Ophthalmology and Therapy最新文献

Introduction: Patients with retinitis pigmentosa (RP) frequently exhibit zonular weakness, which poses challenges for intraocular lens (IOL) stability and refractive prediction. This study aimed to evaluate the impact of capsular tension ring (CTR) implantation on the predictive accuracy of 12 IOL power calculation formulas in patients with RP receiving cataract surgery.

Methods: We conducted a retrospective cohort study where the predictive accuracy of 12 IOL formulas was assessed using refractive prediction error (PE), mean absolute error (MAE), root-mean-square absolute error (RMSAE), and the percentage of eyes achieving target refraction within ± 0.25 D to ± 1.00 D. These metrics were compared between eyes with (n = 23) and without (n = 30) CTR implantation. The influence of lens thickness (LT) on formula accuracy was also evaluated.

Results: In the overall cohort of 53 eyes from 38 patients with RP, the Barrett Universal II (BUII) formula yielded the lowest numerical MAE (0.45 D) and RMSAE (0.56 D), though none of the formulas were statistically superior in RMSAE. In the CTR group, significantly lower MAE was observed for Cooke K6 (P = 0.024), Kane (P = 0.016), Emmetropia Verifying Optical (EVO) 2.0 (P = 0.040), and PEARL-DGS (P = 0.021) compared to the non-CTR group. The CTR group also exhibited a significantly higher percentage of eyes within ± 0.50 D (P = 0.016), ± 0.75 D (P < 0.001), and ± 1.00 D (P < 0.001) of target refraction. Increasing LT correlated with a hyperopic shift for all formulas; however, BUII demonstrated relatively stable MAE across LT quartiles.

Conclusions: Implantation of a CTR was associated with significantly improved predictive accuracy for several modern IOL formulas in patients with RP. The BUII formula showed the highest overall predictive accuracy.

Introduction: This study aimed to analyze the influence of refractive status, residential climate, and exposure to adverse environmental factors in contact lens (CL) dropout.

Methods: This cross-sectional study involved a face-to-face survey conducted by trained optometrists among former and current CL wearers (CLWs) at General Óptica centers throughout Spain. The survey included questions related to demographic characteristics, refractive status, residential climate, and adverse environmental factors. The chi-square test and a forward stepwise binary logistic regression analysis were performed.

Results: A total of 1094 surveys were included, comprising 509 former CLWs and 585 current CLWs. Age (B = 0.03; OR 1.03, 95% CI 1.02-1.04) and exposure to chemical (B = 3.51; OR 41.67, 95% CI 12.06-143.95) or dusty environments (B = 1.05; OR 2.93, 95% CI 1.16-7.41) were significantly associated with CL dropout. However, residing in a continental climate was associated with a lower CL dropout compared with a Mediterranean climate (B = - 1.39; OR 0.25, 95% CI 0.15-0.42). Spherical refraction, cylindrical refraction, and near addition power did not show statistically significant associations with CL dropout. Furthermore, the model excluded sex, exposure to high-humidity or dry environments, and the interactions between adverse environmental factors and residential climate as predictive factors.

Conclusions: Older age, residence in the Mediterranean climate, and exposure to chemical or dusty environments increase the risk of contact lens dropout. However, climate-specific conditions do not appear to significantly influence dropout rates, suggesting that other factors may play a more important role.

Introduction: This study investigated early anatomical and functional outcomes in patients with treatment-naïve neovascular age-related macular degeneration (nAMD) treated with 8 mg aflibercept compared to patients treated with the standard dose of 2 mg aflibercept using spectral domain optical coherence tomography (SD-OCT), microperimetry, and macular pigment optical density (MPOD) after loading phase administration.

Methods: This prospective, observational study included 30 eyes of 30 patients (mean age 70 ± 5 years; 15 male, 15 female) recruited between January and June 2025 at the Eye Clinic of the University of Naples "Federico II". Patients were assigned to one of two age- and gender-matched groups receiving intravitreal injections of aflibercept at the dose of 2 mg (group A) or 8 mg (group B). All patients underwent complete ophthalmological examination, SD-OCT, OCT angiography, microperimetry, fixation stability, and measurement of MPOD at baseline, month 2, and month 4.

Results: Group B showed an improvement in all parameters, compared to group A, in particular: a greater reduction in central macular thickness (CMT) (p = 0.008), an improvement in best-corrected visual acuity (BCVA) (p = 0.012), increased retinal sensitivity (p = 0.015), increased MPOD (p = 0.027), and reduced bivariate contour ellipse area (BCEA) (p = 0.039). Group B showed a faster drying rate during the first 2 months (70 vs. 40 μm/month) and overall at month 4.

Conclusions: Intravitreal injections of aflibercept 8 mg resulted in significant short-term anatomical and functional improvement compared to standard dose and thus appear to be an effective option to achieve faster results in nAMD. MPOD can be considered as a potential new biomarker of macular health to study retinal functional response.

Trial registration: The research protocol was registered on ClinicalTrials.gov (NCT07074054).

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.

