Ophthalmic Research最新文献

Introduction: Study aims to investigate the relationship between the location of retinal vascularization and plus severity with re-treatment rates in intravitreal bevacizumab (IVB) treated eyes.

Methods: For this retrospective, observational study, 200 eyes treated with IVB for Type 1 retinopathy of prematurity (ROP) and aggressive-ROP were included. The pre-treatment retinal vascularization was evaluated by analyzing quantitative measurements of optic disc to fovea distance (DFD), disc diameter, and shortest and longest distance between the optic disc and ridge of wide-field fundus photographs (WFPs). Plus severity was qualified in five grades such as normal, pre-plus, mild plus, moderate plus, and severe plus, by evaluating WFPs. Re-treatments up to 60 weeks postmenstrual age (PMA) were evaluated. Re-treated eyes up to first month after initial treatment were labeled as early re-treatment group, and re-treated eyes after the first month of initial treatment up to 60 weeks PMA were labeled as middle term re-treated group.

Results: 36% of eyes had zone Ⅰ, 64% of eyes had zone Ⅱ disease, and 42% eyes had mild plus disease. Forty-three (21.5%) eyes of 23 infants underwent re-treatment prior to 60 weeks PMA. Thirteen eyes and 30 eyes were in the early and middle term re-treated groups, respectively. In middle term re-treated group, 27 (13.5%) eyes re-treated for progressive reactivated disease, and 3 (1.5%) eyes re-treated for prophylactic purposes. Advanced pre-treatment retinal vascularization and high birth weight were negatively associated with the re-treatment rate (p=0.016, odds ratio=0.774; p=0.041, odds ratio=0.999, respectively). There was a positive association between the re-treatment rate and pre-treatment plus severity (p=0.044, odds ratio =1.449). The lower ratio of shortest distance between the optic disc and ridge to DFD was considered as an independent predictive variable for higher rate of re-treatment (p=0.002; odds ratio: 0.450).

Conclusion: The location of retinal vascularization and plus disease showed a wide distribution in bevacizumab treated eyes. Graded evaluation of retinal vascularization and plus severity may help predict the need for additional treatment. Unresponsiveness to the initial treatment, increased fibrotic activity, progressive reactivated stage 2-3 ROP and extraretinal new vessels, and prophylactic purposes were the main re-treatment indications.

Introduction: To investigate the anterior segment anatomical parameters associated with the scleral spur and cornea for risk profiling of primary angle-closure glaucoma (PACG).

Methods: A retrospective study was conducted, collecting parametric measurements obtained using CASIA 2 and IOLMaster 700. Univariate and multivariate logistic regression models were utilized to compare ocular parameters between the narrow angle (NA) group and PACG group, as well as identify risk factors for PACG. The predictive performance of each parameter was evaluated using the area under the receiver operating characteristic curve (AUROC).

Results: A total of 84 patients with PACG (48 with PACG and 36 with chronic PACG) and 84 patients with NA were included in this study. In the multivariable model, it was demonstrated that individuals with a smaller trabecular scleral-spur angle (TSA; OR = 0.810, per 1 degree increase, p < 0.001, AUROC =0.738) and larger relative lens vault (rLV: OR = 1.112, per 1 percent increase, p < 0.001, AUROC =0.720) had an increased risk of developing PACG. Furthermore, combining TSA with rLV yielded an improved AUROC value of 0.807 (p<0.001).

Conclusion: AS-OCT is a valuable tool for early assessment of progression risk in NA patients at risk for developing PACG. Our findings suggest that both TSA and rLV are significant risk factors for PACG. Moreover, the novel parameter TSA demonstrates promising potential as a predictive tool for early PACG screening.

Introduction: To investigate the effect of different levels of early intraocular pressure (IOP) on long-term outcomes of patients with primary open-angle glaucoma (POAG) who were treated with primary trabeculectomy.

Methods: This was a retrospective cohort study, with a total of 74 patients (90 eyes) with primary open-angle glaucoma (POAG) who were treated with trabeculectomy surgery at a single center from 2021 to 2022. Based on IOP at 1 day after surgery, they were divided into the high IOP group (≥ 15mmHg) and the low IOP group (< 15mmHg). The Student's t-test and a chi-square test were used to compare the differences between the two groups. The generalized estimating equation (GEE) model compared the included binocular data to adjust for internal correlations between the two eyes of the same subject. The Kaplan-Meier method compared the surgical success rates of the two groups. Besides, to identify the relationship between IOP at different postoperative time points and IOP at 1-year follow-up, the Spearman correlation analysis was established.

