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Preoperative Structural Risk Factors for Glaucoma After Penetrating Keratoplasty for Congenital Corneal Opacity: An Observational Study 先天性角膜混浊穿透性角膜移植术后青光眼的术前结构性风险因素:观察性研究
IF 3.3 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-13 DOI: 10.1007/s40123-024-01027-5
Zi-jun Xie, Xin Wang, Ting Yu, Jing-hao Qu, Ling-ling Wu, Jing Hong

Introduction

Post-keratoplasty glaucoma (PKG) is a major complication following penetrating keratoplasty (PKP) for congenital corneal opacity (CCO). This study aims to assess the preoperative structural risk factors for PKG following PKP for CCO using ultrasound biomicroscopy (UBM).

Methods

Pediatric patients with CCO who underwent preoperative UBM and primary PKP were enrolled. Patients with anterior segment operation history or with a follow-up duration less than 12 months were excluded. The structural features of the anterior segment including central corneal thickness, anterior chamber depth, angle closure range (ACR), anterior synechia range, maximum iridocorneal adhesion length, abnormal iridocorneal synechia, and lens anomalies were identified on UBM images. The medical histories were reviewed to identify clinical features. The incidence of PKG was assessed to determine significant structural and clinical risk factors.

Results

Fifty-one eyes of 51 pediatric patients with CCO were included. The median age at surgery was 8.0 months, and the mean follow-up duration was 33 ± 9 months. Eleven (21.6%) eyes developed PKG. The main structural risk factors were abnormal iridocorneal synechia (P = 0.015), lens anomaly (P = 0.001), and larger ACR (P = 0.045). However, a larger range of normal anterior synechia without involvement of the angle was not a significant risk factor. Preoperative glaucoma (P < 0.001) and higher intraocular pressure (P = 0.015) were clinical risk factors. A shallow anterior chamber was a unique risk factor for sclerocornea (P = 0.019).

Conclusions

Detailed preoperative examination of iridocorneal synechia, lens, and angle closure using UBM is critical for PKG risk assessment, surgical prognosis evaluation, and postoperative management in patients with CCO.

导言角膜移植术后青光眼(PKG)是先天性角膜混浊(CCO)穿透性角膜移植术(PKP)后的主要并发症。本研究旨在使用超声生物显微镜(UBM)评估 CCO PKP 术后发生 PKG 的术前结构性风险因素。排除了有前段手术史或随访时间少于 12 个月的患者。通过 UBM 图像确定前段的结构特征,包括中央角膜厚度、前房深度、角膜闭合范围(ACR)、前裂范围、最大虹膜角膜粘连长度、异常虹膜角膜裂隙和晶状体异常。回顾病史以确定临床特征。对 PKG 的发生率进行评估,以确定重要的结构和临床风险因素。手术时的中位年龄为 8.0 个月,平均随访时间为 33 ± 9 个月。11只眼睛(21.6%)出现了PKG。主要的结构性风险因素是虹膜角膜异常鞘(P = 0.015)、晶状体异常(P = 0.001)和较大的 ACR(P = 0.045)。然而,无角膜受累的较大范围正常前房裂并不是一个重要的风险因素。术前青光眼(P < 0.001)和较高眼压(P = 0.015)是临床风险因素。结论使用 UBM 术前详细检查虹膜角膜混浊、晶状体和角膜闭合对于 CCO 患者的 PKG 风险评估、手术预后评估和术后管理至关重要。
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引用次数: 0
Safety, Tolerability, and Short-Term Efficacy of Low-Level Light Therapy for Dry Age-Related Macular Degeneration 低强度光疗法治疗干性老年性黄斑变性的安全性、耐受性和短期疗效
IF 3.3 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-13 DOI: 10.1007/s40123-024-01030-w
Enrico Borrelli, Giulia Coco, Marco Pellegrini, Marco Mura, Nicolò Ciarmatori, Vincenzo Scorcia, Adriano Carnevali, Andrea Lucisano, Massimiliano Borselli, Costanza Rossi, Michele Reibaldi, Federico Ricardi, Aldo Vagge, Massimo Nicolò, Paolo Forte, Antonio Cartabellotta, Murat Hasanreisoğlu, Cem Kesim, Sibel Demirel, Özge Yanık, Federico Bernabei, Pierre-Raphael Rothschild, Sarah Farrant, Giuseppe Giannaccare

Introduction

Photobiomodulation (PBM) has become a promising approach for slowing the progression of early and intermediate dry age-related macular degeneration (dAMD) to advanced AMD. This technique uses light to penetrate tissues and activate molecules that influence biochemical reactions and cellular metabolism. This preliminary analysis is aimed at assessing the safety, tolerability, and short-term effectiveness of the EYE-LIGHT®PBM treatment device in patients with dAMD.

