Ophthalmic Research最新文献

Introduction: The present study aimed to evaluate the effect of estimated individual vitreous volume (VV) on intraocular pressure (IOP) spikes after intravitreal anti-vascular endothelial growth factor injections (IVIs).

Methods: VVs of eyes were calculated using an axial length (AL)-based formula AL3 × (π/6) × 0.76 + 0.012 × (AL - 24), and study eyes were divided into four groups according to their VVs; <4.5 cm3 (Group 1, n = 52), 4.5-5.0 cm3 (Group 2, n = 60), 5.0-5.50 cm3 (Group 3, n = 60), and >5.50 cm3 (Group 4, n = 35). IOP measurements were taken Pre-IVI, immediately after (Post-IVI-0), 5 min (Post-IVI-5), 15 min (Post-IVI-15), and 30 min after the IVI.

Results: A significant IOP change was found between the five-time points in all groups (p < 0.001 for all). Regarding the same time point measurement comparison between the groups, only a statistically significant change was found in the Post-IVI-0 point (p = 0.001). In a post hoc analysis, Group 1, Group 2, and Group 3 had significantly higher IOP values when compared to Group 4 (p < 0.05 for all). Patients treated with prefilled ranibizumab syringes exhibited lower IOP increases than vial-prepared aflibercept injection at the Post-IVI-0 time point (p = 0.042).

Conclusions: A similar increase in IOP was observed in eyes with low and intermediate volumes, but the increase was less pronounced in those with high volumes after the IVI. Prefilled syringe form showed a lower IOP increase tendency in comparison with vial-prepared forms of the molecules.

Introduction: New anti-vascular endothelial growth factor (VEGF) treatments are emerging for the treatment of diabetic macular edema (DME)/neovascular age-related macular degeneration (nAMD). This study aimed to explore the treatment attributes patients find important when deciding on treatment options.

Methods: This noninterventional survey study assessed treatment preferences through a discrete choice experiment (DCE) among patients with DME/nAMD in the USA, Canada, France, Italy, Spain, and the UK. The DCE design was informed by a targeted literature review and qualitative interview research and included five treatment attributes: mode of administration, frequency of examinations, frequency of injections or refills, likely change in visual acuity, and eye-related side effects. Conditional logit models were used to analyze the choice data.

Results: Overall, 537 patients completed the DCE (DME, n = 173; nAMD, n = 364). Patients reported preferring "injection" over "implant surgery and refills" and better visual outcomes over "stabilization," which were also the most important attributes driving preference (35.1% and 31.5%, respectively). They also showed a preference for less-frequent treatment and examinations and for "mild-moderate, frequent" over "severe, rare" side effects. These findings were generally consistent across the two conditions, although significant differences were found depending on anti-VEGF treatment duration (nAMD, DME) and number of reported barriers (nAMD).

Conclusion: Patient preferences for treatment are driven by several factors. Considering these preferences is essential when designing/introducing new therapies. Individual treatment preferences should be identified and given key consideration when helping patients select from an expanding array of treatment options.

Introduction: Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery. But it may lead to temporary dry eye due to reversible damage to the corneal subbasal nerve plexus. However, evidence on chronic ocular surface changes are unclear. This study reports the ocular surface changes, partial blinking rates, and meibomian gland statuses in eyes that underwent LASIK for at least 48 months.

Methods: Cross-sectional, matched case-control comparison study, including 48 post-LASIK patients and 48 sex-, age-, smoking-, and axial length-matched healthy controls, recruited from a community eye screening program. Outcome measures include anterior segment clinical findings, keratographic and meibographic imaging.

Results: Totally, 48 right eyes of 48 post-LASIK Chinese patients (39 females, 2 smokers) were analyzed with 48 right eyes of 48 matched healthy controls. The mean age at the time of ocular surface examination was 50 ± 11 years, and the axial length 26±1 mm. Post-LASIK eyes had a lower quality of meibum (p = 0.008) compared to healthy controls. Post-LASIK eyes were associated with a shorter Schirmer's test (p = 0.03). The ocular surface disease index (OSDI) score was higher in post-LASIK patients (p = 0.00001). Other anterior segment examination parameters, partial blinking rate, meibomian gland dropout, lipid layer thickness, noninvasive tear break-up time, and tear meniscus height were comparable between the 2 groups.

