Ophthalmology and Therapy最新文献

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.

Introduction: To develop prediction models for retinopathy of prematurity (ROP) recurrence after initial intravitreal injection of ranibizumab (IVR) or laser photocoagulation (LP).

Methods: This multicenter retrospective cohort study included infants with aggressive posterior ROP (AP-ROP) and type-I ROP. Recurrence was defined as the reappearance of vascular dilation, tortuosity, or new/recurrent neo-vascularization in either eye of infants. The recurrence rates within 6 months after initial treatment were compared. Machine learning (i.e., extreme gradient boost, categorical boost, adaptive boost, and random forest) and multivariable logistic regression were performed to identify risk factors and establish individualized prediction models for ROP recurrence. Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to evaluate the performance of the prediction models.

Results: A total of 440 infants were included, with a mean gestational age (standard deviation [SD]) of 28.2 (2.4) weeks and birth weight (SD) of 1.1 (0.4) kg. ROP recurrence occurred in 62 of 344 (18.0%) infants after IVR treatment, while 7 of 96 (7.3%) infants after LP treatment required additional treatment (P < 0.05). Neonatal pneumonia, respiratory distress, septicemia, 5-min Apgar scoring, AP-ROP, and maternal uterine infection were significantly associated with the risk of ROP recurrence (all P < 0.05). The Categorical Boost model achieved the best overall performance. The mean AUC, accuracy, sensitivity, and specificity were 0.96 (95% confidence interval [CI] 0.93-0.99), 85.9% (95% CI 80.3-91.5%), 94.7% (95% CI 89.6-99.8%), and 77.0% (95% CI 67.4-86.6%) on the validation dataset, and 0.94 (95% CI 0.89-1.00), 84.1% (95% CI 77.1-93.2%), 95.5% (95% CI 89.8-100%), and 72.7% (95% CI 59.6-85.5%) on the testing dataset, respectively.

Conclusion: This study presents a simple, rapid, and reliable predictive strategy for early identifying infants at high risk of ROP recurrence after initial treatment, which is potentially useful in improving the success rate of retreatment and reducing blindness resulting from ROP.

Introduction: The global burden of retina care is large and increasing. Many countries have their own guidelines for diagnosis and management of the different retinal diseases, but a unified decision framework could help healthcare professionals to address capacity issues while ensuring excellent and up-to-date patient care. The purpose of this study was to explore the development of such a unified decision framework for retina care.

Methods: A modified Delphi methodology was employed. A steering committee meeting with one expert from The Ophthalmology Network was held in April 2024. An independent facilitator guided the meeting, and three main topics of focus were identified. Following discussions, 27 statements were agreed upon and an online survey containing a 4-point Likert scale to indicate level of agreement was produced and distributed to ophthalmologists. Responses to surveys were anonymous, and analysis was conducted independently. The consensus threshold was defined a priori at 75%. Results were reviewed by the steering committee of eight experts resulting in the production of recommendations.

Results: Overall, 188 responses to the online survey were received from six regions (Europe, Asia, North America, South America, Africa, and Australia/Oceania). Twenty-six statements achieved very high consensus, and one achieved high consensus within three overarching topics of "accessing and maintaining retina care", "key principles of unified decision framework", and "benchmarking criteria". Further subgroup analysis revealed only 67% of clinicians with less than 5 years' experience agreed with the statement "Intravitreal injections should only be administered after reviewing an OCT scan". Since overall, there was a high level of agreement for all statements and stopping criteria were met, no further Delphi rounds were deemed necessary.

Conclusion: This consensus demonstrates that retina care experts believe that a unified decision framework would be beneficial. Their recommendations should facilitate development and implementation of such a framework.

Introduction: Cutaneous squamous cell carcinoma (cSCC) is a common eyelid malignancy that is typically treated by surgical excision. Locally destructive periocular cSCC may not be amenable to surgery in cases where extensive resection would result in structural or functional compromise.

Methods: We report the first series of biopsy-confirmed periocular cSCC cases treated with intralesional interleukin-2 (IL-2)-based therapy.