Methods

The EYE-LIGHT® device employs two wavelengths, 590 nm (yellow) and 630 nm (red), in both continuous and pulsed modes. Patients over 50 years of age with a diagnosis of dAMD in any AREDS (Age-Related Eye Disease Study) category were randomly assigned to either the treatment group or the sham group. The treatment plan consisted of an initial cycle of two sessions per week for 4 weeks. Safety, tolerability, and compliance outcomes, along with functional and anatomical outcomes, were assessed at the end of the fourth month.

Results

This preliminary analysis included data from 76 patients (152 eyes). All patients were fully compliant with treatment sessions, and only one fifth of patients treated with PBM reported mild ocular adverse events, highlighting exceptional results in terms of tolerability and adherence. Changes in best-corrected visual acuity (BCVA) from baseline to month 4 differed significantly between the sham and PBM-treated groups, favoring the latter, with a higher proportion achieving a gain of five or more letters post-treatment (8.9% vs. 20.3%, respectively; p = 0.043). No significant differences in central subfield thickness (CST) were observed between the two groups over the 4-month period. The study also found a statistically significant disparity in mean drusen volume changes from baseline to month 4 between the groups in favor of patients treated with PBM (p = 0.013).

Conclusion

These preliminary results indicate that PBM treatment using the EYE-LIGHT® system is safe and well tolerated among patients with dAMD. Furthermore, both functional and anatomical data support the treatment’s short-term efficacy.

Trial Registration

ClinicalTrials.gov identifier NCT06046118.

导言光生物调节(PBM)已成为减缓早期和中期干性老年性黄斑变性(dAMD)向晚期黄斑变性发展的一种很有前景的方法。这种技术利用光穿透组织,激活影响生化反应和细胞代谢的分子。这项初步分析旨在评估 EYE-LIGHT®PBM 治疗设备对 dAMD 患者的安全性、耐受性和短期有效性。年龄超过 50 岁、被诊断为任何 AREDS(老年性眼病研究)类别中的 dAMD 患者被随机分配到治疗组或假治疗组。治疗计划包括一个初始周期,每周两次,持续 4 周。在第四个月结束时,对安全性、耐受性、依从性结果以及功能和解剖结果进行评估。所有患者都完全遵守治疗疗程,仅有五分之一接受 PBM 治疗的患者报告了轻微的眼部不良反应,这说明在耐受性和依从性方面取得了卓越的成果。从基线到第4个月的最佳矫正视力(BCVA)变化在假性治疗组和PBM治疗组之间存在显著差异,假性治疗组的最佳矫正视力提高了5个或5个以上视点(分别为8.9%和20.3%;P = 0.043),而PBM治疗组的最佳矫正视力提高了5个或5个以上视点(分别为8.9%和20.3%;P = 0.043)。在 4 个月的时间里,两组患者的中央子场厚度 (CST) 没有明显差异。研究还发现,两组患者从基线到第 4 个月的平均色素沉着量变化有显著统计学差异,采用 PBM 治疗的患者更胜一筹(p = 0.013)。此外,功能和解剖学数据都支持该疗法的短期疗效。试验注册ClinicalTrials.gov标识符NCT06046118。
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引用次数: 0
Letter to the Editor Regarding: An Emerging Ophthalmology Challenge: A Narrative Review of TikTok Trends Impacting Eye Health Among Children and Adolescents. 致编辑的信,内容涉及新出现的眼科挑战:关于影响儿童和青少年眼健康的 TikTok 趋势的叙述性评论。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.1007/s40123-024-00989-w
Chisom T Madu, Imani Nwokeji, Jin Ming Lin
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引用次数: 0
Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction. 以证据为基础的睑板腺功能障碍温敷疗法策略。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-11 DOI: 10.1007/s40123-024-00988-x
Gladys Lee

Aim: Despite promising results from technological therapies like intense pulsed light application, warm compress therapy is a mainstay in meibomian gland dysfunction (MGD). However, applying warm compresses (WC) to the eyelids is palliative rather than curative and not always dispensed with specific instructions. The range of eyelid warming treatments available and lack of clear directives for use creates uncertainty for patients accustomed to explicit dosage information. This report examines data from clinical studies across the past 20 years to identify effective protocols for three types of WC-hot towel, microwavable eye mask, and self-heating eye mask (EM).

