Ophthalmology and Therapy最新文献

Introduction: This study investigates the anterior chamber (AC) inflammation in the early postoperative period after femtosecond laser-assisted cataract surgery (FLACS) in comparison to conventional phacoemulsification (CPS) by quantifying inflammatory and oxidative stress mediators in aqueous humor and correlating findings with clinical data.

Methods: In this prospective single-center study, 80 patients with cataracts were enrolled. Aqueous humor samples were collected from AC after femtosecond laser pretreatment in the FLACS group (40 patients) and at the beginning of standard cataract surgery before the primary incision was created in the CPS group (40 patients, control group). Mediators of postoperative inflammation including TNF-α, VEGF, IL-2, IL-1 β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, GM-CSF, IFN-γ, CXCL5/ENA-78, FGF-basic, G-CSF, IL-1-α, IL-1-ra, IL-17, CCL2/MCP-1, CCL3/MIP-1a, CCL4/MIP-1b, TPO, TGF-β-1, TGF-β-2 and TGF-β-3 were measured using a multiplex array system. The differences between both groups were analyzed using Mann-Whitney U test.

Results: In the FLACS group, significantly higher concentrations of IL (interleukin)-4, FGF-basic (fibroblast growth factor) and TGF-ß2 (Transforming growth factor-beta 2) were detected compared to the CPS group. Conversely, IL-10 levels were significantly higher in the CPS group than in the FLACS group.

Conclusions: FLACS triggers a distinct cytokine and growth factor profile in the aqueous humor, including elevated levels of IL-4, IL-12, FGF-basic, and TGF-β2 and a reduction in anti-inflammatory IL-10, indicating a shift toward proinflammatory and fibrotic signaling. These molecular changes may underlie immune activation and tissue remodeling not apparent in clinical examination and highlight the need for further studies to evaluate their long-term clinical relevance.

Myopia, particularly high myopia, poses a significant global public health burden. While low-concentration atropine is effective in controlling myopia progression, its conventional eye drop formulation is hampered by low bioavailability, poor patient compliance, and side effects, driving the need for advanced delivery systems. This review explores the contact lens-based drug delivery platform as a promising strategy to overcome these limitations. It synthesizes current evidence on the global myopia prevalence, atropine's pharmacology, and clinical efficacy, with a detailed analysis of the design principles for atropine-eluting lenses-encompassing material selection, drug-loading techniques, release mechanisms, and performance evaluation. The review systematically argues the superiority of this sustained-release system over traditional eye drops and discusses the remaining technical challenges, safety considerations, and future directions. We infer that integrating sustained drug delivery into a vision-correction device represents a transformative frontier in myopia management and has the potential to enhance efficacy, improve adherence, and reshape treatment paradigms.

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 characterized the prevalence of thin corneas and identified tomographic patterns following Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods: We conducted a retrospective observational study at a tertiary referral center, including 88 eyes with FECD treated by DMEK and an age- and sex-matched control group. Tomographic parameters such as central corneal thickness (CCT), pachymetric progression indices including Belin-Ambrosio D index (BAD-D), and anterior corneal asymmetry indices were analyzed using Scheimpflug imaging (Pentacam HR). Statistical analyses were performed to compare the DMEK and control groups and to examine correlations between clinical characteristics and CCT values.

Results: At 1 year, the mean CCT in the DMEK group was 525 ± 36 µm, compared with 561 ± 32 µm in healthy controls (p < 0.001). Women were much more likely than men to have thin corneas (40% vs. 3.6% with CCT below 500 µm, p < 0.001) and higher BAD-D values (2.71 vs. 1.99, p = 0.007). In multivariate analysis, baseline CCT (β = -0.001, p < 0.001), age (β = -0.001, p = 0.032), and sex (β = 0.046, p < 0.001) were the strongest predictors of percentage pachymetric reduction, indicating that thicker preoperative corneas, older patients, and women experienced greater deswelling and thinner 1-year CCT. Postoperative endothelial cell density had no impact on pachymetry outcomes.

Conclusion: Patients with FECD undergoing DMEK often present with postoperative corneal thinning, particularly among women. Although the underlying cause is not fully understood, these findings suggest a potential link between chronic preoperative corneal edema and the likelihood of stromal remodeling. Further research is required to elucidate the mechanisms underlying this thinning phenomenon.

Introduction: Diabetic macular edema (DME) imposes a substantial clinical and psychosocial burden on patients and caregivers due to frequent visits and intravitreal treatments. The fluocinolone acetonide intravitreal implant (Iluvien^®) offers sustained drug delivery for up to 3 years. We assessed its real-world impact on vision, macular anatomy, intraocular pressure (IOP), quality of life (QoL), and treatment burden, including caregiver impact.

