Ophthalmology and Therapy最新文献

Introduction: Optical coherence tomography (OCT) and OCT angiography (OCT-A) are valuable tools for detecting retinal and choroidal changes in systemic diseases. This systematic review evaluates the current evidence on retinal and choroidal alterations associated with transthyretin-related amyloidosis (ATTR).

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines across PubMed, Scopus, Web of Science, and Embase up to December 2024 to investigate structural and microvascular alterations in the retina and choroid of patients with genetically confirmed ATTR, aiming to evaluate their potential as imaging biomarkers for disease monitoring.

Results: Nine eligible studies were identified, encompassing a total of 246 individuals, including both symptomatic patients and pre-symptomatic carriers. Reported findings included thinning of the outer nuclear layer (ONL), reduced vessel density in the superficial and deep capillary plexuses, enlargement of the foveal avascular zone (FAZ), and a decreased choroidal vascularity index (CVI).

Conclusions: Thinning of ONL was the most consistent structural finding, suggesting photoreceptor degeneration. Decreased CVI, reduced vascular density, and enlargement of the FAZ further indicate impaired vascular integrity. Although OCT and OCT-A show promise for early detection and monitoring of ocular involvement in ATTR, most studies were case-control studies with small sample sizes and possible confounding from ongoing treatments. These limitations highlight the need for standardized imaging protocols and longitudinal studies to confirm findings and clarify the link between ocular and systemic disease severity.

Introduction: Chronic ocular surface pain (COSP) is defined as ocular pain that is perceived to originate from the ocular surface and persists for more than 3 months. Clear epidemiological data on COSP prevalence are lacking.

Methods: In 2025, a total of 100 eye care providers were surveyed, including 50 optometrists and 50 ophthalmologists. The survey aimed to assess the percentage of their weekly patient volume diagnosed with COSP, the diagnostic methods used, contributing etiologies, and current management strategies. Additionally, practitioners identified key indicators of successful treatment and attributes they believed would have the greatest impact on patient outcomes. Lastly, they rated their satisfaction with current therapeutic options.

Results: An estimated 33% of optometrists' patients and 29% of ophthalmologists' patients had COSP. Of those diagnosed with dry eye disease (DED), 63% also had COSP. Providers managed COSP with over-the-counter (OTC) artificial tears (97% of respondents), OTC gels and ointments (90%), hot compresses (86%), and prescription therapies indicated for DED (30-88%), while a minority routinely used amniotic membranes (37%), serum tears (26%), intense pulsed light (18%), and LipiFlow (16%). The proportions of providers who were satisfied or very satisfied with these therapies were as follows: 64% for amniotic membranes and serum tears, 63% for device-based therapies, 40% for prescription medications, and 21% for OTC drops, ointments, and hot compresses.

Conclusions: This survey provides initial insight into the prevalence of COSP among patients in US eye care clinics, along with perspectives on managing this condition from both optometrists and ophthalmologists. The most common therapeutic strategies for COSP (OTC artificial tears, gels, and ointments) were associated with the lowest levels of provider satisfaction. COSP and dry eye disease are distinct but closely linked conditions. These results demonstrate an unmet need for new treatment options to address COSP.

Introduction: This study investigated the long-term natural history of peripapillary pachychoroid syndrome (PPS), analyzing both morphological and functional outcomes.

Methods: This retrospective study included 24 eyes from 14 participants diagnosed with PPS. No interventions were administered. Baseline and follow-up assessments comprised best-corrected visual acuity (BCVA), measured on the LogMAR scale, inner nasal (IN) and outer nasal (ON) macular thickness measured using the ETDRS (Early Treatment Diabetic Retinopathy Study) subfields. To account for repeated measures and the hierarchical structure of eyes nested within participants, and to appropriately handle incomplete longitudinal data, linear mixed-effects models were utilized for all statistical analyses.