Results: A total of 90 eyes (74 patients) with POAG were included in this investigation. After a 1-year follow-up, both the qualified surgical success rates in the high IOP group and the low IOP group were 92.3% and 92.2% respectively, and there was no statistically significant difference between them (P=0.890). The rate of bleb massage in the high IOP group was 82.1% (32 eyes) which was significantly higher than in the low IOP group (19.6%, 10 eyes) (P<0.001). In the Spearman correlation analysis, it was observed that in the high IOP group, the significant correlation with IOP at 1 year emerged at 1 week after surgery (r= 0.496, P=0.002) and a higher correlation at 1 month after surgery (r=0.515, P=0.002). In the low IOP group, the significant correlation with IOP at 1 year emerged at 3 month after surgery (r=0.314, P=0.038) and a higher correlation at 6 month after surgery (r=0.592, P< 0.001).

Conclusion: In the POAG patients with primary trabeculectomy, we demonstrated that compared with the low IOP group, the high IOP group could provide a similar surgical success rate, while requiring a higher frequency of bleb massage. In addition, in the high IOP group, IOP at 1 month after surgery predicted long-term IOP control outcomes.

Background Electrodiagnostic tests (EDTs) provide non-invasive, objective and measurable indications of retinal and visual pathway function. These hold the promise of evaluating drug efficacy and disease progression over shorter periods than traditional 'end-stage' outcome measures (e.g., best-corrected visual acuity) in various ophthalmological pathologies. The International Society for Clinical Electrophysiology of Vision has defined rigorous standards for EDTs, intended to optimise diagnostic power, enabling meaningful inter-laboratory comparisons and facilitating application as outcome measures in increasing numbers of multicentre clinical trials. Summary This review outlines the main EDTs, including full-field, pattern and multifocal electroretinography, the electro-oculogram and the cortical visual evoked potential, and highlights the possible role for monitoring disease progression and assessing treatment safety and efficacy. The utility and potential of EDTs are highlighted in studies that have assessed function and tested or monitored treatment safety or efficacy for a range of acquired retinal and optic nerve disorders, including central retinal vein occlusion, diabetic retinopathy, glaucoma, age-related macular degeneration, posterior uveitis and autoimmune-related retinopathies. Key messages EDTs are fundamental to the diagnosis and phenotyping of many acquired retinal and visual pathway disorders. They also provide methods for the objective assessment of the efficacy and safety of potential novel treatments across short periods. Conventional psychophysical tests, such as visual acuity, are of limited value in localizing and characterizing dysfunction, and are not always suitable for monitoring purposes. This review highlights where EDTs may address the need for better outcome measures to evaluate novel treatments within clinical trials, helping to select early treatment candidates and for the assessment of safety and efficacy.

Introduction: Cataract may cause severe visual impairment in eyes with microphthalmos and uveal coloboma. Despite their similarities, distinguishing between these conditions is crucial for cataract surgery. We aimed to compare complications, nucleus hardness, surgical strategies, and outcomes of cataract surgery between microphthalmos and uveal coloboma.

Methods: This retrospective comparative study included 19 eyes with microphthalmos and 20 with uveal coloboma. Preoperative, intraoperative, and postoperative data of eyes that underwent cataract surgery were analysed.

Results: MO eyes had lower high-hardness nucleus rates (P=0.002) than UC. The most common preoperative complications in the microphthalmos and uveal coloboma groups were glaucoma (37.5%) and retinal detachment (15.4%), respectively. No significant differences in the phacoemulsification (P=0.45) or intraocular lens implantation (P>0.99) rates between the two groups. Extracapsular cataract extraction was performed in five eyes (25%), and posterior capsular rupture was the most common surgical complication (15%) in the uveal coloboma group. Combined surgery was mainly used to deal with high or unstable intraocular pressure (77%) in the microphthalmos group versus posterior pars plana vitrectomy (85.71%) in the uveal coloboma group to treat vitreoretinal pathologies. Corrected distance visual acuity was significantly improved in both microphthalmos (P=0.0005) and uveal coloboma (P<0.001) groups, while intraocular pressure was decreased (P=0.03) in the microphthalmos group.