Results: Treatment courses for five patients are summarized, with one representative case detailed here. A 74-year-old man presented with a large, painful, centrally pedunculated mass on the left upper eyelid, measuring 5.5 cm by 2.5 cm. Mass excisional biopsy and reconstruction revealed moderately differentiated invasive SCC involving deep and peripheral margins. Given the risks associated with further resection, the patient opted to pursue local immunotherapy. He received five doses of intralesional IL-2 every 2 weeks. The lesion was completely clinically cleared at 6 weeks, and there was no recurrence noted at 15-month follow-up.

Conclusion: Local intralesional IL-2-based therapy may be a treatment option for periocular cSCC in cases that may result in significant functional or aesthetic compromise, or in those who have failed prior standard of care.

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.

Corneal disorders are among the leading causes of visual impairment worldwide, with corneal transplantation historically serving as the cornerstone of surgical treatment. However, the global shortage of donor tissue, risk of immune rejection, and variable long-term graft survival underscore the urgent need for alternative approaches, particularly in the setting of ocular surface diseases such as inflammation or dry eye that can compromise graft survival. Regenerative medicine has emerged as a transformative paradigm, offering strategies to restore corneal architecture and function through cell-based therapies, tissue engineering, and gene modulation. These strategies are promising, addressing structural repair and modulating wound-healing responses. In the corneal epithelium, cultivated limbal epithelial transplantation, simple limbal epithelial transplantation, and cultivated oral mucosal epithelial transplantation have expanded therapeutic options for limbal stem cell deficiency, with clinical trials demonstrating long-term ocular surface stability. Regulatory approval of commercial products, such as Holoclar and Nepic, confirms the potential of standardized regenerative products. Stromal regeneration with stromal and mesenchymal stem cells has shown promise in preclinical and early phase clinical trials, with intrastromal stem cell injection improving corneal transparency and biomechanics and potentially stabilizing progressive disorders such as keratoconus. For endothelial dysfunction, intracameral injection of cultured corneal endothelial cells supplemented with Rho-associated protein kinase (ROCK) inhibitors has yielded sustained corneal clarity and visual restoration at 5-10 years, marking a paradigm shift from transplantation to minimally invasive, donor-independent therapies. Tissue engineering innovations, including matrices, hydrogels, and three-dimensional bioprinting, are advancing toward translation, while gene therapy approaches using viral vectors and Clustered Regularly Interspaced Short Palindromic Repeats -Cas9 are being explored to modulate angiogenesis, fibrosis, and inherited dystrophies. Overall, regenerative medicine is reshaping corneal therapeutics, offering effective alternatives to conventional transplantation with reduced donor dependence and improved safety. Future work must focus on long-term safety, cost-effectiveness, and equitable global access to realize its full clinical potential.

Background: Accurate, patient‑specific estimation of vitreous cavity volume can support planning and safety during vitreoretinal surgery and tamponade procedures. We evaluated the performance of the vitreous volume exact (VIVEX) formula-which predicts vitreous volume from axial length (AL)-in a first clinical case series.

Methods: This retrospective observational case series included 27 eyes undergoing vitreoretinal procedures. Intraoperative volume measurements (aspirated fluid in group 1 (G1), injected silicone oil in group 2 (G2), and removed silicone oil in group 3 (G3)) were compared with VIVEX‑predicted volumes computed from AL. Accuracy metrics included mean absolute error (MAE) and mean absolute percentage error (MAPE). Agreement was assessed using Pearson correlation, ordinary least-squares regression (slope, intercept, 95% confidence intervals (CIs)), and Bland-Altman analysis.

Results: Across all eyes (N = 27), VIVEX predictions correlated strongly with intraoperative measurements (r = 0.961, p < 0.0001). Overall, MAE and MAPE were 0.48 mL and 7.43%, respectively. Regression yielded a slope of 0.74 (95% CI 0.65-0.83) and an intercept of 1.17 mL (95% CI 0.60-1.74). Bland-Altman analysis showed a bias of +0.42 mL with 95% limits of agreement from -0.88 to +1.73 mL. Subgroup results were: G1 (n = 17), MAE 0.33 mL and MAPE 6.09%; G2 (n = 5), MAE 0.39 mL and MAPE 6.9%; G3 (n = 5), MAE 1.07 mL and MAPE 12.51%, with a positive bias indicating slightly higher VIVEX values than intraoperative measurements.