Results: The mean age was 74 ± 7 years, and 71% of patients had bilateral PPS. All patients had peripapillary atrophy at baseline. The mean baseline BCVA was 0.05 and showed only small variations over time. ON macular thickness showed a significant decrease at 2 years (Δ = - 36.9 µm, p = 0.034), whereas IN macular thickness decreased significantly at both 2 years (Δ = - 40.75 µm, p = 0.023) and 3 years (Δ = - 39.97 µm, p = 0.042). One-quarter of participants developed a serous pigment epithelium detachment with subretinal fluid, suggesting an overlapping PPS/CSC (central serous chorioretinopathy) phenotype.

Conclusions: Peripapillary atrophy appears to be an important anatomical predisposition for PPS. Waxing and waning of intraretinal fluid were observed during the natural course of PPS, with a significant reduction at 2 years. Most patients remained asymptomatic and maintained stable BCVA throughout long-term follow-up, indicating a generally favorable prognosis in the absence of intervention.

Introduction: This study aims to describe complications of pediatric-onset uveitis and their predictors among baseline and treatment-related factors.

Methods: This registry-based observational study included patients with noninfectious uveitis with disease onset < 18 years.

Results: A total of 309 patients were enrolled (535 eyes). Uveitis was anterior in 290 eyes (54.2%), panuveitis in 121 (22.6%), intermediate in 88 (16.4%), and posterior in 24 (4.5%). Over a median follow-up of 49.0 months (interquartile range [IQR] 101.0), 137 children (44.3%) developed ≥ 1 complication (14.4 per 100 patient-years). Idiopathic uveitis (p < 0.001), longer topical glucocorticoid (GC) monotherapy (p < 0.001) and longer delay of immunosuppressive therapy (IST) (p = 0.03) were associated with a higher frequency of complications. In multivariate analysis, anterior uveitis was protective against complications (odds ratio [OR] 0.10, 95% confidence interval [CI] - 4.1 to - 1.6, p < 0.001), whereas a chronic course of uveitis significantly increased the risk (OR 6.13, 95% CI 1.0-2.6, p < 0.001). Older age at onset was protective against cataract (OR 0.91, 95% CI - 0.2 to - 0.02, p = 0.020) and band keratopathy (OR 0.8, 95% CI - 0.4 to - 0.1, p = 0.003). Final best-corrected visual acuity (BCVA) (Snellen decimals) was inversely correlated with the duration of topical GC monotherapy (ρ = - 0.23; p = 0.001). In multivariate analysis, panuveitis was linked to a 0.142 decimal reduction (95% CI - 0.219 to - 0.066, p < 0.001), and cataract to a 0.295 reduction (95% CI - 0.372 to - 0.217, p < 0.001) in the final BCVA.

Conclusions: Children with chronic, idiopathic, early-onset, and non-anterior uveitis are at greatest risk for complications. Structured screening for these children, along with early initiation of systemic IST, is essential to prevent visual impairment.

Introduction: Reducing intravitreal injection frequency while maintaining efficacy is a critical goal in alleviating the burden associated with anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema (DME) or neovascular age-related macular degeneration (nAMD). In clinical trials, aflibercept 8 mg and faricimab 6 mg administered at extended dosing intervals have demonstrated similar efficacy compared with aflibercept 2 mg, but with fewer injections. This network meta-analysis (NMA) indirectly compared numbers of injections and efficacy between aflibercept 8 mg and faricimab 6 mg administered according to a treat-and-extend (T&E)-based regimen in patients with DME or nAMD.

Methods: A systematic literature review was conducted on 10 January 2025, to identify randomized controlled trials of aflibercept 8 mg or faricimab T&E with observation periods of approximately 2 years. Outcomes included number of injections, absolute change from baseline in best-corrected visual acuity (BCVA), and absolute and percentage change from baseline in central subfield thickness (CST). NMAs were performed with Bayesian statistical models. Injection numbers were adjusted to 104 weeks to account for differences in trial observation periods.

Results: The NMA included 2-year data from six trials: PHOTON, YOSEMITE, and RHINE (DME); and PULSAR, TENAYA, and LUCERNE (nAMD). Treatment with aflibercept 8 mg was associated with significantly fewer injections compared with faricimab T&E in patients with DME (mean difference -3.62 [95% credible interval -4.22, -3.02]) or nAMD (-1.47 [-1.90, -1.05]). Mean changes from baseline in BCVA (absolute) or CST (absolute and percentage) did not differ significantly between the two treatments.