Conclusion: Eyes with microphthalmos and uveal coloboma exhibited distinct cataract grades and complications, necessitating varied surgical strategies; while cataract surgery has proven to be effective in improving the visual acuity in both groups. Our findings hold significant value for guiding clinical treatment decision-making.

Introduction: The use of posterior chamber phakic intraocular lenses are a reasonable option in the armamentarium to treat refractive error in patients with keratoconus. We present our experience with the use of posterior chamber phakic intraocular lens (PCPIOL) for the management of ametropia in patients with keratoconus.

Methods: Patients included those with stable keratoconus treated in the Corneoplastic Unit, Queen Victoria Hospital. East Grinstead, United Kingdom, with PCPIOL (ICL Staar Surgical and IPCL Care Group) to improve their visual acuity. Data were obtained from preoperative visit and 1, 3, 6 and 12 months after surgery. Clinical characteristics, pre- and postoperative uncorrected (UDVA) and best corrected (CDVA) logMAR visual acuities and perioperative complications were analyzed.

Results: 23 eyes of 21 patients were included. UDVA changed from 0.75 preoperatively to 0.18 post-surgery (P = < 0.001) and CDVA from 0.07 to 0.12 (P = 0.12). Seventy percent of the cases increased 3 or more lines of UDVA while none of the eyes lost more than 2 lines of CDVA. No significant difference in final UDVA was found between patients with and without previous keratoplasty (0.27 and 0.18, P=0.38), previous corneal collagen crosslinking (0.16 and 0.3, P=0.24), intracorneal ring segments (0.2 and 0.2, P=0.94) or type of lens implanted (0.2 ICL and IPCL. P = 0.94). One intraoperative complication reported was an inverted PCPIOL insertion and postoperatively 4 axis rotations and 1 cataract were observed.

Conclusions: The use of PCPIOL in patients with stable keratoconus is effective in improving their UDVA, even in cases with previous corneal procedures such as keratoplasty, crosslinking and intracorneal rings. Rotation is the most common postoperative complication.

Introduction: To characterize fundus autofluorescence (AF) changes that occur in the macula of patients with retinitis pigmentosa (RP).

Methods: We conducted a case series on ninety-nine patients with RP. Features seen on fundus AF images were evaluated, organized into a grading scheme and correlated with ellipsoid zone (EZ) width. Patterns of AF changes occurring in the macula and correlation with EZ width.

Results: Four primary fundus AF phenotypes were identified: (1) hyperAF arc, (2) hyperAF ring, (3) hyperAF ring with abnormal hyperAF within the ring, and (4) central hyperAF. The second phenotype was most common and had 3 subgroups, hyperAF rings within the macula, those extending outside the macula, and incomplete rings. HyperAF rings were also characterized as narrow or wide with wide rings having a greater amount of hyperAF. Linear Mixed-Effects Model showed mean measured EZ width was significantly greater for phenotype 1 versus each of the other 3 phenotypes (p<0.01) and for phenotype 2 versus phenotypes 3 and 4 (p<0.05), and also differed among phenotype 2 subgroups (p<0.05). Other AF characteristics identified were focal posterior distinct or indistinct hypoAF which sometimes formed complete or incomplete hypoAF rings surrounding a hyperAF ring, diffuse or focal hyperAF outside hyperAF rings, and the amount of encroachment of peripheral hypoAF.

Conclusion: A grading scheme for macular AF features in patients with RP identified phenotypes that correlate with stage of disease based upon EZ width. Longitudinal studies are needed to test whether presumed early AF phenotypes evolve into later phenotypes. Use of the grading scheme for patient populations in interventional trials could help to determine if any of the defined AF features provide predictive value for therapeutic responses.

Introduction: In recent years, intravitreal injections (IVT) of vascular endothelial growth factor (VEGF) inhibitors have become the standard of care for several macular disorders. Frequently, the therapeutic course requires numerous injections, posing a burden on patients. Non-adherence to treatment may result in reduced visual outcomes, therefore understanding and addressing the underlying causes is imperative.

Methods: A cross-sectional study of patients who missed their scheduled appointment for anti-VEGF IVT as part of the routine management of their macular disease at a single tertiary center between November 2020 and February 2021. A telephone survey was conducted and patient medical charts were reviewed for ophthalmological data.