Conclusions: The VIVEX formula demonstrates high correlation and clinically useful accuracy for individualized vitreous volume estimation across common surgical contexts. It seems that the largest error and a positive bias occur during silicone oil removal, warranting caution in oil-filled eyes. In such cases, measurement artifacts due to altered optical pathways in silicone-oil-filled eyes and the possible presence of residual oil remnants after removal may contribute to minor discrepancies between calculated and true intraoperative volumes, indicating a need for further evaluation. Overall, VIVEX may assist preoperative planning and realistic volume targeting in routine practice. As this is the first clinical case series evaluating the VIVEX formula in real surgical settings, larger prospective multicenter studies are needed to confirm and expand the findings.

Introduction: This study evaluates the efficacy and safety of faricimab in a real-world cohort of treatment-naïve patients with neovascular age-related macular degeneration (nAMD). Data were retrospectively collected from 130 eyes of 118 patients across 11 centers of the Swiss Retina Research Network, all treated with faricimab using a treat-and-extend regimen and followed for 12 months between May 2022 and October 2024.

Methods: Demographic data, visual and anatomical outcomes, treatment intervals, and adverse events were extracted from the electronic medical records over a 12-month follow-up period. Main outcomes included change in best corrected visual acuity (BCVA), central retinal thickness (CRT), presence of intra- and subretinal fluid, retinal pigment epithelial detachment (PED), injection intervals, and safety. Data are presented as mean ± standard deviation.

Results: Twelve months after the initiation of faricimab therapy, mean BCVA improved from 64.6 ± 14.1 to 69.2 ± 20.3 ETDRS (Early Treatment of Diabetic Retinopathy Study) letters (p < 0.001), while mean CRT decreased from 386.3 ± 172.3 to 246.6 ± 90.4 μm (p < 0.001). An early anatomical response to faricimab was observed in 34.6% of eyes achieving complete retinal fluid resolution after the first injection and in 55.6% after 12 months. The mean treatment interval was extended to 10.5 ± 4.3 weeks, with 26.2% of eyes achieving intervals of 8-11 weeks and 39.2% achieving intervals of ≥ 12 weeks after 12 months. Intraocular inflammation occurred in 0.77% of eyes (n = 1, anterior uveitis); serious adverse events were not reported.

Conclusion: Faricimab demonstrates favorable anatomical and functional outcomes with extended treatment intervals in a majority of patients with treatment-naïve nAMD, offering the potential of reduced treatment burden and the absence of retinal fluid in more than half of the subjects during the first year, while maintaining safety in a real-world setting.

Introduction: Neuropathic corneal pain (NCP) is a challenging condition with limited consensus on its diagnosis and management. This study aimed to gather global insights from corneal specialists on the causes, investigative approaches, and management strategies for NCP.

Methods: A 32-question survey covering demographic, causes, investigations, treatments, and multidisciplinary engagement was sent to 152 invited international corneal specialists; 51 (34%) responded. We explored descriptive statistics and examined how responder characteristics influenced their answers.

Results: The most reported causes of NCP were chronic ocular surface disease (n = 41; 41%) and post-surgical factors (n = 34; 34%). The most common investigations, routinely performed by respondents, were the anesthetic challenge test, Schirmer's test, and corneal esthesiometry. In vivo confocal microscopy (IVCM) was routinely used by 37% (n = 19), with 69% (n = 29) of specialists stating that an abnormal result influenced their management. Ocular surface and pain questionnaires were used by 69% (n = 35), with the Ocular Surface Disease Index being the most popular (n = 25; 31%). Common treatments included artificial tears (n = 48; 94%), serum/plasma-derived tears (n = 41; 80%), topical corticosteroids (n = 34; 67%), and topical cyclosporin (n = 30; 59%). Only 38% (n = 19) felt comfortable independently prescribing systemic pharmacotherapy. A multidisciplinary approach was adopted by 47% (n = 24), with the two most common specialties involved being pain management (n = 30; 37%) and neurology (n = 26, 32%).

Conclusions: This survey provides valuable global insights into the causes, investigations, and management of NCP from the perspective of corneal specialists. These findings support further research and the development of guidelines to address this challenging condition.