Conclusion: This NMA indicated that aflibercept 8 mg required significantly fewer injections while maintaining similar efficacy over 2 years of treatment compared with faricimab T&E in patients with DME or nAMD.

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: This study aimed to analyze the patterns and trends in the burden of blindness due to diabetic retinopathy (DR) from 1990 to 2021 at the global, regional, and national levels.

Methods: We conducted a population-based analysis using the latest data from the Global Burden of Disease Study 2021. We examined the prevalence and number of cases of DR-related blindness stratified by type of diabetes, sex, age, and sociodemographic index (SDI) level. The trends in the blindness burden were quantified via the average annual percentage changes. A decomposition analysis was performed to identify key drivers of the changing burden. A Bayesian age‒period‒cohort model was used to predict the future burden of DR-related blindness from 2022 to 2035.

Results: Globally, the number of people blind due to DR increased by 326.0% from 1990 to 2021, with the age-standardized prevalence rate (ASPR) increasing from 7.59 to 15.28 per 100,000 population. Regionally, Tropical Latin America had the highest ASPR in 2021, whereas South Asia and East Asia had the greatest number of prevalent cases. Nationally, India and China had the highest number of prevalent cases in 2021, whereas Marshall Islands reported the highest ASPR. In 2021, the middle SDI group had the greatest number of patients who became blind due to DR. Decomposition analysis revealed that the increased global burden between 1990 and 2021 was driven by population growth, population aging, and epidemiological changes. Predictions suggest the burden will continue to rise through 2035.

Conclusions: The global burden of DR-related blindness has increased significantly over the past three decades, with notable disparities across regions, countries, and SDI groups. More efforts should be made to mitigate the growing impact of DR-related blindness.

Introduction: Orthokeratology (ortho-K) is an established intervention for myopia control in children, yet the vascular mechanisms within the choroidal sublayers underlying its efficacy remain unclear. This study aims to investigate the changes in the choroidal vascularity index (CVI) of choroid sublayers after ortho-K treatment, the association between 1-month CVI changes and 1-year axial length (AL) elongation, and the role of CVI responses in predicting the 1-year control efficacy of ortho-K treatment.

Methods: A prospective cohort study was conducted, enrolling 257 children with myopia aged 7-16 years. The subjects wore ortho-K lenses continuously for 12 months. Choroidal volume, vascular volume (CVV), stromal volume (CSV), and CVI of the choroid sublayers were assessed using optical coherence tomography images at baseline and 1-month follow-up. The total choroidal layer (TCL) includes the large-vessel choroidal layer (LVCL) and the medium-vessel choroidal layer (MVCL). The Early Treatment of Diabetic Retinopathy Study (ETDRS) grid divides the macular area into nine subfields for detailed analysis.

Results: The 1-month CVI of TCL and MVCL in all ETDRS grid regions were significantly lower than the baseline CVI (P ≤ 0.036), except for the superior outer ring subfield in TCL (P = 0.070). After the 1-month ortho-K treatment, both choroidal volume and CSV significantly increased in all choroidal sublayers compared with baseline data (P ≤ 0.027), while CVV also showed significant increases in half of the ETDRS grid regions (14/27). After adjusting for age and gender, the baseline CVI of temporal inner ring subfield in TCL (β = 0.146, P = 0.006), and 1-month CVI changes of the temporal outer ring subfield (β = 0.337, P < 0.001) and nasal inner ring subfield (β = 0.174, P = 0.002) in MVCL, were independently associated with 1-year AL elongation during ortho-K treatment. On the basis of the 1-month CVI changes of temporal outer ring subfield and nasal inner ring subfield in MVCL, as well as age and sex, the prediction model demonstrated an area under the curve (AUC) of 0.905 (95% CI 0.870-0.941) for distinguishing children with myopia who exhibited slow versus fast AL elongation.

Conclusions: After the 1-month ortho-K treatment, choroidal volume, CVV, and CSV, of all choroidal sublayers significantly increased, while CVI of TCL and MVCL significantly decreased. The CVI in LVCL showed no significant changes. The differences in short-term CVI changes among choroidal sublayers indicate disproportionate changes in CVV and CSV, which help to explore the possible choroidal mechanisms of myopia control with ortho-K treatment. Early CVI changes in MVCL possess potential clinical significance for predicting long-term AL elongation.