Method: Literature search for studies on WC and MGD published between 2004 and 2023 in English was conducted. Studies wherein hot towel, microwavable EM, and self-heating EM were used in a treatment arm were included and those wherein they served only as control or were used in conjunction with another intervention were excluded. 20 resulting studies were separated into 3 groups: 5 on temperature profiles of WC, 6 with single application of WC, and 9 with repeated applications. Study methods and outcomes were tabulated, and a qualitative review was performed, attending to WC protocol and efficacy, as indicated by measures of tear film, meibomian gland health, and dry eye questionnaires.

Results: Data from the aforementioned studies revealed that each method can achieve target eyelid temperature of 40 °C. A single application of WC-ranging from 5 to 20 min-can significantly improve tear quality, while repeated applications significantly relieve symptoms associated with dry eyes from MGD and, in most studies, significantly improve meibomian gland health. Hot towels, however, require frequent reheating to maintain eyelid temperatures above 40 °C, rendering them relatively ineffective in longitudinal studies. Microwavable EM retain heat well across 10 min and were found to improve tear break-up time and/or meibomian gland score. Self-heating EM have variable activation times and were typically applied for longer periods, showing benefits akin to microwavable EM in short-term studies. Studies monitoring compliance indicate greater deviation from protocol with higher application frequencies or longer-term use. Evidence suggests superior heat retention and therapeutic effects on specific contributing factors in MGD (such as Demodex) with moist-heat compress.

Conclusion: Considering decreased patience adherence to therapy with increased usage frequencies, and balancing needs to provide succinct instructions for various compress types, an advisable strategy is for patients to apply a moist-heat generating EM (microwavable or self-heating) to each eye for at least 10 min, prepared according to manufacturer's instructions.

目的:尽管强脉冲光等技术疗法取得了可喜的成果,但热敷疗法仍是治疗睑板腺功能障碍(MGD)的主要方法。然而,对眼睑进行热敷(WC)只是缓解而非治疗,而且并不总是有具体的说明。眼睑热敷疗法种类繁多,缺乏明确的使用说明,这给习惯于明确剂量信息的患者带来了不确定性。本报告研究了过去 20 年的临床研究数据,以确定三种眼睑加温疗法--热毛巾、微波眼罩和自热眼罩(EM)--的有效方案:方法:对 2004 年至 2023 年间发表的有关 WC 和 MGD 的英文研究进行文献检索。纳入了在治疗组中使用热毛巾、微波加热眼罩和自动加热眼罩的研究,排除了仅作为对照组或与其他干预措施同时使用的研究。由此产生的 20 项研究被分为 3 组:5 组研究了 WC 的温度曲线,6 组研究了单次使用 WC 的情况,9 组研究了重复使用 WC 的情况。对研究方法和结果进行了列表,并进行了定性审查,通过泪膜、睑板腺健康状况和干眼症问卷调查等指标,对 WC 方案和疗效进行了关注:结果:上述研究数据显示,每种方法都能使眼睑温度达到 40 °C。单次使用热毛巾(5 至 20 分钟不等)可显著改善泪液质量,而反复使用热毛巾则可明显缓解多发性硬化症引起的干眼症状,在大多数研究中,热毛巾还能显著改善睑板腺健康。然而,热毛巾需要频繁加热才能将眼睑温度保持在 40 °C 以上,因此在纵向研究中效果相对较差。微波炉加热的电磁炉能在 10 分钟内保持良好的热量,并能改善泪液破裂时间和/或睑板腺评分。自发热电磁炉的激活时间不固定,通常使用时间较长,在短期研究中显示出与微波炉电磁炉类似的益处。监测依从性的研究表明,使用频率越高或使用时间越长,偏离规程的情况就越多。有证据表明,湿热敷具有更好的保温性,对导致多发性湿疹的特定因素(如肛门脓疱疮)具有治疗效果:考虑到随着使用频率的增加,患者对治疗的耐心依从性会降低,同时需要为不同类型的敷料提供简明扼要的说明,因此可取的策略是让患者按照制造商的说明,在每只眼睛上敷上湿热敷料(微波炉加热或自加热)至少 10 分钟。
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引用次数: 0
OCTA: Essential or Gimmick? OCTA:必要还是噱头?
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-06 DOI: 10.1007/s40123-024-00985-0
Siddharth Gandhi, Niveditha Pattathil, Netan Choudhry