Conclusions: Up to 75% of post-LASIK patients complained of on-going, chronic dry eye symptoms. Post-LASIK eyes were associated with a reduced aqueous tear production. Post-LASIK patients with chronic dry eye symptoms are advised to have periodic ocular surface evaluation. Treatments might be considered in patients with poor tear film stability.

Introduction: Optical coherence tomography angiography (OCTA) is an emerging technique to investigate retinal and choroidal microvascular alterations in patients with systemic sclerosis (SSc). This systematic review and meta-analysis aimed to evaluate the features of retinal and choroidal microvasculature using OCTA among SSc patients.

Methods: The methodology of the study was based on PRISMA guidelines. PubMed, Scopus, Web of Science, and Embase were searched systematically on November 25, 2023, for relevant studies utilizing OCTA as the main diagnostic tool to assess the retinal and choroidal microvasculature in SSc patients versus healthy controls. Random-effect or fixed model meta-analysis was used based on the heterogeneity of studies.

Results: Eleven observational comparative studies, including 366 patients with SSc and 350 healthy controls, conducted between 2020 and 2023, were included in this review. Meta-analysis findings revealed a significant decrease in vessel densities in both the superficial and deep capillary plexuses among SSc patients compared to controls. However, there were no significant differences observed in the foveal avascular zone area and choriocapillaris flow area between SSc patients and controls. Moreover, central macular thickness (CMT) consistently exhibited a decrease in SSc patients, while retinal nerve fiber layer thickness showed no significant differences. Although radial peripapillary capillary vessel density, subfoveal choroidal thickness, and cup/disk ratio yielded mixed results, with some studies indicating significant changes in the SSc group, meta-analysis could not be performed due to variations in the OCTA machines used across the included studies.

Conclusion: This systematic review demonstrates retinal and choroidal microvascular abnormalities in SSc using OCTA. Longitudinal studies are needed to understand how these abnormalities evolve over time in patients with SSc and whether these abnormalities correlate with the clinical features of SSc.

Introduction: Dry eye disease (DED) is a prevalent ocular condition that significantly impacts quality of life. Umbilical cord serum (UCS) has emerged as a promising therapeutic option, but its efficacy requires further investigation. This systemic review and meta-analysis aimed to evaluate the therapeutic effects of UCS eye drops in the treatment of DED.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of science, Embase, Science Direct, Cochrane Library, and China National Knowledge Network, to identify relevant clinical trials. The efficacy of UCS was assessed based on key outcome measures, such as the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer I test, and corneal fluorescein staining scores. Meta-analyses were performed to pool the results, and the findings were presented in a forest plot.

Results: Eight studies were included in the meta-analysis, with two relevant randomized controlled trials (RCTs) involving a total of 204 patients. Most of the included studies had a follow-up time of less than 2 months. The pooled results showed that UCS treatment significantly improved the OSDI, with a mean difference (MD) of -9.16 (95% confidence interval [CI], -12.0, -6.36) compared to baseline. Additionally, the TBUT values were higher in the UCS group, with an MD of 2.65 (95% CI, 0.93, 4.36). The Schirmer I test results showed an improvement, with an MD of 1.18 (95% CI, 0.30, 2.06). The fluorescein staining score were also lower in the UCS treatment group, with an MD of -4.71 (95% CI, -5.72, -3.69).

Conclusion: This meta-analysis suggested that UCS eye drops had a beneficial therapeutic effect on DED, significantly improving the OSDI, TBUT, Schirmer I test, and corneal fluorescein staining scores. However, larger RCTs with longer follow-up periods were needed to further evaluate the long-term efficacy and safety of UCS in the management of DED.

Introduction: Pars plana vitrectomy (PPV) is a primary surgical method for rhegmatogenous retinal detachment (RRD). The introduction of the 3D head-up system has provided ophthalmologists with a new surgical experience. This study aimed to compare the surgical outcomes between 3D low-light intensity-assisted and traditional eyepiece-assisted PPV for RRD.

Methods: A prospective randomized controlled design was employed to compare the surgical outcomes of 3D low-light intensity-assisted and traditional eyepiece-assisted PPV for RRD. The optical intensity parameters of optical fibers and chandeliers were set according to the minimum lighting standard for 25-G PPV. Surgery duration and intraoperative conditions were documented. Post-surgery, the light intensity of the optical fiber and chandeliers during surgery was measured using a photometer. Patients were followed up for six months to assess their postoperative recovery. Statistical analysis was performed using SPSS 26.0 software, with p < 0.05 indicating statistically significant differences.

