Ophthalmic Research最新文献

Purpose: To evaluate the rotational stability of three toric intraocular lens (TIOL) platforms in patients undergoing repositioning surgery.

Methods: This comparative retrospective study enrolled eyes that underwent cataract surgery and implanted with a AcrySof, AT TORBI/LISA, or TECNIS TIOL. Patients who experienced TIOL misalignment ≥10° postoperatively and underwent repositioning surgery were included. The incidence of repositioning surgery after cataract surgery and the misalignment degree before and after repositioning surgery of the three TIOL platforms were mainly compared.

Results: Of the 2598 eyes implanted TIOLs, 56 eyes (2.156%) undergoing repositioning. The repositioning rates for the AcrySof, AT TORBI/LISA, and TECNIS platforms were 0.848% (10/1179), 2.935% (28/954), and 3.871% (18/465), respectively, showing significant differences (P<0.001). Misalignment degrees before repositioning surgery for the AcrySof, AT TORBI/LISA, and TECNIS TIOLs were 27.90±15.74°, 60.79±18.79°, and 31.61±20.84°, respectively (P<0.001). AT TORBI/LISA platform had a significantly greater misalignment degree compared to AcrySof (Difference:32.89°, P<0.001) and TECNIS platforms (Difference:29.18°, P<0.001). There was no significant difference between AcrySof and TECNIS (Difference:3.71°, P=0.629). After repositioning, the AT TORBI/LISA platform showed significantly higher misalignment degrees compared to AcrySof and TECNIS (Difference:6.63°;5.49°, P=0.009).

Conclusion: AcrySof TIOLs had a lower incidence of repositioning surgery comparing with AT TORBI/LISA and TECNIS, while AT TORBI/LISA TIOLs exhibited a higher degree of axis misalignment both before and after repositioning.

Background: Juvenile-onset open-angle glaucoma (JOAG) is a rare and refractory form of glaucoma, primarily characterized by structural abnormalities in the trabecular meshwork and Schlemm's canal. These abnormalities disrupt aqueous humor outflow, resulting in elevated intraocular pressure and progressive glaucomatous damage. Pharmacological and laser therapies are generally ineffective in managing JOAG. Surgical intervention, particularly Schlemm's canal surgery, is considered an optional component of its treatment.

Summary: This review comprehensively analyzes the advancement of Schlemm's canal surgery for JOAG, including ab externo and ab interno Schlemm's canal surgery.

Key messages: Schlemm's canal surgery is a procedure designed to enhance aqueous humor outflow by reducing resistance within the outflow pathway, offering a safe and effective option for treating JOAG. Recent advances in our understanding of JOAG pathogenesis, coupled with continuous improvements in surgical techniques, have ushered in a new era of "ab interno" and minimally invasive procedures. These procedures targeting the extensive trabecular meshwork may enhance therapeutic efficacy. However, prospective and comparative studies with larger sample sizes and extended follow-up periods are needed to validate the long-term safety and efficacy of these surgical methods in managing JOAG.

Background: Previous observational studies have suggested an association between vitamin D levels and the risk of cataracts. Whilst this correlation has been well reported, there is a lack of causal evidence.

Methods: We first conducted an observational study using UK Biobank (UKBB) data to explore the correlation between vitamin D levels and deficiency with incident cataract. To assess causality, we then performed both one-sample and two-sample Mendelian Randomisation (MR) analyses. The one-sample MR used genetic risk scores (GRS) reflecting a genetic predisposition to higher vitamin D levels and vitamin D deficiency, examining its association with incident cataract. The two-sample MR, publicly available summary statistics for vitamin D levels and deficiency were used to investigate their relationship with cataract. Sensitivity analyses using a UKBB meta-analysis for vitamin D in a two-sample MR and a gene-focused analysis using variants in genes with a known role in vitamin D metabolism.