This commentary article delves into the transformative role of optical coherence tomography angiography (OCTA) in diagnosing and managing a wide array of eye conditions, including diabetic retinopathy, age-related macular degeneration, retinal vein occlusions, and white dot syndromes. Developed in 2005, OCTA has emerged as a non-invasive, high-resolution imaging technique that offers advantages over traditional fluorescein angiography (FA), providing quicker and safer monitoring of ocular conditions with similar diagnostic accuracy. In diabetic retinopathy, OCTA has been instrumental in early identification of retinal changes, offering quantifiable metrics including perfused capillary density (PCD) for assessing vascular alterations. For age-related macular degeneration (AMD), OCTA has deepened our understanding of non-exudative neovascular AMD, allowing for more effective monitoring and potential earlier initiation of treatment. In cases of retinal vein occlusions, OCTA can reveal specific microvascular features and allow for depth-resolved measurements of the foveal avascular zone, providing significant prognostic implications. OCTA has also been invaluable in studying rare white dot syndromes, enabling nuanced differentiation between conditions that often present similarly. Emerging research also suggests that OCTA can have potential utility in neurodegenerative diseases like Alzheimer's, where retinal vascular patterns could offer diagnostic insights. While OCTA is revolutionizing ophthalmic care, further clinical trials and standardization are needed for its broader adoption into clinical practice.

这篇评论文章深入探讨了光学相干断层血管造影术(OCTA)在诊断和管理糖尿病视网膜病变、老年性黄斑变性、视网膜静脉闭塞和白点综合征等多种眼部疾病方面的变革性作用。OCTA 开发于 2005 年,是一种无创、高分辨率成像技术,与传统的荧光素血管造影术(FA)相比,它具有更多优势,能更快速、更安全地监测眼部病变,诊断准确率也与之相当。在糖尿病视网膜病变方面,OCTA 在早期识别视网膜病变方面发挥了重要作用,它提供了可量化的指标,包括用于评估血管病变的灌注毛细血管密度(PCD)。对于老年性黄斑变性(AMD),OCTA加深了我们对非渗出性新生血管性AMD的了解,从而可以进行更有效的监测,并有可能更早地开始治疗。在视网膜静脉闭塞的病例中,OCTA 可以显示特定的微血管特征,并能对眼窝无血管区进行深度分辨测量,从而对预后产生重要影响。OCTA 在研究罕见的白点综合征方面也非常有价值,它能对通常表现相似的病症进行细致的区分。新近的研究还表明,OCTA 在阿尔茨海默氏症等神经退行性疾病中也有潜在的应用价值,视网膜血管模式可为诊断提供洞察力。虽然 OCTA 正在为眼科护理带来革命性的变化,但要将其更广泛地应用于临床实践,还需要进一步的临床试验和标准化工作。
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引用次数: 0
Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uveitic Glaucoma. 微脉冲经巩膜环形光凝术治疗葡萄膜性青光眼的效果。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-07 DOI: 10.1007/s40123-024-00991-2
Julia L Xia, Monica K Ertel, Amit K Reddy, Alan G Palestine, Arthur J Stanley, Cara E Capitena Young, Mina B Pantcheva

Purpose: To report a case series of patients with uveitic glaucoma who were treated with micropulse transscleral cyclophotocoagulation (mpCPC).

Methods: This retrospective case series consists of patients from the University of Colorado Sue Anschutz-Rodgers Eye Center from 2015 to 2020 who were diagnosed with uveitic glaucoma. Information collected includes demographic data, type of uveitis, glaucoma severity, and prior glaucoma surgeries. Pre- and postoperative best corrected visual acuity, intraocular pressure (IOP), glaucoma medications, degree of inflammation, and uveitis therapies were included up to 36 months postoperatively. Surgical success was defined as an IOP reduction of 30% with achievement of IOP goal using the same number of glaucoma medications or less at 6 months or 1 year. Uveitis success was defined as the absence of persistent anterior uveitis at 3 months.

Results: Six patients and seven eyes with uveitic glaucoma underwent mpCPC. Types of uveitis included idiopathic anterior uveitis, HLA-B27-associated anterior uveitis, varicella zoster virus anterior uveitis, juvenile idiopathic arthritis-associated chronic anterior uveitis, lichen planus-associated intermediate uveitis, and sarcoidosis-associated panuveitis. Two of six eyes (33.3%) at 6 months and three of five eyes (60%) at 1 year achieved surgical success. Around 6 months postoperatively, two out of seven eyes (28.6%) required Ahmed glaucoma valve placement (n = 1) or repeat mpCPC (n = 1). One eye (14.3%) required phacoemulsification with goniotomy followed by an Ahmed glaucoma valve 18 months after mpCPC. There were no cases of persistent anterior uveitis, hypotony, or phthisis after mpCPC in this cohort.

Conclusions: Micropulse transscleral cyclophotocoagulation may safely reduce intraocular pressure in some patients with uveitic glaucoma without exacerbation of intraocular inflammation. Multiple treatments may be required to achieve longer-term success.