Results: There was no statistically significant difference between the two groups in baseline data (p > 0.05). PPV was completed in all patients, and there was no statistically significant difference in surgery time between the two groups (p > 0.05). The optical fiber and chandelier light intensity in the 3D group were significantly lower than those in the eyepiece group and the difference being statistically significant (p < 0.001). Six months after surgery, the retinal attachment rate was 100%. Post-surgery, both best corrected visual acuity (BCVA) and intraocular pressure (IOP) were significantly higher than presurgery levels. There were no significant differences between the two groups in terms of retinal attachment rate, BCVA, IOP, and flash electroretinogram (p > 0.05).

Conclusion: Compared to the traditional eyepiece, the 3D head-up system can effectively complete surgery under lower illumination intensity. The anatomical restoration and functional success of the retina after surgery are equivalent.

Introduction: This study is a population-based investigation into the prevalence and causes of blindness and vision impairment (VI) among people aged 50 years and older living in the State of Qatar.

Methods: A Rapid Assessment of Avoidable Blindness (RAAB) methodology, applied from May 2022 to June 2023, utilized stratified two-stage cluster random sampling to select 5,060 persons aged 50 years and older resident in Qatar from 145 communities chosen by probability proportional to size. Communities were stratified by Qatari and non-Qatari nationality. Participants were examined by ophthalmologists in primary health centers. Data collection was through the RAAB7 Android application and supervised by a trainer using secure, encrypted cloud storage.

Results: Of the 3,206 participants examined, 14 (0.4%) had blindness and 10 (0.3%) had severe VI. Compared to a previous RAAB study in 2009, the prevalence of blindness (presenting visual acuity [VA] <3/60) decreased from 1.28% to 0.4% (95% confidence interval (CI): 0.2-0.7%). The age-sex-adjusted prevalence of all VI (presenting VA <6/12-NPL) was 9.7% (95% CI: 8.3-11.1), higher among females 12.6% (95% CI: 10.5-14.6), and Qataris 16.7% (95% CI: 14.4-19.1), compared to males 7.6% (95% CI: 6.3-9.0), and non-Qataris 6.3% (95% CI: 5.1-7.5). The principal causes of blindness included diabetic retinopathy (DR) (33.3%), cataract (20%), glaucoma (13%), and other posterior segment diseases (13%). All VI was mainly attributed to uncorrected refractive errors at 58% and cataract at 17%, with the former being more common among non-Qataris and cataract more prevalent among Qataris.

Conclusion: Our findings show a low prevalence of VI compared with many countries that have published VI data. VI was mainly caused by DR, cataract, and uncorrected refractive error. Further reduction in vision loss can be achieved with early detection and improved access using innovation and technology.

Introduction: Cataract surgery has been reported to have a reducing effect on intraocular pressure (IOP) in glaucomatous and non-glaucomatous eyes. This effect seems to be more noticeable in eyes with narrow angles (NAs) than in eyes with open angles (OAs). Decrease in IOP may be a result of the increase in anterior chamber angle and Schlemm canal (SC) after cataract surgery. The purpose of this paper was to evaluate the relationship between Schlemm canal-cross-sectional area (SC-CSA) changes and trabecular meshwork, ciliary muscle changes after cataract surgery and the difference in non-glaucomatous eyes with NAs and OAs.

Methods: IOP, SC-CSA, Schlemm canal diameter (SCD), trabecular meshwork width (TMW) and thickness (TMT), trabecular-iris angle at 500 µm from the scleral spur (TIA500), and the distance between the inner apex of the ciliary muscle and scleral spur (IA-SS) were measured by swept-source-optical coherence tomography preoperatively and 1-week post-surgery. Patients were divided into NA and OA groups according to the degree of TIA500, and SC-CSA-related parameters were compared.

