generalized linear models adjusted for dry eye and prostaglandin therapy.

Results: LOZ treatment was associated with significantly lower mean scores for hyperemia (0.52 vs. 1.51), discharge (0.15 vs. 0.91), tarsal papillae (0.02 vs. 0.57), corneal changes (0.04 vs. 0.58), burning (0.25 vs. 1.69), and foreign body sensation (0.21 vs. 1.58) compared to 0.6% PI (all p < 0.001). VAS scores confirmed superior tolerability in the LOZ group (mean 0.23 vs. 1.58). No cases of endophthalmitis occurred in either group.

Conclusions: LOZ (0.5%) represents an ophthalmic antiseptic that addresses the limitations of traditional povidone-iodine preparations, suggesting it may represent a more patient-friendly prophylactic alternative for IVI.

Introduction: The aim of this work is to predict the implantable Collamer lens (ICL) vault using machine learning (ML) algorithms and a data wrangling approach based on multicenter big data.

Methods: This retrospective cross-sectional study developed ML models using preoperative biometric data and ICL vault from 6715 eyes across five hospitals. Mutual information regression was employed to identify important parameters. A digital vault information system (DVIS) was constructed for data wrangling. ML models integrated with DVIS were used to develop ICL vault prediction and classification models, which were validated in both internal (6552 eyes) and external (163 eyes) validation.

Results: The XGBoost model combined with DVIS exhibited statistically superior performance in ICL vault prediction, with lower mean absolute error (MAE) of 39.15 μm (internal validation) and 149.72 μm (external validation) compared to other ML algorithms. The R² value was 0.86 in the internal validation. For ICL vault classification, the XGBoost algorithm achieved accuracies of 81.4% (internal validation) and 57.27% (external validation), representing accuracy gains of 27.1% and 10.2% respectively, compared to traditional ML algorithms.

Conclusions: The development of DVIS is valuable for ICL vault prediction models, as it provides a data wrangling strategy that improves ML efficiency. Experimental results confirm the applicability of this synergistic method in enhancing existing ML approaches for ICL vault prediction, thereby facilitating more informed clinical decision-making in ICL implantation surgery.