目的:报告采用微脉冲经巩膜环形光凝术(mpCPC)治疗葡萄膜炎性青光眼患者的系列病例:该回顾性病例系列包括科罗拉多大学苏安舒茨-罗杰斯眼科中心 2015 年至 2020 年确诊的葡萄膜炎性青光眼患者。收集的信息包括人口统计学数据、葡萄膜炎类型、青光眼严重程度和之前的青光眼手术。术前和术后最佳矫正视力、眼压(IOP)、青光眼药物、炎症程度和葡萄膜炎治疗方法均包括在内,直至术后 36 个月。手术成功的定义是眼压降低 30%,并在 6 个月或 1 年内使用相同数量或更少的青光眼药物达到眼压目标。葡萄膜炎的成功定义为 3 个月后无持续性前葡萄膜炎:结果:6 名患者和 7 只葡萄膜炎性青光眼眼接受了 mpCPC 治疗。葡萄膜炎类型包括特发性前葡萄膜炎、HLA-B27相关性前葡萄膜炎、水痘带状疱疹病毒前葡萄膜炎、幼年特发性关节炎相关性慢性前葡萄膜炎、扁平苔藓相关性中间葡萄膜炎和肉样瘤病相关性泛葡萄膜炎。6只眼睛中有2只(33.3%)在术后6个月和5只眼睛中有3只(60%)在术后1年取得了手术成功。术后 6 个月左右,7 只眼睛中有 2 只(28.6%)需要进行青光眼瓣膜置入术(1 例)或重复 mpCPC(1 例)。有一只眼睛(14.3%)在 mpCPC 术后 18 个月需要进行乳化手术,同时进行眼球切开术,然后再植入艾哈迈德青光眼瓣膜。本组病例中,没有人在接受微脉冲经巩膜环切术后出现持续性前葡萄膜炎、眼压过低或咽峡炎:结论:微脉冲经巩膜环形光凝术可以安全地降低部分葡萄膜炎性青光眼患者的眼压,同时不会加重眼内炎症。要取得长期成功,可能需要多次治疗。
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引用次数: 0
Treat-and-Extend Versus Pro re nata Regimens of Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration: A Comparative Study from Routine Clinical Practice. 雷珠单抗和阿弗利百普治疗新生血管性老年性黄斑变性的 "治疗-延长 "方案与 "临终方案":常规临床实践比较研究》。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.1007/s40123-024-00983-2
Eloi Debourdeau, Helene Beylerian, Vuong Nguyen, Daniel Barthelmes, Mark Gillies, Pierre Henry Gabrielle, Stela Vujosevic, Louise Otoole, Martin Puzo, Catherine Creuzot-Garcher, Benjamin Wolff, Vincent Daien

Introduction: Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or "treat-and-extend" (T&E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T&E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T&E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T&E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice.

Methods: We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naïve eyes starting nAMD treatment with at least three injections using a T&E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2 years versus baseline. The secondary outcome was the number of injections at 2 years.

Results: From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T&E regimen. At 24 months, patients on the T&E regimen experienced significantly greater mean (95% confidence interval) improvement in VA than those on PRN (+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] letters; p < 0.001), with more injections (14.9 standard deviation(SD) 4.3) vs. 9.8(SD 4.3); p < 0.001).

Conclusions: Eyes treated with a T&E regimen had better VA outcomes from VEGF inhibitors than eyes treated PRN. This large real-world data assessment supports previous data from randomized clinical trials that the T&E regimen delivers better outcomes than PRN.

导言:抗血管内皮生长因子(VEGF)治疗新生血管性年龄相关性黄斑变性(nAMD)通常采用 "原位 "或 "治疗-延长"(T&E)方案。随机临床试验报告显示,T&E优于Pro re nata(PRN),但临床试验的结果并不总能在临床实践中得到复制。比较 T&E 和 PRN 方案治疗 nAMD 的真实世界数据非常有限。本研究旨在报告常规临床实践中使用雷尼珠单抗和阿弗利贝赛普治疗 nAMD 的 PRN 与 T&E 方案的 24 个月疗效:方法:我们对前瞻性设计的观察结果登记处--抗击视网膜失明项目(FRB)的数据进行了回顾性分析!项目(FRB)的数据进行了回顾性分析。我们通过 FRB 追踪了开始接受 nAMD 治疗并使用 T&E 或 PRN 方案进行至少三次注射的未接受过治疗的眼睛。主要结果是视力(VA)的平均变化,以 2 年后最小解像角对数图上读取的字母数与基线相比来衡量。次要结果是两年内的注射次数:从2015年1月1日至2019年1月31日,共纳入了2948名nAMD患者的3313只眼睛:1065名患者中的1243只眼睛被归类为PRN,1935名患者中的2070只眼睛开始接受T&E治疗。24 个月后,接受 T&E 方案治疗的患者视力改善的平均值(95% 置信区间)明显高于接受 PRN 方案治疗的患者(+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] 个字母;P 结论:接受 T&E 方案治疗的患者视力改善的平均值(95% 置信区间)明显高于接受 PRN 方案治疗的患者:采用 T&E 方案治疗的患者与接受 PRN 治疗的患者相比,血管内皮生长因子抑制剂的 VA 效果更好。这一大型真实世界数据评估支持了之前的随机临床试验数据,即 T&E 方案比 PRN 方案的疗效更好。
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引用次数: 0
The Influence of Corneal Thickness on Surgically Induced Corneal Astigmatism Derived from Total Keratometry Measured by Anterior Segment Swept-Source OCT. 角膜厚度对手术引起的角膜散光的影响(通过前段扫描源 OCT 测量的全角膜度数得出)。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-17 DOI: 10.1007/s40123-024-00996-x
FangYu Zhao, Yufan Yin, Emmanuel Eric Pazo, Fang Tian, Yuanfeng Jiang, Shaochong Bu