Methods: Prospective, real-world observational study of 41 patients with previously treated DME. Assessments occurred at baseline and at 6, 12, 18, 24, and 30 months. Outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), IOP, and National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) composite scores. Burden metrics included clinic visits per year and caregiver accompaniment/absenteeism.

Results: At baseline, mean BCVA was 0.42 ± 0.30 logMAR, CMT 415.8 ± 106.5 µm, IOP 16.6 ± 4.1 mmHg, and NEI VFQ-25 67.6 ± 16.4; 46.3% of patients required caregiver accompaniment, and 61% reported pre-injection anxiety (median duration 2 days). At last follow-up, mean BCVA improved to 0.29 ± 0.26 logMAR (≈+6-7 ETDRS letters; p < 0.001), CMT decreased to 368.1 ± 79.6 µm (p = 0.002), and IOP remained stable at 16.7 ± 4.1 mmHg. The NEI VFQ-25 increased to 77.0 ± 18.0, with a significant main effect of time (repeated-measures analysis of variance (ANOVA), p = 0.001; partial η² = 0.675); improvements were evident by 6 months and sustained through 30 months (all comparisons p < 0.05). Clinic visits declined from 5.8 ± 1.6 to 3.7 ± 1.5 per year (p < 0.001).

Conclusions: In a prospective real-world setting, Iluvien was associated with durable improvements in vision, macular anatomy, and QoL, with stable IOP. Treatment reduced the frequency of clinic visits and procedures, alleviating patient burden and caregiver absenteeism. These findings support Iluvien as a patient-centered, long-acting therapy for chronic DME and motivate multicenter validation and health-economic studies that incorporate caregiver outcomes.

Introduction: The purpose of this study is to evaluate the anatomical and functional outcomes of photobiomodulation (PBM) in patients with chronic central serous chorioretinopathy (cCSC).

Methods: In this retrospective study, ten eyes from nine patients with cCSC were treated with PBM. All patients had persistent subretinal fluid (SRF) for ≥ 6 months and no history of prior laser therapy. PBM was delivered once a week for 4 weeks, then monthly for two additional months using a dual-wavelength (590 and 625 nm) protocol delivered through the eye-light® device. Anatomical and functional outcomes were assessed at baseline and 6 months through multimodal imaging and best-corrected visual acuity (BCVA).

Results: Mean patient age was 45.37 years. At 6 months, mean BCVA improved significantly from 67.12 (±4.96) to 77.87 (±7.77) ETDRS letters (p = 0.0053). SRF completely resolved in 70% of eyes, partially improved in 10%, and remained unchanged in 20%. Among five eyes with serous avascular pigment epithelial detachment (PED), two PEDs resolved, one partially regressed, and two were unchanged. No adverse events were reported.

Conclusions: PBM may be beneficial in improving retinal anatomy and visual function in cCSC, with an excellent safety profile. These findings support PBM as a promising noninvasive treatment modality in patients with cCSC. Prospective controlled trials are warranted to validate its efficacy and durability.

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: Behçet's disease (BD) frequently arises with exclusively mucocutaneous involvement, but some patients will develop major organ involvement, including ocular inflammation. This study aims to assess the patients' demographic and clinical characteristics that may be associated with the development of ocular involvement in patients with BD with exclusively mucocutaneous involvement in the early stages.

Methods: Patients' data were collected in the International AutoInflammatory Disease Alliance (AIDA) Network registry dedicated to BD.

Results: A total of 328 patients with BD were enrolled, 36 (11%) of whom developed ocular involvement over time. The following variables were significantly associated with the development of ocular inflammation at binary logistic regression: positive family history for BD (OR 4.32, 95% CI 1.16-14.72, p = 0.02), Arab ethnicity (OR 3.6, 95% CI 1.3-9.9, p = 0.01), presence of major oral aphthous ulceration (OR 3.26, 95% CI 1.18-8.99, p = 0.02), pseudofolliculitis plus erythema nodosum (OR 4.58, 95% CI 1.33-15.7, p = 0.016); conversely, white patients/patients of European descent (OR 0.33, 95% CI 0.12-0.91, p = 0.03) and the presence of a low number (one to two) ulcers at genital aphthous flares (OR 0.002, 95% CI ~ 0-0.07, p = 0.0006) were protective against the occurrence of ocular inflammatory manifestations. Genital aphthosis with more than five concurrent ulcers was associated with eye involvement in Arab patients (OR 209.2, 95% CI 5.8-7497, p = 0.003).

Conclusions: Major oral aphthosis, genital aphthous attacks with more than five concurrent ulcers, erythema nodosum coexisting with pseudofolliculitis, a positive family history of BD, and Arab ethnicity are associated with a higher risk of ocular involvement when BD arises with the sole mucocutaneous involvement.