Results: The observational analysis showed a statistically significant relationship between both vitamin D levels (OR = 0.998, ln(OR)SE = 3.23x10-4, p = 6.72x10-14) and deficiency (OR = 1.237, ln(OR)SE = 0.022, p = 9.05x10-23) with incident cataract risk. However, there was insufficient evidence to suggest an association between vitamin D supplementation and cataract risk (OR = 0.971, ln(OR)SE = 0.016, p = 0.057). Furthermore, no evidence was found in our one-sample MR analysis to suggest a causal relationship between vitamin D levels (OR = 1.001, ln(OR)SE = 0.002, p = 0.541) or vitamin D deficiency (OR = 1.095, ln(OR)SE = 0.145, p = 0.534) and incident cataract. The inverse variance weighted two-sample MR analysis also showed no evidence to suggest a causal association between vitamin D levels (IVW: OR = 1.122, 95% CI: 0.968-1.301, p = 0.125) or deficiency (IVW: OR= 0.987, 95% CI: 0.959-1.015, p = 0.344) and cataract risk, with consistent results observed using a multi-ethnic cataract cohort. Some evidence was observed between vitamin D levels and increasing cataract risk (Weighted median OR = 1.076, 95% CI: 1.002-1.156, p = 0.045), however, due to sample overlap between the exposure and outcome, datasets should be interpreted with caution.

Conclusion: Whilst we identified a correlative association between vitamin D levels and cataract, we found no robust evidence to support a causal relationship between vitamin D levels and deficiency with cataract risk.

Purpose: To evaluate the effect of different correlated color temperatures (CCT) of organic light-emitting diode (OLED) lighting on accommodative lag (LAG) and near work-induced transient myopia (NITM).

Methods: The refractions of 31 young adults (11 male) were measured with an open-field autorefractor at 33 cm after 30 and 60 minutes of reading under 4274 K and 1877 K. The initial NITM and LAG were assessed objectively at baseline and every 30 minutes. The use of two CCTs was determined in the order of the random number table.

Results: After reading under for 30 minutes, the mean LAG for low-CCT lighting was slightly lower than the high-CCT lighting (-0.97 ± 0.53 D vs -1.21 ± 0.50 D, P = 0.10); after reading for 60 minutes, the difference was significant (-1.09 ± 0.55 D vs -1.36 ± 0.51 D, P = 0.048). When grouped according to the degree of myopia, both mild myopes (-1.11 ± 0.43 vs -1.38 ± 0.60 after 30-minute reading, P = 0.38; -1.34  ± 0.27 vs -1.5  ± 0.54 after 60-minute reading, P = 0.53) and moderate myopes (-0.90 ± 0.57 vs -1.12 ± 0.42 after 30-minute reading, P = 0.16; -0.96  ± 0.61 vs -1.28  ± 0.50 after 60-minute reading, P = 0.05) presented lower LAG magnitude under low-CCT lighting than high-CCT lighting, while the difference was not significant. As for NITM, no significant difference has been found between two CCTs in any group.

Conclusion: Reading under low-CCT lighting (1877 K) had a lower LAG magnitude than reading under high-CCT lighting (4274 K), suggesting the potential usefulness of low-CCT lighting for reducing LAG magnitude during near work.

Purpose: To evaluate the levels of 40 cytokines in the aqueous humor (AH) and their correlation with ultrasound cycloplasty (UCP) outcomes in patients with primary glaucoma.

Methods: Aqueous humor samples were collected from 38 primary glaucoma patients after UCP procedure. The cytokines were measured via antibody arrays and evaluated via Cox proportional hazards regression to determine the UCP outcomes. Follow-up visits were performed at 1 day, 1 week, and 1 and 3 months postoperatively. The study subjects were allocated into success and failure groups based on surgical results.

Results: Significantly high MCP-1 (P=0.034) and TGF-β1 levels (P=0.041) were observed in the failure group. Both univariate and multivariate analyses indicated that high MCP-1 (P=0.040, P=0.018) and TGF-β1 (P=0.049, P=0.041) levels were significant risk factors for UCP failure. The levels of MCP-1 were positively correlated with intraocular pressure (IOP) at 1 day (r=0.416, P=0.010) and 3 months (r=0.329, P=0.044) postoperatively.

Conclusions: In primary glaucoma patients, high postoperative levels of MCP-1 and TGF-β1 were significant risk factors for UCP failure. MCP-1 levels in the AH could be a potential indicator for predicting postoperative IOP.