Introduction: The purpose of the study was to explore the possible correlations between the anterior segment parameters derived from anterior segment swept-source optical coherence tomography (AS-SS-OCT) with the surgically induced corneal astigmatism (CSIA) calculated from total keratometry (TK) measured by AS-SS-OCT.

Methods: Seventy-one eyes of 67 patients with age-related cataract who underwent phacoemulsification combined with intraocular lens implantation with 2.2-mm incision were included. The CSIA values were calculated from anterior keratometry (CSIAKant) and TK (CSIATK) measured by AS-SS-OCT, respectively. Hotelling's T2 test was used to evaluate the difference. The correlation of CSIA with various parameters derived from AS-SS-OCT was tested with the Spearman correlation coefficient.

Results: The centroid of CSIAKant and of CSIATK were 0.31 ± 0.55 D @ 54° and 0.41 ± 0.59 D @ 51°, with no significant difference (F = 1.283, p = 0.281, Hotelling's T2). The mean absolute CSIAKant and CSIATK were 0.58 ± 0.24 D and 0.65 ± 0.28 D. Spearman test showed that the magnitude of CSIAKant was negatively correlated with preoperative peripheral corneal thickness (PCT, p = 0.045) and the magnitude of anterior keratometry (p = 0.044). The magnitude of CSIATK was negatively correlated with preoperative central corneal thickness (CCT, p = 0.003) and preoperative PCT (p = 0.015).

Conclusions: The increased thickness of the peripheral cornea is correlated with the decrease in the magnitude of the CSIA. The correlation we identified between the corneal thickness and the CSIA indicated that certain preoperative parameters should be considered for the prediction of CSIA for a more precise refractive outcome.