Results: Seventy-five patients (89 eyes) were included. IOP significantly decreased, SC-CSA, SCD, TMW, TMT, and TIA500 significantly increased post-surgery (p < 0.001). Changes in nasal SC-CSA were associated with TMW (p = 0.003) and TIA500 (p < 0.001) changes; changes in temporal SC-CSA were associated with TMW (p = 0.001) and TMT (p < 0.001) changes. SC-CSA expansion was correlated with changes in TMW (β3.726 ± 1.085, p = 0.001 nasally; β3.405 ± 0.945, p = 0.001 temporally), TMT (β5.224 ± 2.033, p = 0.012 nasally; β11.853 ± 3.059, p < 0.001 temporally), and TIA500 (β40.330 ± 15.100, p = 0.009 nasally; β35.453 ± 17.527, p = 0.047 temporally). There was no association between SC-CSA expansion and IA-SS changes. SC-CSA expansion was greater in the NAs than in the OAs group (p < 0.001).

Conclusion: Cataract surgery results in IOP reduction and SC-CSA expansion. Increased SC-CSA correlates with increases in TMW, TMT, and TIA500. SC-CSA increased more in NAs than in OAs group post-surgery, which may explain the greater decrease in IOP in eyes with NAs.

Introduction: Intrableb structures are hallmark features of the filtering bleb. This study aimed to compare the characteristics of functioning blebs using anterior segment optical coherence tomography (AS-OCT) according to amniotic membrane transplantation (AMT).

Methods: Forty eyes from 40 patients diagnosed with primary open-angle glaucoma who underwent trabeculectomy, either with AMT (20 eyes) or without AMT (control group, 20 eyes), were included. Parameters including bleb height, bleb wall thickness, striping layer thickness, striping to bleb wall ratio, bleb wall reflectivity, fluid-filled space score/height/area, and presence of microcysts were assessed using AS-OCT. Surgical success was defined at the time of AS-OCT as an intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥30% without medication. In these patients, if the bleb had a clinically diffuse and healthy without any signs of an encapsulated bleb, the bleb was then defined as functioning bleb.

Results: Except for bleb height (p = 0.352) and microcyst formation (p = 0.266), significant differences were observed between the two groups. The functioning blebs of the AMT group exhibited greater fluid-filled space score, area, and height than those of the control group, following adjustment for AS-OCT time (all p < 0.001). Conversely, the functioning bleb of the control group demonstrated thicker bleb wall and striping layer, higher striping to bleb wall ratio, and lower bleb wall reflectivity than those of the AMT group, following adjustment for AS-OCT time (all p ≤ 0.001).

Conclusion: Distinct intrableb structures were identified in functioning blebs according to AMT. The reflectivity and thickness of the bleb wall structures were more pronounced in the functioning bleb after trabeculectomy alone. In contrast, the extent of the fluid-filled space emerged as a more distinctive feature of the intrableb structures in the functioning bleb after trabeculectomy with AMT.

Introduction: Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disorder. Ocular involvement in patients with MMD has increasingly been recognized and reported in recent years. This study aimed to investigate the changes of optic disc morphology and the peripapillary retinal and choroidal thickness in patients with MMD.

Methods: This cross-sectional study included 56 patients diagnosed with idiopathic MMD and 56 healthy controls matched by age and gender. All participants underwent swept-source optical coherence tomography to capture the optic disc morphology as well as the peripapillary retinal and choroidal thickness. Optic disc parameters, including cup area, rim area, cup volume, rim volume, cup-disc area ratio (CDR), linear CDR, and vertical CDR were measured and compared between the two groups. Additionally, the thickness of the whole peripapillary retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and choroid were evaluated and analyzed across 12 clock-hour segments around the peripapillary region.

Results: The rim area in MMD patients was significantly less than in controls, while the CDR in MMD patients was significantly larger than that in the control group. There was no statistically significant difference between the two groups regarding disc area, cup area, cup volume, rim volume, vertical and horizontal diameter of disc. The retinal thickness at the 7 o'clock position was significantly thinner in the MMD group compared to the control group and the temporal RNFL thickness, particularly at the 7 o'clock and 9 o'clock positions, was significantly reduced in the MMD group (p < 0.05). The GCL layer at the 7 o'clock position was thinner in the MMD group than in the control group (p < 0.05). The MMD group showed a notably reduced average choroidal thickness, particularly in the inferior-temporal region (p < 0.05). There was a correlation between peripapillary choroidal and GCL layer thickness in the MMD group, but no significant correlations were found with rim area, CDR, or RNFL.

Conclusions: In patients with MMD, there is an increase in the CDR accompanied by a decrease in the rim area. Additionally, there is thinning of the temporal RNFL, GCL, and choroidal thickness, notably in the inferotemporal quadrant of the optic disc.