Introduction: We evaluated the rotational stability and factors associated with it in patients implanted with Eyecryl™ roric IOL after phacoemulsification surgery. We also assessed the factors associated with refractive efficacy in these patients.

Methods: The present study is a secondary analysis to study the rotation in 121 eyes from 94 patients. We included the following data: demographics; preoperative refraction and corrected distance visual acuity (CDVA), type of astigmatism, axial length, anterior chamber depth, and aqueous depth; power of the implanted IOL, axis of the implanted IOL, and predicted residual error; magnitude and direction of postoperative rotation of the IOL; postoperative vision and refraction (day 30 ± 3 days).

Results: About 86% of the eyes had postoperative astigmatism of ≤ 0.25 D and 9% had 0.26 to 0.50 D on day 30. The median (IQR) rotation of the IOL on day 30 (± 3 days) was 1 (1, 3) degree and the mean (SD) rotation was 2.31 (2.97) degrees. Eyes with high rotation had significantly higher median (IQR) preoperative sphere (more positive side) (1.50 D [0, 1.75] vs 0 D [- 1.0, 0.75]; p = 0.013) and lower mean (SD) axial length (22.6 [0.9] vs 23.2 [0.9]; p = 0.02). The mean (SD) postoperative refractive efficacy was 85.1 (13.6) %; it was significantly lower in those who had with-the-rule astigmatism compared with against-the-rule astigmatism (69.6% vs 86.7%; p = 0.046). The proportion of eyes with difference in lines between postoperative UDVA and CDVA was significantly higher in those with low postoperative efficacy (70.0% vs 21.8%; p < 0.001).

Conclusion: The Eyecryl™ toric intraocular lens had low rotation at 1-month post-surgery. Higher rotation was associated with a higher preoperative sphere (more positive side) and shorter eyes. Postoperative efficacy was higher in eyes with against-the-rule astigmatism. Eyes with < 75% efficacy and/or ≥ 5° rotation showed over-correction on vector analysis.

Introduction: Previous studies have suggested that premyopia shows high prevalence and high risk of progression to myopia among children. Therefore, the purpose of this study was to investigate the efficacy and safety of 0.01% atropine eye drops and novel positive Lenslet-ARray-Integrated spectacle lenses (LARI) in slowing myopia onset and myopic shift among children with premyopia in China.

Methods: This was a prospective randomized controlled trial. A total of 400 children aged 6-12 years with premyopia in both eyes were enrolled. Subjects were randomly divided into four groups in equal proportions: 0.01% atropine eye drops group (group A), LARI group (group S), combination group (group AS), and control group without any clinical intervention (group E). Measurements were conducted at baseline and at 3-, 6-, and 12-month follow-up. The incidence of myopia and the percentage of patients with fast myopic shift over 1 year were the primary outcomes. The secondary outcomes were changes in cycloplegic spherical equivalent refraction (SE) and axial length (AL). Changes in uncorrected visual acuity (UCVA), corneal curvature (CC), subfoveal choroidal thickness (SFCT), and intraocular pressure (IOP) were the exploratory outcomes. Adverse events were also recorded.

Results: The incidence of myopia and the percentage of patients with fast myopic shift in groups A, S, and AS were significantly lower than those in group E. Treatment with 0.01% atropine, LARI, and their combination decreased myopia progression by 55.88%, 64.71%, and 77.94%, and axial elongation by 65.00%, 75.00%, and 77.50%, respectively. Further analyses were conducted based on age stratification. SFCT in intervention groups increased significantly. No serious adverse events were detected.

Conclusions: These 1-year results suggest that, combined with the progression of SE, the reduction in AL, and the increase in SFCT, 0.01% atropine and LARI can be used as effective and safe treatments for the prevention of myopia progression in children with premyopia. Combination therapy showed superior efficacy in this cohort, but long-term effects beyond 12 months remain unknown.

Trial registration: ChiCTR2500098887.