简介该研究旨在探讨前段扫源光学相干断层扫描(AS-SS-OCT)得出的前段参数与AS-SS-OCT测量的总角膜度数(TK)计算出的手术诱发角膜散光(CSIA)之间可能存在的相关性:纳入了 67 名接受超声乳化联合人工晶体植入术(2.2 毫米切口)的老年性白内障患者的 71 只眼睛。CSIA值分别根据AS-SS-OCT测量的前角膜测量值(CSIAKant)和TK值(CSIATK)计算得出。霍特林 T2 检验用于评估差异。用 Spearman 相关系数检验了 CSIA 与 AS-SS-OCT 得出的各种参数之间的相关性:结果:CSIAKant 和 CSIATK 的中心点分别为 0.31 ± 0.55 D @ 54°和 0.41 ± 0.59 D @ 51°,差异不显著(F = 1.283,P = 0.281,Hotelling's T2)。Spearman检验显示,CSIAKant的大小与术前周边角膜厚度(PCT,p = 0.045)和前角膜厚度(p = 0.044)呈负相关。CSIATK的大小与术前中央角膜厚度(CCT,p = 0.003)和术前PCT(p = 0.015)呈负相关:结论:周边角膜厚度的增加与 CSIA 值的降低相关。我们在角膜厚度和 CSIA 之间发现的相关性表明,为了获得更精确的屈光结果,在预测 CSIA 时应考虑某些术前参数。
{"title":"The Influence of Corneal Thickness on Surgically Induced Corneal Astigmatism Derived from Total Keratometry Measured by Anterior Segment Swept-Source OCT.","authors":"FangYu Zhao, Yufan Yin, Emmanuel Eric Pazo, Fang Tian, Yuanfeng Jiang, Shaochong Bu","doi":"10.1007/s40123-024-00996-x","DOIUrl":"10.1007/s40123-024-00996-x","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of the study was to explore the possible correlations between the anterior segment parameters derived from anterior segment swept-source optical coherence tomography (AS-SS-OCT) with the surgically induced corneal astigmatism (CSIA) calculated from total keratometry (TK) measured by AS-SS-OCT.</p><p><strong>Methods: </strong>Seventy-one eyes of 67 patients with age-related cataract who underwent phacoemulsification combined with intraocular lens implantation with 2.2-mm incision were included. The CSIA values were calculated from anterior keratometry (CSIA<sub>Kant</sub>) and TK (CSIA<sub>TK</sub>) measured by AS-SS-OCT, respectively. Hotelling's T<sup>2</sup> test was used to evaluate the difference. The correlation of CSIA with various parameters derived from AS-SS-OCT was tested with the Spearman correlation coefficient.</p><p><strong>Results: </strong>The centroid of CSIA<sub>Kant</sub> and of CSIA<sub>TK</sub> were 0.31 ± 0.55 D @ 54° and 0.41 ± 0.59 D @ 51°, with no significant difference (F = 1.283, p = 0.281, Hotelling's T<sup>2</sup>). The mean absolute CSIA<sub>Kant</sub> and CSIA<sub>TK</sub> were 0.58 ± 0.24 D and 0.65 ± 0.28 D. Spearman test showed that the magnitude of CSIA<sub>Kant</sub> was negatively correlated with preoperative peripheral corneal thickness (PCT, p = 0.045) and the magnitude of anterior keratometry (p = 0.044). The magnitude of CSIA<sub>TK</sub> was negatively correlated with preoperative central corneal thickness (CCT, p = 0.003) and preoperative PCT (p = 0.015).</p><p><strong>Conclusions: </strong>The increased thickness of the peripheral cornea is correlated with the decrease in the magnitude of the CSIA. The correlation we identified between the corneal thickness and the CSIA indicated that certain preoperative parameters should be considered for the prediction of CSIA for a more precise refractive outcome.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2381-2391"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stereopsis Following Implantation of Presbyopia-Correcting Intraocular Lenses: A Narrative Review. 植入老花矫正眼内镜片后的立体视:叙述性综述。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-02 DOI: 10.1007/s40123-024-01004-y
Yongyuan He, Bijun Zhu, Baojiang Li, Haidong Zou, Yingyan Ma

Recent advancements in cataract surgery have broadened its scope from mere vision restoration to include correction of refractive errors and presbyopia. This evolution has introduced multifocal and extended depth-of-focus (EDOF) intraocular lenses (IOLs), allowing enhanced vision across multiple distances. However, the influence of these advanced IOLs on stereopsis remains controversial. Factors influencing stereopsis after surgery include visual acuity, interocular differences, residual astigmatism, and the type of IOL, etc. Binocular vision integration and neuroadaptation further affect stereopsis, especially in cases of presbyopia-correcting IOLs. It is widely acknowledged that bilateral implantation of presbyopia-correcting IOLs yield superior stereopsis compared to unilateral implantation. However, there remains no consensus on whether binocular implantation of multifocal or monofocal IOLs provides superior stereopsis. Most studies suggest no significant difference in stereopsis between these two types of implants. Among different types of multifocal IOLs, refractive multifocal IOLs may offer better stereopsis than diffractive multifocal IOLs when implanted bilaterally. Emerging EDOF and hybrid multifocal-EDOF IOLs also demonstrate promising postoperative stereopsis. Additionally, a mix-and-match strategy with different types of IOLs implanted in each eye may result in interocular differences in visual acuity at certain distances, potentially affecting stereopsis. Nevertheless, with appropriate selection, most patients can achieve satisfactory postoperative stereopsis. This review synthesizes current literature on the effects of presbyopia-correcting IOLs on postoperative stereopsis recovery following cataract surgery. Studies on stereopsis outcomes with different IOLs have yielded mixed results, urging further investigation for optimized surgical strategies and patient outcomes.