Results: A total of 100/556 (18%) patients who failed to attend their scheduled anti-VEGF IVT appointments were documented. Among these subjects, the average age was 66 (SD ±14) years with a nearly equal gender distribution of 49:51 F:M ratio. Reported no-show reasons included concurrent illness (39%), administrative issues such as missing financial coverage forms or scheduling problems (28%), and lack of motivation (11%). Additionally, 73% of patients who missed appointments expressed a need for accompaniment, and 74% resided outside the hospital city.

Conclusions: Study results highlight modifiable factors contributing to no-shows to anti-VEGF IVT, such as poor transportation access, complicated administrative processes, and difficulty rescheduling missed appointments. Understanding potential obstacles to anti-VEGF IVT therapy, particularly those that are preventable, can enhance adherence and potentially improve the clinical outcome.

Introduction: The aim of the study was to evaluate clinical and biometric factors leading to a prediction error related to lens position in pars plana vitrectomy.

Methods: This study was conducted as a consecutive retrospective case series at the Department of Ophthalmology, Montpellier University Hospital. All medical files and PCI biometrical reports from a single surgeon were reviewed from 2017 to 2019. Patients who had phacoemulsification with the ASPHINA 509 MP® intraocular lens were selected and stratified into 3 groups: phacoemulsification alone (group 1), phacoemulsification and vitrectomy with gas tamponade (group 2), and phacoemulsification and vitrectomy without tamponade (group 3). Clinical factors and biometry factors from initial and final biometry were collected. Refractive error, actual lens position, C constant, axial length delta, and pre-operative and post-operative anterior and posterior segment variation parameters were calculated.

Results: A total of 140 eyes were analyzed, 90 in group 1, and 25 in group 2 and 3. The mean prediction error was 0.10 ± 0.55 D (group 1); -0.36 ± 0.74 D (group 2); and -0.12 ± 0.54 D (group 3) with p < 0.05 for group 1 vs. group 2. The mean actual lens position was 5.25 ± 0.29 mm; 5.66 ± 0.60 mm; and 5.50 ± 0.43 mm for the 3 groups, respectively (p < 0.001). Axial length delta was -0.10 ± 0.13 mm in group 1, -0.062 ± 0.20 mm in group 2, and -0.022 ± 0.17 mm in group 3 (p = 0.015). Multilinear regression analysis found a significant and independent influence of vitrectomy and gas tamponade on prediction error.

Conclusion: Myopic shift in the case of vitrectomy is multifactorial, effective lens position is modified by vitrectomy and vitreous refractive index is changing. The integration of these data in formulas may improve refractive outcome after cataract and vitrectomy surgery.

Introduction: The aim of the study was to systematically review the evidence from randomized controlled trials that evaluate the efficacy and safety of perfluorohexyloctane in the treatment of dry eye disease.

Methods: Literature search was conducted on PubMed and Scopus in April 2024 with the search strategy ("perfluorohexyloctane" or "NOV03" or "semifluorinated alkane") and "dry eye." Extension and paired-eyes study were excluded. The risk of bias was assessed using the Cochrane risk-of-bias tool. Forest plots and a summary of findings were prepared for total corneal fluorescein staining (tCFS), tear film break-up time (TFBUT), eye dryness score (EDS), and Ocular Surface Disease Index (OSDI).

Results: The pooled standardized mean difference (SMD) for tCFS after 8 weeks of treatment was -0.53 (95% CI: -0.68 to -0.38; p < 0.001), indicating a significant improvement in patients treated with perfluorohexyloctane. The between-study heterogeneity was moderately high (I2 = 52.0%). No significant differences in TFBUT were observed (SMD = 0.05; 95% CI: -0.16 to 0.25; p = 0.654). Regarding symptoms, patients treated with NOV03 had significantly lower EDS compared to controls (SMD = -0.49; 95% CI: -0.66 to -0.32; p < 0.001), with moderately high heterogeneity (I2 = 71.1%). Conversely, the pooled SMD of OSDI was -0.13 (95% CI: -0.43 to 0.17; p = 0.412), indicating no significant difference.

Conclusion: Perfluorohexyloctane is an effective and safe alternative for the treatment of evaporative dry eye disease due to MGD that can significantly reduce tCFS and eye dryness symptoms. More well-designed non-sponsored randomized clinical trials are required to investigate the impact on other ocular surface parameters.