Vision impairment resulting from defects in the visual pathway was once considered irreversible. The main barrier is the limited plasticity of the visual system after the critical period. However, as our understanding of noninvasive brain stimulation (NIBS) deepens, its ability to enhance neural plasticity and regulate the neural system indicates a transformation in treatment and rehabilitation strategies. To verify the potential of NIBS in visual restoration, this review elaborates on the mechanisms underlying the immediate effects and aftereffects of NIBS with proofs from molecular, cellular, and systematic levels. The concept of neural oscillation is especially emphasized as it contributes greatly to cognition and can be interfered with by NIBS. Meanwhile, it discusses recent clinical findings on the use of NIBS, with or without visual perceptual learning, focusing on two key questions which have not been specified in previous reviews: (1) the duration of behavioral improvements, and (2) the optimal treatment period required for different visual functions and NIBS modalities. On the basis of the inconsistency in existing studies, this review is also devoted to optimizing the practical application of combining NIBS with VPL and concludes that the location, timing, and form of NIBS are crucial to achieving satisfying complementary effects.

Introduction: The purpose of this analysis was to assess the safety outcomes of a subgroup of patients who received a travoprost intracameral implant in an office-based surgery setting from one of the phase 3 registration trials, GC-012, for the implant.

Methods: Adult patients with open-angle glaucoma or ocular hypertension on 0 to 3 pre-study intraocular pressure (IOP)-lowering medications underwent a washout period (if applicable). Patients who qualified based on having an unmedicated mean diurnal IOP of 21 mmHg or greater and an IOP of 36 mmHg or less at each of the diurnal timepoints received a travoprost intracameral implant and were followed for safety outcomes at eight visits over a 12-month period. Safety evaluations included adverse events, slit-lamp examination, gonioscopy, pachymetry, dilated fundus examination, specular microscopy, perimetry, and best-corrected visual acuity.

Results: A total of 37 patients received a travoprost intracameral implant in an office-based surgery setting. Administration of the implant was successful in 100% of patients. There were no serious ocular adverse events or ocular infections in patients administered the implant.

Conclusions: This subgroup analysis demonstrated that administration of the travoprost intracameral implant in an office-based surgery setting was safe and well tolerated.

Trial registration: ClinicalTrials.gov identifier, NCT03868124.

Introduction: Neurotrophic keratitis (NK) is a rare, vision-threatening corneal disease characterized by impaired epithelial healing and frequent recurrence of defects. Amniotic membrane transplantation (AMT) is an established therapeutic option, but outcomes remain variable and predictors of failure are poorly defined. We aimed to identify clinical and systemic factors associated with recurrence following AMT using both classical statistics and machine learning approaches.

Methods: We conducted a retrospective cohort study of 66 patients with NK who underwent AMT at a tertiary referral center between 2019 and 2025. The primary endpoint was post-AMT epithelial defect recurrence. The prespecified primary analysis was a multivariable logistic regression, complemented by exploratory machine learning approaches. Clinical, demographic, and ophthalmic variables were abstracted from medical records. All patients had complete outcome data; covariate-level missingness was minimal and handled with complete-case analyses. Associations with recurrence were examined using bivariate tests and multivariable regression; data structure was explored with principal component analysis (PCA) and hierarchical clustering; and predictive performance was additionally evaluated using random forest classifiers.

Results: Epithelial defect recurrence occurred in 46 patients (70%). Multivariable analysis identified systemic immunosuppressive therapy (odds ratio [OR] 19.9; p = 0.023) and number of AMTs (OR 2.73 per graft; p = 0.040) as independent predictors, with prior ocular surgery showing a borderline association (p = 0.060). PCA and clustering revealed three phenotypic subgroups, including a high-risk cluster (72% recurrence) characterized by immunosuppression, multiple AMTs, prior surgery, and inflammatory complications. Random forest classification confirmed the predictive role of these variables, achieving an AUC of 0.82 with balanced sensitivity (74%) and specificity (81%).

Conclusion: Systemic immunosuppression, repeated AMTs, and prior ocular surgery are key predictors of AMT failure in NK. Combining regression models, clustering, and machine learning provides a robust framework for risk stratification. These findings support the development of personalized monitoring and treatment strategies to improve surgical outcomes in NK.

Introduction: Neurotrophic keratopathy (NK) is a rare degenerative disease that can lead to epithelial breakdown, corneal ulceration, and potentially perforation and vision loss. Cenegermin is a recombinant human nerve growth factor approved for stage 2/3 NK, though data on its efficacy outside of United States/European populations are limited.

Methods: This prospective, phase IV, open-label, multicenter study investigated the efficacy, safety, and pharmacokinetics (PK) of cenegermin eye drops in Chinese patients with stage 2/3 NK in a routine clinical setting (CTR20220066). Patients received cenegermin eye drops (20 mcg/mL; 6 times/day at 2-hour intervals) for 8 weeks with follow-up to week 56. The primary endpoint was corneal healing at week 8 per investigator assessment. Additional endpoints included lesion worsening, corneal healing through week 56, safety, and PK.

Results: Of the 28 patients receiving cenegermin, 22/26 (84.6%, 95% confidence interval 65.1-95.6%; 2 missing) achieved corneal healing at week 8; 3/22 (13.6%) reported recurrence during 48-week follow-up but 20/22 (90.9%) were healed at week 56; and 2/28 (7.1%) experienced lesion worsening during 8-week treatment. In addition, 25/28 (89.3%) experienced ≥ 1 treatment-emergent adverse event (TEAE); for the majority (23/28, 82.2%) of these patients, TEAEs were mild/moderate. None of the serious TEAEs reported by 10 (35.7%) patients were assessed as related to cenegermin or led to treatment discontinuation. Eye pain was the most common cenegermin-related TEAE (5/28, 17.9%), primarily limited to the treatment period.

Conclusions: These findings demonstrate that cenegermin eye drops are an effective, generally well-tolerated treatment in Chinese patients with stage 2/3 NK, supporting their use in this patient population.

Trial registration: CTR20220066.

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.