白内障手术的最新进展扩大了手术范围,从单纯的视力恢复扩展到了屈光不正和老花眼的矫正。这一演变引入了多焦点和扩展焦深(EDOF)眼内人工晶体(IOLs),从而提高了多距离视力。然而,这些先进的人工晶体对立体视的影响仍存在争议。影响术后立体视的因素包括视力、眼间差异、残余散光和人工晶体类型等。双眼视力整合和神经适应会进一步影响立体视,尤其是在使用老花矫正人工晶体的情况下。人们普遍认为,与单侧植入相比,双侧植入老花矫正人工晶体的立体视效果更好。然而,对于双眼植入多焦或单焦人工晶体是否能带来更佳的立体视效果,目前仍未达成共识。大多数研究表明,这两种植入方式的立体视差异不大。在不同类型的多焦人工晶体中,屈光性多焦人工晶体在双侧植入时可能比衍射性多焦人工晶体提供更好的立体视。新兴的 EDOF 和多焦-EDOF 混合型人工晶体也显示出良好的术后立体感。此外,每只眼睛植入不同类型的人工晶体的混合搭配策略可能会导致在某些距离上出现眼间视力差异,从而可能影响立体视。不过,只要选择得当,大多数患者术后都能获得满意的立体视效果。本综述综述了目前关于老花眼矫正人工晶体对白内障手术后立体视恢复的影响的文献。对不同人工晶体的立体视效果研究结果不一,因此需要进一步研究,以优化手术策略和患者效果。
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引用次数: 0
The Role of Widefield Optical Coherence Tomography Angiography in Assessing the Severity of Diabetic Retinopathy. 宽视场光学相干断层扫描血管造影术在评估糖尿病视网膜病变严重程度中的作用。
IF 2.6 3区 医学 Q2 OPHTHALMOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-12 DOI: 10.1007/s40123-024-00995-y
Deepika C Parameswarappa, Amelia Janis Langstang, Sanagavarapu Kavya, Ashik Mohamed, Michael W Stewart, Padmaja Kumari Rani

Introduction: Physicians need an accurate understanding of diabetic retinopathy (DR) severity to optimally manage patients. The aim of this prospective study is to correlate the severity of macular and peripheral retinal vascular abnormalities seen on widefield (WF) optical coherence tomography angiography (OCTA) with DR grading based on WF fundus photography.

Methods: The study included 150 eyes from 82 patients with treatment-naïve DR. All patients were imaged with WF fundus photography and swept-source WF OCTA. Quantitative and qualitative analyses of the foveal avascular zone (FAZ) size and shape, and measurement of capillary nonperfusion (CNP) areas, were performed from the OCTA images. The mixed-effects model was used to compare the DR grading from WF photography with the vascular changes seen on WF-OCTA, and Bonferroni correction was applied to the gradings.

Results: The mean [± standard deviation (SD)] age of patients was 55.5 (± 9.4) years. The WF-OCTA showed that an increasing size of the FAZ (from 0.442 (± 0.059) µm to 0.933 (± 0.086) µm) correlated with increasing severity of the DR (as determined with WF photography). The deep capillary plexus, FAZ size, and CNP areas in eyes with proliferative diabetic retinopathy (PDR) differed from those with mild nonproliferative diabetic retinopathy (NPDR) (p < 0.001). Most eyes with severe nonproliferative DR were found to have CNP in four quadrants [superficial capillary plexus (SCP) 60%, deep capillary plexus (DCP) 50%]. The WF-OCTA detected subtle neovascularization of the disc (NVD) in 7 eyes (10%) and neovascularization elsewhere (NVE) in 13 eyes (18%) that had been diagnosed with only moderate NPDR on WF photography.

Conclusions: FAZ and CNP areas as measured by WF-OCTA correlate with DR severity. WF-OCTA can also detect subtle NVE and NVD that cannot be seen with fundus photography.

导言:医生需要准确了解糖尿病视网膜病变(DR)的严重程度,以便对患者进行最佳管理。这项前瞻性研究的目的是将宽视场(WF)光学相干断层血管成像(OCTA)所见黄斑和周边视网膜血管异常的严重程度与基于 WF 眼底摄影的 DR 分级联系起来:该研究包括 82 名未接受过治疗的 DR 患者的 150 只眼睛。所有患者均接受了 WF 眼底摄影和扫源 WF OCTA 扫描。根据 OCTA 图像对眼窝无血管区(FAZ)的大小和形状进行定量和定性分析,并测量毛细血管无灌注区(CNP)。混合效应模型用于比较WF摄影的DR分级和WF-OCTA的血管变化,并对分级进行Bonferroni校正:患者的平均年龄为 55.5 (± 标准差 (SD))岁。WF-OCTA显示,FAZ的增大(从0.442(± 0.059)µm到0.933(± 0.086)µm)与DR严重程度的增加相关(由WF摄影确定)。增殖性糖尿病视网膜病变(PDR)患者的深部毛细血管丛、FAZ 大小和 CNP 面积与轻度非增殖性糖尿病视网膜病变(NPDR)患者不同(p 结论:PDR 患者的深部毛细血管丛、FAZ 大小和 CNP 面积与轻度非增殖性糖尿病视网膜病变(NPDR)患者不同:WF-OCTA 测量的 FAZ 和 CNP 面积与糖尿病视网膜病变的严重程度相关。WF-OCTA 还能检测出眼底照相无法看到的细微 NVE 和 NVD。
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引用次数: 0
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Ophthalmology and Therapy
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