Background This study investigates the role of the immune costimulatory factor B7-H3 in laser-induced choroidal neovascularization (CNV) and its underlying molecular mechanisms. Methods A CNV model was established in C57BL/6J mice to examine the temporal expression dynamics of B7-H3 in choroidal tissues. B7-H3 knockout (B7-H3-KO) mice were used to assess CNV lesion size compared to wild-type (WT) controls after laser induction. RNA sequencing and xCELL analysis were performed to identify differentially expressed genes and immune cell infiltration patterns. Additionally, in vitro experiments using culture supernatants from murine B7-H3+/- peritoneal macrophages were conducted to evaluate B7-H3's role in angiogenesis using bEnd.3 endothelial cells. Results B7-H3 expression in the CNV model exhibited an initial upregulation followed by a decline. CNV lesions were significantly smaller in B7-H3-KO mice (1.47 × 106 ± 0.21 × 106 µm2, P < 0.001) and in mice receiving intravitreal injections of B7-H3 monoclonal antibody (2.29 × 106 ± 0.21 × 106 µm2, P < 0.05) compared to WT controls (3.46 × 106 ± 0.41 × 106 µm2). Transcriptomic and xCELL analyses revealed reduced M2 macrophage infiltration and downregulation of the S100A8/A9 heterodimer in B7-H3-KO mice. In vitro, B7-H3-KO peritoneal macrophages and RAW264.7 cells treated with S100A8/A9-siRNA exhibited diminished proliferation, migration, and tube formation of bEnd.3 cells. These effects were reversed upon supplementation with exogenous S100A8/A9 heterodimer to B7-H3-KO peritoneal macrophages. Further mechanistic investigation demonstrated that B7-H3 modulates bEnd.3 proliferation and CNV progression via S100A8/A9-mediated activation of the TLR4-NF-κB-VEGFA signaling pathway. Conclusions The immune costimulatory molecule B7-H3 promotes CNV by modulating macrophage-mediated S100A8/A9 signaling, which activates the TLR4-NF-κB-VEGFA axis. These findings highlight B7-H3 as a potential therapeutic target in CNV-associated diseases.

Introduction: Cataract may cause severe visual impairment in eyes with microphthalmos (MO) and uveal coloboma (UC). 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 MO and UC.

Methods: This retrospective comparative study included 19 eyes with MO and 20 with UC. 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 MO and UC 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 UC group. Combined surgery was mainly used to deal with high or unstable intraocular pressure (IOP; 77%) in the MO group versus posterior pars plana vitrectomy (85.71%) in the UC group to treat vitreoretinal pathologies. Corrected distance visual acuity was significantly improved in both MO (p = 0.0005) and UC (p < 0.001) groups, while IOP was decreased (p = 0.03) in the MO group.

Conclusion: Eyes with MO and UC 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 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: Monthly anti-vascular endothelial growth factors (VEGFs) are the primary line of management of diabetic macular edema (DME). However, a large number of patients do not respond to anti-VEGF and require dexamethasone implants (DEXIs) as a second line of therapy. There remains a clinical conundrum on the optimal timing of the switch to DEXI. We systematically reviewed the literature to assess outcomes after an early versus late switch to DEXI after failed anti-VEGF therapy in DME.

Methods: Relevant studies were identified by searching PubMed, CENTRAL, Scopus, Web of Science, and Embase till 25th December 2024. We assessed changes in central retinal thickness (CRT), best-corrected visual acuity (BCVA), and risk of ocular hypertension between early versus late switch groups.

Results: Six studies were included. Pooled analysis of all six studies showed that there was a tendency of improved CRT (MD: 19.01; 95% CI: -27.29, 65.31; I2 = 85%) and BCVA (MD: 0.05; 95% CI: -0.04, 0.14; I2 = 72%) with early switch as compared to late switch group but without statistical significance. Removing one outlier study showed statistically significant improvement in CRT (MD: 36.84; 95% CI: 7.54, 66.14; I2 = 48%) and BCVA with early switch (MD: 0.09; 95% CI: 0.08, 0.11; I2 = 0%). Subgroup analysis based on the definition of late switch indicated better outcomes with an early switch when the late switch was defined as after >6 anti-VEGF injections. No difference was noted in the risk of ocular hypertension between the two groups (OR: 0.81; 95% CI: 0.38, 1.73; I2 = 30%).

Conclusions: An early switch to DEXI may tend toward better outcomes as compared to a late switch in treatment-resistant DME patients. High heterogeneity of the meta-analysis and outlier studies are important limitations of present evidence, which can only be resolved with high-quality randomized controlled trials.

Introduction: In recent years, intravitreal injections (IVTs) 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. Nonadherence 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.